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News Article
Poorer areas in England suffer most from GP shortage, study finds
Patient Safety Learning posted a news article in News
The gap between the number of GPs per patient in richer and poorer parts of England is widening, according to analysis by University of Cambridge. The study for BBC Newsnight saw "stark inequalities" in GPs' distribution. Separate BBC research also found patient satisfaction on measures such as how easy a practice is to reach by phone is lower in deprived areas. The Department of Health and Social Care said it was focusing support on those who need it most. Earlier this year, public satisfaction with GP care - as measured by the British Social Attitudes poll - fell to its lowest level across England since the survey began in 1983. The fall was widespread across all income groups. The finding chimes with a Health Foundation analysis of official checks on the quality of services carried out by the Care Quality Commission (CQC). It found practices serving patients living in the most deprived areas are more likely to receive CQC ratings of "inadequate" and "requires improvement" than those serving patients who live in the most affluent areas. Read full story Source: BBC News, 4 November 2022 -
News Article
GPs giving antidepressants to children against guidelines
Patient Safety Learning posted a news article in News
GPs are breaching medical guidelines by prescribing antidepressants for children as young as 11 who cannot get other help for their mental health problems, NHS-funded research reveals. Official guidance says that under-18s should only be given the drugs in conjunction with talking therapies and after being assessed by a psychiatrist. But family doctors in England are “often” writing prescriptions for antidepressants for that age group even though such youngsters have not yet seen a psychiatrist, according to a report by the National Institute for Health and Care Research (NIHR), the NHS research body. The report linked the prescriptions to the long wait many young people, some self-harming or suicidal, face before starting treatment with NHS child and adolescent mental health services (CAMHS). Under-18s are prescribed the drugs for anxiety, depression, pain and bedwetting. The guidance on antidepressants has been issued by the National Institute for Health and Care Excellence (NICE), which advises the NHS on which treatments are effective. Referencing NICE’s recommendation of a two-step approval process, the NIHR study said “this often” did not happen. “No antidepressants are licensed in the UK for anxiety in children and teenagers under 18 years, except for obsessive compulsive disorder. Yet both specialists [psychiatrists] and GPs prescribe them. Thousands of children and teenagers in the UK are taking antidepressants for depression and anxiety. The numbers continue to rise and many have not seen a specialist.” Read full story Source: The Guardian, 4 November 2022 -
Community Post
Expert patients and repeat medications
Clive Flashman posted a topic in GP and primary care
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It's rare that I post personal information of any kind on a website such as this, but this really irked me so felt it was worth sharing. Context: I've been an Asthma sufferer since the age of 3 years old. I know exactly how to manage my condition having had it for over 50 years, and have always used a blue ventolin inhaler as and when necessary (perhaps once every 2-3 months). I have not had any serious issues with my Asthma for at least 20 years, and then only in Hayfever season. Issue: I only renew my inhaler when it expires, every 2 years or so. Therefore it is not listed on my repeat medications list. My most recent one had just run out, so I needed a replacement. Action: I emailed the GP's website as I knew I was meant to, and received an automated email back saying that I would receive a response within 5 working days. So far so good. Response: I received another email response 2 days later (pretty good!) saying that the GP would have to call me to run through why I needed a new inhaler. GP call: The GP rang on the set day and within the allocated time window and started asking me how often I used the inhaler, for what, and did I really need that or the preventative one (which I've had before). At the end of our 10 minute call, she agreed that I just needed a replacement blue ventolin inhaler, as I had asked for in the first place. What a waste of the GP's time, and mine!! It made me think that it would be a helpful thing if certain patients with decades of experience in managing their condition(s) in a very stable way could be classed as 'expert patients' on their GP record. This could save a huge amount of wasted time on both sides!! This blog post first appeared on Linkedin on 30 October 2022. I will post some of the responses to it below for added insight.- Posted
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News ArticleGeneral practices should delay rolling out the accelerated citizens’ access programme, due to go live on 1 November, if they have concerns over safety, the BMA has said. In guidance published on 25 October the BMA’s General Practitioners Committee said that while many practices would be able to implement the scheme before the deadline some would need more time to prepare, to ensure that they can roll it out in line with the Data Protection Act and safeguarding measures. The access scheme, led by NHS England, will automatically give patients the ability to see any new entries to their GP medical record through the NHS App. As part of safeguarding practices it will require GPs to review each record to identify any safety concerns related to providing patient access, such as in cases of domestic violence or coercive relationships. Where there are safeguarding concerns, practices can prevent patients from having automatic access by adding a specific SNOMED code to the patient’s record before 1 November 2022. David Wrigley, deputy chair of the BMA’s GP Committee for England, said, “We have a duty of care to speak up when patient safety is at risk, which is why we encourage practices even slightly unsure about whether they can deliver this programme before the start of November, to refer to our guidance. Our patients are at the heart of what we do, and we will always act in their best interests.” Read full story Source: BMJ, 26 October 2022
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News Article
Home blood test kits ‘piling work on NHS’
Patient Safety Learning posted a news article in News
Private companies are offering “misleading” home blood-testing kits that fuel health anxieties and pile pressure on the NHS, a report has suggested. There has been a boom in sales of the kits, which promise to reveal everything from cancer risk to how long patients can expect to live. But an investigation by the BMJ found these “unnecessary and potentially invasive tests” can be misleading and generate false alarms. The NHS is then left to “clear up the mess” as worried patients see GPs for reassurance or extra tests, piling more pressure on the overstretched service. One GP described patients coming in “clutching the results of private screening tests”, with doctors asked to review the results. The companies have been criticised for not providing sufficient follow-ups after the “poor quality and overhyped” tests, and for misleading results such as wrongly telling people their test levels are outside the “normal” range. Bernie Croal, president of the Association for Clinical Biochemistry and Laboratory Medicine, said: “Most of the online [tests] will send the results to the patient with at best a sort of asterisk next to the ones that are abnormal, with advice to either pay some more money to get some sort of health professional to speak about it or go and see your own GP.” Doctors are calling for the tests to be more tightly regulated by the health watchdog, the Care Quality Commission. Read full story (paywalled) Source: The Times, 27 October 2022 -
Content Article'State of Care' is the Care Quality Commission's annual assessment of health care and social care in England. The report looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve.
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News Article
General practice is like calling an Uber, MPs say
Patient-Safety-Learning posted a news article in News
Patients in England are being put at risk because of the unacceptably poor service they receive from GPs, MPs say. The House of Commons' Health Committee blamed the failure to tackle doctor shortages, which had led to a decline in the GP-patient relationship. Seeing a GP should not be like booking an Uber with a driver you are unlikely to see again, the MPs said. The warning comes just weeks after ministers launched a drive to improve access to GP services. But the cross-party group of MPs said more needed to be done. Louise Ansari, from the patient group Healthwatch England, said, "The impacts of poor access can be huge, with people feeling abandoned and suffering in silence and not getting referred to hospitals for more specialised treatment." Read full story Source: BBC News, 20 October 2022 -
Content ArticleThis Health and Social Care Select Committee report examines the pressure currently facing general practice, which is leading to low morale, GPs leaving the profession and problems recruiting new GPs. In turn, patients are increasingly dissatisfied with the level of access they receive. The root cause of the situation is that there are not enough GPs to meet the ever-increasing demands on the service, coupled with patients presenting with increasing complexity due to an ageing population. The report outlines the Committee's assessment of the key issues, including the problems with reliance on locum doctors and lack of continuity of care, and outlines what the Government should do to equip general practice for the future.
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Content ArticleThis opinion piece by GP educator and writer John Launer looks at the current delays and cancellations to routine appointments facing patients with long term conditions. He describes his personal experience of waiting three years with no face-to-face of phone appointment to review his condition, when this should happen every six months. John outlines the fact that routine outpatient care in some hospitals is unravelling, but with no monitoring of the situation and without publicity. He highlights the risks for patients who are not receiving the regular contact with healthcare professionals that they need, including medical complications, emergency admissions and even preventable deaths. There is particularly risk to patients who do not feel able to contact their consultant or specialist. When speaking to the hospital department about how the risks were being mitigated, John was concerned to discover that there were no screening procedures in place for clinicians to determine which patients were at highest risk; no prioritisation as going on and there was no system in place to monitor the consequences of this.
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News Article
Ovarian cancer: 1 in 4 patients ‘see GP three times before referral for tests’
Patient Safety Learning posted a news article in News
More than a quarter of women with ovarian cancer saw their GP three or more times before getting a referral for tests, according to a new study. Researchers also found that almost a third had waited for longer than three months after first going to see their GP before being given the right diagnosis. If doctors are able to diagnose ovarian cancer at the earliest stage, nine out of 10 women will go on to live for five years or longer, but only around one in 10 survive if it is not caught until it has progressed to stage 4, the most advanced stage. The report, by Target Ovarian Cancer, also revealed that 14 per cent of women polled said they were not given their diagnosis in private, meaning others could listen in on the exchange. “I was told of my stage 4 diagnosis behind the curtain on a busy respiratory ward. The rest of the ward heard the conversation,” one woman said. Meanwhile, GPs and ovarian cancer patients told researchers that the support available for the disease is insufficient – with almost half of the women polled not having been asked by a doctor, nurse or other individual providing treatment about how the cancer diagnosis was affecting their mental health. This is despite the fact that 60% of the women diagnosed with ovarian cancer said their mental health had been harmed by the disease. Read full story Source: The Independent. 18 October 2022 -
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 All Party Parliamentary Group on Menopause (the APPG), chaired by leading parliamentary campaigner Carolyn Harris MP, has published its final report following a year-long inquiry into the subject. The MPs findings demonstrate that widespread action is needed across all spheres to improve the situation for those going through the menopause, and the families, friends and colleagues affected by it. Menopause symptoms can have a debilitating impact on the day-to-day lives of women. Whether from the inability to get the right diagnosis at the right time, difficulties in accessing HRT, a lack of support from their employer while struggling at work, or simply not being able to recognise what is happening to them and their bodies and seek help. Despite the fact that 51% of the population will experience the menopause, the entrenched taboo around women’s health issues has meant that the support for the 13 million women currently going through peri-menopause or menopause is completely inadequate. The APPG is particularly concerned about the socio-economic divide emerging between women who are able to access the right treatment, and those who lose out in the postcode lottery and do not have the financial means to seek treatment elsewhere.
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Content ArticleRealistic Medicine is Scotland's approach to a sustainable health and social care system. The Realistic Medicine Podcast shares the stories, experiences and projects of teams and communities across Scotland. In this episode, Dr Graham Kramer, National Clinical Lead for Self Management and Health Literacy, talks about health literacy and the importance of people being able to understand and engage in their own health and healthcare.
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Content ArticleDuring the Covid-19 pandemic there was a large-scale shift to remote consulting in UK general practice. In 2021, we saw a partial return to in-person consultations, which occurred in the context of extreme workload pressures due to backlogs, staff shortages and task shifting. This study in the British Journal of General Practice looked at media depictions of remote consultations in UK general practice at a time when general practice was under stress. The authors did a thematic analysis of national newspaper articles about remote GP consultations during two time periods: 13–26 May 2021, following an NHS England letter, and 14–27 October 2021, following a government-backed directive, both stipulating a return to in-person consulting. They found that newspaper coverage of remote consulting was strikingly negative and conclude that remote consultations have become associated in the media with poor practice. They recommend proactive dialogue between practitioners and the media to help minimise polarisation and improve perceptions around general practice.
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Content ArticlePatient safety in ambulatory care settings is receiving increased attention. Based on interviews and focus groups with patients, providers, and staff at ten patient-centered medical homes, this qualitative study explored perceived facilitators and barriers to improving safety in ambulatory care. Participants identified several safety issues, including communication failures and challenges with medication reconciliation, and noted the importance of health information systems and dedicated resources to advance patient safety. Patients also emphasised the importance of engagement in developing safety solutions.
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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 Article
This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Sarah and Jaydee are working on an innovative project at NHS Dorset Integrated Care Board (ICB) to ensure general practice is a central part of improving patient safety across services. They talk about the value and challenges of collaborative working, how they are tailoring their offer to fit the needs of local GP practices, and making patient safety a core part of training for all healthcare professionals. -
Content ArticleTalking General Practice speaks to Dr Helen Garr, medical director of NHS Practitioner Health, the NHS service that looks after doctors and dentists - and also other NHS staff - who are experiencing mental ill health. In this conversation, Helen talk about the impact that pressures on the NHS are having on doctors’ wellbeing and how this is affecting GPs in particular. Helen also explains what doctors and other NHS staff can do if they are suffering from burnout, how to prevent burnout, what people can do if they are worried about a colleague and how NHS Practitioner Health supports doctors who seek help from the service. She also outlines how she thinks the NHS could change to help ensure better mental health for doctors and other staff.
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Content ArticleAcute prescribing forms a large part of the daily workload for GP practices. Quality improvement (QI) methodology can be used to help improve prescribing processes and ensure that prescribing work is managed by the right member of your team, safely and effectively. This toolkit is designed to help primary care multidisciplinary teams, including pharmacotherapy services, safely improve their acute prescribing processes in line with the Essentials of Safe Care. An acute prescription is defined as any prescription without a serial or repeat mandate.
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Content ArticleM was a young boy who had severe asthma, resulting in regular trips to A&E. His condition was eventually well controlled with a Seretide inhaler. When M's family moved house and changed their GP, they requested a new prescription of Seretide, but when they got to the pharmacy were given the wrong type of inhaler used to treat a different form of asthma. The GP had unwittingly chosen the wrong medication from a drop-down menu. M and his family were unaware that he was taking the wrong medication, and after a few days, M became breathless and his family decided to take him to hospital. Sadly, he died on the journey to A&E. At the inquest, the Coroner found that there two main issues that contributed to M’s death: the unintentional prescription of Serevent the failure to arrange and organise follow up contributed to M’s death.
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Content ArticleThis practice pointer in The BMJ provides an update on treating Long Covid in primary care and outlines how healthcare professionals might respond to questions that patients ask about the condition. The article provides information on: Definition of Long Covid Epidemiology Symptoms and case definition Questions patients ask Further resources for patients and healthcare professionals
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News Article
Dying patient should have been seen in person
Patient Safety Learning posted a news article in News
NHS officials ruled a man who died after his ear infection was not picked up in GP telephone consultations should have been seen face to face, a BBC Newsnight investigation has found. David Nash, 26, had four remote consultations over three weeks during Covid restrictions but was never offered an in-person appointment. His infection led to a fatal abscess on his brainstem. David first spoke to the practice on 14 October 2020, after finding lumps on his neck. He sent a photograph but was never examined. With David worried the lumps might be cancerous, the GP asked a series of questions about his health and reassured him that while she could not rule it out completely, she was not worried about cancer. She suggested he booked a blood test for two to three weeks' time. In those three weeks, David would go on to speak to another GP and two advanced nurse practitioners but never face to face or via video call. He was actually due to be seen in person at the GP surgery that day, for the blood tests booked some 19 days earlier, when he had presented with neck lumps. But - fearing he could have coronavirus, despite a negative PCR test - the nurse cancelled the bloods and asked David to retest for Covid. In its investigation, NHS England found "the overarching benefit [of this decision] was less than the risk with going ahead with blood tests". After five calls to NHS 111, David was taken to hospital in an ambulance that day but died two days later. NHS England, in a finding seen by Newsnight, said: "A face-to-face assessment should have been offered or organised to confirm the diagnosis and initiate definitive management." Read full story Source: BBC News, 29 September 2022 -
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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News Article
Women's symptoms ignored by GPs
Patient Safety Learning posted a news article in News
Too many women feel fobbed off or not listened to when they raise concerns about their health, according to a women's health campaign group. The Women's Health Wales coalition says women are often misdiagnosed or have to push for a diagnosis. The theme has emerged repeatedly during BBC Wales interviews with women. The Welsh government said it had set out what's expected of the NHS on women's health, and a full plan is due to be published this autumn. "From the moment I went to my GP about my symptoms in my late teens, I have always felt dismissed," said Jessica Ricketts, 35, who was diagnosed with endometriosis. But the feeling of being fobbed off has cropped up in countless conversations with women whether it be in relation to a heart attack, UTI, stroke, autism or even brain tumour. Patients have told us that clinicians thought they were having a panic attack rather than a heart attack," said Gemma Roberts, policy and public affairs manager at British Heart Foundation Cymru, and co-chair of the Women's Health Wales coalition. "We hear from patients and from clinicians that women have to see their GPs multiple times before they get a diagnosis. Women often aren't listened to. "They are told that pain is a normal part of the female experience but actually that isn't the case. I think we need to be listening to women more about what's going on with their own bodies." The coalition wants: Greater focus on women's health from the very beginning of medical training. Health data to be broken down by protected characteristics because "the stories of women with those backgrounds goes untold". Equitable access to healthcare, including specialist care, regardless of where women live in Wales. Read full story Source: BBC News, 28 September 2022 Related blogs on the hub ‘Women are being dismissed, disbelieved and shut out’ The normalisation of women’s pain Gender bias: A threat to women’s health -
News Article
One in four people could be left without a GP within a decade, doctors claim
Patient Safety Learning posted a news article in News
One in four people could be left without a GP within a decade, medics say. The forecasts from Doctors’ Association UK suggest 16 million people in England could be left without access to a family doctor, amid growing staffing shortages. Today the new Health Secretary is expected to set out plans to boost access to GPs, following warnings that public satisfaction is the lowest on record. Research by the Health Foundation suggests that the NHS will lose up to 8,800 full-time equivalent GPs by 2030 if current trends continue. On Wednesday, Doctors’ Association UK said this could leave one in four people without access to a GP. Dr Lizzie Toberty, GP lead for the Doctors’ Association UK, said the workload of a family doctor now placed “unrealistic demands” on them. She said: “GPs will cut their hours, quit the NHS, or quit the country. We fear patients will suffer the same ‘postcode lottery’ for seeing their GP as many do now with getting an NHS dentist.” Read full story (paywalled) Source: The Telegraph, 21 September 2022
