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Farmer’s Tan

As a nation we love to talk about the weather and in my experience we do so often. It can be a way of starting a conversation with a stranger or a way of breaking an uncomfortable silence with a friend, family member or loved one.
We can’t even escape it if we pick up a newspaper or switch on the television and radio to listen to the news. It can unite us and it can divide us. In fact, so significant is the impact that the weather is having on people that it is no wonder it features regularly as a topical item for discussion.
In relation to healthcare, most professionals dread the winter months, as during this period our elderly and most vulnerable are at the greatest risk from the extremes of the weather.
Primary and secondary care nearly buckles under the weight of unprecedented demand year after year and each winter takes longer and longer to recover from.
Indeed, many who work in healthcare are already bracing themselves for this year’s winter onslaught.
There is already panic spreading into every boardroom of every Hospital and CCG across England, as the sudden realisation dawns upon us that all of the winter pressure wards are still open from last year, so where will we put our patients?
But it isn’t just the cold that we need to concern ourselves with. This year has seen severe snow, lots of rain, flooding and not enough sunshine.
The lack of sunshine becomes even more problematic, especially if we consider sunshine in relation to Vitamin D. Small amounts of Vitamin D can be obtained from food such as oily fish, eggs and fortified cereals, but mostly it is synthesized by the body through exposure to sunshine.
Vitamin D deficiency can lead to bone and muscle problems – yet another impact of the unpredictable weather patterns here in England.
The question therefore is, “should everybody in England be on Vitamin D supplements at certain times of the year?” Previous advice suggested this should be the case, particularly for pregnant women, people who are not exposed to the sun regularly and ethnic minority groups with dark skin.
New guidelines from Public Health England extend this advice to cover everybody in the UK during autumn and winter months.
The advice from Public Health England is supported by research carried out by the University of Manchester and Salford Royal Hospitals.
In a study of white children aged 12-15 it was found that 16% of those involved had lower than required levels of Vitamin D in their blood by the end of the summer period. This study focused on one season of the year and when it was extended to cover all four seasons, the study concluded that 75% of those involved failed to reach the level it should be by the end of winter.
As such, future studies are now underway focusing on people aged 65-84. The impact of poor muscle and bone health will be another significant health concern and financial headache for the NHS in the future, especially with an ageing population.
If 1 in 5 of the population will not get the necessary Vitamin D from the sun that is required to prevent bone disease, then action must be taken.
Regardless of how impractical or undesirable it is, the only course of action is to consider supplementation for all. At first glance, this may seem like yet another thing for GPs to do in their already busy day. But, if Vitamin D was prescribed to all during autumn and winter then these recommendations have the potential to alleviate some pressure on services, at the very least by avoiding the need to refer patients for screening for Vitamin D deficiency.

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Compensation Nation

Medical indemnity and the fees that some GPs have to pay, is once again hitting the general practice arena, but this time the news is of a more positive note. Hope is on the horizon, and the first signs are now visible that ‘General Practice Forward View’ will soon begin to make a difference for those being hit hardest by the dramatic fee hikes. ‘Forward View’ promises large scale reform of some of the more inefficient, outdated and unfair working conditions facing today’s modern profession. It has recently been announced that with immediate effect NHS England will release £60million of funding, over a 2 year period, to Practices across the country in an effort to combat spiralling costs associated to indemnity fees.

In recent years fees have risen dramatically, as a result of an ever increasing number of claims being made against the profession. When claims have been successful, in some instances, the awards paid have been relatively staggering in their amounts. Ironically this comes at a time when quality and safety has never rated so highly amongst patients in relation to their service. With an upward trend in claims being made and the ‘compensation’ culture affecting the whole of the NHS, the situation looks set only to worsen.

Conservative estimations place fee rises during the last twelve months at 26%, which has affected 90% of all GPs. Clearly this isn’t sustainable for the workforce and it is also affecting where GPs choose to work. The greatest risks and therefore the greatest costs are associated to locum, urgent care and out of hours work. It’s often much cheaper for GPs to work part-time, which at a time when GP workloads are at saturation point is a major cause for concern. We need our GP workforce to work more sessions, not less. We should be incentivising the profession to give more and reap the rewards of their hard work and dedication. We shouldn’t be forcing GPs to work in other areas of the UK where it is more affordable to work because litigation claims, and the amounts paid out for successful claims are significantly lower than in England.

In the latest news it has been revealed that the additional money will be shared out according to the list size of individual Practices, and this will not be influenced by the current indemnity fees of the GPs working there. In the process that will no doubt follow this news, one can only hope that this additional funding filters through to the Locum workforce, to ensure equity to all of the profession. Locums can be the life line for many Practices across England, but often face some of the dramatic charges reported within the media.

It is too early to assess how much of a difference this cash injection will make in the pockets of GPs. £60million may not even scratch the surface, with some in the profession speculating that by just throwing money at the problem this may only prove to worsen the current situation in the future. NHS England and the Government need to take steps towards standardising and legitimising the amounts paid out by the MDU and MPS, if the ‘blame and claim’ culture is truly to be overcome. The rising and unrealistic expectations of the general public need to be addressed, especially when resource and funding fall short in attempts to meet demand.

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GP Indemnity Rises by 25%

It has been reported that GP indemnity costs have gone up by 25% in just one year according to a Pulse Today report.

The survey carried out in August reported that the annual fee for a GP doing 10 sessions a week had gone up to £11,320 in 2015, as member annual cost per session rose from £869 to £1,132 in the last 12 months.

This has concerned many people in the profession because it has been reported in a survey by Urgent Health that a high percentage of GPs are limiting the amount of Out of Hours shifts they do because the cover is too expensive.

With this said, Private sector firms are stepping in and claiming that they can reduce the cost of the insurance by up to 75%, but this may come at a risk of not being fully covered according to Pulse.

The Medical Defence Organisations have ensured GPs that they remain Not-for-profit, and will support GPs with any claims that arise, even if the GP is retired or ceased practice years before.

This poses a question which every GP must ask – Do they keep paying the increased  fees from the MDO or do they shop around for cheaper indemnity that might not cover them for all possibilities?