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Is the NHS sleepwalking into crisis?

The number of patients waiting too long for routine operations has risen to its highest level in nearly a decade.

New NHS data shows over 400,000 people waited longer than the official 18-week target for non-urgent treatment in August, with hundreds remaining on waiting lists for more than a year.

The latest waits are the highest for a single month since 2008, while the number of patients treated within the NHS target has fallen to its lowest point since 2011.

This has caused a strain on the NHS services in the summer months which is normally seen in winter.

The raft of new NHS statistics also laid bare strains in other areas as patients faced longer waits in A&E and cancer treatment times had slipped, although bed blocking rates had improved.

To ensure the NHS is able to cope with the inevitable spike in demand during the winter period, the Government needs to urgently put in place measures to address the funding, capacity and recruitment issues facing the system as a whole.

Shadow Health Secretary Jonathan Ashworth said the “shocking” figures showed how the winter crisis had extended to the rest of the year, prompting concerns over patient wellbeing.

Earlier, Mr Hunt told GPs there was no “silver bullet” to the problems facing them, but the Government was “absolutely committed” to increasing funding and capacity.

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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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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.

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Junior Doctors’ Strike

Junior Doctors went on strike this week resulting in over 3,000 operations being cancelled nationwide.

Patients were urged to see their GPs instead of attending hospital.

NHS England said about 10,000 junior doctors had reported for duty out of 26,000 scheduled to work the day shift on Tuesday – although many of those had agreed in advance to come in to make sure emergency cover was provided and others were not members of the BMA.

The action came after the BMA and the government failed to reach agreement on a proposed new contract for junior doctors.

The BMA, which is concerned about pay for weekend working, career progression and safeguards to protect doctors from being overworked, said the strike had sent a “clear message” to the government.

However, Health Secretary Jeremy Hunt described the walkout as “completely unnecessary” and urged junior doctors to return to the negotiating table.

Officials from Acas (Conciliation service) said they would hold discussions with both sides, although government sources said they were still prepared to impose the contract if the deadlock could not be broken.

Danny Mortimer, chief executive of NHS Employers, which represents the government in contract talks, said he hoped that would not happen.

“I’m really hopeful that when the BMA return to the talks we can give junior doctors more confidence in both the pay offer that we’re putting to them, but also the improved protections we want to put in place around their safety.

“I am desperate to avoid another repeat of industrial action at the end of the month. It’s not in their interest and it’s not in the interest of patients.”

The next proposed strike is a 48-hour one beginning on 26 January.