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This report on public service performance at the local level, shows that patient satisfaction is higher in GP practices that have more GPs (particularly GP partners), have smaller list sizes, deliver more GP appointments and do more of those appointments face-to-face. Additional direct patient care staff – such as physiotherapists, pharmacists and care co-ordinators – are not associated with higher satisfaction. Despite that, all those trends are heading in the opposite direction: the number of GP partners continues to fall, particularly among those aged under 40. GP practices do far more appointments remotely than they did before the pandemic. The closure and merging of practices means that patient list sizes continue to creep up. In addition, the addition of almost 40,000 direct patient care staff since 2019 does not seem to have improved satisfaction.  The report argues that the government needs to urgently address the crisis in the GP partner workforce, aim to improve the conversion rate from GP traineeship into the GP workforce, understand how to use the expanded direct patient care workforce most effectively, and better communicate how its reform programme will improve patients' experience of general practice.

The government’s long term workforce plan, developed by NHS England, was finally published on 30 June, having first been promised more than five years ago by the then secretary of state for health and current chancellor, Jeremy Hunt. The plan is a welcome and necessary step towards solving the workforce challenges that have vexed the health service, although it is more of a jigsaw puzzle than a masterplan. The overall picture of a future NHS workforce with many more staff, increasingly working in more diverse multidisciplinary teams, and with greater support from technology, is encouraging but several pieces are missing from the vision and roadmap for its delivery, writes William L Palmer and Rebecca Rosen in this BMJ Editorial.

Patients who visit their GP practice with an ongoing health problem may see several different GPs about the same symptoms. To make sure they receive safe and efficient care, there needs to be a system in place to ensure continuity of care. In the context of this report, continuity of care is where a patient has an ongoing relationship with a specific doctor, or when information is managed in a way that allows any doctor to care for a patient. While some GP practices in England operate a formalised system of continuity of care, many do not. This investigation explored the safety risk associated with the lack of a system of continuity of care within GP practices. The investigation focused on: How GP practices manage continuity of care. This includes how electronic record systems alert GPs to repeat attendances for symptoms that are not resolving and how information is shared across the healthcare system. Workload pressures that affect the ability of GP practices to deliver continuity of care. This investigation’s findings, safety recommendations and safety observations aim to prevent the delayed diagnosis of serious health conditions caused by a lack of continuity of care and to improve care for patients across the NHS. Reference event Brian had a history of breast cancer and had been discharged from the breast cancer service. Two years later he began to have back pain. Initially the pain was so severe that Brian visited his local emergency department (ED). He was discharged from the ED with pain relief and was advised to contact his GP practice. A month later, Brian telephoned his GP practice and saw his named GP. The GP referred Brian to the GP practice’s physiotherapist and requested a blood test. Brian saw the physiotherapist, who gave him advice about exercises to help relieve the back pain. The exercises did not relieve Brian’s pain and over the following 8 months he saw two out-of-hours GPs and six practice GPs, a nurse and a physiotherapist at the GP practice. Brian also had consultations with healthcare professionals during this time for other conditions not relating to his back pain. When Brian saw a GP at end of the 8-month period, the GP found a lump on his spine and advised Brian to go to the local ED. At the ED, Brian had a computerised tomography (CT) scan. A lump was found on his spine which was later diagnosed as metastatic breast cancer (that is, breast cancer that had spread to his spine). Findings The GP contract, which sets out the mandatory requirements for GP services commissioned by the NHS, does not specifically require GP practices to adopt an approach that ensures continuity of care, but practices can do so voluntarily. Many GP practices do not operate a formalised system of continuity of care. There is no standard framework to deliver continuity of care in GP practices, so it is done differently across the country. Many GPs understand the benefits of continuity of care; however, some practices did not believe that it was possible to deliver such a system. Other practices were able to maintain continuity of care through systems developed by those practices. There is no requirement for GP IT systems to consider continuity of care or to ‘surface’ information (that is, identify and flag up relevant patient information) to GPs when they see a patient with unresolving symptoms. Patients told the investigation that they found it beneficial to see their named GP for long-term health conditions, including mental health conditions. GPs working in a practice with a system of continuity of care had more time to process information during consultations and to carry out any follow-on actions to ensure patients received the care they needed. GP practices that operated a system of continuity of care reported to have better staff welfare and retention, and fewer recruitment issues, than those that did not. Safety recommendations HSSIB recommends that the Department of Health and Social Care ensures that the GP contract explicitly includes and supports the need for GP practices to deliver continuity of care. This is to improve patient safety by building clinician–patient relationships as well as providing continuity of information. HSSIB recommends that NHS England updates the GP IT standards to ensure that patient continuity of care is maintained, including the identification and prioritisation (technically known as ‘clear surfacing’) of information to health and care professionals, when patients visit GP practices multiple times with unresolving symptoms. Safety observation GP practices can improve patient safety by aligning their staff wellbeing and patient safety policies to those of NHS England’s proposed patient safety strategy.

On paper, a GP’s working schedule can look quite inviting: consulting for three and a half hours in the morning, with a coffee break in the middle, then a gap for lunch and home visits before a similar length afternoon surgery. However, this is rarely the reality for NHS GPs. In this BMJ opinion piece, GP Helen Salisbury talks about what working life is really like for GPs and highlights the mismatch between their scheduled hours and tasks and the reality, which often involves them doing much more. She highlights how the unrealistic demands GPs face have been exacerbated by a movement of work from secondary to primary care, and argues that this is contributing to the workforce crisis that general practice faces.

Calculating nurse staffing in the acute hospital has become a key issue but solutions appear distant. Community, mental health and areas such as learning disability nursing have attracted less attention and remain intractable. This review from Leary and Punshon aimed to examine current approaches to the issue across many disciplines.

Healthcare settings are high-risk environments for fatigue and staff burnout. The Need For Recovery (NFR) scale quantifies inter-shift recovery, which contributes to cumulative fatigue and may precede occupational burnout. Advanced clinical practitioners (ACPs) are an established feature of the emergency medicine workforce in the UK, however, little is known about factors affecting their inter-shift recovery, fatigue or how NFR correlates with formal burnout inventories.

Continuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere. An association lasting more than 15 years between a patient and a specific GP reduces the probability of any of these factors by 25-30%, a study by Sandvik et al. found. The researchers said 'promoting stability among GPs' should be a priority for health authorities, and warned that continuity of care was under pressure.

This is a simple tool that helps you to understand the time you have available for your main work activity, e.g. seeing patients or managing a service. It is an excel spreadsheet that calculates this for you if you enter the time spent on various activities. When analysing and planning capacity, it’s important to look at time available for people to do the work required. This means understanding how much time people can actually spend on the required tasks. The tool provides a helpful way to understand this for individuals and teams and therefore can help plan work and improve productivity.

The Human Connection is a comprehensive set of clear and resonant stories that illustrate the impact of ergonomics and human factors, produced by the Chartered Institute of Ergonomics and Human Factors (CIEHF). The 60-page document is intended to be of value to a wide range of audiences, including government, policy makers, industry, third sector groups, educators, research funders, regulatory bodies and collaborators. The case studies, available here as the complete set or individually, have been written to increase understanding of the complexity, range and value of the discipline of ergonomics and human factors. The full case studies document is free to download. Request a copy by completing the request form, after which you will receive a link to the document on screen and by email.

The Health Foundation’s Report, Untapped potential: Investing in health and care data analytics, highlights nine key reasons why there should be more investment in analytical capability. Nine key reasons why there should be more investment in analytical capability: Clinicians can use the insights generated by skilled analysts to improve diagnosis and disease management. National and local NHS leaders can evaluate innovations and new models of care to find out if expected changes and benefits were realised. Board members of local NHS organisations and systems can use analysis to inform changes to service delivery in complex organisations and care systems. Local NHS leaders can improve the way they manage, monitor and improve care quality day-to-day. Senior NHS decision makers can better measure and evaluate improvements and respond effectively to national incentives and regulation. Managers can make complex decisions about allocating limited resources and setting priorities for care. Local NHS leaders will gain a better understanding of how patients flow through the system. New digital tools can be developed and new data interpreted so clinicians and managers can better collaborate and use their insights to improve care. Patients and the public will be able to better use and understand health care data. Action and investment is needed across the system so the NHS has the right people with the right tools to interpret and create value from its data. This could result in an NHS that can make faster progress on improving outcomes for patients.

"It’s time to halt, take a break, and redraw the relationship between patient care and self-care. Self-care isn’t an optional luxury. It must sit at the heart of what we do, to ensure our teams can continue to rise to the challenges of working in the 21st century NHS, to give our patients the best of both ourselves, and the organisation so many of us are proud to be a part of." This editorial by Dr Michael Farquhar, published in Anaesthesia, explains the importance of taking breaks while on shift and ensuring a good sleep between shifts and the inextricable link between sleep and patient safety.

This research paper discusses the problem of decision fatigue and how it can impact patient safety.  The authors hypothesised that decision fatigue, if present, would increase clinicians’ likelihood of prescribing antibiotics for patients presenting with acute respiratory infections as clinic sessions wore on.

Professor Alison Leary, Patient Safety Learning Trustee, is Chair of the Healthcare & Workforce Modelling at London South Bank University. In this interview with Patient Safety Learning, Alison discusses why she got involved in patient safety and what needs to change to enable the NHS to become a high performing organisation. Q: Alison, please tell us about yourself? A: I started out as an engineer and then went on to become a registered nurse. I worked in cancer for about 15 years and became an Advanced Nurse Practitioner. I also studied PG medicine and data science so have an eclectic background. I spend a lot of my time researching the relationship between workforces and safety. Q: What got you involved in patient safety? A: As a registered nurse, safety is a core part of the job and I’ve always worked in industries which take safety seriously. For some time, I was calculating optimum caseloads for people like specialist nurses and various people approached me to see if it could be done for the wider workforce. I like looking at complex issues, so I’ve worked on several problems. Q: You have had a varied career – which role has been the most challenging and why? A: Nursing has been the most challenging because nursing generally isn’t valued or seen for the contribution it brings. I struggle to communicate to decision makers/policy makers the risk of diluting the skill of the frontline workforce. Q: We often hear in healthcare that we can learn from other industries – what needs to change to enable the NHS to become a high performing organisation? A: Mostly a shift in culture – being more open when things don’t go well, learning from issues and experiences as they arise and learning from when things do go well. I think employers need to change their view of the people they employ – too often they are seen as some kind of expensive burden instead of an essential asset. Q: Who inspires you, and why? A: A lot of people inspire me. I think really though I keep doing this because I see people going to work everyday under quite difficult conditions. A lot of patients and families who have suffered but still campaign, like Sara Ryan and Julie Bailey, have given tremendous insight into to the very real challenge we face. I think we are fortunate that people who work in patient safety tend to have a real passion for it. Q: How do you envisage patient safety in the future, and how are you playing a part? A: I'd like to see the same legislative framework that other industries have. My part is largely modelling using data – I'd like to see an improvement in the quality of healthcare data so that it's more sensitive to things like workloads and safety. A: If you had a magic wand, what would you add to make safer care for patients? Q: If I could wave a magic wand, I would introduce safety legislation and a proper safety management system into health. As someone at NASA said to me “people shouldn’t need courage to come to work”.

The Royal College of Radiologists’ (RCR) annual radiology workforce report collected data and commentary from imaging department leaders from all 172 UK health boards and trusts that employ radiologists. The report highlights the UK’s current and predicted shortage of radiologists and urgently calls for more funding for trainees and improved retention and recruitment. Key findings from the Clinical Radiology UK Workforce Census Report 2018 include: Three quarters of radiology clinical directors say they do not have enough radiology consultants to deliver safe and effective patient care. NHS hospitals spent £165m last year on outsourcing, overtime and locums to cover radiologist work, £49m more than in 2017 and three times what was spent in 2014. The amount spent on outsourcing would pay for 1,887 full-time radiologists, which would more than pay to cover the current shortfall of 1,104 consultants. Only one in five UK trusts and health boards has enough interventional radiologists to run a safe 24/7 service to perform urgent procedures . England has seen an increase in its full-time radiologist workforce; however, consultant numbers in Scotland, Wales and Northern Ireland are flatlining.

This report, from Deloitte, examines how the healthcare workforce is responding to the inexorable rise in demand for healthcare and the challenge of meeting this demand with the right numbers of appropriately skilled staff. It provides actionable insights and evidence-based case solutions to these challenges.