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Content ArticleGuidance needs to be applied in a careful, caring and person-centred way to ensure that patients benefit from, and are not harmed by, healthcare. In this blog, Dr Sam Finnikin, an academic GP in Sutton Coldfield, uses the story of 86 year-old Joan to illustrate the importance of shared decision-making in ensuring patients receive the most appropriate care. Joan was prescribed multiple medications by the hospital cardiology team after being diagnosed with acute coronary syndrome and a severely impaired left ventricle, but the medications made her feel very unwell and inhibited her quality of life. Joan then reached out to her GP surgery as she wanted to stop taking them, and Dr Finnikin realised that she and her family were unaware of the the reason each medication had been prescribed and the potential benefits and side effects of each one. After a long conversation about her priorities, Joan stopped the medications that were not benefitting her symptoms and died in peace and comfort at home a few weeks later. Dr Finnikin argues that shared decision-making is not an optional extra, but must be considered a vital part of healthcare, stating that "omitting shared decision making can be just as harmful to patients as being ignorant of clinical recommendations."
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Content ArticleA group of patients and families with experience of end-of-life care worked with researchers from the Nuffield Trust to review findings from its research investigating the effect of the pandemic on people who were receiving end-of-life care at home. This web page summarises the research findings from the perspective of patients and family.
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EventThis Westminster conference will examine policy and funding priorities for general practice. The agenda also looks at wider issues around GP wellbeing, patient access, service integration, and service recovery in the wake of disruptions caused by the pandemic. Stakeholders and policymakers will discuss progress, issues and next steps for ambitions to increase capacity within general practice for urgent same-day care, tackle areas of inefficiency, and improve transparency and accountability - in the context of the NHS Long Term Plan and the Winter Access Fund. Overall, the agenda will bring out latest thinking on priorities and key issues moving forward, including: integration - implementing reforms within the Health and Care Bill and the role of primary care workforce - recruitment and retention, the role of locum and other support staff, supporting mental health and wellbeing, and tackling burnout primary care networks - progress in development and their role in improving local health outcomes innovation and infrastructure - taking forward innovation from the pandemic and how the estate can support innovative working, tackle inefficiencies, and improve patient access going forward personalised care - opportunities and challenges, the role of community services, and ways to improve the delivery of patient-centred care. The conference will be an opportunity for stakeholders to consider the issues alongside key policy officials who are due to attend fromthe DHSC; CQC; the OHID; National Audit Office; and DWP. Agenda Register
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Content ArticleThis study in the British Journal of General Practice aimed to examine the impact of Covid-19 on GP contacts with children and young people in England. The authors conducted a longitudinal trends analysis using electronic health records from the Clinical Practice Research Datalink (CPRD) Aurum database. The study found that: GP contacts fell 41% during the first lockdown compared with previous years. Children aged 1-14 years had greater falls in total contacts (≥50%) compared with infants and those aged 15–24 years. Face-to-face contacts fell by 88%, with the greatest falls occurring among children aged 1-14 years (>90%). Remote contacts more than doubled, increasing most in infants. Total contacts for respiratory illnesses fell by 74% whereas contacts for common non-transmissible conditions shifted largely to remote contacts, mitigating the total fall (31%).
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Content ArticleSpecialty referrals—when a clinician refers a patient to a specialist for evaluation or treatment—are on the rise in the US. Despite the introduction of electronic health records (EHRs), the referral process is often hindered by lack of clarity over roles, communication breakdowns, workloads and variations in requirements among specialists. These difficulties can lead to missed or delayed diagnoses, delays in treatment and other lapses in patient safety. This guide from the Institute for Healthcare Improvement offers recommendations that aim to help standardise how primary care practitioners activate referrals to specialists and then keep track of the information over time. It describes a nine-step, closed-loop process in which all relevant patient information is communicated to the correct person through the appropriate channels, in a timely manner.
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Content ArticleThis editorial in BMJ Quality & Safety looks at the need for urgent improvement in the test result management and communication process in primary care. The authors highlight the inconsistency in tracking and communicating test results and look at potential solutions to reduce the patient safety risks associated with test results. They look at the evidence surrounding automated alerts built into provider IT systems and giving patient direct access to test results through apps, highlighting the growing importance of patients in safeguarding their own care through actively pursuing test results.
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Content ArticleMedication errors are any Patient Safety Incidents (PSI) where there has been an error in the process of prescribing, preparing, dispensing, and administering, monitoring or providing advice on medicines. Medication errors can occur at many steps in patient care, from ordering the medication to the time when the patient is administered the drug. From April 1 2015 to 31 March 2020 NHS Resolution received 1,420 claims relating to errors in the medication process. Of those claims, 487 claims settled with damages paid, costing the NHS £35 million (excluding legal costs). NHS Resolution initial data for medication errors indicates that anticoagulants, opioids, antimicrobials, antidepressants, and anticonvulsants are the most common medications to be implicated in incidents.
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Content ArticleThe pandemic has had an enormous impact on health and care services in the UK. In this article, Nuffield Trust fellows Jessica Morris and Sarah Reed take a closer look at access and waiting times before and after the start of the Covid-19 pandemic. They highlight that before the pandemic, pressure on the system was already reducing access to NHS services and making waiting times longer. Covid-19 has made the situation significantly worse due to the need for heightened infection control practices, rising levels of staff sickness and burnout, the cancellation of routine care and redirection of staff. Enabling services to recover will be challenging given these ongoing pressures and real-term budget cuts for the NHS this year. The article examines the impact of the pandemic on waiting times relating to: General practice Elective (planned) care Diagnostic testing Cancer care A&E Ambulance
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Content ArticleGPOnline Editor, Emma, speaks with Dr Carey Lunan, a GP in Edinburgh and chair of the Deep End GP Group in Scotland, and Dr David Blane a GP in Glasgow and clinical research fellow in General Practice, University of Glasgow, who is the academic lead of the Deep End GP Group. The Deep End Group covers the 100 most deprived practices in Scotland and the discussion highlights what the group is doing to tackle health inequalities, the impact of COVID-19 and what other practices can learn from their work.
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Content ArticleDepression is one of the most common mental health issues and GPs often diagnose and treat patients with the condition. In this blog, Dr Ed Beveridge offers his top tips for the assessment, management and treatment of adults with depression in primary care. It provides information on: assessing and screening people with depression for underlying conditions. pharmacological and nonpharmacological treatment options. when to refer to secondary care or seek specialist advice.
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NHSE - Commitment to carers
Patient-Safety-Learning posted an article in NHS England
With 1.4 million people providing 50 or more carer hours a week for a partner, friend or family member, carers make a significant contribution to society and the NHS. NHS England has developed 37 commitments to carers spread across eight key priorities, that have been developed in partnership with carers, patients, partner organisations and care professionals. Some of the areas covered include: raising the profile of carers education and training person-centred coordinated care primary care This webpage contains information on: Supporting carers in general practice: a framework of quality markers How to identify and support unpaid carers Supporting commissioners End of year progress summary -
Content ArticleSince 2013/14, there has been a growth in the volume and value of clinical negligence claims involving patients with diabetes-related lower limb complications. The majority of claims have involved patients with a diabetic foot ulcer who went on to undergo a major lower limb amputation. This thematic review by Nicole Mottolini, Clinical Fellow at NHS Resolution, looks at 92 claims of negligence for lower limb problems involving patients with diabetes. The author used qualitative analysis to identify recurrent clinical themes leading to patient harm including unacceptable delays in diagnosis, delayed referral to specialised care and failures in the Multidisciplinary Diabetic Foot Team (MDFT). Her report highlights shortcomings in diabetes foot care in England, makes recommendations to improve patient care and proposes certain standards which should be put into practice and regularly audited.
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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 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 ArticleMost of the contact that people have with the NHS is with general practice: there are an estimated 300 million appointments each year. These services provide the first step in diagnosing and treating most patients’ health conditions. Due to changes in the data, trends in general practice staff are limited to 2015 at the earliest. The data do not include staff working in prisons, army bases, educational establishments, specialist care centres including drug rehabilitation centres and walk-in centres. From July 2019, primary care networks (PCNs) will offer services to patients and employ new specialist staff such as clinical pharmacists, social prescribing link workers, physiotherapists, physician associates and paramedics. NHS Digital has started to publish information on the PCN workforce, but the data does not presently cover all PCNs. Based on the PCN data that is available, the Nuffield Trust has estimated the number of certain primary care staff groups employed by PCNs across England,.
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In this article, published in Guidelines in Practice, Dr Ashish Chaudhry and Dr Harsha Master offer nine top tips for recognising and managing Long COVID-19 symptoms in primary care. This article aims to help clinical colleagues learn about: lingering or new symptoms after an acute case of COVID-19, known as ‘Long COVID’ identifying patients with Long COVID managing or referring patients who need active intervention and investigation. -
Content ArticleThis video from NHS Resolution looks at the criteria that need to be met in order for patient consent to be legally valid. Advice is provided on how to ensure practitioners obtain legally valid consent.
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Content ArticleThis publication presents UK-focused analysis of The Commonwealth Fund’s 2019 International Health Policy Survey of Primary Care Doctors in 11 Countries. This includes responses to several UK-specific questions funded by the Health Foundation. The Health Foundation present their analysis of the data, including comparisons with the 2015 survey where possible, under three main themes: how GPs view their job what care GPs are providing and how it is changing how GPs work with other professionals and services.
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Content ArticleThis FAQ resource from the Royal College of General Practitioners, provides information about a number of topics relevant to general practice and how to keep patients and staff safe during the coronavirus pandemic.
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Content Article
Royal College of General Practitioners: COVID-19 advice
Patient Safety Learning posted an article in Guidance
The Royal College of General Practitioners is closely monitoring the situation and developing practical resources and support for GPs and their teams. They have launched specific guidance for general practice, including out-of-hours. This will be updated as the situation develops but things are extremely fast moving so please make sure you are using the latest version. -
Content ArticleThis is a guide to end of life care symptom control when a person is dying from COVID19 for General Practice Teams, prepared by the Royal College of General Practitioners (RCGP) and the Association for Palliative Medicine.
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Content ArticleThis resource on managing contraceptive provision without face to face consultations has been produced by the Primary Care Women’s Health Forum to help primary care clinicians support women with their contraceptive needs during the coronavirus pandemic. It covers hormonal contraception including pills, patches, combined hormonal ring, IUD, IUS, implant, depo provera and emergency contraception.
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Content ArticleThe Remote by Default research study, a collaboration between the Universities of Oxford and Plymouth and the Nuffield Trust, has been exploring how technology can be harnessed to support excellent primary care. Using workshops, interviews, and focus groups of clinicians, service users, and other stakeholders, they have begun to map the multiple interacting influences on the choice of consultation modality.
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Content ArticleA short video to show you how to have a video consultation with your GP surgery after receiving an invitation via text message.
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