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Found 208 results
  1. News Article
    NHS staff at GP surgeries are facing unprecedented abuse and aggression from patients, while stressed doctors are increasingly suffering from mental illness, because of an appointments system “in meltdown”, family doctors’ leaders have revealed. The scale of the deep crisis in GP surgeries was revealed in an emergency summit of more than 60 NHS doctors, dentists and administrative staff in Salford, which the Guardian attended, triggered by a recent rise in verbal abuse. "Patients are short-tempered and not happy waiting for anything … They want letters. The latest one was a request to speak to a GP because he needs a letter to confirm anxieties that cause him a problem in long queues – because he wants to take his son to [Southport amusement park] Pleasureland and does not want to queue," says Jan Crowshaw, a GP manager It comes after a recent poll by the body representing GP surgery staff across the UK found that 75% of them face abuse every day, including assaults, threats, racism and sexism. Read full story Source: The Guardian, 28 May 2021
  2. News Article
    GP practices should not switch off their online consultation systems outside of core hours as it will “reduce patient satisfaction”, according to NHS England. It comes in controversial new guidance issued amid a row over GP access. NHSE issued the new “standard operating procedures” this afternoon. HSJ revealed last month that large numbers of overwhelmed GP practices were turning off their online consultation services at weekends after the recent boom in digital appointments uncovered an ‘unmet demand’, leading to large numbers of queries to deal. But the new SOP says: “Patients should be able to make requests in an online system at any time.” Disabling the system outside of core hours, which some practices have done to help manage demand, is “less convenient” for patients and would “reduce satisfaction”, it says. Read full story Source: HSJ, 20 May 2021
  3. News Article
    Monica Evans's initial misdiagnosis could have proved life-threatening – and she is just one of many to have suffered during pandemic. Since The Telegraph began reporting on the struggles of patients around the country to access GP services during the pandemic, they have been inundated with messages and letters. There have been multiple stories of serious misdiagnoses made after telephone consultations with doctors that took place in lieu of face-to-face assessments; of interminable waits to get through to practices on jammed phone lines; and of lengthy delays while worried patients have waited for referrals to be made. Those who shared their experiences have also shared their fury, frustration, fear and dismay. Some who could afford to have felt they had no option but to turn to private healthcare, unable to obtain the help they needed from an NHS struggling with Covid and all its knock-on effects. Others have been left with nowhere to turn. GPs have spoken, too, about their dissatisfaction with a system that has discouraged face-to-face consultations. Amid an outpouring of anger from both patients and doctors, NHS England yesterday rowed back on plans for "total triage" of patients to keep them out of surgeries whenever possible. But for many the damage has already been done. Read full story (paywalled) Source: The Telegraph, 13 May 2021
  4. News Article
    NHS England has said GP practices must start opening their receptions and allow people to book initial face-to-face appointments — scrapping the controversial ‘total triage’ rule — for the first time since the early days of the coronavirus pandemic. Since last spring, NHSE guidance, supported by the profession, has said that face-to-face appointments must generally only take place after a phone, video or digital consultation. Many GP practice receptions have been closed to people wanting to make routine appointments. This rule was kept in place throughout last summer, despite covid circulation being low, and some health systems made the approach one of the pillars of planned post pandemic transformation. “Embedding total triage” was encouraged in 2021-22 operational rules for the NHS. The shift was seen by some as part of a move to a potentially more effective and efficient way of working. But there have been concerns about access and complaints in the media. Read full story (paywalled) Source: HSJ, 14 May 2021
  5. Content Article
    In the Patients Association 2020 survey, patients told us about their experiences of living with health and care needs during the COVID-19 pandemic. Their testimony painted a bleak picture in many ways. This follow-up survey finds that many aspects of their experiences are not much better, and some are worse.
  6. Content Article
    The Healthcare Safety Investigation Branch (HSIB) have identified a safety risk involving outpatient follow-up appointments which are intended but not booked after an inpatient stay. If a patient does not receive their intended follow-up appointment, it could lead to patient harm owing to delayed or absent clinical care and treatment. The investigation was launched after HSIB identified an event where a patient was discharged from hospital on two separate occasions with a plan to follow-up in outpatient clinics. Neither of the outpatient appointments were made.
  7. News Article
    Patients are finding it increasingly hard to see their GPs, with warnings that pandemic restrictions have too often “closed the door” on NHS treatment, a report warns. The Patients’ Association survey comes as an investigation reveals that almost 100 GP surgeries closed down or merged with other practices last year. In total, almost 2.5 million patients were forced to switch to a new surgery because of 788 such closures since 2013, the freedom of information disclosures reveal . Rachel Power, chief executive of the Patients’ Association, said the findings from its survey were “worrying” and show “clear dissatisfaction” from the public. The report said: “It is increasingly clear that many patients have found that new methods for arranging appointments do not work for them, or simply that they do not understand how to go about it. GPs are the front door to the NHS, and patients are increasingly perceiving that that door is closed to them.” Roughly half of those who had telephone consultations said the experience was worse than a traditional appointment, with three times as many saying they were unhappy about their experience, compared with those offering praise. The report warns: “The data does not show a ringing endorsement of new or remote methods for accessing NHS care; indeed, in most cases patients rated these methods worse than traditional contact.” Read full story Source: The Telegraph, 30 April 2021
  8. Content Article
    The Doctor Will Zoom You Now was a rapid, qualitative research study designed to understand the patient experience of remote and virtual consultations. The project was led in partnership with Traverse, National Voices and Healthwatch England and supported by PPL. The study engaged 49 people over 10 days (June 22nd – July 1st 2020) using an online platform, with 20 additional one to one telephone interviews. Participants were also invited to attend an online workshop on the final day of the study. Using insight from the key findings from the research, this website provides useful tools and tips for getting the most out of your appointment.
  9. News Article
    The NHS should pause the planned roll out of bookable A&E slots until a robust evaluation of the new system has been undertaken, the Royal College of Emergency Medicine president has told HSJ. The proposals were set out in NHS England’s 2021-22 planning guidance last month. The guidance say local systems should “promote the use of NHS 111 as a primary route into all urgent care services”. It instructs local systems to “maximise the use of booked time slots in A&E with an expectation that at least 70% of all patients referred to an emergency department by NHS 111 receive a booked time slot to attend”. Sites only began piloting the model late last year. But by March the new system appeared to be being actively rolled out across the service. Seventy five of England’s 126 acute trusts with a type 1 emergency departments had begun allowing patients to book appointments in A&E by calling 111, according to NHS England data published this month. But RCEM president Katherine Henderson has told HSJ that NHSE has failed to release any data on the effectiveness of the new approach. She said NHSE must pause its plans while a full evaluation of the pilots is carried out to ensure the model was delivering operational and clinical benefits before it is adopted on a widescale basis. She said: “We are very keen to see some data and clinical validation so we can robustly assess how the 111 First model is working, because, at the moment, we haven’t really seen enough to say: ‘this is something that we really need to push on with’. Read full story (paywalled) Source: HSJ, 26 April 2021
  10. News Article
    Many GPs find telephone appointments with patients frustrating and want to see them in person because they fear they will otherwise miss signs of illness , the leader of Britain’s family doctors has said. Prof Martin Marshall told the Guardian that remote consultations felt like working “in a call centre” and risked damaging the relationship between GPs and their patients. Telephone and video appointments had proved useful during the Covid pandemic, when GP surgeries limited patients’ ability to come in for face-to-face appointments, he said. However, while that helped limit the spread of coronavirus, “this way of working has been frustrating for some GPs, particularly when most consultations were being delivered remotely, who have felt like they’ve been delivering care via a call centre, which isn’t the job they signed up for." “Remote consultations have advantages, particularly in terms of access and convenience for patients. But we know that patients prefer to see their GP face to face." “Remote working has been challenging for many GPs, particularly when delivering care to patients with complex health needs,” said Marshall, who is a GP in London. “It can also make it harder to pick up on soft cues, which can be helpful for making diagnoses.” His remarks come as NHS leaders and doctors groups are discussing how far appointments should return to being in person now the pandemic is receding. Read full story Source: The Guardian, 28 March 2021
  11. News Article
    The pandemic has been a catalyst for innovation in the NHS and some changes will have a lasting effect, says Dr John Wright of Bradford Royal Infirmary. The Covid pandemic has transformed our hospitals. Car parks are empty, once-bustling corridors are quiet, and these days you won't see any staff making fashion statements - we're all in scrubs and masks. Dr Wright says changes made to reduce spread of infection are here to stay and will help us live with future outbreaks of Covid and other infectious diseases. But there is also much to learn from how we have adapted to non-Covid care - with drive-through PCR swabs and blood tests, for example, or the use of oximeters to monitor oxygen levels in the blood of Covid patients in their homes, providing warning if they need to be admitted to hospital. But the biggest change has been in the way hospital consultations are carried out. Before the pandemic nearly all appointments took place face-to-face. Last year probably 90% occurred via telephone or video call, and most of my colleagues at Bradford Royal Infirmary are still running remote clinics today. This is much more convenient for patients. In the past a typical consultation might have involved a half-day of travel, the search for a parking place, and then sitting in a waiting room. However, remote consultations do have their drawbacks. Patients tend to underplay their symptoms on the phone and it is easier to avoid discussing challenging issues. Life-changing diagnoses require sensitive, face-to-face communication. Another problem is that some patients struggle with technology. The main drawback, though, is that clinicians are unable to undertake physical examination remotely. Clinical histories are the yin of the consultation but physical examinations are the yang, and video consultations only provide half the picture. Read full story Source: BBC News, 15 March 2021
  12. News Article
    Almost half of people with potential cancer symptoms did not contact their GP during the first wave of the pandemic, a survey suggests. Symptoms left unchecked included coughing up blood, lumps and changes to the appearance of moles. NHS figures showed a fall in referrals to cancer services last spring. However, this study, of almost 8,000 people, captures the fall in people contacting their GP in the first place. The team that carried out the study, from Cardiff University and Cancer Research UK, said this raised concerns that people could be diagnosed later - and so be less likely to be treated successfully and recover. They surveyed a representative sample of people across the UK and found that of 3,025 people who said they had experienced at least one symptom which could be a warning sign of cancer, 45% did not seek help. They also found that: 31% did not seek help after coughing up blood 41% did not seek help for an unexplained lump or swelling 59% did not seek help after noticing changes to the appearance of a mole. Some of the reasons given by people who did not contact their GP were not wanting to waste doctors' time or put extra strain on the NHS; not wanting to be seen as someone who made a fuss; and fear of catching Covid at appointments. But people who did contact their GP reported feeling "safe" and "secure" when attending face-to-face appointments. Read full story Source: BBC News, 25 February 2021
  13. Content Article
    Keeping a record of your pain and symptoms can help you and your doctor to manage your symptoms, could help with a diagnosis and also could be used when submitting information for evidence e.g. when claiming for benefits, for work or for school/university.  Endometriosis UK has produced a handy pain and symptoms diary you can use.
  14. News Article
    Acutely ill patients requiring emergency care are being diverted to their GP via the new NHS 111 First call-before-you-walk A&E triage system, Pulse has learned. GPs have reported receiving inappropriate NHS 111 referrals including: an acutely dizzy elderly patient who was later confirmed to have had a posterior circulation stroke; a patient with acute coronary syndrome; and a patient with acute UTI symptoms. Meanwhile, GPs are also warning that patients are using the triage system as a way of ‘jumping the queue’ because the route is likely to get them an appointment quicker than calling their practice. From this month, patients in England are being asked to call 111 before attending A&Es – with 111 triaging them to the most appropriate service, including GP practices. Scottish patients are also being asked to phone ahead of attending A&E; while pilots are ongoing in Northern Ireland; and Wales is in the process of rolling out a ‘contact first’ model following summer pilots. The BMA has said the influx of inappropriate referrals by NHS 111 is likely being ‘compounded’ by the new 111 First system, which is ‘contributing to the immense pressures currently facing primary care’. GPs have raised concerns about several cases in which patients should not have been sent to them by 111 because they required more urgent care. One GP, who asked not to be named, told Pulse: "I had a patient with UTI symptoms – a temperature of 39°C, a heart rate of 140, nausea and abdomen/loin pain. They were told: speak to your GP." Read full story Source: Pulse, 21 December 2020
  15. Content Article
    Failure to attend scheduled hospital appointments disrupts clinical management and consumes resource estimated at £1 billion annually in the UK NHS alone. Accurate stratification of absence risk can maximise the yield of preventative interventions. The wide multiplicity of potential causes, and the poor performance of systems based on simple, linear, low-dimensional models, suggests complex predictive models of attendance are needed. In this paper, Nelson et al. quantify the effect of using complex, non-linear, high-dimensional models enabled by machine learning.
  16. Content Article
    In this short analysis from the Health Foundation, data from the GP patient survey, an annual independent survey run by Ipsos MORI on behalf of NHS England, was used to explore who gets good access to general practice, unpicking how patient satisfaction with the service they receive varies by deprivation, age and ethnicity. Note: The 2020 GP patient survey data were mostly collected before the COVID-19 pandemic, therefore this analysis doesn’t reflect patient experiences or service changes during the pandemic.
  17. Content Article
    The purpose of this Royal College of Nursing (RCN) document is to provide standards and sample assessment tools for training in genital examination in women for registered nurses working in sexual and reproductive health settings, and related health and social care settings. It is envisaged that this document could be used by registered health care professionals who would require training in genital examination in order, for example, to undertake the following procedures: cervical sampling including liquid based cytology and colposcopy taking swabs as part of a sexual health examination inserting, checking or removing intrauterine devices and IUS vaginal ultrasound hysteroscopy nurses working within early pregnancy and acute gynaecology settings and as part of any extended role in history taking and examination for the assessment of symptomatic women.
  18. Content Article
    Dr Kathryn Leask outlines steps GPs can take to try and avoid patients coming to harm as a result of delayed referrals and provides advice on dealing with patient complaints on this issue. There are some steps GPs can take to try to avoid patients coming to harm while putting themselves in the best position to address the potential medico-legal ramifications. In their guidance on Delegation and referral the GMC says that you are not accountable for the actions or omissions of colleagues to whom you make referrals. However, you are accountable for your decisions to transfer care and the steps you have taken to make sure that patient safety is not compromised. If you are aware that there are delays for a particular service and your patient is likely to be affected by this, you should make this clear to them and manage their expectations from the outset. In this GP Online article, Kathryn gives practical tips for GPs and shares a case example.
  19. News Article
    GPs’ warnings about restricted services may have put patients off seeking treatment, delaying diagnoses and worsening existing illnesses, the health and care watchdog has said. The Care Quality Commission (CQC) said that millions of people had struggled to see their doctors during the pandemic, which had magnified inequalities and risked “turning fault lines into chasms”. Between March and August 119.5 million GP appointments were made in England, down from 146.2 million last year, according to NHS Digital. Ian Trenholm, the CQC’s chief executive, said: “The number of lost GP appointments translates into millions of people potentially . . . not getting conditions diagnosed early enough, not getting those referrals on for diagnoses like cancer and other conditions.” Read full story (paywalled) Source: The Times, 16 October 2020
  20. News Article
    East Cheshire faces a serious issue with head and neck cancer, with missed target times and inefficient practices leading to worsening outcomes for patients. That’s prompted officials from the NHS Cheshire Clinical Commissioning Group (CCG) to come up with a plan of action to tackle the problem — but as Cheshire East councillors heard this week, it’s hit a snag. Since 2014, the East Cheshire NHS Trust and Manchester Foundational Trust (MFT) have co-delivered the head and neck cancer pathway. This means that patients are seen by staff at Macclesfield Hospital for diagnostic tests — and if malignant cells are detected, then the patient will be referred on to Wythenshawe for surgery or, if sadly needed, East Cheshire’s own palliative care team for supportive care. In a presentation to CEC’s health scrutiny committee, the CCG said just 10% of patients in the borough were seen at Macclesfield within the 62-day target time in Q3 of 2019/20 — against a desired level of 85%. Simon Goff, chief operating officer of East Cheshire NHS Trust, told the committee: “There is no one stop service - which is where a patient gets diagnostics all on the same day. Biopsies are not always up to the standards required so patients need to have it again. This is a key weakness in the existing service.” The lack of a ‘one stop service’ means there are no on-site pathology services — so samples are taken off-site for testing, and with biopsies needing to be analysed within 24 hours of collection, it results in 39% of all patients having to undergo the procedure again. So what did East Cheshire do about it? The first step was to launch a consultation, with 64 former patients out of roughly 300 eligible providing feedback to the Trust over the summer. The ‘robust’ consultation, saw patients express their desire to ‘know what is going on as soon as possible’, with the ‘issue of travel being outweighed by [the desire for] a quick diagnosis’. Fortunately for health chiefs in Cheshire, there are ‘outstanding’ hospitals surrounding the county — with the Care Quality Commission giving top marks to hospitals in Salford, St Helens, and The Christie in Didsbury. So with East Cheshire’s patients happy to travel a distance in order to gain a quick and accurate diagnosis, and the existing partnership with Manchester’s trust, officials are proposing moving some patients experiencing positive diagnoses and ‘bad news’ cases to MFT sites, such as The Christie or Wythenshawe Hospital. The idea is that ‘neck lump’ patients will be immediately sent to Wythenshawe, with all other patients undergoing initial tests in Macclesfield first before being either sent home with the all clear, or referred on. Biopsies will be done in Wythenshawe, as will ‘breaking bad news’ appointments — where patients are told of a positive cancer diagnosis. Officials say this solution ‘would start to address some of the clinical and performance concerns’ by cutting the average diagnosis wait time from four weeks down to one, reducing the amount of appointments patients need to attend, and allowing for continuity of care throughout treatment. Read full story Source: Knutsford Guardian, 10 October 2020
  21. News Article
    Famous faces, including TV chefs Gordon Ramsay, Nadiya Hussein, and actress Emma Thompson are backing a major new campaign urging anyone concerned about cancer to get checked and to keep routine appointments, as new research found that even now, nearly half (48%) of the public would delay or not seek medical help at all. A fifth (22%) would not want to be a burden on the health service while a similar number said that fear of getting coronavirus or passing it onto others was a major reason for not getting help. More than four in ten people would leave it longer to get health advice than they normally would have before the coronavirus outbreak, however delaying can have serious consequences for some cancers. NHS staff have pulled out all the stops to keep cancer services going throughout the pandemic, with almost one million people referred for checks or starting treatment since the virus took hold. The NHS’s Help Us Help You access campaign will use TV adverts, billboards and social media to urge people to speak to their GP if they are worried about a symptom that could be cancer, and also remind pregnant women to attend check-ups and seek advice if they are worried about their baby. People with mental health issues are also been encouraged to access NHS support. Read full story Source: NHS England, 9 October 2020
  22. News Article
    Much has been said about the delays to patient care during the first wave of COVID-19, but the full picture has been hard to pin down as statistics come in different forms and are released gradually. However, one recently-published poll performed by Ipsos Mori, with more than 2,000 UK adults aged between 18-75, revealed two-thirds of people who needed treatment for new or recently changed conditions had their care cancelled or delayed during March and July. The poll also revealed three-quarters of people missed out on routine treatment in the same timeframe. It is believed to be the hitherto largest patient-focused survey exploring the impact of the pandemic on non-COVID-19 care during its first peak. It found that – of the people who needed treatment for a new or changed condition – 23% chose to cancel their treatment while 42% had their treatment cancelled or delayed by their healthcare provider. Within the group of people requiring care for an ongoing problem, 31% of patients delayed or cancelled their treatment. Mark Davies, chief medical officer at IBM – which commissioned the poll – told HSJ the number of people with new or recently changed conditions choosing to cancel or delay their care was “really worrying”. “This survey backs up the anecdotal evidence we hear about people being worried about going into hospital during the pandemic,” he said. “It is striking that the proportion of this group of patients who did not get treatment is roughly similar to the proportion of patients requiring treatment for an ongoing health problem who cancelled or delayed their care." He said he would have expected the former group – those with new or changed conditions – to be more anxious to get treated, and warned of a “backlog of unmet need that is only going to emerge in the next few months”. Read full story (paywalled) Source: HSJ, 6 October 2020
  23. News Article
    Hundreds of people believe the 111 helpline failed their relatives. Now the Guardian reports that they are demanding a full inquiry into the service. When the coronavirus outbreak hit in March, the NHS feared hospitals could be overwhelmed and so patients with suspected symptoms were directed to call the designated 111 helpline. Call volumes were massive and waiting times were often over an hour. The Guardian’s David Conn has spent months talking to bereaved relatives about that difficult time and during his conversations he found many were deeply unhappy about the service they felt had been provided by the 111 helpline. Lena Vincent’s partner Patrick McManus died from the virus in April following a short period in hospital. He had called 111 three times and had not been advised to seek further medical help. Lena tells Anushka she wants to know who is accountable for the service. Listen to the podcast Source: The Guardian, 28 September 2020
  24. News Article
    People requiring A&E will be urged to book an appointment through NHS 111 under a trial in parts of England. The aim is to direct patients to the most clinically-appropriate service and to help reduce pressure on emergency departments as staff battle winter pressures, such as coronavirus and flu. The pilots are live in Cornwall, Portsmouth, Hampshire and Blackpool and have just begun in Warrington. If they are successful, they could be rolled out to all trusts in December. However, people with a life-threatening condition should still call 999. Under the new changes, patients will still be able to seek help at A&E without an appointment, but officials say they are likely to end up waiting longer than those who have gone through 111. More NHS 111 call handlers are being brought in to take on the additional workload, alongside extra clinicians, the Department of Health and Social Care said. A campaign called Help Us Help You will launch later in the year to urge people to use the new service. Read full story Source: BBC News, 17 September 2020
  25. Content Article
    It is often the case that particular healthcare policies and practices change overnight from being discouraged or even forbidden to becoming more or less compulsory. An example of this is the change in how patients can access doctors during the coronavirus pandemic. At the end of July, Matt Hancock gave a speech on the future of healthcare in which he declared “… from now on, all consultations should be teleconsultations unless there is a compelling reason not to.” The following day, Sir Simon Stevens’ letter on the third phase of the NHS response to COVID-19 gave more nuanced messages and acknowledged the place of face to face consultations alongside digital and telephone consultations in some circumstances. Meanwhile, a recent RCGP survey reported that at the present time 61% of appointments are full telephone consultations and 16% are telephone triages. Many changes in how patients can access doctors have the potential to offer great benefits to patients and to ease pressures on health systems; however, what is right in some circumstances is not right for all as Ros Levenson, Chair of Academy Patient and Lay Committee, Academy of Medical Royal Colleges, discusses in her blog.
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