post

GP workloads are now at saturation point.

During recent years, there has been a widespread and shared belief, amongst many GPs and others working in Primary Care that workloads have increased exponentially. The Government has failed to resource adequately for this and, as such, not only is this having an impact on the health and wellbeing of GPs, it is also at times affecting their ability to provide safe and consistent levels of care.

It is now commonplace for the media to sensationalise issues occurring within Primary Care concerning the supply and demand of services and the impact that this has on other frontline services. Most GPs want the best for their patients and, as such, the increase in workloads has been raised repeatedly and consistently with the Government, only for these concerns to be rebuffed, by both NHS England and the Department of Health, with promises of thousands of extra staff in Primary Care by 2020.

Despite the attractiveness of thousands of more staff in 2020, a new study in the Lancet led by researchers from the BMA and the Royal College of GP’s, provides clear objective evidence of what GPs have been saying for years and demonstrates that action must be taken now.

The key messages from the study, which covered over 100 million GP and Nurse Consultations at 398 practices in England during 2007 and 2014, include:

– ‘There is a substantial increase in practice consultation rates, the average duration of the consultations being given and the total patient-facing clinical workload.

– GPs are facilitating more consultations than ever before for patients who are living longer, who often have multiple long-term conditions resulting in a complex presentations of symptoms that cannot be dealt with in the previously allocated time.

– Due to the change in nature and volume of workloads, GP practices and their teams are working harder than ever before, but struggle to provide basic levels of care as services are overwhelmed.’

The impact of inaction in the face of such significant objective data could be disastrous not only for staff but for patients also. With many GPs now facing the prospect of burnout or feeling the impact of being overworked, over tired and exhausted the results could be damaging for patients especially if this results in substandard care, harm or misdiagnosis.

Compounding these issues are figures released from Health Education England, who have revealed that one third of GP training places still remain vacant. Despite this representing a 1% increase on last year’s figures these results are second lowest recruitment results of all the specialities. This is not unsurprising as in 2015; GPs in England reported having the lowest job satisfaction rates since records began in 2001.

The solution for many of the problems reported across the NHS, according to the Government, is a greater shift towards ‘place based care’, a new model being explored to reduce the burden on the acute care system. However, without a serious focus on patients’ and communities abilities to self-care and make the most of non-traditional services, such as the extended pharmacy offer, the ‘place-based model’ will only once again serve to shift the burden from acute to primary care and resulting in further pressure to under-resourced and overworked GPs, and once again endanger the whole system of collapse.

post

Fallout from EU Referendum.

On the 24th June 2016 the people of the UK made the decision to leave the EU, a decision that has since sent shockwaves across the entire global community. Politically, this has sent the country into chaos with changes and challenges of leadership across the three main political parties. Economically, the impact is widely expected to result in recession in the UK, which could then have a knock on effect and force other EU countries down the same path.
With the decision to leave predicated on strong views concerning NHS Funding and Immigration policies, it now seems ironic that these two issues, along with economic gloom, once again plunge the future sustainability of the health service further towards uncertainty. Furthermore, with the ‘Leave’ campaign distancing themselves from claims that were made indicating that funds previously sent to the EU could be reinvested into the NHS, this is an uncertain time for many of the 110,000 EU healthcare workers who already work tirelessly to deliver more with less resources.
Previous estimates relating to shortages in both the future Medical and Nursing workforces may potentially pale in comparison to the reality, especially when one considers that the UK has traditionally tried to fill existing gaps in healthcare workers from abroad. A huge majority of these workers – 10% of Doctors and 20,000 Nurses, have come from other EU countries. With already rising social unrest and concerns over existing immigration policies the current challenge of motivating, recruiting and retaining an already disenfranchised GP profession will continue to escalate, especially if no help is perceived to be coming from anywhere other than inside the UK. The GMC is currently exploring how doctors from the EU will be granted access to the UK medical register once the UK is no longer a member state. As it stands, the EU vote will have no impact on the current registration of any doctor on the register, but there may be implications relating to regulation in coming years.
In the aftermath of a heavily sensationalised and manipulative leave campaign, many of us now ask if it was right to trust such an important decision to the people, especially when the outcome now stands to jeopardise so much. Should this have been left in the hands of people with the power, knowledge, experience and understanding to assess the impact on our services, our economy and our health care system? It’s too early to be able to ascertain with any great certainty, but one thing is for certain there is an ageing population. By limiting free movement of skilled workers, we are widening the gap concerning demand and supply for our health care services and we are pushing our already heavily burdened finances a step closer to the brink of destruction.

post

Unified DNA-CPR

End of life and palliative care symptom control can be some of the most fulfilling aspects of the GP role, but huge variations still exist across the whole of the UK. Getting it right every time for every patient is the ultimate goal in these situations, and supporting people to live well before dying with peace and dignity in a place of their choice can be incredibly satisfying for all involved, despite the bleakness of the situation.
A number of strategies have arisen in recent years to help GPs and other professionals to facilitate the wishes of patients approaching the end of their lives, and they have ensured that care is uniquely tailored to the patient. This has resulted in their needs increasingly being met and care is often managed in a much more collaborative and coordinated way. Ironically, the ultimate goal of healthcare, which is to save lives, can be a barrier in these circumstances and can prevent patients from achieving a peaceful and dignified death, especially when we consider the issue of CPR.
Discussions relating to resuscitation can be one of the most sensitive and difficult that GPs, patients and family members may ever have to be involved in. It is essential to identify patients for whom cardiopulmonary arrest represents the terminal event in their lives and for whom CPR will fail or is inappropriate. It is also essential to identify those patients who would not want CPR to be attempted and who competently refuse this treatment option. Some patients may wish to make an advance directive about treatment. Such directives must be respected as long as the decisions are made by patients with the mental capacity to do so. These decisions should be informed, current, made without coercion and should apply to the current clinical picture. All of these variables have to be considered and should include the patient where appropriate. With emotions high in these situations, unsurprisingly there are still many reports detailing when patients have been excluded and decisions made in their best interests, with some of the worst cases reaching the media. This does nothing but create a culture of fear and results in further anxiety around such discussions. There needs to be convincing reasons not to involve patients in these discussions, or as seen with the Tracey Judgement, there is a risk to patients under Article 8 of the European Convention on Human Rights.
Once the decision concerning CPR is made, it is absolutely essential that inappropriate, futile or unwanted attempts do not occur. This is not to say that decisions cannot be reviewed and amended accordingly, if it is appropriate to do so. Variations in local policies can cause further misunderstandings and can lead to distressing incidents for patients, families and staff. The increased movement of patients and staff between different care settings makes a single integrated and consistent approach complex and difficult to achieve. The caution for Locums is that this can be very confusing, especially if they work in one area of the UK where there is a unified approach in place and then they choose to work in another area, where this approach is yet to be implemented and the policies once again differ significantly.
The introduction of the ‘Unified-Do-Not-Attempt-CPR-Form’  represents a significant step in the right direction for standardising the approach relating to decisions concerning CPR. The concept is quite simple but very effective and just involves the appropriate professional completing a resuscitation form. Ideally this form should be initiated in the Primary Care setting, and therefore should be a GP, but it can be commenced when the patient is still in the Secondary Care setting. Its significance comes from the fact that once the decision has been made it doesn’t mandate the process be revisited just because the patient may move between different settings prior to their death. Of equal importance, is it is recognised by the Ambulance Service and will therefore prevent inappropriate CPR if the service is contacted, when previously Paramedics would have been duty bound to act. The paperwork is transferable to all services.
It isn’t without its criticisms. The decision is only applicable if the lilac form stays with the patient at all times (or can be easily found) regardless of their setting. There are reports that this is much easier said than done, and forms often get lost and need re-writing. The fact that it is currently only available in a paper format when most services are working towards an Electronic Patient Record is also another area of weakness and a potential pitfall.
The introduction of the Unified DNA-CPR Form is in varying degrees of implementation across the UK. Due to the positive impact the process can have on patients and their families, there needs to be increasing amounts of pressure from all healthcare professionals to ensure that there is rapid roll out in those areas that are lagging behind, or have yet to embrace the idea.

post

CQC – A hindrance or a help?!

For many employed within Primary Care the very mention of a pending CQC inspection is enough to trigger anxiety, panic, fear and frustration. These emotions can be felt by every member of the team regardless of their professional roles and responsibilities, even more so when there is an overwhelming feeling that we just don’t have the resources to do what we do currently any differently. With recent news that the Organisation intends to increase the amount of unannounced visits over the next couple of years many are left pondering whether clinical staff will ever get an opportunity to see patients again or just be forever lost in a constant and never ending sea of paperwork?
The CQC prides itself on monitoring, inspecting and rating health care providers, making bold claims that this is done in partnership with the teams who deliver those services. A rating is given in accordance to how safe, caring, effective, responsive and well-led that service is and then this is published nationally. Why then, when most of the Primary Care workforce take such pride in our work and when nobody gets up in the morning to go to work and do a bad job, is this Organisation able to illicit such negative emotions in the run up to an inspection? Why does the very mention of the Organisation unite the profession into calling for its immediate dissolution?
Here at dealdirectlocums.com we have put together a few potential reasons why:
– The amount of preparation and work required for a Practice to survive an inspection is substantial, and heavily bureaucratic. Despite what the Organisation claims, it is not always reflective of a diverse and modern health care system with many inspections being reported as being undertaken with an autocratic ‘we know best approach’ rather than a collaborative approach to dealing with real issues.
– The inspections are dependent upon data being readily available, up to date and correct in order to make a rating. Often, data comes from multiple sources, is difficult to collate and across England transparency in dealing with data and presenting it varies significantly, with the reasons why being multifactorial.
– Poor ratings often result in job losses and staff replacement, rather than addressing root causes of problems and working with leaders to resolve the system problems which are often out of the control of the staff leading the services.
– CQC inspections are often the ‘final nail in the coffin’ for struggling Practices and can destroy the last vestige of hope and morale currently keeping that Practice afloat. Surely an injection of resource, support and leadership is much more effective than an injection of inspectors telling disillusioned staff what they already know? If this results in the closure of a Practice then this causes additional pressure to other Practices who have to pick up this work and as such, care if often compromised.
– Ratings should not be issued on the basis of a single visit and some consideration should be given to how responsive that Practice is in dealing with any identified issues and what systems and processes are put in place to deal with them.
– Some GPCs have called for the CQC regime to be abolished and replaced with a proportionate and fair system that empowers and supports Practices to improve without recourse to an unachievable action plan.
– The CQC does not take into account resource allocations when considering ratings. When the BMA reviewed CQC ratings from 2814 GP Practices in England from 2015 they found that practices with the highest ratings received more funding per patient.

  • Practices rated as ‘outstanding’ received on average £152 per patient
  • Practices rated as ‘good’ received on average £140 per patient
  • Practices rated as ‘needs improvement’ received on average £128 per patient
  • Practices rated as ‘inadequate’ received on average £111 per patient

The correlation between performance and funding per patient are not shock findings, they are common sense. The CQC does not take this into account when issuing ratings, but maybe now that so much importance is being placed on finances driving our services influencing their sustainability, this is the time that funding should be published. This may in some way act as some consolation that at least people may have some ideas of the real pressures that Practices face.
For Practices who have an inspection pending then the BMA have released advice and guidance in relation to this and this can be accessed via this link

post

Medical Revalidation – Under the Microscope

Revalidation started on 3 December 2012 and the vast majority of Doctors are now reported to have undertaken the process at least once. Opinion on Revalidation is extremely divided and this can be a contentious topic of discussion, especially when one considers how much time, energy and effort GPs and their partners have to invest in order to work through the process and demonstrate the requirements. It is absolutely essential that GPs provide up to date and evidenced based treatment to patients. Nobody can argue that this should be done by competent, compassionate and resilient GPs who are caring and sensitive in their approach to patients and their families. What many GPs are disgruntled about is where they are finding the time to complete Revalidation. With constant pressure from rising workload demands, attempts to ensure quality is never compromised and the rising expectation to undertake non-patient facing work and additional roles, many GPs are having to tackle Revalidation in the evenings after an exhausting day in the Surgery or during their downtime.

If Revalidation creeps into social and leisure time then surely this will have an impact on the resilience of GPs, their ability to deal with stress and may bring about one of the conditions the process has been brought in to root out, unstable Doctors! For Locum colleagues the process can be even more daunting with concerns being raised in relation to finding not only time, but a Responsible Officer to undertake the review. One only hopes this process is not having an impact on the current poor recruitment and retention rate across the whole of the medical profession. Is it just becoming too difficult to maintain one’s licence in the face of just wanting to treat patients?

Two significant reports have been published in recent months that aim to review the effectiveness of the process for both patients and for colleagues. The hope is the reviews will help to identify what doesn’t add value and what needs to improve.

The first report, a GMC sponsored evaluation, is a report by an independent collaboration of researchers referred to as UMbRELLA. The survey reveals some encouraging feedback that the process may be having a positive impact on practice especially when used in line with appraisal. Other important findings include:
• 90% of doctors have had a medical appraisal in their career; of this group, 94% have had an appraisal in the past 12 months
• 42% of doctors agreed that appraisal is an effective way to help improve clinical practice
• 32% thought that revalidation has had a positive impact on appraisal, with a small number saying that the impact has been very positive
• Doctors who got feedback from patients said it is the most helpful information to support reflection on their practice
• Some specialty doctors have highlighted difficulties with collecting patient feedback.
The Department of Health commissioned the second report and the main findings include:
• Revalidation has led to important changes in the way that medical performance is managed and assured
• It has helped to integrate sources of information within organisations, therefore giving the Responsible Officer the authority and scope to bring together information on performance and to act upon it
• There are issues around variation, especially from organisation to organisation, and as such there are still considerable areas of the process that could be more efficient and effective.
In short, the jury is still out as to how much value this process adds to safer and better quality of care for patients. The process is full of good intentions but there is still considerable work required to make it user-friendly and less time consuming. Currently, countless hours are not accounted for when referring to guidelines online, discussing cases with colleagues and referring to the BNF. One useful tip is to ensure that you use the GP Notebook  CPD tracker when you are quick referencing guidelines during Surgery, as this may add up to a few hours through the course of the year.

post

CVD risk calculations error

Following a statement issued by the MHRA, an investigation has been launched into how a digital calculator (QRISK2) used by GPs to assess the potential risk of cardiovascular disease, has resulted in incorrect risk estimation scores being calculated. The SystemOne’s version of the QRISK2 calculator is used in more than 2,500 practices across the country and it is now thought that incorrect scores could have been determined for potentially hundreds of thousands of patients, dating as far back as 2009.

The MHRA confirmed that it was only the interaction between QRisk2 and SystemOne that have caused the alert and this must be reiterated to patients when concerns are being raised. Having said that, this is a major system error, one that could potentially result in a loss of confidence in the tool and one that could create a lot of additional work to already excessive GP workloads.

The risk to patients can vary and includes:

– Thousands of patients may have been prescribed statins when they are not indicated.

– Patients who should not be on statins may suffer unnecessary side effects from being on them.

– Patients may choose to stop their statins because of a loss of confidence in the decision making process. This may cause cholesterol to return to dangerously high levels in just a few weeks.

– The risk of a cardiovascular event from not being on a statin, when in actual fact one should have been commenced.

The numbers of patients affected by use of the tool are thought to be low because this is a tool to aid to clinical decision making. Therefore, the hope is that only a small number of patients will require changes to their CVD management plan. If only one patient is affected by a software system error this, however is one patient too many. GPs and the company that manufactures the SystemOne software system, TTP, are therefore working frantically to enable practices to identify patients to ensure that they receive accurate risk estimation scores and treatment where necessary is altered accordingly.

TTP have temporarily, but only recently suspended the use of their tool until the glitches within the system have been identified. The MHRA are working closely with the company to get to the root cause of the problem. One thing is certain, it is going to take a lot of time and reassurance from TTP before many GPs find confidence in this particular brand of the tool, especially in the face of so many other competitors whose end product is much more reliable. In the meantime GPs are advised that if it is necessary to use an algorithm to assess a patients risk then QRISK2 is available at www.qrisk.org

post

Leadership I – GPs as Leaders, what’s your style?

The evidence for strong leadership at every level of the healthcare system has never been more compelling with research proving that good leadership skills can have a positive impact on effective team working, the health and wellbeing of team members, quality of care, patient experience and patient outcomes. During recent years huge amounts of money have been invested in leadership development across the whole spectrum of the NHS aimed not only at those who manage services but with particular focus towards clinicians.

GPs have an intrinsic leadership role within health and social care services and therefore are essential in the effective delivery, running and future delivery of these services. Both ‘The NHS Five Year Forward’ and ‘General Practice: Forward View’ recognise how significant this role is and therefore it is essential for GPs and others within Primary Care to embark on leadership development programmes. Development within Primary Care should now begin to match pace and scale of colleagues within Secondary Care who are much further along the road in relation to the importance placed on leadership development.

Indeed much can be gained from developing GPs as leaders in as much as it enables resilience, adaptability and collaboration in the face of the difficult working conditions that are faced daily. With services being delivered through more interconnected and interdependent organisations in order to nurture, develop and maintain these relationships, collaborative and transformational leadership skills are required, as health care moves across traditional boundaries.

The reality is that the people in the system know it the best and therefore it is essential for them to get involved and lead the way. The reality for GPs however, are that full clinics, numerous home visits, unnecessary workloads, staff shortages and extreme demands on the service result in very limited non-patient facing work being completed. In a system that has no time it seems incredibly ill conceived that the very people who need time, energy and resource spent on them to develop them as leaders cannot be released because this will leave no one else to do the work. How will we ever get the best out of GPs, get them to think differently and enable them to use their skills and their knowledge to get the best out of people, services and the most from their patients without running them into the ground?

Recognising how difficult it is to get time away from work to focus on leadership development, this is the first of a series of blogs on the topic. In this first series you are asked to consider;

  • Which leadership style you most closely associate with?
  • Which leadership style do you use in your daily work life?
  • Which leadership style is your dominant preference?

Leadership styles describe a person’s habitual behaviour when confronted with any number of managerial situations. They can be influenced by personality, values, preference, culture, team/organisational culture, the response of others and behaviours learned from others such as mentors or colleagues. The concept of leadership styles is based on work by psychologists Litwin and Stringer at Harvard University. Each of these styles has pros and cons when being used, especially if the behaviours that arise have damaging effects towards patients or colleagues. No single style is effective in all situations but rather leaders need to ensure they’re able to adapt to different situations with different styles to get the most out of people and not just a quick win.

 

Leadership style and definition

These styles are effective when….

These styles are least effective when…

Directive:

“Do it the way I tell you”

Effective when the primary objective is immediate compliance

– Applied to relatively straight forward tasks

– Used in crisis situations

– Deviations from compliance will result in serious problems

– All else has failed with problem employees

– Applied to complex tasks

– Used over extended periods with self-motivated employees

– Used with individual specialists or talented people who are expected to be creative

Visionary:

“This is where we are going and why”

Effective when the primary objective is providing long-term direction or vision

– A new vision or clear direction and standards are needed (e.g. in times of change)

– A manager is perceived to be the “expert”

– New employees depend on the manager for active guidance

– The manager does not develop employees

– The manager is not seen as credible or if used with experienced employees who are themselves knowledgeable

– Trying to promote self-managed teams

Affiliative:

“It’s important we all get on”

Effective when the primary objective is creating harmony

 

 

– Used as part of a repertoire that includes Visionary, Participative or Coaching styles

– Tasks are routine and performance adequate

– Giving personal help

– Getting conflicting groups/ individuals to work in harmony

– Employees’ performance is inadequate and negative performance feedback is required

– The situation requires direction and control

– Employees are task focused

 

Participative:

“What do you think”

Effective when the primary objective is building commitment and generating new ideas

 

 

– Employees are competent

– Employees possess critical information

– Employees have clear ideas about the best approach to take

– Visionary style has already been used to create and champion a clear overall direction for the team

– There is a crisis, and there is no time to hold meetings

– Employees are incompetent, lack crucial information, or need close supervision

 

 

 

Pacesetting:

“This is the way to do it”

Effective when the primary objective is accomplishing tasks to a high standard of excellence

 

 

– Employees are highly motivated, competent, know their jobs, and need little direction

– Managing “individual contributors”

– Quick results are required

-Developing employees who are similar to the manager

– The manager cannot do all the work personally, and needs to increase delegation- Employees need direction,

– Employees need direction, development and co-ordination

 

 

Coaching:

“Here is an opportunity to practice”

Effective when the primary objective is the long term professional development of others

– Employees acknowledge discrepancy between their current level of performance and where they would like to be

– Employees are motivated to take initiative, be innovative, and seek professional development

– The manager lacks expertise –

– Employees require much direction and feedback- There is a crisis

– There is a crisis

 

(The Hay Group, 2015)

post

GP Forward View – improvement on the horizon or more broken promises?

In recent months, GP Leaders along with the Government have been working tirelessly to ensure that a new strategic direction for the future of Primary Care is realised. This has come in the wake of what appears to be an endless release of new or changed policies, reform, documents and promises of investment to improve the current state.

The challenge of overhauling the system to efficiently meet the increasingly co-morbid health needs of the UK population is extremely complex. Even more so when one considers that quality care and patient and staff experience are the core values driving the work-streams. Its success is dependent upon lots of diverse microsystems (GP surgeries), working collectively and cohesively in the best interests of patients, colleagues and national health. Many GPs out there do think reform is possible, despite seeming like an unsurmountable task at this stage, and of the recent literature reviewed a lot of the successes are aimed at ensuring that;

  • Primary Care is sustainable for the local populations for which they serve and that the health needs of the local population reflect what the GP surgery can offer without one size to fit all.
  • The role of the GP is one that appeals to the future medics of tomorrow, but at the same time proves attractive enough to entice back those who have left the profession.
  • GPs are given time to spend some of their professional working lives freed up from only patient facing activities so that they can provide leadership on improvement, strategy and service development.
  • Workloads don’t cripple the system that they are so desperately needed to support, by ensuring that work that can be completed by another suitably trained professional is completed by that professional. It doesn’t have to remain the role of the GP, just because ‘that is the way that it has always been done in the past’.
  • GPs are nurtured and develop the necessary skills required to be able to manage and adapt to the future landscape of an ever changing NHS.

Many GPs have their own ideas on what the root cause of the problems within primary care are, what actions are necessary so that improvement occurs and what change is required in order to ensure sustainability. ‘General Practice: Forward View’ (NHS England, 2016) is the latest document released outlining change, investment and reform. It seeks to address rising workload pressures and growing patient concerns about access.

To summarise ‘General Practice: Forward View’ focuses on improvement in the following areas:

On investment: by 2020/21 recurrent funding to increase by an estimated £2.4 billion a year, decisively growing the share of spend on general practice services, and coupled with a ‘turnaround’ package of a further £500 million. There will be investment in staff, technology, GP premises, and action will be taken concerning indemnity and growing red tape.

On workforce: attempts will be made to try to double the growth rate in GPs, through new incentives for training, recruitment, retention and return to practice. During the last 10 years there has only been a net increase of around 5,000 full time GPs, however the aim will be to achieve a further 5,000 net in just the next five years. In addition, the aim will be to recruit and train 3,000 new fully funded practice based mental health therapists, an extra 1,500 co-funded practice clinical pharmacists, and nationally funded support for practice nurses, physician assistants, practice managers and receptionists.

On workload: there will be a new practice resilience programme to support struggling practices, changes to streamline the CQC inspection regime, support for GPs suffering from burnout and stress, leadership and management development for GPs, legal limits on administrative burdens at the hospital/GP interface, and action to cut demand on general practice.

On infrastructure: there will be new rules to allow up to 100% reimbursement of premises developments, direct practice investment tech to support better online tools and appointments. Consultations and workload management systems along with better record sharing to support team work across practices.

On care redesign: there will be support for individual practices and for federations and super-partnerships. There will be direct funding for improved in hours and out of hours access, including clinical hubs and reformed urgent care; and a new voluntary contract supporting integrated primary and community health services.

This is a substantial investment and strategy for reform. It represents a significant amount of support and should add a large amount of resilience in to a system that has been under resourced for the last decade. It is aimed as a five year piece of work and within that time period it will be important that the system continues to learn and respond to changes in circumstance, national health and government.

Will this represent the solution to the complex challenge of solving the primary care system crisis?

post

GPC suggest 15 minute appointments

General Practice is under tremendous pressure, affecting GPs, patients’ and the wider health care economy. With an ageing population many patients often attend for GP consultations with multiple and complex health issues, which often results in consultation times that are no longer adequately timed to address every concern. Compounding these issues, is a rising public expectation that all appointment times must be adhered to with no delays to the patient. Patients often expect not to have to return to another consultation and would much prefer all issues addressed and corrected in one tidy, concise consultation. GPs who show visible signs of exhaustion, frustration or who are not able to achieve or manage their workloads leave themselves vulnerable to complaints, verbal abuse and, in some instances, physical assault and therefore all work must be completed with a smile on one’s face.

Introduce low recruitment and retention figures into the mix and the situation and workload imbalances really begin to become evident. Yet, given the nature of future health needs, never have primary care services been so important to the success and sustainability of the NHS. Why then, do financial resources not match the level of importance the government places on primary care? With a constant stream of promises from the government for more money and more staff, not now obviously but in years to come, it has never been as important to explore the supply, demand and capacity issues crippling many GP surgeries. We need to work smarter, more efficiently and ensure workloads are delivered in the right place, at the right time by the right and most appropriately trained healthcare professional. With government action proving too little too late, the GPC along with many GP leaders have made their own recommendations that they believe will prevent primary care from imploding upon itself.

In a bid to reduce workloads and solve the recruitment crisis, the actions suggested by the GPC, which are outlined in the ‘Urgent Prescription for General Practice Campaign’, include these key areas:

  • ‘Fair and sustainable funding and resources to reach a minimum of 11% of NHS spend to cover the work of general practice and resolve the funding deficit of around £2.5bn.
  • Reducing workload to ensure delivery of safe and high-quality care with a national standard for a maximum number of patients that GPs, nurses and other primary care professionals can reasonably deal with within a working day, and greater clarity about what work is appropriate to be delivered by practices.
  • Ensure GPs and other practice team members are enabled to routinely offer 15 minute consultations or longer where necessary for patients with greater needs such as complex or multiple morbidity.
  • An expanded and demarcated workforce, both within and around the practice so that non-essential GP work can be completed by other healthcare professionals.
  • Reducing the regulatory burden of the CQC, to prevent time and resource being taken away from service provision. Reducing bureaucracy and duplication, to empower professionals and to give more time to meet the needs of patients.
  • Reducing bureaucracy and duplication, to empower professionals and to give more time to meet the needs of patients.
  • Empowering patients to give them confidence to manage their care and to free up GPs’ time for those who need it most.
  • Infrastructure and technology to deliver practice and system resilience to ensure practices are able to deliver the services needed’.

Placing optimism to one side, it will be interesting to see what similarities, if any, there are to Jeremy Hunt’s ‘GP Roadmap’ – the rescue package for GP’s and for Primary Pare. Will this just end in another distraction, creating more tiers of bureaucracy and debate, as a result of unachievable goals or generate suggestions for improvement that just don’t quite get to the heart of the issues at hand?

More pressure is needed from GPs and other Primary Care leaders to ensure that action means action.

post

NHS 111 Chokes A+E

NHS 111 which was meant to offer help to patients and direct them away from emergency services has come under fire in recent months by both Government and Senior Clinicians, about its effectiveness at performing this function.

As the latest data released by NHS England shows, of all calls triaged by NHS 111, a staggering 12% had ambulances dispatched, while a further 8% were referred to A&E. Of note, 62% were recommended to primary care, 4% were recommended to another service and only 14% were managed directly by the service. The figures for further referral represent the highest ever recorded since the service first began in 2010.

The service is currently facing criticism on many fronts with many of its referrals being regarded as inappropriate and therefore placing unnecessary pressure on frontline services.
Is this the service, or is this a product of the system as a whole, which is widely regarded as inefficient and cost ineffective?
This criticism is also being fuelled by the fact that the majority of the workforce do not have a Nursing or Medical background, and therefore lack the necessary knowledge and skills to triage appropriately, without recourse to an automated rigid computer algorithm.

There is a growing body of evidence suggesting that many patients are being inappropriately referred on to A&E because of issues arising in primary care. For example, at the peak call times for NHS 111, there are a significant number of calls for urgent repeat prescriptions. These patients are then booked into out of hour appointment slots as the call handler cannot triage the urgency of the missing medications. This blocks OOH slots which would be better utilised by GPs assessing patients with higher medical acuity.  Instead, appointments are full and because of the risk adverse nature of the 111 service, patients are referred on to A&E.

With a public perception of lack of appointments and inadequate services in primary care, there is growing pressure on GPs to provide leadership on improvement and change within the NHS.