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Would you want to be treated by a 'medic' with just two years' training?

Peter Marshall was delighted when he finally got an appointment after calling his GP surgery for several days.

On the day, he saw a young medic who said his excruciating stomach pain was caused by irritable bowel syndrome (IBS) and suggested over-the-counter peppermint tablets to ease the discomfort.

And off the 69-year-old retired IT specialist went, happy to have a diagnosis and treatment.

In fact, Peter hadn't had an appointment with a GP — he had been seen by a physician associate (PA).

This is a type of healthcare worker whose numbers are about to soar in the NHS in order to reduce the pressure on doctors so that they can concentrate on the most complex and seriously ill patients.

It all sounds like a great idea. Indeed, PAs are now being employed across areas that are particularly stretched, with around a third of PAs working in GP surgeries and 10% in A&E departments, according to the latest census by the Royal College of Physicians. But they are actually spread across 46 NHS specialties, from urology and surgery to cardiology and mental health.

In this role, they are permitted to carry out a range of medical tasks, from performing physical examinations, diagnosing patients and analysing test results to running clinics and performing minor procedures — as well as doing home visits — all under the supervision of a doctor.

However, in the case of Peter Marshall, although he was reassured by his diagnosis, his symptoms were, in fact, a sign of bowel cancer — and he died nine months later, in January this year.

His sister, who has told Good Health his story, says: 'My brother had no idea that he had seen a PA and not a qualified doctor — he didn't know the word physician associate even existed, no one does.'

The family, from London, later received an apology from the PA. 'Patients are so desperate to get an appointment with their GP, you are grateful to see anyone and whatever they say, you accept,' she says.

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Source: Daily Mail, 9 October 2023

 

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Worst-off find it harder than well-off to access NHS care, survey finds

Poorer people find it much harder to access NHS care than the well-off and have a worse experience when they do get it, research by the health service’s consumer watchdog has found.

Those on the lowest incomes have much more difficulty getting a GP appointment, dental care or help with mental health problems, according to a survey by Healthwatch England.

They are also more likely to feel they are not listened to by a health professional and not involved in key decisions about their care compared with those who are financially comfortable.

The links between poverty and ill-health are well known, but the Healthwatch findings show that the worse-off also face the disadvantage what the watchdog called barriers to obtaining healthcare when they need it.

The findings have prompted fears that the NHS is too often a “two-tier service” with access closely related to wealth, and calls for it to do more to make services more accessible to everyone.

Healthwatch’s survey of 2,018 people aged 16 and over in England, which was a representative sample of the population, found that:

  • 42% of those who described their financial situation as “really struggling” said they had trouble getting to see a GP, double the 21% of those who were “very comfortable”.
  • 38% of the worst-off found it hard to get NHS dental care, compared with 20% of the better-off.
  • 28% of the very poor had difficulty accessing mental health treatment, whereas only 9% of the very comfortable did so.

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Source: The Guardian, 4 March 2024

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Worst affected care homes revealed by watchdog

The number of people who have died in each care home has been published for the first time. According to reports, more than 39,000 care home residents died with the virus between 10 April 2020 and 31 March 2021.

The data, released by the Care Quality Commission (CQC) shows 21 homes had more than 30 Covid-19 related deaths, with the highest number of deaths in a single care home being 44.

Kate Terroni, CQC chief inspector for adult social care has said "Every number represents a life lost". 

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Source: BBC News, 21 July 2021

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World's Best Hospitals 2023

These are challenging times for hospitals. Covid-19 put unprecedented stress on health systems, as have inflation and global financial uncertainty. In the USA and around the world, leading hospitals are dealing with rising costs, aging populations and a medical workforce exhausted from battling a global pandemic.

Among the hallmarks of great hospitals, however, are not just first-class care, first-class research and first-class innovation. The very best institutions also share another quality: consistency. The world's best hospitals consistently attract the best people and provide the best outcomes for patients as well as the most important new therapies and research. Of all the hospitals in the world, relatively few can do all those things year in and year out. 

To recognise them, Newsweek and global data firm Statista have put together their fifth annual listing of the World's Best Hospitals 2023. This year, they have ranked over 2,300 hospitals in 28 countries, including one that is new to the list, Taiwan. For the first time, they have ranked all top 250 global hospitals. They have listed the best hospitals by country; each country list also includes a listing of top specialty hospitals.

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Source: News Week

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World-renowned NHS centre downgraded by watchdog

A world-renowned cancer centre hit by whistleblowing concerns over alleged bullying has been downgraded by the health watchdog.

The Care Quality Commission (CQC) told The Christie NHS Foundation Trust in Manchester it "requires improvement" in safety and leadership.

A former trust nurse told the BBC leaders had intimidated staff to stop them voicing concerns to inspectors.

Rebecca Wight worked at The Christie - Europe's largest cancer centre - from 2014 but quit her role as an advanced nurse practitioner in December, claiming her whistleblowing attempts had been ignored.

She told BBC Newsnight the trust had attempted to manipulate the inspection by intimidating those who wished to paint an honest picture.

Roger Kline, an NHS workforce and culture expert from Middlesex University Business School, told BBC Newsnight there was a culture at The Christie which was "unwelcoming of people raising concerns".

He said: "The trust response is more likely... to see the person raising the concerns as the problem rather than the issues they have raised," adding this was "not good for patient care".

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Source: BBC News, 12 May 2023

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World will face a mental health crisis after coronavirus pandemic, experts warn

The world is likely to face a global crisis in poor mental health after the coronavirus pandemic has passed, experts have warned.

Two dozen mental health scientists including neuroscientists, psychiatrists, psychologists, and public health experts have warned of the long-term impact of the virus on people’s mental health and demanded governments prioritise research to come up with evidence-based treatments.

They also called for real-time monitoring of mental health in the UK and across the world in order to gauge the severity of the expected increase in poor mental wellbeing.

Their warning, in the journal Lancet Psychiatry, comes as a new Ipsos Mori survey carried out at the end of March revealed people’s mental health was already being affected by the UK lockdown and self-isolation policy.

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Source: The Independent, 16 April 2020

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World Sepsis Day: 12,000 Irish people treated for condition last year, with one in five dying

At least 12,000 people were treated for sepsis in hospitals in Ireland last year, with one in five of those dying from the life-threatening condition.

However, the HSE said the total number of cases is likely to be much higher.

Marking World Sepsis Day, it said the condition kills more people each year than heart attacks, stroke or almost any cancer.

The illness usually starts as a simple infection which leads to an “abnormal immune response” that can “overwhelm the patient and impair or destroy the function of any of the organs in the body”.

Dr Michael O’Dwyer, the HSE’s sepsis clinical lead, said: “The most effective way to reduce deaths from sepsis is by prevention.

“A healthy lifestyle with moderate exercise, good personal hygiene, good sanitation, breastfeeding when possible, avoiding unnecessary antibiotics and being vaccinated for preventable infections all play a role in preventing sepsis.

“Early recognition and then seeking prompt treatment is key to survival. Recognising sepsis is notoriously difficult and the condition can progress rapidly over hours or sometimes evolve slowly over days.”

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Source: Independent Ireland, 13 September 2022

hub resources on sepsis

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World Pharmacists Day

Today millions of pharmacists worldwide will celebrate World Pharmacists Day, this year themed “safe and effective medicines for all.”

The annual day is used to highlight the value of the pharmacy profession to stakeholders and to celebrate pharmacy globally. It was originally adopted in 2009 at the World Congress of Pharmacy and Pharmaceutical Sciences.

The theme for 2019 aims to promote pharmacists’ crucial role in safeguarding patient safety through improving medicines use and reducing medication errors.

“Pharmacists use their broad knowledge and unique expertise to ensure that people get the best from their medicines. We ensure access to medicines and their appropriate use, improve adherence, coordinate care transitions and so much more. Today, more than ever, pharmacists are charged with the responsibility to ensure that when a patient uses a medicine, it will not cause harm”, says International Pharmaceutical Federation (FIP) President Dominique Jordan.

Watch Dominique Jordan's video

Source: FIP, 25 September 2019

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World must prepare for disease more deadlier than Covid, WHO chief warns

The head of the World Health Organisation warned on Tuesday that governments need to prepare for a disease even deadlier than Covid-19.

Dr Tedros Adhanom Ghebreyesus, director general of WHO, told its annual health assembly in Geneva that it was time to advance negotiations on preventing the next pandemic.

He warned that nation states cannot “kick this can down the road” and that the next global disease was bound to “come knocking”.

Dr Tedros said: “If we do not make the changes that must be made, then who will? And if we do not make them now, then when?”

He added: “The threat of another variant emerging that causes new surges of disease and death remains. And the threat of another pathogen emerging with even deadlier potential remains.”

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Source: The Independent, 24 May 2023

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World Mental Health Day 2019

Today is World Mental Health Day. An opportunity for all of us to raise awareness of mental health issues and advocate against social stigma. This year's theme, set by the World Federation for Mental Health, is suicide prevention. 

Every year close to 800,000 people globally take their own life and there are many more people who attempt suicide. Every suicide is a tragedy that affects families, communities and has long-lasting effects on the people left behind. It's the leading cause of death among young people aged 20-34 years in the UK and is the second leading cause of death among 15-29 year-olds globally.

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Source: Mental Health Foundation, 10 October 2019

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World Menopause Day: "We have to better support women"

MP Carolyn Harris is part of a movement determined to smash the remnants of the menopause taboo, pushing a private member’s bill to turn up the volume on a debate about the menopause that is growing louder by the day.

As an increasing number of countries, businesses and individuals mark World Menopause Day today, Harris says she is ready to shame whoever stands in the way of progress.

Harris will lead a small army of supporters to Parliament Square in London before her bill, which is due to be heard on the 29 October, to demand free prescriptions for hormone replacement therapy in England – already available in Scotland and Wales. The government is said to be “interested” in the bill, with Harris adding that she has cross-party support from dozens of MP.

“In the last two years the narrative has completely changed,” says Harris, who adds that since the private members bill was announced she’s had calls from countries from Canada and the US, to Australia and Japan.

“People are waking up to the fact that we have to find a better way of supporting women through the menopause,” she says. “Women are enhanced coming through this process, but only if they get the support they need.”

The evidence suggests they all too often don’t. There are more than 13 million currently experiencing menopause or perimenopause in the UK. Menopause campaigners argue that medical sexism and a lack of training means many women are left to suffer the symptoms of menopause – which can include depression, anxiety, insomnia and brain fog as well as hot flushes.

Harris’s own experience with the menopause was brutal. Twenty years after losing her eight-year-old son in a road traffic accident she blamed herself for not processing her grief when she was hit by a deep depression. “It took me six years, having conversations with women, for me to realise I was going through the menopause,” she says.

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Source: The Guardian, 18 October 2021

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World first in hologram patients

Medical students are using hologram patients to hone their skills with life-like training scenarios. The project at Addenbrooke’s Hospital in Cambridge is the first in the world to use the mixed reality technology in this way.

Students wear Microsoft HoloLens headsets that let them interact with the patient while still being able to see each other. Lecturers are able to alter the patient’s response, make observations and add complications to the scenario. It enables realistic and immersive safe-to-fail training which can be delivered remotely as well as in person.

The first module, covering respiratory conditions and emergencies, has already been launched and more are planned around cardiology and neurology.

The HoloScenarios system is being developed by Cambridge University Hospitals NHS Foundation Trust, in partnership with the University of Cambridge and US-based tech firm GigXR.

Consultant anaesthetist Dr Arun Gupta, who is leading the project in Cambridge, said: “Mixed reality is increasingly recognised as a useful method of simulator training. As institutions scale procurement, the demand for platforms that offer utility and ease of mixed reality learning management is rapidly expanding"

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Source: CIEHF, 21 July 2022

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World faces ‘perfect storm’ for measles outbreak affecting children, WHO warns

A spike in the number of measles cases around the world has sparked concerns over the potential for serious outbreaks this year.

Almost 17,338 measles cases were reported worldwide in January and February 2022, compared to 9,665 during the first two months of last year – which represents a rise of 79%.

Unicef and the World Health Organisation (WHO) warned that there is a “perfect storm” for serious outbreaks of the vaccine-preventable illnesses such as measles.

As of this month, the agencies report 21 large and disruptive measles outbreaks around the world in the last 12 months.

The five countries with the largest measles outbreaks since the past year include Somalia, Yemen, Nigeria, Afghanistan, and Ethiopia.

The coronavirus pandemic has seen much of health funding and resources diverted to deal with the spread of the virus since 2020.

In 2020, the first year of the pandemic, 23 million children missed out on basic childhood vaccines through routine health services, the highest number since 2009 and 3.7 million more than in 2019.

These pandemic-related disruptions – as well as increasing inequalities in access to vaccines – has left many children without protection against contagious diseases while Covid restrictions are eased in most countries, the two organisations said.

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Source: The Independent, 28 April 2022

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World Antibiotic Awareness Week: Letter from senior NHS and health system leaders

The World Health Organization's (WHO) World Antibiotic Awareness Week (WAAW) aims to increase awareness of antibiotic resistance as a global problem, and to promote best practices among the general public, health workers and policy-makers to avoid the further emergence and spread of antibiotic resistance.

Since their discovery, antibiotics have served as the cornerstone of modern medicine. However, the persistent overuse and misuse of antibiotics in human and animal health have encouraged the emergence and spread of antibiotic resistance, which occurs when microbes, such as bacteria, become resistant to the drugs used to treat them.

As part of preparations for the 2019 Awareness Week this November, a group of senior leaders from across the health system, including NHS England and Improvement, have co-signed a letter, coordinated by Public Health England, that reminds commissioners and providers alike of their responsibility to contribute to this important agenda. The letter also reminds colleagues that this year’s WAAW campaign is the first of a new five-year UK National Action Plan for antimicrobial resistance, which contains stretching ambitions for reducing inappropriate prescriptions; as well as controlling and preventing infections.

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World ‘on cusp of first generation of treatments for Alzheimer’s’ as new drug ‘slows symptoms’

The world is “on the cusp of a first generation of treatments for Alzheimer’s disease”, experts have said, as a new drug was found to slow cognitive and functional decline.

The drug donanemab, made by Eli Lilly and Company, slowed decline by 35% to 36% in a late-stage phase 3 clinical trial, the company said.

Donanemab appeared to slow the decline associated with Alzheimer’s compared to placebo in 1,182 people with early-stage disease based on those with intermediate levels of a protein known as tau.

The drug also resulted in 40% less decline in the ability to perform activities of daily living, according to the firm.

Dr Susan Kolhaas, executive director of research and partnerships at Alzheimer’s Research UK, said: “This is incredibly encouraging, and another hugely significant moment for dementia research".

“The treatment effect is modest, as is the case for many first-generation drugs, and there are risks of serious side effects that need to be fully scrutinised before donanemab can be marketed and used.

“However, this news underlines the urgency of preparing the NHS to make these treatments available should regulators deem them safe and effective".

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Source: The Independent, 3 May 2023

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Workplace sexual-harassment clampdown for doctors

Conduct guidelines for UK doctors are being updated to spell out what constitutes workplace sexual harassment, amid concerns abuse is going unchallenged.

The General Medical Council, which regulates doctors to ensure they are safe and fit to care for patients, says it is adopting a zero-tolerance policy.

The new advice explains it is not just physical acts that can be a breach. Verbal and written comments or sharing images with a colleague count too.

The new guidance will not come into effect until the end of January, after a five-month familiarisation period for staff. And some say there is still a long way to go.

Dr Chelcie Jewitt, an emergency-medicine doctor who is part of the Surviving in Scrubs campaign group, which aims to raise awareness of sexism, harassment and sexual assault in the healthcare workforce, said: "We have spoken with the GMC about the guidelines and we do think that they are a step in the right direction - but there is still a long way to go on this journey to eradicating the culture of sexual misconduct within healthcare.

"The GMC has the potential to make a real difference and we need to see them supporting victims when they report perpetrators.

"We need their reporting processes to be transparent and clearly explained to victims.

"We need cases to be thoroughly investigated rather than dismissed.

"And we need appropriate, proportionate sanctioning of perpetrators."

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Source: BBC News, 22 August 2023

Read a blog Dr Chelcie Jewitt wrote for the hub: Calling out the sexist and misogynist culture within healthcare

 

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Working women need greater menopause rights

Women going through menopause should be given greater rights and protection in the workplace, MPs say.

The Women and Equalities Committee said a lack of support in the UK was pushing women out of work.

The cross-party group wants menopause to become a protected characteristic like pregnancy, to give working women more rights.

Caroline Nokes, who chairs the committee said: "Stigma, shame and dismissive cultures can, and must, be dismantled."

The government, speaking on the issue for England as health issues is devolved to the national governments in Scotland, Wales and Northern Ireland, said the issue was a priority, highlighting it had recently appointed a women's health ambassador and set up a menopause taskforce to look into workplace support.

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Source: BBC News, 28 July 2022

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Workers fighting America’s overdose crisis are ‘hanging by a thread’

President Biden has endorsed “harm reduction,” which aims to cut down on overdoses by encouraging safer drug use. But the organizations carrying out that strategy are severely underfunded.

In his State of the Union address on Tuesday, Mr Biden, the first president to endorse the strategy, highlighted the federal government’s attention to some of the core features of harm reduction work, including a provision in a recently enacted spending package that makes it easier for doctors to prescribe buprenorphine, an effective addiction medication that Ms Krauss works to get to drug users. During his speech, Mr Biden recognised the father of a 20-year-old from New Hampshire who died from a fentanyl overdose, citing the more than 70,000 Americans dying each year from the potent synthetic opioid.

But two years after Mr Biden took office, with the nation’s drug supply increasingly complex and deadly, the practice of harm reduction remains underfunded and partially outlawed in many states.

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Source: New York Times, 10 February 2023

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Work stress could be triggering troubling surge in women ‘suffering heart disease warning signs’

A new study has found stress in the workplace could be leading women suffering from warning signs of heart disease. These signs included work-related stress, sleep disorders, and tiredness - which are important but non-traditional risk factors for having a heart attack or a stroke.

Dr Wagner, a neurology professor at the University of Zurich, said "Traditionally men have been perceived to be more affected by heart attacks and strokes than women, but in some countries, women have overtaken men. There is a gender gap and further research is needed to find out why”.

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Source: The Independent, 31 August 2021

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Work pressures driving nurses and midwives away

Work pressures are driving thousands of nurses and midwives a year away from the profession, the Nursing and Midwifery Council  (NMC) says.

The NMC said retention was becoming a major concern despite an overall growth in the register.

Its annual report found 27,000 professionals had left the register in the UK in the year to the end of March.

While retirement appeared to be the most common reason for leaving, health and exhaustion were cited as the next.

NMC Chief Executive Andrea Sutcliffe said: "There are clear warnings workforce pressures are driving people away.

"Many are leaving earlier than planned, because of burnout and exhaustion, lack of support from colleagues, concerns about quality of care and workload and staffing levels."

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Source: BBC News, 24 May 2023

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Worcestershire NHS managers knew cancers missed due to X-ray backlog

According to reports, senior managers at an NHS trust knew up to 30 cancers may have gone undetected two years before an official probe into a backlog of thousands of X-rays.

Although the Care Quality Commission (CQC) and Healthwatch made investigations in 2016, neither one were told of potential harm to patients. The backlog was publicly exposed by Ken Hall, who approached the Care Quality Commission in 2016, where it then identified 11,000 X-rays had not been processed, but was subsequently struck off after allegations of fraud. 

"These go through a rigorous quality assurance process and the Care Quality Commission would not publish any statement in an inspection report that it did not believe to be true." Said the CQC when asked about its findings of no harm after being shown the 2014 trust management committee reports, the CQC also told the BBC it could find no record of inspectors having had sight of them. 

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Source: BBC News, 27 August 2021

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Women’s healthcare in Britain ‘worse than in China and Saudi Arabia’

Women’s healthcare in the UK is worse than that of China and Saudi Arabia, according to a global tracker. 

Poor efforts at prevention, diagnosis and treatment of health problems left the UK ranked lower than several countries with a troubling record on women’s rights.

The research, which compared a wealth of data, found Britain fared worse than most comparable Western countries, including the United States, Australia, New Zealand, France and Germany.

The UK was placed 30th out of 122 countries, in the 2021 Hologic Global Women’s Health Index published on Tuesday.

The score – three points lower than when a similar exercise was carried out last year – places it on a par with Kazakhstan, Slovenia, Kosovo and Poland for women’s healthcare provision.

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Source: The Telegraph, 24 January 2023

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Women's symptoms ignored by GPs

Too many women feel fobbed off or not listened to when they raise concerns about their health, according to a women's health campaign group.

The Women's Health Wales coalition says women are often misdiagnosed or have to push for a diagnosis.

The theme has emerged repeatedly during BBC Wales interviews with women.

The Welsh government said it had set out what's expected of the NHS on women's health, and a full plan is due to be published this autumn.

"From the moment I went to my GP about my symptoms in my late teens, I have always felt dismissed," said Jessica Ricketts, 35, who was diagnosed with endometriosis.

But the feeling of being fobbed off has cropped up in countless conversations with women whether it be in relation to a heart attack, UTI, stroke, autism or even brain tumour.

Patients have told us that clinicians thought they were having a panic attack rather than a heart attack," said Gemma Roberts, policy and public affairs manager at British Heart Foundation Cymru, and co-chair of the Women's Health Wales coalition.

"We hear from patients and from clinicians that women have to see their GPs multiple times before they get a diagnosis. Women often aren't listened to.

"They are told that pain is a normal part of the female experience but actually that isn't the case. I think we need to be listening to women more about what's going on with their own bodies."

The coalition wants:

  • Greater focus on women's health from the very beginning of medical training.
  • Health data to be broken down by protected characteristics because "the stories of women with those backgrounds goes untold".
  • Equitable access to healthcare, including specialist care, regardless of where women live in Wales.

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Source: BBC News, 28 September 2022

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Women's health: Female patients to be asked about 'gender health gap'

Women and girls in England are being asked to share their experiences of the health system as part of a government strategy to address inequalities.

Ministers say there is "strong evidence" services for female patients need improving. Fertility, maternity and menopause care are among the areas to be discussed.

Campaigners say they are "delighted" steps are "finally" being taken to close the so-called "gender health gap".

While women in the UK have a longer life expectancy than men, the Department for Health and Social Care says they are spending less of their life in good health.

Nadine Dorries, minister for women's health, said: "Women's experiences of healthcare can vary and we want to ensure women are able to access the treatment and services they need.

"It's crucial women's voices are at the front and centre of this strategy so we understand their experiences and how to improve their outcomes."

Studies suggest gender biases in clinical trials are a contributing factor. Less is also said to be known about many female-specific conditions and how to treat them.

Patients have repeatedly reported to the BBC that they have felt overlooked when talking to doctors about conditions like endometriosis or complications following a pelvic mesh repair.

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Source: BBC News, 6 March 2021

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Women's health: Body part names taboo a risk to health

Doctors are warning that embarrassment about naming parts of the female anatomy is putting women's health in jeopardy.

Dr Aziza Sesay said the hyper-sexualisation of women's bodies and anatomy "perpetuates the taboo, stigma and embarrassment".

She said it could lead to women not getting the medical help they need.

She said a lot of women's health conditions are often considered benign - meaning they're not life-threatening - but that she disliked the term as it minimised "how much it will affect someone's life".

Dr Sesay is one of a number of women's health specialists who are due to appear at Cardiff's Everywoman Festival on 24 June, where topics will range from periods to menopause.

The festival is the brainchild of colorectal surgeon, Julie Cornish, who works for Cardiff and Vale health board.

She said "embarrassing" symptoms are all too often never discussed.

"It's not uncommon to see patients who waited 10, 15 years with symptoms," she said. "It's got to the point where they've had to stop working, or their relationship has broken down.

"People retire early, they stop working or stop socialising. And that delay often means it's more severe. They might need surgery rather than simple physiotherapy, dietary tricks or modifications that could've worked so easily early on."

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Source: BBC News, 3 April 2023

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