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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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Content ArticleThis study in the British Journal of General Practice aimed to examine the impact of Covid-19 on GP contacts with children and young people in England. The authors conducted a longitudinal trends analysis using electronic health records from the Clinical Practice Research Datalink (CPRD) Aurum database. The study found that: GP contacts fell 41% during the first lockdown compared with previous years. Children aged 1-14 years had greater falls in total contacts (≥50%) compared with infants and those aged 15–24 years. Face-to-face contacts fell by 88%, with the greatest falls occurring among children aged 1-14 years (>90%). Remote contacts more than doubled, increasing most in infants. Total contacts for respiratory illnesses fell by 74% whereas contacts for common non-transmissible conditions shifted largely to remote contacts, mitigating the total fall (31%).
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Content ArticleLisa Drake, an NHS ex General Practice Manager now working in a digital advisory role, shares some of the missed opportunities for digital ways of working she witnessed when she was a patient herself.
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Content ArticleVideo and telephone consultations have, through the course of the pandemic, become a central of daily operations across the NHS. In this blog, Ben Gadd and Amanda Nash of University Hospitals Plymouth NHS Trust share their experiences about how they are being received and the potential lessons we can learn.
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Content ArticleThe Department of Health today published the 2021/22 Inpatient, Day Case and Outpatient Hospital Statistics for Northern Ireland. Analysed by HSC Trust, hospital and specialty, these Hospital Statistics publications outline: the number of inpatient and day case admissions. the number of attendances at consultant led outpatient services in Northern Ireland during 2021/22.
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Content ArticleWith the number of outpatient hospital appointments in England recently as high as 125 million per year and a huge elective care backlog following the Covid-19 pandemic, patient-initiated follow-up on outpatient appointments has been touted as a potential solution in appropriate cases. But can it free up much-needed capacity while maintaining quality of patient experience and outcomes? As the NHS begins to expand its use of the approach, the NIHR RSET research team has conducted a first review of the available evidence.
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Content ArticleFor many patients, online access to their GP’s services is a normal part of their everyday interaction with the NHS. The majority of patients in England use at least one GP Online Service to request prescriptions, book appointments or access their electronic health record. It is part of modern, responsive primary care services for patients, their families and carers. It is convenient and reliable for patients and useful for practices. It can foster a person-centred approach to care, especially for patients with long term conditions or complex multi-morbidity. The Royal College of General Practitioners (RCGP), in collaboration with NHS England, have developed the guidance and resources in this Toolkit to help practices provide GP online services effectively, efficiently, safely and securely. The Toolkit includes clinical exemplars which demonstrate how GP online services can empower patients to take greater control of the management of their health conditions. It does not cover online consultations.
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Content ArticleThis guide by the charity Menopause Support offers advice for women who may be experiencing menopause symptoms about how to approach an appointment with their GP. It covers preparing for the appointment with research, making a note of your symptoms, how to ask questions, taking a friend or family member to support you, and further support you can request during the consultation.
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Content ArticleThe Covid-19 pandemic triggered a very sudden and widespread shift to remote consulting in general practice. Many patients and healthcare professionals have welcomed the convenience, quality and safety of remote consulting, but there are inherent tensions in choosing between remote and face-to-face care when capacity is limited. This report by the Nuffield Trust explores the opportunities, challenges and risks associated with the shift towards remote consultations, and the practical and policy implications of recent learning.
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Content ArticleIn this blog, Jeremy Hunt MP, Founder of Patient Safety Watch, argues against introducing more targets for GPs. The new Health Secretary, Therese Coffey MP, plans to introduce a target to ensure that all patients see their GP within two weeks. The blog highlights two issues with this approach: Setting a new target won’t make it a reality Having too many targets result is a system that depersonalises patients, deprofessionalises frontline staff and means it is difficult for health services to prioritise It then proposes that the health system should learn from the UK education system's approach to regulatory oversight, which is aimed at driving up standards, rather than achieving grades.
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Content ArticleIn this short analysis from the Health Foundation, data from the GP patient survey, an annual independent survey run by Ipsos MORI on behalf of NHS England, was used to explore who gets good access to general practice, unpicking how patient satisfaction with the service they receive varies by deprivation, age and ethnicity. Note: The 2020 GP patient survey data were mostly collected before the COVID-19 pandemic, therefore this analysis doesn’t reflect patient experiences or service changes during the pandemic.
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Content ArticleThe purpose of this Royal College of Nursing (RCN) document is to provide standards and sample assessment tools for training in genital examination in women for registered nurses working in sexual and reproductive health settings, and related health and social care settings. It is envisaged that this document could be used by registered health care professionals who would require training in genital examination in order, for example, to undertake the following procedures: cervical sampling including liquid based cytology and colposcopy taking swabs as part of a sexual health examination inserting, checking or removing intrauterine devices and IUS vaginal ultrasound hysteroscopy nurses working within early pregnancy and acute gynaecology settings and as part of any extended role in history taking and examination for the assessment of symptomatic women.
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Content ArticleDr Kathryn Leask outlines steps GPs can take to try and avoid patients coming to harm as a result of delayed referrals and provides advice on dealing with patient complaints on this issue. There are some steps GPs can take to try to avoid patients coming to harm while putting themselves in the best position to address the potential medico-legal ramifications. In their guidance on Delegation and referral the GMC says that you are not accountable for the actions or omissions of colleagues to whom you make referrals. However, you are accountable for your decisions to transfer care and the steps you have taken to make sure that patient safety is not compromised. If you are aware that there are delays for a particular service and your patient is likely to be affected by this, you should make this clear to them and manage their expectations from the outset. In this GP Online article, Kathryn gives practical tips for GPs and shares a case example.
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Content Article
NHS: How to register with a GP practice
Patient Safety Learning posted an article in GP and primary care
You have the legal right to choose a GP practice that best suits your needs. Here are some tips on how to register with a GP practice. -
Content ArticleIt is often the case that particular healthcare policies and practices change overnight from being discouraged or even forbidden to becoming more or less compulsory. An example of this is the change in how patients can access doctors during the coronavirus pandemic. At the end of July, Matt Hancock gave a speech on the future of healthcare in which he declared “… from now on, all consultations should be teleconsultations unless there is a compelling reason not to.” The following day, Sir Simon Stevens’ letter on the third phase of the NHS response to COVID-19 gave more nuanced messages and acknowledged the place of face to face consultations alongside digital and telephone consultations in some circumstances. Meanwhile, a recent RCGP survey reported that at the present time 61% of appointments are full telephone consultations and 16% are telephone triages. Many changes in how patients can access doctors have the potential to offer great benefits to patients and to ease pressures on health systems; however, what is right in some circumstances is not right for all as Ros Levenson, Chair of Academy Patient and Lay Committee, Academy of Medical Royal Colleges, discusses in her blog.
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Content ArticleIn this blog, Steve Turner provides a guide for patients to help them understand what they should come away with at the end of a consultation. He argues that if these areas have not been covered, the consultation is incomplete and a patient should not accept this.
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Content ArticleNHS England is pushing plans to introduce a ’call before you walk’ model for accident and emergency by winter. But are the health service and the public ready for such a significant shift? HSJ bureau chief and performance lead James Illman tracks the prospects and progress in HSJ's Recovery Watch newsletter.
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Content ArticleResearch by the British Medical Association (BMA) concludes that over a million planned operations and treatments as well as over twenty thousand cancer treatments have been cancelled or delayed between April and the end of June this year because of the pandemic. The Association’s research also estimates that more than two and a half million first time outpatient appointments were cancelled during the same time period. This paper coincides with the BMA’s latest survey of 5,905 doctors in England and Wales, asking about the impact of the pandemic on their patients and their working lives. As part of the survey, they were asked if, within the last week, they had treated patients with conditions at a later stage (e.g. cancer, heart disease) than they would normally expect. A little over 40% said that they had. Behind this data are the scores of patients whose routine surgery or procedure has been put aside in the rush to reconfigure the NHS to cope with COVID-19. Even worse, doctors know there are those whose illnesses are far more serious than they were, some now beyond cure.
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Content ArticleThe National Patient Safety Agency (NPSA) issued guidance on preventing delay to follow up for patients with glaucoma [NPSA/2009/RRR004]. This followed evidence of harm to patients with glaucoma suffering visual loss after delays to follow up appointments. This came to light from incidents reported by staff in the NHS relating to glaucoma. This paper provides background information and a checklist for organisations to help implement actions in the accompanying guidance to prevent harm from delayed follow-up appointments for patients with glaucoma. It presents details of incident data and litigation data. This work was supported by an interactive event in March 2009 with input from ophthalmic surgeons (and the Royal College of Ophthalmologists), nurses, service managers and patient representatives.
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Content ArticleThe Care Quality Commission (CGC) is the independent regulator of health and adult social care in England. They make sure that health and social care services provide people with safe, effective, compassionate, high-quality care and encourage care services to improve. Independent acute hospitals play an important role in delivering healthcare services in England, providing a range of services, including surgery, diagnostics and medical care. As the independent regulator, the CQC, hold all providers of healthcare to the same standards, regardless of how they are funded.
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Content ArticleIt is now very common for clinicians to carry out consultations with patients over the telephone. If you have time to prepare for the consulation Steve Turner has some suggestions. The aim being to help all patients / users of health and care services lead on their own care. This is a rolling blog. Steve Turner is a nurse prescriber and clinical educator and Associate Lecturer at Plymouth University.
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Content ArticleLetter to all cancer alliances providing guidance on managing cancer referrals.
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Content Article
Health appointment information sheet: Easy read
Claire Cox posted an article in Learning disabilities
This easy read document, from Macintyre, should be used as an aid in helping people to: prepare for their appointment participate in the appointment understand the advice given at the appointment. It can also be presented to the health professional - by using information from One Page Profile, the document serves as an aid for the health professional on how to engage with the person during the appointment. -
Content ArticleCaring for people with learning disabilities in an acute hospital setting can be challenging, especially if that patient has transitioned from children’s services to adult services. The experience in children’s acute care differs to adult acute care; this difference in processes of care can cause great anxiety for the patient and their family and carers. The reasonable adjustments that were perhaps made and sustained in children’s services may now not exist. The purpose of this blog is to demonstrate the importance for services to be designed around patients’ needs with patients, families and carers. If we get this right, the quality of care given will be improved, patient satisfaction increases and, in turn, a reduction in patient harm. It is important to note that designing services around patients is not exclusive to learning disabilities; designing services with ALL patients at the centre with their involvement is crucial for trusts to provide safe care.
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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.
