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EventuntilWith general practice in crisis due to workforce shortages, an increasingly complex workload, rising public expectations, and further pressures caused by the Covid-19 pandemic, The King's Fund are providing the time and space for you to reflect, think differently, share and learn. Join peers and experts from The King’s Fund to explore: what the future of general practice looks like how the experience for patients and staff can be improved how to ensure those actions are building blocks towards the future. This event is for GPs, commissioners, nurses, practice managers, allied health professionals, Additional Roles Reimbursement Scheme (ARRS)-funded roles, and other professionals working in multidisciplinary general practice teams and those responsible for general practice at place or neighbourhood level. Register
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Content ArticlePrimary care is a crucial part of every healthcare system, but the US spends less on primary care and more on specialty care than other high-income countries. The results of this are burnout, high staff turnover and physician shortages. These were all major problems before Covid-19, that have been worsened by the pandemic. In this episode of The Commonwealth Foundation's podcast The Dose, host Shanoor Seervai asks Asaf Bitton, MD, executive director of the health innovation center at Ariadne Labs, what it will take to rebuild the USA's broken primary care system.
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News Article
GPs to face six-month complaint response targets under ombudsman proposals
Patient Safety Learning posted a news article in News
GP practices are set to face new targets for responding to patient complaints under standards being piloted by the health ombudsman. All ‘straightforward’ complaints should be dealt with within six months and 95% within three, while 80% of ‘complex’ complaints should be completed within six months and half within three, under the proposals. The new Parliamentary and Health Service Ombudsman (PHSO) complaint standards are currently being piloted in every sector of the NHS – including one GP practice – and were due to be implemented across the NHS this year. However, a PHSO spokesperson told Pulse that due to delays caused by the pandemic, the full rollout is now planned for the beginning of next year, with the ombudsman to implement the standards from April 2023. The proposed complaints standards said staff should ensure they ‘consistently meet expected timescales for acknowledging a complaint’ and ‘respond to complaints at the earliest opportunity’, providing ‘regular updates throughout’. They should also give ‘clear timeframes’ for how long investigating the complaint will take and ‘agree timescales with everyone involved’, including the complainant. An accompanying draft model complaint handling procedure said that complaints will be acknowledged within three working days either verbally or in writing. Read full story Source: Pulse, 24 March 2022 -
Content Article
BMA - On the edge: GPs in despair (18 March 2022)
Patient-Safety-Learning posted an article in GP and primary care
This article by the British Medical Association (BMA) looks at the pressures GPs face that are leading to an increasing number leaving the profession. Several GPs from around the UK share their personal experience of unsustainable workloads and burnout, and the impact this has had on their health and wellbeing. The article highlights the impact of changes to the system on doctors at different career stages, including the increasing number of older GPs who are retiring early due to the intense pressure of their role. -
Content ArticleThis briefing by The Health Foundation Improvement Analytics Unit looks at recent data around patient preferences for online and face-to-face consultations and examines the impact of the increasing use of online tools on patient access to primary care. The Improvement Analytics Unit examined 7.5 million patient-initiated requests for primary care made using the askmyGP online consultation system between March 2019 and September 2021 at 146 general practices in England. These practices had a combined total list size of 1.35 million patients.
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News Article
Over 80% of UK GPs think patients are at risk in their surgery, survey finds
Patient Safety Learning posted a news article in News
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 -
Content ArticleIn this opinion piece for BJGP Life, GP Chris Lowe explores potential problems with electronic access to primary care. He describes his own experience of e-consultation and warns of the potential of such technologies to make life harder for staff. He also raises concerns that rather than widen access to GPs, online access makes appointments less accessible for certain populations, and that introducing too many new technologies too quickly may cause experienced GPs to retire early.
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News ArticleJust 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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Content Article
Blog - Why do I have to wait? (12 July 2021)
Patient-Safety-Learning posted an article in GP and primary care
This blog by GP Dr Abbie Brooks examines rising patient demand for GP services and the need to manage patient expectations around appointment waiting times. It looks at the impact of the pandemic, and how patients can help primary care cope with increased demand by ensuring they are using the appropriate NHS service for their needs and being patient while waiting for initial and follow up appointments. -
Content ArticleAdvice and guidance on the health needs of migrant patients from Ukraine for healthcare practitioners.
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Content ArticleFocused practice is an approach to primary care where a family doctor or GP chooses one or more specific clinical areas as a major part-time or full-time component of their practice. In recent years, there has been a global increase in focused practice and a decline in offering a comprehensive scope of practice in primary care. This Canadian study in the British Journal of General Practice looked at factors influencing family doctors' decisions to work in focused practice. The authors of the study concluded that: both early-career and resident family doctors unanimously saw focused practice as a way to avoid the burnout or exhaustion they associated with comprehensive practice in the current structure of the healthcare system. more research is needed to understand the implications of family physician choices of focused practice within the physician workforce.
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Content ArticleFewer than 1% of UK general practice consultations occur by video. This study by Trisha Greenhalgh and colleagues aims to explain why video consultations are not more widely used in general practice.
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Content ArticleThis guidance from the British Medical Association (BMA) covers frequently asked questions around prescribing in primary care and informs GPs of the BMA general practice committee’s policies in prescribing.
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Content Article'Deep End’ general practices serve communities in the most socioeconomically disadvantaged areas. The analogy of the deep end of the swimming pool to describe how a one size fits all funding model for NHS GP practices regardless of area-based differences in patient needs leaves health professionals in high-deprivation places treading water to stay afloat. Lincolnshire’s East Coast is now amongst the most deprived communities in the UK. This in-depth article in BJGP Life reports on an event for local healthcare professionals and academic researchers hosted by First Coastal Primary Care Network (FCPCN) in November 2021, in Skegness, Lincolnshire. The aim of the event was to discuss the challenges that health professionals working within the FCPCN face with a focus on inequities and the experiences of the healthcare workforce.
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Content ArticleGeneral practice has always been the foundation and gateway to the NHS, but this part of the healthcare system is now under strain due to greater demand from an increasingly complex patient profile, and a stretched workforce. Lack of staff and coherent planning means that the current model is not fit for purpose, and this has resulted in a recent decrease in patient satisfaction. This proposal by the think tank Policy Exchange outlines the reforms that could help the NHS develop a model of general practice to better meet the needs and interests of patients and healthcare workers.
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News Article
More support needed for GPs to treat eating disorders
Patient Safety Learning posted a news article in News
Two leading medical organisations have told the BBC that GPs are not getting the right support to treat eating disorders. The Royal College of General Practitioners (RCGP) and the British Medical Association (BMA) say doctors need more time with patients and more specialist units. Beat Eating Disorders asked nearly 1,700 people about their experience of trying to get a diagnosis from their GP. Over 92% asked thought their GP needed more training with eating disorders. Out of those questioned, 69% also said they felt their GP didn't know how to help them. The survey has been released to coincide with Eating Disorder Awareness Week. Jess Griffiths had an eating disorder between the ages of 11 and 21 and, now in full recovery, she works as a consultant to NHS England and with her local eating disorder service in Dorset. She tells the BBC that when she first went to her GP to try to get help, she wasn't entirely transparent about what she was struggling with. "I was presenting at a low weight and not having periods, so the GP put me on the pill, but I went there hoping he would ask me the questions [about a potential eating disorder]" she says. "But it's really hard for people with eating disorders to - in a really pressurised situation with a doctor - say how they really feel." Dr Richard Van Mellaerts is part of the BMA's GP committee and has told the BBC the results of the survey are "deeply saddening". "People with eating disorders should never feel that GPs are a barrier to accessing care, so it is vital that medical education and training supports doctors to identify eating disorders and support their treatment," he says. But he adds that there is "poor provision of specialist care", which has left GPs "frustrated up and down the country". Read full story Source: BBC News, 3 March 2022 Read hub blog from Dr Joanna Silver on the challenges the pandemic has brought to patients with eating disorders -
Content ArticleThis systematic review in the BJGP aimed to review literature published up to December 2020 on the prevalence of burnout among GPs in general practice, and to determine GP burnout estimates worldwide. The review found: there is moderate to high GP burnout around the world. substantial variations in how burnout is defined, which has resulted in considerable variation in GP burnout prevalence estimates. that this variation presents a challenge in developing a uniform approach that considering GPs' work contexts will allow better understanding and definition of burnout.
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Content Article
Binge Eating Disorder GP Leaflet
Patient Safety Learning posted an article in Eating disorders
This leaflet from Beat Eating Disorders is designed for people with binge eating disorder to bring to a GP appointment, to help them get a quick referral from their GP to an eating disorders specialist. It has guidance for the person with binge eating disorder, and a tear-off section for the GP. -
News Article
‘Advice to GPs’ will count towards elective care target
Patient Safety Learning posted a news article in News
Avoiding GP referrals by providing ‘advice and guidance’ will contribute significantly towards NHS performance on the government’s elective care targets, according to draft NHS plans seen by HSJ. Under the elective recovery plan, hospital specialists are being asked to offer more advice when GPs are deciding whether to refer a patient for an outpatient appointment, which would avoid some patients being added to waiting lists. This is aimed at reducing instances where GPs may want to be risk averse and refer a patient when they might be unsure whether a secondary referral is needed. New documents seen by HSJ, shared in draft by NHSE last week, reveal this avoided activity will be counted in assessing if the service or individual trusts have hit key government targets to increase activity. NHS England has agreed with government to carry out 10% more ‘clock-stop’ activity in 2022-23 than was taking place pre-covid, but this is “after accounting for the impact of an improved care offer through system transformation, and advice and guidance”. Read full story (paywalled) Source: HSJ, 28 February 2022 -
News Article
Face-to-face GP appointments fall despite plea to ‘restore routine service’
Patient Safety Learning posted a news article in News
Face-to-face GP appointments have continued to fall, despite a rallying cry for doctors to restore normal services. The proportion of GP appointments held in person fell for the third month in a row to 60.3% in January, latest data show. Data published by NHS Digital on Thursday show about 25.6 million appointments were carried out in January. Of these, some 15.4 million were face-to-face. The last time it fell below this level was August 2021, when just 57.6% of appointments were face-to-face. Pre-pandemic, the proportion of GP appointments held in person was about 80%. Dr Nikki Kanani, NHS England’s medical director of primary care, told doctors last month to “restore routine service” following the successful rollout of the booster jab campaign. Writing to GPs, she said: “It is now important that all services across the NHS, including in primary care, are able to restore routine services where these were paused in line with the Prime Minister’s request to focus all available resource on the omicron national mission.” But patient groups say the “situation hasn’t improved” and patients are still struggling to see their doctor in person. Dennis Reed, from patient group Silver Voices, said the figures were “worrying” but not surprising. “I'm still getting complaints on a daily basis that people are struggling to see their GP,” he said. Read full story Source: The Telegraph, 24 February 2022 -
Content ArticleAs Clare Gerada finished the final house calls of her long career in general practice, it struck her how detached she was from her patients now – and that it was not always like this. Where did we go wrong, and what can we do to fix it? she asks in this article in the Guardian.
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Content ArticleAn author turned junior doctor’s account of the chaos at work and anguish at home as Covid-19 arrived in the UK.
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News Article
GPs each seeing 15% more patients, BMA says
Patient Safety Learning posted a news article in News
The average number of patients each individual GP is responsible for has increased by 15%, or around 300 people, since 2015, the BMA has said. This is due to the ‘slow but steady haemorrhaging’ of GPs over the last few years, which has led to pressures on services growing ‘even more acute’, it suggested. The Association’s statement comes in response to the latest GP workforce data – published by NHS Digital (10 February) – which showed that 188 FTE GPs left between December 2020 and December 2021. Dr Farah Jameel, chair of the BMA’s GP committee, said the figures are the direct result of an ‘over-stretched’ and ‘under-resourced’ NHS. She said: ‘Family doctors, exhausted and disenchanted, feel as though they have no choice but to leave a profession they love because of chronic pressures now made worse by the pandemic. Workload has dramatically increased, there are fewer staff in practices to meet patient needs.’ Insufficient staffing is particularly concerning as the backlog for care continues to grow, she suggested, with many GPs believing ‘the day job is just no longer safe, sustainable or possible anymore’. The NHS and the Government must work to retain current staff as its ‘immediate priority’ and must urgently refocus on retention strategies as a key enabler for the NHS’ recovery. She said: ‘The Government has repeatedly argued that the number of doctors is growing, but this isn’t the reality for general practice, and it begs the question: how many more have to go before something is finally done about it? Our NHS is the people who work in it, and without them, the entire system and provision of patient care is under threat.’ Read full story Source: Management in Practice, 11 February 2022 -
Content ArticleIn this article in The BMJ, Farah Hameed highlights that the backlog of care in the aftermath of the Covid-19 pandemic is having a significant and detrimental effect on primary care services, not just elective hospital treatment. The combined impact of patients not coming forward for treatment during the pandemic, and hospitals having to cancel non-urgent procedures and routine clinics, has led to a huge backlog of patients living with conditions that are gradually getting worse. It is primary care that has to support these patients in the absence of capacity in secondary care. Consultant-led hospital services rejecting GP referrals due to lack of capacity is a major problem, with the number of GP referrals rejected due to lack of slots jumping from 238,859 in February 2020 to 401,115 in November 2021. Farah argues that emphasis must be placed on how tackling the build-up of care in our communities can help the wider system. For example, making GP continuity of care a policy priority would be a cost-effective way of improving patient outcomes and reducing the burden on other parts of the healthcare system, including secondary care.
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Content ArticleIn this blog, Dr Charlotte Paddison, Senior Fellow at the Nuffield Trust, discusses whether the shift towards digital primary care risks making access easier for people with less need and harder for those more likely to be in poorer health. She also describes the actions that would help make access to primary care easier for different groups of patients.
