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All GP practices in England will be able to book cancer tests directly for their patients from later this month, NHS bosses say. The option of GPs booking CT scans, ultrasounds and MRIs has been gradually rolled out in recent years, as community testing centres have opened. NHS England chief executive Amanda Pritchard will announce later all GPs will now be able to do this. GPs have previously relied on referring on to specialist hospital doctors. Before referring, they have to identify clear symptoms the patient may have a specific type of cancer. But only one out of every five cancer cases is diagnosed through these urgent GP referrals. Patients with less clear symptoms face long waits for check-ups or are diagnosed only after presenting at an accident-and-emergency (A&E) unit or being referred to hospital for something else. And Ms Pritchard will tell delegates at the NHS Providers annual conference of health managers, in Liverpool, today, she hopes the new initiative will lead to tens of thousands of cancer cases every year being detected sooner. Read full story Source: BBC News, 16 November 2022

GP surgeries across Scotland are at risk of collapsing because of staff shortages and increased demand, a senior doctor has warned. Dr Andrew Buist, chairman of the British Medical Association's (BMA) Scottish GP committee, told the BBC many practices were at "tipping point". More than a third of surveyed surgeries reported at least one GP vacancy – up from just over a quarter last year. About half of the GP surgeries in Scotland took part in the BMA survey. It showed 81% of practices said demand was exceeding capacity - with 42% saying demand substantially exceeded capacity. Dr Buist told BBC Scotland: "I worry that we're reaching a tipping point for some practices. "They lose one or maybe two doctors out of three, and the remaining doctors cannot continue so they return the contract and the practice may cease to exist. "That is a real concern in some parts of Scotland that that is happening and it's going to happen increasingly as the situation develops over this winter." Read full story Source: BBC News, 15 November 2022

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

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

GP leaders have written to NHS England to demand that an NHS hospital trust urgently restores routine referrals as it has 'closed its doors' to some patients, ‘destabilising’ practices in the process. Oxfordshire LMC said local GPs are ‘concerned and angry’ about the ‘ongoing closure’ to routine referrals across multiple ‘high-demand’ specialties by Oxford University Hospital Foundation Trust, while warning GPs are also being asked to carry out tests that should be done in hospital. A ‘significant’ number of specialties are affected, including ENT, general gynaecology, dermatology, ophthalmology, endoscopy and urology, as well as plastics and maxillofacial, it added. The hospital trust said it had remained open for urgent and emergency care and was accepting clinically urgent and suspected cancer referrals, while reinstating services to support 'the vast majority' of routine referrals. But Oxfordshire LMC has this week written to NHS England and the council of governors at OUHFT to demand that there are ‘no further delays’ in restoring the services amid concerns of ‘patient harm’. It said: ‘The LMC believes the continuing closure of some specialty services to routine referrals is now so serious for patients that it has taken a decision to formally raise the concerns of Oxfordshire’s GPs with NHS England.’ Read full story Source: Pulse, 13 August 2020

Dr Rebecca Fisher gives the lowdown on why maintaining general practice as a ‘front door’ to the NHS that is safe for both GPs and patients is not easy. It’s fair to say that Matt Hancock’s pronouncement that henceforth all consultations should be “teleconsultations unless there’s a compelling reason not to”, has not been universally welcomed in general practice. In my surgery, practicing in a pandemic has seen us change our ways of working beyond imagination. In March, like many other practices, we shifted overnight to a “telephone first” approach. And whilst at peak-pandemic we kept face-to-face consultations to a minimum, we’re now seeing more and more patients in person again. Although many consultations can be safely done over the phone, we’re very clear that there are some patients – and some conditions and circumstances – where a patient needs a face-to-face appointment with a GP. NHS England have also been clear that all practices must offer face-to-face consultations if clinically appropriate. But maintaining general practice as a “front door” to the NHS that is safe for both GPs and patients is not easy. Options to quarantine and pre-test patients set out in national guidance and intended to help protect secondary care cannot be deployed in primary care. Other national guidance – for example regarding wearing masks in clinical sites – often seems to be issued with secondary care in mind, with little or delayed clarity for primary care. Measures like maintaining social distancing are also likely to be harder in general practice, where the ability of a surgery to physically distance staff from each other, and patients from each other and staff, is in part dependent on physical factors. Options to quarantine and pre-test patients set out in national guidance and intended to help protect secondary care cannot be deployed in primary care Things like the size and layout of a practice, or the availability of a car park for patients to wait in are hard to change quickly. Stemming from those challenges are ones related to staffing; how to keep practice staff safe from covid-19? NHS England and the British Medical Association have stated that staff should have rigorous, culturally sensitive risk assessment and consider ceasing direct patient contact where risks from covid-19 are high. The risk of catching COVID-19 – or dying from it – is not equally distributed amongst GPs. Age, sex, ethnicity, and underlying health conditions are all important risk factors. New Health Foundation research finds that not only are a significant proportion of GPs at high or very high risk of death from covid-19 (7.9 per cent), but one in three single-handed practices is likely to be run by a GP at high risk. If those GPs step back from face-to-face consultations we estimate that at least 700,000 patients could be left without access to in-person appointments. Even more concerningly, there’s a marked deprivation gradient. If GPs at high risk from COVID-19 step back from direct face-to-face appointments, and gaps in provision aren’t plugged, the patients likely to be most affected are those in deprived areas – the same people who have already been hardest hit by the pandemic GPs at high risk of death from covid are much more likely to be working in areas of greater socioeconomic deprivation. And single-handed practices run by GPs classed as being at very high risk from covid are more than four times as likely to be located in the most deprived clinical commissioning groups than the most affluent. If GPs at high risk from COVID-19 step back from direct face-to-face appointments, and gaps in provision aren’t plugged, the patients likely to be most affected are those in deprived areas – the same people who have already been hardest hit by the pandemic. Where do solutions lie? Ultimate responsibility for providing core general practice services to populations lies with CCGs. In some areas, collaborations between practices (such as GP federations and primary care networks), may be able to organise cross-cover to surgeries where face-to-face provision is not adequate to meet need. But these collaborations have not developed at equal pace across the country, have many demands on their capacity and may not be sufficiently mature to take on this challenge. These local factors – including the availability of locums – will need to be considered by commissioners. It’s vital that CCGs act quickly to understand the extent to which the concerns around GP supply highlighted by our research apply in their localities. In some cases, additional funding will be needed to enable practices to ‘buy in’ locum support for face-to-face consultations. This should be considered a core part of the NHS covid response. Face-to-face GP appointments remain a crucial NHS service, and must be available to the population in proportion with need. Just as in secondary care, protecting staff, and protecting patients in primary care will require additional investment. Failure to adequately assess the extent of the problem, and to provide sufficient resource to engineer solutions is likely to further exacerbate existing health inequalities. Original Source: The HSJ

Hundreds of thousands of NHS patients could lose the ability to see their GP face to face because their doctors may have to protect themselves from coronavirus. An analysis by the Health Foundation charity has found around a third of GPs who run their practice on their own are at high risk from the virus themselves. If they are forced to abandon face-to-face consultations the charity warned it could deny 710,000 patients access to their doctor. Dr Rebecca Fisher, senior policy fellow at the Health Foundation and a GP said: “The ongoing risk of Covid-19 to the safety of both patients and GPs means hundreds of thousands of people may find it much harder to get a face-to-face GP appointment. “It’s particularly worrying that GPs at higher risk from Covid-19 are far more likely to be working in areas of high deprivation. Those are precisely the areas with the greatest health need, the biggest burden from Covid-19, and an existing under-supply of GPs relative to need. Unless urgent action is taken this could become another way in which poorer communities become further disadvantaged, and risks further widening health inequalities.” Read full story Source: The Independent, 6 August 2020

More than one in five GP partners said they removed practice staff away from face-to-face care due to ethnicity during the pandemic, a Pulse survey has revealed. The survey in June revealed that 84 of the 378 respondents said that ‘ethnicity was a crucial factor in removing anyone in your practice away from face-to-face assessments’. Around 70% of respondents said they had been counting ethnicity as a factor when risk assessing staff. See full article here

Urgent cancer referrals were "inappropriately" rejected by hospitals during the coronavirus lockdown without tests being carried out, GPs have said. Cancer Research UK said the findings from a survey of more than 1,000 GPs were "alarming", warning that patients whose lives may be at risk were being left "in limbo". Family doctors were surveyed in June and asked what had happened to patients they had referred to hospitals for tests in the month to that point because cancer was suspected. A quarter of GPs said urgent referrals had been inappropriately turned down by hospitals more often than had been the case before the pandemic. Four in 10 said that, when tests were refused, patients had been left without proper checks to see whether their case could safely be left without investigation. Read full story (paywalled) Source: The Telegraph, 8 July 2020

A High Court judge has ruled that an NHS trust was negligent in failing to consider early enough that a toddler with fever, lethargy, and vomiting might have had a serious bacterial infection and to give her intramuscular antibiotics. Mr Justice Johnson said that doctors from University Hospital Southampton NHS Foundation Trust should have ordered a lumbar puncture on the 15 month old girl on the day she was first seen or the next day. The girl, referred to in court as SC, was sent by her GP to the hospital by ambulance on 26 January 2006 with a note describing his findings on examination and ending “?meningitis.” The GP, Mark Dennison, had given her intramuscular penicillin. Read full story (paywalled) Source: BMJ, 22 June 2020

A new risk tool could be used to identify those most at threat from COVID-19, so GPs can give patients tailored advice, health officials have said. Scientists at Oxford University are working on a clinical risk prediction model, which aims to give individuals more precise information about the likely impact of the disease on them, instead of a blanket approach. Health officials said the plans aimed to allow “very individualised discussions” between patients and their doctors, in the event of future outbreaks, particularly as winter approaches. Read full story (paywalled) Source: The Telegraph, 23 June 2020

A poll of members by the Medical Protection Society (MPS) found that 43% of doctors fear investigation if patients come to harm because of delays to referrals and reduced NHS services during the pandemic. Treatment has been delayed for millions of patients while the NHS has focused on managing the pandemic - with GPs in many areas still unable to refer as normal and even urgent referrals delayed while the UK has been in lockdown. The NHS Confederation has warned that 10 million people could be on NHS waiting lists by Christmas. Reduced NHS services during the pandemic have left even patients who need urgent treatment or scans for cancer waiting longer. GPonline reported in April that patients had been waiting more than a month for urgent cancer checks - and Cancer Research UK warned in May that 2.4 million patients were waiting longer for scans or treatment because of disruption to services during the pandemic. Read full story Source: GPonline, 11 June 2020

More than three quarters of GPs fear delays to care because of COVID-19 will harm patients, with one in three reporting that urgent referrals have been rejected during the pandemic, a GPonline poll shows. The poll of 415 GPs found that 77% were concerned that delays to operations and treatments for non-COVID-19 issues would result in patients coming to harm. Meanwhile, 30% of GPs said they have had an urgent referral rejected during the pandemic. Rejected referrals included two-week-wait referrals for suspected cancer as well as urgent referrals for investigations such as ECGs, echocardiograms and CT scans. GPs also highlighted concerns over delays to treatment for cancer, with respondents warning that breast cancer surgeries had been postponed or chemotherapy delayed. Read full story Source: GP Online, 5 May 2020

Four in ten people are not seeking help from their GP because they are afraid to be a burden on the NHS during the pandemic, polling by NHS England reveals. The findings – from a survey of 1,000 people – are the latest in a wave of evidence that fewer people are seeking care for illnesses other than those related to coronavirus during the pandemic. GP online reported on 20 April that data collected by the RCGP showed a 25% reduction in routine clinical activity in general practice, and figures from Public Health England (PHE) and the British Heart Foundation show that A&E attendances overall and patients going to hospital for heart attacks are down 50%. Warnings that patients' reluctance to come forward could put them at risk come as leading charities warned that suspension of some routine GP services during the pandemic could also lead to a 'future crisis' if control of conditions such as asthma and COPD deteriorate. Professor Carrie MacEwen, chair of the Academy of Medical Royal Colleges, said: 'We are very concerned that patients may not be accessing the NHS for care because they either don’t want to be a burden or because they are fearful about catching the virus. 'Everyone should know that the NHS is still open for business and it is vitally important that if people have serious conditions or concerns they seek help. This campaign is an important step in ensuring that people are encouraged to get the care they need when they need it.' Read full story Source: GP online, 25 April 2020

A key element in the new covid-19 response service run by NHS 111 urgently needs more doctors, NHS England has said. The national covid-19 clinical assessment service, or CCAS, serves a cohort of patients with coronavirus symptoms deemed by 111 as needing a clinical assessment over the phone or online. An email to GPs from NHSE’s primary care directors on Friday evening said: “We urgently need more GPs help to staff this service, especially as covid-19 cases increase over coming days, because of your expertise and experience.” Read full story Source: HSJ, 6 April 2020

GPs are having end of life conversations with their patients because of concerns over a lack of intensive care beds during the coronavirus crisis. Multiple GPs have told HSJ they are talking to patients who are older or in very high risk groups about signing “do not attempt to resuscitate” forms in case these patients were to go on to contract the virus. Some practices have also sent letters to patients requesting they complete the forms, it is understood. One leader of a primary care network, who asked not to be named, told HSJ: “Those in the severe at-risk group and those over 80 are being told they won’t necessarily be admitted to hospital if they catch coronavirus.” Read full story Source: HSJ, 1 April 2020

A GP surgery has apologised after sending a letter asking patients with life-limiting illnesses to complete a "do not resuscitate" form. A letter, from Llynfi Surgery in Maesteg, asks people to sign to ensure emergency services would not be called if their condition deteriorated due to coronavirus. "We will not abandon you.. but we have to be frank and realistic," it said. Cwm Taf health board issued an apology from the surgery, the Guardian reports. The letter says in an "ideal situation" doctors would have had this conversation in person but had written to them due to fears they were carrying the virus and were asymptomatic. Read full story Source: BBC News, 1 April 2020

GP practices should review 1.5 million patients identified by NHS England as the most vulnerable to the coronavirus. NHS England will send a standard letter to these patients asking them to stay at home at all times and avoid any face-to-face contact for at least 12 weeks. GPs will be able to access a report on which patients will be contacted with specific advice, with NHS England directing GPs to review the list and provide additional support to patients. The patients, who are at ‘the highest risk of severe illness that would require hospitalisation from coronavirus’, include those who have had an organ transplant; people with specific cancers; people with severe respiratory conditions; people with rare diseases; people on immunosuppression therapies; and pregnant women with significant heart disease. In a letter to GPs, NHS England said: "We ask that you review this report for accuracy and, where any of these patients have dementia, a learning disability or autism, that you provide appropriate additional support to them to ensure they continue receiving access to care." Read full story Source: Management in Practice, 24 March 2020

As coronavirus spreads widely across the UK, many of those who fall sick may seek treatment at their GP's surgery. But are family doctors ready to deal with a wave of patients, prevent the spread of the disease and protect the most vulnerable? "This is a massive crisis, probably the biggest crisis the NHS has ever had to face," says Prof Martin Marshall, an east London GP who is also chair of the Royal College of General Practitioners' council. He says not enough has been done yet to prepare family doctors for the epidemic, although he adds: "We need to be a little bit understanding of the pressures that the whole system is under." As the virus circulates in the community, he says we need "urgent action" to protect healthcare workers, give them the information they need and provide technology to allow for more consultations by phone or the internet. Given the pressures the NHS will be under, Prof Marshall says it is vital that doctors and nurses are not taken out of action for seven days of isolation unnecessarily. "We're not saying that health professionals are more important than patients, we're saying that health professionals have a responsibility," he says. "We therefore need to keep them as healthy as possible and we need to get them back into the workforce as quickly as possible. So we're asking that health professionals are tested early." Read full story Source: BBC News, 16 March 2020

Two out of five GPs have still not received any personal protective equipment (PPE) against coronavirus, a Pulse survey suggests. The poll of over 400 GPs saw 41% of respondents say they have not received any PPE, while a further 32% said they had not received enough. Just 15% of GPs said they have sufficient PPE, with the remainder unsure. This comes despite NHS England promising last week that it would ship PPE free of charge to practices. The Welsh Government made the same announcement this week, while in Scotland health boards should be distributing PPE. A GP who has received no proper equipment, Dr Kate Digby, in Cirencester, said she feels "woefully underprepared". She told Pulse: "I'm becoming increasingly concerned at the lack of resources being provided for frontline primary care". Read full story Source: Pulse, 2 March 2020

Just 1 in 4 UK GPs are satisfied with time they are able to spend with patients – appointment times are among the shortest of 11 countries surveyed. A report published today by the Health Foundation paints a picture of high stress and low satisfaction with workload among UK GPs. The report is an analysis of an international survey of GPs from 11 high-income countries, including 1,001 UK GPs, undertaken by the Commonwealth Fund in 2019. Among 11 high-income countries included in the study, only France has lower levels of overall satisfaction with practising medicine, and only Sweden reported higher levels of stress. Over half of UK GPs (60%) say they find their job 'extremely' or 'very' stressful, and almost half (49%) plan to reduce their weekly hours in the next three years. UK GPs also reported significantly shorter appointment lengths than their international colleagues. The average length of a GP appointment in the UK is 11 minutes, compared with a 19 minute average appointment for GP and primary care physicians in the other countries surveyed. Dr Rebecca Fisher, one of the Health Foundation report's authors and a practising GP, says: "These findings illustrate the pressures faced by general practice, and the strain that GPs are under. Right now the health system is in unprecedented territory and mobilising to meet the challenge of Covid-19. This survey shows that over the long term we need concerted action to stabilise general practice. Despite performing strongly in some aspects of care, many GPs consider that appointments are simply too short to fully meet the needs of patients. Too many GPs are highly stressed and overburdened – to the point of wanting to leave the profession altogether." Read full story Source: The Health Foundation, 5 March 2020

Neglect and serious failures by the Home Office and multiple other agencies contributed to the death of a vulnerable man who died from hypothermia, dehydration and malnutrition in an immigration removal centre, an inquest has found. Prince Fosu, a 31-year-old Ghanaian national, died in October 2012 when his naked body was found on the concrete floor of his cell in Harmondsworth, a detention centre near Heathrow. He had been experiencing a psychotic episode but he was not referred for a mental health assessment due to “gross failures” by all agencies to recognise the need to provide appropriate care to a person unable to look after himself. Four GPs, two nurses, two Home Office contract monitors, three members of the Independent Monitoring Board (IMB) and countless detention custody officers and managers who visited him failed to take any meaningful steps, the inquest found. Three doctors have since been referred to the UK’s medical watchdog for their alleged failures relating to the death of Mr Fosu on recommendation of the Prison and Probation Ombudsman (PPO), who said the care he received fell “considerably below acceptable standards”. Read full story Source: The Independent, 3 March 2020

Following a doctor’s suicide, a petition is calling for the GMC to take responsibility for the wellbeing of those under its investigation. Read full story (paywalled) Source: Pulse, 25 February 2020

The NHS has launched a patient safety inquiry after a private contractor failed to send more than 28,000 pieces of confidential medical correspondence to GPs. NHS bosses are trying to find out if any patients have been harmed after 28,563 letters detailing discussions at outpatient appointments were not sent because of a mistake by Cerner, an IT company. The letters should have been sent by doctors at Barnet and Chase Farm hospitals in north London to GPs after consultations with 22,144 patients between June last year and last month. However, a “clinical harm review” is under way after it was found they had not been dispatched. The incident has prompted concern among GPs and patient representatives. “Patients who have attended these two hospitals will now be very worried about whether their care might have been compromised by this IT bungle”, said Rachel Power, the chief executive of the Patients Association. Read full story Source: The Guardian, 18 February 2020

The number of British cases of coronavirus has doubled to eight – with two healthcare workers among those testing positive – while a GP surgery in Brighton was closed amid fears of the infection spreading. Brighton’s County Oak medical centre closed on Monday with a warning notice on its door telling patients it was “closed due to operational difficulties”. According to reports, one of those infected was a GP, who was at work for one day but did not see any patients. Workers wearing protective suits were pictured cleaning the surgery and pharmacy on Monday afternoon. The government has since classified the virus, which has infected more than 40,000 people in China and led to the death of more than 1,000, as a “serious and imminent threat” to public health while activating emergency powers that can see it force people to remain in quarantine. “I will do everything in my power to keep people in this country safe,” Matt Hancock, the Health Secretary, said in a statement. “We are taking every possible step to control the outbreak of coronavirus. NHS staff and others will now be supported with additional legal powers to keep people safe across the country.” Read full story Source: The Independent, 11 February 2020