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Flu warning may put the NHS at risk?

Hospitals have been urged to brace themselves this winter season, as other countries have struggled to cope with an outbreak of flu. Some hospitals in Australia have had to close their doors to patients as they have struggled to cope.

The NHS will have to do a great deal of work over the next 2 months to ensure everything is in place to deal with the winter ahead.

GP services will be put under pressure trying to cope with the high demand of flu vaccinations, while hospitals will have to find extra beds.

The reality is that extra funding is needed to help with the existing pressures. It would help to free up extra bed capacity in hospitals, help to recruit more doctors, nurses and care home staff during winter pressures.

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The Importance of Locums

A GP online poll in 2016 suggested that three in five GP surgeries had to rely a great deal on locums to ensure they could provide services to patients.

23% of surgeries needed locums to provide nearly a fifth of GP appointments during the last year. (The poll had 370 partners and salaried GPs)

This was an increase compared to a similar poll conducted by GPonline last year. Last year just 14% said over a fifth of appointments were conducted by locums.

Around 6% of GPs confirmed more than 40% of appointments in their practice were being covered by locums.

The GPC said the data showed the ‘serious’ impact of workforce shortages and showed the essential role of locums.

GPC sessional committee chair Dr Zoe Norris warned earlier this month that many vulnerable practices would collapse overnight if doctors were forced out of locum roles.

Around 59% of GPs said the amount of appointments filled by locums in their surgeries increased over the last year.

It is becoming apparent that the NHS needs locums with their floating coverage in order to sustain services and relieve Partners for holidays or other commitments as surgeries are too stretched to be able to provide that cover from in-house. Shouldn’t NHS England and the local CCGs do more to support this fundamental part of the workforce instead of trying to force them out?

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My Son is my Twin!

It’s been almost 20 years since Dolly the Sheep shocked the world and sparked moral debate regards cloning, but this week has been ablaze with new research findings sparking all kinds of new fanciful concepts like “parenting your non-identical twin” etc.
Earlier this year scientists in China reported they have created human embryos without the use of sperm. They took stem cells and tricked them into becoming a precursor of sperm called primordial germ cells and following this they then tricked them into becoming the next phase in sperm development called spermatids by exposing them to ordinary testicular cells and testosterone. They managed to successfully fertilise mice eggs with this artificial sperm – thus removing the need for male sperm – opening all kinds of doors for male infertility or for the fantasists – a world a without the need for men.
Earlier this week scientists from the University of Bath reported they have evidence that one day we could create babies without the need for eggs. They created mice pseudo-embryos by manipulation of unfertilised eggs and then successfully created real embryos by injecting them with sperm. They argue that pseudo-embryos are much like ordinary cells in many of their properties and their research suggests that it may be possible to achieve fertilisation of cells other than eggs one day. Now our fantasists are dreaming up a world without women.
It just got more exciting for those of you who love this stuff, as a group in China just yesterday reported they have successfully created 30 Human Embryo Clones.
All of this means there is hope on the horizon for couples with fertility problems, with the possibility of all kinds of magical combinations available, especially for same sex couples wanting to have a biological child of their own.
The question now is who will take that first step into the ethical mind storm and bring a cloned human into the world. Dolly the sheep was named after Dolly Parton, as the cloned cell was from a sheep’s udder in reference to the singer’s famous bust. What will the first human be called?

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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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GP Rebellion Quashed!

In what has been seen by many as a shock change of stance, the GPC have announced that it will not ballot their membership in relation to mass resignation. The idea was always a controversial one, but a decision that many were considering nether the less, which reflects the profession’s level of frustration with the Government and the slow pace of reform. After all, this type of threat has been used successfully in the past to lure the Government to the negotiating table, when all other attempts have failed.

In this instance, the ballot was avoided as early indications do appear to demonstrate that some headway is being achieved in relation to workloads, and the Government now appears ready to negotiate. NHS England has reportedly decided to take on board a number of suggestions from the BMA’s, Urgent Prescription for General Practice, and these will form the basis of future negotiations.
These relate to:
– Ensuring that GPs work within safe workload limits each day.
– Enabling GPs to have longer appointments, in particular for those patients with multiple and complex problems.
– Ending inappropriate workload that could be done by other services within the NHS.
– Empowering patients to better manage their own health when appropriate.
– Ending inefficient bureaucracy, such as chasing up hospital actions or re-referring patients.
– Providing GP practices with more frontline staff and facilities to meet increasing demand.

Whatever your stance concerning mass resignation, if the Government and GP leaders are successful in these negotiations then there is real potential for significant change across the Primary Care system. The system at least has a chance of becoming more efficient, especially now that more clinicians are involved in reform than ever before. Interestingly, General Practice Forward View is not being cited as having been successful in avoiding the ballot or future industrial action by the profession.

Other signs that workload inequity is beginning to reform can be seen at the hospital/general practice interface. The NHS Standard Contract now stipulates 6 requirements to be upheld, and these include:

1. Hospitals are prevented from discharging patients automatically back to their GP, if they fail to attend an outpatient appointment.
2. Hospitals are required to send discharge summaries for inpatient, day case or A&E care within 24 hours and must be standardised so that GPs can find key information in the summary more easily. This should be electronic whenever reasonably possible, and Commissioners are required to facilitate this approach to handling the summaries.
3. Hospitals are to communicate clearly and promptly with GPs following outpatient clinic attendance. If there are actions for the GP, then this needs to be communicated in a timely and achievable fashion.
4. Patients should be referred directly on to other services where reasonably possible and the Hospital should avoid re-referral back to the GP, especially for non-urgent conditions directly related to the complaint or condition which caused the original referral. Re-referral for GP approval is only required for onward referral of non-urgent, unrelated conditions.
5. Hospitals to supply patients with medication following discharge from inpatient or day case care. Medication must be supplied for the period established in local practice or protocols, but must be for a minimum of seven days (unless a shorter period is clinically necessary).
6. Hospitals to organise the different steps in a care pathway promptly and to communicate clearly with patients and GPs. This specifically includes a requirement for hospitals to notify patients of the results of clinical investigations and treatments in an appropriate and cost-effective manner, for example, telephoning the patient.

It is estimated that this reform will release up to 13.5 million appointments a year and will therefore create additional capacity to care. Additional capacity is a commodity for all Practices, and therefore one can only hope that any time that may come as a result is used wisely by GP Leaders and Practice Managers. There is no doubt that workloads do need to be addressed and there is no doubt that the Government and NHS England has its part to play. One has to consider though, that if we are to avoid freed capacity just filling up with more of the same, then frontline teams have their part to play too. “If you always do what you’ve always done, you’ll always get what you’ve always got.”
England is facing a GP shortage and so now is the time to ensure current workloads are analysed to identify what work lies only within the scope of practice of GPs and what work can be done by other professionals. There is a real opportunity to ensure that the right care is provided in the right place at the right time by the right staff. Otherwise, the only other outcome for the future will be the profession will once again resort to yet another threat of mass resignation and the cycle just continues.

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Statins and Aging

Statins are again coming under fire in the popular media with reports like “ Statins Age you Faster”.

This comes following a report published in the American Journal of Physiology  which states that statins’ “…impact on other biologic properties of stem cells provides a novel explanation for their adverse clinical effects.”

The study conducted on stem cells found that those exposed to statins changed into immune cells at lower levels than those that weren’t exposed to statins.

The authors believe that this might be beneficial to the prevention of cardiovascular disease, but could have adverse effects including advancing the “process of aging” and that “…long-term use of statins has been associated with adverse effects including myopathy, neurological side effects and an increased risk of diabetes.”

 

Is this going to make the new NICE guidelines more difficult to implement when patients shake their finger back at you at the mere suggestion they consider starting a statin?

 

Though the guidance states, and evidence is clear that there is benefit to be had for individuals with a QRISK2 of 10% or more, it’s worth looking at the NNT.

At 20% the NNT to prevent 1 cardiovascular event after 10 years of statin is 14. At 10% you need to treat 25 people for 10 years to prevent that 1 event.

 

It’s worth remembering that an estimated 80% of men over 50y and 55% of women over 60y have a 10y CVD risk over 10%.

 

So, if you’re in the mood to convince the patient with a QRISK2 of 10% in favour of statins, you may quote a 40% reduction in Cardiovascular Events over 10 years ( remember this is relative risk reduction). Or, if you can’t face a battle, you may agree with the patient and quote the NNT, so that of course your patient is making an informed decision.

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Should we recommend e-cigs as an aid to quitting smoking?

There has been a lot of discussion on e-cigs and “Vaping” since it first appeared in 2007. Hailed as a safer alternative to smoking traditional cigarettes, or a means to quitting – but how safe are e-cigs?

Public Health England (PHE) has concluded that, on “the best estimate so far”, e-cigarettes are about 95% less harmful than tobacco cigarettes and could one day be dispensed as a licensed medicine in an alternative to anti-smoking products such as patches.

Prof Kevin Fenton, director of health and wellbeing at PHE has said in a statement: “E-cigarettes are significantly less harmful than smoking. One in two lifelong smokers dies from their addiction. All of the evidence suggests that the health risks posed by e-cigarettes are small by comparison,”

But common sense suggests we need more research into the long term effects of e-cigs, particularly as the tobacco companies fight for their share in this new market with new flavours and more sophisticated delivery systems. ( Yes – most e-gigs are produced and marketed by the big tobacco companies. ) Wasn’t traditional tobacco once thought to be safe until decades of smoking revealed the long-term health hazards?

The American FDA analyzed samples of two popular brands of e-cigarette and found traces of toxic chemicals including known carcinogens.

A study conducted by researchers from the University of Southern California found that the vapour produced by a popular brand of e-cigarette contained levels of certain toxic metals far greater than those found in the smoke of traditional cigarettes.

So perhaps its worth pointing out the “unknowns” before recommending your patients make the switch to e-cigs as a safer option to smoking. Although, it’s worth considering them as an aid to quitting smoking, with the aim of only targeted short term use, as PHE recommend.

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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?

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Why is it hard to get a Locum GP?

Getting a locum to cover a shift can be hard work these days. Getting out your list, going down it one by one can be time consuming, and cost the surgery money.

An alternative to this is using recruitment agencies, but it has been known that recruitment agencies charge 30% on average which has cost nearly 2bn last year alone.

Recruitment Agencies also underpay the locum doctors and prevent them getting there NHS Pensions.

Another way of getting locums is by using Chambers sites, but Chambers charge a fee to the locums to join or charge a percentage of their wage, which mean less money for the locums.

This is where DealDirectLocums.com can help.

DealDirectLocums.com allows surgeries to take control of the locum hiring process by allowing the surgery to:

  • Control the level of pay the locum gets (It is not dictated by an agency or the locum).
  • Advertising the hours required (not being told to commit to a day shift when you only need them for a morning).
  • Advertise way in advance – which increases the chance of a successful placement.
  • Look at the Locums Profile and Essential Documents before booking the Locum Doctor.

It is also a lot cheaper to book a locum because you pay the locum directly and our fee is only £5 per Shift successfully booked.

For More information, please go to dealdirectlocums.com