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News ArticleA decision not to "urgently" refer an anorexic woman whose condition had significantly deteriorated contributed to her death, a coroner said. Amanda Bowles, 45, was found at her Cambridge home in September 2017. An eating disorder psychiatrist who assessed her on 24 August apologised to Ms Bowles' family for not organising an admission under the Mental Health Act. Assistant coroner Sean Horstead said the decision not to arrange an assessment "contributed to her death". Mr Horstead told an inquest at Huntingdon Racecourse that also on the balance of probabilities the "decision not to significantly increase the level of in-person monitoring" following 24 August "contributed to the death". In his narrative conclusion, Mr Horstead said it was "possible... that had a robust system for monitoring Ms Bowles in the months preceding her death been in place, then the deterioration in her physical and mental health may have been detected earlier" and led to an earlier referral to the Adult Eating Disorder Service. He said this absence "was the direct consequence of the lack of formally commissioned monitoring in either primary or secondary care for eating disorder patients". Read full story Source: BBC News, 17 September 2020
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News ArticleA damning report into Devon’s NHS 111 and out of hours GP service has revealed shocking stories of patients who have either had their health put at risk or tragically died due to the service being in need of urgent improvement. Devon Doctors Limited, which provides an Urgent Integrated Care Service (UICS) across Devon and Somerset, was inspected by independent health and social care regulator the Care Quality Commission (CQC) in July, after concerns were raised about the service. They included the care and treatment of patients, deaths and serious incidents, call waits, staff shortages, and low morale. Inspectors found 'deep rooted issues'. The CQC concluded it was not assured that patients were being treated promptly enough and, in some cases, they had not received safe care or treatment. It is calling for the service to make urgent improvements which will be closely monitored. Since August 2019, the report stated Devon Doctors had received 179 complaints. Nine had been identified by the service as incidents of high risk of harm and six had been identified by the service as incidents of moderate risk of harm. These had been recorded on the service’s significant event log. However, on review, the CQC identified an additional 30 events from the complaints log which could also have been classed as either moderate or high risk of harm. Read full story Source: Devon Live, 15 September 2020
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News ArticleAlmost 86% of doctors in England say they expect a second peak of coronavirus in the next six months, according to a new survey, as concern continues to grow over a recent rise in cases. On Friday, new results from a population-based study suggested the R number for England is now at 1.7, with infections doubling every 7.7 days. While the prevalence of the disease remains lower than it was in the spring, an R value above 1 means cases could grow exponentially. Sunday marked the third day in a row that new coronaviruses cases reported for the UK topped 3,000 – the highest figures since May – with 2,837 new cases reported in England alone. While testing has increased over the past months, experts have said this does not fully explain the recent surge. In a poll, the British Medical Association (BMA) asked more than 8,000 doctors and medical students in England what their top concerns were out of five possibilities, from a second peak of coronavirus to sickness and burnout among staff and winter pressures, including a possible flu outbreak. Almost 30% of respondents selected a second peak as their number-one worry. Overall, 86% of respondents said they believed a second peak of coronavirus during the next six months is either “quite likely” or “very likely”. When asked which of a range of factors might risk causing a second peak, almost 90% of respondents agreed or strongly agreed that failures of the test-and-trace system posed a risk, while a similar proportion cited a lack of infection-control measures in places like bars and restaurants, and 86% agreed or strongly agreed confusing messaging on public health measures was a risk. Read full story Source: The Guardian, 14 September 2020
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News ArticleGP practices are being told they must make sure patients can be seen face to face when they need such appointments. NHS England is writing to all practices to make sure they are communicating the fact doctors can be seen in person if necessary, as well as virtually. It's estimated half of the 102 million appointments from March to July were by video or phone call, NHS Digital said. However, the Royal College of GPs said any implication GPs had not been doing their job properly was "an insult". NHS England said research suggested nearly two thirds of the public were happy to have a phone or video call with their doctor - but that, ahead of winter, they wanted to make sure people knew they could see their GP if needed. Nikki Kanani, medical director of primary care for NHS England, said GPs had adapted quickly in recent months to offer remote consultations and "safe face-to-face care when needed". Prof Martin Marshall, chair of the Royal College of GPs, said general practice was "open and has been throughout the pandemic", with a predominantly remote service to help stop the spread of coronavirus. He said: "The college does not want to see general practice become a totally, or even mostly, remote service post-pandemic. However, we are still in the middle of a pandemic. We need to consider infection control and limit footfall in GP surgeries - all in line with NHS England's current guidance." He said most patients had understood the changes and that clinical commissioning groups had been asked to work with GP practices where face-to-face appointments were not possible - for example, if all GPs were at a high risk from coronavirus. "Any implication that they have not been doing their job properly is an insult to GPs and their teams who have worked throughout the pandemic, continued delivering the vast majority of patient care in the NHS and face an incredibly difficult winter ahead," he said. Read full story Source: BBC News, 14 September 2020 Research from the college indicated that routine GP appointments were back to near-normal levels for this time of year, after decreasing at the height of the pandemic. "Each and every day last week an estimated third of a million appointments were delivered face to face by general practices across the country," added Prof Marshall.
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David Oliver: Should doctors be on first name terms?
Patient Safety Learning posted an article in Culture
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News ArticleOver 1,000 doctors plan to quit the NHS because they are disillusioned with the government’s handling of the COVID-19 pandemic and frustrated about their pay, a new survey has found. The doctors either intend to move abroad, take a career break, switch to private hospitals or resign to work as locums instead, amid growing concern about mental health and stress levels in the profession. “NHS doctors have come out of this pandemic battered, bruised and burned out”, said Dr Samantha Batt-Rawden, president of the Doctors’ Association UK, which undertook the research. The large number of medics who say they will leave the NHS within three years is “a shocking indictment of the government’s failure to value our nation’s doctors,” she added. “These are dedicated professionals who have put their lives on the line time and time again to keep patients in the NHS safe, and we could be about to lose them.
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Content ArticleKey points Audit measures practice against performance. The audit cycle involves five stages: preparing for audit; selecting criteria; measuring performance level; making improvements; sustaining improvements. Choose audit topics based on high risk, high volume, or high cost problems, or on national clinical audits, national service frameworks, or guidelines from the National Institute for Health and Clinical Excellence (NICE). Derive standards from good quality guidelines. Use action plans to overcome the local barriers to change and identify those responsible for service improvement. Repeat the audit to find out whether improvements in care have been implemented after the first audit.
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Covid death rates dropped as doctors rejected ventilators
Patient Safety Learning posted a news article in News
Death rates among seriously ill COVID-19 patients dropped sharply as doctors rejected the use of mechanical ventilators, analysis has found. The chances of dying in an intensive care unit (ICU) went from 43% before the pandemic peaked to 34% in the period after. In a report, the Intensive Care National Audit & Research Centre said that no new drugs nor changes to clinical guidelines were introduced in that period that could account for the improvement. However, the use of mechanical ventilators fell dramatically. Before the peak in admissions on 1 April, 75.9% of COVID-19 patients were intubated within 24 hours of getting to an ICU, a proportion which fell to 44.1% after the peak. Meanwhile, the proportion of ICU patients put on a ventilator at any point dropped 22 percentage points to 61% either side of the peak. Researchers suggested this could have been a result of “informal learning” among networks of doctors that patients on ventilators were faring worse than expected. Read full story Source: The Telegraph, 3 September 2020 -
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Health appointment information sheet: Easy read
Claire Cox posted an article in Learning disabilities
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Foundation Doctor Handbook App
Claire Cox posted an article in Apps for health and care
There are 4 types of documents in the Foundation Doctor Handbook; Assessment Management Reference Calculator. -
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Your Life In My Hands: a Junior Doctor's Story
Claire Cox posted an article in Recommended books and literature
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COVID-19: Shielding doctors express concerns about returning to work
Patient Safety Learning posted a news article in News
Doctors who have been shielding during the covid-19 pandemic have said they are worried for their safety when they return to work. From 1 August those who are at high risk of serious illness if they contract covid-19 will no longer be advised to shield in England, Scotland, and Northern Ireland.123 But doctors who have been shielding during the pandemic have expressed concerns about their safety when they return to work, and say they feel forgotten by their employers. Read full story (paywalled) Source: BMJ, 21 July 2020 -
Content ArticleKey findings These findings are from a survey to UK doctors which closed on 18 June 2020. Over 45% of hospital doctors and just over half of GPs say they are not very or not at all confident of their ability to manage a second peak of COVID-19. 80% of hospital doctors have seen some increase in the levels of demand with a fifth experiencing levels back a pre-March level. Over a quarter of GPs and 33% of hospital doctors who consider themselves to be suffering from depression, anxiety, stress, burnout, emotional distress or another mental health condition, say it is worse during the pandemic than before. 81% of GPs have been asked to carry out new investigations and manage ongoing care that would normally have been done in hospitals.
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News ArticleRegulators have uncovered multiple examples of patients being put at risk when junior doctors are left with tasks they are not trained for, lacking support, and facing bullying and inappropriate behaviour. Inspection teams have had to intervene – in some cases contacting senior trust staff – to ensure urgent issues are addressed, after the inspections. Health Education England oversees training nationally, which includes making the checks at trusts which have been put under “enhanced monitoring” by the professional regulator, the General Medical Council, because of concerns from trainees. HSJ has obtained and examined 20 reports, all produced since the beginning of 2019. Themes running through the reports included: Lack of support from consultants. Trainees struggled to contact consultants out of hours. Bullying and inappropriate behaviour was reported at several trusts. Inspectors found a reluctance to report concerns and/or a lack of knowledge of how to do it. Teaching was often of poor quality or cancelled – and sometimes trainees struggled to attend sessions because of how their shifts and rotations were scheduled. Trainees in several trusts reported IT problems, such as being locked out of systems so being unable to access clinical notes and blood tests, and IT systems taking up to 30 minutes to start up, sometimes delaying patient care. Read full story (paywalled) Source: HSJ, 29 June 2020
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Six in 10 NHS doctors facing shortage of scrubs, shows UK survey
Patient Safety Learning posted a news article in News
Dozens of hospitals are running short of scrubs in the latest problem to hit the NHS over the supply of personal protective equipment (PPE) during the coronavirus pandemic. The shortages are revealed in a survey of UK doctors undertaken by the Doctors’ Association UK (DAUK), which found that 61% said that the hospital where they worked was facing a shortage of scrubs. In recent months, many more NHS staff have begun wearing scrubs, which are usually used mainly by surgical staff, to protect themselves against COVID-19. The prevalence of coronavirus in hospitals has prompted many to switch from wearing their own clothes at work to using scrubs, and handing them in to be washed at the end of their shift. However, the big increase in demand for scrubs from doctors, nurses, physiotherapists and occupational therapists has left many hospitals unable to keep up and also put unprecedented pressure on hospital cleaning services. Some staff have even worn pyjamas intended for patients when scrubs have run out. “Protective clothing must be considered to be at a par with other PPE by Public Health England and must be provided to staff by the NHS," said said Dr Samantha Batt-Rawden, the president of the DAUK. She added: “A failure to adequately supply scrubs to staff may risk further community spread of Covid-19.” Read full story Source: The Guardian, 15 June 2020 -
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BMA. COVID-19: PPE for doctors (18 May 2020)
Patient Safety Learning posted an article in Guidance
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Italy's medical workers: 'We became heroes but they've already forgotten us'
Clive Flashman posted a news article in News
"I'm not sure I want to be a nurse anymore," she tells me. "I've seen more people die in the past two months than in the whole six years." Some 70% of health workers dealing with COVID-19 in Italy's hardest-hit areas are suffering from burnout, a recent study shows. "This is actually the hardest moment for doctors and nurses," says Serena Barello, the author of the study. Read story Source: BBC News, 26 May 2020 -
Content ArticleKey recommendations Ask the patient if they would like to have the conversation and how much information they would want. All healthcare professionals reviewing patients with chronic conditions, patients with more than one serious medical problem or terminal illness, should initiate shared decision making including advance care planning in line with patient preferences. Conversations about the future can and should be initiated at any point. The conversation is a process not a tick-box, and does not have to reach a conclusion at one sitting. Be aware of the language you use with patients and those they have identified as being important to them, and try to involve all the relevant people in agreement with the patient.
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