GP SERVICES/OUT OF HOURS/111
GPs offered cash to refer fewer people to hospital (The Guardian, 28 February 2018)
GPs are being offered cash payments not to refer patients to hospital, in a move which leading family doctors have criticised as ethically questionable and a risk to health.
NHS bodies in four parts of England are using schemes under which GP practices are given up to half of the money saved by sending fewer patients to hospital for tests and treatment
The disclosure by the GP website Pulse about the controversial “profit share” initiatives operated by the four NHS clinical commissioning groups (CCGs) has triggered a row.
Critics said the schemes were the latest example of NHS bodies increasingly resorting to the rationing of care to help them operate within their budgets.
NHS Coastal West Sussex CCG has offered to give groups of practices working together in its area 50% of savings made from GPs referring fewer patients for dermatology care, ear, nose and throat treatment in the community, and minor surgery and wound closure.
Helen Stokes-Lampard, chair of the Royal College of GPs, said: “Cash incentives based on how many referrals GPs make have no place in the NHS, and frankly it is insulting to suggest otherwise.” Family doctors did need help to ensure they were refer the right patients but that should not involve “ethically questionable initiatives that prioritise cash savings over patient care”, she said.
Peter Swinyard, chair of the Family Doctor Association, said: “From a patient perspective it means GPs are paid to not look after them. It’s a serious dereliction of duty, influenced by CCGs trying to balance their books.”
England’s 207 CCGs hold the budget for the NHS locally and decide which services are provided for patients. NHS West Leicestershire, which is offering federations of GP surgeries 30% of savings resulting from fewer “first referrals”, said the scheme was designed to cut the number of “clinically unwarranted and unnecessary referrals, particularly into secondary care” and would let hospitals treat the most needy cases. ...read more
Satisfaction with GPs at lowest level for 30 years, survey finds (The Guardian, 28 February 2018)
Public satisfaction with GP services has fallen to the lowest level in 30 years and dissatisfaction with the NHS overall has reached its highest level for a decade, according to authoritative polling.
Voters are increasingly concerned about staff shortages in the NHS, long waits to receive care and the amount of money given to health services. The research findings are from the latest British Social Attitudes (BSA) survey into people’s opinions about the NHS, collected by the National Centre for Social Research.
Only 65% of the representative sample of 3,004 people in England, Scotland and Wales questioned last autumn were satisfied with GP services, the lowest percentage since records began in 1983. That is sharply down on the 80% satisfaction rating seen as recently as 2009. Satisfaction fell by 7% between 2016 and 2017 alone in what experts said reflected public frustration at the increasing difficulty in getting a timely GP appointment.
Ruth Robertson, a fellow at the King’s Fund health thinktank, which analysed the BSA findings alongside the Nuffield Trust, said they threatened general practice’s longstanding international reputation as “the jewel in the crown of the NHS”. “The data sends out an unmistakeable message that general practice is in decline,” she said. The fall in satisfaction was seen across all age groups. ...read more
Nearly 15,000 patients affected as CCG considers closing three practices (Pulse today, 15 February 2018)
Some 14,700 patients face the risk of being displaced as a CCG in the Midlands considers the future of three practices.
The practices are all operated under APMS contracts due to expire in March next year, with NHS Sandwell and West Birmingham CCG consulting on their future.
The affected practices are the Malling Health centres in Sandwell and Great Bridge,West Bromwich, both run by Malling Health Ltd, and the Summerfield Primary Care Centre in Birmingham, run by Virgin Care.
Regarding the Malling Health centres, the CCG consultation document said that neighbouring practices ‘may be able to accommodate new patients’ but added that ‘there would potentially be additional pressure on other local practices by registering new patients’.
The CCG consultation document also said that new housing developments, which will mean 1,800 additional households, will increase pressure on primary care. ...read more
Despite pressure, £45m online GP service does not have the desired effect. (National Health Executive: 23 November 2017)
Plans to introduce an online consultation system for GPs may not fix workload and waiting time issues in the way the government is hoping, it has been argued.
Research, funded by the National Institute for Health Research (NIHR), has suggested there is not enough evidence to say the system will have a positive impact, despite NHS England offering a £45m fund to encourage practitioners to adopt the service.
‘eConsult’ was piloted in 36 GP practices in Bristol, North Somerset and South Gloucestershire, but research by the University of Bristol found that it was only being used by two in every 1,000 patients.
A total of 38% of the online consultations led to a face-to-face contact, with another 32% leading to a phone consultation.
The company has confirmed that it will take this research into account to improve its services...see more
Pressure and cash concerns rise as GP numbers drop by 1000 over the last year. (National Health Executive: 21 November 2017)
GP numbers have fallen by around 1,200 in the last year despite the government’s pledge in 2015 to bring in another 5,000 practitioners.
Official figures from NHS Digital show a 3.5% fall since September 2016 – from 34,495 full-time equivalent GPs to 33,302 in September this year.
High pressure and low funding to the health sector are being blamed for the drop, as concerns rise among fears a fifth of GPs could leave after Brexit.
NHS Digital also warns this overall figure is artificially inflated by changes in how numbers are reported which saw the figure increase by 300.
Professor Helen Stokes-Lampard, chair of the Royal College of GPs (RCGP), said staff were “gravely concerned” by the numbers and were desperate for progress to be made.
“We understand that change takes time, but we desperately need more family doctors, and we need them sooner rather than later,” she commented...see more
Landmark study links Tory austerity to 120,000 deaths (The Independent: 16 November 2017)
The Conservatives have been accused of “economic murder” for austerity policies which a new study suggests have caused 120,000 deaths.
The paper found that there were 45,000 more deaths in the first four years of Tory-led efficiencies than would have been expected if funding had stayed at pre-election levels.
On this trajectory that could rise to nearly 200,000 excess deaths by the end of 2020, even with the extra funding that has been earmarked for public sector services this year.
Real terms funding for health and social care fell under the Conservative-led Coalition Government in 2010, and the researchers conclude this “may have produced” the substantial increase in deaths....read more
Smartphone GP service 'risks luring doctors from frontline practice' (The Guardian: 6 November 2017)
GP leaders have raised concerns about the first NHS smartphone virtual GP service.
Millions of NHS patients who live or work in various locations in London can sign up to the service offering a GP consultation via a smartphone 24 hours a day.
But the Royal College of GPs said that while the scheme might be seen as a golden ticket for some patients, others are not eligible for it.
The GP at Hand service – created with the technology company Babylon Health – offers a booking system through a smartphone app, with the promise of a video consultation within two hours of booking.
If a patient needs a face-to-face appointment, he or she must travel to a clinic in a commuter hub.
Commenting on the launch of the project, Prof Helen Stokes-Lampard, chair of the Royal College of GPs, said: “Technology can achieve wonderful things when used properly, but we are really worried that schemes like this are creating a twin-track approach to NHS general practice and that patients are being ‘cherry-picked’, which could actually increase the pressures on traditional GPs based in the community....read more
NHS straining at the seams year before 70th birthday, finds regulator (The Guardian: 10 October 2017)
The NHS is in danger of a sharp decline in its services around its 70th birthday next year, with the risk of the quality of care becoming precarious, the health service’s regulator has warned.
The Care Quality Commission said staff shortages, rising demand and increasing numbers of patients with preventable illnesses meant services were straining at the seams.
An increase in the number of older people who are frail, many with dementia and have multiple long-term conditions, was placing unprecedented pressure on the system, it added.
Examples of pressure in the system include the fact 2.5 million people spent longer than four hours in A&E in 2016-17, up from 1.8 million the previous year. Hospital bed occupancy reached record levels of 91.4% this year.
Behan said the NHS was in need of modernisation and it had been created almost 70 years ago when the big issues were diseases such as TB and polio.
“Today, the NHS and social care are dealing with obesity, diabetes, coronary heart disease, cancers, dementia. All of which are driven less by those diseases of the middle of the last century and more by lifestyle choices.”
He continued: “We are living longer but are not living healthier so I think what we are signalling is that the system now and into the future has got to deal with those increased numbers of older people who are going to have more than one condition.”....read more
GP appointment waiting times 'risk to patient safety', warns RCGP (Pulse: 24 July 2017)
Patients across England face waiting longer than a week for a GP or practice nurse appointment on more than 100 million occasions by 2022, according to new analysis from the RCGP.
The figures, from the GP Patient Survey, reveal that if current trends continue, the number of instances when patients will have to wait a week or more to see a GP or practice nurse will jump from 80 million in 2016/17 to 102 million in 2021/22.
The analysis comes after Pulse has revealed that the average wait for a GP appointment is around 13 days, despite measures introduced by the NHS to alleviate pressures on general practice.
The RCGP points out that the situation across England is patchy, with patients in some areas facing long waiting times even to see a practice nurse.
In 21 CCG areas, covering 5.6 million patients, waiting times for an appointment with a GP or practice nurse are at least a week for more than a quarter of the time, the figures reveal.
Some of the worst areas to secure a GP appointment include Corby (36%), Fareham and Gosport (34%), Swindon (31%) and Central London (Westminster) (31%) where currently more than three in 10 patients wait a week or more for an appointment with their GP or practice nurse.
Even in places where access is better there are still thousands of patients waiting a week or more for an appointment, says the RCGP. In Bradford City, for example, where access to general practice is best, one in 10 patients (9%) still has to wait a week or more.
The RCGP warns that if the situation does not improve there is a genuine risk to patient safety. It is now calling on the Government once again to deliver on the pledges made in NHS England’s GP Forward View as a matter of urgency, to ensure that patients get the timely, quality care they need, when they need it....read more
General practice is being ground down so that private providers can take over (The Guardian: 24 July 2017)
“A GP, eh? Well I guess there are worse things you could do.”
That was the only careers advice I got in my final year at medical school.
The Royal College of General Practitioners (RCGP) has previously raised awareness of bad mouthing of GPs during medical school training.
The college highlighted the fact that many consultants teaching in medical schools talk about general practice as a second-rate career option to hospital medicine and that this is one of the reasons we are short of GPs.
I’ve no doubt that bad press does nothing to improve recruitment to our ranks, but the pressures on the family doctor service, which has led to the closure of dozens of practices across the country, has also played its part in making general practice less attractive to medical graduates.
GP surgeries are not part of the NHS in the way hospitals are. Most surgeries are still small businesses. In most cases the doctors own or rent their premises, they employ and pay their own staff and have all the usual responsibilities of running a business in addition to their work as doctors.
What many patients do not realise is how much general practice is being squeezed at both ends at the moment. Income for general practice is falling in real terms year-on-year, while the costs of running a practice are spiralling out of control.
Furthermore, 90% of all patient contacts in the NHS occur in general practice and in 2017-18 we were predicted to receive 7.29% of the NHS budget – general practice is exceptionally good value for taxpayers’ money. The RCGP is currently campaigning for general practice to receive 11% of the NHS budget....read more
Outstanding trust extends overnight urgent care closures (HSJ: 26 June 2017)
A foundation trust rated outstanding has extended the temporary overnight closure of its urgent care centres for a further three months.
Northumbria Healthcare Foundation Trust announced last week it was going to extend the temporary arrangements to maintain nursing levels at its specialist emergency care hospital.
The trust said in November the opening hours of the centres at Hexham, North Tyneside and Wansbeck general hospitals would reduce from 24 to 16 hours from December.
The trust said at the time the 8am to midnight opening hours are part of its winter resilience planning so highly trained nursing staff could move to its Cramlington site, where there has been a surge in demand.
The trust said the temporary arrangements were extended from March to June and have now been extended again through to September.
It said it would be “inappropriate” to deploy staff back to the three urgent care centres because demand continued to be very high at Cramlington, while overnight urgent care attendances were low.
But the trust stressed it was still a temporary measure, despite now being extended for six months beyond initial plans.... read more
Deer Park Medical Centre: Campaigners to fight on after closure (BBC: 24 March 2017)
Campaigners have said they will fight to reopen an Oxfordshire doctor's surgery forced to close.
Witney's Deer Park practice will close later, leaving 4,000 people to look for new doctors. Oxfordshire Clinical Commissioning Group said it had not found a new provider to run the practice after its contract with Virgin Care ended.
Health secretary Jeremy Hunt ruled it would not be safe to keep it open with no provider in place.
Campaigner Yvonne De Burgo said: "We intend to fight on, to get it back open and running as good as it was before, either with Virgin Care or not.
"We have all had to go elsewhere and we haven't wanted to, and we are not getting as good a service as at Deer Park.
"That's not the fault of the other practices, they are just overwhelmed, they could only barely cope before."
Witney MP Robert Courts had said the "vital community asset" needed to stay open.
The decision to shut the practice has been referred to an independent reconfiguration panel, but it is not due to report back until 11 April....read more
Don’t blame GPs for NHS crisis. Blame chronic cuts to social care (The Guardian: 21 February 2017)
The ongoing A&E crisis has shifted attention on to GPs. We are being blamed for being less accessible (with appointments hard to get or surgeries not being open for long enough), while A&E is open 24/7 and therefore faces unchecked demand.
But this makes little sense. You only need to take a walk through an A&E department to see why: long trolley queues in corridors and acute admission units exist because of cuts in bed numbers and delayed discharges from a shortfall in social care. These are not patients who can be seen in GP surgeries and sent home on a prescription.
Last year there were about 23m A&E attendances in England of which 65% were at major A&E departments – an increase of 2.2% when compared to 2014-15.Although the number of patients attending A&E is continuing to rise (an average of 1,400 more per day than last year), as a percentage of total hospital patients, admission rates were roughly the same last year (20.2%) as in 2009-10 (21.8%)...Read More
LMCs stepping up plans for GPs to do more private work by end of this year (Pulse: 24 January 2017)
GPs leaders in England are pushing ahead with plans to develop new structures that will enable GPs to carry out more private work in a bid to increase GP funding, Pulse has learnt.
The chair of Oxfordshire LMC told Pulse that they have been in discussions with LMCs across England about implementing new structures by the end of the year that will allow GPs to charge fees for carrying out non-contractual work.
Current rules prevent GPs from charging their own patients for care, but Oxfordshire LMC chair Dr Prit Buttar said they have developed models using third-party companies that would ’allow practices to take on what they want’.
The LMC said last year it was developing a ‘Plan B’ to take GPs out of the NHS, following the lead of Northern Ireland, where the GPC is set to vote on collecting practice resignations later this month.
It was, in part, a response to the UK GPC abandoning plans to ballot practices on mass resignation from the NHS, after receiving reassurances from NHS England that it was willing to consider the GPC’s proposals to alleviate pressures on GPs.
Dr Buttar told Pulse that the plans for GPs to provide more private services at the expense of NHS work have moved forward, and he expected to have a model for alternative working in place by the end of 2017....read more
Seventh practice in under two years set to close in English city (Pulse: 18 January 2017)
Yet another GP practice has closed in Brighton, bringing the total number of closures up to seven in less than two years, covering more than 30,000 patients.
Some 2,300 patients have been left with instructions to temporarily rely on a local walk-in centre after the GP principal at single-handed Lewes Road Surgery handed back their contract.
It follows four practices in the city closing last year, while two more closed in 2015 - with one GP partner telling Pulse it was 'like a bereavement'.
Local leaders said that it is creating further pressure in an area that already has 'significant capacity problems'.
It further admitted that it was likely patients may have to register elsewhere by the end of this month to 'guarantee' their 'ongoing care'....read more
NHS spends millions on private companies that block GP referrals, investigation finds (The Independent: 4 January 2017)
The NHS is spending millions on private companies that stop GPs referring patients to hospitals, an investigation has revealed.
Controversial "referral management centres" are supposed to cut costs and improve the quality of GP referrals – but three quarters of NHS bodies that told the British Medical Journal (BMJ) they used the schemes could not say whether they had saved money overall.
At least £57m has been paid out to them since April 2013, according to the 69 per cent of Clinical Commissioning Groups (CCGs) using the schemes which gave details of their operating costs.
Doctors expressed concern that paying third parties to screen GP referrals – around a third of which are run by private companies – was of questionable effectiveness.
“[CCGs] are leaping at these schemes without any clear evidence of benefit and that they’re just hopeful that it might reduce their costs,” Dr Richard Vautrey told the journal....read more