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Found 1,299 results
  1. News Article
    NHS England’s plan to make the 111 service a ‘primary route’ into emergency departments has fallen ‘far short of aspiration’, with only a small fraction of attendances being booked through it. NHSE began recording the numbers of ED appointments booked via 111 in August 2020, as it aimed to reduce unnecessary attendances and demand on emergency services, via the programme known as “111 First”. Planning guidance for 2021-22 told local systems to “promote the use of NHS 111 as a primary route into all urgent care services”. It added that at least 70% of patients referred to ED by 111 services should receive a booked time slot to attend. Pilots experimented with making it harder for people who had not called 111 to attend A&E, although proposals to direct those people away were rejected. Data published by NHSE shows the number of ED attendances that were booked through 111, but not those referred to ED without a booking. Jacob Lant, head of policy and research at Healthwatch England, said: “Sadly, it’s clear from these figures that implementation across the country is lagging behind where we would have hoped. “Obviously this has to be seen in the context of the massive pressures on A&E departments at the moment as a result of the pandemic, but there is also a need for the NHS to really step up efforts to tell people about this new way of accessing care.” Read full story (paywalled) Source: 25 February 2022
  2. News Article
    Face-to-face GP appointments have continued to fall, despite a rallying cry for doctors to restore normal services. The proportion of GP appointments held in person fell for the third month in a row to 60.3% in January, latest data show. Data published by NHS Digital on Thursday show about 25.6 million appointments were carried out in January. Of these, some 15.4 million were face-to-face. The last time it fell below this level was August 2021, when just 57.6% of appointments were face-to-face. Pre-pandemic, the proportion of GP appointments held in person was about 80%. Dr Nikki Kanani, NHS England’s medical director of primary care, told doctors last month to “restore routine service” following the successful rollout of the booster jab campaign. Writing to GPs, she said: “It is now important that all services across the NHS, including in primary care, are able to restore routine services where these were paused in line with the Prime Minister’s request to focus all available resource on the omicron national mission.” But patient groups say the “situation hasn’t improved” and patients are still struggling to see their doctor in person. Dennis Reed, from patient group Silver Voices, said the figures were “worrying” but not surprising. “I'm still getting complaints on a daily basis that people are struggling to see their GP,” he said. Read full story Source: The Telegraph, 24 February 2022
  3. Content Article
    The COVID-19 pandemic placed unprecedented pressure on councils and care providers. A new report from the Local Government and Social Care Ombudsman analyses just how those organisations coped.
  4. News Article
    Sickle cell patients have begun receiving the first new treatment for the blood disorder in over 20 years. The inherited condition can cause severe pain and organ failure, often requiring hospital admissions. Crizanlizumab is given as a monthly infusion and is thought to cut visits to A&E by 40%. Loury Mooruth, 62, received the treatment at Birmingham City Hospital, having suffered repeated periods of intense pain for decades. During a crisis, patients often need powerful opioid painkillers but Loury, like many others, has faced suspicion when at A&E. "You know the protocol when you go in, which needles and so on. They think straight away you are a drug addict - they don't believe you," she says. She has refused to go to hospital during a crisis for the past two years because of her negative experiences. A report from MPs last year found "serious failings" in sickle cell care with some evidence of discrimination against patients. Dr Shivan Pancham, a consultant haematologist at Birmingham City Hospital, told the BBC: "Our patients often find the experience in emergency departments challenging with a lack of understanding of the severity of pain. "It is hoped with these new therapies if we reduce the likelihood of attending emergency departments, ultimately this will be much better for the patients." Read full story Source: BBC News, 24 February 2022
  5. Content Article
    In my first blog, ‘Visiting restrictions and the impact on patients and their families’, I highlighted how the pandemic has shone a stark spotlight on so many inequities and inconsistencies in access to health and social care. I wanted to draw attention to how visiting restrictions can result in worse outcomes for patients and their families. In my second blog I want to focus on the terms ‘visiting’ and ‘visitor’ and discuss what defines a visitor and why, in my opinion, it requires redefining and renaming.
  6. News Article
    The NHS plans to treat up to 25,000 hospital patients at home in “virtual wards” to help clear the backlog caused by the pandemic, the “living with Covid” plan has revealed. Patients will be offered acute clinical care at home, including remote monitoring and treatment, as an alternative to hospital stays. Consultants or GPs will review patients daily via digital platforms and phone calls. In some cases, patients will be provided with a wearable device to continuously monitor and report their vital signs. The NHS has set a national target of 40 to 50 virtual beds per 100,000 population, which equates to about 25,000 beds across England, according to the “living with Covid” plan published this week. The document said: “The use of ‘virtual wards’ and ‘hospital at home’ models of care have ensured that patients can be safely cared for in their own homes and that additional bed capacity can be freed up in hospitals.” Commenting on the initial rollout of virtual wards, Dr Tim Cooksley, the president of the Society for Acute Medicine, warned a “hasty” rollout could risk patient safety. He said: “Virtual wards do have the potential to be a model of the future. However, it is essential they are appropriately planned, resourced and staffed so they simply cannot be seen as a short-term mitigation measure which can be hastily rolled out mid-pandemic. Incorrect implementation could risk patient safety and significantly impact clinician and patient confidence.” Read full story (paywalled) Source: The Telegraph, 22 February 2022
  7. Event
  8. Event
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    In order to support the NHS Priorities set out for 2022/2023 in delivering significantly more elective care to tackle the elective backlog and to reduce long waits, this exclusive webinar from GovConnect will take a look at the developing approaches to patient care using collaborations with providers delivering treatments in the home in order to support patient flow. This webinar will explore: How teams have innovated to provide hospital-at-home during the Covid-19 crisis and what’s needed to maintain the momentum of change? What is the future direction for hospital-at-home, post-pandemic, and what will accelerate or prevent adoption at scale? Evaluation and evidence required to support the case for change. There will be the first virtual wards presentation from Tim Staughn and the first one to case study the Covid virtual ward from Dr Andrew Barlow. Speakers: Jill Ireland, Chief Executive and Clinical Director, HomeLink Healthcare Jon Green, Consultant and Former NHS CEO Dr Andrew Barlow, Director of medicine, West Hertfordshire hospitals NHS trust Tim Straughan, Director of NHS @home NHS England & Improvement Register
  9. Content Article
    UK experts have issued an update on the timing of elective surgery and risk assessment after COVID-19 infection. Your operation may be delayed if you test positive for Covid-19. Studies of people who had COVID-19 just before or after their surgery show that they had more complications and an increased risk of dying. The risks of chest problems, blood clots or death are about 3 or 4 times greater for a full 7 weeks following COVID-19. These risks are increased even if the patient had no symptoms from COVID-19 (i.e. just a positive test).
  10. News Article
    Medical records contain a plethora of information, from a patient’s diagnoses and treatments to marital status to drinking and exercise habits. They also note whether a patient has followed medical advice. A health provider may add a line stating that the patient is “noncompliant” or “non-adherent,” signalling that the patient has been uncooperative and may exhibit problematic behaviours. Two large new studies in the US found that such terms, while not commonly used, are much more likely to appear in the medical records of Black patients than in those of other races. The first study, published in Health Affairs, found that Black patients were two and a half times as likely as white patients to have at least one negative descriptive term used in their electronic health record. About 8% of all patients had one or more derogatory terms in their charts, the study found. The most common negative descriptive terms used in the records were “refused,” “not adherent,” “not compliant” and “agitated.” The second study, published in JAMA Network Open, analysed the electronic health records of nearly 30,000 patients at a large urban academic medical centre between January and December 2018. The study looked for what researchers called “stigmatising language,” comparing the negative terms used to describe patients of different racial and ethnic backgrounds as well as those with three chronic diseases: diabetes, substance use disorders and chronic pain. Overall, 2.5% of the notes contained terms like “nonadherence,” “noncompliance,” “failed” or “failure,” “refuses” or “refused,” and, on occasion, “combative” or “argumentative.” But while 2.6% of medical notes on white patients contained such terms, they were present in 3.15% of notes about Black patients. Looking at some 8,700 notes about patients with diabetes, 6,100 notes about patients with substance use disorder and 5,100 notes about those with chronic pain, the researchers found that patients with diabetes — most of whom had type 2 diabetes, which is often associated with excess weight and called a “lifestyle” disease — were the most likely to be described in negative ways. Nearly 7% of patients with diabetes were said to be noncompliant with a treatment regimen, or to have “uncontrolled” disease, or to have “failed.” The labels have consequences, warns Dr. Schillinger, who directs the Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center. “Patients whose physicians tend to judge, blame or vilify them are much less likely to have trust in their doctors, and in the medical system overall,” Dr. Schillinger said. “Having health care providers who are trustworthy — who earn their patients’ trust by not judging them unfairly — is critical to ensuring optimal health and eliminating health disparities.” Read full story (paywalled) Source: The New York Times, 20 February 2022
  11. Content Article
    Waiting for procedures delayed by COVID-19 may cause anxiety and related adverse consequences. This study from Gagliardi et al. looked at the research on the mental health impact of waiting and patient-centred mitigation strategies that could be applied in the COVID-19 context. Findings revealed patient-centred strategies to alleviate the mental health impact of waiting for procedures. Ongoing research should explore how to optimize the impact of those strategies for diverse patients and caregivers, particularly in the COVID-19 context.
  12. Content Article
    This decision aid is for women who have complications caused by pelvic mesh that was used to treat their stress urinary incontinence. Pelvic mesh has also been called ‘tape’, ‘net’ or a ‘sling’. Stress urinary incontinence is when you leak urine accidentally, especially during exercise or when you cough, laugh or sneeze. This decision aid has been written for women who have been referred to a specialist centre to treat complications from mesh used for stress urinary incontinence.
  13. News Article
    The average number of patients each individual GP is responsible for has increased by 15%, or around 300 people, since 2015, the BMA has said. This is due to the ‘slow but steady haemorrhaging’ of GPs over the last few years, which has led to pressures on services growing ‘even more acute’, it suggested. The Association’s statement comes in response to the latest GP workforce data – published by NHS Digital (10 February) – which showed that 188 FTE GPs left between December 2020 and December 2021. Dr Farah Jameel, chair of the BMA’s GP committee, said the figures are the direct result of an ‘over-stretched’ and ‘under-resourced’ NHS. She said: ‘Family doctors, exhausted and disenchanted, feel as though they have no choice but to leave a profession they love because of chronic pressures now made worse by the pandemic. Workload has dramatically increased, there are fewer staff in practices to meet patient needs.’ Insufficient staffing is particularly concerning as the backlog for care continues to grow, she suggested, with many GPs believing ‘the day job is just no longer safe, sustainable or possible anymore’. The NHS and the Government must work to retain current staff as its ‘immediate priority’ and must urgently refocus on retention strategies as a key enabler for the NHS’ recovery. She said: ‘The Government has repeatedly argued that the number of doctors is growing, but this isn’t the reality for general practice, and it begs the question: how many more have to go before something is finally done about it? Our NHS is the people who work in it, and without them, the entire system and provision of patient care is under threat.’ Read full story Source: Management in Practice, 11 February 2022
  14. News Article
    A life-saving campaign is being launched by the NHS to urge people to learn how to spot signs of a heart attack. The survival rate for heart attack sufferers is seven in 10, rising to nine in 10 for those who have early hospital treatment. The most common sign of a heart attack is chest pain, but other symptoms to look out for include chest, arm, jaw, neck, back and stomach pain, lightheadedness or dizziness, sweating, shortness of breath, nausea, vomiting, anxiety, coughing and wheezing. The health service are encouraging anyone experiencing these indicators to call 999. It comes after a poll found found that fewer than half of people knew to dial 999 if they or a loved one experienced the more vague signs of a heart attack. Another priority of the campaign is to teach people how to differentiate between a heart attack and cardiac arrest. According to the health service, there is often no warning and the person quickly loses consciousness when they suffer cardiac arrest. Those experiencing a cardiac arrest will usually die within minutes if they do not receive treatment. It also points out that a heart attack can lead to a cardiac arrest. NHS medical director Professor Stephen Powis said: “Sadly, cardiovascular disease causes a quarter of all deaths across the country and we have identified this as the single biggest area where we can save lives over the next decade. Read full story Source: 13 February 2022
  15. Content Article
    The Covid-19 pandemic exposed the need to harness and leverage digital tools and technology for remote patient monitoring (RPM). This article explores the benefits of RPM for clinicians as well as how it can be changed to improve outcomes.
  16. Content Article
    The tinnitus decision aid is designed to help clinicians and patients work together to choose the right treatment option for each individual. People with tinnitus vary in their preferences, for example, some like to use sound, others prefer a talking therapy approach. The decision aid provides information on key points that patients need to know to make a decision. The decision aid was developed through a systematic process of reviewing evidence, gathering key questions from patients and refining the information to be readable and useable. All the approaches listed are available everywhere but may require some travel or cost to access them. This should be discussed in consultations.
  17. Content Article
    In this study, 156 participants were recruited and randomised to placebo (n=83) or ketamine (n=73), stratified by centre and diagnosis: bipolar, depressive, or other disorders. Two 40-minute intravenous infusions of ketamine (0.5 mg/kg) or placebo (saline) were administered at baseline and 24 hours, in addition to usual treatment. The primary outcome was the rate of patients in full suicidal remission at day 3, according to the scale for suicidal ideation total score ≤3. Analyses were conducted on an intention-to-treat basis. The findings indicate that ketamine is rapid, safe in the short term, and has persistent benefits for acute care in suicidal patients. Comorbid mental disorders appear to be important moderators. An analgesic effect on mental pain might explain the anti-suicidal effects of ketamine. There are also some useful and thought-provoking comments on this research, and a helpful visual aid.
  18. Content Article
    This study from West et al. explore the relationships between leader support, staff influence over decisions, work pressure and patient satisfaction. The results provide evidence that leader support influences patient satisfaction through shaping staff experience, particularly staff influence over decisions and work pressure. Patients’ care is dependent on the health, well-being, and effectiveness of the NHS workforce. That, in turn, is determined by the extent to which leaders are supportive in ensuring that work environments are managed in a way which protects the well-being of staff.
  19. News Article
    Unable to move and with her newborn baby crying out of reach, Neya Joshi was left alone for hours on an understaffed maternity ward and had to beg for a glass of water. “It was awful, I was so helpless and so desperate, and no one was interested in helping me. I have never felt fear like it,” she said. The medical copywriter, 30, was diagnosed with post-traumatic stress disorder months after giving birth to her son Arjun at Croydon University Hospital in May 2020 and had therapy for a year to recover from the trauma. She is one of thousands of mothers across the country experiencing poorer care because maternity units lack enough staff. Data from 122 NHS trusts in England shows maternity units were forced to shut their doors to women in labour more than 323 times in 2020-21, with units shut for a total of 16,294 hours, the equivalent of 679 days. When this happens women are forced to go to an alternative hospital to give birth. Staffing shortages were given as a reason in more than two-fifths of the closures. Joshi saw first hand the impact of a lack of midwives when she was admitted to hospital to be induced after her waters broke at the height of the pandemic. Visiting restrictions meant she was alone on a ward for 24 hours and, despite being told she was a high priority, there were no free beds. “After they had started the induction I was told someone would come and check me within six hours but no one came and I was just left on my own for hours,” she said. Eventually, after concerns over her baby’s heart rate, she had an emergency caesarean section but her husband was then made to leave an hour later. “I was taken to the postnatal ward and that’s where it all really went downhill,” she said. “It was awful. I was just lying there. I couldn’t move because I had the epidural and my baby was crying." Read full story (paywalled) Source: The Times, 6 February 2022
  20. Content Article
    This article, published in JMIR mHealth and uHealth, explores the impact and effectiveness of patient-facing mobile health technology on patient outcomes. It concludes that these technologies can empower patients to play a more active and meaningful role in improving their outcomes, but that there is a need for better understanding of the interactions between patients, technology and health care providers.
  21. Content Article
    The pandemic has shone a stark spotlight on so many inequities and inconsistencies in access to health and social care. Unfortunately, many of these inequities were already there and so, in some respects, its nothing new. In this blog, I want to draw attention to how visiting restrictions can result in worse outcomes for patients and their families. I will focus mainly on the needs of older adults in hospital or care, and those with dementia, because that has been my own experience. But these restrictive practices have affected so many groups: among them, those with mental health conditions and those with learning and behavioural difficulties. 
  22. Content Article
    Medical expertise is fundamental to the practice of medicine. But other skills and knowledge are important too. Doctor Informed gives the inside story on the evidence about giving the best care and having positive relationships with patients and colleagues.
  23. Event
    until
    In order to support the NHS Priorities set out for 2022/2023 in delivering significantly more elective care to tackle the elective backlog and to reduce long waits, we take a look at the developing approaches to patient care using collaborations with providers delivering treatments in the home in order to support patient flow. This webinar will explore: How teams have innovated to provide hospital-at-home during the Covid-19 crisis and what’s needed to maintain the momentum of change? What is the future direction for hospital-at-home, post-pandemic, and what will accelerate or prevent adoption at scale? Evaluation and evidence required to support the case for change. Register
  24. Content Article
    This study in the International Journal of Nursing Studies looked at the role of primary care nurses in coaching patients in shared decision making about their treatment. It evaluated an approach to support nurses in coaching patients, which was found to have a positive impact overall. Nurses became more aware of their own attitudes and learning needs and reported more in-depth discussions with patients. However, nurses struggled to integrate the approach in routine care and highlighted the need to receive support from their practice to implement the new approach.
  25. News Article
    Nightclubs have reopened, concerts have been given the go-ahead and football stadiums are welcoming fans - but there are still restrictions on face-to-face GP consultations. Only a limited number of patients are being invited into surgeries, where there continue to be strict rules on physical distancing. Edinburgh GP Dr Carey Lunan says she understands why the situation is confusing. "The difference between a healthcare setting and, say, a restaurant or a football stadium, is that we have people coming into our building who are much more vulnerable and frail and don't have a choice in being unwell," she tells BBC Scotland. "So we have to have higher levels of safety than a setting where people can choose to go, knowing that there may be a little bit of risk." According to the British Medical Association's Dr Andrew Buist, the balance between telephone and in-person consultations should continue to adjust as we move out of the pandemic, guided by evidence. But many patients will "very easily" have their needs met by phone appointments. So-called telephone triage - where patients are assessed over the phone before being invited into the building - has now become the norm. "For a lot of patients it works really well if it's a simple problem and it means not having to take time off work or travel," says Dr Lunan. "It works less well if English isn't their first language or they've not got the privacy at home to have a conversation about something that is a bit more sensitive, if it's a very complex issue or it's just not clear what the diagnosis is." She adds: "We deal with things when someone comes in with problem A, but actually we end up having a conversation about problem B when they are in the room with us. "It is much more challenging to do that kind of health care on the phone and I think we just need to be honest that there are limitations. Dr Lunan says she hopes a return to more face-to-face appointments will come "in the not too distant future. I miss seeing patients if I'm honest," she says. "When we get to the point where we are able to bring in more people we will welcome that because it feels like a treat at the moment." Read full story Source: BBC News, 25 January 2022
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