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NHS struggling to open extra winter beds and fill staffing gaps

Hospital bosses in England are warning a lack of funds means they are having to scale back on plans to open extra beds to cope with winter.

The warning, from NHS Providers, which represents managers, came after the Treasury rejected pleas for an extra £1bn to cover the cost of strikes.

Recruitment to plug gaps in the workforce was also having to be put on hold, NHS Providers said.

But the government said winter planning was on track.

It pointed out the goal to open 10,000 "virtual" hospitals beds had been met. This is where doctors remotely monitor patients with conditions such as respiratory and heart problems who would otherwise have to be in hospital.

Progress was also being made on opening 5,000 new permanent hospital beds - a 5% increase in numbers, the government said.

"We recognise the challenges the NHS faces over the coming months, which is why we started preparing for winter earlier than ever," a Department of Health and Social Care spokesman added.

But NHS Providers said the steps being taken may be insufficient.

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Source: BBC News, 14 November 2023

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Overseas doctors will remain 'crucial' despite recruitment drive

Attracting skilled overseas-trained doctors to the UK will remain "crucial", despite plans to train more healthcare staff here, the doctors' regulator has said.

The General Medical Council (GMC) found that nearly two-thirds (63%) of new doctors in 2022 qualified abroad.

The government launched a major plan in June to train and recruit more healthcare workers in England. But it will take many years for this to take effect, the GMC says.

NHS England says it currently has 10,855 full-time doctor vacancies - a rate of 7.2%.

Under NHS England's Long Term Workforce Plan, it hopes to recruit and retain "hundreds of thousands" more healthcare staff over the next 15 years. The plan includes spending £2.4bn on additional training places for healthcare workers, with the number of medical school places for student doctors set to double to 15,000 a year.

Charlie Massey, the GMC's chief executive, said the drive to boost the workforce was "brilliant", but said "it takes a long time to make a doctor".

"We're not going to see the impact of that coming on stream for probably the best part of a decade. And that means we're going to need to rely on doctors who have trained overseas coming to the UK in much greater numbers than in recent years to maintain the workforce that we need to meet the needs of the population."

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Source: BBC News, 13 November 2023

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Charge trusts with criminal offence for demonising whistleblowers, says HCSA

The Hospital Consultants and Specialists Association (HCSA), a hospital doctors union, has called for an independent body to register and monitor cases where doctors raise safety concerns and for criminal charges to be brought against trusts when whistleblowers suffer harm.

Naru Narayanan, president of HCSA, called for the changes after a survey found that doctors worry that speaking up about patient safety will put their careers at risk and that the creation of freedom to speak up guardians in 2016 has not increased their confidence.

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Source: BMJ, 13 November 2023

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AI could predict heart attack risk up to 10 years in the future, finds Oxford study

Artificial intelligence could be used to predict if a person is at risk of having a heart attack up to 10 years in the future, a study has found.

The technology could save thousands of lives while improving treatment for almost half of patients, researchers at the University of Oxford said.

The study, funded by the British Heart Foundation (BHF), looked at how AI might improve the accuracy of cardiac CT scans, which are used to detect blockages or narrowing in the arteries.

Prof Charalambos Antoniades, chair of cardiovascular medicine at the BHF and director of the acute multidisciplinary imaging and interventional centre at Oxford, said: “Our study found that some patients presenting in hospital with chest pain – who are often reassured and sent back home – are at high risk of having a heart attack in the next decade, even in the absence of any sign of disease in their heart arteries.

“Here we demonstrated that providing an accurate picture of risk to clinicians can alter, and potentially improve, the course of treatment for many heart patients.”

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Source: The Guardian, 13 November 2023

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NHS board named in Glasgow hospital corporate homicide probe

Scotland's largest health board has been named as a suspect in a corporate homicide investigation following the deaths of four patients at a Glasgow hospital campus.

NHS Greater Glasgow and Clyde (NHSGGC) informed families of the development via a closed Facebook group set up during a water contamination crisis.

The board confirmed it had received an update from the Crown Office. But it added there was no indication prosecutors had "formed a final view".

Police Scotland launched a criminal investigation in 2021 into a number of deaths at the Queen Elizabeth University Hospital (QEUH) campus, including that of 10-year-old Milly Main.

The Crown Office and Procurator Fiscal Service (COPFS) instructed officers to investigate the deaths of Milly, two other children and 73-year-old Gail Armstrong.

Milly's mother previously told a separate public inquiry into the building of several Scottish hospitals that her child's death was "murder".

A review earlier found an infection which contributed to Milly's death was probably caused by the QEUH environment.

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Source: BBC News, 13 November 2023

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Record number of child deaths last year with hundreds more dying since pandemic

The number of child deaths has hit record levels, with hundreds more children dying since the pandemic, shocking new figures show.

More than 3,700 children died in England between April 2022 and March 2023, including those who died as a result of abuse and neglect, suicide, perinatal and neonatal events and surgery, new data from the National Child Mortality Database has revealed – with more than a third of the deaths considered avoidable.

Children in poorer areas were twice as likely to die as those in the richest, while 15 per cent of those who died were known to social services.

The UK’s top children’s doctor, Dr Camilla Kingdon, president of the Royal College of Paediatrics and Child Health, hit out at the government for failing to act to tackle child poverty, which she said was driving the “unforgivable” and “avoidable” deaths.

The report said: “Whilst the death rate in the least deprived neighbourhoods decreased slightly from the previous year, the death rate for the most deprived areas continued to rise, demonstrating widening inequalities.”

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Source: The Independent, 11 November 2023

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Widespread ‘toxic culture’ is forcing us out, say staff

Large numbers of midwives report being left feeling undervalued and afraid to speak up due to bullying and widespread staffing shortages, which some say is putting mothers’ and babies’ lives at risk, according to a new publication shared with HSJ.

The Say No to Bullying in Midwifery report comprises hundreds of accounts, ranging from students, newly qualified and senior midwives, heads of midwifery, maternity support workers and more. It aims to publicise and share concerns they have raised online.

The report said: “Midwives have described their experiences of toxic cultures within their workplaces, with cliques, preferential treatment, unfounded allegations and poor working conditions leading to a negative impact on their health and wellbeing, including suicide attempts and midwives leaving their job or profession.

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Source: HSJ, 13 November 2023

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Two-thirds of homecare patient safety incidents linked to major provider

Two-thirds of patient safety incidents recorded during hospital trusts’ monthly reporting period for homecare medicine provision were for services provided by the company Sciensus, an investigation by The Pharmaceutical Journal has revealed.

In response to a freedom of information request sent to 131 hospital trusts in England in August 2023, 32 trusts recorded 417 patient safety incidents during their most recent monthly reporting period, which ranged from May to July 2023.

Some 66% of these incidents (277) related to services delivered by homecare provider Sciensus, despite providing medicines to fewer than half (44%) of the 96,849 patients covered in the data.

The findings come after the House of Lords Public Services Committee opened an inquiry into homecare medicines services in May 2023 following press reports of complaints from patient organisations and others about the service provided. The inquiry heard evidence from patient groups, regulators, homecare companies and the government during the summer and the committee will publish its report on 16 November 2023.

Sciensus was previously known as Healthcare at Home and is one of the UK’s largest homecare companies.  

The data also uncovered that Sciensus was a poor performer on “failed” deliveries, defined as those that did not arrive on the scheduled day.

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Source: The Pharmaceutical Journal, 9 November 2023

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Collective intelligence can help reduce medical misdiagnoses

An estimated 250,000 people die from preventable medical errors in the U.S. each year. Many of these errors originate during the diagnostic process. A powerful way to increase diagnostic accuracy is to combine the diagnoses of multiple diagnosticians into a collective solution. However, there has been a dearth of methods for aggregating independent diagnoses in general medical diagnostics.

Researchers from the Max Planck Institute for Human Development, the Institute for Cognitive Sciences and Technologies (ISTC), and the Norwegian University of Science and Technology have therefore introduced a fully automated solution using knowledge engineering methods.

The researchers tested their solution on 1,333 medical cases provided by The Human Diagnosis Project (Human Dx), each of which was independently diagnosed by 10 diagnosticians. The collective solution substantially increased diagnostic accuracy: Single diagnosticians achieved 46% accuracy, whereas pooling the decisions of 10 diagnosticians increased accuracy to 76%. Improvements occurred across medical specialties, chief complaints, and diagnosticians’ tenure levels.

"Our results show the life-saving potential of tapping into the collective intelligence," says first author Ralf Kurvers. He is a senior research scientist at the Center for Adaptive Rationality of the Max Planck Institute for Human Development and his research focuses on social and collective decision making in humans and animals.

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Source: Digital Health News, 2 November 2023

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NHS staff are carrying out the equivalent of one 'never-event' every day, figures show

NHS staff are carrying out the equivalent of one 'never-event' every day, figures show. 

This is despite the Government ordering a crackdown on the mistakes, which cost hospitals an estimated £800million in compensation each year. 

Experts today demanded further action on 'unacceptable' levels of never-events, blaming inadequate staffing levels and a lack of investment in the NHS. 

A MailOnline audit of a decade's worth of NHS data found a colossal 4,328 never-events have occurred in England since 2013. This equates to roughly eight a week. 

Shocking incidents uncovered include women getting parts of their reproductive anatomy cut out instead of an appendix, men getting unwanted circumcisions and laser procedures to the wrong eye. 

The Royal College of Surgeons said the level of never-events was 'unacceptable' and blamed NHS staffing levels for increasing the risk to patients. 

"Surgeons will be working hard to do their best for patients, but they do so in difficult circumstances," a spokesperson said. 

"The NHS is overstretched, with staff shortages, a workforce suffering from burn-out and pressure to get record waiting times down. 

"This increases the risk of mistakes happening." 

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Source: MailOnline, 10 October 2023

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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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