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Found 64 results
  1. News Article
    Staff without medical training who fill gaps in the NHS workforce must tell patients they are “not a doctor” when introducing themselves, under new guidance. The advice has been issued to “physician associates” (PAs), a type of clinical role that requires less training than doctors receive, amid a row over their use in the NHS. PAs complete a two-year postgraduate qualification, but no medical degree, and can diagnose and treat patients. They can work in A&E or GP surgeries. NHS England has set out plans to expand the number of PAs to deal with staff shortages, with a workforce of 10,000 PAs wanted over the next decade. The plan has been met with opposition from doctors’ leaders, who say the growing use of PAs instead of fully qualified doctors is leading to missed diagnoses and deaths. Guidance published by the Faculty of Physician Associates, a part of the Royal College of Physicians, said that PAs must not mislead patients into thinking they are doctors. Read full story (paywalled) Source: The Times, 6 October 2023
  2. Content Article
    Physician associates (PAs) are healthcare professionals who work as part of a multidisciplinary team under the supervision of a named senior doctor (a General Medical Council (GMC)-registered consultant or GP). While they are not medical doctors, PAs can assess, diagnose and treat patients in primary, secondary and community care environments within their scope of practice. PAs are part of NHS England’s medical associate professions (MAPs) workforce grouping. MAPs add to the breadth of skills within multidisciplinary teams, to help meet the needs of patients and enable more care to be delivered in clinical settings. PAs do not fall under the allied health professions (AHPs) or advanced practice groups. The Faculty of Physician Associates has created this guidance to provide clarity around the role of PAs. It provides practical examples of how physician associates should describe their role and is aimed at increasing understanding for patients, employers, other healthcare professionals and the public. It is important that PAs take all reasonable steps to inform patients and staff of their role and to avoid confusion of roles. This includes considering the potential for verbal and written role titles to be misunderstood and taking the time to explain their role in any clinical interaction.
  3. News Article
    The use of non-medics in clinical roles is leading to deaths and missed diagnoses, senior doctors have warned. Hundreds of doctors have signed an open letter to the leadership of the Royal College of Physicians (RCP), urging them to take a stand over the rollout of physician associates (PAs). PAs are a newer type of medical role that involves significantly less training than doctors receive. The NHS has used PAs since 2003 but concerns have emerged in recent months about them taking on more advanced work than is appropriate. NHS England set out plans earlier this year to expand their numbers significantly amid ongoing staff shortages. Now an open letter to the RCP’s council, to date signed by 46 fellows of the college and 194 other doctors, sets out concerns ranging from patient safety and liability to the fact that newly qualified PAs can earn more than newly qualified doctors. They say: “There have been several high-profile incidents in which serious illness was missed by a PA when undertaking a role that would normally be filled by a doctor. In some cases, avoidable deaths have resulted. “Given that some of these conditions required more advanced training than the PA had received, the implication is that rare avoidable deaths are a price society must pay for the replacement of medical staff with non-medical staff. We believe this trade-off must be debated widely not just by doctors but also by the lay public.” Read full story (paywalled) Source: The Times, 5 October 2023
  4. News Article
    A private healthcare provider has been ordered to pay more than £1.5m – the largest fine issued for such a case – after pleading guilty in a criminal prosecution brought by the Care Quality Commission (CQC) over the death of a young woman at Cygnet Hospital Ealing in July 2019. It is the highest ever fine issued to a mental health service following a prosecution by the CQC. The firm pleaded guilty to one offence of failing to provide safe care and treatment, acknowledging failures to: provide a safe ward environment to reduce the risk of people being able to use a ligature; ensure staff observed people intermittently in line with the company procedures; and train staff to be able to resuscitate patients in an emergency. The offences related to the case of a young woman who was admitted to a ward in Cygnet Hospital Ealing in November 2018. In July 2019, she took her own life while on the ward. CQC said Cygnet Ealing had been aware the young woman tried to harm herself in an almost identical way four months earlier, but had failed to mitigate the known environmental risk she was exposed to. Read full story (paywalled) Source: HSJ, 21 September 2023
  5. News Article
    An NHS maternity department has been handed a warning notice by the health regulator because of safety failings. The Care Quality Commission (CQC) said it was taking the action over the James Paget Hospital in Norfolk to prevent patients coming to harm. Inspectors found the unit did not have enough staff to care for women and babies and keep them safe. The maternity department has been deemed "inadequate" by the CQC, which meant the overall rating for the hospital has now dropped from "good" to "requires improvement". Between June and November 2022 there were 30 maternity "red flags" that the inspectors found, of which more than half related to delays or cancellations to time-critical activity. In one instance, there was a delay in recognising a serious health problem and taking the appropriate action. The report also highlighted the service did not have enough maternity staff with the right qualifications, skills, training and experience "to keep women safe from avoidable harm and to provide the right care and treatment". Read full story Source: BBC News, 31 May 2023
  6. News Article
    National guidelines are needed to help maternity care professionals navigate discussions with pregnant women about past traumas, experts have said. Their study, published in the journal Plos One, also found that while talking about previously experienced traumas can be valuable, they can also trigger painful memories if not approached sensitively. The authors also raised concerns about the support available for professionals who may not feel equipped to explore challenging topics such as domestic or sexual abuse, childhood trauma and birth trauma without adequate guidelines or referral pathways. Joanne Cull, a midwife and PhD student at the University of Central Lancashire’s School of Community Health and Midwifery, who is corresponding author on the study, said: “As awareness of the long-term effects of trauma on health and wellbeing has grown, there has been a move toward asking pregnant women about previous trauma, usually at the first appointment. “No national guidance on this has been published in the UK so NHS Trusts have implemented this on a piecemeal approach.” Read full story Source: The Independent, 17 May 2023
  7. News Article
    Hospitals are deploying staff with less training than nurses – wearing the same uniforms – a conference has heard. Nurses said trusts trying to make “cost savings” were using cheaper nursing associates, and treating student nurses as free labour, to try to plug gaps that should be filled by more qualified staff. They are trained in similar basic skills to nurses, but have two years of training and a foundation degree qualification, compared to three years studying and a university degree for registered nurses. Nurses at the RCN annual congress in Brighton said the associate workers are frequently being given equally complex tasks, as pressures mounted. In some cases, they were even being given the same uniforms, meaning patients cannot distinguish between nurses and less-qualified staff, nurses said. Meanwhile, student nurses, who should be shadowing trained staff to learn new skills, were increasingly being asked to fill in for healthcare assistants, the conference heard. Read full story (paywalled) Source: The Telegraph, 16 May 2023
  8. News Article
    Thousands of NHS-funded talking therapy sessions are still being carried out by unaccredited practitioners every month, despite NHS England trying to stop the practice for at least five years. NHS Digital data for January this year showed 44,170 sessions involved practitioners who were neither in training nor had done an accredited course. The actual figure could be higher as, of the 517,027 sessions in total carried out, data about who was involved was missing for more than half (328,433). Since last June, practitioners delivering NHS-funded “low intensity” talking therapies – previously known as Improving Access to Psychological Therapies – are required to be part of either the British Psychological Society or the British Association for Cognitive and Behavioural Psychotherapies’ registers. The registers, which were set up in 2021, confirm practitioners have completed an accredited course, ensure continuous professional development and provide a framework for striking off. Meanwhile, NHSE’s IAPT manual – first published in 2018 – states all clinicians should have completed an accredited training programme and a “robust and urgent” plan should be in place to train those who have not, including the possibility of those without accreditation being prevented from working alone. Read full story (paywalled) Source: HSJ, 3 May 2023
  9. Content Article
    This Healthcare Safety Investigation Branch (HSIB) investigation aims to improve patient safety by supporting healthcare staff in the safe use of central venous catheters to access a patient’s blood supply. Specifically, it looks into the use of tunnelled haemodialysis central venous catheters, which are a type of central line. The reference event involved Joan, who had a cardiac arrest caused by an air embolus after her haemodialysis catheter was uncapped, unclamped, and left open to air. This took place during a procedure to take blood culture samples to test for a possible line infection (where bacteria or viruses enter the bloodstream). This investigation’s findings, safety recommendations and safety observations aim to prevent the future occurrence of an air embolus following uncapped and unclamped haemodialysis catheters, and to improve care for patients across the NHS.
  10. News Article
    An inquest report into the death of a young boy who died at home in his sleep has called for health bodies to take action to prevent further deaths. Louis Rogers' death was initially categorised as Sudden Unexplained Death in Childhood (SUDC) but the report recorded febrile seizures contributed. The recommendations include: A greater emphasis on medical education, research and public information for sudden unexpected deaths associated with febrile seizures Referrals for assessment of febrile seizures should be undertaken earlier to exclude more severe underlying illnesses The NHS website and pamphlet given to parents and guardians following a child's febrile seizure should be updated to help assist them in picking up potential early indicators of a more severe illness "Robust national guidance" and education should be given to GPs so that timely referrals could be made A checklist should be provided for health practitioners so that a child was not given a misdiagnosis of a febrile seizure Records of all contact with health practitioners - including GPs and paramedics - should be available for all The recommendations were made to six health authorities: Royal College of Paediatricians, Joint Royal Colleges Ambulance Liaison Committee, National Institute for Health and Care Excellence (NICE), Royal College of General Practice, Royal College of Emergency Medicine and NHS England. Read full story Source: BBC News, 29 March 2023
  11. News Article
    Whistleblowers have described the accident and emergency (A&E) department at Hull Royal Infirmary as "incredibly dangerous" and a "death trap". The Care Quality Commission (CSC) found Hull University Teaching Hospitals required improvement overall and its A&E department was rated inadequate. Two clinical staff members, who wished to remain anonymous, described it as a "toxic" place to work. Speaking to the BBC, the two staff members who have worked in Hull's A&E department said they had raised concerns with senior managers and the CQC. They said there were frequently fewer staff than needed and warned inexperienced staff, one whom had never seen a cardiac arrest, were working in areas like resuscitation, which was "incredibly dangerous". "Nurses who aren't even signed off to give oral medication are being put in resuscitation," one said. "It's a death trap, it is terrifying." Despite these concerns, CQC inspectors in December and November did find the service "had enough nursing and support staff to keep patients safe". Read full story Source: BBC News, 28 March 2023
  12. News Article
    Vulnerable mental health patients are being put at risk by unregulated “eating disorder coaches” who do not have the necessary qualifications, experts have said. As demand for eating disorder support soars – hospital admissions for eating disorders increased by 84% in the last five years – more people are filling gaps in NHS care. So-called eating disorder coaches, who tend to be personal trainers or dietitians recovering from the illness themselves, are charging as much as £1,000 a month for sessions to offer support to others despite having little or no training and expertise. The Guardian has found that many coaches cite short courses, which are intended as professional development for psychologists, as a qualification to practise. The National Centre for Eating Disorders (NCED) offers a number of professional training courses, accredited by the British Psychological Society (BPS). The Guardian found a number of coaches were using these courses to claim they were qualified to offer professional services to people with eating disorders. Agnes Ayton, chair of the Royal College of Psychiatrists’ eating disorders faculty, said she was “amazed” to see people “advertising themselves as experts after going on one course”. “Eating disorders sit between physical and mental health so the risks associated with eating disorders can be physically debilitating and potentially fatal,” Ayton said. “I don’t know why there is not better regulation on that because there is lots of regulation for a medical professional – but therapy is the first line of treatment for eating disorders, and if it is not delivered properly, it can be harmful or misleading.” Read full story Source: The Guardian, 21 March 2023
  13. News Article
    Two health watchdogs have issued safety warnings after junior staff were left to work unsupervised on maternity wards previously criticised after a baby’s death. Training regulator, Health Education England (HEE), criticised the “unacceptable” behaviour of consultants who left junior doctors to work without any superiors at South Devon and Torbay Hospital Foundation Trust’s wards. The maternity safety watchdog Healthcare Safety Investigation Branch (HSIB) also raised “urgent concerns” over student midwives and “unregistered midwives” providing care without supervision. The latest criticism comes after the trust was condemned over the death of Arabella Sparkes, who lived just 17 days in May 2020 after she was starved of oxygen. According to a report from December 2022, seen by The Independent, the HEE was forced to review how trainees were working at the trust’s maternity department after concerns were raised to the regulator. It was the second visit carried out following concerns about the department, and reviewers found there had been “slow progress” against concerns raised a year earlier. Read full story Source: The Independent, 16 February 2023
  14. News Article
    A Norfolk surgeon who left two patients with life-changing injuries has received a formal warning by a disciplinary panel. Camilo Valero Valdivieso was found guilty of "serious misconduct" by an independent medical panel after two operations went wrong in six days. One of his patients, Paul Tooth, 65, said his life was "a constant struggle" since his operation in January 2020. However, the panel found the surgeon had "learned from these events". The findings from the Medical Practitioners Service (MPTS) panel said that his actions had "risked damaging public confidence in the profession". It heard that he twice "misinterpreted the anatomy" - on one occasion severing a patient's gallbladder. The panel also concluded Mr Valero's fitness to practise was not currently impaired, allowing him to continue working. Read full story Source: BBC News, 7 February 2023
  15. News Article
    Five wards at Scotland's largest hospital had to operate with one registered nurse on duty each. Staff at the Queen Elizabeth University Hospital in Glasgow experienced the shortage on Monday night. It is an example of the severe pressure affecting health services across the country, which has intensified due to the Covid-19 pandemic. Greater Glasgow and Clyde health board said nurses were supported by a number of other staff. Originally reported in the Daily Record, the shortage was described to staff in an email sent on Monday afternoon. The email said nurse staffing levels across medicine were critical, despite attempts to seek support from bank or agency workers. It said admin staff had been asked to stay on to offer support including answering phones and door buzzers for the rest of the week. As well as staffing problems, the pandemic has caused more bed blocking in Scotland's hospitals and longer waits for both emergency and outpatient treatment. Norman Provan, associate director at the Royal College of Nursing Scotland said the shortage had an impact on patient safety as well as staff wellbeing - concerns that had been raised with the health board and the Scottish government. He added: "We're in this situation largely because of the failure of Scottish government to address the nursing workforce crisis, which has seen registered nurse vacancies reach a record high. "Urgent action is needed to protect patient safety, address staff shortages and demonstrate that the nursing workforce is valued as a safety critical profession." Read full story Source: BBC News, 24 July 2022
  16. News Article
    A shortage of maternity staff is putting women and babies at risk in Gloucestershire, inspectors have said. The county's maternity services have been downgraded by two levels, from good to inadequate, by the Care Quality Commission (CQC). Its report highlighted staff shortages, missed training, exhaustion among workers and concerns over equipment. Gloucestershire Hospitals NHS Foundation Trust issued an apology and said improvements have been made. CQC inspectors visited maternity wards, birth units and community midwives in Gloucester, Cheltenham and Stroud in April after receiving concerns about the "culture, safety and quality of services". They found the service did not have enough midwifery staff with the "right qualifications, skills, training and experience to keep women safe from avoidable harm or to provide the right treatment all the time". Read full story Source: BBC News, 22 July 2022
  17. News Article
    Student paramedics are missing out on learning how to save lives because they are wasting hours in ambulances outside A&E instead of attending calls, it has been revealed. The College of Paramedics and ambulance directors say the hold-ups mean trainees are missing vital on-the-job experience, leading to fears over the safety of patients. Will Boughton, of the College of Paramedics Trustee for Professional Standards, said handover delays had become a problem for trainees’ development and exposure to real-life experience, meaning training had become “unpredictable”. If steps weren’t taken to increase training opportunities and address wider quality concerns in education, “it is very possible that patient safety may be at risk due to missed experience during practice education”, he warned. “A student could complete a regular shift and see lots of patients, getting lots of things in their portfolio signed off, or they could be the unlucky ambulance that joins the back of a queue and is then at hospital X for however many hours waiting to release that patient, so and it varies from county to county and service to service,” he said. Read full story Source: The Independent, 22 June 2022
  18. News Article
    The UK's biggest chain of GP practices lets less qualified staff see patients without adequate supervision, an undercover BBC Panorama investigation has found. Operose Health is putting patients at risk by prioritising profit, says a senior GP. The company, with almost 600,000 NHS patients, is owned by US healthcare giant Centene Corporation. BBC Panorama sent undercover reporter Jacqui Wakefield to work as a receptionist at one of the UK company's 51 London surgeries. A GP working at the practice said they were short of eight doctors. The practice manager said they hired less qualified medical staff called physician associates (PAs), because they were "cheaper" than GPs. Physician associates were first introduced by the NHS in 2003, so that doctors could deal with more complex patient needs. PAs are healthcare professionals who have completed two years of post-graduate studies on top of a science degree, as opposed to 10 years education and training for GPs. They support GPs in the diagnosis and management of patients, but should have oversight from a doctor. Panorama gathered evidence that PAs were not being properly supervised at the Operose practice. The PAs told the undercover reporter they saw all sorts of patients, sometimes without any clinical supervision. They said the practice treated them as equivalent to GPs. Prof Sir Sam Everington, a senior practising GP at an unconnected partner-run practice, reviewed BBC Panorama's undercover footage and said he was concerned for patient safety. During the undercover investigation at the London practice, administrative workers also revealed a backlog of thousands of medical test results and hospital letters on Operose computer systems. One worker said they were tasked with getting through 200 documents a day, deciding which were important enough to be seen by a GP or pharmacist and which would be filed to the patient's records. One member of staff, worried about making mistakes said they sometimes used Google to help them work out what to do with the documents. Read full story Source: BBC News, 11 June 2022
  19. News Article
    A retired consultant gastroenterologist has been struck off the UK medical register for “wide ranging failings” in treating young transgender patients and in prescribing testosterone for men. Michael Webberley, who was charged with failing to provide good care to 24 patients, acted outside the limits of his expertise, a medical practitioners tribunal concluded. Through the private online clinic GenderGP, which he ran with his wife Helen, a GP, Webberley prescribed puberty blockers to a child of nine and cross sex hormones to a teenager who died by suicide a few months later. He faced charges over his care of seven transgender patients, and the tribunal found that he had provided treatment that was not clinically indicated or that had been prescribed without adequate tests, assessments, or examinations. Read full story (paywalled) Source: BMJ, 30 May 2022
  20. News Article
    A private hospital facing a police investigation following a patient’s death has been given an urgent warning by the care regulator due to concerns over patient safety. The Huntercombe Hospital in Maidenhead, which treats children with mental health needs, was told it must urgently address safety issues found by the Care Quality Commission (CQC) following an inspection in March. The CQC handed the hospital a formal warning due to concerns over failures in the way staff were carrying out observations of vulnerable patients. The move comes as The Independent revealed police are investigating the hospital in relation to the death of a young girl earlier this year. In a report published last week, the care watchdog said it had received “mainly negative” feedback from young people at the hospital’s Thames ward, a psychiatric intensive care unit which treats acutely unwell children. Commenting on the hospital overall, the report said: “Young people told us that staff did not follow the care plans in relation to their level of observations. They told us that if there was an incident the staff stopped doing intermittent observations. Staff in charge of shifts on wards asked new staff members to do observations before they understood how to do it. Staff had to ask the young person how to carry out their observations as they did not always understand what was expected of them in carrying out different levels of observations.” Read full story Source: The Independent, 19 May 2022
  21. News Article
    A “shocking” number of nurses from overseas are winding up “in trouble” or sanctioned within their first few months of working in the UK partly because of a lack of induction and support, a conference has heard. The issue was raised during a panel session at the Unison health conference in April discussing the importance of ethical recruitment practices in nursing and midwifery. According to Unison, it is supporting “many” overseas nurses who have been “exploited, unfairly treated and subject to racism” since their move. Among the panel was Gamu Nyasoro, a clinical skills and simulation nurse manager in the NHS and an elected member of Unison’s nursing and midwifery occupational group committee. Ms Nyasoro, who is from Zimbabwe and has been working in the NHS for the past two decades, said she herself had been discriminated against and had faced several challenges during her migration. She raised concern that overseas nurses were not given enough information about how to live and work in the UK, including about how to access healthcare services themselves, or about country specific rules and regulations. There was also the issue that UK employers “don’t look at their skills beforehand”, which means nurses were being put in roles or areas they were not confident in. She cited examples of staff who had been specialising in neonatal services before moving, who were then being asked to work with older people, and those who had been practising as a midwife in their home nations and then being required to work in emergency departments in the UK. Read full story Source: Nursing Times, 28 April 2022
  22. News Article
    The culture at a long-troubled ambulance trust is ‘worsening, not improving’, its staff have told a health watchdog. Concerns about culture and patient safety at East of England Ambulance Service Trust (EEAST) were raised to inspectors at the Care Quality Commission (CQC) during an inspection of the trust last month, according to public documents. In a feedback letter to the trust following the inspection, the CQC said staffing at EEAST’s control room was below planned levels, and the inspectors were “not assured that staffing levels met the demands within the service and this may impact on patient safety when managing the high volume of calls”. The trust, which is in the equivalent of special measures and currently rated “requires improvement” by the CQC, has had long-standing cultural problems and last year signed a legal agreement with the Equality and Human Rights Commission on how it would protect staff from sexual harassment. According to the feedback letter, staff described a “worsening, not improving, culture” and said the workforce was “tired” and not receiving mandatory training, one-to-ones with managers or appraisals. The letter, published in the trust’s latest board papers, also reported inspectors raising concerns about potential risks to patients over the management of the trust’s call stack and a lack of consistency over “standard operating procedures”. Additionally, some staff in the control room on an accelerated training programme were unable to undertake full patient assessments and had to call for assistance from others. Read full story (paywalled) Source: HSJ, 11 May 2022
  23. News Article
    A trust which is facing major governance issues is failing to respond to hundreds of complaints properly, with patients and families waiting more than twice as long as the NHS target for responses to their concerns, an external review has found. Cornwall Partnership Foundation Trust, which is subject to regulatory action by NHS England, was found to be “not classifying complaints, concerns and comments accurately”, while staff had “no formal training”, meaning complaints were “not investigated appropriately”. Last year, the trust was embroiled in a governance scandal in which NHSE investigated multiple allegations of finance and governance failings, resulting in the departure of former CEO Phil Confue. Rachel Power, chief executive of the advocacy group Patients Association, told HSJ patient complaints often contain “vital intelligence” on how trusts can improve services and “essential warnings about any area where things might be going wrong”. According to the review, the backlog had stemmed from several factors. These included more work being needed on investigations that had not been thorough enough, and the relevant service teams not responding to enquiries by the complaints team. Additionally, there was a “lack of formal monitoring and review” to ensure complaint points were reported appropriately and consistently, and an “apparent lack of accountability by local teams for complaints” triaged through the trust’s patient liaison and complaints team. Read full story (paywalled) Source: HSJ, 12 April 2022
  24. Content Article
    This Prevention of Future Deaths report relates to the death of four patients who all died from endoscopic retrograde cholangio-pancreatography (ERCP) related complications, within a six-month period. All four patients had their treatment carried out by the same doctor during his training for this high-risk procedure. In her report, the Coroner Laurinder Bower raises concerns about the systems in place to gain consent and inform patients of the risks of these procedures.
  25. News Article
    A resident at an inadequate care home died after their blood glucose increased to high levels and staff acted too slowly, a report found. Inspectors said The Berkshire Care Home in Wokingham breached guidelines in nine areas and must improve. They found residents were put at risk after medicines were not used properly and that records were not up to date. The Care Quality Commission (CQC) said an ambulance was only called for the person who died when they were found to be unresponsive. They later died in hospital. Its report said staff were "not sufficiently skilled" to safely care for people with diabetes. A resident was given paracetamol and co-dydramol eight times over three days, when they should not be used together because they both contain paracetamol, the report said. Another person was burned by a cup of tea and staff did not treat the injury properly, leading to the person developing an infection and later being admitted to hospital. Staff sometimes felt "rushed and under pressure", the report found. Read full story Source: BBC News, 18 December 2021
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