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News ArticleSome doctors in Australia are using the title “specialist general physician” despite not having completed the training required by law, potentially misleading patients with complex and chronic health conditions that require specialised care, physicians say. After completing a medical degree and postgraduate work experience, graduates can apply to the Royal Australasian College of Physicians (RACP) fellowship training program. All RACP trainees complete similar foundational training before choosing areas of advanced training to specialise in such as geriatrics, cardiology, general medicine or other areas. General physicians are different from general practitioners (also known as GPs). General physicians care for patients with unusual or complex conditions and see patients either in hospital or those who are referred to them, usually by the patient’s GP. Medical practitioners can only use titles such as “specialist general physician”, “specialist geriatrician” or “specialist cardiologist” if they have completed the advanced specialist RACP training in the corresponding field of practice and have registered with the Australian Health Practitioner Regulation Agency (Ahpra). But Dr Jenna Paterson, a specialist general physician working in Victoria and South Australia, said there are “many, many” doctors who advertise their services to patients as a “general physician” without the qualifications to do so. Read full story Source: The Guardian, 13 June 2023
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News Article
Plan for GPs to offer NHS patients weight-loss jab
Patient Safety Learning posted a news article in News
GPs in England may start offering weight-loss jabs to some patients to reduce obesity-related illnesses and resultant pressure on hospitals. Wegovy was approved for NHS use after research suggested users could shed over 10% of their body weight. The drug blunts appetite, so users feel full and eat less. Rishi Sunak said it could be a "game-changer" as he announced a £40 million pilot scheme to increase access to specialist weight management services. But experts warn "skinny jabs" - widely used in the US and endorsed by many celebrities - are not a quick fix or a substitute for a healthy diet and exercise. NHS drugs watchdog, the National Institute for Health and Care Excellence (NICE), says patients can access Wegovy for a maximum of two years via specialist weight-management services. The new scheme will test how GPs could safely prescribe such drugs and the NHS provide support in the community or digitally, contributing to the government's wider ambition to reduce pressure on hospitals and give patients access to the care they need where it is most convenient for them. Read full story Source: BBC News, 7 June 2023 -
News Article
NI patients suing GPs over hospital waiting time targets
Patient Safety Learning posted a news article in News
Northern Ireland GPs are being hit with bills of thousands of pounds as they are sued by patients coming to harm on hospital waiting lists. Family doctors are being taken to court by their patients as a result of spiralling hospital waiting lists — even though GPs are not responsible for the crisis. It comes as official figures show 14% of the population — around one in seven — had been waiting longer than a year for an outpatient or inpatient appointment at the end of March. The growing risk to patient safety, as the health service struggles to cope with demand, and the potential for primary care doctors to be held accountable have been blamed as reasons for the rising number of GPs who are handing back their contracts. Sixteen GP surgeries in Northern Ireland have handed back contracts in recent months, bringing the key NHS service closer to collapse. Read full story Source: Belfast Telegraph, 30 May 2023 -
News Article
GPs urged to trial experimental drugs on patients
Patient Safety Learning posted a news article in News
Lord O’Shaughnessy has carried out a widespread review of clinical trials in Britain and found it is falling behind in medical research. He has suggested a raft of reforms, which include financial incentives for GPs who carry out community drugs and treatments trials on their patients at local surgeries or in their own homes. Patients who receive genomic testing on the NHS should also be automatically asked to consent to their genetic data being used for research, the report recommends. The Medicines and Healthcare products Regulatory Agency (MHRA) has been told to cut red tape and speed up approvals for medicines. It has also been asked to approve clinical trials within 60 days of submission. Writing in The Telegraph, Will Quince, Minister of State for Health and Secondary Care, said: “Cutting the time it takes for new medicines to reach patients is vital and has a direct impact on how patients recover faster or better manage conditions. “We want to make it easier for more people to be a part of life-changing research and giving the option to take part in trials virtually will improve the scope of who wants to, or can take part. “From cancer to obesity, these research studies can lead to billions of pounds in savings for the NHS and cut waiting lists through faster diagnosis and enhanced treatment.” Read full story (paywalled_ Source: The Telegraph, 26 May 2023 -
News Article
Essex GP struck off over 'sexually motivated' examination
Patient Safety Learning posted a news article in News
A GP accused of trying to pull down a patient's gym shorts and of touching her genitalia has been struck off the medical register. The Medical Practitioners Tribunal Service found Dr Kamran Ali's behaviour towards four women at a surgery in Essex amounted to misconduct. The tribunal heard he had not practised since the allegations in 2016. The 44-year-old, of Glendale Gardens, Leigh-on-Sea, was cleared of criminal charges following a trial in 2018. Panel chairman William Hoskins said at the tribunal on Thursday that erasing him from the register was necessary to "protect public confidence in the medical profession". A female patient - referred to as Patient C - reported his behaviour to police in the November. She had complained of spots on her face, white coating on her tongue and wanted a repeat prescription for anxiety medication. The panel heard Dr Ali began to pull down her gym shorts and examined her genitalia without wearing gloves and without obtaining consent. Read full story Source: BBC News, 23 May 2023 -
News Article
Male GPs in England less likely to refer patients for IVF, report finds
Patient Safety Learning posted a news article in News
Male GPs are less likely to refer eligible patients for IVF, research by a fertility charity suggests, raising concerns about access to NHS-funded treatment. The Progress Educational Trust’s (PET) report highlights “utter confusion” and a lack of knowledge among GPs about eligibility criteria for NHS-funded treatment, which it says is exacerbating the so-called IVF postcode lottery. GPs typically make the initial referral to fertility clinics, meaning that they play a crucial role in access. “For NHS treatment, GPs are the main initial gatekeeper. If you’re not getting pregnant, that’s who you go to for advice and support,” said Sarah Norcross, the director of PET. “It struck me that, when people have a known cause of infertility, male GPs still weren’t passing them on.” The report is based on a survey of 200 GPs and commissioners across England, carried out by an independent research company, which investigated knowledge of national fertility guidelines and criteria they use for referral decisions. Read full story Source: The Guardian, 19 May 2023 -
News ArticleICBs should ensure there are ‘formal escalation routes’ in place for GPs after 25 daily clinical contacts, the BMA has said in new guidance. From next week (15 May), GP practices are contractually required to offer an ‘appropriate response’ to patients the first time they get in contact, by offering them an appointment or redirection, rather than asking them to call back at a different time. While GP leaders warned this would lead to increased pressure on NHS 111 and A&E, NHS England attempted to clarify in this week’s recovery plan that GPs should only redirect patients in ‘exceptional circumstances’. It also said practices should inform their ICB on each such occasion. However, conflicting BMA guidance has now been published, warning that practices attempting to adhere to the new requirement ‘may do so at the expense of clinician wellbeing and patient safety’. It reiterates the GP Committee for England’s safe working guidance recommending that clinicians have no more than 25 clinical contacts per day because anything beyond this "can lead to decision fatigue, clinical errors and patient harm, and clinician burn out". Read full story Source: Pulse, 11 May 2023
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News ArticleStaff shortages forced pharmacies to shut for 100,000 hours in a year, new figures show, just as the government has unveiled plans to shift more GP work their way. The data, shared exclusively with The Independent by the organisation which represents pharmacies in England, also showed that almost 1,000 establishments closed for good between October 2016 and November 2022. The Pharmaceutical Services Negotiating Committee (PSNC) figures revealed that pharmacies in the most deprived areas were more likely to shut permanently due to lack of staff, with areas such as Birmingham and Manchester among the worst affected. The figures come as the government announced plans on Tuesday to allow pharmacists to prescribe medicines for conditions including earache, sore throats and urinary tract infections without GP involvement. However, experts have said the plans are unlikely to significantly reduce pressure on GP practices as prescriptions for these conditions make up just 3 per cent of all appointments. And the King’s Fund health think tank warned of the potential for a postcode lottery – saying some pharmacies will not be able to offer the services because they may not have access to diagnostic tools, or sufficient staff and consultation rooms. Read full story Source: The Independent, 10 May 2023
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News Article
GP is struck off for “utterly deplorable” litany of treatment failures
Patient Safety Learning posted a news article in News
A senior GP has been struck off the UK medical register for an “utterly deplorable” litany of treatment failures and for “reprehensible” professional conduct that included leaving patients in the care of unprepared trainee doctors and operating without adequate professional insurance. At least two patients suffered “grave consequences” from inaction on the part of Surraiya Zia, including a man whose deteriorating condition was effectively ignored for six months, despite the fact that he “presented to Dr Zia frequently, sometimes up to three times within a week, with red flag symptoms,” said Samantha Gray, chairing the medical practitioners tribunal. The patient was eventually persuaded to seek private magnetic resonance imaging by his family. This showed widespread stage IV lung cancer that took his life within weeks. Read full story (paywalled) Source: BMJ, 21 April 2023 -
News Article
Millions wait more than a fortnight to see a GP in England
Patient Safety Learning posted a news article in News
Nearly five million patients each month in England wait more than a fortnight for a GP appointment, NHS figures show, which Labour is calling "unacceptable". The government says it expects all patients needing a GP appointment to be seen within two weeks. The Royal College of GPs says 85% of appointments happen within two weeks and nearly half on the same day. Those taking longer than two weeks may be routine ones for which the wait is therefore appropriate, it says. Prof Kamila Hawthorne, who chairs the Royal College of GPs, said: "GPs and our teams are working tirelessly to deliver safe, timely and appropriate care and to give patients the choice of appointment they want. "We share our patients' frustration when they struggle to access our care. However, this is not down to GPs and their hard-working teams, but due to decades of underfunding and poor resource planning." Read full story Source: BBC News, 21 April 2023 -
News Article
Over two million patients have to visit GP four times for referral
Patient Safety Learning posted a news article in News
More than two million patients each year have to make four or more repeat visits to their GP before they get a referral, a patient watchdog has warned. Patient safety campaigners said people faced waits of “weeks, months or even years” before officially joining NHS waiting lists, and that their health and wellbeing was suffering as a result. They warned it would also add to pressure on other services such as A&E departments. Research by Healthwatch England revealed what the patient watchdog called a “hidden waiting list”. “People wait for a GP appointment; they wait for their GP to tell them they will be referred; they wait for the hospital to confirm that referral; and then they join a hospital waiting list,” it said. “NHS statistics monitor only the hospital waiting list, leaving the steps between getting a GP referral and a letter confirming a hospital appointment as a dangerous ‘blind spot’ for the NHS and patients.” Read full story (paywalled) Source: The Times, 11 April 2023 -
News Article
‘It is not right to normalise the current GP workload’, says RCGP chair
Patient Safety Learning posted a news article in News
It is ‘not right to normalise’ the current workload in general practice as numbers of GPs and practices goes down, the RCGP chair told delegates at Pulse Live this week. Professor Kamila Hawthorne highlighted the pressure GPs are under with general practice appointments increasing most last year, compared to A&E and outpatients. She also said her priority from a new GP contract would be better resourcing for GPs working in deprived areas. Her speech looked at the challenges facing general practice and imagined what the future could look like, including what the college can do to bring about change. Professor Hawthorne said: ‘The workload that we’re facing – it’s not right to normalise it. The sort of work days that we have in general practice, it is not right to normalise this. ‘The number of GPs is going down because they’re leaving the profession faster than they’re entering it. The number of practices in England is going down, and compared with affluent areas, GPs in deprived areas earn less but see more patients with more chronic illness.’ Read full story Source: Pulse, 21 March 2023 -
News ArticleYoung people with eating disorders are coming to harm and ending up in A&E because they are being denied care and forced to endure long waits for treatment, GPs have revealed. NHS eating disorders services are so overwhelmed by a post-Covid surge in problems such as anorexia that they are telling under-19s to rely on charities, their parents or self-help instead. The “truly shocking” findings about the help available to young people with often very fragile mental health emerged in a survey of 1,004 family doctors across the UK by the youth mental health charity stem4. The shortage of beds for children and young people with eating disorders is so serious that some are being sent hundreds of miles from home or ending up on adult psychiatric wards, GPs say. “The provision is awful and I worry my young patients may die,” one GP in the south-east of England told stem4. Another described the specialist NHS services available in their area as “virtually non-existent and not fit for purpose”. Read full story Source: The Guardian, 22 March 2023
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News Article
UK GPs have the highest stress levels, finds survey of 10 countries’ doctors
Patient Safety Learning posted a news article in News
GPs in the UK have some of the highest stress levels and lowest job satisfaction among family doctors, a 10-country survey has found. British GPs suffer from high levels of burnout, have a worse work/life balance and spend less time with patients during appointments than their peers in many other places. Heavy workloads, seemingly endless paperwork and feelings of emotional distress are prompting many GPs to stop seeing patients regularly or even retire altogether, the research found. Seven in 10 (71%) NHS family doctors find their job “extremely” or “very stressful”, the joint-highest number alongside GPs in Germany among the countries analysed. The Health Foundation, which undertook the survey, said its “grim” findings showed that the “unsustainable” pressures on GPs and number of them quitting pose a threat to the NHS’s future. -
News Article
GP training to be overhauled to meet ‘ever-shifting’ needs of patients
Patient Safety Learning posted a news article in News
Health Education England (HEE) has outlined a new vision for general practice training which it says will better prepare GPs for future models of care. The programme will have greater focus on areas such as addressing health inequalities and managing the growing proportion of patients with mental health care needs seen in general practice, HEE said. Innovative placements, perhaps with charities, third sector organisations and services such as CAHMS will be explored, the Training the Future GP report said. And it should include educational opportunities around improving cancer detection and referral, the report said, as well as training in the harms of overdiagnosis. Overall the goal is to move to a flexible model of training that meets the needs, skills and experiences of the trainee as well as the area they are working in. HEE said it would also continue to work to address issues of discrimination, prejudice, bias and specifically racism at individual, institutional and systemic levels, and to reduce differential attainment. It will include plans to ensure patients in deprived areas are able to access care, with the development of specific training offers on these issues and prioritising expansion of training capacity to areas in need. Read full story Source: Pulse, 17 March 2023 -
Content ArticleMany people see their GP with symptoms that could either get better without treatment, or be a sign of serious illness; their diagnosis is uncertain. Research has explored how GPs and patients can work together to develop follow-up plans (a process known as safety-netting). New recommendations could help GPs manage uncertain diagnoses. To avoid unnecessary referrals, GPs may adopt a ‘watch and wait’ strategy when someone has an uncertain diagnosis. This strategy should come with a clear follow-up plan so that people understand the possible causes of their symptoms, how to look after themselves and what to do if symptoms persist. This is good safety-netting. Without good safety-netting, watch and wait carries risks. For example, late cancer diagnoses have been linked to poor safety-netting. However, professional guidance on safety-netting is lacking. This is a knowledge and practice gap. A study from Friedemann Smith explored the best ways to deliver safety-netting advice. It suggests that people are more likely to follow advice if they are involved in developing the follow-up plan. They need to understand: why they are receiving this advice what actions are required, and by whom. The lack of time within primary care consultations is well known. This may need to be addressed for clinicians to have long enough to develop a safety-netting plan. Professionals may also need training to develop the appropriate communication skills.
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Content Article
Dr Freya Smith, a Specialty Trainee in General Practice, reflects on the sinister and toxic side of medicine, using the recent Paterson and vaginal mesh scandals to demonstrate how patients have been let down by the system. In an honest and personal account, she shares with us the horror and sadness she felt at learning of these scandals and how she aspires to keep her future patients safe. -
Content ArticleRoughly 16 million Americans are living with Long Covid, but many are not getting the right medical care. In this article in Popular Science, Miles Griffis argues that one way to improve the system is by letting patients lead. He describes his own disabling case of Long Covid, the issues he has faced in gaining access to Long Covid clinics and the lack of treatment options available to him. He argues that at some point, the demand from patients for treatment will force progress in Long Covid research.
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Content Article
RNID - Our ear wax removal campaign (2022)
Patient-Safety-Learning posted an article in GP and primary care
Many people who usually go to their GP for ear wax removal have recently been told this service is no longer available on the NHS. As a result, they are now being advised to manage their own ear wax build-up or to seek ear wax removal from private providers. However, advice on self-management is inconsistent and sometimes dangerous, and the cost of private removal can make it unaffordable. The Royal National Institute for Deaf People (RNID) wants to make sure everyone is offered clear advice on managing excess ear wax safely themselves and has access to professional removal on the NHS if self-management doesn’t work. This campaign page highlights research by RNID and outlines how people can get involved in the campaign by writing to their MP and local healthcare organisations. -
Content ArticleBehind the outcry about waiting times lies the anxiety that our cherished GP system will, in the words of one Gloucester doctor, ‘soon reach a threshold where there is a collapse’. We witness life on the frontline in this Guardian article.
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Content ArticleA survey conducted by the Commonwealth Fund has found that a majority of primary care doctors in the US and other high-income countries say they are burned out and stressed, and many feel the pandemic has negatively impacted the quality of care they provide. This article presents the survey results in the form of graphs with a commentary, and you can also download data from the survey.
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Content ArticlePatient safety is vital to well-functioning health systems. A key component is safe prescribing, particularly in primary care where most medications are prescribed. Previous research has demonstrated that the number of patients exposed to potentially hazardous prescribing can be reduced by interrogating the electronic health record (EHR) database of general practices and providing feedback to general practitioners (GPs) in a pharmacist-led intervention. This study aimed to develop and roll out an online dashboard application that delivers this audit and feedback intervention in a continuous fashion.
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Content ArticleThis article by Rebecca Rosen and Trisha Greenhalgh in the BMJ looks at the safety of remote GP consultations. It begins by looking at the case of student David Nash, who tragically died in 2020 after four telephone consultations with his GP; he was denied an in-person appointment for a painful ear infection that led to a fatal brain abscess. One coroner has raised concerns that this is not a one-off incident, noting that in five inquest reports they wrote during the pandemic, they question whether deaths could have been prevented by in-person consultations. The authors look at the recommendations of the ongoing 'Remote by Default 2' study, which is exploring how best to embed remote consulting in future GP services. They highlight better triage of appointment requests, active listening, checking back, increasing the use of video consulting and better training for clinicians as factors that could improve the safety of remote consultation.
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Content Article
Sarah Kay and Jaydee Swarbrick are involved in the Patient Safety in Primary Care Project in Dorset. In this blog, they summarise a recent event they held to share learning from medicines incidents. -
Content ArticleThe Patients Association has been working with NHS England to look at how to improve GP referrals of patients to hospital. The goal was to look at ways specialists could support GPs so they could reduce the number of outpatient appointments patients have to attend, without compromising care. This report includes an overview of the patient panel workshops, key themes and findings from the workshops, and a set of recommendations.
