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News Article
IT outages hit thousands of services
Patient Safety Learning posted a news article in News
Thousands of GP practices — and some other localised services — are without their IT systems today, due to global outages also affecting banking, media and aviation. All EMIS GP IT systems, which are used by more than half of the 8,000-odd GP practices in England, were down. It was leaving many practices unable to book appointments or consult with patients first thing on Friday morning. This will quickly lead to a backlog of appointments and likely pressure on other urgent care. Patient-facing digital services linked to EMIS also appeared to be down, such as records access via the NHS app. The National Pharmacy Association said some community pharmacy services were down — such as “accessing of prescriptions from GPs and medicine deliveries” were disrupted. It’s unclear if that is also caused by EMIS, or other systems. Read full story (paywalled) Source: HSJ, 19 July 2024 -
News Article
Threefold ICS variation in GP phone access revealed
Patient Safety Learning posted a news article in News
Patients trying to reach their GP are almost three times as likely to fail to get through in the worst-performing integrated care systems (ICS) than the best, according to analysis of new annual figures. The data is from NHS England’s annual GP patient survey, which has a large sample size, and is considered one of the best measures of GP access and experience. In Birmingham and Solihull and Black Country, 7% of patients said their calls went unanswered — significantly lower than the best-performing systems at 2%, and the national average of 4%. Some more urban and racially diverse areas tended to do worse on key GP access measures – such as Birmingham, the Black Country, large parts of London, Greater Manchester, and Bedfordshire, Luton and Milton Keynes – although more rural patches like Northamptonshire and parts of the South West also have big problems. NHSE said in a statement: “NHS staff have worked incredibly hard to cope with increased demand for patient care, but this survey makes it clear there is much more to do to improve patient’s satisfaction and experience in accessing primary care services.” It will work with the government to “tackle the issues that matter most to patients” including long-term conditions, continuity of care and patient access, it added. Read full story (paywalled) Source: HSJ, 12 July 2024 -
News Article
Wes Streeting pledges billions to GPs in order to ‘fix front door’ of NHS
Patient Safety Learning posted a news article in News
Ministers will divert billions of pounds from hospitals to GPs to “fix the front door to the NHS”, Wes Streeting has promised as he said millions of patients will be able to see the same family doctor at every appointment. The health secretary made his first major policy announcement as he prepared to begin vital talks with junior doctors on Tuesday, aimed at finally ending the strikes that have crippled the health service since 2022. Less than 10% of the £165bn NHS budget in England is spent on primary care, and that share has been falling, despite record high demand at GP surgeries. In a significant policy shift, Streeting on Monday said he would reverse that trend and boost the proportion of the budget for primary care so patients could access help sooner. More than 5 million patients a month in England are waiting longer than a fortnight for a GP appointment after the previous government promised everyone would be able to get one within 14 days. After visiting Abbey Medical Centre, a GP surgery in St John’s Wood, London, Streeting said: “Patients are finding it harder than ever to see a GP. Patients can’t get through the front door of the NHS, so they aren’t getting the timely care they need. “That’s no surprise, when GPs and primary care have been receiving a smaller proportion of NHS resources. I’m committed to reversing that.” Read full story Source: The Guardian, 8 July 2024 -
News Article'PAs' - who have just two years training - are being used to treat NHS patients, but doctors are concerned about patient safety, reports Sarah Graham. PAs, or physician associates, are a relatively new type of health professional, first introduced in the UK in 2003 and increasingly used across the NHS to provide care to patients, including at GP surgeries. They undergo two years of postgraduate training (compared with the ten years of medical training needed to become a GP). There are now more than 3,000 PAs working in the NHS. The Government has said it wants to increase the number to 10,000 by 2037, but the scheme has become controversial following a series of reports of patients being misdiagnosed, some with fatal consequences. As far as Dave Hay knew, he was seeing a GP. It was 2022 and he’d started having bouts of dizziness, brain fog and fatigue. “It was having an impact on my work and everyday life, so I called my local surgery to make an appointment. I saw someone who wasn’t my usual doctor, but she introduced herself as Dr Smith,” says Hay, 57, a scientist from Yorkshire. “I explained my symptoms. She didn’t do any kind of examination – didn’t check my ears or my vision – and just said, ‘look, I don’t think there’s anything seriously wrong with you, but come back if your symptoms get worse’,” he says. Two weeks later Dave, now 57, a scientist from Yorkshire, felt worse. It was only later, during a chance conversation with the practice nurse, that Dave learned he hadn’t been seeing a GP at all. “I was at a routine appointment and explained what had happened,” Dave says. “The nurse asked who I’d seen and said, ‘that’s not a doctor, that’s a PA’. I had no idea what a PA was.” When Dave arranged an appointment with one of the named GPs, she diagnosed depression and anxiety, because of issues at work and a recent family bereavement. “She looked at my medical history and asked some much more targeted questions, pieced it all together, and recommended talking therapy and antidepressants,” Dave explains, who is now well. However, he does feel that he was misled and waited longer for the right treatment because the PA did not explain her actual role, which they are supposed to do. Read full story Source: iNews, 1 Jul7 2024
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News Article
NHS England’s plans to replace traditional GP referrals
Patient Safety Learning posted a news article in News
An NHS England document has confirmed that that it wants to ‘optimise’ GP referrals to secondary care via an enhanced model of advice and guidance. GP leaders recently raised concerns that NHS England had encouraged Integrated Care Boards (ICBs) to adopt the ‘advice and refer’ model, effectively replacing traditional GP referrals and adding barriers for patients in accessing secondary care. At the time, NHS England did not address concerns about this specific model, but Pulse has now seen a ‘framework’ document which encouraged local commissioners to ‘strengthen’ specialist advice services in order to ‘optimise’ referrals. The guidance suggested the use of the ‘advice and refer’ model, which means all referrals or advice requests from GPs ‘come in through one route’ and directly bookable appointments are ‘discouraged or removed’. Under this service, all referrals are then ‘triaged’, allowing hospitals to reject referrals and send them back to GPs with advice. This mechanism removes the option for GPs to send standard referrals, whereas the usual model of advice and guidance (A&G) allows GPs to seek advice if they wish, but maintains the direct referral route. NHS England emphasised its commitment to empowering regions to ‘develop diverse models’ of specialist advice in line with their local needs. Read full story Source: Pulse, 26 June 2024 -
News Article
Almost half of antidepressant users could quit with GP support, study finds
Patient Safety Learning posted a news article in News
Almost half of long-term antidepressant users could stop taking the medication with GP support and access to internet or telephone helplines, a study suggests. Scientists said more than 40% of people involved in the research who were well and not at risk of relapse managed to come off the drugs with advice from their doctors. They also discovered that patients who could access online support and psychologists by phone had lower rates of depression, fewer withdrawal symptoms and reported better mental wellbeing. Prof Tony Kendrick, of Southampton University, who was the lead author of the research, said the findings were significant because they showed high numbers of patients withdrawing from the drugs without the need for costly intense therapy sessions. He said: “This approach could eliminate the risk of serious side-effects for patients using antidepressants for long periods who have concerns about withdrawal. “Offering patients internet and psychologist telephone support is also cost-effective for the NHS. Our findings show that support not only improves patient outcomes but also tends to reduce the burden on primary healthcare while people taper off antidepressants.” Read full story Source: The Guardian, 26 June 2024 -
News Article
Four in five locum GPs in England unable to find work, BMA study finds
Patient Safety Learning posted a news article in News
More than four in five locum GPs in England are unable to find work with a third forced to leave the NHS because they cannot make ends meet, a survey has found. A survey of 1,852 locums, conducted by the British Medical Association (BMA), found that 84% cannot find work despite patients across the country waiting weeks for GP appointments. The study also found that more than half are considering a career change owing to a lack of work, while a third (33%) have made definite plans to work in a different career away from the NHS. Just under a third (31%) of respondents said that the lack of suitable shifts was leading them to leave the NHS entirely, while 71% said the government funding model was to blame for the levels of unemployment. More than half of GP appointments are now conducted by non-GP practice staff as they are cheaper, which is leading to locums being unable to find work. Read full story Source: The Guardian, 21 June 2024 -
Content ArticleWhen GP practices have a patient who is violent or exhibiting behaviour that makes them fear for their safety, the patient should immediately be removed from the practice list. This guidance from the BMA explains how to do this as well as outlining the special allocation scheme (SAS), which provides primary care medical services in a secure environment to patients who meet the criteria. In the SAS, designated GP practices provide services to patients by appointment at specific locations and times as detailed in individually agreed contracts. Patients join the scheme after being immediately removed as a result of an incident that was reported to the police. It aims to protect GPs, practice staff and patients who have the right to be in the practice without fear of intimidating behaviour.
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Content ArticleFebriDx® is a single-use, analyser-free, point-of-care test with markers for bacterial and viral infection, measured on a finger-prick blood sample. As part of a larger feasibility study, this study explored the views of healthcare professionals (HCPs) and patients on the use of FebriDx® to safely reduce antibiotic prescriptions for lower respiratory tract infections (LRTI) in primary care. The authors concluded that the tool was perceived as a useful in guiding antibiotic prescribing and supporting shared decision making. Initial practical problems with testing and communicating results are potential barriers to use. Training and practice on using the test and effective communication are likely to be important elements in ensuring patient understanding and satisfaction and successful adoption.
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Content Article
Abbie experienced a high-risk pregnancy with her twin girls. They were born at 27 weeks gestation and weighed in at just 677g and 500g. After 150 nights in Neonatal Intensive Care Unit (NICU), both of Abbie’s daughters came safely home. In this blog, Abbie highlights the importance of building a trauma-informed, clinical network around women whose babies have spent time in NICU. Drawing on her own experience and insights, she offers suggestions for how midwives, GPs and health visitors can support their mental health postnatally. -
News Article
Ethnic minorities in England ‘need more GP visits’ before cancer diagnosis
Patient Safety Learning posted a news article in News
Ethnic minorities and young people require more visits than other people to the GP before being diagnosed with cancer, according to new analysis. On average, one in five people across England require three or more GP interactions before being diagnosed with cancer. But for people from ethnic minority backgrounds, the figure rises to one in three, according to analysis of the NHS cancer patient experience 2022 survey by QualityWatch, a joint programme from the Nuffield Trust and the Health Foundation. For young people aged between 16 and 24, about half needed at least three GP visits before being diagnosed, with 20% needing at least five visits. Despite this, young people were still more likely to be diagnosed at an early stage in their cancer. Prof Kamila Hawthorne, the chair of the Royal College of GPs, said that identifying cancer symptoms in young people could be challenging as the risk for the group was generally much smaller. Hawthorne said: “Ensuring patients receive timely and appropriate referrals for suspected cancers is a priority for GPs – and to this end, they are doing a good job, making more urgent referrals and ensuring more cancers are being diagnosed at an early stage than ever. “Whilst GPs are highly trained to identify cancers, this remains challenging in primary care, not least and particularly with some cancers, because the symptoms are often vague and typical of other, more common conditions.” Dr Liz Fisher, senior fellow at the Nuffield Trust, said: “Delays to a cancer diagnosis pose real risks for people and an early diagnosis plays a pivotal role in determining the treatments available to people and determining outcomes. “The NHS has set an ambitious goal to dramatically increase early detection of cancer, but performance in this area has stubbornly stalled in recent years. Everyone’s experience of cancer diagnosis is different but the risks to delays aren’t felt equally, with younger people and those from minority ethnic groups requiring more visits to health professionals to secure a diagnosis.” Read full story Source: The Guardian, 24 April 2024 -
News Article
One in seven callers could not reach GP in worst-performing ICS
Patient Safety Learning posted a news article in News
People attempting to contact their GP practice are almost three times as likely to report failing to get through in some integrated care systems (ICS) than others, according to NHS England-commissioned data. The survey figures, collected for the first time by the Office for National Statistics (ONS), show 8.5% of people nationally who tried to call their GP between mid-January and mid-February this year said they could not reach the practice. This equates to 1.5 million people across England, according to the ONS. In Northamptonshire – the worst performing ICS – 14.7% of callers did not manage to make contact. That is the equivalent of around one in seven people. By comparison, only 3.9% of callers in Gloucestershire, the best performing ICS, could not get through. The findings are broadly similar when population and age are accounted for. Read full story (paywalled) Source: HSJ, 12 April 2024 -
News Article
The ICSs ‘diverting’ the most GP referrals through controversial model
Patient Safety Learning posted a news article in News
There is huge regional variation in the rate at which health systems are preventing patients joining the elective waiting list through “advice and guidance” to GPs, according to analysis by HSJ. Some systems – including Northamptonshire – have managed to ramp up these “diverts” to such an extent that they now report around one A&G case to every 3.5 cases cleared from the waiting list through treatment or seeing a consultant. This contrasts with others, such as Lancashire and South Cumbria, which only reports one A&G case for every 16 cleared from the waiting list. Advice and guidance involves GPs consulting specialists before making direct referrals and around half the time this results in a referral being avoided. The model is set to be a cornerstone of NHS England’s new outpatient transformation strategy, which is due imminently. Victoria Tzortziou-Brown, vice chair of the Royal College of GPs, said the analysis “confirms reports we’ve heard from our members – that there is too much regional variation in the use of the ‘advice and guidance’”. She added: “Some GPs report that when advice and guidance is properly resourced and well implemented, it can be a helpful tool for improving communications with their colleagues in secondary care. “[But] it is clear that more time, funding and capacity needs to be dedicated to allow clinicians to communicate efficiently and effectively whilst respecting professionalism.” Read full story (paywalled) Source: HSJ, 9 April 2024 Related reading on the hub: Rejected outpatient referrals are putting patients at risk and increasing workload pressure on GPs -
News Article
More than half of England’s army veterans have health problems
Patient Safety Learning posted a news article in News
More than half of England’s army veterans have experienced mental or physical health issues since returning to civilian life, and some are reluctant to share their experiences, a survey has revealed. The survey of 4,910 veterans, commissioned jointly by the Royal College of GPs (RCGP) and the Office for Veterans’ Affairs (OVA), found that 55% have experienced a health issue potentially related to their service since leaving the armed forces. Over 80% of respondents said their condition had got worse since returning to civilian life. One in seven of those surveyed said they had not sought help from a healthcare professional. A preference for managing issues alone and the belief that their experience would not be understood by a civilian health professional were the most common reasons given. This fear of being misunderstood is demonstrated by the finding that 63% of veterans said they would be more likely to seek help if they knew their GP practice was signed up to the Veteran Friendly Accreditation scheme. More than 3,000 of England’s 6,313 GP practices are accredited, but the survey’s findings have prompted the RCGP – with NHS England and the OVA – to launch an initiative to get more GP practices on to the scheme. Practices that sign up will be provided with a “simple process” for identifying, understanding and supporting veterans and, where appropriate, referring them to dedicated veterans’ physical and mental health and wellbeing services. Read full story Source: The Guardian, 25 March 2024 -
News ArticleNHS England’s workforce ambitions are based on ‘significant’ substitution of fully qualified GPs with trainees and specialist and associate specialist (SAS) doctors, the public spending watchdog has revealed. In a new assessment of the NHS long-term workforce plan, the National Audit Office (NAO) found that NHS England’s modelling of the future workforce had ‘significant weaknesses’ and that some of its ‘assumptions’ may have been ‘optimistic’. Last year, the national commissioner committed to doubling medical school places to 15,000 and increasing GP training places to 6,000 by 2031. This was based on modelling which predicted that, without these changes, the NHS could face a staffing shortfall of 360,000 and a GP shortfall of 15,000 by 2036. The NAO’s report has examined the robustness of NHS England’s predictions, and made a number of recommendations which could influence the refreshed projections NHSE has committed to publishing every two years. The long-term workforce plan (LTWP) projected only a 4% increase in fully-qualified GPs between 2021 and 2036, compared to a 49% growth in consultants. "The total supply of doctors in primary care is projected to increase substantially over the modelled period but the total number of fully qualified GPs is not," the report said. It found that NHSE’s projected supply growth in general practice "consists mainly of trainee GPs", who accounted for 93%, as well as "making increased use of specialist and associate specialist (SAS) doctors in primary care". Read full story Source: Pulse, 22 March 2024
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Content ArticleDoctors working in temporary positions (known as locums) are a key component of the medical workforce and provide necessary flexibility and additional capacity for NHS organisations and services. There have been concerns about the quality and safety of locum practice and the way NHS uses locum doctors. The number of doctors working as locums, and the costs of this to the NHS have caused some concerns nationally in recent years. It has also been suggested that locum doctors may not provide as good a quality of care as permanent doctors. Research carried out by a team at the University of Manchester provided important new information on these issues. The findings indicated that locum working and how locums were integrated into organisations could pose significant challenges for patient safety and quality of care.
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News Article
‘My GP suggested it’: Britons explain why they went private for surgery
Patient Safety Learning posted a news article in News
Private hospitals are caring for a record number of patients paying through their own savings or private medical insurance, according to figures from the Private Healthcare Information Network. Helen, a semi-retired frontline worker in south-east England, spent nearly £50,000 of her retirement savings on major spinal surgery to get her life back after two years of debilitating pain. Helen, 56, began experiencing extreme lower back pain and leg pain in September 2021, triggered by a dog colliding with her leg in the park. Though it was not caused by the trigger, she was diagnosed by the NHS with spondylosis in November 2021, and then a pars defect (a condition affecting the lower spine), and offered scans and physiotherapy. She said six months of physiotherapy, beginning in early 2022, resulted in no improvement, and she was offered pain management and a steroid epidural, which she said also did not help. “I rarely ventured out in these two years … due to the extreme pain I was in when sitting, standing or walking. Life effectively stopped in 2021,” she said. Desperate, she booked a consultation in May 2023 with a neurosurgeon and was told she needed an operation. Helen asked whether it would be possible for the neurosurgeon, who also works within the NHS, to do it on the NHS rather than privately. A referral could be made, she was told – but the surgery was likely to involve a waiting time of 18 months to two years. “My husband and I discussed it, and he said: you’ve already had no life for the last two years, do you really want to wait another two?” She had the spinal surgery in August 2023 and is now managing her pain with over-the-counter medication, rather than the stronger painkillers she was on before. It cost her a staggering £48,345. The financial hit has been huge. “I was absolutely gutted to have to go private. This has knocked us both; we didn’t see us in our lives having to pay for something like this. We’ve managed our finances carefully and always saved where we can. But that lump sum [that we] can access when we retire … That lump sum has just gone now.” Read full story Source: The Guardian, 8 March 2024 -
Content ArticleIn this opinion piece for inews, Dr Punam Krishan describes the increasing levels of verbal and physical abuse GPs are experiencing from patients in the NHS. She describes how a shift in the public's perception of GPs since the pandemic has contributed to this increase in aggression and highlights that although it is only a minority of patients who display abusive behaviour, it has a big impact on GPs wellbeing and ability to treat other patients. She goes on to outline stricter measures her practice has had to put in place to crack down on abuse from patients.
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News Article
Patients facing uphill struggle to see GPs
Patient Safety Learning posted a news article in News
Patients in parts of England are facing an uphill struggle to see a GP, experts say, after an analysis showed wide regional variation in doctor numbers. The Nuffield Trust think tank found Kent and Medway had the fewest GPs per person, followed by Bedfordshire, Luton and Milton Keynes. It comes as ministers have struggled to hit the pledge to boost the GP workforce by 6,000 this Parliament. But the government said it had plans in place to tackle shortages. However, Dr Billy Palmer, of the Nuffield Trust, said: "Solely boosting the number of staff nationally in the NHS is not enough alone - the next government should set a clear aim of reducing the uneven distribution of key staffing groups and shortfalls to tackle unfairness in access for patients." The think-tank report found while the government had met its target to increase the number of nurses by 50,000 this Parliament, the rises had not been felt evenly, with some specialist nurse posts, such as health visitors and learning-disability nurses, seeing numbers shrink. Dr Palmer said minimum numbers of GPs may have to be set for local areas - and better incentives to attract them to those with the fewest. Read full story Source: BBC News, 8 March 2024 -
News Article
ICB shelves same-day hub plans due to GP and patient backlash
Patient Safety Learning posted a news article in News
Same-day access hubs will not be mandated in North West London as the Integrated Care Board (ICB) bows to pressure from GPs and patients. In a letter to GP teams, seen by Pulse, the ICB said that their controversial same-day access programme "will not form part of the single offer for enhanced services for 2024/25". Instead, ICB leaders said they want to work with PCNs "to consider how access can be improved" and that they do not have a "presumption" about a "particular model" all PCNs should adopt. They are now aiming for a new model to be implemented from April next year instead. The hub model aimed to "deliver a single point of triage for same-day, low complexity" demand for all 2.1 million residents within the integrated care system, leaving GP practices with only longer-term, "complex" care. But London GP leaders, as well as patients, raised "immense concern" with the plans, including patient safety, quality of care, and logistics. In response to these concerns, the ICB confirmed yesterday that it has "adjusted" the same-day hub programme, and that it wants to "move forward collectively" to address both patient access issues and GP pressures. Read full story Source: Pulse, 6 March 2024 -
News ArticleGPs do not ‘face huge amounts of complexity’ and most of their appointments are ‘incredibly straightforward’, according to a former Conservative health minister. Speaking to BBC Radio 4 last week, Lord Bethell defended upcoming legislation that will bring physician associates (PAs) under GMC regulation, which could be struck down by the House of Lords this evening. Both the Doctors’ Association UK and the BMA had previously complained about the lack of debate in Parliament. Discussing the role of PAs on Friday, Lord Bethell said he had not seen ‘any evidence’ of patients being confused about whether they were seeing a doctor or an associate. "GPs don’t face huge amounts of complexity. Most interactions are incredibly straightforward. Certainly my own experience over the last 20 years of going to my GP, it really hasn’t required 10 years of training to deal with my small problems," he said. Lord Bethell added: ‘When they are complex, they should be escalated. But there’s a much wider group of people who have professional training who should be respected, celebrated – they shouldn’t be denigrated, they shouldn’t be in any way patronised by other professionals.’ Read full story Source: Pulse, 26 February 2024
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Content Article
Top picks: Ten resources on eating disorders
Patient-Safety-Learning posted an article in Eating disorders
Eating Disorders Awareness Week takes place 26 February - 3 March 2024 Eating disorders are complex mental health conditions that affect an estimated 1.25 million people in the UK. There are many unhelpful myths about who eating disorders affect, what the symptoms are and how to support people in recovery. Alongside a current lack of appropriately trained staff and capacity in mental health services, this can make it challenging for people with eating disorders to access the help and support they need. Patient Safety Learning has pulled together ten useful resources shared on the hub to help healthcare professionals, friends and family support people with eating disorders. They include awareness-raising articles, practical tips for patients and their loved ones, and clinical guidance for primary, secondary and mental health providers. -
Content ArticleThere is currently a lack of research addressing the impact of patient suicide on GPs. This qualitative study in BMJ Open aimed to examine the personal and professional impact of patient suicide, as well as the availability of support and why GPs did or did not use it. The authors found that GPs are impacted both personally and professionally when they lose a patient to suicide, but may not access formal help due to commonly held idealised notions of a ‘good’ GP who is regarded as being unshakable. Fear of professional repercussions also plays a major role in deterring help-seeking. A systemic culture shift which allows GPs to seek support when their physical or mental health requires it is needed, and this may help prevent stress, burnout and early retirement.
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Content ArticleThis report by The King's Fund argues that the health and care system in England must shift its focus away from hospital care to primary and community services if it is to be effective and sustainable. It looks at a wholesale shift in the focus towards primary and community health and care across leadership, culture and implementation. Successive governments have repeated a vision of health and care services focused on communities rather than hospitals, but that vision is very far from being achieved. The report outlines research that explored the underlying factors that have prevented change, and what might need to be done to achieve the vision. The researchers analysed published evidence and national datasets, and interviewed stakeholders across the health and care system. The report concludes that to achieve community-based care, political and other national leaders will need to completely shift their focus away from hospitals towards primary and community health and care.
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Content ArticleContinuity of care, defined as an ongoing therapeutic relationship between a patient and a physician, is a defining characteristic of primary care. However, arranging a consultation with one’s regular doctor is increasingly difficult as practices face physician shortages. Kajaria-Montag et al. studied the effect of declining care continuity on the productivity of physicians by analysing data of over 10 million consultations in 381 English primary care practices over a period of 11 years. Specifically, they examined whether a consultation with the patient’s regular doctor is more productive than with another doctor in the practice. The authors found that the time to a patient’s next visit is on average 18.1% longer when the patient sees the doctor they have seen most frequently over the past two years, while there is no operationally meaningful difference in consultation duration. The data show that the productivity benefit of care continuity is larger for older patients, patients with multiple chronic conditions, and patients with mental health conditions. The authors estimate that the total consultation demand in their sample could have fallen by up to 5.2% had all practices offered continuity of care at the level of the top decile of practices while prioritising patients expected to yield the largest productivity benefits.
