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Doctors plan to leave NHS in growing numbers due to burnout, GMC warns

A growing number of doctors plan to leave the profession due to burnout and dissatisfaction, the General Medical Council has said, highlighting fears that the government’s long-term strategy for the NHS may have come too late.

The GMC’s annual report on the medical workforce said the benefits of measures announced by the government in the NHS long-term workforce plan in June, such as the ambition to create more medical school places, “will only start to be seen a decade from now”.

The report found that the number of licensed doctors increased in 2022, with 23,838 joining and 11,319 leaving. However, it said there were “still high vacancy rates and workforce pressure”, and that the rate of doctors leaving the profession was returning to pre-pandemic levels, at 4% last year.

The GMC warned there were “worrying signs” that a growing number “plan to leave the profession as a result of high levels of dissatisfaction and high risk of burnout”. It added that there may be “a limited window of opportunity to address current issues” before more medics leave.

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Source: The Guardian, 12 November 2023

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Woman who suffered complications from vaginal mesh implant awarded at least £1m

A woman who suffered traumatic complications from a vaginal mesh implant has been awarded a record settlement of at least £1m from the NHS.

Yvette Greenway-Mansfield, 59, was given a mesh implant at Coventry’s University Hospital in 2009 and went on to suffer serious complications. Her medical negligence claim against the hospital trust found that the surgery was carried out prematurely and unnecessarily and that her consent form had been doctored to include additional risks after Greenway-Mansfield had signed it.

Greenway-Mansfield said that being awarded the compensation was a “huge relief”, but added that many other women who have suffered similar damage had received little or no compensation, and criticised the government’s failure to establish a financial redress agency for victims.

“I’m not the only one. There are thousands of mes,” she said. “There should be a pot of money to provide damages for these women and a care plan in place as an automatic response to mesh-damaged people. It comes down to a perception of women and women’s health problems. We’ve all had enough of it.”

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Source: The Guardian, 13 November 2023

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Four-plus pathway patients account for 700k of waiting list

New data suggests around 700,000 cases on the elective waiting list relate to patients who are on at least four different pathways, and NHS England says personalised care plans must be developed to treat them more efficiently.

NHSE has published new data that reveals the overall referral to treatment waiting list, of 7.8 million cases, is made up of 6.5 million individual patients. The difference is due to some patients waiting for more than one treatment.

Stella Vig, NHSE’s clinical director for secondary care, told HSJ around 2-3% of the individual patients on the waiting list are on four to five pathways or more.

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Source: HSJ, 9 November 2023

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Funding for winter clinics axed despite NHSE backing

Community clinics credited with easing pressure on A&E and GP practices nationally last winter have not yet been funded for this year, and many may not be able to open, HSJ has learned.

Several local and regional sources said they were concerned no funding had been announced for acute respiratory hubs, despite respiratory illness already starting to rise.

Last year national funding was announced in December and – despite the late notice – NHS England collected evidence showing that, once they were opened, ARI hubs reduced acute respiratory infection attendances by up to two-thirds, and released GP appointments.

The hubs, normally held at community clinics, offer urgent same-day appointments for those with suspected ARI problems to patients referred in by other services.

David Bramley, deputy director in NHSE’s NHS@Home team, said on a webinar on Tuesday: “This year, perhaps unsurprisingly, we are seeing ARI rates beginning to climb… but we’re also not expecting any additional funding for ARI hubs this year.”

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Source: HSJ, 10 November 2023

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Prof Sir Chris Whitty says UK faces rural and coastal ageing crisis

The UK faces an ageing crisis and healthcare must step in, England's chief medical officer, Prof Sir Chris Whitty, warns in his annual report.

People are living longer but some spend many of their later years in bad health - and that has to change, he said.

Based on projections, the elderly boom will be in rural, largely coastal, areas and these places are often poor cousins when it comes to provision.

In deprived regions, age-related issues emerge 10 years earlier, on average.

"We've really got to get serious about the areas of the country where ageing is happening very fast, and we've got to do it now.

"It's possible to compress the period of time that people spend in ill health...because otherwise we will end up with large numbers of people leading much more dependent lives."

Providing services and environments suitable for older adults in these areas is an absolute priority, the report says.

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Source: BBC News, 10 November 2023

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Don’t panic when staff leave, NHSE advises managers

New NHS England guidance has advised line managers to ‘remain calm’, ‘not panic’, and ‘show kindness’ when handling staff resignations.

The Expectations of Line Managers in Relation to People Management framework, published on the NHS England website, contains guidelines on several areas for line managers, including equality, diversity and inclusion, recruiting and flexible working.

In the “managing exits” section, managers are told they are expected to:

  • “Support your colleague by showing kindness to them, respect their decision, and wish them well for the future”;
  • “Lead by example and remain calm, ie do not panic when key colleague leaves”;
  • “Use opportunity to reflect and innovate, ie should services be redesigned?”; and
  • “Be mindful that the colleague may have mixed emotions about leaving. Include them in planning any leaving event”.

Managers are also told they should “undertake an exit interview, or ask another manager if appropriate, to understand the employee’s experience of working in your organisation” and “consider skills gaps and risks of someone leaving”. 

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Source: HSJ, 9 November 2023

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Black babies in England three times more likely to die than white babies

Black babies in England are almost three times more likely to die than white babies after death rates surged in the last year, according to figures that have led to warnings that racism, poverty and pressure on the NHS must be tackled to prevent future fatalities.

The death rate for white infants has stayed steady at about three per 1,000 live births since 2020, but for black and black British babies it has risen from just under six to almost nine per 1,000, according to figures from the National Child Mortality Database, which gathers standardised data on the circumstances of children’s deaths. Infant death rates in the poorest neighbourhood rose to double those in the richest areas, where death rates fell.

The mortality for Asian and Asian British babies also rose, by 17%.

The annual data shows overall child mortality increased again between 2022 and 2023, with widening inequalities between rich and poor areas and white and black communities.

Most deaths of infants under one year of age were due to premature births. Karen Luyt, the programme lead for the database and a professor of neonatal medicine at Bristol University, said many black and minority ethnic women were not registering their pregnancies early enough and the “system needs to reach them in a better way”.

“There’s an element of racism and there’s a language barrier,” Luyt said. “Minority women often do not feel welcome. There’s cultural incompetence and our clinical teams do not have the skills to understand different cultures.”

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Source: The Guardian, 9 November 2023

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AstraZeneca faces legal challenge over Covid vaccine

AstraZeneca is facing legal action over its Covid vaccine, by a man who suffered severe brain injury after having the jab in April 2021.

Father-of-two Jamie Scott suffered a blood clot that left him with brain damage and unable to keep working.

The action, taken under the Consumer Protection Act, alleges the vaccine was "defective" as it was less safe than individuals were entitled to expect.

Studies suggest Covid vaccines have saved millions of lives.

In June 2022, the World Health Organization said the AstraZeneca vaccine was "safe and effective for individuals aged 18 and above".

A further claim from about 80 people who say they were injured by the AstraZeneca vaccine is also due to be launched later this year but Mr Scott's case is expected to be heard first.

AstraZeneca said: "Patient safety is our highest priority and regulatory authorities have clear and stringent standards to ensure the safe use of all medicines, including vaccines.

"Our sympathy goes out to anyone who has lost loved ones or reported health problems.

"From the body of evidence in clinical trials and real-world data, Vaxzevria [the vaccine against Covid] has continuously been shown to have an acceptable safety profile and regulators around the world consistently state that the benefits of vaccination outweigh the risks of extremely rare potential side effects."

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Source: BBC News, 9 November 2023

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USA: Hospital acquired infections are down post-COVID, but other risks remain for patients

Hospital-acquired infections, which became substantially more common during the pandemic, have returned to pre-pandemic levels, according to a new report from a US patient safety watchdog group. It's key to note, researchers say, that infection rates before March 2020 were nothing to celebrate.

On top of that moderately good news, the Leapfrog Group found other metrics that measure patient safety and satisfaction have fallen significantly, likely because of hospital staffing shortages and other pandemic-era challenges.

"We're encouraged and relieved to see that infections are rapidly decreasing in hospitals following the spike during the pandemic, but we remain very concerned about a number of major problems in hospitals," said Leah Binder, president and CEO of Leapfrog, an independent, national nonprofit founded by large employers and other purchasers.

Patient surveys following hospital visits found declines in experiences for the second year in a row in all states. Particularly significant drops were reported in “communication about medicines” and “responsiveness of hospital staff." Preventable errors have been linked to these problems.

"Hospitals need to take a hard look at what they are unnecessarily continuing post-pandemic that are not helping patients," Binder said.

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Source: USA Today News, 6 November 2023

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Most foreign doctors in NHS face ‘racist microaggressions’, survey shows

Three in five foreign doctors in the NHS face “racist microaggressions” at work, such as patients refusing to be treated by them or having their abilities doubted because of their skin colour.

The widespread “thinly veiled, everyday instances of racism at work” experienced by medics trained overseas has been uncovered by a survey of more than 2,000 UK doctors and dentists.

Almost three in five (58%) said they had encountered such behaviour, from colleagues as well as patients, although most did not report it because they thought that no action would be taken. Doctors affected can feel upset, humiliated, marginalised and not taken seriously as a result.

The findings have raised fears that international medical graduates may choose not to work in the NHS, which is increasingly reliant on their skills given the service’s shortage of doctors.

Dr Naeem Nazem, the head of medical at the medical defence organisation MDDUS, which acts for doctors accused of wrongdoing, said: “These findings show us that a worryingly large number of overseas-trained doctors working in the NHS face racist microaggressions in the course of their work, from both patients and colleagues, and that many do so regularly.”

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Source: The Guardian, 8 November 2023

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Consultant carried out 'unnecessary' surgery for financial gain, tribunal hears

A doctor who worked for the same private healthcare company as rogue surgeon Ian Paterson performed unnecessary shoulder operations for financial gain, a medical tribunal has heard.

Orthopaedic consultant Michael Walsh worked at a Spire Healthcare hospital in Leeds from 1993 until 2018, when he was suspended after concerns were raised about his work.

Spire, which runs 38 hospitals around the UK, reported him to the General Medical Council (GMC) after an investigation found he carried out operations unnecessarily or badly, with many patients left suffering pain or trauma.

Mr Walsh, who also worked at another private hospital in Leeds run by Nuffield Health but is now retired, is facing dozens of medical negligence claims from patients, with some already having received payouts.

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Source: Medscape, 8 November 2023

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Indigestible and illegible: the sorry state of board safety reports

A report highlights that maternity and neonatal services are often regular agenda items at board meetings, but the quality and quantity of information that is presented and the subsequent discussion (or lack thereof) doesn’t lead to effective oversight.

The shocking and distressing stories emerging from the Lucy Letby case in August 2023 shone a light on the “cover-up culture” in the NHS. Although deliberate harming of babies is thankfully exceedingly rare, some of the issues raised in this case echo concerns that trusts are failing to react to signs of poor performance in maternity and neonatal services.

Responsibility ultimately lies with trust boards which have a statutory duty to ensure the safety of care. However, the actions (or inactions) of leadership have come up frequently in inquiries and reviews.

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Source: HSJ, 7 November 2023

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Three million callers fail to get through to GP every month, government research reveals

One in 10 people attempting to contact their GP practice do not manage to get in contact, while a further 6% are only told to try again another day, according to new official survey findings commissioned by the government.

The Office for National Statistics has been quietly carrying out the new regular GP access survey since the spring after ministers said they wanted to monitor the impact of their primary care recovery plan.

After a sign of slight improvement in the summer, the latest survey results – for October – show no significant change since May.

It also found, as did previous rounds, that of those who had tried to contact a GP practice in the past month, 10 per cent said they could not do so (see chart below, ‘Contact with GP practice’). Of those who did make contact, a further 6 per cent reported they were told to try again another day (see chart below, ‘Next step after contact’).

The government and NHS England have made it a high priority in recovery plans that patients should no longer be asked to call back another day to book an appointment and should know “on the day” how their request will be managed, which may mean being advised to use a different service.  

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Source: HSJ, 9 November 2023

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Covid inquiry: Ex-minister challenged on plan for disabled people

An ex-minister has defended the government's approach to disabled people during the pandemic, following claims they were "largely disregarded".

Justin Tomlinson, a former minister for disabled people, told the Covid inquiry the government recognised this group was at greater risk from the virus.

He added that work had been done "at pace" to address this.

The inquiry has previously been told that disabled people's views were not properly heard ahead of key decisions.

Nearly six out of 10 people who died with coronavirus in England from January to November 2020 were disabled, according to the Office for National Statistics (ONS).

In a witness statement published earlier this month, chief executive of charity Disability Rights UK, Kamran Mallik, said: "From the statements, decisions and actions of the UK government throughout the crisis, considerations relating to disabled people appeared to be largely disregarded."

In his evidence earlier this month, Mr Mallik of Disability Rights UK said there was a "shocking disregard" when it came to providing information in alternative formats for disabled people, including letters on shielding for clinically vulnerable groups.

He said his charity had also raised concerns about protections for care home residents, and help for disabled people who were not shielding but still needed support accessing food and essentials.

Mr Mallik added that there had been no consultation to allow the views of charities or disabled people to be "properly heard before decisions were made".

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Source: BBC News, 8 November 2023

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‘Controversial’ A&E policy 'showed we're all shouldering the pain', says CEO

A high-profile shift to admitting patients from A&E to wards irrespective of bed capacity has ‘turned the dial’ for an acute trust’s emergency care, its chief executive has told HSJ.

Since introducing the model in July last year North Bristol Trust has seen a significant improvement in its performance against the national target, with the number of patients seen within four hours rising from 51% to 72% in August 2023 – with a peak of 80% in April 2023.

The model attracted interest from NHS England last year, as well as some concern from the Nuffield Trust over patient safety – but NBT CEO Maria Kane said the trust was “happy, on balance” with the system.

She said the model “won’t be for everyone and we never claimed it would be” but she added: “Engendering whole hospital conversations about the principles of flow and understanding of [the emergency department] is something we could all do.”

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Source: HSJ, 8 November 2023

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NHS: Woman waited nine months for hospital discharge

A woman who spent nine months in hospital waiting for a suitable care home placement became a "shadow of her former self", her mother has said.

Jocelyn Ullmer, 60, from West Sussex, saw her health deteriorate after being admitted to hospital in June last year.

Her mother, Sylvia Hubbard, 86, said: "We tried to get her out of hospital, but no-one wanted her."

Across England, around 60% of patients classed as fit to leave remain in hospital at the end of an average day.

Figures show the biggest obstacle is a lack of beds in other settings, such as care homes and community hospitals.

The government said it was investing £1.6bn over the next two years to help improve the situation.

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Source: BBC News, 8 November 2023

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‘Excess deaths’ due to A&E delays rise by nearly a third in one year

Long waits in A&E departments may have caused around 30,000 ‘excess deaths’ last year, according to new estimates.

Using a methodology backed by experts, HSJ analysis of official data has produced an estimate of 29,145 ‘excess deaths’ related to long accident and emergency delays in 2022-23, up from 22,175 in 2021-22, and 9,783 related deaths in 2020-21.

For the first time, the analysis has also produced estimates of excess mortality related to long A&E delays for every acute trust.

The data suggests the rate of excess deaths from 2022-23 has so far continued into 2023-24.

The analysis followed a methodology used in a peer-reviewed study published in the Emergency Medicine Journal, which found delays to hospital admission for patients of more than five hours from time of arrival at A&E were associated with an increase in all-cause mortality within 30 days.

Data scientist Steve Black, one of the authors of the EMJ study, said: “Long waits in A&E should never happen and 12-hour waits should be something like a never event. They should be intolerable anywhere. If we want to fix them it’s helpful to know which trusts have the worst problems with long waits.”

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Source: HSJ, 7 November 2023

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NHSE failing to hold trusts to account on inequalities

NHS England ‘lacks a clear vision’ on a key part of its health inequalities agenda and is not holding trusts to account for delivering an ‘inclusive recovery’, a study by the King’s Fund has concluded.

The think-tank’s report, which represents one of the most comprehensive analyses on the subject to date, said system leaders had not made the case for change “strongly or clearly enough to convince clinicians and other staff to consider inequalities” when tackling elective backlogs.

The think-tank said it had undertaken the research to investigate to what extent local NHS organisations had taken an “inclusive approach” to managing waiting lists, as NHS England had ordered them to do in August 2020.

The research team said in a statement alongside the report: “There has been a lack of a clear vision from national leaders on why inclusive recovery is important for delivering better and fairer services for patients and the public.

“The report calls on the government to pay greater attention to inclusive recovery to ensure progress is made so that patients can be treated fairly, no matter their background.”

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Source: HSJ, 8 November 2023

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Birmingham's Priory Healthcare charged after patient's death 'contributed to by neglect'

Priory Healthcare faces legal action following the death of a vulnerable man who was hit by a train after leaving Birmingham’s Priory Hospital Woodbourne in September 2020.

Matthew Caseby, 23, detained under the Mental Health Act, escaped the hospital by climbing a 2.3-metre fence.

The inquest jury, which heard the University of Birmingham graduate should have been under constant observation but was left alone, reached a conclusion that his death “was contributed to by neglect”.

Concerns were raised about the hospital's record-keeping, risk assessments, and fence safety.

Following the inquest, the Care Quality Commission (CQC) charged Priory Healthcare with two offences under the Health and Safety Act 2008, related to failing to provide safe care and treatment, and exposing a patient to avoidable harm.

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Source: ITV, 6 November 2023

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Mouth-cancer deaths fear over NHS dentist shortage

Lack of access to dentists is costing lives because mouth cancers are not being spotted or treated early enough, a health charity has told BBC News.

The disease killed more than 3,000 people in 2021 - up 46%, from 2,075 a decade ago, latest figures obtained by the Oral Health Foundation show.

And last year, a BBC News investigation revealed 90% of UK NHS dental practices were not accepting new adult patients.

The government has announced plans to increase dental-training places by 40%. It also said the NHS was treating more people for cancer at an earlier stage than ever before.

Oral Health Foundation chief executive Nigel Carter says dental check-ups "are a key place for identifying the early stage of mouth cancer".

"With access to NHS dentistry in tatters, we fear that many people with mouth cancer will not receive a timely diagnosis," he adds.

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Source: BBC News, 8 November 2023

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NHS to offer 150,000 people with type 1 diabetes an artificial pancreas

More than 150,000 adults and children with type 1 diabetes in England and Wales are to be offered an artificial pancreas on the NHS, which experts are hailing as a “gamechanger” that will “save lives and heartbreak”.

The groundbreaking device, also called a hybrid closed-loop system, uses a hi-tech algorithm to determine the amount of insulin that should be administered and reads blood sugar levels to keep them steady. A world-first trial on the NHS showed it was more effective at managing diabetes than current devices and required far less input from patients.

Final draft guidance from the National Institute for Health and Care Excellence (NICE) recommends that people in England and Wales should benefit from the wearable device if their diabetes is not adequately controlled by their current pump or glucose monitor. The decision to give the go-ahead for widespread use of the artificial pancreas was announced on Tuesday at NICE’s annual conference in Manchester by Dr Sam Roberts, its chief executive.

The artificial pancreas has been found to be better at keeping blood sugar levels within a healthy range, cutting the risk of people suffering complications from diabetes. It works via a continuous glucose monitor sensor attached to the body which transmits data to a body-worn insulin pump.

This pump then calculates how much insulin is needed and delivers the precise amount to the body. Hybrid closed-loop systems mean people do not need to rely on finger-prick blood tests or injecting insulin to control their blood sugar levels.

Yasmin Hopkins, who took part in trials of the artificial pancreas, said: “From day one it was amazing. Before the closed-loop system, I would experience a lot of highs, which I’d then overcorrect, go low and eat a lot of sugar. All of that has been eradicated.

“This technology gives me the freedom to get on with my life and live without fear of what might happen in a few hours, days or years.”

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Source: The Guardian, 7 November 2023

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Record NHS drug shortages as HRT, contraceptives and ADHD medicines run low

Britain faces record shortages of medicines amid a row between drug makers and the NHS over payments. 

Patients face issues getting hold of drugs for epilepsy and ADHD, as well as hormone replacement therapy (HRT) for the menopause. 

A total of 111 drugs are currently facing supply issues, according to the British Generic Manufacturers Association (BGMA). This is the highest level on record and more than double the number of drugs facing shortages at the start of 2022. 

The BGMA blamed an NHS drugs levy for the supply issues, saying it was discouraging pharmaceutical companies from supplying the health service.

Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies, said pharmacists were “spending long hours in the day trying to source medicines for patients and this is on top of all the other activities they do in a busy pharmacy”.

She said: “Our pharmacy teams see firsthand the anxiety and stress experienced by patients caused by medicines shortages.” Shortages have also led to more abuse and aggression towards pharmacists, she said.

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Source: The Telegraph, 

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GP leaders in England call for a pause in recruitment of physician associates

The BMA’s GP committee for England (GPC England) has called for an immediate pause in the recruitment of physician associates (PAs) in general practice.

In an emergency motion passed on 2 November the committee expressed “concerns over the increasing trend of PAs being used to substitute GPs” and called on practices and primary care networks to stop PA recruitment “until appropriately safe regulatory processes and structures are in place.”

GPs and GP registrars were also reminded that they can refuse to sign prescriptions and turn down requests for investigations made by PAs.

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Source: BMJ, 3 November 2023

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US nurse charged with killing 2 patients admits to trying to kill 17 more

A former Pennsylvania nurse admitted she tried to kill 19 people at multiple different care facilities, piling dozens of new charges on the woman who allegedly administered lethal doses of insulin to numerous patients, killing two.

On Thursday, the state's attorney general's office announced the new charges against Heather Pressdee, who now faces two counts of first-degree murder, 17 counts of attempted murder and 19 counts of neglect of a care-dependent person.

The 41-year-old nurse was first arrested in May for killing two nursing home patients and injuring a third.

From 2020 up until her arrest, prosecutors say Pressdee gave 19 patients at five different care facilities excessive amounts of insulin, some of whom were diabetic and needed it and others who did not.

The plaintiff would typically administer these insulin doses overnight while fewer staff members were working and as "emergencies wouldn't prompt immediate hospitalization," Pennsylvania Attorney General Michelle Henry said.

"If Pressdee sensed the victim would 'pull through' there is a pattern of her taking additional measures to try to kill the victims before they could be sent to the hospital by either administering a second dose of insulin or the use of an air embolism to ensure death," the criminal complaint, which also said Pressdee admitted to harming patients with intent to kill, said.

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Source: Scripps News, 3 November 2023

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Drug that can halve breast cancer risk offered to 289,000 women in England

Drug that can halve breast cancer risk offered to 289,000 women in England

Anastrozole to be made available to women who have been through the menopause and have family history of breast cancer

Almost 300,000 women at higher risk of developing breast cancer are being given access to a drug that can halve their risk in a “major step forward” in the fight against the disease.

An estimated 289,000 women in England who are at moderate or high risk of breast cancer will from Tuesday be able to take the tablet to try to prevent it from developing, NHS bosses said.

The drug, anastrozole, is being made available to women who are in greater danger because they have been through menopause and have a major family history of Britain’s commonest form of cancer. It displays “remarkable” potential to reduce the number of people who go on to develop the disease, the head of the NHS said last night.

Every year, around 56,000 women in the UK are diagnosed with breast cancer – about 150 a day. While survival rates have improved, it still claims about 11,500 lives each year.

“It’s fantastic that this vital risk-reducing option could now help thousands of women and their families avoid the distress of a breast cancer diagnosis,” said Amanda Pritchard, NHSC England’s chief executive. The drug will be taken as a 1mg tablet once a day for five years.

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Source: The Guardian, 7 November 2023

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