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Keep up to date with the latest news, research and activity in patient safety.

Just 1 in 10 patients preferred face-to-face GP during Covid, finds NHS-backed research

Just 1 in 10 patients preferred face-to-face GP appointments during the Covid pandemic, with most requesting telephone consultations instead, according to research carried out on behalf of NHS England.
The Improvement Analytics Unit (IAU) – a partnership between NHS England and think-tank the Health Foundation – looked at data from 146 England GP practices using the askmyGP online consultation system between March 2019 and September 2021, examining over 7.5 million patient-initiated consultation requests.
During the pandemic, GPs suffered a backlash from the media, Government and NHS England over accusations that general practice was closed and GPs were not seeing patients face-to-face.
GP leaders suggested that NHS England needed to take the research into account and allow practices to decide their own way of working.
The research found that:
Before the pandemic, 30% of patients requests specified a face-to-face consultation, dropping to less than 4% at the beginning of the pandemic.  But by the end of the study period in September 2021, only 10% of patients requests were for face-to-face GP appointments.  Telephone consultations were the most popular option, making up over half (55%) of patient requests in 2020/21. However, less than 1% of patients preferred a video consultation, according to the data. IAU head at the Health Foundation Arne Wolters said: ‘Our analysis shows that patients often choose remote over face-to-face consultations and that GP practices can mitigate the risk of digital exclusion via a blended approach.’
He said that ‘traditional routes to accessing and delivering care’ had been ‘offered alongside an online option and, in planning care, practices were able to take account of factors such as patients’ age, frequency of use, clinical needs and preferences’, at the studied practices."
And he added: ‘With patient demand at an all-time high due to the care backlog
Read full story
Source: Pulse, 18 March 2022
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Australia: Disability carer sentenced to six years’ jail over death of patient due to criminal neglect

The carer who admitted the manslaughter of Adelaide woman Ann Marie Smith, who had cerebral palsy, has been jailed for at least five years and three months for her criminal neglect.
Sentencing Rosa Maria Maione in the Supreme Court, Justice Anne Bampton said the 70-year-old was grossly negligent, with her care for Smith falling well short of the standard expected.
“You did not mobilise her from the chair in which she was found. You did not toilet her properly and you did not clean her properly,” she told Maione on Friday.
“You did not feed her a nutritional diet or monitor her intake. You knew you were not capable of properly supporting her and you did not seek assistance in providing for Ms Smith’s needs."
“Despite the deterioration in Ms Smith’s health, you did not seek assistance from your supervisor or medical professionals until it was too late.”
Justice Bampton said Maione had absolutely no insight into Smith’s physical condition leading up to her death.
“Your incompetence, lack of training, lack of assertiveness and lack of supervision produced an environment where you failed to provide appropriate care,” she said.
“Every person living with a disability, every person who requires support, every parent, carer and support worker of persons living with a disability, I have no doubt shudders with fear when they hear of the utter lack of care and human dignity afforded to Ms Smith in those last months of her life.”
Read full story
Source: The Guardian, 18 March 2022
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Gloucestershire CQC inspection highlights urgent care delays

An inspection of a county's urgent and emergency services found delays were caused by a lack of empty beds and prolonged waiting times.
The Care Quality Commission (CQC) inspected Gloucestershire emergency care services in November and December.
The report found staff worked well in challenging circumstances but the CQC said pressures on workers across the system needed addressing.
Dr Jeremy Welch said: "The system is being stretched and we need to adapt."
CQC deputy chief inspector for hospitals, Nigel Acheson, said: "We found the system to be complicated. As a result, staff and patients weren't always able to understand which urgent and emergency care service was best suited to their needs.
"This meant people sometimes attended the emergency department when they could have been treated more appropriately elsewhere."
In addition the report touched on adult social care and the possibility of using empty care home beds when hospitals were struggling to cope.
Dr Welch recognised "it's been a blinking tough time in care homes" over the pandemic and credited the relaxing of rules to allow visits but said there are other factors that would need to be considered.
However he added: "We've got enough beds when we map across, it's just getting patients through the hospital and home because home is where they want to be."
Read full story
Source: BBC News, 17 March 2022
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US health officials monitor the rising cases of UK Covid hospitalisations

US health officials are monitoring an unusual situation in the UK, where COVID-19 cases and hospitalisations are simultaneously climbing due to the BA.2 subvariant, CNN reports. 
COVID-19 cases were up 52% in the UK last week compared with the week prior, and hospitalisations were up 18%t over the same period, according to the UK Coronavirus Dashboard. 
The seemingly in-tandem ascent of cases and hospitalisations is unusual, given that increases in COVID-19 cases preceded increases in hospitalisations by about 10 days to two weeks in previous waves. 
"So we're obviously keenly interested in what's going on with that," Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, told CNN.
Dr Fauci said in conversation with his U.K. counterparts, they attribute the rising cases and hospitalisations to three things, listed in order of contribution: the BA.2 variant, which is more transmissible than the original omicron; the opening of society, with people socializing indoors without masks; and waning immunity from vaccination or prior infection. 
Hospitalisations in the U.K. raise questions, given that BA.2 doesn't appear to cause more severe disease.
"The issue with hospitalization is a little bit more puzzling, because although the hospitalizations are going up, it is very clear their use of ICU beds has not increased," Dr. Fauci said. "So are the numbers of hospitalizations a real reflection of COVID cases, or is there a difficulty deciphering between people coming into the hospital with COVID or because of COVID?"
Read full story
Source: Becker Hospital Review, 16 March 2022
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‘Disproportionate’ infection control holding back electives, say NHS bosses

Infection control rules in hospitals are ‘now disproportionate to the risks’ posed by covid and should be relaxed, some of the NHS’s most senior leaders have warned.
The government rules – such as not allowing covid-positive staff to work, and separating out services for covid, non-covid and covid-contact patients – make a big dent in hospital capacity and slows down services.
Glen Burley, who is chief executive of three Midlands trusts and involved in national-level discussions on elective matters, told HSJ: “Pretty much every pathway has a covid and non-covid route, which slows down flow and staff productivity.
“There is a growing argument that these rules are now disproportionate to the risks. With covid cases in the community also rising now, we may have to question again the relative risks of continuing to isolate staff.”
NHS Confederation director of policy Layla McCay told HSJ: “Healthcare leaders are concerned the current [IPC] measures are having a serious knock-on effect on capacity and that the measures in their current form are reducing efficiency and capacity within healthcare settings.
“We need more clarity on if and how current measures can be safely adjusted so [the NHS] can further increase bed capacity and patient throughput, as well as the ability to transport patients more quickly and efficiently.”
But NHS Providers, which has previously said relaxing the IPC guidance would not enable a “rapid” increase in the NHS’ capacity to tackle the elective care backlog and could pose significant “risks”, remains more cautious.
Read full story (paywalled)
Source: HSJ, 21 March 2022
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Doctor accused of failings following Claire Roberts' death

A paediatrician who was at the centre of one of Northern Ireland's longest running public inquiries will appear before a professional misconduct panel.
Dr Heather Steen is accused of several failings following the death of Claire Roberts at the Royal Belfast Hospital for Sick Children in October 1996.
The nine-year-old's death was examined by the hyponatraemia inquiry, which lasted 14 years.
It examined the role of several doctors.
Among his findings, the inquiry's chairman Mr Justice O'Hara said there had been a "cover-up" to "avoid scrutiny."
Monday's tribunal will inquire into allegations that, between 23 October 1996 and 4 May 2006, Dr Steen "knowingly and dishonestly carried out several actions to conceal the true circumstances" of the child's death.
Also that the doctor provided inappropriate, incomplete and inaccurate information to the child's parents and GP regarding the treatment, diagnosis, clinical management and cause of her death.
The tribunal website adds: "It is also alleged that Dr Steen inappropriately recommended a brain-only post-mortem for Patient A (Claire Roberts) when a full post-mortem was necessary.
"In addition, it is alleged that Dr Steen failed to refer Patient A's death to the coroner, inappropriately completed the medical certificate of cause of death and inaccurately completed the autopsy request form for Patient A.
"Furthermore, it is alleged that during a review of Patient A's notes, Dr Steen failed to consult with the necessary colleagues and medical teams and provided a statement and gave evidence to the coroner's inquest into Patient A's death which omitted key information."
Read full story
Source: BBC News, 21 March 2022
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Over 80% of UK GPs think patients are at risk in their surgery, survey finds

More than 80% of GPs believe that patients are being put at risk when they come into their surgery for an appointment, a new survey shows.
A poll of 1,395 GPs found only 13% said their practice was safe for patients all the time. Meanwhile, 85% expressed concerns about patient safety, with 2% saying patients were “rarely” safe, 22% saying they were safe “some of the time” and 61% saying they were safe “most of the time”.
Asked if they thought the risk to patient safety was increasing in their surgery, 70% said it was.
Family doctors identified lack of time with patients, workforce shortages, relentless workloads and heavy administrative burdens as the main reasons people receiving care could be exposed to risk. The survey, which was self-selecting, also found that:
91% said more GPs would help improve the state of general practices. 84% have had anxiety, stress or depression over the past year linked to their job. 31% know a colleague who was physically abused by a patient in the last year. 24% know of a member of general practice staff who has taken their own life due to work pressures. Read full story
Source: The Guardian, 21 March 2022
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Women died after ‘gross failings’ by scandal hit mental health trust

A young woman died following “gross failings” and “neglect” by a mental health hospital in Essex which is also facing a major independent inquiry into patient deaths.
Bethany Lilley, 28, died on 16 January whilst she was an inpatient at Basildon Mental Health unit, run by Essex Partnership University Hospitals.
The inquest examined the circumstances of her death this week and concluded that her death was contributed by neglect due to a “plethora of failings by Essex University Partnership Trust”.
Following the three week inquest, heard before coroner Sean Horstead, a jury found “neglect” contributed to Ms Lilley’s death and identified “gross failures” on behalf of the trust.
The jury identified a number of failings in her care including evidence that cocaine had made its way onto a ward where she was an inpatient.
There was evidence of “very considerable problems in the record-keeping at EPUT psychiatric units.”
It was also concluded staff failed to carry out a risk assessment of Ms Lilley in the days leading up to her death, and failed to carry out observations.
Ms Lilley’s death is one of a series of patients who have died under the care of mental health services in Essex, which have been brought into the light following the campaigning of bereaved families.
Read full story
Source: The Independent, 19 March 2022
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NHS Trust declares two critical incidents as Covid admissions double

A hospital in Devon has declared a second critical incident following extreme pressures, as Covid-19 admissions in the region double, The Independent has learnt.
North Devon Healthcare Trust declared a critical incident on Monday, after it declared another earlier this month it has confirmed.
The news comes as the number of people with Covid-19 across two hospitals in Devon has doubled in just two weeks.
As of Thursday, there were 292 Covid positive patients in across hospitals in Devon, with a further 37 awaiting test results.
According to a statement from healthcare leaders in Devon, Plymouth and Torbay, as of Thursday there were almost 1,200 NHS staff off work due to Covid.
Meanwhile 183 care services, such as care homes and other social care providers, in the area have reported Covid outbreaks, making it harder to discharge patients, the leaders said.
NHS data published on Thursday showed there were 213 patients across three hospitals in Devon, waiting to be discharged.
Covid-19 infections are also continuing to rise across most of the UK, with levels in Scotland hitting another record high, new figures show.
Read full story
Source: The Independent, 19 March 2022
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Jeremy Hunt joins BMA call to stem ‘bleed’ of NHS doctors

The former health secretary Jeremy Hunt will join doctors’ representatives today in a call to stem the “bleed” of GPs or risk endangering patients.
Polling shows that almost nine in ten GPs fear that patient safety is being put at risk by shortages of family doctors and too little time for appointments.
The government has admitted that it will fail to fulfil an election pledge to recruit 6,000 extra full-time GPs by 2024.
Hunt is campaigning with the British Medical Association and the GPDF, which represents local medical committees, in calling for the government to put forward a GP workforce plan to “rebuild general practice”.
He said: “The workforce crisis is the biggest issue facing the NHS. We can forget fixing the backlog unless we urgently come up with a plan to train enough doctors for the future and, crucially, retain the ones we’ve got.
“As someone who tried hard to get more GPs into local surgeries but ultimately didn’t succeed because the numbers retiring early exceeded those joining, I’m passionate about fixing this.”
The campaign wants the government to deliver on its pledge for an extra 6,000 GPs in England and action to tackle the reasons for GPs leaving the profession, such as burnout. It says that a plan is needed to reduce GP workload, which would improve patient safety.
Patient Safety Learning

Vaccine used to free a man who was trapped at home with Covid

A vaccine has been used to free a man who was trapped at home by a Covid infection that lasted for more than seven months.
It is the first time that a vaccine has been used to "treat" Covid rather than "prevent" it.
Ian Lester, 37, has a weakened immune system due to Wiskott-Aldrich syndrome, and was unable to defeat the virus on its own.
He says he became a prisoner in his home in Caerphilly, Wales, as he isolated for months on end.
He shielded during the first wave of Covid, but coronavirus eventually found him in December 2020. He had one of the classic symptoms - a slight loss of sense of taste and smell - which cleared up within a month.
For most of us that would be the end of it, but Ian's Covid journey was only just beginning. His doctors wanted him to keep on testing because his weakened immune system meant there was a risk he could be contagious for longer than normal.
But month after month, test after test came back positive. Ian had to give up work.
Scientists and doctors were monitoring the battle between the virus and Ian's immune system at Cardiff University and at the Immunodeficiency Centre for Wales in the University Hospital of Wales.
The analysis showed Ian had a long-term infection, it was not just "dead virus" being detected, and his symptoms were not long-Covid.
Prof Stephen Jolles, clinical lead at the Immunodeficiency Centre, said: "This infection was burbling along, but with his [weakened] immune system it was just not enough to kick off a response sufficient to clear it.
"So the vaccine really made a huge difference, in antibodies and T-cells, and utilised and squeezed every last drop out of what his immune system could do."
Read full story
Source: BBC News, 21 March 2022
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Trust admits staff shortages causing inappropriate discharges

A trust has admitted it is having to discharge patients inappropriately into care homes or community hospital beds because of a shortage of home care workers.
A report to East Kent Hospitals University Foundation Trust’s board last week revealed that 160 extra beds had been commissioned to maintain flow across the local health economy “due to insufficient domiciliary/care package capacity.”
It went on: “The clinical commissioning group have tried via Kent County Council to commission additional domiciliary care without success. It is acknowledged by the local health economy that it is important to withdraw from these additional beds as quickly as possible as they are not a cost-effective resource and more importantly, in many cases, they are not the ideal discharge destination for those patients who could have been discharged home with a care package.
“Patients are being transferred into community hospital beds or residential home beds due to a lack of domiciliary care packages. Although this is a national issue, it will not be resolved locally until appropriate pathway capacity is commissioned.”
Professor Adam Gordon, president elect of the British Geriatrics Society, said: “If people have been sent to a care home when they don’t want or need to be there that can affect their motivation and result in a form of deconditioning. One of the principles of effective rehabilitation in older people is that if you don’t use it, you lose it.”
Read full story (paywalled)
Source: HSJ, 17 March 2022
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Derby doctor who put patients at risk has eighth tribunal in nine years

A Derby doctor who has been the subject of eight tribunals in less than nine years has been sanctioned for a further four months. Dr Anatta Nergui was originally found guilty of misconduct in 2014 and has been found to have not fully reflected on the severity of his offending in six different hearings since.
The psychiatrist was suspended by the Medical Practitioner Tribunal Service (MPTS) in 2014 for running a website and blog which offered incorrect medical advice to those who got in contact with him. In 20 of 22 cases, he was found to have failed to recommend that the patient saw a doctor or psychiatrist, and failed to recommend a counselling or psychotherapy course in 30 cases, among other complaints, which put patients at "significant risk of harm".
The latest tribunal aimed at assessing his fitness to practice, held in March 2022, has imposed a further four months of conditions on him, after the MPTS found that "despite there being a low risk of repetition, the remediation had not yet been completed", according to the chair of the tribunal, Jetinder Shergill.
In the MPTS determination, released on Thursday (March 17), Mr Shergill said: "While the tribunal was satisfied that there is sufficient evidence Dr Nergui is a competent and safe doctor, there remains a lingering concern that he did not appreciate the findings made against him from the patient’s perspective and/or did not express this in a clear, cogent manner. The tribunal considered that Dr Nergui might have benefitted from seeking feedback from a trusted colleague or mentor, reflecting on what went wrong and setting out his thought processes on avoiding similar risk.
"In short, the self-reflection has led Dr Nergui down a restricted path of understanding, leading him to focus on the legal aspects of the process and semantics rather than the primary issue which was one of patient safety. If he had sought the input of a third party, it may have led to him developing an alternative view rather than the binary approach that he has adopted. This left the tribunal with the view that whilst there has been some insight, remediation is not yet complete."
Read full story
Source: Derbyshire Live, 18 March 2022
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Covid deaths impossible to calculate as authorities used 14 different ways to record them

The number of people who have died from Covid in Britain during the pandemic is impossible to determine because of the inconsistent definitions of what is meant by a coronavirus death, researchers have concluded.
Experts from Oxford University discovered that public health and statistics organisations across the UK are operating under 14 different definitions to classify a death from Covid.
Freedom of Information (FOI) requests show that many people who died in the first wave never tested positive for the virus, particularly older people who died in care homes. Instead, their deaths were registered as Covid simply based on a statement of the care home provider, and because coronavirus was rife at the time.
The authors also point out that it is unlikely that a Covid infection on its own could cause death in the absence of contributing factors, such as other illness, or the infection leading to a more deadly condition such as pneumonia.
The report also found that in some trusts, up to 95% of Covid deaths were in people with Do Not Resuscitate (DNR) orders.
The team said the confusion meant they were unable to separate deaths caused by Covid from those triggered by the pandemic response, and called for a proportion of deaths to be verified by post-mortem in future pandemics to determine the true reason.
Read full story (paywalled)
Source: The Telegraph, 19 March 2022
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Learning disability training for all nurses set to be mandated in law

Members of the House of Lords have passed an amendment to the Health and Care Bill to enshrine mandatory training for health and care staff on learning disabilities and autism in law.
The Oliver McGowan Mandatory Training in Learning Disabilities and Autism programme is being developed by Health Education England in partnership with organisations such as Skills for Care and the Department of Health and Social Care, and alongside Oliver’s family.
“It means that organisations have no choice but to free up their staff to attend this training”
The training is named after Oliver whose death shone a light on the need for health and social care staff to have better training on learning disabilities and autism, and has been campaigned for by his parents Paula and Tom McGowan who believe his death was avoidable.
The 18-year-old, who had mild hemiplegia, focal partial epilepsy, a mild learning disability and high-functioning autism, died in November 2016 after he was given antipsychotic medication even though he and his family warned it could be harmful to him.
Following campaigning efforts and a consultation on training proposals for health and care staff, in November 2019, the government committed to developing a standardised training package. It draws on existing best practice, the expertise of people with autism, people with a learning disability and family carers and subject matter experts.
Read full story
Source: Nursing Times, 18 March 2022
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Abuse of staff at ‘dangerous level’, say NHS bosses

Healthcare leaders have written an open message to NHS staff, drawing attention to “the dangerous level” of abuse many are confronted with, “simply for going to work”.
In the message, more than 40 NHS leaders in London said that every year “tens of thousands” of NHS staff are “confronted with violence and aggression from patients”. 
“Now, the abuse is at a dangerous level, with many of our once hailed heroes fearing for their safety,” they said.
“We, leaders of the NHS in London, are speaking with one voice to say that aggression and violence towards our staff will not be tolerated.”
Signatories include Andrew Ridley, the NHS England London interm regional director, integrated care system leaders, leaders from general practice and community pharmacy, and many trust bosses from the capital, including Central and North West London FT chief executive and national director for mental health Claire Murdoch.
The message thanked NHS staff for continuing to care for people and encouraged the reporting of “all forms of verbal and physical abuse from patients, their families and friends so that we may take action”.
They also sent a message to patients and their families: “We will strive to do our best for you and your loved ones. People who are most unwell do need to be seen most urgently, but all our patients are important to us and will receive the care needed. While we are thankful for the support shown by so many, to those who show violence and aggression let it be known: abusing our staff is never ok.”
Read full story (paywalled)
Source: HSJ, 21 March 2022
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