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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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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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GMS contract 2016/17

Here’s a summary of what the new contract recently negotiated brings.

An investment of £220 million into the GP contract for 2016/17, in recognition of rising financial pressures facing practices. The investment is designed to result in a pay uplift of 1% above expenses.

A 28% increase to the item of service fee for vaccinations and immunisations which will rise from the current £7.64 to £9.80.

For 2016/17 there will be no change to the number of QOF points available, and we have resisted introduction of any new NICE indicators or further increases to QOF thresholds. Next years negotiations will explore ending QOF in its entirety.

The Dementia Enhanced Service will end in March 2016 with the associated money transferred into core GP funding.

NHS Employers and GPC will work with NHS England and the Department of Health to ensure that appropriate and meaningful data relating to patients’ named accountable GP is made available at practice level. This data will be shared internally within practices and used to improve services for patients.

No changes to the contracted current hours or the Extended Hours Enhanced Service.

GP practices will  record data on the availability of evening and weekend opening hours for routine appointments.

NHS England suggests setting a maximum rate of pay for locum doctors, which may have some degree of regional variation.

Commitment to look at ending the Avoiding Unplanned Admissions enhanced service.

Source: BMA