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Content ArticleThis report by the Royal College of General Practitioners (RCGP) sets out recommendations for the Government to tackle the workforce and workload crisis in general practice, and support GPs and their teams to meet the healthcare challenges of the 21st century. Based on a survey of more than 2,600 GPs and other practice team members from across the UK, the report provides a snapshot of what frontline staff have faced during one of the most difficult winters experienced in the NHS, and what they think needs to happen to make general practice more sustainable. Respondents describe a profession in crisis, with unmanageable workload and workforce pressures fuelling an exodus of fully qualified GPs.
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Content ArticleA repository of resources aimed at patients and carers which have been co-produced by the Falls and Fragility Fracture Audit Programme (FFFAP) patient and carer panel.
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Content Article
This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Isabela shares how her experience of losing her baby daughter to avoidable harm in 2006 led to her involvement in patient safety advocacy. She talks to us about the vital role of patient campaigners in driving the movement to reduce avoidable harm, and why we need to shift from patient inclusion to belonging in order to improve patient safety. -
Content ArticleIn this video Kenny Gibson, Head of Safeguarding for NHS England and NHS Improvement, explains what trauma informed care is and describes the role of healthcare professionals in recognising trauma in colleagues and patients. He talks about the importance of overcoming unconscious bias around whether individuals have experienced trauma and outlines the importance of avoiding retraumatising victims. He also highlights that healthcare professionals can play a key role in bringing hope to people who have been traumatised.
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Content ArticleThis paper identifies the critical reasons healthcare leaders today must invest in experience leadership and structure. Contributions to this paper were captured from 42 participating organisations through a 50-item survey designed by the Institute’s Experience Leaders Circle. The reveals six reasons why a dedicated experience effort, and a structure to support it, are essential to becoming a provider of choice. The study concludes with seven positive outcomes important for healthcare executives to consider.
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Content ArticleIn this National Health Executive article, Dr Tom Milligan, Clinical Lead for Diabetes in Humber and North Yorkshire, discusses how ICB-led text messaging could dramatically increase patients' participation in programmes where other methods of patient outreach have already been tried.
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Content ArticleEating disorders are often seen as an illness that affects young women, but research estimates that one in four people with eating disorders are male. As a result, boys and men with eating disorders most often live in silence with the double stigma of having a mental health condition that is not recognised in their gender. In this BBC documentary, former England cricketer and TV presenter Andrew "Freddie" Flintoff goes on a personal journey into the eating disorder he has kept secret for over 20 years–bulimia. He discusses his own experience and meets specialists and young men with eating disorders across the UK.
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Content ArticleStephanie Longe first arrived in the UK from Switzerland in 2019 to work at the High Consequence Emerging Viruses Group at what is now the UK Health Security Agency. At the time, her project was focused on Ebola virus disease survivors. But Covid quickly changed plans. Stephanie and her colleagues had to use their skills to develop Covid treatments and new antivirals. Stephanie was involved in early research to study the Sars-CoV-2 infection, and test vaccine candidates. Then in June 2022, Stephanie had Covid and she is now one of the 2 million people who experience self-reported Long Covid symptoms in the UK. She shares her experience of Long Covid and the research she is doing in this Guardian article.
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Content ArticleGP services are the first point of call for many health issues and the gateway to NHS specialist support. GP teams are highly skilled and may decide that treatment without specialist care is the best action. But when you need specialist support, such as hospital tests or treatment, you may need a referral from your GP team first. New research from Healthwatch highlights that it can be very hard for some people to get a GP referral to another NHS service. And for 21% of people we spoke to, even when they get referrals, they can be lost, rejected or not followed up on. When services don't process referrals properly, it can cause significant frustration, unnecessary anxiety, and even cause harm to patients. It can also lead to increased demand for either more GP appointments or help from healthcare teams in other parts of the NHS, putting more pressure on already overstretched services.
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Content ArticleWaiting 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.
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News ArticleThe NHS should “urgently investigate” after Byline Times uncovered “disturbing” figures showing that more than 4,000 patients, visitors and NHS staff were raped or sexually assaulted in hospitals over the past four years, the Shadow Health and Social Care Secretary has said. An investigation by Byline Times has unearthed that 4,100 patients, visitors and NHS staff were raped (1,364) or sexually assaulted (at least 2,744) in a hospital setting between January 2019 and September 2022–with 633 raped or assaulted while on a hospital ward. At least three of the incidents were against a female child aged under 13. Data from 31 police forces in England and Wales based on reported rapes and assaults revealed the scale of sexual violence within hospital settings, with victims including patients and staff members. Labour’s Shadow Health and Social Care Secretary Wes Streeting said, “Hospitals ought to be safe places for patients and staff, but these disturbing findings show that is not the case for far too many people. The NHS should urgently investigate why these disgusting crimes are allowed to happen and on such a widespread scale.” Read more Source: Byline Times, 5 December 2022
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News Article
Automatic roll-out of patient access to GP records halted at eleventh hour
Patient Safety Learning posted a news article in News
In an eleventh-hour decision NHS England has halted the automatic, blanket roll-out of a scheme that would have given all NHS patients in England prospective online access to their GP-held records the day before it was due to come in. The high-profile scheme to enable patents to automatically view their GP records via the NHS app by 30 November, has been a key digital promise by successive Conservative health secretaries. The last-minute u-turn came following a series of talks between the British Medical Association (BMA) and NHS England, in which the BMA made clear many practices would not be ready to roll out the programme in a safe way for patients, and that it didn’t comply with their data protection obligations. The BMA says the decision is the ‘right thing to do’ for patient safety. The BMA said in a statement that while some practices were ready to implement this, many expressed concerns over safety aspects and that it wasn’t fit for purpose at the present time. Dr David Wrigley, deputy chair of GPC England at the BMA, said: “We’re pleased to hear that NHS England has decided to review the pace and timing of the automatic, mass roll-out of the Citizens’ Access programme. This is, without doubt, the right thing to do for patient safety. “We want patients to be able to access their GP medical records, but this must be done carefully, with the appropriate safeguards in place to protect them from any potential harm. “The deadline of 30 November was, for many practices, just too soon to do this, and removing it will come as a huge relief to GPs and their teams across the country.” Read full story Source: Digital Health, 30 November 2022 -
News Article
NHS England ad campaign hopes to change behaviours and relieve service
Patient Safety Learning posted a news article in News
Plans have been drawn up to avoid the NHS being overwhelmed this winter by encouraging patients to “behave in ways they’ve not experienced before” and cut down on in-person GP visits, the Guardian can reveal. An advertising campaign devised by M&C Saatchi, awarded a contract by NHS England worth up to £28.6m, suggested ways people could be encouraged to settle for a virtual appointment or visit a pharmacist instead. To help reduce the mounting pressures facing medics, documents show the agency also advised patients should be told that seeking help via alternative routes instead of rushing to A&E would help the NHS “work better for everyone”. The three-year contract is for the ad campaign “Help Us Help You”, which seeks to change people’s behaviour when accessing healthcare to reduce pressures on the NHS and maintain capacity. Wes Streeting, Labour’s shadow health secretary, said patients were already cutting back on in-person GP appointments – “not because they don’t need them but they’re finding it impossible to get one”. He told the Guardian: “Among those millions of patients who can’t get an appointment when they need it, there will be problems which go undiagnosed until it’s too late". Read full story Source: The Guardian, 30 November 2022 -
News Article
Scotland’s NHS ‘already two-tier’ as more pay to go private
Patient Safety Learning posted a news article in News
Nicola Sturgeon has been accused of running a two-tier NHS after it emerged that tens of thousands of patients are going private for crucial operations and healthcare. Anas Sarwar, the Scottish Labour leader, cited figures that showed more than 39,000 patients underwent private procedures in the past year. These included thousands of hip and knee surgeries, costing an average of £12,500 per patient. “Often these are people who are forced to borrow money, turn to family and friends, or even remortgage their home to get healthcare that should be free at the point of need,” Sarwar told MSPs at first minister’s questions. He said that almost 2,000 people had gone for private treatment for endoscopies and colonoscopies, more than 7,800 for cataract surgery and 3,500 have had a hip or knee replacement in a private hospital. “These figures make clear that under the SNP, healthcare in Scotland is already a two-tier system,” he added. Read full story (paywalled) Source: The Times, 24 November 2022 -
News Article
Severely ill refusing sicknotes as they cannot afford time off, says GPs’ head
Patient Safety Learning posted a news article in News
Ill patients are refusing sicknotes from their GP because they cannot afford time off work, while doctors suffer “moral distress” at their powerlessness to do more to help the most vulnerable, the new leader of Britain’s family doctors has revealed. More patients are experiencing asthma attacks or other serious breathing problems because they cannot afford to heat their homes, said Dr Kamila Hawthorne, the chair of the Royal College of GPs, while many have reported deteriorating mental health due to financial stress. Soaring food costs are also leading to a rise in fatigue, mouth ulcers and weak muscles, with people deficient in key vitamins because they cannot afford to eat anything other than a poor diet. So many patients are presenting with complex physical and psychological problems related to poverty, domestic violence, childhood abuse or poor housing that GPs are suffering psychologically from their inability to take the requisite action, she said. Hawthorne said: “Recently I’ve had patients refusing sicknotes because they can’t afford not to work. Quite often, when it’s clear that somebody needs some time off, they won’t take it. “These are people who ideally, medically, should not be at work [because] they have a chronic condition such as asthma or diabetes, but quite often mental health problems, quite severe mental health problems, I [see] some cases that really do require a bit of sicknote peace and quiet to try and help them get better. “I’ve been really surprised in the last year that when I’ve offered a sicknote they’ve said: ‘Oh no, no, I can’t take time off. I need the money from work.’ They’ve refused. They say: ‘I need to keep working to earn and to feed myself and my family.’ I don’t take it personally, of course, but I feel sad for people because for a few minutes you enter their lives and see that it’s really tough.” Read full story Source: The Guardian, 23 November 2022 -
News Article
Patients prescribed heating as part of health trial
Patient Safety Learning posted a news article in News
Doctors are prescribing heating to patients with conditions that get worse in the cold as part of a health trial. The Warm Home Prescription pilot paid to heat the homes of 28 low-income patients to avoid the cost of hospital care if they became more ill. Michelle Davis, who has arthritis and serious pulmonary illness, had her energy bills paid for and said the difference was "mind-blowing". "When the weather turns cold, I tend to seize up," she told the BBC. "It's very painful, my joints ache and my bones are like hot pokers." In 2020 Ms Davis spent most of the winter in bed, trying to keep warm and was admitted to hospital with pneumonia and pleurisy. But not in winter 2021. "You're not stuck in bed, you're not going to hospital, my children were able to have a life, they were able to go out and play and get cold," she said. Academics estimate that cold homes cost NHS England £860m a year and that 10,000 people die every year due a cold home. But that research was completed before the current cost of living crisis took hold. This first trial achieved such good results, that it's being expanded to 150 households in NHS Gloucestershire's area, plus about 1,000 in Aberdeen and Teesside. Dr Matt Lipson helped design the pilot programme and feels like this preventative step is a no-brainer for the health service. "If we buy the energy people need but can't afford, they can keep warm at home and stay out of hospital," he said. "That would target support to where it's needed, save money overall and take pressure off the health service." The change in patients was swift: "The NHS were telling us they were seeing a benefit much more quickly than pills and potions," Dr Lipson added. "It was taking days, not weeks and months." Read full story Source: BBC News, 22 November 2022 -
News ArticleGP practices can block abusive patients from gaining automatic access to their records online if they pose a ‘risk of harm’ to staff, the Royal College of General Practice has said. Automatic access to patients’ prospective patient records is due to be switched on by the end of this month, following delays related to concerns about patient safety. But the RCGP’s toolkit on access to records said practices can refuse access to online records for patients that pose a risk of harm to others too. The guidance said access should "be refused where there is a clear risk of serious harm to the safety of the patient or members of the practice team, or to the privacy of a third party". It added: "If potentially harmful information cannot be successfully redacted and the practice remains concerned about the safety of record access for an individual patient – or in extreme cases, remains concerned that the patient may react violently to information in the record – then the practice may refuse to give the patient record access or restrict the level of access. "It may be possible to give them access to a reduced part of the record such as the Summary Care Record or restrict access to appointments and repeat prescriptions." The guidance said that records access should only be refused or restricted "after discussion with the practice leads for GP Online Services and Safeguarding or after seeking further professional advice from a local relevant agency or national medical indemnity organisation". Read full story Source: Pulse, 18 November 2022
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News ArticleAt a time when it feels like the world’s perpetually on fire, we all need a therapist – but trying to find one in the USA is difficult. A study from the American Psychological Association (APA) found that 6 in 10 psychologists “no longer have openings for new patients” in America. The shortage comes as demand for therapy soars: since the beginning of the pandemic, about three-quarters of practitioners have seen their waiting lists expand. In the same period, almost 80% of practitioners report an increase in patients with anxiety disorders and 66% have seen an increase in those needing treatment for depression. “I started my private practice just before Covid hit, and it was certainly filling up then,” says Dr Jennifer Reid, a psychiatrist, writer and podcast host in Philadelphia. “But the numbers have exponentially risen since that time.” Reid focuses on anxiety and insomnia, which have been “major players” in the pandemic. Early on, people with anxiety, phobias or obsessive-compulsive disorder related to germs had particular trouble, she says. Then there was the isolation and the doomscrolling. And now, she says, people are struggling to re-enter the world. “People are finding they’re having anxiety trying to re-engage in social settings in situations that were previously not as safe” at Covid’s peak, she says. Often, she says, people may need to return to their primary care doctor for a period of time, “or they just end up going without and waiting on waitlists, unfortunately”. The APA study found that the average psychologist reported being contacted by 15 potential patients every month; Reid, who combines therapy and medical approaches, says she generally has space for about one new patient every few weeks. Read full story Source: The Guardian, 21 November 2022
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News Article
GPs in England treat up to three times more patients than safety limit demands
Patient Safety Learning posted a news article in News
GPs are struggling to cope with as many as 90 appointments and consultations a day – more than three times a recommended safety limit. General practices in England are carrying out more appointments than before the pandemic but face severe workforce shortages. More than 1.45 million patients waited at least 28 days to see a GP in September, according to the most recent NHS figures. GPs who spoke to the Observer last week say that almost every day they breach the BM) guideline of “not more than 25 contacts per day” to deliver safe care. One doctor said he had more than 90 consultations on one day. A conference of local medical committee representatives in England this week will highlight the growing pressures faced in general practice. Surgeries are being urged to impose stricter caps on the number of patient appointments for each GP. One of the proposed motions submitted to the conference by Kensington and Chelsea local medical committee says “focusing on patient safety” is more appropriate than meeting high patient demand. It says the NHS should focus on “safe capacity”. Such a move would mean longer waits for GP appointments, but doctors say it would help safeguard patient care and the welfare of staff in general practice. Read full story Source: The Guardian, 20 November 2022 -
News Article
ICSs may be breaching patient confidentiality, watchdog warns
Patient Safety Learning posted a news article in News
The health service’s independent data watchdog has issued a warning to local NHS bodies over concerns confidential patient information is being shared unlawfully with third parties, including for ‘population health’ analysis. In a letter to integrated care systems (ICSs), National Data Guardian Nicola Byrne and UK Caldicott Guardian Council chair Arjun Dhillon said they had both “been made aware that within some local record sharing programmes, organisations could be processing confidential patient information without ensuring that the processing does not breach confidentiality”. They added among the four areas of concern health and care staff had raised with them was that confidential patient information may be being transferred from local record sharing programmes to third party hosted secure data environments. Secure Data Environments are data storage and access platforms where organisations can apply to access data for planning and research purposes. It is not clear what kind of patient data may have been unlawfully shared. Read full story (paywalled) Source: HSJ, 17 November 2022 -
News ArticleVoices offer lots of information. Turns out, they can even help diagnose an illness — and researchers in the USA are working on an app for that. The National Institutes of Health is funding a massive research project to collect voice data and develop an AI that could diagnose people based on their speech. Everything from your vocal cord vibrations to breathing patterns when you speak offers potential information about your health, says laryngologist Dr. Yael Bensoussan, the director of the University of South Florida's Health Voice Center and a leader on the study. "We asked experts: Well, if you close your eyes when a patient comes in, just by listening to their voice, can you have an idea of the diagnosis they have?" Bensoussan says. "And that's where we got all our information." Someone who speaks low and slowly might have Parkinson's disease. Slurring is a sign of a stroke. Scientists could even diagnose depression or cancer. The team will start by collecting the voices of people with conditions in five areas: neurological disorders, voice disorders, mood disorders, respiratory disorders and pediatric disorders like autism and speech delays. This isn't the first time researchers have used AI to study human voices, but it's the first time data will be collected on this level — the project is a collaboration between USF, Cornell and 10 other institutions. The ultimate goal is an app that could help bridge access to rural or underserved communities, by helping general practitioners refer patients to specialists. Long term, iPhones or Alexa could detect changes in your voice, such as a cough, and advise you to seek medical attention. Read full story Source: NPR, 10 October 2022
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News ArticleA Guardian analysis has found that as many as one in three hospital beds in parts of England are occupied by patients who are well enough to be discharged, with a chronic lack of social care meaning many do not have suitable places to go. Barry Long's 91-year-old mother has Alzheimer’s and was admitted to Worthing hospital on 30 May after a minor fall. She was a bit confused but otherwise unhurt, just a bit shaken. Whilst in hospital, she caught Covid and had to be isolated, which she found distressing, and became increasingly disoriented. She was declared medically fit to be discharged but no residential bed could be found for her. Then, in August, she was left unsupervised and fell over trying to get to the toilet and she fractured her hip, which required surgery. Her hip was just about healed when she caught her shin between the side bars and the frame of the bed, cutting her shin so badly that she is being reviewed by a plastic surgeon to see if it needs a skin graft. "Since the operation, my mum is pretty much bedbound and lives in a state of confusion and anxiety", says Barry. "Her physical health and mental wellbeing have deteriorated considerably in the almost five months she has spent in the care of the NHS. She spends all day practically trapped in bed, staring into space or with her eyes shut, just rocking to and fro. She has little mental stimulation." Read full story Source: The Guardian, 13 November 2022
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News Article
Half of ambulance arrivals ‘inappropriate’, says acute trust
Patient Safety Learning posted a news article in News
An audit conducted by an acute trust has found more than half the patients taken to one of its hospitals by ambulance were deemed “inappropriate for conveyance”. The assessment at Scarborough Hospital in Yorkshire, obtained by HSJ through a freedom of information request, examined a random sample of 100 patients, of which around 50 arrived by ambulance. Of those arriving by ambulance, half were deemed not to have required an ambulance conveyance. The Missed Opportunities Audit, which the trust said was “routine” and looked at a range of areas where the emergency department could streamline operations, said: “Fifty-two per cent of conveyance[s] by ambulances were deemed as inappropriate". “The reviewer did not have access to the policies of Yorkshire Ambulance Service, which may account for the low number of appropriate conveyances. However, based on clinical judgment for cases presenting by ambulance the arrivals should have presented either to a community service (33%) or via their own transportation methods (38%), as their documented clinical condition and social circumstances allowed for this.” Read full story (paywalled) Source: HSJ, 9 November 2022 -
News Article
Mental health patients held ‘unlawfully’ in A&Es across the country, experts warn
Patient Safety Learning posted a news article in News
Mental health patients are being held “unlawfully” in A&Es across the country as long waits for care and beds force staff into “fudging” the law, The Independent has been told. The University Hospital of North Midland Trust has been sanctioned by the Care Quality Commission (CQC) for holding mental health patients without any legal authority. However, experts have told The Independent the problem is widespread and occurs across every emergency department in the country with some patients waiting “days” and even “weeks” in A&E. Leaders at Barking, Havering and Redbridge NHS Trust have raised repeated concerns in recent months over patients waiting days in their A&E for mental health care. The CQC raised concerns about the assessment of mental health patients at UHNM following an inspection in October and served the trust with a warning notice. In a letter seen by The Independent, the CQC said two patients were “restricted within hospital unlawfully”. It said although staff were working in the patient’s best interests in both cases it was clear that legal procedures “were not being followed”. “Therefore, this can be seen as a significant infringement of any personal or welfare,” it said. Read full story Source: The Independent. 8 November 2022 -
News Article
GPs giving antidepressants to children against guidelines
Patient Safety Learning posted a news article in News
GPs are breaching medical guidelines by prescribing antidepressants for children as young as 11 who cannot get other help for their mental health problems, NHS-funded research reveals. Official guidance says that under-18s should only be given the drugs in conjunction with talking therapies and after being assessed by a psychiatrist. But family doctors in England are “often” writing prescriptions for antidepressants for that age group even though such youngsters have not yet seen a psychiatrist, according to a report by the National Institute for Health and Care Research (NIHR), the NHS research body. The report linked the prescriptions to the long wait many young people, some self-harming or suicidal, face before starting treatment with NHS child and adolescent mental health services (CAMHS). Under-18s are prescribed the drugs for anxiety, depression, pain and bedwetting. The guidance on antidepressants has been issued by the National Institute for Health and Care Excellence (NICE), which advises the NHS on which treatments are effective. Referencing NICE’s recommendation of a two-step approval process, the NIHR study said “this often” did not happen. “No antidepressants are licensed in the UK for anxiety in children and teenagers under 18 years, except for obsessive compulsive disorder. Yet both specialists [psychiatrists] and GPs prescribe them. Thousands of children and teenagers in the UK are taking antidepressants for depression and anxiety. The numbers continue to rise and many have not seen a specialist.” Read full story Source: The Guardian, 4 November 2022
