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News Article
Face-to-face GP appointments in Scotland 'still feel like a treat'
Patient Safety Learning posted a news article in News
Nightclubs have reopened, concerts have been given the go-ahead and football stadiums are welcoming fans - but there are still restrictions on face-to-face GP consultations. Only a limited number of patients are being invited into surgeries, where there continue to be strict rules on physical distancing. Edinburgh GP Dr Carey Lunan says she understands why the situation is confusing. "The difference between a healthcare setting and, say, a restaurant or a football stadium, is that we have people coming into our building who are much more vulnerable and frail and don't have a choice in being unwell," she tells BBC Scotland. "So we have to have higher levels of safety than a setting where people can choose to go, knowing that there may be a little bit of risk." According to the British Medical Association's Dr Andrew Buist, the balance between telephone and in-person consultations should continue to adjust as we move out of the pandemic, guided by evidence. But many patients will "very easily" have their needs met by phone appointments. So-called telephone triage - where patients are assessed over the phone before being invited into the building - has now become the norm. "For a lot of patients it works really well if it's a simple problem and it means not having to take time off work or travel," says Dr Lunan. "It works less well if English isn't their first language or they've not got the privacy at home to have a conversation about something that is a bit more sensitive, if it's a very complex issue or it's just not clear what the diagnosis is." She adds: "We deal with things when someone comes in with problem A, but actually we end up having a conversation about problem B when they are in the room with us. "It is much more challenging to do that kind of health care on the phone and I think we just need to be honest that there are limitations. Dr Lunan says she hopes a return to more face-to-face appointments will come "in the not too distant future. I miss seeing patients if I'm honest," she says. "When we get to the point where we are able to bring in more people we will welcome that because it feels like a treat at the moment." Read full story Source: BBC News, 25 January 2022 -
News Article
Public told not to delay cancer check-ups
Patient Safety Learning posted a news article in News
The public are being urged not to put off seeking help for worrying cancer symptoms because of NHS pressures. NHS England chiefs said record numbers were being seen for check-ups before Omicron hit - and despite the current situation cancer was being prioritised. There have been nearly 50,000 fewer cancer diagnoses across the UK since the start of the pandemic, Macmillan Cancer Support say. This risks an increase in late-stage diagnoses, reducing survival chances. Past surveys have suggested people are reluctant to come forward during surges in Covid cases because they did not want to be a burden to the health service. NHS England said record numbers had had urgent cancer check-ups in November when 246,000 saw a consultant after a referral by a GP - although just over three quarters of these were seen in the target time of two weeks. NHS England cancer director Dame Cally Palmer added it was vital people did not delay now even though hospitals were under huge strain. "NHS staff are working hard to ensure that those who are coming forward for checks can be seen quickly so that cancer can be caught at an earlier stage." She said common symptoms to look out for included diarrhoea that lasts for three weeks or more, new lumps or bumps and unexplained weight loss or fatigue. Read full story Source: BBC News, 2o January 2022 -
News Article
Patients 'wait two years' for check-ups as dentists drop NHS work
Patient Safety Learning posted a news article in News
NHS dentistry is "hanging by a thread" with some patients facing two-year waits for check-ups, the British Dental Association has said. Department of Health data analysed by the BBC shows almost 1,000 dentists working in 2,500 roles across England and Wales left the NHS last year. One woman told how she had been in pain for more than a year while waiting to have root canal surgery. NHS England said patients who most needed care should be prioritised. Pamela Carr, 58, from Carlisle, has been looking for an NHS dentist to fix her root canal since November 2020. "I've become used to the pain," she said. "I can't afford the private care, and I've tried every practice within 30 miles. I phoned NHS England too." "They said there's nothing they can do because there are no NHS dentists. That was the end of the conversation." Clinical Commissioning Group North Cumbria, which covers the area, lost 4% of its dentists in the last year. The worst-affected area was NHS Portsmouth CCG, which lost 26% of its NHS dentists over 12 months. At least 10% of NHS dentists were lost in 28 other English CCGs. Read full story Source: BBC News, 19 January 2022 -
News Article
US Patients can order ‘don’t weigh me’ cards to take to doctors
Patient Safety Learning posted a news article in News
Patients in the US are able to order “don’t weigh me” cards to take to the doctors in a move aimed at reducing anxiety and stress on a visit. The US group behind the initiative said being weighed and talking about weight “causes feelings of stress and shame for many people”. The cards say: “Please don’t weigh me unless it is (really) medically necessary.” It adds: “If you really need my weight, please tell me why so that I can give you my informed consent”. On the other side, it explains why the patient may not want to be weighed, including “when you focus on my weight I get stressed” and “weighing me every time I come in for an appointment and talking about my weight like it’s a problem perpetuates weight stigma”. It also says most health conditions can be addressed without knowing the patient’s weight. Public Health England guidance to health and care professionals says they are in a “unique position to talk to patients about weight management to prevent ill-health” and recommends brief interventions. It says the first step in a brief intervention over a patient’s weight is to weigh and measure them. “You should view this as a normal part of a routine consultation,” it says. Read full story Source: The Independent, 23 December 2021 -
News ArticleThe NHS may be missing more than 9 million referrals, while patients face a “postcode lottery” for cancer treatment and routine operations, a parliament watchdog has warned. Millions of patients have either avoided or been unable to obtain healthcare during the pandemic leaving the NHS with a potential unknown backlog of operations, which could push the national waiting list to 12 million by 2025. A report from the government’s National Audit Office today also warned patients across England are facing a postcode lottery in terms of waits with some hospital waiting lists far larger than others following the pandemic. Eve Byrne, head of campaigns and public affairs, at Macmillan Cancer Support, said: “This report confirms what we hear day in, day out from people living with cancer. Chronic staffing shortages are already having a devastating impact on cancer patients, and we have major concerns that is only set to worsen without urgent action. She said the government’s plan to tackle operations backlog must be backed up by steps to ensure enough nurses staff. “Without these critical pieces of the puzzle, we risk increasing numbers of people facing later diagnoses, poorer care and potentially worse chances of survival. This has to change,” she added. Read full story Source: The Independent, 1 December 2021
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News ArticlePlans to scrap tens of millions of “unnecessary” hospital follow-up appointments could put patients at risk and add to the overload at GP surgeries, NHS leaders and doctors are warning. Health service leaders in England are finalising a radical plan under which hospital consultants will undertake far fewer outpatient appointments and instead perform more surgery to help cut the NHS backlog and long waits for care that many patients experience. The move is contained in the “elective recovery plan” which Sajid Javid, the health secretary, will unveil next week. It will contain what one NHS boss called “transformative ideas” to tackle the backlog. Thanks to Covid the waiting list has spiralled to a record 5.8 million people and Javid has warned that it could hit as many as 13 million. Under the plan patients who have spent time in hospital would be offered only one follow-up consultation in the year after their treatment rather than the two, three or four many get now. “While it is important that immediate action is taken to tackle the largest ever backlog of care these short-term proposals by the health secretary have the potential to present significant challenges for patients and seek to worsen health disparities across the country,” said Dr David Wrigley, the deputy chair of council at the British Medical Association. Read full story Source: The Guardian, 25 November 2021
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News Article
GPs dispute Javid’s claim lack of appointments is overloading A&Es
Patient Safety Learning posted a news article in News
Family doctors have reopened their bitter dispute with the government by accusing Sajid Javid of misleading MPs and the public by blaming overloaded A&Es on a lack of GP appointments. The Royal College of GPs has told the health secretary in a strongly worded letter that there is no basis for the claim, which he made to MPs last week and which was widely covered by the media. In it Prof Martin Marshall, the college’s chair, said that its 54,000 members “are dismayed and disappointed at the media coverage of your evidence session, which suggested that the lack of face-to-face GP appointments was placing additional strain on accident and emergency departments”. He disputed Javid’s claim that there is evidence which links the issues. He wrote: “You told the [health and social care select] committee you had seen data which showed that more patients were presenting at A&E departments because they were unable to access primary care. I am not aware of any evidence to suggest that this is happening and would welcome sight of any data you have.” Tensions are simmering between GPs and the government since Javid’s edict last month that GPs in England must see any patient who wants an in-person appointment. Read full story Source: The Guardian, 12 November 2021 -
News Article
In-person GP appointments save lives and must return
Patient Safety Learning posted a news article in News
Last week a receptionist saved a patient’s life. She put him straight into a face-to-face appointment early in the day. The doctor saw him and sent him to A&E urgently. He was operated on the same day. Receptionists are are given an impossible task, to fit a large number of patients into a small number of slots, and they have to stay calm. When the slots run out – which sometimes happens by 9am – they then have to persuade one of the doctors, already at the end of their tether, to add any patient they are especially worried about to their list. So it’s not surprising that when during the early part of the pandemic demand for appointments dropped by 30%, some very stressed and overworked GPs found their lives were a lot nicer without patients. And now that appointment levels have finally (as of May 2021) gone back to normal levels, some are finding the demand very difficult to cope with. This could explain GPs’ persistence at keeping patients at arms length. Telephone consultations are less intense somehow, less tiring. Some GPs feel they can control the day better by using telephone consultations and only bringing in some patients. But patients are experiencing this persistent distancing as rejection. And these rejections are hurtful. Some people have held on to problems for six months or more and then finally felt free to book an appointment when the restrictions ended in August. Except the restrictions haven’t ended, not in general practice. GPs seem unable to let the remote triage go. GPs say: “We are seeing patients face-to-face. We’ve been seeing them throughout the pandemic,” which is true. But only some patients. Plenty of patients who would have benefitted from a face-to-face appointment or an examination have not been seen. Patients are not idiots. They know telephone consultations are not as good. They know, especially older patients, that proper doctoring involves an examination. They know that the rapport and connection with a doctor can only come from a face-to-face appointments. And they wish to book an appointment with their GP themselves, without facing multiple barriers. Read full story Source: The Independent, 6 November 2021 -
News Article
BMA urges GPs to move to 15-minute consultations and close patient list
Clive Flashman posted a news article in News
The BMA has advised practices to immediately start offering consultations of 15 minutes or more; and apply to close their patient list, as part of the fightback against the Government’s new GP access plan. It set out a range of measures GPs should take to protect their staff and patients and ‘prioritise’ core work amid pressure to return to pre-pandemic ways of working. In an email bulletin sent to GPs on Friday, the BMA’s GP Committee said that practices ‘should not feel pressured to return to a traditional 10-minute treadmill of face-to-face consultations that are neither good for patients nor clinicians’. It said: ‘Instead, they should offer patients consultations that are 15 minutes or more [and] apply to close the practice list to focus on the needs of existing patients.’ Read full article here Original source: Pulse -
News Article
GPs to vote on industrial action over ‘name and shame’ reforms
Patient Safety Learning posted a news article in News
GPs are set to be balloted on industrial action over controversial reforms proposed by health secretary Sajid Javid. The “outraged” doctors in England have voted unanimously to reject the government’s plans at a British Medical Association (BMA) meeting. The government wants to see GP surgeries ranked in league tables to “name and shame” those that do not carry out enough face-to-face appointments with their patients. From early November, GPs will have to have their names and wages published if they earn an NHS salary of more than £150,000. The BMA says that forcing GPs to publish their earnings “provides no benefit to patients or their care, yet will potentially increase acts of aggression towards GPs, will damage morale amongst the profession, and only worsen practices’ ability to recruit and retain GPs”. GP surgeries will not be eligible for new funding if they fail to provide an “appropriate” number of in-person consultations. Patients will also be asked to rate their GPs via text message. Mr Javid has insisted that his plans would improve patients’ access to primary care – but the union representing the GPs says it has been “left with no alternative” but to ballot over whether to take industrial action. Read full story Source: The Independent, 22 October 2021 -
Content ArticleShared decision making (SDM) is when patients and clinicians work together to make evidence-based decisions based on patient values and preferences. This may be to select a test or intervention, such as going ahead with surgery. SDM ensures individuals are supported to make decisions which are right for them. The Centre for Perioperative Care has a number of resources on their website on shared decision making.
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News Article
24 children wait year for first cancer appointment in Northern Ireland
Patient Safety Learning posted a news article in News
Twenty-four children in Northern Ireland with confirmed or suspected cancers had to wait over a year for a first appointment, a review has found. The figure, for April, is in a review of child health waiting lists by the Northern Ireland Commissioner for Children and Young People. More than 17,000 children were waiting more than a year to see a hospital consultant for the first time. The commissioner said the waiting times were "terrifying". The review examined official waiting list data for children's health services not published as part of the Department of Health's statistical bulletins. Koulla Yiasouma said that waiting for any health service treatment can and does have a "profound impact on a child's health outcomes, emotional and mental well-being". She said it was "shocking not only for the child but their families too". "Each and every single one of them is a child and each and every single one of them is a child whose life has almost been put on hold, and a family whose life has been put on hold, because they are not getting the most fundamental right of healthcare that they deserve," she said. Read full story Source: BBC News, 19 October 2021 -
News Article
Plan to boost face-to-face GP consultations
Patient Safety Learning posted a news article in News
GPs in England are being told to see more patients face-to-face as ministers unveil a £250m winter rescue package. The emergency funding is being handed to GPs so they can recruit extra locum staff with an emphasis on providing more same-day appointments. Social distancing rules are also expected to be relaxed so that GPs can bring more people into their buildings. It comes amid mounting criticism about the fall in face-to-face appointments since the start of the pandemic. Only 58% of patients were seen face-to-face in August - the first full month following the ending of restrictions. That compares with 54% in January and more than 80% before the pandemic. Patients have also complained of long waits on phone lines to book an appointment. The £250m funding is part of the extra £5bn Covid fund announced last month to help the NHS through to the end of the year, and comes on top of the £12bn set aside for GP services this year. Read full story Source: BBC News, 14 October 2021 -
Content ArticleThis article from Healthwatch outlines the communications patients should expect from their healthcare provider while they are waiting for treatment. It also describes how healthcare staff should involve patients in shared decision-making about their care and communicate clearly, personally and transparently.
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News Article
Concern raised over death of five patients seen remotely by GPs
Patient Safety Learning posted a news article in News
Patients being assessed remotely in general practice, rather than face-to-face, has been raised as a risk in reports on five deaths by a single coroner since the pandemic hit. Senior coroner for Greater Manchester Alison Mutch has written five prevention of future deaths reports highlighting concerns that doctors were missing details in telephone appointments which may have been spotted, had the patient been seen in person. The reports cover a variety of conditions, including covid, a broken femur, and anxiety and depression. In March 2020, NHS England guidance instructed GPs to adopt a “total triage” approach, where face-to-face appointments should generally only follow a phone, video or digital consultation. But, in May, NHSE wrote to GPs to ask them to “ensure they are offering face to face appointments”, adding remote appointments “should be done alongside a clear offer of appointments in person”. There have been growing calls in the media for increased face-to-face appointments, while, in March 2021, a report by Healthwatch concluded: “While telephone appointments are convenient for some, others are worried that their health issues will not be accurately diagnosed.” Maureen Baker, former chair of the Royal College of GPs and Patient Safety Learning trustee told HSJ she was “not aware pre-pandemic of any major concerns with remote consulting”, adding: “It’s not that things don’t go wrong. They do, but things can and do go wrong in face-to-face consultations as well.” “Many practices have been using remote consulting very successfully for many years [but for GPs introducing remote consultations during the pandemic] the concern is that practices will have had to change and implement it very quickly.” Read full story (paywalled) Source: HSJ, 9 September 2021 You may also be interested in a recent blog from Trish Greenhalgh: 'Why remote consultation with a doctor is difficult – and how it can be improved' -
News Article
Covid in Scotland: Can in-person GP appointments ever fully return?
Patient Safety Learning posted a news article in News
Community doctors in Scotland have told the BBC they cannot imagine returning to normal face-to-face service with current levels of demand. Allowing more patients to see their GP in person is a top priority for the government's NHS Recovery Plan. But as the country tries to emerge from the pandemic, surgeries are seeing unprecedented pressure to catch up with patients. The health secretary has confirmed that new guidance should allow practices to see more people in person. But greater use of telephone and video appointments, brought in when the pandemic hit, is going to continue. Dr Begg has been a GP for 25 years. He says they won't go back to business as usual, the way they worked before. "In person consultations are really important, to examine people, to give injections, to remove lesions, all of these. I think a flexible approach is what we need. It's what we were planning to do before the pandemic anyway; a flexible mix of phone call, video and in-person consulting where it is appropriate." Dr Begg says the new ways of working are essential to deal with the huge number of requests they get. "There is a demand, capacity gap and indeed there was before the pandemic. We are seeing at last more students come through medical school and more people finally coming to join general practice training, but this is going to take at least ten years to turn things around." Read full story Source: BBC News, 7 September 2021 -
Content ArticleWith remote consultations with a doctor becoming more frequent, Trish Greenhalgh explores why this can be difficult and looks at the ways it can be improved.
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News Article
Rheumatology care disruptions related to Covid-19
Patient-Safety-Learning posted a news article in News
It has been found that follow-up appointment cancellations have climbed to 60% during the height of the pandemic. People from older, ethnic and poorer backgrounds were the worst hit according to the data. According to the report, the impact was only partially offset by the use of telehealth sessions. Read full story. Source: Healio Rheumatology, June 10 2021 -
Content ArticleThis Healthcare Safety Investigation Branch (HSIB) investigation looked at the risks involved in the correct identification of patients in outpatient departments. Correct identification is crucial to make sure they receive the right clinical procedure. In the last 10 years the number of patients treated in outpatient clinics has nearly doubled. Many minor surgical procedures can now be carried out in an outpatient clinic, whereas in the past they would have been carried out in an inpatient theatre setting. The high number of patients treated in an outpatient clinic requires efficient management. Clinical consultation and delivery of the required intervention often needs to be completed within a 15-20-minute appointment. In a single outpatient waiting area there may be patients arriving for different clinical interventions. Staff need to make sure that all patients are seen in the right place, at the right time and (if required) receive the right procedure. Outpatients are not provided with any physical means that staff can use to identify them. This is different to inpatients where a wristband is worn following an initial check of the patient’s identity. Checking the identity of a patient in an outpatient department typically relies on staff speaking to patients. There is a risk of patients being missed or misunderstood due to the environment, work demands, language or cultural barriers.
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News ArticleA woman was subjected to an unnecessary invasive procedure in an NHS outpatient clinic after she was confused for another patient, a safety watchdog has found. The Healthcare Safety Investigation Branch has called for a review of how the NHS can avoid the mishap happening again after investigating the case of a 39-year-old woman who was subjected to an unnecessary cervical examination. HSIB said a better system was needed as the number of outpatient appointments has increased from 54 million to 94 million during the last 10 years with many clinics carrying out more invasive procedures. According to its latest investigation, the female patient was attending a gynaecological outpatient clinic for a fertility treatment assessment. The error happened when she was called through from the waiting room as another patient had a similar sounding name. Read full story Source: The Independent, 2 June 2021
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News Article
Staff at UK GP surgeries facing abuse and ‘tsunami of demand’
Patient Safety Learning posted a news article in News
NHS staff at GP surgeries are facing unprecedented abuse and aggression from patients, while stressed doctors are increasingly suffering from mental illness, because of an appointments system “in meltdown”, family doctors’ leaders have revealed. The scale of the deep crisis in GP surgeries was revealed in an emergency summit of more than 60 NHS doctors, dentists and administrative staff in Salford, which the Guardian attended, triggered by a recent rise in verbal abuse. "Patients are short-tempered and not happy waiting for anything … They want letters. The latest one was a request to speak to a GP because he needs a letter to confirm anxieties that cause him a problem in long queues – because he wants to take his son to [Southport amusement park] Pleasureland and does not want to queue," says Jan Crowshaw, a GP manager It comes after a recent poll by the body representing GP surgery staff across the UK found that 75% of them face abuse every day, including assaults, threats, racism and sexism. Read full story Source: The Guardian, 28 May 2021 -
News Article
GPs should not switch off online consultations, NHSE says
Patient Safety Learning posted a news article in News
GP practices should not switch off their online consultation systems outside of core hours as it will “reduce patient satisfaction”, according to NHS England. It comes in controversial new guidance issued amid a row over GP access. NHSE issued the new “standard operating procedures” this afternoon. HSJ revealed last month that large numbers of overwhelmed GP practices were turning off their online consultation services at weekends after the recent boom in digital appointments uncovered an ‘unmet demand’, leading to large numbers of queries to deal. But the new SOP says: “Patients should be able to make requests in an online system at any time.” Disabling the system outside of core hours, which some practices have done to help manage demand, is “less convenient” for patients and would “reduce satisfaction”, it says. Read full story Source: HSJ, 20 May 2021 -
News ArticleMonica Evans's initial misdiagnosis could have proved life-threatening – and she is just one of many to have suffered during pandemic. Since The Telegraph began reporting on the struggles of patients around the country to access GP services during the pandemic, they have been inundated with messages and letters. There have been multiple stories of serious misdiagnoses made after telephone consultations with doctors that took place in lieu of face-to-face assessments; of interminable waits to get through to practices on jammed phone lines; and of lengthy delays while worried patients have waited for referrals to be made. Those who shared their experiences have also shared their fury, frustration, fear and dismay. Some who could afford to have felt they had no option but to turn to private healthcare, unable to obtain the help they needed from an NHS struggling with Covid and all its knock-on effects. Others have been left with nowhere to turn. GPs have spoken, too, about their dissatisfaction with a system that has discouraged face-to-face consultations. Amid an outpouring of anger from both patients and doctors, NHS England yesterday rowed back on plans for "total triage" of patients to keep them out of surgeries whenever possible. But for many the damage has already been done. Read full story (paywalled) Source: The Telegraph, 13 May 2021
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News Article
GPs told to resume booking face-to-face appointments following row over access
Patient Safety Learning posted a news article in News
NHS England has said GP practices must start opening their receptions and allow people to book initial face-to-face appointments — scrapping the controversial ‘total triage’ rule — for the first time since the early days of the coronavirus pandemic. Since last spring, NHSE guidance, supported by the profession, has said that face-to-face appointments must generally only take place after a phone, video or digital consultation. Many GP practice receptions have been closed to people wanting to make routine appointments. This rule was kept in place throughout last summer, despite covid circulation being low, and some health systems made the approach one of the pillars of planned post pandemic transformation. “Embedding total triage” was encouraged in 2021-22 operational rules for the NHS. The shift was seen by some as part of a move to a potentially more effective and efficient way of working. But there have been concerns about access and complaints in the media. Read full story (paywalled) Source: HSJ, 14 May 2021 -
Content ArticleIn the Patients Association 2020 survey, patients told us about their experiences of living with health and care needs during the COVID-19 pandemic. Their testimony painted a bleak picture in many ways. This follow-up survey finds that many aspects of their experiences are not much better, and some are worse.
