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‘Hips, knees and eyes’ funding focus ‘not fair’, says medical leader

Physical health and “hips, knees and eyes” still command the lion’s share of government money, despite persistent calls for fairer mental health funding, the Royal College of Psychiatrists’ departing president has told HSJ.

Adrian James also said future leaders must tackle bed and workforce shortages, while upcoming inquiries into poor care must allow people to speak openly without fear. 

NHS England CEO Amanda Pritchard has called the minimum investment standard for mental health “non-negotiable”. However, in an interview with HSJ, Dr James said mental health services are often missing out while “big chunks” of government money are allocated to reduce waiting lists. 

He said: “The [covid] recovery plan that was negotiated with the government really was about your hips, knees and eyes, in spite of big voices – one of them mine – saying, ‘what about the mental health backlog’. At that point, we didn’t get any extra money.”

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Source: HSJ, 18 July 2023

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NHS trust criticised over deaths of new mothers from herpes

A coroner has criticised an NHS trust over the deaths of two new mothers with herpes.

Kimberley Sampson, 29, and Samantha Mulcahy, 32, died in 2018 after having caesarean sections six weeks apart by the same surgeon at hospitals in Kent.

Their families have been waiting five years for answers on how they came to be infected with the virus, which can cause sores around the mouth or genitals.

Catherine Wood, Mid Kent and Medway coroner, said Sampson could have been given an anti-viral treatment sooner.

Wood added that in Mulcahy’s case “suspicion should have been raised” given the knowledge among staff from Sampson’s earlier death.

The coroner ruled out human culpability of any of the medical staff involved in the case and said it was “unlikely” for the surgeon to be the cause of the herpes infection found in both women.

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Source: The Guardian, 14 July 2023

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Girl, 14, could be left unable to walk after brain surgery cancelled three times

A14-year-old girl could lose the ability to walk after her brain surgery was cancelled three times as NHS children’s services are stretched to breaking point.

Piper Miller, who has severe autism, needs urgent surgery to remove fluid on her brain that if unaddressed could also leave her unable to control her bladder.

But her operation has been pushed back three times in the past month due to emergency operations taking priority and severe short staffing made worse by junior doctors’ strikes.

Her mum, Toni Milner said the delays had had a “heartbreaking and gut-wrenching” effect on her daughter whose anxiety is “sent through the roof” each time she is told she is not having her surgery.

Piper’s story comes as NHS data uncovered by The Independent reveals at least 340 life-saving children’s operations, such as transplant and lung surgery, were shelved from April to December 2022, while 763 emergency operations were refused due to a lack of intensive care beds.

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Source: The Independent, 16 July 2023

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‘He could have died’: family calls for better jaundice testing of black and Asian babies

Soon after her son Jaxson was born, Lauren Clarke spotted that his eyes were yellow and bloodshot. “We kept asking if he had jaundice, but each time we were told to keep feeding him and just put Jaxson in front of a window,” she says.

It was only when Clarke was readmitted six days later with an infection that Jaxson’s jaundice was detected by a midwife. By this time, his levels were becoming dangerously high.

“We spent a further five days in hospital for Jaxson to be treated with light therapy and antibiotics. If I hadn’t had to go back to hospital, he could have died or had serious long-term health conditions,” she says.

This week, the NHS race and health observatory will announce new funding for research into the efficacy of jaundice screening in black, Asian and minority ethnic newborns on the back of a recent report showing that tests to assess newborn babies’ health are not effective for non-white children.

The research cannot come too soon. Jaxson’s aunt, Gemma Poole, a midwife from Nottingham, created her company, the Essential Baby Company, to develop resources and training about the specific needs of women and babies with black and brown skins, after Jaxson’s jaundice was initially missed by clinicians.

Poole believes the trauma her nephew, brother and sister-in-law had to go through could have been avoided if health professionals had known better ways to spot jaundice in non-white babies.

“The colour of gums, the soles of the feet and hands, the whites of eyes, how many wet and dirty nappies and if the baby is waking for feeds and alert could be more reliable indicators if a black or brown baby has jaundice,” she says.

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Source: The Guardian, 16 July 2023

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Doctors call for return of face mask guidance

Doctors have warned the decision to remove face mask guidance in healthcare settings is "playing Russian roulette" with staff and patients' welfare.

It was withdrawn in May in hospitals, dentists and GP surgeries having been in place since June 2020.

Doctors from the British Medical Association (BMA) Scotland condemned the decision at the time.

Now, the Scottish Healthcare Workers Coalition has written to ministers to highlight the "very serious flaws" in changing the guidance.

The group is made up of Scottish healthcare workers who worked throughout the pandemic and are now living with long Covid or another chronic post-viral illness or disability.

In the letter, the coalition states the updated guidance is not based on the science of coronavirus transmission and "represents a flawed and dangerous decision which will result in more infection in health and social care settings".

Dr Shaun Peter Qureshi, of the Scottish Healthcare Workers Coalition, said: "At-risk patients have entirely legitimate concerns that they may endanger their health by visiting their GP or hospital.

"With at least 4% of NHS staff now living with chronic post-Covid complications, the Scottish government must follow the evidence and improve protections from the airborne spread (of the virus) in healthcare settings, not reduce them."

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Source: BBC News, 17 July 2023

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UK children waiting 16 months on average for ADHD and autism screening

Children with suspected ADHD and autism are waiting as long as seven years for treatment on the NHS, as the health service struggles to manage a surge in demand during a crisis in child mental health.

Experts said “inhumane” waits are putting a generation of neurodiverse children at risk of mental illness as they are “pushed to the back of a very long queue” for children and adolescent mental health services (Camhs).

UK children with suspected neurodevelopmental conditions faced an average waiting time of one year and four months for an initial screening in 2022, more than three times longer than the average wait for all Camhs services, according to research carried out by the House magazine and shared with the Guardian.

Half of all trusts responding to a freedom of information request had an average wait of at least a year, and at one-sixth of trusts it was more than two years. The NICE guidance for autism and mental health services stipulates that no one should wait longer than 13 weeks between being referred and first being seen.

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Source: The Guardian, 17 July 2023

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Government on track to break Boris Johnson’s ‘40 new hospitals’ promise

The government is on track to break a key election promise from Boris Johnson to build 40 new hospitals in England by the end of the decade, a damning report by the public spending watchdog has found.

Delays to projects mean the target is unlikely to be met, with work on buildings in the second cohort of the scheme yet to have started as of May, according to the National Audit Office.

The approach to achieving objectives at the lowest possible cost could also result in hospitals that are too small, the watchdog warned, as modelling assumptions may be unrealistic about the extent to which care in future will be provided outside hospitals.

The government failed to achieve good value for money, with the scheme having cost £1.1bn by March this year, and progress has been slower than expected, the report concluded.

The claim will ignite concerns that the new hospitals would struggle to cope in the event of another pandemic, given England already has one of the highest rates of hospital bed occupancy among countries in the Organisation for Economic Co-operation and Development.

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Source: The Guardian, 17 July 2023

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Maternity unit breached safety standards

A trust at the centre of a maternity scandal has been failing to meet Royal College standards in one of its maternity units, HSJ can reveal.

The duty anaesthetist for the maternity unit at the William Harvey Hospital in Ashford has also had to cover the hospital’s primary percutaneous coronary intervention suite. This could mean no anaesthetist is available to carry out an emergency Caesarean if they are needed to treat a heart attack patient. 

This goes against Royal College of Anaesthetists’ guidelines, which say a duty anaesthetist must be “immediately available for the obstetric unit 24/7”. The guidelines add that where the duty anaesthetist has other responsibilities – because, for example, they work at a smaller maternity unit where the workload does not justify them being there exclusively – then “these should be of a nature that would allow the activity to be immediately delayed or interrupted should obstetric work arise”. 

The William Harvey unit is East Kent Hospitals University Foundation Trust’s major birth centre. The trust has around 6,500 births a year – the majority at the WHH – and was heavily criticised for poor maternity care in a report by Bill Kirkup last year.

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Source: HSJ. 17 July 2023

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US regulators approve first over-the-counter contraceptive pill

The US Food and Drug Administration (FDA) has approved the first over-the-counter contraceptive pill, allowing millions of women and girls in the country to buy contraception without a prescription at a time when some states have sought to restrict access to birth control and abortion.

FDA officials said on Thursday it cleared Perrigo’s Opill – an every day, prescription-only hormonal contraception first approved in 1973 – to be sold over-the-counter. The pill will be available in stores and online in the first quarter of next year, and there will be no age restrictions on sales. The regulatory approval paves the way for people to purchase the pill without a prescription for the first time since oral contraceptives became widely available in the 1960s.

“Today’s approval marks the first time a nonprescription daily oral contraceptive will be an available option for millions of people in the United States,” Patrizia Cavazzoni, the director of the FDA’s center for drug evaluation and research, said in a statement.

“When used as directed, daily oral contraception is safe and is expected to be more effective than currently available nonprescription contraceptive methods in preventing unintended pregnancy.”

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Source: The Guardian, 13 July 2023

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‘Shocking’ A&E with ‘police everywhere you look’ must be solved, says director

A former national director has expressed her shock at visiting an accident and emergency department struggling with record numbers of mental health patients accompanied by police officers, and warned the issue needs an “absolute solution” from the area’s mental health trusts.

Kathy McLean, a non-executive director at Barking, Havering, and Redbridge University Hospitals Trust, and previously NHS Improvement’s medical director, told a board meeting last week there were “police officers everywhere you looked” at the accident and emergency at King George Hospital in Ilford, which had just experienced its third consecutive record month for mental health referrals.

While she recognised nearby mental health trusts North East London Foundation Trust and East London FT were “working hard”, she added: “This is not our problem, it is their problem that we’ve now got, and it’s not right for [patients], nor is it right for other people attending the emergency departments.

“I’ve been to more emergency departments than most people in the country and I was shocked, everywhere you looked there was a police officer… This now needs an absolute solution. If this was ambulances sitting outside our ED, people would be saying, you’ve got to sort it.”

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Source: HSJ, 14 July 2023

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Robots-led surgeries could boost efficiency and free up beds, say surgeons

Using robots to assist in operations could make surgery more efficient and free up NHS beds, a report has suggested.

The Royal College of Surgeons of England (RCS England) has published a guide: Robotic Assisted Surgery – a pathway to the future; exploring the potential benefits and challenges of the technology.

It said the document “provides a structured pathway” for surgeons who want to transition to robotic-assisted surgery, which allows doctors to operate with more precision using interactive, mechanical arms.

The report outlined “significant advantages” of using robots in surgery, including reduced post-op pain, fewer blood transfusions, more efficient use of anaesthetics and shorter hospital stays for patients.

There are also benefits when it comes to patient safety, the college said, with platforms eliminating tremors and providing a magnified image of the surgical site.

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Source: The Independent, 14 July 2023

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CQC inspection process may be ‘disproportionate’, finds Government review

The Care Quality Commission (CQC) inspection process may be ‘disproportionate’, a Government survey found, although the incredibly low response rate hampered conclusions.

All 51,000 providers registered with the CQC were given access to a survey as part of a post implementation review but only 86 responded and only 36 of those were NHS providers.

Most NHS responses to the survey came from organisations employing between 10 and 49 people, the review found.

The lack of engagement with the survey meant no conclusion could be reached about whether an alternative system would impose less regulation of the health and social care sector.

Criticisms among those who did respond included that the registration process is too inflexible, and the regulations too onerous and burdensome.

Some also felt the CQC regulations do not cover all health and social care activities where there is a possible risk to patient safety or service users.

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Source: Pulse, 13 July 2023

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Betsi Cadwaladr: More patient deaths may be linked to treatment

More families have been told by a health board that their relatives' deaths may have been linked to treatment by vascular services.

Betsi Cadwaladr University Health Board (BCUHB) has written to families who were part of a review after concerns were raised last year.

Four cases had already been reported to a coroner and the health board says it has been "very open" with relatives of other patients.

The service has recently been described by inspectors as making "satisfactory progress", but the health board admit it is still on a "long journey".

A report by the Royal College of Surgeons England (RCSE) in January 2022 found risks to patient safety due, in part, to poor record keeping.

It recommended to the health board that it investigate fully what happened to the 47 patients its report focused on.

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Source: BBC News, 13 July 2023

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New panel will oversee NHS competition regime, DHSC decides

The government will set up an independent panel to oversee disputes arising from decisions made under a new provider selection regime, it said today.

The new panel should “help ensure that… procurement processes are transparent, fair and propionate, enabling all providers to compete for contracts” and “are not unfairly excluded from offering services to patients and service users”, the Department of Health and Social Care said in a response to its consultation on the new rules governing the commissioning of healthcare services.

The intent is to move the NHS away from always putting new contracts out to competitive tender and “towards collaboration across the health and care system”, the document says. 

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Source: HSJ, 14 July 2023

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NHS waiting list in England hits record 7.5 million

NHS waiting lists in England have climbed to a record level, according to new figures that show 7.47 million patients were waiting to start routine hospital treatment at the end of May, up from 7.42 million at the end of April.

The growing list includes 416,000 children waiting to start treatment – up 9.7% in just one month, and including 21,282 who have been waiting more than a year.

Royal College of Paediatrics and Child Health president Camilla Kingdon said it is “unacceptable” and “unfathomable” to have so many children waiting so long.

However, hospital leaders warned on Thursday they are not confident they will hit key NHS targets to reduce the waiting list in 2024 and 2025.

The figures come during a five-day junior doctors’ strike during which tens of thousands of operations and appointments are expected to be cancelled and ahead of NHS consultants’ strikes where the major of planned care is expected to be paused.

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Source: The Independent, 13 July 2023

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NHS end-of-life care in England ‘variable and inequitable’ says watchdog

End-of-life care across the NHS in England is “variable and inequitable” and “often falls below expectations”, according to the Healthcare Safety Investigation Branch (HSIB).

HSIB found care for patients who are dying is “inconsistent” across England, despite a national strategy for proceedings being in place since 2008.

The report highlighted “concerns about the limitations of the delivery of palliative and end-of-life care” which are more noticeable in deprived areas.

Services were found to not always be able to deliver individualised care, and varied due to the likes of staff shortages and the availability of charitable donations.

Nick Woodier, a national investigator at the HSIB, said: “Conversations about death and end-of-life care are challenging and emotive but it is crucial that health and care professionals can discuss needs and expectations with their patients and families.

“They should be supported by a system that provides continuity of care, reassurance and dignity at what is sometimes a very distressing time.”

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Source: The Guardian, 13 July 2023

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Black maternal health in crisis across hemisphere, not just in USA

Black women in the Americas bear a heavier burden of maternal mortality than their peers, but according to a report released Wednesday by the United Nations, the gap between who lives and who dies is especially wide in the world’s richest nation — the United States.

Of the region’s 35 countries, only four publish comparable maternal mortality data by race, according to the report, which analyzed the maternal health of women and girls of African descent in the Americas: Brazil, Colombia, Suriname and the United States. And while the United States had the lowest overall maternal mortality rate among those four nations, the report said Black women and girls were three times more likely than their U.S. peers to die while giving birth or in the six weeks afterward.

“The risk factor is racism,” said Joia Crear-Perry, an OB/GYN and founder of the National Birth Equity Collaborative, a nonprofit group dedicated to eliminating racial inequities in birth outcomes and one of the report’s co-sponsors. “This report drives this home over and over. When your pain is ignored, when your blood pressure is ignored, you die, and that happens across the Americas.”

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Source: The Washington Post, 12 July 2023

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‘Helpless’ CEO’s report expresses ‘extreme concern’ over doctors strikes

Acute trust leaders have expressed ‘extreme concern’ over their ability to maintain safe services in the upcoming junior doctor and consultant strikes.

Leaders at Worcestershire Acute Hospitals Trust are “extremely concerned about the impact on patients… as well as on the health and wellbeing of staff”, according to its latest CEO report to the board,

Junior doctors are striking between 7am on Thursday 13 July and 7am on Tuesday 18 July. The report warned this would result in “complete withdrawal of labour, with no exemptions to cover emergency and critical services”.

The report said: “Junior doctors may only be recalled to work in the event of a mass casualty incident… Although other staff can cover for junior doctors they are becoming exhausted and increasingly reluctant to do so. 

“We are therefore extremely concerned about our ability to maintain safe services.”

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Source: HSJ, 12 July 2023

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NHSE cuts elective targets and admits PM’s waiting list pledge under threat

NHS England has reduced its elective activity target for the service because of the impact of junior doctors’ strike, and acknowledged the service may not hit the prime minister’s pledge to reduce waiting lists before the next general election if the industrial action continues.

NHSE has agreed a deal with ministers which will see the “value based” elective activity target set for the service reduced for 2023-24 from 107 per cent of pre-pandemic levels to 105 per cent (See explainer box on value-based targets below).

Trust finance bosses were briefed by NHSE chief finance officer Julian Kelly this morning (Wednesday 12 July) on the eve of junior doctors’ longest strike action to date.

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Source: HSJ, 12 July 2023

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Essex mental health staff fell asleep on duty, inspection found

Staff fell asleep while on duty at a mental health trust, inspectors found.

The Care Quality Commission (CQC) said it was "very disappointed" to find patient safety being affected by the same issues it had seen previously.

It said on acute wards for adults of working age and psychiatric intensive care units, five patients described staff falling asleep at night.

Despite CCTV being available, managers told the CQC they could not always immediately prove staff had been sleeping as accessing the pictures could take up to a fortnight.

The CQC report added trust data from June to December 2022 recorded 20 incidents of staff falling asleep while on duty but no action was taken because the video evidence had not been viewed.

Rob Assall, the CQC's director of operations in London and the East of England, said: "When we inspected the trust, we were very disappointed to find people's safety being affected by many of the same issues we told the trust about at previous inspections.

"This is because leaders weren't always creating a culture of learning across all levels of the organisation, meaning they didn't ensure people's care was continuously improving or that they were learning from events to ensure they didn't happen again."

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Source: BBC News, 12 July 2023

 

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National rollout for triage scheme which cut ambulance journeys

A scheme in which ‘category 2’ 999 calls are validated by clinicians will be extended nationally after reducing journeys by 4%in a pilot, with no adverse incidents, NHS England has told HSJ.

NHSE also confirmed that one ambulance trust in the scheme, the West Midlands, has begun delaying the dispatch of ambulances for some category 2 calls by up to 23 minutes so that the validation can take place. 

At three other trusts – London, South Western and the East Midlands – about 40% of category 2 calls receive clinical validation, but an ambulance is dispatched to them as soon it is available, as normal.

Officials said they believe the demand benefit could be greater if ambulance trusts are able to devote more clinical capacity to the validation process. About 40% of category 2 calls are judged suitable for validation, but not all of them complete the process before an ambulance arrives.

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Source: HSJ, 11 July 2023

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Ambulance service apologises to families

An ambulance service has apologised to families following a review into claims it covered up errors by paramedics and withheld evidence from coroners.

The families of a teenager and a 62-year-old man were not told paramedics' responses were being investigated by North East Ambulance Service (NEAS).

The deaths, in 2018 and 2019, were raised by a whistleblower last year.

Among the findings of the independent review carried out by Dame Marianne Griffiths, were inaccuracies in information provided to the coroner, employees who were "fearful of speaking up" and "poor behaviour by senior staff".

The study, commissioned by the former health secretary Sajid Javid in August, examined four of the five cases that were highlighted by the whistleblower, initially in The Sunday Times.

It found two bereaved families were left in the dark about investigations into the response of paramedics called to help their loved ones.

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Source: BBC News, 12 July 2023

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Former surgeon wants NHS MeToo movement for sexual harassment

A former breast cancer surgeon has said the NHS needs a MeToo movement because of sexual harassment in hospitals.

Dr Liz O'Riordan said she experienced sexual harassment from colleagues on a weekly to monthly basis in some of her jobs as a junior doctor.

In her first week as a junior doctor, she recalled a colleague asking if she "got an erection" after removing an 11-year-old boy's appendix.

"We need to be able to say this is not good enough," said Dr O'Riordan. "When you are a trainee in a practical field, you are relying on your boss to let you operate to show you how to cut; it is a craft that you learn."

"Basically you are naked in scrubs stood from shoulder, to hip, to knee, next to someone all squeezed in; a lot of body contact; you are relying on them to let you cut, and if you call them out they may say 'I don't like you, you are not coming to theatre today'.

"It's very, very, very hard to stand up for yourself and say 'that is not on' and the minute you let them get away with it, it is accepted and they can carry on getting away with it."

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Source: BBC News, 12 July 2023

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Bullying and safety concerns raised by ‘outstanding’ hospital’s juniors

An inspection of an ‘outstanding’ hospital has revealed concerns about unsafe staffing, as well as bullying and undermining behaviour. 

The then Health Education England issued Frimley Health Foundation Trust 14 mandatory requirements after visiting its Frimley Park Hospital in March to look at training in medical specialties. The risk-based review followed concerns in the 2022 national training survey and previous quality interventions by HEE.

Among the problems HEE was told about were:

  • Junior doctors feeling staffing on some shifts was unsafe. Foundation year one doctors were sometimes the only doctors on a ward, while one foundation doctor spent their first weekend on call looking after two wards by themselves.
  • Concerns about bullying and undermining behaviour in an unnamed department, and consultant behaviour during weekend handover which left some staff feeling “uncomfortable”.

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Source: HSJ, 11 July 2023

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GP trainers among those at highest risk of burnout, GMC warns

GP trainers are more at risk of burnout than the average for all specialties, according to the GMC’s annual training survey results. 

The survey of over 70,000 doctors who are trainees or trainers found that 15% of GP trainers are at high risk of burnout, which is higher than the average of 12% and ranked second only to emergency medicine at 24%.

The results also showed that 24% of GP trainers said that every working hour is tiring for them, compared to 11% of public health trainers. 

Last month, GP leaders raised concerns about how trainers and experienced GPs will handle the long-term workforce plan’s expansion of training places, especially given the existing pressures and lack of retention measures.

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Source: Pulse, 11 July 2023

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