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News ArticleGPs are being paid £1,000 to cancel second dose appointments for Covid jabs and given a script to follow to deal with angry patients amid growing chaos in the roll-out of the vaccine programme. Practices have been offered the payments to cover the workload of postponing hundreds of patients who were set to have their second dose and booking new ones in their place. NHS sources said the shift has contributed to delays in rolling out the programme. Some GPs have refused to postpone the appointments, with practice managers saying it was "too cruel" to dash the hopes of those who were booked for a second jab. In December, everyone given a first vaccine by Pfizer was told to come back for their second dose three weeks later. But the strategy was changed 10 days ago in a bid to get a first dose to more of the population more quickly. Patients are now being told they will have to wait 12 weeks for the second dose, with a reassurance from health officials that the longer gap could strengthen its effectiveness. By the time the plan was changed, around one million people had already been booked in for their second dose. GPs are now under orders to postpone such appointments and instead give the slots to those awaiting a first dose. Read full story Source: The Telegraph, 8 January 2021
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News ArticleAcutely ill patients requiring emergency care are being diverted to their GP via the new NHS 111 First call-before-you-walk A&E triage system, Pulse has learned. GPs have reported receiving inappropriate NHS 111 referrals including: an acutely dizzy elderly patient who was later confirmed to have had a posterior circulation stroke; a patient with acute coronary syndrome; and a patient with acute UTI symptoms. Meanwhile, GPs are also warning that patients are using the triage system as a way of ‘jumping the queue’ because the route is likely to get them an appointment quicker than calling their practice. From this month, patients in England are being asked to call 111 before attending A&Es – with 111 triaging them to the most appropriate service, including GP practices. Scottish patients are also being asked to phone ahead of attending A&E; while pilots are ongoing in Northern Ireland; and Wales is in the process of rolling out a ‘contact first’ model following summer pilots. The BMA has said the influx of inappropriate referrals by NHS 111 is likely being ‘compounded’ by the new 111 First system, which is ‘contributing to the immense pressures currently facing primary care’. GPs have raised concerns about several cases in which patients should not have been sent to them by 111 because they required more urgent care. One GP, who asked not to be named, told Pulse: "I had a patient with UTI symptoms – a temperature of 39°C, a heart rate of 140, nausea and abdomen/loin pain. They were told: speak to your GP." Read full story Source: Pulse, 21 December 2020
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News Article
GPs say rule change makes covid vaccine programme ‘unfeasibly challenging’
Patient Safety Learning posted a news article in News
Coronavirus vaccinations at GP practices will now take ‘twice as long’ after regulators announced new rules just days before the jabs are rolled out across primary care. The Medicines and Healthcare products Regulatory Agency announced patients would have to be observed for 15 minutes after they received the vaccine. This came after two people had severe allergic reactions to the Pfizer/BioNTech vaccine. Primary care directors told HSJ the change means they have had to overhaul plans in their primary care networks and, in some areas, the vaccine programme will be “unfeasibly challenging” to deliver. Sources told HSJ workforce plans are being overhauled, while vaccines risk being wasted because of the additional time constraints. There have been claims some practices may drop the vaccination programme altogether, as they lack capacity to carry out 15-minute observations for each patient. One primary care director, who spoke to HSJ anonymously, said: “For us, we now need additional space for an observation area. It also makes it more difficult to efficiently flow through the vaccines as the actual vaccination process might take a few minutes, but the through flow of patients will be limited by the 15-minute wait.” They added: “The vaccine now taking at least twice as long to do creates logistical problems. Not insurmountable but there nonetheless." Read full story (paywalled) Source: HSJ, 11 December 2020 -
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News ArticleWearable devices will monitor the mood of all 70 staff at a large GP practice, in a trial aimed at improving employee health and wellbeing. Staff at Amicus Health, a GP practice in Devon, will be provided with a wearable device which allows the user to log how their day is going by pressing one of two buttons. The information gathered can be viewed by employers on a dashboard, identifying whether there are particular times in the day when moods drop. Users will also be able to see their data on a personal app, allowing them to track mood triggers and patterns. On the dashboard, employees’ data is divided into teams and is not anonymised, so employers can track the mood of individuals. Asked by HSJ whether this could deter some from using it, company co-founder Jonathan Elvidge said previous trials suggested it does not. He told HSJ that during trials on construction sites, employers found it easier to take action if they were able to identify workers who were regularly reporting that they were feeling low. He said employees preferred being identified as it gave them a voice and made it easier to express how they were feeling. The device — called a Moodbeam One — will be trialled on all 70 clinical and non-clinical staff members at the practice, including 25 GPs. It will largely be down to the practice to decide how the data is used, according to Mr Elvidge. Read full story (paywalled) Source: HSJ, 5 November 2020
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Content ArticleKey findings The more deprived the area that a person lives in, the less likely they are to report a positive experience of accessing general practice and a good overall experience of general practice. Older patients tend to report better access to general practice – they are more satisfied with their experiences making appointments and find it easier to get through to their practice by phone. However, they are less likely to have used online services. Asian patients report poorer experiences making appointments and more difficulty getting through to their GP practice by phone. Black patients are the least likely to have used any online services. Differences in experience of and access to general practice observed between demographic groups have been consistent over the past 3 years of survey data (changes in survey method mean that we can’t look any further back).
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Content ArticleThe results of the survey showed a high degree of confidence among patients about visiting GP premises in person, despite the ongoing COVID-19 pandemic. Two thirds of patients reported feeling very (35%) or somewhat (31%) confident about making such a visit. Measures such as having hand sanitiser and Perspex screens at reception would increase this confidence further, with relatively few patients concerned about them. They also confirmed that many patients had been offered remote consultations, and that phone calls were much more common than online appointments. Rachel Power, Chief Executive of the Patients Association, commented: “These results show that patients are keen to visit their GP’s premises in person, and feel confident about doing so. They also show that remote consultations have worked well for some patients, but that real-world access to premises is essential for others. In reopening its primary care services, the NHS must ensure that the options for accessing GP premises meet the needs of all patients, and build on the strong confidence in visiting their GPs that patients continue to hold.”
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Covid-19: GPs need extra support to withstand second wave, BMA warns
Patient Safety Learning posted a news article in News
General practices will struggle to cope with a second wave of COVID-19 unless urgent measures are put in place to support them, the BMA has warned. It said that practices in England were reporting that they did not have the capacity to carry out all of the work required of them while managing ongoing patient care, dealing with the backlog of care put on hold during the first wave of the pandemic, and reconfiguring services. Richard Vautrey, chair of the BMA’s General Practitioners Committee England, said, “GPs, like all doctors, are extremely concerned that without decisive action now services will be overwhelmed if we see another spike in the coming weeks and months.” In the report, the committee called for a package of measures to support the GP workforce, including making occupational health services available to all staff to ensure that they are properly risk assessed and to provide free supplies of personal protective equipment. It also called for the suspension of routine inspections by the Care Quality Commission and of the Quality and Outcomes Framework, as part of efforts to reduce bureaucracy. NHS England’s covid support fund for practices should be rolled over until March 2021 and expanded to ensure that all additional costs such as additional telephony and cleaning are included, it added. Vautrey said, “The measures we’ve outlined are aimed at supporting practices and their staff to deliver high quality care while managing the increased pressures of doing so during a pandemic, and it is vital that the government and NHS England listen and implement these urgently, to ensure that primary care can continue to operate safely through what looks to be an incredibly difficult winter.” Read full story Source: BMJ, 1 October 2020 -
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NHS: How to register with a GP practice
Patient Safety Learning posted an article in GP and primary care
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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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GPs asked to keep doors open after ‘significant incidents’ warning
Patient Safety Learning posted a news article in News
New guidance requires GPs to offer at least some face-to-face appointments, amid reports that some had completely eliminated them, sparking ‘significant incidents’. NHS England’s instructions for the third phase of the NHS response to COVID-19 were issued on Friday, including the call that “all GP practices must offer face to face appointments at their surgeries” along with remote triage and remote consultations. Most appointments in primary care have been carried out remotely since the NHS instituted new operating procedures in response to covid, with practices offering a mix of remote consultations over the telephone or video, with a diminished number face-to-face. However, there have been reports of some GP practices not offering any face-to-face appointments at all, and continuing this approach following the peak of cases in the spring. A letter to GPs last month told them they must offer appointments in person “where clinically appropriate”, now reiterated in the phase three guidance. The letter added: “It should be clear to patients that all practice premises are open to provide care, with adjustments to the mode of delivery. No practice should be communicating to patients that their premises are closed.” Read full story Source: HSJ, 4 August 2020 -
News Article
All GP consultations should be remote by default, says Matt Hancock
Clive Flashman posted a news article in News
All GP appointments should be done remotely by default unless a patient needs to be seen in person, Matt Hancock has said, prompting doctors to warn of the risk of abandoning face-to-face consultations. In a speech setting out lessons for the NHS and care sector from the coronavirus pandemic, the health secretary claimed that while some errors were made, “so many things went right” in the response to Covid-19, and new ways of working should continue. He said it was patronising to claim that older patients were not able to handle technology. The plan for web-based GP appointments is set to become formal policy, and follows guidance already sent to GPs on having more online consultations. But the Royal College of GPs (RCGP) hit back, saying it would oppose a predominantly online system on the grounds that both doctors and patients benefited from proper contact. Read full article here -
News Article
A third of GP practices may take year or longer to return to pre-Covid capacity
Patient Safety Learning posted a news article in News
A third of GPs believe it will take up to a year or longer for their practice to return to pre-Covid levels of capacity, even with ‘no future spikes’ of the virus. The data comes from the BMA’s latest COVID-19 tracker survey, which polled almost 2,000 GPs in England and Wales. GPs have previously warned that they are battling a backlog of referrals and patients who have been ‘overlooked’ during the coronavirus crisis. Around 26% of the 1,770 GP respondents said consultations would take between three and 12 months to return to normal when asked how quickly their practice will ‘return to full pre-Covid levels of capacity... assuming there are no future Covid spikes’. And a further 7% of GPs believed it could take ‘longer’ than a year or that consultations would ‘never’ return to pre-Covid levels. Read full story Source: Pulse, 23 July 2020 -
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All patients' Covid test results to become visible to GPs
Patient Safety Learning posted a news article in News
GP systems will now be updated in 'near-real time' to reveal the result of Covid-19 tests taken by all of their patients. GPs will not need to act on the information, which will be visible on systems whether the patient tested positive or negative. This will apply to all patients where it has been possible to identify the patient's NHS number, NHS Digital said. EMIS Health chief medical officer Shaun O’Hanlon said: "Technology has played a pivotal role in the response to COVID-19 across the board and keeping the medical record up to date with COVID-19 test results means everyone who can share that record has a full picture of the patient’s health, including the patient themselves via Patient Access." "This will not only help day to day patient care, and it will also help on a wider population health level, as data-led insight relies on full and complete medical records as analysts continue to research COVID-19 and its short- and long-term impact on the nation." Read full story Source: Pulse, 20 July 2020 -
News ArticleA GP practice serving one of Greater Manchester’s most deprived communities has been banned from operating for four months after regulators uncovered a catalogue of basic failures - including failing to follow up on a child reporting breathing difficulties for three days. Jarvis Medical Practice in Glodwick has had its registration with the Care Quality Commission (CQC) suspended after ‘serious concerns’ passed to the body led to a snap inspection last month. Inspectors found the practice, based at Glodwick Primary Care Centre, was failing 20 separate standards, many of them relating to patient safety. It noted ‘poor quality’ and conflicting records that were sometimes impossible to properly understand and urgent home visits delayed or not carried out at all. In one case a patient with a lump apparently received no physical examination and was not referred for tests or scans ‘due to Covid-19’. Inspectors also found examples of patients with breathing difficulties, including a child, who were not dealt with for days after they got in touch. In one case no further contact was made for 11 working days, with no explanation provided in the patient's notes. The practice, which serves more than 5,000 patients in the Oldham neighbourhood of Glodwick, has now been suspended by the CQC until October 11. Read full story Source: Manchester Evening News, 17 July 2020
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News ArticleA GP surgery that had been told it required improvement has been shut down after an inspection found patients could be at "risk of harm". Hampshire's Brockhurst Medical Centre had already been due to close on 31 December. However, the Care Quality Commission (CQC) suspended its registration with "immediate effect" following an unannounced inspection on Monday. Patients are expected to be transferred to other practices on Saturday. In September, a CQC assessment of the practice, on Brockhurst Road in Gosport, rated it overall as "requires improvement". The issues highlighted in the report included that the practice "did not have systems for the appropriate and safe use of medicines" and "there was a risk that some patients were not receiving the care and treatment they needed". Following Monday's inspection, Garry Higgins, of the CQC, said it had taken "urgent action" to suspend the registration of the GP surgery. "We took the action because we believe if we didn't people using the service may be exposed to the risk of harm," he added. Read full story Source: BBC News, 5 December 2020
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Three in four GP partners fear for staff safety as practice workload floods back
Patient Safety Learning posted a news article in News
Almost three quarters of GP partners are concerned about how to keep colleagues safe as numbers of patients attending practices return to pre-pandemic levels - with access to PPE a major worry, a GPonline poll has found. Half of the 185 GP partners responding to the poll said that they were either 'very worried' or 'slightly worried' about the government's ability to supply the PPE that GPs and practice staff needed to keep them as safe as possible through the rest of the pandemic. Only 9% said they were 'very confident' that the government would be able to supply adequate PPE, with a further 20% saying they were 'slightly confident'. Some 73% of GP partners said that they were concerned about how to ensure the safety of practice staff as the number of patients attending the surgery begins to rise. BMA GP committee chair Dr Richard Vautrey said keeping staff safe was 'a challenge for everyone in the NHS'. He told GPonline: 'Even months now into this crisis the government still hasn’t sorted out PPE in a way that means people have absolute confidence that they will have enough to meet their needs, and the growing needs of practices as they will need to be seeing more patients face-to-face for important procedures that can’t be done remotely. Read full story Source: GPonline, 8 June 2020 -
Content ArticleThis paper presents a narrative review of the evidence relating to the quality and safety of locum medical practice. Its purpose is to develop our understanding of how temporary working in the medical profession might impact on quality and safety and to help formulate recommendations for practice, policy and research priorities. The authors conclude that there is very limited empirical evidence to support the many commonly held assumptions about the quality and safety of locum practice, or to provide a secure evidence base for the development of guidelines on locum working arrangements. It is clear that future research could contribute to a better understanding of the quality and safety of locum doctors working and could help to find ways to improve the use of locum doctors and the quality and safety of patient care that they provide.
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Content ArticleThe toolkit is designed to be used by the whole primary care team within the GP practice or out of hours setting. These resources can be used flexibly, either as standalone materials or as part of an integrated package. The Royal College of General Practitioners do recommend that all resources are used if this is feasible. Using the TARGET Antibiotics Toolkit resources will enable primary care organisations to demonstrate compliance with the Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance.
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Time to Change: Our guide to asking twice
Patient Safety Learning posted an article in Mental health
