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Found 387 results
  1. Content Article
    In this blog for the British Journal of General Practice comment and opinion website, BJGP Life, GP Will Mackintosh discusses the impact of health inequalities on patients' ability to play an active role in their care. He calls for training for all GPs to understand the constraints and pressures that may be affecting their patients, so that they can better assess the causes of health issues and therefore treat them more effectively. The article examines concepts of freedom for both GP and patient, and argues that a purely evidence-based approach does not help patients from deprived backgrounds overcome health issues. The author highlights that GPs operate in a 'grey zone' between the medical and the non-medical, and argues that this means they are well placed to understand and help tackle the root causes of health disparities.
  2. Content Article
    These free e-learning courses about communicating the potential harms and benefits of treatment to patients have been produced by the Winton Centre for Risk & Evidence Communication, the Academy of Medical Royal Colleges in the UK and the Australian Commission on Safety & Quality in Healthcare.
  3. News Article
    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
  4. Content Article
    This research gives insights into the views of doctors who were previously practising in the UK but who are not currently doing so, in terms of their characteristics, motivations and likelihood to return to clinical practice in the UK. A survey of over 13,000 doctors was carried out between 21 January 2020 and 10 March 2020. This report was developed in partnership between the General Medical Council (GMC), Health Education England (HEE), The Department of Health (Northern Ireland), NHS Education for Scotland (NES) and Health Education and Improvement Wales (HEIW).
  5. News Article
    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
  6. News Article
    A new information standard has been developed for sharing digital information on medication and allergies across different parts of health and social care services. The standard, which aims to reduce medicines errors comes into effect this month. NHS and social care organisations will have to show compliance by March 2023. GP practices, hospitals, mental health trusts, pharmacists, community teams and residential care homes will all have to meet the standard when transferring medication and prescription information between teams. The standard will be particularly helpful in reducing medication errors when patients transfer between care locations NHS Digital said. Having specific requirements in place for how medicine and allergy information is transferred will also provide clinicians with a more detailed and consistent source of medicines related information across all care settings and allow them to obtain medicines information more quickly and efficiently, they added in a document outlining the changes. The standard defines how the send and receive messages involving medicines information are constructed, and how the data within is structured so that it is machine-readable when sent between different IT systems. Dr Simon Eccles, deputy CEO of NHSX and national chief clinical information officer said: ‘This new standard will make medicine prescribing safer for patients and easier for clinicians, reducing errors in prescription and improving the monitoring of medications that can cause harm. ‘This is the result of a true collaborative effort between NHSX, NHS Digital, industry and the frontline that will make a real difference to the care and support local clinicians can provide to their patients." Read full story Source: Pulse, 28 October 2021
  7. News Article
    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
  8. News Article
    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
  9. Content Article
    The General Practice: Health of the Nation report gives a unique overview of Australian general practice. The report reflects the experience of more than 1300 RACGP Fellows from across Australia, and incorporates information from the Australian Bureau of Statistics (ABS), Medicare, the Australian Institute of Health and Welfare (AIHW) and various government publications. The report provides information at a specific point in time and identifies longer-term trends across the general practice sector. The 2021 Health of the Nation report also highlights a number of critical issues affecting GPs and their patients, including: treatment of multimorbidities in general practice the increasing mental health burden on general practice restrictions to GP involvement in aged care barriers to the use of video telehealth services the COVID-19 vaccine rollout.
  10. Content Article
    Research shows that patients who stayed registered with the same GP over many years have fewer out-of-hours appointments and acute hospital admissions, as well as a reduced risk of death. Helen Salsibury in this BMJ article discusses the benefits of continuity of care not only for the patient but also the doctor.
  11. News Article
    Almost three out of five GPs reported managing patient expectations about vaccinations to be one of the most challenging issues of the pandemic, with multiple changes to vaccine eligibility requirements leaving many people confused and overwhelmed, the president of the Royal Australian College of General Practitioners, Dr Karen Price, said. In her foreword to the college’s Health of the Nation report, published on Thursday, Price said: “Unfortunately, some of these patients took their frustrations out on general practice staff”. “Differing eligibility requirements across jurisdictions added to the strain.” Schools should stay open as greatest risk of Covid transmission is in households, research finds The report is published annually and provides an insight into the state of general practice in Australia. It includes the findings of a survey of 1,386 GPs between April and May, of which 70% were in major cities, 20% inner-regional, 8% outer‐regional, and 2% remote and very remote. Read full story Source: Guardian, 21 October 2021
  12. News Article
    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
  13. Content Article
    This article in Social Science & Medicine examines how GPs and patients explore medical and existential uncertainty in consultations. The authors analysed 20 naturally occurring clinical consultations between general practitioners and patients in England, focusing on interactions and how they negotiated uncertainty. They found that the doctor-patient dynamic contributes significantly to the way in which medical uncertainty is discussed. By conceptualizing uncertainty in an indirect and depersonalized manner, GPs manage to safeguard against clinical errors without compromising their authority and credibility.
  14. News Article
    Pharmacists will be allowed to write prescriptions under plans reportedly being considered by England's Health Secretary Sajid Javid. Mr Javid last month vowed the Government will "do a lot more" to ensure GPs see more patients face-to-face following complaints from the public. The proposals would see more prescriptions provided through pharmacies and hospitals for routine illnesses to allow doctors more time to see patients in person, according to The Sunday Times. GPs will also reportedly be able to pass off bureaucratic processes such as providing supporting medical evidence to the Driver and Vehicle Licensing Agency (DVLA) over a patient's fitness to drive. The plans are expected to include sanctions for doctors who do not increase the number of face-to-face appointments with patients, the paper added. Read full story Source: 11 October 2021, Medscape
  15. News Article
    Continuity of care in general practice reduces use of out-of-hours care, acute hospitalisations and mortality, researchers have shown - as GP leaders warned staff shortages and heavy workload means it is becoming harder to deliver in the UK. Long-lasting personal continuity with a GP is 'strongly associated with reduced need for out-of-hours services, acute hospitalisations, and mortality', according to a study by researchers in Norway. An association lasting more than 15 years between a patient and a specific GP reduces the probability of any of these factors by 25-30%, the study published in the British Journal of General Practice found. The researchers said 'promoting stability among GPs' should be a priority for health authorities, and warned that continuity of care was under pressure. The findings come as general practice in the UK faces intense pressure amid a shortage of GPs and intense workload after more than 18 months of the COVID-19 pandemic. Responding to the findings, RCGP chair Professor Martin Marshall said: "Continuity of care is highly valued by patients and GPs and our teams alike. It is what allows us to build relationships with our patients, often over time, and this study builds the strong evidence base of its benefits for patients and the NHS." Read full story Source: GP Online, 4 October 2021
  16. Content Article
    Continuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere. An association lasting more than 15 years between a patient and a specific GP reduces the probability of any of these factors by 25-30%, a study by Sandvik et al. found. The researchers said 'promoting stability among GPs' should be a priority for health authorities, and warned that continuity of care was under pressure.
  17. News Article
    GPs are failing to urgently refer patients with “red flag” signs of suspected cancer to a specialist, research suggests. Six out of 10 patients in England with key symptoms indicating possible cancer did not receive an urgent referral for specialist assessment within two weeks, as recommended in clinical guidelines, according to a new study. Nearly 4% of these patients were subsequently diagnosed with cancer within the next 12 months. The findings were published in the journal BMJ Quality & Safety. In the study, researchers analysed records from almost 49,000 patients who consulted their GP with one of the warning signs for cancer that should warrant referral under clinical guidelines. Of the 29,045 patients not referred, 1,047 developed cancer within a year (3.6%). Early diagnosis and prompt treatment is crucial to survival chances. Every four-week delay in cancer treatment increases the risk of death by 10%. Read full story Source: The Guardian, 5 October 2021
  18. Content Article
    Clinical guidelines advise GPs in England which patients need urgent referral for suspected cancer. This study in BMJ Quality & Safety used linked primary care, secondary care and cancer registration data to assess: how often GPs follow the guidelines on cancer referral whether certain patients are less likely to be referred how many patients were diagnosed with cancer within one year of non-referral. The study included patients who presented for the first time with blood in the urine, breast lump, difficulty swallowing, iron-deficiency anaemia and post-menopausal or rectal bleeding during 2014–2015. The authors found that the majority of patients presenting with common possible cancer symptoms were not being referred by GPs in line with clinical guidelines. They also found that a significant number of these patients went on to develop cancer within a year, and suggest that improvement is needed in the cancer diagnosis process.
  19. News Article
    GP practices will be included in the remit of a new patient safety watchdog, due to come in from 2023 under the new Health and Care Bill, the Department of Health and Social Care (DHSC) has said. DHSC said that it expects the new Health Services Safety Investigations Body (HSSIB) to be ‘fully operational’ in England from April 2023 – ‘subject to parliamentary clearances’. It confirmed that the statutory independent body will investigate NHS care in GP practices, although it said that the HSSIB’s ‘focus is likely to be predominantly on investigating patient safety incidents in NHS trusts’. The body will also investigate care provided by the independent healthcare sector. RCGP vice-chair Dr Gary Howsam said: ‘It is important that we have further details about how this regulator will interact with general practice, and the expectations it will have of GPs and our teams, including ensuring GPs are not implicated for systemic issues out of their control.’ Read the full article here
  20. News Article
    Many patients are being prescribed unnecessary and even harmful treatments, a new report warns. The review, in England, suggests one-tenth of items dispensed by primary care are inappropriate or could be changed. Around 15% of people take five or more medicines a day - some are to deal with the side-effects of the others. The government is appointing a prescribing tsar to help with the issue and stop waste. Overprescribing can happen when: a better alternative is available but not given the medicine is appropriate for a condition but not the individual patient a condition changes and the medicine is no longer appropriate the patient no longer needs the medicine but continues to be prescribed it. Chief pharmaceutical officer for England, Dr Keith Ridge, said: "Medicines do people a lot of good and this report is absolutely not about taking treatment or services away from people where they are effective. But medicines can also cause harm and can be wasted." Read full story Source: BBC News, 22 September 2021
  21. Content Article
    The government commissioned Dr Keith Ridge, Chief Pharmaceutical Officer for England, to lead a review into the use of medication and overprescribing.
  22. News Article
    GPs in England are finding it "increasingly hard to guarantee safe care" as the number of doctors falls and demand surges, a senior medic said. Prof Martin Marshall, chair of the Royal College of GPs, told the Guardian GP numbers had fallen by 4.5% despite an ageing population with an increased need for care. GPs feared making serious mistakes due to excessive workloads, he said. Prof Marshall also defended the continued use of remote consultations. Prof Marshall said the demand for services from GPs, including more complex consultations and the vaccination programme, on top of this decline in numbers was putting family doctors under strain. "The fact that general practice is under such enormous pressure means it can't deliver the patient-centred services that it wants to. Many GPs are even finding it challenging to maintain a safe service," he said. He said family doctors were more likely to make a mistake if they were working 11- or 12-hour days, seeing 50 or 60 patients. "GPs are finding it increasingly hard to guarantee safe care to their patients," he said. "The chances of making a mistake in a diagnosis or a mistake in a referral decision or a mistake in prescribing are all greater when you're under stress." Read full story Source: BBC News, 11 September 2021
  23. News Article
    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'
  24. News Article
    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
  25. News Article
    GP surgery staff are facing abuse from patients who are “angry and upset” that their blood test has been cancelled because of the NHS-wide chronic shortage of sample bottles. “Patients are angry when we ring them up and say, ‘Sorry we can’t do your blood test after all’. A lot of people are quite angry and concerned about their own health,” Dr David Wrigley, the deputy chair of council at the British Medical Association, said. “Patients are quite rightly upset and some get quite aggressive as well. They are worried because they don’t know what the implications of their cancelled test are for their health.” GP practices in England had begun cancelling appointments because the NHS’s main supplier could not deliver stocks as planned for one to two weeks because of “unforeseen road freight challenges”. NHS England has responded to the shortage of blood sample bottles by telling GPs to cancel all but clinically urgent blood tests and hospitals to cut back the tests they do by at least 25%. Read full story Source: The Guardian, 6 September 2021
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