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Content Article
Ron Daniels is a Consultant in Critical Care, Vice President of the Global Sepsis Alliance, Chief Medical Officer of the United Kingdom Sepsis Trust, and a Topic leader for Patient Safety Learning’s hub. In this interview, Ron explains why doctors have to carefully manage the use of antibiotics in order to protect patients, now and in the future. What’s the issue with prescribing antibiotics? For decades we have been using antibiotics to treat and reduce infection, and to stop people dying from infection. Unfortunately, some of the bacteria (and related organisms) we’ve been fighting have become resistant to certain types of antibiotics (or antimicrobials, in the case of other germs such as viruses, parasites and fungi). This is also known as antimicrobial resistance (AMR). Lots of people wrongly think that a patient can become resistant to antibiotics. It’s the bug, not the person. Prescribing antibiotics unnecessarily leads to more and more bugs becoming resistant, leaving patients with fewer treatment options. This is already having a huge impact on healthcare as we know it, with thousands of people affected. We need to manage the risks now, and as we move forward into the future. What does this mean for patients? If you become poorly with a bug that is resistant to a type of antibiotic, prescribing that antibiotic to you will not make you better. Your symptoms will remain or get worse. As you can imagine, this makes those particular bugs very difficult to treat, and serious life-threatening infections like sepsis more likely to occur. Worryingly, statistics indicate that patients in more deprived areas are more likely to be affected. If a doctor is concerned that you are unwell with a bug that cannot be treated with the usual ‘first choice’ course of antibiotics, they may change it or prescribe something called a ‘broad spectrum antibiotic’ to help you feel better. In some circumstances, this is lifesaving. Unfortunately using these ‘broad spectrum antibiotics’ can lead to even more bugs becoming resistant to even more types of antibiotics. There also tends to be more side effects for the patient. What are the big risks? There are a number of risks and challenges that have to be really carefully managed around the use of antibiotics. Essentially, we want to make sure: Standard and broad-spectrum antibiotics are not being prescribed unnecessarily and contributing to the issue of an increasing number of bugs being resistant to our treatments. Patients get the antibiotics they need and do not become seriously unwell or at risk of sepsis. Health inequalities do not widen. How do doctors know what to do for the best? Deciding whether or not to give antibiotics to a patient, and which type is best if you do, can be very difficult. There are tests that can identify what type of bug a patient has and what it is resistant to. There are other tests – called biomarkers – which can help with the decision as to whether or not antibiotics are needed at all. These tests can really help healthcare professionals make decisions around antibiotics, but these services are not yet widely available. What do you hope to see in future? We need to help the public understand these issues and how they are affecting healthcare and decision-making. Many people visiting their doctor will strongly believe that antibiotics are the solution to their problem. There can be a lot of pressure to prescribe them, and it can be hard to explain why that’s not always the best approach. If someone looks very sick, their GP will be sending them straight to hospital. But if not, having access to a biomarker test in the community would help people feel reassured and support that important doctor-patient relationship, especially when antibiotics are not being prescribed. Doctors need to be empowered to make the best and safest decisions for their patients. I believe we should be piloting having biomarker testing within close access to GP surgeries. For those patients deemed in need of antibiotics, further tests should guide the choice of medicine. That way, patients could quickly and easily be offered testing, and the rapid results would help their doctor decide whether to prescribe antibiotics and if so, which type would be most effective. Focusing the pilots in urban areas where there is significant variation in wealth would also help us understand and manage the risk of widening health inequalities. These actions could help reduce unnecessary antibiotic use and protect patients from serious infection. Ultimately, helping to limit the threat to human life both now and in the future. Related content Top picks: 14 key resources on antimicrobial resistance Tackling antibiotic underdosing: Interview with Ruth Dando, Head of Nursing for Theatres, Critical Care and Anaesthetics at BHRUHT What factors in the workplace enable success in antimicrobial stewardship in paediatric intensive care? Tackling antimicrobial resistance: How to keep antibiotics working for the next century Antimicrobial resistance survivors: calling the world to action Patient capacity building for advocacy and research: The case of the European Patient Group on Antimicrobial Resistance Department of Health and Social Care: Confronting antimicrobial resistance 2024 to 2029 -
News Article
Trusts rejecting GP referrals risk contract breach, LMCs warn
Patient_Safety_Learning posted a news article in News
GP leaders are pushing back against hospital trusts rejecting referrals, with LMCs issuing warnings of potential contract breaches. A number of LMCs have encouraged GPs to send warnings back to providers who reject their referrals, stating that there are no valid grounds for the rejection. Some template letters produced by LMCs to help GPs do this are badged as part of collective action efforts, since the BMA’s ‘menu’ of actions encourages GPs to ‘stop rationing referrals’. It comes after Pulse revealed that GPs are concerned about a rise in rejected referrals and particularly from ‘anonymous’ clinicians, with referrals coming back to general practice unsigned, and patients being put at risk when secondary care and other providers do not accept GP referrals. Read full story Source: Pulse, 28 October 2024 -
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 4: Pitfalls to prescribing better care Event programme: The invaluable role of pharmacists Common medicine error claims recommendations Q&A panel discussion Contributors: Joanne Hughes- Partner | Hill Dickinson Dr Anwar Khan - Senior Clinical Advisor for General Practice |NHS Resolution Register
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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 3: Dissecting a claim part 2 Event programme: Exploration through the use of an illustrative case studyQ&A panel discussion Contributors: Chris Dexter - Partner | Weightmans Alison Brennan - Principal associate |Weightmans Register
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EventNHS 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 2: Helping general practice manage and learn from claims part 1 Event programme: Exploration through the use of an illustrative case study Q&A panel discussion Contributors: Chris Dexter - Partner | Weightmans Alison Brennan- Principal associate |NHS Resolution Register
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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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Content ArticleThe model of general practice is changing and, at the core of this, general practice is moving away from a model of 'seeing a GP' to a model that is 'consulting with the multi-disciplinary team'. National Voices set up a project to understand awareness and experience of multidisciplinary teams across two groups: frequent users of primary care services and those who experience health inequalities. This report presents those insights and includes recommendations on how to improve experiences of multidisciplinary teams within general practice amongst populations who experience health inequalities and frequent users of primary care services. In particular, the report highlights how primary care teams can build trust and assure people that general practice has oversight of their care.
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Content Article
The King's Fund: Activity in the NHS (19 June 2023)
Patient Safety Learning posted an article in Data and insight
Over the past 10 years, it has often been stated that the NHS treats more than a million people every 36 hours, but is that still true? Here, the King's Fund analyse NHS activity (eg, calls, appointments, attendances and admissions) and explore some of the underlying trends that lie behind these headline statistics. Following the disruption caused by the Covid-19 pandemic, NHS activity has almost returned to pre-pandemic levels. -
Content ArticleNHS services have been under increasing pressure in recent years, particularly since the start of the Covid-19 pandemic. We have previously reported on the NHS’s efforts to tackle the backlogs in elective care and its progress with improving mental health services in England. This report gives an overview of NHS services that may be used when people need rapid access to urgent, emergency or other non-routine health services, and whether such services are meeting the performance standards the NHS has told patients they have a right to expect. It covers: general practice community pharmacy 111 calls ambulance services (including 999 calls) urgent treatment centres accident and emergency (A&E) departments. Key findings Population changes are contributing to increasing demand for healthcare. Demand for unplanned or urgent care is increasing. The number of general and acute hospital beds has increased slightly following a downward trend before the Covid-19 pandemic, but occupancy rates have also risen and patients are now staying longer in hospital compared with previous years. The number of NHS staff has increased, including those working in unplanned or urgent care. he number of staff vacancies across the NHS rose from the start of 2021 but has recently fallen. Spending on the NHS continues to increase. The total budget for NHSE in 2022-23 was £152.6 billion, some £28.4 billion more than in 2016-17 at 2022-23 prices. Patients’ access to services for unplanned or urgent care has worsened. There is considerable variation in service performance and access, both between regions and between different providers. Covid-19 had, and continues to have, an adverse impact on the NHS’s capacity to meet healthcare needs. The NHS has not met key operational standards for unplanned or urgent care since before the pandemic. Performance against operational standards, and more widely, has deteriorated further since the onset of the pandemic. Overall performance of the unplanned and urgent care system has been worsened by delays transferring patients from one service to another. The NHS has not been able to secure the full benefits of increased spending and staff numbers and productivity has fallen since the onset of the Covid-19 pandemic. NHSE has a plan to reduce waiting times and improve patients’ experiences.
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Content ArticleThis guide is a self assessment tool to enable Primary Care to become dementia friendly. It includes a checklist for GP practices to help people with dementia and their carers access high quality care and support. People with dementia, carers and staff in GP practices have worked together to co-design and develop this guide. It outlines the benefits for general practice in becoming dementia friendly and includes checklists covering: General practice systems General practice culture Patient diagnosis, care and support Physical environment This guide is adapted from the Alzheimer’s Society’s Guide to Making General Practice Dementia Friendly.
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Content ArticleWith demand for GPs outstripping supply, GP retention must be a priority in tackling the current workforce crisis. The NHS has lost the equivalent of 2,187 full-time fully qualified GPs since 2015, 8% of the current total of full-time fully qualified GPs. GPs in the UK are reporting the highest stress levels and lowest job satisfaction compared to their counterparts in nine other high-income countries. In this article, published by the King's Fund, GP Trainee, Holly Young reflects on a recent roundtable that explored solutions for GP retention, organised by the Royal College of General Practitioners.
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News Article
Ministers reject Hunt’s plans for general practice
Patient Safety Learning posted a news article in News
The Government has rejected several policy proposals to promote “continuity of care” in general practice which were put forward by Jeremy Hunt. The now chancellor championed significant policy changes to strengthen the link between patients and an individual, named GP, when he was Commons health and social care committee chair. However, the government’s response to the report rejects several of the key proposals. The committee under Jeremy Hunt said “NHS England should champion the personal list model” – under which each patient is linked to a particular GP – “rather than dismiss it as unachievable”. The Department of Health and Social Care response said: “The department does not accept this recommendation. We agree that continuity of care is important within general practice but do not agree that requiring a return to the personal list model is the correct approach. Government also rejected recommendations from Mr Hunt’s committee to introduce a new national measure to track continuity of care by practice; and to fund primary care networks to appoint a GP “continuity lead” for a session a week. Read full story (paywalled) Source: HSJ, 24 July 2023 -
Content ArticleGuidance needs to be applied in a careful, caring and person-centred way to ensure that patients benefit from, and are not harmed by, healthcare. In this blog, Dr Sam Finnikin, an academic GP in Sutton Coldfield, uses the story of 86 year-old Joan to illustrate the importance of shared decision-making in ensuring patients receive the most appropriate care. Joan was prescribed multiple medications by the hospital cardiology team after being diagnosed with acute coronary syndrome and a severely impaired left ventricle, but the medications made her feel very unwell and inhibited her quality of life. Joan then reached out to her GP surgery as she wanted to stop taking them, and Dr Finnikin realised that she and her family were unaware of the the reason each medication had been prescribed and the potential benefits and side effects of each one. After a long conversation about her priorities, Joan stopped the medications that were not benefitting her symptoms and died in peace and comfort at home a few weeks later. Dr Finnikin argues that shared decision-making is not an optional extra, but must be considered a vital part of healthcare, stating that "omitting shared decision making can be just as harmful to patients as being ignorant of clinical recommendations."
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Content ArticleA group of patients and families with experience of end-of-life care worked with researchers from the Nuffield Trust to review findings from its research investigating the effect of the pandemic on people who were receiving end-of-life care at home. This web page summarises the research findings from the perspective of patients and family. Key findings Issues relating to medication near the end of life were seen as the biggest roadblock to a good death. Patients and their families faced difficulties getting the medication they needed. The quality of contact with health services is more important than the quantity. For people with Alzheimer's and dementia, informal carers play a particularly vital role. People living in the most deprived areas received fewer services during the pandemic than those in the least deprived areas.
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EventThis Westminster conference will examine policy and funding priorities for general practice. The agenda also looks at wider issues around GP wellbeing, patient access, service integration, and service recovery in the wake of disruptions caused by the pandemic. Stakeholders and policymakers will discuss progress, issues and next steps for ambitions to increase capacity within general practice for urgent same-day care, tackle areas of inefficiency, and improve transparency and accountability - in the context of the NHS Long Term Plan and the Winter Access Fund. Overall, the agenda will bring out latest thinking on priorities and key issues moving forward, including: integration - implementing reforms within the Health and Care Bill and the role of primary care workforce - recruitment and retention, the role of locum and other support staff, supporting mental health and wellbeing, and tackling burnout primary care networks - progress in development and their role in improving local health outcomes innovation and infrastructure - taking forward innovation from the pandemic and how the estate can support innovative working, tackle inefficiencies, and improve patient access going forward personalised care - opportunities and challenges, the role of community services, and ways to improve the delivery of patient-centred care. The conference will be an opportunity for stakeholders to consider the issues alongside key policy officials who are due to attend fromthe DHSC; CQC; the OHID; National Audit Office; and DWP. Agenda Register
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Content ArticleThe Remote by Default research study, a collaboration between the Universities of Oxford and Plymouth and the Nuffield Trust, has been exploring how technology can be harnessed to support excellent primary care. Using workshops, interviews, and focus groups of clinicians, service users, and other stakeholders, they have begun to map the multiple interacting influences on the choice of consultation modality.
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Content Article
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In this article, published in Guidelines in Practice, Dr Ashish Chaudhry and Dr Harsha Master offer nine top tips for recognising and managing Long COVID-19 symptoms in primary care. This article aims to help clinical colleagues learn about: lingering or new symptoms after an acute case of COVID-19, known as ‘Long COVID’ identifying patients with Long COVID managing or referring patients who need active intervention and investigation. -
Content Article
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Sodium Valproate is a treatment for epilepsy and bipolar disorder. It can cause an increased risk of developmental, physical and neurological harms to the human embryo or fetus. This NHS letter is a reminder of information that every woman and girl of childbearing age should receive from their doctors when the drug is first prescribed. It contains important reminders of safety considerations, including around contraception, pregnancy and regular prescribing reviews. Further recommended reading: Sodium Valproate: The Fetal Valproate Syndrome Tragedy Analysing the Cumberlege Review: Who should join the dots for patient safety? (Patient Safety Learning) Findings of the Cumberlege Review: informed consent (Patient Safety Learning) First Do No Harm. The report of the Independent Medicines and Medical Devices Safety Review Regulatory flaws: Women were catastrophically failed in the mesh, Primodos and Sodium Valproate tragedies (Kath Sansom) -
Content ArticleThis cross-sectional survey in the British Journal of General Practice looks at the availability and use of emergency admission risk stratification (EARS) tools across the UK and aims to identify factors that influence their implementation. The authors identified 39 different EARS tools in use. They found that the most important factors in encouraging general practices to use EARS tools were: promotion by NHS commissioners involvement of clinical leaders engagement of practice managers. High workloads and information governance were significant barriers to their use. The authors highlight the need to align policy and practice with research evidence.
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Content ArticleThis video from NHS Resolution looks at the criteria that need to be met in order for patient consent to be legally valid. Advice is provided on how to ensure practitioners obtain legally valid consent.
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Content ArticleThis is a guide to end of life care symptom control when a person is dying from COVID19 for General Practice Teams, prepared by the Royal College of General Practitioners (RCGP) and the Association for Palliative Medicine. This guidance is produced during the COVID-19 outbreak in order to support the care in the community of patients and those important to them, at the end of their lives or who are unwell as the result of COVID-19 or other life-limiting illnesses. This document will be updated and adapted as further contributions are received and in line with changing national guidance. The most current version of the guidance document will be available on the public-facing pages of the RCGP COVID-19 Resource Hub and Association for Palliative Medicine website. Please check that you are referring to the most current version.
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Content ArticleThis FAQ resource from the Royal College of General Practitioners, provides information about a number of topics relevant to general practice and how to keep patients and staff safe during the coronavirus pandemic.
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Content ArticleA short video to show you how to have a video consultation with your GP surgery after receiving an invitation via text message. Increased use of telephone and video consultations is expected during the current COVID-19 situation. In this video, the AccuRX (https://www.accurx.com/) system is being used. The system and process used by other practices may vary. A link to this video can be sent to a patient's phone by the surgery when a video appointment is booked so that they can prepare themselves for their video consultation.
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Content Article
Royal College of General Practitioners: COVID-19 advice
Patient Safety Learning posted an article in Guidance
The Royal College of General Practitioners is closely monitoring the situation and developing practical resources and support for GPs and their teams. They have launched specific guidance for general practice, including out-of-hours. This will be updated as the situation develops but things are extremely fast moving so please make sure you are using the latest version. -
Content ArticleThis publication presents UK-focused analysis of The Commonwealth Fund’s 2019 International Health Policy Survey of Primary Care Doctors in 11 Countries. This includes responses to several UK-specific questions funded by the Health Foundation. The Health Foundation present their analysis of the data, including comparisons with the 2015 survey where possible, under three main themes: how GPs view their job what care GPs are providing and how it is changing how GPs work with other professionals and services. Key points The Commonwealth Fund surveyed 13,200 primary care physicians across 11 countries between January and June 2019. This included 1,001 general practitioners (GPs) from the UK. The Health Foundation analysed the data and reports on the findings from a UK perspective. In some aspects of care, the UK performs strongly and is an international leader. Almost all UK GPs surveyed use electronic medical records and use of data to review and improve care is relatively high. The survey also highlights areas of major concern for the NHS. Just 6% of UK GPs report feeling ‘extremely’ or ‘very satisfied’ with their workload – the lowest of any country surveyed. Only France has lower overall GP satisfaction with practising medicine. GPs in the UK also report high stress levels and feel that the quality of care that they and the wider NHS can provide is declining. A high proportion of surveyed UK GPs plan to quit or reduce their working hours in the near future. 49% of UK GP respondents plan to reduce their weekly clinical hours in the next 3 years (compared to 10% who plan to increase them). UK GPs continue to report shorter appointment lengths than the majority of their international colleagues. Just 5% of UK GPs surveyed feel ‘extremely’ or ‘very satisfied’ with the amount of time they can spend with their patients, significantly lower than the satisfaction reported by GPs in the other 10 countries surveyed. Workload pressures are growing across general practice, and UK GPs report that they are doing more of all types of patient consultations (including face-to-face, telephone triage and telephone consulting). Policymakers expect GPs to be offering video and email consultations to patients who want them in the near future but the survey suggests that this is currently a long way from happening. Only 11% of UK GPs report that their surgeries provide care through video consultation.
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