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Found 211 results
  1. 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
  2. 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
  3. 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.
  4. News Article
    GP practices are being told they must make sure patients can be seen face to face when they need such appointments. NHS England is writing to all practices to make sure they are communicating the fact doctors can be seen in person if necessary, as well as virtually. It's estimated half of the 102 million appointments from March to July were by video or phone call, NHS Digital said. However, the Royal College of GPs said any implication GPs had not been doing their job properly was "an insult". NHS England said research suggested nearly two thirds of the public were happy to have a phone or video call with their doctor - but that, ahead of winter, they wanted to make sure people knew they could see their GP if needed. Nikki Kanani, medical director of primary care for NHS England, said GPs had adapted quickly in recent months to offer remote consultations and "safe face-to-face care when needed". Prof Martin Marshall, chair of the Royal College of GPs, said general practice was "open and has been throughout the pandemic", with a predominantly remote service to help stop the spread of coronavirus. He said: "The college does not want to see general practice become a totally, or even mostly, remote service post-pandemic. However, we are still in the middle of a pandemic. We need to consider infection control and limit footfall in GP surgeries - all in line with NHS England's current guidance." He said most patients had understood the changes and that clinical commissioning groups had been asked to work with GP practices where face-to-face appointments were not possible - for example, if all GPs were at a high risk from coronavirus. "Any implication that they have not been doing their job properly is an insult to GPs and their teams who have worked throughout the pandemic, continued delivering the vast majority of patient care in the NHS and face an incredibly difficult winter ahead," he said. Read full story Source: BBC News, 14 September 2020 Research from the college indicated that routine GP appointments were back to near-normal levels for this time of year, after decreasing at the height of the pandemic. "Each and every day last week an estimated third of a million appointments were delivered face to face by general practices across the country," added Prof Marshall.
  5. News Article
    Pilots for a new urgent care model requiring walk-in patients to book slots in emergency departments are expected to be rolled out in at least one site in every health system in the coming weeks, HSJ has learned. The move comes amid concerns from trust managers who warned some 111 providers’ systems were too “risk averse” and were sending too many patients who could have been treated in other care settings to hospitals. Local managers believe NHS 111 not directing enough people to alternative services was a cause of a major incident at Gloucestershire Hospitals Foundation Trust’s emergency services earlier this month, HSJ understands. And trust leaders in other parts of the country are understood to have similar concerns. Trials of 111 First have already been publicly confirmed at Portsmouth Hospitals Trust, Royal Cornwall Trust, Newcastle Hospitals FT and Blackpool Hospitals FT. HSJ also understands five London sites, one for each integrated care system in the capital, are also running trials. These “early adopter” trusts have been given autonomy to trial different models for “111 First”. Most EDs at these sites still treat “walk-in patients” as normal. But in Portsmouth, patients with minor injuries who turn up at ED without calling ahead have, on three different days, been instead told to call 111 following assessments. NHS England said further trials will take place in the Midlands and East of England, but the specific trusts undertaking these trials have not been decided yet. Read full story (paywalled) Source: HSJ, 2 September 2020
  6. News Article
    Trusts are being encouraged to adopt a system in which patients initiate follow up appointments by the lastest guidance from NHS England designed to help the NHS recover from the covid crisis. It is hoped the approach can reduce unnecessary demand and therefore help trusts cut waiting lists that have soared as a result of the restrictions placed on hospital activity during the pandemic. Under 'patient initiated follow up' (PIFU) patients decide when they require follow up appointments. They are given guidance as to what symptoms and other factors they should take into account when deciding if a follow up appointment is necessary. PIFU is already used by some trusts, but it has not yet become widely adopted. The plan to increase PIFUs was set out in a guidance published today designed to underpin the “phase three letter” sent out to NHS leaders last week. The guidance, Implementing phase 3 of the NHS response to COVID-19 pandemic , says “individual services should develop their own guidance, criteria and protocols on when to use PIFUs”. The document also sets out some overarching principles. It says services will be rated against the following headline metrics: “total number and proportion of patients on the PIFU pathway; patient outcomes, e.g. recovery rates, relapse rates; waiting times; and DNA rates”. Read full story (paywalled) Source: HSJ, 7 August 2020
  7. News Article
    Hundreds of thousands of NHS patients could lose the ability to see their GP face to face because their doctors may have to protect themselves from coronavirus. An analysis by the Health Foundation charity has found around a third of GPs who run their practice on their own are at high risk from the virus themselves. If they are forced to abandon face-to-face consultations the charity warned it could deny 710,000 patients access to their doctor. Dr Rebecca Fisher, senior policy fellow at the Health Foundation and a GP said: “The ongoing risk of Covid-19 to the safety of both patients and GPs means hundreds of thousands of people may find it much harder to get a face-to-face GP appointment. “It’s particularly worrying that GPs at higher risk from Covid-19 are far more likely to be working in areas of high deprivation. Those are precisely the areas with the greatest health need, the biggest burden from Covid-19, and an existing under-supply of GPs relative to need. Unless urgent action is taken this could become another way in which poorer communities become further disadvantaged, and risks further widening health inequalities.” Read full story Source: The Independent, 6 August 2020
  8. News Article
    New guidance requires GPs to offer at least some face-to-face appointments, amid reports that some had completely eliminated them, sparking ‘significant incidents’. NHS England’s instructions for the third phase of the NHS response to COVID-19 were issued on Friday, including the call that “all GP practices must offer face to face appointments at their surgeries” along with remote triage and remote consultations. Most appointments in primary care have been carried out remotely since the NHS instituted new operating procedures in response to covid, with practices offering a mix of remote consultations over the telephone or video, with a diminished number face-to-face. However, there have been reports of some GP practices not offering any face-to-face appointments at all, and continuing this approach following the peak of cases in the spring. A letter to GPs last month told them they must offer appointments in person “where clinically appropriate”, now reiterated in the phase three guidance. The letter added: “It should be clear to patients that all practice premises are open to provide care, with adjustments to the mode of delivery. No practice should be communicating to patients that their premises are closed.” Read full story Source: HSJ, 4 August 2020
  9. Content Article
    This easy read document, from Macintyre, should be used as an aid in helping people to: prepare for their appointment participate in the appointment understand the advice given at the appointment. It can also be presented to the health professional - by using information from One Page Profile, the document serves as an aid for the health professional on how to engage with the person during the appointment.
  10. Content Article
    In this blog, Steve Turner provides a guide for patients to help them understand what they should come away with at the end of a consultation. He argues that if these areas have not been covered, the consultation is incomplete and a patient should not accept this.
  11. Content Article
    NHS England is pushing plans to introduce a ’call before you walk’ model for accident and emergency by winter. But are the health service and the public ready for such a significant shift? HSJ bureau chief and performance lead James Illman tracks the prospects and progress in HSJ's Recovery Watch newsletter.
  12. Content Article
    Research by the British Medical Association (BMA) concludes that over a million planned operations and treatments as well as over twenty thousand cancer treatments have been cancelled or delayed between April and the end of June this year because of the pandemic. The Association’s research also estimates that more than two and a half million first time outpatient appointments were cancelled during the same time period. This paper coincides with the BMA’s latest survey of 5,905 doctors in England and Wales, asking about the impact of the pandemic on their patients and their working lives. As part of the survey, they were asked if, within the last week, they had treated patients with conditions at a later stage (e.g. cancer, heart disease) than they would normally expect. A little over 40% said that they had. Behind this data are the scores of patients whose routine surgery or procedure has been put aside in the rush to reconfigure the NHS to cope with COVID-19. Even worse, doctors know there are those whose illnesses are far more serious than they were, some now beyond cure. 
  13. News Article
    Trials of new systems to prevent overcrowding in emergency departments ahead of a potential second wave of COVID-19 in the winter are taking place at hospitals in Portsmouth and Cornwall and are due to shortly be expanded to other areas, with Dorset and Newcastle likely sites, HSJ can reveal. London is also experimenting with introducing the system, having pulled back from an earlier proposal to roll it out it rapidly, shortly after the COVID-19 peak. In the trials, NHS 111 has acted as a “triage point” enabling patients not facing medical emergencies but needing urgent treatment to book access to primary care, urgent treatment centres or same-day emergency “hot clinics” staffed by specialists. Patients are discouraged from attending without an appointment, but they are able to do so; and sources said performance targets would continue to apply to them, although these were already subject to review pre-covid. Both the Royal College of Emergency Medicine and NHSE are now hopeful a new triage system for emergency care can be in place by the winter. Read full story (paywalled) Source: 15 July 2020
  14. News Article
    People with non-life threatening illnesses will be told to call before going to Wales' biggest A&E department. Patients will be assessed remotely and given a time slot for the University Hospital of Wales in Cardiff if needed. Hospital bosses feel returning to over-crowded waiting rooms would provide an "unacceptable" risk to patients due to coronavirus. The system is set to start at the end of July, but will not apply to people with serious illnesses or injuries. Details are still being discussed by Cardiff and Vale health board, but patients with less serious illnesses or injuries will be told to phone ahead, most likely on the 24-hour number used to contact the local GP out-of-hours service. They will be assessed by a doctor or a nurse and, depending on the severity of the condition, will either be given a time window to go to A&E or be directed to other services. This system was introduced in Denmark several years ago. "This is all about being safe and ensuring that emergency medicine and emergency care is safe and not about putting barriers in place to those more vulnerable people," says the department's lead-doctor Dr Katja Empson. "What we really think is that by using this system, we'll be able to focus our attention on those vulnerable groups when they do present." If successful, the system could become a long-term answer to reducing pressures on emergency medicine, she added. Read full story Source: BBC News, 14 July 2020
  15. News Article
    Waiting times for tests and treatment not related to COVID-19 are likely to increase significantly in the second half of 2020 because of the fallout from the pandemic, the head of NHS England has acknowledged. Giving evidence to the Commons health select committee on 30 June, NHS England’s chief executive Simon Stevens said that contrary to some commentary, the NHS’s overall waiting list actually dropped by over half a million people between February and April 2020 because fewer people were coming forward for treatment. But, he added, “As referrals return we expect that will go up significantly over the second half of the year.” Stevens said that there were 725 000 fewer elective admissions to NHS hospitals during March and April, but that number has begun to recover significantly. “As we speak, we think we’re now somewhere north of 55% of pre-covid-19 elective activity levels,” he said. He added that he hoped the NHS would return to around three quarters of normal activity levels by July or August. Stevens told MPs that the NHS would pursue a range of measures to increase capacity over the coming months, including extending the deal with the private sector to use its facilities, and repurposing some of the Nightingale hospitals for diagnostic testing. Read full story Source: BMJ, 1 July 2020
  16. Content Article
    Caring for people with learning disabilities in an acute hospital setting can be challenging, especially if that patient has transitioned from children’s services to adult services. The experience in children’s acute care differs to adult acute care; this difference in processes of care can cause great anxiety for the patient and their family and carers. The reasonable adjustments that were perhaps made and sustained in children’s services may now not exist. The purpose of this blog is to demonstrate the importance for services to be designed around patients’ needs with patients, families and carers. If we get this right, the quality of care given will be improved, patient satisfaction increases and, in turn, a reduction in patient harm. It is important to note that designing services around patients is not exclusive to learning disabilities; designing services with ALL patients at the centre with their involvement is crucial for trusts to provide safe care.
  17. News Article
    Appointments to be seen in A&E could be introduced permanently in response to coronavirus, the president of the Royal College of Emergency Medicine has said. Dr Katherine Henderson said it would cause "enormous harm" to patients if Britain returned to crowded casualty units with "elastic walls". Instead, she said patients should be given a "contact point" such as the NHS 111 line to book a slot in an emergency department, or to be seen directly by a specialist or diverted to the care they need. "The old way of doing things involved emergency departments having elastic walls," Dr Henderson told MPs. "We were able to have an infinite number of patients. We were never able to say: 'We're full, we're at capacity.' We now need to recognise that we can't do that." Read full story (paywalled) Source: The Telegraph, 16 June 2020
  18. News Article
    A poll of members by the Medical Protection Society (MPS) found that 43% of doctors fear investigation if patients come to harm because of delays to referrals and reduced NHS services during the pandemic. Treatment has been delayed for millions of patients while the NHS has focused on managing the pandemic - with GPs in many areas still unable to refer as normal and even urgent referrals delayed while the UK has been in lockdown. The NHS Confederation has warned that 10 million people could be on NHS waiting lists by Christmas. Reduced NHS services during the pandemic have left even patients who need urgent treatment or scans for cancer waiting longer. GPonline reported in April that patients had been waiting more than a month for urgent cancer checks - and Cancer Research UK warned in May that 2.4 million patients were waiting longer for scans or treatment because of disruption to services during the pandemic. Read full story Source: GPonline, 11 June 2020
  19. News Article
    The postponement of tens of thousands of hospital procedures is putting the lives of people with long-term heart conditions at risk, according to the British Heart Foundation. The coronavirus pandemic has created a backlog which would only get larger as patients waited for care, it said. People with heart disease are at increased risk of serious illness with COVID-19, and some are shielding. The BHF estimates that 28,000 procedures have been delayed in England since the outbreak of coronavirus in the UK. These are planned hospital procedures, including the implanting of pacemakers or stents, widening blocked arteries to the heart, and tests to diagnose heart problems. People now waiting for new appointments would already have been waiting for treatment when the lockdown started, the charity said, as it urged the NHS to support people with heart conditions "in a safe way". Read full story Source: 5 June 2020
  20. News Article
    Suspected cancer patients are being refused hospital appointments despite being referred by GPs, it has emerged. Family doctors working for one NHS trust in north east London claimed that hundreds of referrals had been rejected in recent weeks. Many were for ultrasounds and chest X-rays and were sent via the two-week wait system, in which suspected cancer patients referred by GPs are seen within a fortnight. A rejection letter sent from Whipps Cross hospital seen by Pulse magazine, said the referral had been “due to the Covid-19 pandemic”. It added: “Following triage by a consultant radiologist, your imaging request has been assessed as non-urgent and cancelled.” Read full story Source: The Telegraph (18 May 202)
  21. Content Article
    It is now very common for clinicians to carry out consultations with patients over the telephone. If you have time to prepare for the consulation Steve Turner has some suggestions. The aim being to help all patients / users of health and care services lead on their own care. This is a rolling blog. Steve Turner is a nurse prescriber and clinical educator and Associate Lecturer at Plymouth University.
  22. News Article
    Tens of thousands of outpatient video consultations have been carried out by NHS trusts following the national rollout of a digital platform to support the coronavirus response. Digital healthcare service Attend Anywhere was introduced across the country at the end of March after NHSX chief clinical information officer Simon Eccles called for its rapid expansion. There has been a major push to boost digital healthcare services across the country in order to support the national response to coronavirus. Much of primary care has already switched to working virtually. Undertaking hospital outpatient appointments digitally has been identified as a way of keeping patients safe by removing their need to travel. There have now been more than 79,000 consultations with Attend Anywhere. The number of consultations started at around 200 per day, but has rapidly increased to more than 6,000 per day. Data released by NHS Digital showed that GPs moved swiftly to change their practice model in the face of COVID-19. The proportion of appointments conducted face-to-face nearly halved and the proportion of telephone appointments increased by over 600 per cent from 1 March to 31 March as GPs moved to keep patients out of surgeries except when absolutely necessary. However, concerns have been raised over the limitation of remote appointments, particularly in mental health services. Royal College of GPs chair Martin Marshall raised concerns that video appointments could make it difficult for doctors to diagnose and manage patients’ conditions during the pandemic. Read full story Source: HSJ, 11 May 2020
  23. News Article
    Concerns for the wellbeing of babies born in lockdown are being raised, as parents struggle to access regular support services. England's children's commissioner is highlighting pressures facing mothers caring for babies without the usual family and state support networks. Playgroups are closed and health visitor "visits" are being carried out remotely in most cases. The NHS said adaptations had been made to keep new mothers and babies safe. The briefing paper from Anne Longfield's office says an estimated 76,000 babies will have been born in England under lockdown so far. But births are not being registered, because of temporary rules tied to the virus pandemic, so even basic information about new babies is not being gathered. At the same time, support services provided by health visitors and GPs are not readily accessible, with many taking place via phone and video calls or not at all. There are concerns many babies may have missed their developmental health checks, due in the first few weeks of life to pick up urgent developmental needs. "In some areas, the six-week GP baby check hasn't been available or parents haven't wanted to attend it due to a potential risk of infection," she said. Read full story Source: BBC News, 7 May 2020
  24. News Article
    GPs will now be able to access records for patients registered at other practices during the coronavirus epidemic in a major relaxation of current rules. The move will allow appointments to be shared across practices, and NHS 111 staff will also have access to records to let them book direct appointments for patients at any GP practice or specialist centre. The change in policy has been initiated by NHS Digital and NHSX to enable swift and secure sharing of patient records across primary care during the covid-19 pandemic. It means that the GP Connect1 system, currently used by some practices to share records on a voluntary basis, will be switched on at all practices until the pandemic is over. In addition, extra information including significant medical history, reason for medication, and immunisations will be added to patients’ summary care records and made available to a wider group of healthcare professionals. Usually, individuals must opt in but following the changes only people who have opted out will be excluded. Read full story Source: The BMJ, 27 April 2020
  25. News Article
    The British Dental Association (BDA) has criticised NHS England for “dragging its feet” in setting up an urgent care system for dental patients, putting further strain on already overstretched GPs. At the end of March, dental practices were ordered to suspend all routine treatment, as part of plans to prevent the spread of coronavirus. NHS regions were instructed to set up local urgent dental care centres. However, GPs have told HSJ they have been experiencing a rise in calls from patients with dental problems, but when they direct them to the urgent care centres, appointments appear to be limited. The BDA has said, in some regions, there is “nowhere” to send patients in need of urgent dental care. Sources working in primary care and tech said GPs were dealing with a spike in demand from dental patients who did not know where to go. Read full story Source: HSJ, 17 April 2020
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