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News Article
Substantial fall in diabetic health checks as GPs reprioritised during pandemic
Patient Safety Learning posted a news article in News
The proportion of patients with type 2 diabetes who have had recommended health checks has fallen substantially, provisional data from 2021 suggests, as have the numbers hitting key disease control targets. In response, primary care experts have called for GP practices to receive targeted investment to focus on the checks, which they had to deprioritise as the vaccination programme was introduced. There are now 3.24 million people with a diagnosis of type 2 diabetes in England, the data across all GP practices shows. National Diabetes Audit figures for England from January to September 2021 showed that: 74% of patients had received a HbA1c check and 70% a blood pressure check compared with 93% and 95% respectively in 2019/20. In the first nine months of last year, 61.9% of patients had an HbA1c under 58 mmol/mol, compared with around 66% in previous years. The proportion of patients with blood pressure targets of under 140/80 was 66.5% in the latest figures compared with around 73-74% during 2015 to 2020. Speaking with Pulse, Professor Partha Kar, NHS England national specialty advisor for diabetes said while this was not the final data, a drop off had been expected for a range of reasons outside GPs control. ‘What we have seen is that there was a massive drop off in wave one. Then around the middle of 2020 it started to pick up again but then it’s dropping off again so irrespective of data cleaning, I suspect you will see a massive drop off compared to where things have been over the last four or five years. ‘We need to be very clear its not because anyone was twiddling their thumbs, it’s because primary care was asked to do something else. ‘We can’t go back to primary care again for the vaccines because they are being taken away from the thing that they’re amazing at which is delivering long-term conditions at scale.’ Read full story Source: Pulse, 2 February 2022 -
Content ArticleThis article in the British Journal of General Practice examined GP perspectives and concerns about safeguarding during the Covid-19 pandemic, focusing on the challenges and opportunities created by remote consultation. GPs interviewed for the study expressed concern about missing observational information during remote consultations, with pooled triage lists seen as further weakening safeguarding opportunities. They were also worried that conversations might not be private or safe. Remote consultations were seen as more ‘transactional’, with reduced opportunities to explore ‘other reasons’ including new safeguarding needs. Remote consultation was seen as more difficult and draining and associated with increased GP anxiety and reduced job satisfaction. However, GPs also recognised opportunities that remote consulting offers, including providing more opportunities to interact with vulnerable patients.
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Content ArticleDoctor Laura Mount reveals in a new series in the Guardian how staff sickness, spiralling waiting lists and political pressure have left GPs on the brink.
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Content ArticleThis report by The Health Foundation reviews attempts to tackle inequities in the supply of general practice services in England over the past 30 years. The ‘inverse care law’ was first defined by the GP Julian Tudor Hart 50 years ago and describes how people who most need health care are least likely to receive it. The report looks at policies on general practice funding, workforce, premises, contracts and commissioning, examining recent evidence on differences in GP services between more and less deprived areas of England and assessing past national policies to reduce inequities. The report then looks at the implications of this analysis and outlines policy recommendations for addressing the inverse care law in general practice.
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Content ArticleThis study in the British Journal of General Practice looked at the association between continuity of GP care and potentially inappropriate prescribing in patients with dementia, as well as the incidence of adverse health outcomes. The study authors found that for patients with dementia, consulting with the same doctor consistently, resulted in: 35% less risk of delirium 58% less risk of incontinence 10% less risk in emergency admission to hospital less inappropriate prescribing. The results demonstrate that increasing continuity of care for patients with dementia could improve their treatment and outcomes.
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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 -
Content ArticleIn this article for The Independent, Hannah Fearn looks at the issues women face when seeking treatment for urinary tract infections (UTIs). New research from Garmin has found that 40% of young women say they have been accused of over-exaggerating symptoms or being “over dramatic” about their wellbeing when seeing a doctor. The author highlights several personal stories of women who have experienced debilitating recurring urinary tract infections (UTIs), describing dismissive and discriminatory treatment from both GPs and secondary care doctors. She also looks at the work of the UK's only dedicated research centre focused on recurrent UTIs for women, based at London’s Whittington Hospital, and highlights new treatments that are becoming available for women with recurrent UTIs.
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News Article
GP’s ethnicity ‘affects level of support they get’
Patient Safety Learning posted a news article in News
A GP’s ethnicity has an impact on the level of leadership support it gets from regulators and external bodies, a new Care Quality Commission (CQC) report has suggested. In 2021, the CQC conducted research looking at concerns raised by some doctors that ethnic minority-led GP practices were “more likely to have a poorer experience or outcomes” from regulation. In a final report, the CQC has admitted ethnic minority-led practices are “not operating on a level playing field”, due to several factors including the fact they are more likely to care for populations with higher levels of socio-economic deprivation and poorer health. This can affect their ability to achieve some national targets used in assessments of quality, and increase challenges around recruitment and funding. The evidence gathered by the CQC also suggested that practices led by ethnic minority doctors “often lacked leadership support from other bodies and suffered from low morale”. Read full story (paywalled) Source: HSJ, 19 January 2022 -
Content ArticleProviders led by GPs of an ethnic minority background have raised with the Care Quality Commission (CQC) concerns that they do not receive the same regulatory outcomes from CQC as providers led by GPs of a non-ethnic minority background. To investigate and respond to these concerns, CQC started a programme of work in February 2021. The focus of this has been on how CQC's regulatory approach affects ethnic minority-led GP practices and how it can improve its methods to address any inequalities identified.
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News Article
GPs should regularly review self-harm patients, says draft NICE guidance
Patient Safety Learning posted a news article in News
GPs should regularly review self-harm patients and offer a specific CBT intervention, according to a consultation on the first new guidance for self-harm to be drawn up in 11 years. The new draft guidance emphasises the importance of referring patients to specialist mental health services, but stresses that, for patients who are treated in primary care, continuity is crucial. If someone who has self-harmed is being treated in primary care, GPs must ensure regular follow-up appointments and reviews of self-harm behaviour, as well as a medicines review, the draft guideline say. They must also provide care for coexisting mental health issues, including referral to mental health services where appropriate, as well as information, social care, voluntary and non-NHS sector support and self-help resources. The guidance says that referring people to mental health services would ‘ensure people are in the most appropriate setting’. However, the committee agreed that ‘if people are being cared for in primary care following an episode of self-harm, there should be continuity of care and regular reviews of factors relating to their self-harm to ensure that the person who has self-harmed feels supported and engaged with services’. The draft guidance, out for consultation until 1 March, also says ambulance staff should suggest self-harming patients see their GP to maximise the chance of engagement with services. It says: ‘When attending a person who has self-harmed but who does not need urgent physical care, ambulance staff and paramedics should discuss with the person (and any relevant services) if it is possible for the person to be assessed or treated by an appropriate alternative service, such as a specialist mental health service or their GP.’ It notes that ‘ambulance staff often felt that the emergency department was not the preferred place that the person who had self-harmed wanted to be taken. They agreed that referral to alternative services could facilitate the person’s engagement with services’. Read full story Source: Pulse, 18 January 2022 -
Content ArticleThis study in the British Journal of General Practice aimed to examine the relationship between empathy and patient-reported satisfaction, consultation quality, and patients’ trust in their physicians. It also sought to determine whether this relationship is moderated by a physician’s gender. The authors found that doctors self-reported more gender differences in measures of empathy than were observed in external measures, which included a facial recognition test, observations and a Synchrony of Vocal Mean Fundamental Frequencies (SVMFF), which measures vocally coded emotional arousal. SVMFF significantly predicted all patient outcomes, and could be used as a cost-effective proxy for relational quality.
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Content ArticleIn this second podcast focusing on the Care Quality Commission's (CQC) GP Inequalities Project, Annabelle Stigwood, joint project lead, talks to Dr Faizan Ahmed, National Clinical Advisor at the CQC, and Dr Bola Olowabi, Director - Health Inequalities at NHS England and NHS Improvement. The guests discuss health inequalities and how they impact on the ability of GP practices to do their job. They discuss what we mean by health inequalities, why it's so important to focus on them in health and social care, and the role of providers, systems and regulators in addressing them. Listen to the first episode which introduces the project
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News Article
Tory pledge to bolster GP surgery staff set to be broken, say health leaders
Patient Safety Learning posted a news article in News
A manifesto pledge to hire 26,000 extra health professionals to work in GP surgeries is set to be broken by the government, health leaders have warned, leaving family doctors straining under a heavier workload. About 9,500 of the promised physiotherapists, pharmacists, mental health therapists and other clinical staff so far have been recruited to help GPs and practice nurses. Senior doctors have warned that patients will pay the price for the slow delivery of extra personnel by facing persistently long waits for an appointment. The plan was to free up family doctors’ time by having physiotherapists see patients with sore backs, pharmacists undertaking medication reviews, counsellors supporting people with mental health problems and dieticians advising those with food-related problems. Those 26,000 staff, alongside the arrival of “6,000 more doctors in general practice” in a separate pledge, would help GPs and their teams offer 50m more consultations, the Conservatives said. But in November the health secretary, Sajid Javid, admitted that Johnson’s often-repeated 6,000 extra GPs pledge would be missed. “Whilst progress in meeting this target is better than the GP [recruitment] target, it’s still slow and very concerning that this could be another promise that won’t be met,” said Prof Matin Marshall, the chair of the RCGP. “The impact of not having enough staff in general practice is being felt acutely both by GPs and our team members who are working to their limits, and our patients, who are facing longer waits for the care they need. Meeting this [extra staff] target – and the GP target – will be vital to addressing this.” Read full story Source: The Guardian, 9 January 2022 -
Content ArticleThis guide by the University of Birmingham's Institute for Mental Health is designed to help young people prepare to talk with their GP about self-harm and suicidal experiences. It contains advice about what to do before, during and after a GP visit.
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Content ArticleUniversity Hospitals Leicester NHS Trust has published a guide to help parents and carers know what to do when young children fall ill. It gives advice on when and where to seek treatment for children suffering from common illnesses or injuries. The guidance, written by doctors, focuses on coughs, minor head injuries, vomiting and fever. The trust said it hoped to help families avoid long waits in A&E departments. Advice in the guide aims to help people decide whether to seek help from their GP, call 111, visit A&E or treat children at home.
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Content ArticleThis study in the British Journal of General Practice aims to identify and understand the unintended consequences of online consultations in primary care. The authors interviewed 19 patients and 18 general practice staff at eight general practices using online consultation tools in South West and North West England between February 2019 and January 2020. The study found the following unintended consequences of online consultation: Creation of difficulties for some patients in communicating effectively with a GP. The system disadvantaged digitally-excluded patients. Patient uncertainty about how their queries were dealt with, and whether practices used online consultations as their preferred method for patients to contact the practice. Creation of additional work for some staff. Isolation and dissatisfaction for some staff.
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News Article
GPs in dark over plans to drop care warn move could ‘swamp NHS’
Patient Safety Learning posted a news article in News
GPs and hospital leaders have been left hanging over plans to drop “non-urgent” care, and warn there’s no way to safely stem demand without impacting patients health or “swamping” the NHS further. On Monday evening the NHS published guidance for GPs and hospital leaders over expectations to deliver the government’s new deadline for all adults to be offered a booster vaccine by the new year. The guidance comes as reports surfaced on Tuesday that ministers were warned the NHS should expect a “significant” increase in hospitalisations, as modelling showed Omicron cases may reach 200,000 a day. NHS England sent letters to all GP practices and Trust chiefs on Monday evening setting out some plans to support the vaccine drive, which included opening community vaccine clinics 12 hours a day every day of the week. However, the guidance was not clear on what work GPs and trusts could specifically drop to support the drive. Several NHS leaders raised concerns over the “nightmare” of deciding what care can be reduced, in lieu of any detailed guidance from the government or NHS England, with one leader calling for “clear directive”. Read full story Source: The Independent, 14 December 2021 -
Content ArticleThe Cardiovascular Disease Prevention Audit (CVDPREVENT) is a national primary care audit that automatically extracts routinely held GP data. This tool provides open access to the data, with clear, actionable insights for those tasked with improving cardiovascular health in England.
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Content ArticleIn this blog Dr Peter Green, CVDPREVENT Workstream Clinical Lead for the NHS Benchmarking Network, looks at the importance of understanding how demographic factors impact the risk of cardiovascular disease, which is a leading risk factor for premature death. He discusses how the CVDPREVENT audit will help primary care healthcare professionals work with their patients to achieve better outcomes for all.
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Content ArticleIn this podcast for the Care Quality Commission (CQC), Dr Ayisha Ashmore and Dr Faizan Ahmed discuss the CQC's GP Inequalities Project which is investigating the concern that GPs from an ethnic minority background receive poorer CQC ratings or regulatory outcomes.
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News ArticleAround 80% of adolescents who died by suicide or who had self-harmed had consulted with their GP or a practice nurse in the preceding year, shows new research. The large study of 10 to 19-year-olds between 2003 and 2018, published in the Journal of Child Psychology and Psychiatry, also puts forward a series of proposals to deal with the problem. The study, funded by the NIHR Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC), a partnership between The University of Manchester and The Northern Care Alliance NHS Foundation Trust (NCA). It showed that 85% who later took their own lives consulted with their GP or a practice nurse at least once in the preceding year; the equivalent figure was 75% for those youngsters who harmed themselves non-fatally. Lower than expected rates of diagnosis of psychiatric illness, around a third in both groups, were probably down to a lack of contact with mental health services, rather than an absence of psychiatric illness, argue the research team. Depression was by far the commonest of the examined conditions among both groups, accounting for over 54% of all recorded diagnoses. Also, while suicide was more common in boys, non-fatal self-harm was more common in girls. Two-thirds of adolescents who died by suicide had a history of non-fatal self-harm. And while self-harm risk rose incrementally with increasing levels of deprivation, suicide risk did not. Read full story Source: The University of Manchester, 7 December 2021
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News Article
Covid: Doctors' leaders back postponed health checks
Patient Safety Learning posted a news article in News
Doctors' leaders have welcomed plans to allow GPs in England to defer some services to deliver Covid booster jabs instead. Practices can postpone minor surgery and routine health checks for over-75s and new patients until 31 March. All adults in England are expected to be offered boosters by the end of January in response to the emergence of the Omicron variant. A further 75 Omicron cases were confirmed in England on Friday. On Saturday the UK reported a further 42,848 cases of coronavirus and 127 deaths within 28 days of a positive Covid test while 372,557 booster jabs were administered on Friday. Dr Farah Jameel, the GP committee chair of the British Medical Association, said the new measures would release GPs from "filling out paperwork" and chasing unnecessary and often undeliverable targets. She told BBC Radio 4's Today programme: "We have been struggling with significant prevailing workforce pressures - backlog pressures, winter pressures, pandemic pressures. "Whilst these changes make a difference and start to create some time, I think every single practice will have to look at just how much time it does release." Read full story Source: BBC News, 5 December 2021 -
News Article
CQC threatens to suspend licence of ‘large scale’ GP provider
Patient Safety Learning posted a news article in News
A major GP group in Plymouth covering tens of thousands of patients could have its licence removed after failing to make ‘substantial improvements’ ordered by the Care Quality Commission (CQC). In August, the CQC rated the Mayflower Medical Group “inadequate” and last month the regulator said it had served a “letter of intent” on the group after another inspection. Such a letter is the last step the CQC takes before a provider’s licence is suspended. Licence suspension would affect around 40,000 people (a sixth of Plymouth’s population), who live in one of the highest areas of deprivation in the country – according to Public Health England (now the UK Health Security Agency). Among the CQC’s concerns were safety fears about the way medicines were prescribed, poor management of high-risk patients, coding issues, limited monitoring of the outcomes of care and treatment, and patients experiencing difficulties accessing care and treatment. Read full story (paywalled) Source: HSJ, 2 December 2021 -
News Article
GPs in England may stop monitoring vulnerable patients
Patient Safety Learning posted a news article in News
Ministers may allow GPs in England to halt regular monitoring of millions of patients with underlying health problems as part of the urgent new blitz on delivering Covid booster jabs. Sajid Javid and NHS bosses are locked in talks with GP representatives at the British Medical Association (BMA) about relaxing rules which mean family doctors undertake checks on people with diabetes, high blood pressure and other conditions that mean they are at higher risk of having a heart attack or stroke. It came as the health secretary announced the government has secured contracts to buy 114m more vaccine doses for next year and 2023. The deals, accelerated in the wake of the Omicron variant, will see the UK purchase 54m more Pfizer/BioNTech jabs and 60m from Moderna to “future-proof” the inoculation programme, Javid said. The BMA, the doctors’ union, has been lobbying Javid for months to suspend or scrap the Quality Outcomes Framework (QOF), which it says is “bureaucratic” and interferes with GPs’ right to judge how they care for patients. Officials with knowledge of the talks told the Guardian that those involved spent much of Tuesday discussing the suspension of part or all of the requirements under QOF. “They’re talking about a partial suspension of QOF. But they may well just bin it,” one said. However, sources stressed that ministers are nervous about approving a move that could lead to claims that vulnerable patients could see any deterioration in their condition go undetected by GPs. Read full story Source: The Guardian, 1 December 2021 -
News Article
Unsupportive Government ‘indirectly puts GP patient lives at risk’
Patient Safety Learning posted a news article in News
A lack of support for general practice is indirectly putting patient lives at risk, amid escalating abuse in GP practices, the England LMCs conference has heard. A debate around abuse saw 99% of conference delegates agree that ‘the abuse of primary care staff directly affects patient care and puts patient safety at risk’. And 98% agreed that ‘when Government and [NHS England] choose not to support NHS staff, they directly affect patient safety and knowingly put lives at risk’. The conference also voted to ‘demand that healthcare policy is decided based on high-quality evidence on population health, and not the whims of a handful of vitriolic media’, with the vote unanimous on the topic. Speaking in the debate, which focussed on GP abuse and wellbeing, Dr Abel Adegoke of Wirral LMC told delegates that the NHS "runs on the blood of GPs" He said: "About four weeks ago, my younger sister was being buried and I had to watch via Zoom because that was taking place in Nigeria – yet I was still seeing patients. That was the day I felt so sad about being a GP because despite that sacrifice, I was still abused by a patient who wanted to be seen urgently for an absolutely non-urgent condition." "We are being taken for granted." Read full story Source: Pulse, 30 November 2021
