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Community PostPhysician associates are healthcare professionals who work as part of a multidisciplinary team with supervision from a named senior doctor, providing care to patients in primary, secondary and community care environments. First introduced in 2003, PAs have become increasingly talked about in healthcare and in the media, with many discussions focused on the safety of the current approach. We want to hear from patients and carers. Have you, or someone you care for, got an experience of being seen by a PA that you would like to share? Do you feel more information about the PA role would be useful for patients? Do you have any other comments, concerns or perspectives you would like to add? Please comment below (you'll need to sign up first, for free) or contact the team at content@pslhub.org
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News Article
The ICSs ‘diverting’ the most GP referrals through controversial model
Patient Safety Learning posted a news article in News
There is huge regional variation in the rate at which health systems are preventing patients joining the elective waiting list through “advice and guidance” to GPs, according to analysis by HSJ. Some systems – including Northamptonshire – have managed to ramp up these “diverts” to such an extent that they now report around one A&G case to every 3.5 cases cleared from the waiting list through treatment or seeing a consultant. This contrasts with others, such as Lancashire and South Cumbria, which only reports one A&G case for every 16 cleared from the waiting list. Advice and guidance involves GPs consulting specialists before making direct referrals and around half the time this results in a referral being avoided. The model is set to be a cornerstone of NHS England’s new outpatient transformation strategy, which is due imminently. Victoria Tzortziou-Brown, vice chair of the Royal College of GPs, said the analysis “confirms reports we’ve heard from our members – that there is too much regional variation in the use of the ‘advice and guidance’”. She added: “Some GPs report that when advice and guidance is properly resourced and well implemented, it can be a helpful tool for improving communications with their colleagues in secondary care. “[But] it is clear that more time, funding and capacity needs to be dedicated to allow clinicians to communicate efficiently and effectively whilst respecting professionalism.” Read full story (paywalled) Source: HSJ, 9 April 2024 Related reading on the hub: Rejected outpatient referrals are putting patients at risk and increasing workload pressure on GPs -
EventuntilNHS Resolution’s Safety and Learning team in collaboration with the NW panel law firms, are hosting a virtual forum series on learning from claims to promote reflection and improve patient care. The purpose is to raise awareness of the support offered by NHS Resolution as your General Practice indemnifier along with the North West panel firms; Weightmans, Hempsons and Hill Dickinson. This will be of interest to both clinical and non-clinical staff involved in patient care across primary and urgent care . The format is interactive, with presentations followed by questions and panel discussion. Session 1: Seeking support for claims The session will explain how NHS Resolution, and its panel firms, will support you in responding to claims along with an overview of the legal tests used to determine a claim and the steps involved. Event programme: Introduction to the GP Indemnity scheme and clinical negligence Q&A panel discussion Contributors: • Patricia Roe - Partner | Hempsons • Dr Anwar Khan - Senior Clinical Advisor for General Practice, NHS Resolution Register
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News Article
Links between primary and secondary care must be ‘streamlined’ says NHSE
Patient Safety Learning posted a news article in News
All trusts should pick a “designated lead” for improving how they work with primary care, according to new NHS planning guidance. The guidance for 2024-25 published by NHS England today states: “Every trust should have a designated lead for the primary–secondary care interface.” It also asks integrated care boards to “regularly review progress” on how secondary care services are working with primary care. NHSE recovery plans include trying to cut the number of patients effectively referred back to GP practices by other services, in order to reduce GP workload. The guidance states: “Streamlining the patient pathway by improving the interface between primary and secondary care is an important part of recovery and efficiency across healthcare systems”. The planning guidance — published on Wednesday night after months of delays — also said systems should continue to develop integrated neighbourhood teams, including by trying to “improve the alignment of relevant community services” to primary care network footprints. Read full story (paywalled) Source: HSJ, 27 March 2024 -
Content ArticleDoctors working in temporary positions (known as locums) are a key component of the medical workforce and provide necessary flexibility and additional capacity for NHS organisations and services. There have been concerns about the quality and safety of locum practice and the way NHS uses locum doctors. The number of doctors working as locums, and the costs of this to the NHS have caused some concerns nationally in recent years. It has also been suggested that locum doctors may not provide as good a quality of care as permanent doctors. Research carried out by a team at the University of Manchester provided important new information on these issues. The findings indicated that locum working and how locums were integrated into organisations could pose significant challenges for patient safety and quality of care.
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Content Article
NHS England: Pharmacy First
Patient-Safety-Learning posted an article in Community pharmacies
This webpage provides information about the Phramacy First service, launched in England in January 2024. Pharmacy First builds on the NHS Community Pharmacist Consultation Service which enables patients to be referred into community pharmacy for a minor illness or an urgent repeat medicine supply. Pharmacy First adds to this by enabling community pharmacies to complete episodes of care for seven common conditions following defined clinical pathways: Acute otitis media (middle ear infection) Impetigo Infected insect bites Shingles Sinusitis Sore throat Uncomplicated urinary tract infections -
Content ArticleThis consensus statement co-ordinated by the British In Vitro Diagnostics Association (BIVDA) outlines the role of point of care testing in reducing the amount of antibiotics prescribed in primary care. It highlights the issue of antimicrobial resistance (AMR) and outlines evidence for the effectiveness of the rapid point-of-care C-Reactive Protein (POC CRP) test to assist clinical decision making as to whether an individual presenting with symptoms of respiratory tract infection needs an antibiotic. It makes a series of recommendations for the Department of Health and Social Care (DHSC) and NHS England around the use of POC CRP testing in primary care.
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Content ArticleThere is currently a lack of research addressing the impact of patient suicide on GPs. This qualitative study in BMJ Open aimed to examine the personal and professional impact of patient suicide, as well as the availability of support and why GPs did or did not use it. The authors found that GPs are impacted both personally and professionally when they lose a patient to suicide, but may not access formal help due to commonly held idealised notions of a ‘good’ GP who is regarded as being unshakable. Fear of professional repercussions also plays a major role in deterring help-seeking. A systemic culture shift which allows GPs to seek support when their physical or mental health requires it is needed, and this may help prevent stress, burnout and early retirement.
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Content ArticleThis report by The King's Fund argues that the health and care system in England must shift its focus away from hospital care to primary and community services if it is to be effective and sustainable. It looks at a wholesale shift in the focus towards primary and community health and care across leadership, culture and implementation. Successive governments have repeated a vision of health and care services focused on communities rather than hospitals, but that vision is very far from being achieved. The report outlines research that explored the underlying factors that have prevented change, and what might need to be done to achieve the vision. The researchers analysed published evidence and national datasets, and interviewed stakeholders across the health and care system. The report concludes that to achieve community-based care, political and other national leaders will need to completely shift their focus away from hospitals towards primary and community health and care.
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Content ArticleAiring Pain is a podcast from Pain Concern. Each edition brings together people in pain and top specialists to talk about resources that can help. This edition investigates the significant inequalities and disparities in treatment among primary care pain management services. It features the following participants: Professor Jonathan Hill, Director of Research for the School of Allied Health Professionals and Professor of Physiotherapy at the Keele School of Medicine; Dr Ama Kissie, post-doctoral fellow at the University of Ghent and a Clinical Psychologist; Dr Whitney Scott, clinical psychologist who lectures at Kings College London and is the research lead at the INPUT Pain Management Unit at Guy’s & St Thomas’ Hospital.
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Content ArticleContinuity of care, defined as an ongoing therapeutic relationship between a patient and a physician, is a defining characteristic of primary care. However, arranging a consultation with one’s regular doctor is increasingly difficult as practices face physician shortages. Kajaria-Montag et al. studied the effect of declining care continuity on the productivity of physicians by analysing data of over 10 million consultations in 381 English primary care practices over a period of 11 years. Specifically, they examined whether a consultation with the patient’s regular doctor is more productive than with another doctor in the practice. The authors found that the time to a patient’s next visit is on average 18.1% longer when the patient sees the doctor they have seen most frequently over the past two years, while there is no operationally meaningful difference in consultation duration. The data show that the productivity benefit of care continuity is larger for older patients, patients with multiple chronic conditions, and patients with mental health conditions. The authors estimate that the total consultation demand in their sample could have fallen by up to 5.2% had all practices offered continuity of care at the level of the top decile of practices while prioritising patients expected to yield the largest productivity benefits.
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Content ArticlePrimary care appointments may provide an opportunity to identify patients at higher risk of suicide. This study in the British Journal of General Practice aimed to explore primary care consultation patterns in the five years before suicide to identify suicide high-risk groups and common reasons for seeing a healthcare professional. The authors found that frequent consultations (more than once per month in the final year) were associated with increased suicide risk. The associated rise in suicide risk was seen across all sociodemographic groups as well as in those with and without psychiatric comorbidities. However, specific groups were more influenced by the effect of high-frequency consultation, including females, patients experiencing less socioeconomic deprivation and those with psychiatric conditions. The commonest reasons that patients who went on to commit suicide requested consultations in the year before their death, were medication review, depression and pain.
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EventuntilThis webinar hosted by the Patients Association provides an opportunity to hear about the new Pharmacy First Service. Speakers include: David Webb, Chief Pharmaceutical Officer for England Pallavi Dawda, Head of Delivery, Clinical Strategy Community Pharmacy, NHS England Leighton Colegrave, member of Hertfordshire and West Essex ICB's Patient Engagement Forum Tunde Sokoya, community pharmacist, Essex Lindsey Fairbrother, community pharmacist, Derbyshire. The Patients Association Chief Executive Rachel Power will chair the webinar. Register for free.
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News Article
Ethnic minorities in England have worse access to GPs
Patient Safety Learning posted a news article in News
Areas across England where the highest proportion of ethnic minorities live have the poorest access to GPs, with experts attributing this disparity to an outdated model being used to determine funding. As of October 2023, there were 34 fully qualified full-time-equivalent GPs per 100,000 patients in the areas with the highest proportion of people from ethnic minority backgrounds, according to a Guardian analysis of NHS Digital and census data. This is 29% lower than the 48 general practitioners per 100,000 people serving neighbourhoods with the highest proportion of white British people. Although ethnic minorities tend to be younger than the white British population, minority ethnic areas still have the lowest number of GPs per person even when factors such as age, sex and health necessities are considered. Prof Miqdad Asaria at the London School of Economics department of health policy said it was “very concerning” that ethnic minorities “have systematically poorer access to primary care which is likely to be a key driver of current and future health inequalities”. “Primary care plays a crucial role in preventing disease, diagnosing and treating illness, and facilitating access to specialist or hospital treatment for people who need it,” he added. Read full story Source: The Guardian,15 February 2024 -
Content ArticleSet up in January 2023, the Times Health Commission was a year-long projected established to consider the future of health and social care in England in the light of the pandemic, the growing pressure on budgets, the A&E crisis, rising waiting lists, health inequalities, obesity and the ageing population. Its recommendations are intended to be pragmatic, practical, deliverable and able to be potentially taken up by any political party or government, present or future.
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Event
Reducing antibiotic use in primary care
Patient Safety Learning posted an event in Community Calendar
If you work in primary care or primary care research, this one-hour NIHR Evidence webinar is for you. This webinar will cover NIHR research that could help reduce antibiotic prescribing in primary care. Speakers will present actionable evidence on antibiotic stewardship, and safe and effective prescribing. Presentations will be followed by a Q&A session, giving you a unique opportunity to quiz the researchers on how this research could be implemented at your organisation and reflect on potential barriers and facilitators. The webinar will cover: making decisions about who is in most need of antibiotics if antibiotics are needed for children with chest infections how digital tools can help reduce antibiotic prescribing. Register -
Content ArticleError management is a systematic approach aimed at identifying and learning from critical incidents by reporting, documenting and analysing them. However, almost nothing is known about the incidents doctors in outpatient care consider to be critical and how they deal with them. This interview study aimed to to explore outpatient doctors’ views on error management, discover what they regard as critical incidents and find out how error management is put into practice in ambulatory care.
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Content ArticleThe economic impact of managing Long Covid in primary care is unknown. In a study published in BMC Primary Care, Tufts et al. estimated the costs of primary care consultations associated with Long Covid and explored the relationship between risk factors and costs. The study found that costs of primary care consultations associated with Long Covid in non-hospitalised adults are substantial. Costs are significantly higher among those diagnosed with Long Covid, those with Long Covid symptoms, older adults, females, and those with obesity and comorbidities.
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EventuntilThis online conference hosted by the Royal College of General Practitioners (RCGP) is free of charge to RCGP members and £200 for non-members. This is the first in a 2-part series of one-day conferences addressing clinical issues arising from health inequalities and demonstrating how GPs can positively influence health inequalities as practitioners and community leaders. Health inequalities are differences in health across the population and between different groups in society that are systematic, unfair and avoidable. General Practice, with its unrivalled access to the heart of communities, has a key role in addressing both causes and consequences of health inequalities in the UK. General Practice is a diverse profession caring for multiple patient populations and the aim of the conference is to move from conversations to actions, improving patient care in these communities. This programme was put together by RCGP Officers, Faculty Education Leads and expert speakers, who are participating throughout the day and will include examples of best practice, relevant guidance and links to useful resources. Learning objectives: Understand the evidence linking ethnicity, protected characteristics, and health outcomes Acknowledge minority patients' perspectives of health and illness Promote the best clinical management within primary care Promote partnerships working with relevant organisations and community assets to improve patient care Areas to be covered: Incorporating health inequalities into training portfolios Migrant health and asylum seekers in hotels Black women with period issues or fertility concerns Health in gypsy and traveller communities Language discrimination Ramadan clinical management Trans health Social prescribing as a tool for tackling health inequalities Mental health Improving the health and well-being for communities in deprived areas Keynote speaker: Dr Margaret Ikpoh, RCGP Vice Chair Professional Development Register for the conference
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EventuntilThis online conference hosted by the Royal College of General Practitioners (RCGP) is free of charge to RCGP members and £200 for non-members. Health inequalities are differences in health across the population and between different groups in society that are systematic, unfair and avoidable. General Practice, with its unrivalled access to the heart of communities, has a key role in addressing both causes and consequences of health inequalities in the UK. General Practice is a diverse profession caring for multiple patient populations and the aim of this conference is to move from conversations to actions, improving patient care in these communities. The programme was put together by RCGP Officers, Faculty Education Leads and expert speakers, who are participating throughout the day and will include examples of best practice, relevant guidance and links to useful resources. Learning objectives: Understand the evidence linking ethnicity, protected characteristics, and health outcomes Acknowledge minority patients' perspectives of health and illness Promote the best clinical management within primary care Promote partnerships working with relevant organisations and community assets to improve patient care Areas to be covered: Health inequalities in learning disabilities Health inequalities in South Asian women in the UK Exploring and remediating unconscious bias Tackling health inequalities in African and Caribbean communities Barriers to accessing health services for migrant and ethnic minorities patients Panel discussion: improving screening uptake in minority ethnic groups End of life care and bereavement Pain management in populations with high levels of health inequality Ethnicity and disease Issues affecting the LGBTQIA+ community Keynote Speaker: Professor Kamila Hawthorne MBE, Chair of Council, RCGP Register for the conference
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News ArticlePatients who feel fortunate to get a doctor's appointment then find they are in and out of the GP surgery in less than five minutes. A fifth of the consultations in England last year were done within that time. Dennis Reed, of the Silver Voices campaign group for over-60s, said: "It is hard enough to get a face-to-face appointment with a GP these days, without being shown the door before you have had a chance to take your coat off. "The public wants the family doctor back, who knows your family history and has the time to chat about your general health and wellbeing. "A revolving door policy, with the patient exiting after a couple of minutes clutching a prescription, is not the way to run a primary care service." Research from the House of Commons Library, commissioned by the Lib Dems, found 22% of GP appointments between January to October 2023 lasted five minutes or less. Lib Dem MP Wera Hobhouse said: "Seeing a GP is the most vital contact for people to address their health concerns, seek help and start treatment. "Not having quick and easy access to a GP and not having sufficient time for patients during an appointment leads to huge problems later on, let alone the anxiety and additional pain people suffer because of delays." Read full story Source: The Express, 31 December 2023
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Content ArticleThe EvidenceNOW: Advancing Heart Health in Primary Care trial was designed to assist primary care practices in the US in implementing evidence-based practices in cardiovascular care and building capacity for quality improvement. This qualitative study in BMC Primary Care aimed to gain a comprehensive understanding of perspectives from research participants and team members on the value of implementation strategies and factors that influenced the EvidenceNOW initiative in Virginia. Read a simplified research summary: Strategies for implementing large-scale quality improvement in primary care
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Content ArticleA lack of coordination between the everyday primary and community services relied on by people using the NHS is leading to sub-standard care, missed opportunities for home or community-based treatments, and undue strain on hospitals that are already overstretched. There must be significant reform in terms of better staff training, improved data-sharing, flexible healthcare structures and collaboration across different professions in the healthcare system. These reforms will realise the potential of an integrated NHS and deliver more efficient healthcare services ensuring value for money and satisfied, healthier patients. This is the major conclusion of the report 'Patients at the centre: integrating primary and community care'. This report highlights the need for a seamlessly integrated patient-centric healthcare sector where patients are given the type of care they need, when, where, and how they need it; whether that be access to a GP, a pharmacist or a district or mental health nurse. The Government should focus more on preventative rather than reactive care to tackle the needs of an ageing population, many of whom are coping with complex health issues requiring intricate and continuous care.
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EventuntilIn this first webinar of the Changes in Primary Care series, Dr Claire Fuller, Medical Director of Primary Care at NHS England will discuss the new reception team alongside frontline general practice staff. Register for the webinar
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Content ArticleOn Nov 7 2023, NHS Resolution’s Safety and Learning team, hosted a virtual forum on learning from venous thromboembolism (VTE) claims in primary care. The purpose was to raise awareness of the cost and scale of harm, discuss the challenges and recommendations around recognition and treatment of VTE in general practice. We heard from a range of experts in the field with experience in developing and spreading best practice.
