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Found 208 results
  1. Content Article
    In July 2022, HSIB launched a national investigation into the safety risk of clinical investigation booking systems failures. Specifically, the investigation explores the use of paper or hybrid booking systems and the production of appointment letters. This interim bulletin highlights a safety risk identified by the investigation and presents a safety observation for the attention of NHS care providers. Some vital NHS services still use paper-based or hybrid systems, which may have been developed over time and could leave unintended gaps where patients can be lost in the system. The reference case for this investigation is the experience of a patient whose magnetic resonance imaging (MRI) scan was not rescheduled following a cancellation, leading to a delay in the diagnosis of cancer. Hybrid systems were in use, which did not assist staff to keep track of patients. Additionally, the hybrid systems in use did not allow appointment letters in non-English languages to be produced.
  2. News Article
    GP practices can block abusive patients from gaining automatic access to their records online if they pose a ‘risk of harm’ to staff, the Royal College of General Practice has said. Automatic access to patients’ prospective patient records is due to be switched on by the end of this month, following delays related to concerns about patient safety. But the RCGP’s toolkit on access to records said practices can refuse access to online records for patients that pose a risk of harm to others too. The guidance said access should "be refused where there is a clear risk of serious harm to the safety of the patient or members of the practice team, or to the privacy of a third party". It added: "If potentially harmful information cannot be successfully redacted and the practice remains concerned about the safety of record access for an individual patient – or in extreme cases, remains concerned that the patient may react violently to information in the record – then the practice may refuse to give the patient record access or restrict the level of access. "It may be possible to give them access to a reduced part of the record such as the Summary Care Record or restrict access to appointments and repeat prescriptions." The guidance said that records access should only be refused or restricted "after discussion with the practice leads for GP Online Services and Safeguarding or after seeking further professional advice from a local relevant agency or national medical indemnity organisation". Read full story Source: Pulse, 18 November 2022
  3. Content Article
    For many patients, online access to their GP’s services is a normal part of their everyday interaction with the NHS. The majority of patients in England use at least one GP Online Service to request prescriptions, book appointments or access their electronic health record. It is part of modern, responsive primary care services for patients, their families and carers. It is convenient and reliable for patients and useful for practices. It can foster a person-centred approach to care, especially for patients with long term conditions or complex multi-morbidity.  The Royal College of General Practitioners (RCGP), in collaboration with NHS England, have developed the guidance and resources in this Toolkit to help practices provide GP online services effectively, efficiently, safely and securely. The Toolkit includes clinical exemplars which demonstrate how GP online services can empower patients to take greater control of the management of their health conditions. It does not cover online consultations.
  4. News Article
    GPs are struggling to cope with as many as 90 appointments and consultations a day – more than three times a recommended safety limit. General practices in England are carrying out more appointments than before the pandemic but face severe workforce shortages. More than 1.45 million patients waited at least 28 days to see a GP in September, according to the most recent NHS figures. GPs who spoke to the Observer last week say that almost every day they breach the BM) guideline of “not more than 25 contacts per day” to deliver safe care. One doctor said he had more than 90 consultations on one day. A conference of local medical committee representatives in England this week will highlight the growing pressures faced in general practice. Surgeries are being urged to impose stricter caps on the number of patient appointments for each GP. One of the proposed motions submitted to the conference by Kensington and Chelsea local medical committee says “focusing on patient safety” is more appropriate than meeting high patient demand. It says the NHS should focus on “safe capacity”. Such a move would mean longer waits for GP appointments, but doctors say it would help safeguard patient care and the welfare of staff in general practice. Read full story Source: The Guardian, 20 November 2022
  5. News Article
    NHS England “forgot the people” when it published controversial guidelines last month which said patients faced being removed from the waiting list if they declined two appointment dates, a senior director has admitted. NHSE elective recovery chief Sir Jim Mackey said the guidance was drafted to address legitimate concerns from trusts, but that the process had been “rushed”. Following Sir Jim’s comments, NHSE told HSJ the guidance, which had sparked widespead criticism including from patient groups, would not be changing. But Sir Jim said NHSE would “spend time” better understanding patients after “reflecting” on the process which had created the controversial guidelines. Speaking at the King’s Fund annual conference, Sir Jim said: “[The guidance] was largely a response to trusts saying to us: ‘We keep offering these patients options and they won’t take them, so what do we do?’ “We rushed through a policy to try and deal with that, and in the process, I think forgot the people…We’ve reflected on that.” Read full story (paywalled) Source: HSJ, 1 November 2022
  6. News Article
    Patients in England are being put at risk because of the unacceptably poor service they receive from GPs, MPs say. The House of Commons' Health Committee blamed the failure to tackle doctor shortages, which had led to a decline in the GP-patient relationship. Seeing a GP should not be like booking an Uber with a driver you are unlikely to see again, the MPs said. The warning comes just weeks after ministers launched a drive to improve access to GP services. But the cross-party group of MPs said more needed to be done. Louise Ansari, from the patient group Healthwatch England, said, "The impacts of poor access can be huge, with people feeling abandoned and suffering in silence and not getting referred to hospitals for more specialised treatment." Read full story Source: BBC News, 20 October 2022
  7. Content Article
    This guide by the charity Menopause Support offers advice for women who may be experiencing menopause symptoms about how to approach an appointment with their GP. It covers preparing for the appointment with research, making a note of your symptoms, how to ask questions, taking a friend or family member to support you, and further support you can request during the consultation.
  8. News Article
    NHS trusts may be forced to cancel appointments and limit visiting times in a Covid and flu “twindemic” this winter, health leaders have warned. Fears have been raised the viruses could strip back the workforce and further increase demand for services during an already busy period. It comes amid rising Covid infections in the UK. Around 1.3 million tested positive in late September, according to the latest figures, which was a 25% increase on the week before. The UK is also concerned there could be a bad flu season this year, with lower immunity across the population due to reduced exposure in the Covid pandemic. NHS leaders have warned that this background could make winter even more difficult for the health service. “I make no bones about this: we know it’s going to be a pressurised time for trusts over the next four months if not longer,” Saffron Cordery from NHS Providers, which represents trusts in England, told The Independent. The interim chief executive added: “We’re worried about Covid and we’re worried about flu.” Ms Cordery said these joint pressures – which could increase demand, strip back workforces and introduce the need for greater infection control measures – could have a knock-on effect on services. “We need to anticipate that there may well be cancellations for either outpatient appointments or routine procedures or operations, because there could be staff shortages or rising demand in emergency care – that means that those routine appointments cannot take place as quickly as we’d like,” she said. Read full story Source: The Independent, 8 October 2022
  9. Content Article
    The Covid-19 pandemic triggered a very sudden and widespread shift to remote consulting in general practice. Many patients and healthcare professionals have welcomed the convenience, quality and safety of remote consulting, but there are inherent tensions in choosing between remote and face-to-face care when capacity is limited. This report by the Nuffield Trust explores the opportunities, challenges and risks associated with the shift towards remote consultations, and the practical and policy implications of recent learning.
  10. News Article
    Patients with suspected skin and breast cancer have experienced the largest increase in waiting times of everyone urgently referred to a cancer specialist, with 1 in 20 patients now facing the longest waits, analysis of NHS England data shows. Almost 10,000 patients referred by a GP to a cancer specialist had to wait for more than 28 days in July – double the supposed maximum 14-day waiting time. Three-quarters of them were suspected of having skin, breast or lower gastrointestinal cancer, a Guardian analysis has revealed. In total, 53,000 people in England waited more than two weeks to see a cancer specialist. That is 22% of all the patients urgently referred for a cancer appointment by their GPs. Minesh Patel, head of policy at Macmillan Cancer Support, said people were waiting “far too long for diagnosis or vital treatment”. Patients “are worried about the impact of these delays on their prognosis and quality of care”. “The NHS has never worked harder,” said Matt Sample, the policy manager at Cancer Research UK, but patients dealing with long waits “reflects a broader picture of some of the worst waits for tests and treatments on record”. “When just a matter of weeks can be enough for some cancers to progress, this is unacceptable.” Read full story Source: The Guardian, 2 October 2022
  11. News Article
    NHS officials ruled a man who died after his ear infection was not picked up in GP telephone consultations should have been seen face to face, a BBC Newsnight investigation has found. David Nash, 26, had four remote consultations over three weeks during Covid restrictions but was never offered an in-person appointment. His infection led to a fatal abscess on his brainstem. David first spoke to the practice on 14 October 2020, after finding lumps on his neck. He sent a photograph but was never examined. With David worried the lumps might be cancerous, the GP asked a series of questions about his health and reassured him that while she could not rule it out completely, she was not worried about cancer. She suggested he booked a blood test for two to three weeks' time. In those three weeks, David would go on to speak to another GP and two advanced nurse practitioners but never face to face or via video call. He was actually due to be seen in person at the GP surgery that day, for the blood tests booked some 19 days earlier, when he had presented with neck lumps. But - fearing he could have coronavirus, despite a negative PCR test - the nurse cancelled the bloods and asked David to retest for Covid. In its investigation, NHS England found "the overarching benefit [of this decision] was less than the risk with going ahead with blood tests". After five calls to NHS 111, David was taken to hospital in an ambulance that day but died two days later. NHS England, in a finding seen by Newsnight, said: "A face-to-face assessment should have been offered or organised to confirm the diagnosis and initiate definitive management." Read full story Source: BBC News, 29 September 2022
  12. Content Article
    Hughes et al. studied video consulting in the NHS during 2020–2021 through video interviews, an online survey and online discussions with people who had provided and participated in such consultations. Video consulting had previously been used for selected groups in limited settings in the UK. The pandemic created a seismic shift in the context for remote consulting, in which video transformed from a niche technology typically introduced by individual clinicians committed to innovation and quality improvement to offering what many felt was the only safe way to deliver certain types of healthcare. A new practice emerged: a co-constitution of technology and healthcare made possible by new configurations of equipment, connectivity and physical spaces. Despite heterogeneous service settings and previous experiences of video consulting, we found certain kinds of common changes had made video consulting possible. The authors used practice theory to analyse these changes, interpreting the commonalities found in our data as changes in purpose, material arrangements and a relaxing of rules about security, confidentiality and location of consultations.
  13. Content Article
    In this blog, Jeremy Hunt MP, Founder of Patient Safety Watch, argues against introducing more targets for GPs. The new Health Secretary, Therese Coffey MP, plans to introduce a target to ensure that all patients see their GP within two weeks. The blog highlights two issues with this approach: Setting a new target won’t make it a reality Having too many targets result is a system that depersonalises patients, deprofessionalises frontline staff and means it is difficult for health services to prioritise It then proposes that the health system should learn from the UK education system's approach to regulatory oversight, which is aimed at driving up standards, rather than achieving grades.
  14. News Article
    The government is promising to improve access to GPs, including same-day appointments for those that need them, as part of a new plan in England. Health Secretary Thérèse Coffey will make the pledge as she unveils her NHS plan for this winter and next. GPs will be able to take on extra staff, including senior nurses, while pharmacists will be asked to take on more work to free up appointments. Ms Coffey is due to announce the plan, which will also cover hospital services, in the House of Commons today. She is expected to say: "I will put a laser-like focus on the needs of patients, making their priorities my priorities and being a champion for them on issues that affect them most." Alongside same-day appointments when needed, Ms Coffey will promise no-one will have to wait more than two weeks for a routine appointment - currently one in five appointments take longer. The promises on waiting times are not official targets, but Ms Coffey said they should be seen as clear expectations of what patients should be entitled to. But GP leaders said the announcement would have a "minimal impact". Read full story Source: BBC News, 22 September 2022
  15. News Article
    GPs have warned of a ‘tsunami of demand’ this winter as patient contacts surged 200% during the pandemic. One of the largest GP providers in the UK, Modality Partnership, told The Independent it received 4.8 million calls from patients in one year alone with around a quarter going unanswered every day. The provider, which covers 500,000 patients across the country, said its practices were now working above “safe levels” with 50 appointments a day per GP, far higher than the 35 advised by the British Medical Association. Speaking with The Independent, Vincent Sai, chief executive and partner at Modality said the new health secretary Therese Coffey must “not point fingers” and “not find a scapegoat” as “every part of the system is under pressure. Every player in the health system is under the cosh.” Dr Sai said: “We believe patient contacts have increased 200 per cent, over the last few years. The expectation is that GP practices have maybe four to five patient contacts per year, but if you just look at just the number of phone calls alone, it’s showing that it’s much more now. “So something is broken somewhere...there’s more work, there are fewer people. People say I can’t get access to my GP and the hypothesis is they’re just lazy and not working, but it’s not the case.” Read full story Source: The Independent, 7 September 2022
  16. News Article
    Patients will be able to use the NHS app to shop around for hospitals with the shortest waiting lists in a renewed drive to cut backlogs for routine care. Health bosses agreed yesterday to give patients more choice over where they are treated by next April in an effort to use digital league tables to direct people towards hospitals with the shortest waits. Steve Barclay, the health secretary, wants to give patients “real-time data” on their phones to decide whether to travel further to get quicker treatment for hip replacements, cataract removals and other non-urgent procedures. A government source said: “We don’t need a big bureaucracy to funnel patients towards the hospital which NHS managers decide is best, when, armed with a right to choose and the right information on the app, patients will go where waiting times are lowest.” Read full story (paywalled) Source: The Times (31 August 2022)
  17. News Article
    Nearly 38,000 vital follow-up appointments with mental health patients were missed at the time when they were most at risk of suicide, the Royal College of Psychiatrists has said. The medical body has called for “urgent action” to ensure more people are seen for follow-ups within 72 hours of their discharge from inpatient care, to prevent them from falling “through the cracks when they are so vulnerable”. The risk of suicide is highest on the second and third days after leaving a mental health ward, but 37,999 follow-up appointments with patients were not made within this timeframe in England between April 2020 and May 2022. According to NHS data, of the 160,430 instances when patients were eligible for follow-up care within 72 hours after discharge from acute adult mental health care, only three-quarters (76%) took place within that period. The Royal College of Psychiatrists is calling for more trained specialists to check on those perceived to be at risk, which they say requires more staffing and funding. The president of the Royal College of Psychiatrists, Dr Adrian James, said: “We simply can’t afford to let people fall through the cracks at a time when they are so vulnerable. It’s vital that our mental health services are properly staffed and funded to offer proper follow-up care and help prevent suicides. “Staff are working as hard as they can to provide high-quality care, but it’s clear that current resources are not enough to meet these targets. We need urgent action to tackle the workforce crisis and achieve the suicide prevention goals set out in the NHS long-term plan.” Read full story Source: The Guardian, 22 August 2022
  18. News Article
    Britain is in the grip of a new silent health crisis. For 14 of the past 15 weeks, England and Wales have averaged around 1,000 extra deaths each week, none of which are due to Covid. If the current trajectory continues, the number of non-Covid excess deaths will soon outstrip deaths from the virus this year. Experts believe decisions taken by the Government in the earliest stages of the pandemic – policies that kept people indoors, scared them away from hospitals and deprived them of treatment and primary care – are finally taking their toll. Prof Robert Dingwall, of Nottingham Trent University, a former government adviser during the pandemic, said: “The picture seems very consistent with what some of us were suggesting from the beginning. “We are beginning to see the deaths that result from delay and deferment of treatment for other conditions, like cancer and heart disease, and from those associated with poverty and deprivation. “These come through more slowly – if cancer is not treated promptly, patients don't die immediately but do die in greater numbers more quickly than would otherwise be the case.” Read full story (paywalled) Source: The Telegraph, 18 August 2022
  19. News Article
    Half of UK adults with a possible cancer symptom do not contact their GP within six months, despite spotting changes to their body, research suggests. A YouGov poll of 2,468 people for Cancer Research UK found that just 48% of those who had experienced a red flag symptom – including coughing up blood, unexplained weight loss and a new or unusual lump – contacted their GP within half a year. Not telling a doctor about unusual health changes or possible cancer symptoms reduces the chances of an early cancer diagnosis, leading to potentially devastating outcomes. Cancer Research UK’s chief executive Michelle Mitchell said: “Spotting cancer early is vital if more people are to survive, and the first step in that process is getting help for a possible cancer symptom. “It’s really worrying to see such a large gap in accessing services between the UK’s most and least deprived groups. “Earlier this year, the Government announced among its top priorities were improving early diagnosis of cancer and tackling health disparities. “Cancer must remain a top priority and with the upcoming Health Disparities White Paper and 10-Year Plan for England, the new Health and Social Care Secretary has a huge opportunity to transform cancer survival with a clear and strong plan that works for all.” Read full story Source: The Independent, 10 August 2022
  20. News Article
    Patients at trusts with long waiting lists should no longer think ‘they have to go to their local hospital’ for outpatient appointments, but should instead be offered virtual consultations elsewhere in the country where there is greater capacity, Sir Jim Mackey has told HSJ. The NHS England elective chief said recent efforts to abolish two-year waiters by July had meant a “very big” surgical focus. However, the next phase of the elective recovery plan would see a major shift of emphasis onto reducing the wait for outpatient appointments. Sir Jim said: “Providers have been split into tiers again with tier one having national oversight and tier two, regional oversight. Behind that we will be pairing up organisations so that organisations with capacity can help those with the biggest challenges from a virtual outpatient perspective. He added: “There still is a lot to work through [on virtual outpatients], we’re going to be testing the concept… We need to work through how all the wiring and plumbing needs to work. For example, what happens if the patient needs a diagnostic locally, having seen a clinician virtually in another part of the country? “It would be great also to try and stimulate more of a consumer drive on this – encouraging patients to ask about virtual outpatients when the waits locally may be too long, so they don’t just think they have to go to their local hospital. I think this could really help shift the model if we can get it right.” Read full story (paywalled) Source: HSJ, 9 August 2022
  21. News Article
    NHS patients will wait longer for routine checks as part of a national drive to clear record backlogs. Health officials have instructed hospitals to “repurpose” resources to focus on those waiting the longest, who are yet to have their first appointment. Today the NHS claimed it had “virtually eliminated” two year waits, with less than 3,000 people enduring such delays, down from 22,500 at the end of January. Hospitals are being urged to prioritise those waiting 18 months or more, with pledges to get rid of such waits by April next year. NHS chiefs have instructed hospitals to focus on outpatient first appointments, rather than patients who have already had treatment, and are waiting for follow-up checks. Senior officials have said many such appointments are a “a waste of time” saying there should be more use of systems where routine slots are scrapped, and patients instead told to contact their medical team if they have particular concerns. The drive - which health chiefs dubbed “Super September” - will see priority given to tackling the longest waits. Read full story (paywalled) Source: The Telegraph, 9 August 2022
  22. News Article
    A 27-year-old man died from complications linked to diabetes after GPs failed to properly investigate his rapidly deteriorating health. Lugano Mwakosya died on 3 October 2020 from diabetic ketoacidosis, a build-up of toxic acids in the blood arising from low insulin levels, two days before he could see a GP in person. His mother, Petronella Mwasandube, believes his death could have been avoided if doctors at Strensham Road Surgery, in Birmingham, had given “adequate consideration” to Lugano’s diabetic history and offered face-to-face appointments following phone consultations on 31 July and 16 and 30 September. An independent review commissioned by NHS England found two doctors who spoke to Lugano did not take into account his diabetes or “enquire in detail and substantiate the actual cause of the patient’s symptoms”. The review raised concern over the “quality and brevity” of the phone assessments and said the surgery should have offered Lugano an in-person appointment sooner. Read full story Source: The Independent, 7 August 2022
  23. Content Article
    With the number of outpatient hospital appointments in England recently as high as 125 million per year and a huge elective care backlog following the Covid-19 pandemic, patient-initiated follow-up on outpatient appointments has been touted as a potential solution in appropriate cases. But can it free up much-needed capacity while maintaining quality of patient experience and outcomes? As the NHS begins to expand its use of the approach, the NIHR RSET research team has conducted a first review of the available evidence.
  24. Content Article
    The Department of Health today published the 2021/22 Inpatient, Day Case and Outpatient Hospital Statistics for Northern Ireland. Analysed by HSC Trust, hospital and specialty, these Hospital Statistics publications outline: the number of inpatient and day case admissions. the number of attendances at consultant led outpatient services in Northern Ireland during 2021/22.
  25. News Article
    The number of patients unable to get a hospital appointment after being referred by their GP is up more than 50% in two years amid the record NHS backlog, official data show. NHS Digital figures show no appointments were immediately available for 2.3 million referrals made in the first six months of this year – up 51% on the same period in 2020. Appointment slot issues occur when a patient is referred by their GP through the NHS e-Referral Service but no appointment is available to book. The referral is then forwarded or deferred to a patient’s chosen provider, but if an appointment is not made within 180 days it will automatically be removed from the system, according to NHS Digital. Patient safety campaigners have said the scale of the problem must be “urgently investigated” by NHS England to ensure the safety of patients is not being compromised while they wait for appointments. Helen Hughes, the chief executive of the Patient Safety Learning charity, said: “We have significant concerns about the safety of patients who are facing increasingly long waits for treatment, particularly those on high priority cancer pathways and urgent referrals.” She said patients needed to be assured that they will “not be lost in a failing, complex system”, adding: “We believe that NHS England needs to urgently investigate, quantify the scale of the problem and take action if we are to prevent these capacity and system issues resulting in avoidable harm for patients.” Some GPs told Patient Safety Learning they had experienced difficulties getting referrals accepted. One GP, based in the North East, said: “There is an ever-creeping transfer of management of complex conditions from secondary to primary care, without adequate training or resources to manage this safely.” Read full story (paywalled) Source: The Telegraph, 7 August 2022 You may also be interested in Patient Safety Learning's blog: Rejected outpatient referrals are putting patients at risk and increasing workload pressure on GPs
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