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'.

NHS England said in a letter to patients that Lewes Road Surgery principal Dr Amrut Shah was 'stepping down with immediate effect' following 'discussions over Christmas'.

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


GP practices allocated 4% funding boost every year until 2021 (Pulse: 17 December 2015)

The Government will give general practice a funding boost of at least 4% every year over the next five years to cover the ‘changes in GP workload’, and will update the formula used to allocate funding to individual practices, NHS England has announced.

In a statement today, NHS England said that the the budget for general practice will increase by 4.2% next year, to £7.65bn.

The funding increases for general practice will be ‘disproportionately higher’ than for other services.

It has also announced that it is updating the formula used to allocate funding to practices, because of changes to the GP workload since the current Carr Hill formula was developed a decade ago...read more


Lowestoft will not get any new GP surgeries to replace two which have closed (Lowestoft Journal: 12 November 2015)

New GP surgeries to replace two closed in Lowestoft by a health watchdog have been ruled out if the practices are shut permanently. HealthEast – the clinical commissioning group (CCG) for Great Yarmouth and Waveney, which is responsible for healthcare services in the area – released an online questionnaire giving the 5,000 patients affected at the Marine Parade Surgery and Oulton Medical Centre three options for the long-term resolution to the closure.

But it ruled two of those options out, saying that negotiating a service for patients with new and existing providers would take between nine months and a year – even though the chairman of Oulton Medical Centre patient participation group (PPG) said retaining services at that site would be their preferred option.

The CCG also ruled out sending a letter to all patients at the two surgeries telling them to register with another GP, saying: “It would mean GP practices could not plan the services effectively as they would not know how many patients wanted to register.”

That means the only option left is for the CCG to work with the neighbouring Bridge Road and Victoria Road surgeries – which are
currently offering temporary care 
to patients affected by the closures
– to see whether they would have
capacity to look after them long term.

HealthEast aims to make a decision by December and implement it afterwards – but it is still unclear whether the two surgeries will remain permanently closed, should the owners overturn the decision in an appeal...read more



NHS 111 scandal: 25 deaths blamed on ambulance delays (The Telegraph: 30 October 2015)

The Telegraph published an exclusive report on an investigation of 25 patient deaths following a whistleblower's revelation that a policy of 111 managers resulted in delayed help for seriously ill patients.

Senior managers at South East Coast Ambulance trust were warned repeatedly that their “rogue operation” was risking lives, yet the secret policy was allowed to continue, the Telegraph's source said. Documents seen by The Telegraph show how the consequences of the unauthorised policy of deliberately delaying ambulances to thousands of patients suffering from potentially fatal conditions were covered up.

Under NHS rules, calls designated as “life-threatening” are supposed to receive an ambulance response within eight minutes regardless of whether the caller dials 999 or the non-emergency 111 line. But the ambulance trust, which covers Sussex, Kent, Surrey and North East Hampshire, “unilaterally” invented its own system resulting in the routine downgrading of 111 calls, giving paramedics an extra 10 minutes to attend.

Under the secret protocols, for more than two months, thousands of 111 callers were forced to wait up to twice as long, effectively punishing patients for calling the non-emergency number.

Health watchdogs are investigating the trust to uncover how many patients may have been harmed by the delays between last December and February.

This newspaper has established that an NHS investigation was told of 25 deaths of patients whose ambulance response was believed to have been delayed under the policy. Since then there has been a dispute about how many deaths occurred among patients who were treated under the policy.

They include the case of a Sussex man aged 60, whose call was downgraded in January despite the fact he suffered clear signs of a cardiac arrest while on the phone to 111 call handlers. The man, from Horsham, died soon after paramedics finally arrived, 39 minutes after the call was made.

The trust said its own investigation did not find that the protocol had a negative impact on patients.

The Telegraph found that 111 call-handlers had no idea that when they ordered an ambulance to be dispatched for “life-threatening” conditions, calls were being delayed by up to 10 minutes. Documents reveal that as concern grew among senior NHS managers, official reports were doctored in an attempt to ensure the unauthorised policies remained secret.

The trust has refused to say who introduced the policy and whether any managers have been disciplined.

A trust senior manager, who spoke on condition of anonymity, said he warned the trust’s chief executive, Paul Sutton, in January that the policy – which aimed to relieve pressures by reducing the number of ambulances sent out – was too risky.

In early February, Mr Sutton and other senior managers were sent a series of emails from senior staff outlining concerns. But it was not until the NHS manager anonymously contacted health officials at nearby commissioning groups warning them of several deaths that the trust was ordered to abandon the policy.

The manager said: “They were warned again and again about the risks this was posing to patients.”

A trust spokesman said: “We will now work closely with Monitor as they undertake the reviews outlined in their recent media announcement and therefore do not feel that it is appropriate to comment further on specific points at present.”

The spokesman queried the suggestion that 25 people had died as a result of the policy. He said: “Our investigation and our own internal processes to date have not found that the process impacted negatively on patients.”


South East Coast Ambulance 'failure' over NHS 111 calls (BBC England: 30 October 2015)

An NHS ambulance trust is being investigated after it dodged national response targets to gain more time to assess some seriously ill patients. 

In a pilot project, South East Coast Ambulance delayed sending help for certain 111 calls and transferred them to the 999 system, thus gaining an additional 10 minutes to respond. 

Health regulator Monitor said it had not fully considered patient safety. 

The trust has defended the project but acknowledged the "serious findings". 

South East Coast Ambulance Service NHS Foundation Trust (Seacamb) covers Kent, Surrey, Sussex, Brighton and North East Hampshire. 

As part of the pilot from December 2014 to February, the trust transferred some calls between systems to re-assess what type of advice or treatment patients needed and whether an ambulance was really required...read more


NHS at risk from “explosion” in number of ageing patients with multiple illnesses (The Mirror: 1 October 2015)

Rubbishing David Cameron’s plan for a seven-day health service, Britain’s top GP says primary care funding has fallen to dangerous levels. 

The NHS faces an “explosion” of one million extra patients living with multiple life-threatening conditions, warns Britain’s top GP.

Maureen Baker, chair of the Royal College of GPs, says the health service is already “struggling” with an estimated six million over-60s who have several complaints such as cancer, diabetes and heart disease.

She predicts there will be another million by 2025 and accused the Government of allowing funding of primary care to fall to “dangerous” levels.

The RCGP says 90% of all patient contact with the NHS is in general practice but it gets just 8.33% of the budget.

Dr Baker wants chancellor George Osborne to ensure primary care gets 11% of the overall NHS budget, 10,000 more GPs and “an immediate injection of £750 million of additional core funding in the next financial year”.

Describing the growing number of people with more than one serious illness, Dr Baker says: “They might be living into their 70s, 80s, and beyond, and would almost certainly be coping with one, two, three or more long-term conditions.

“It is a great testament to modern medicine that nowadays we are much more likely to prevent or treat diseases that in the past killed people so early in their lives.

“But this success has brought with it a whole new set of challenges to which the NHS is currently struggling to respond.”

David Cameron has pledged seven-day GP services by 2020. But Dr Baker says he is “living in cloud cuckoo land” and his plans were a “recipe for disaster” given the lack of investment in GPs.

She warns: “If you don’t shore up existing GP care, not only will you not get a seven-day service, but you won’t have a five-day service either.”


Two-thirds of GPs say long waits ‘biggest barrier’ to treatments for mental illness (Pulse: 23 September 2015)

Two-thirds of GPs say long waiting times for psychological therapy are preventing patients getting treatment for common mental health problems, a survey has revealed.

The findings suggest GPs are struggling to offer the most appropriate therapy because of lack of access to services – in stark contrast to recent claims by Prime Minister David Cameron that GPs were failing to treat patients or offer them ‘increasingly available’ cognitive behavioural therapy.

The survey of 1,000 GPs in England showed that 66% see waiting times for psychological therapy as the ‘biggest barrier to treatment’.

The research – commissioned by a provider of online mental health therapy services for the NHS – also included focus group discussions, in which GPs reported that longer waiting times for talking therapies would make them more inclined to prescribe antidepressants as a stop-gap. The report also highlighted that 37% of patients referred for Improving Access to Psychological Therapies (IAPT) services did not enter treatment in 2013/14, while 11% – around 76,000 – waited 90 days or longer to be seen.


Overloaded London GPs cannot cope, warns report (The Guardian: 12 September 2015)

GP surgeries in London are at “saturation point” and cannot provide any more care to patients, family doctors’ leaders in the capital have warned in a dossier of evidence sent to MPs. Representatives of 7,000 GPs at 1,300 practices claim they cannot cope with existing demand and that the situation will get worse as London’s population soars to 9.2 million by 2020. Cuts to health visiting, community nursing, mental health and other services have turned surgeries into places where patients with nowhere else to go turn up but experience “a revolving door of consultations”, they say.

This stark depiction of overloaded practices is contained in a submission to the House of Commons health select committee’s new inquiry into the growing pressures on family doctors and primary care. It has been made by Londonwide Local Medical Committees, an umbrella group for the statutory bodies that represent GPs in 27 of the 32 boroughs.

Despite GPs’ efforts to meet rising demand for appointments, “the reality is that the saturation point has been hit even by the most competently working practices in London. General practice in London is beset by blockages in flow, diverting staff from consulting, co-ordinating or planning care, and both reducing access to patients and demotivating professionals,” the submission said. Family doctors are “stressed and depressed” trying to maintain the quality of care they provide in the face of “unprecedented rises in patient demand”, caused by an ageing and growing, and increasingly unwell population.

“It’s reckless and shortsighted to stop providing support services in the community such as health visitors, mental health services and social services because they get overwhelmed and telltale signs of illness get missed,” said Dr Michelle Drage, chief executive of Londonwide LMCs. “That leads to GPs having more consultations, less time with patients, and patients waiting longer for appointments. Everybody gets a worse deal.Too many GPs and practice nurses in London are running on empty trying to manage these rises in demand.”


GP surgery in Gloucestershire closes after 67 years due to no doctors to run it (Gloucester Citizen: 29 July 2015)

The Stroud GP practice St Luke's is to close after 67 years providing health care in the town.

Now St Luke's 4,000 patients will have to find a new GP. The closure of the practice on Cainscross Road also means an end to the provision of anthroposophic medicine, within the NHS in Stroud, a system of healthcare based on the philosophy of Rudolf Steiner.

St Luke's notified NHS England six months ago of the forthcoming retirement of two GP partners at the practice and since then attempts to recruit replacements have been unsuccessful.

St Luke's will now close from September 30.


Private NHS contractor 'boots out patients before finishing treatment to meet targets' (Mirror: 21 July 2015)

A private firm running NHS services is allegedly discharging patients before they have been treated to avoid breaching guidelines.

An undercover probe into Care UK , Britain’s biggest provider of out-of-hours services, has revealed patients are put at “huge risk”.

Healthcare providers face fines for missing the national four-hour target for all emergency departments to conclude 95% of cases.

But covert footage has suggested doctors are discharging patients when they near the limit.

They continue to receive treatment later on, but off the books.

Suzanne Mason, professor of Emergency medicine at the University of Sheffield, said: “By discharging somebody off your system before they’ve left the department, there’s a huge risk something could happen to that patient.”


Jeremy Hunt denies coalition created shortage of GPs (The Guardian: 19 June 2015)

The health secretary Jeremy Hunt will unveil his “new deal” for GPs promising a package of measures designed to ease their workload and make the profession more attractive to young doctors starting their medical careers.

He will pledge on Friday to ensure the recruitment of 1,000 “physician associates” into GP practices by 2020. They have less medical training than doctors, but help them to diagnose and manage patients and also relieve their administrative burden.

They will be among 5,000 extra clinical staff Hunt will say he wants England’s 8,500 surgeries to hire over the next few years to enable the NHS to help primary care services cope with the increasing challenge posed by an ageing population.


Andrew Gwynne, the shadow health minister, said: “David Cameron’s fingerprints are all over the Tory GP crisis. He made it harder to see a GP, scrapping the right to an appointment in 48 hours and cutting the scheme for evening and weekend opening. And he has created a GP workforce crisis by training fewer GPs and sending morale plummeting to rock-bottom.”


Thousands of patients forced to hunt for a new GP as staffing shortages accelerate practice closures (The Independent: 1 June 2015)

Thousands of patients have had to find a new GP because their local practice has closed, as staffing shortages and workload pressures take their toll on surgeries, new figures show.

In England, Scotland and Wales, 61 practices have closed since April 2013 which has forced more than 160,000 people to register somewhere new, figures obtained via Freedom of Information (FOI) requests show. Closures are being forced by problems both in recruiting new GPs and in retaining the existing workforce. The figures, obtained by the GPs’ magazine Pulse, were described as “the tip of an iceberg” by one senior GP.

Data released by the Government last year indicated that more than 500 practices had closed between 2009 and mid-2014. These also include practices lost through mergers and takeovers. However, a previous FOI request by Pulse revealed a sharp increase in the number of practices approaching NHS managers for formal advice about closing: 169 made such requests between April and December last year – compared with just 37 in a year between April 2013 and March 2014.

Practice closures are piling pressure on other GPs who must take on the displaced patients, doctors’ leaders said. Dr Chaand Nagpaul, chair of the British Medical Association’s GP committee, told Pulse: “There are many practices on the brink of collapse, while others are significantly reducing the level of services they can offer.


Private APMS provider has three practices put in special measures by CQC (Pulse: 7 May 2015)

Private providers of out-of-hours GP services deliver poorer care than NHS, research finds (The Independent: 30 April 2015)

GP vacancy rate at highest ever, with 50% rise in empty posts (Pulse: 29 April 2015)

Opening general practice to private providers 'may have worsened patient care' (Pulse: 24 April 2015)


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