Missing data has risked GPs’ patient care

Missing patient data that was mistakenly held in storage for years has led to around 1,700 cases of potential harm caused to GPs’ patients, according to a report published today by the National Audit Office (NAO) | OnMedica

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The NAO’s Investigation: clinical correspondence handling at NHS Shared Business Services report details the watchdog’s investigation into how NHS Shared Business Services (NHS SBS) – an agency contracted by the government to run some back-office operations in the NHS – handled unprocessed clinical correspondence.

Significant amounts of important data on patients including test results and diagnoses were delayed mistakenly between 2011 and 2016 by the NHS Shared Business Services agency before they were delivered to hospitals and GP surgeries.

This data, which included copies of test or screening results, and communications about planned treatment following appointments with other healthcare providers, was sent by hospitals and other GPs to practices where the patient had moved away or was unknown, so needed to be redirected.

Over half of sessional GPs suffer work-related stress

At least half of sessional GPs suffer from work-related stress, according to a new survey by the BMA | OnMedica

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The BMA reported that work-related stress has led more than one in ten sessional GPs to take time off work in the past year.

The BMA also found that a staggering 70% of locums would consider leaving the profession if a locum cap was introduced in general practice. It warned against anything – such as measures that harm locum pay – that could lead to an ‘exodus’ of locum and salaried doctors, who it said play a key part in solving the NHS’s current problems.

The BMA wanted to understand the issues that sessional GPs face, to ensure that its discussions with government accurately address their needs. So its sessional GP subcommittee conducted a UK-wide survey of salaried and locum GPs from 1st March to 6th April 2017.

General practitioners’ views of clinically led commissioning

Involving general practitioners (GPs) in the commissioning/purchasing of services has been an important element in English health policy for many years | BMJ Open

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Objectives: The Health and Social Care Act 2012 handed responsibility for commissioning of the majority of care for local populations to GP-led Clinical Commissioning Groups (CCGs). In this paper, we explore GP attitudes to involvement in commissioning and future intentions for engagement.

Results: While GPs generally agree that they can add value to aspects of commissioning, only a minority feel that this is an important part of their role. Many current leaders intend to quit in the next 5 years, and there is limited appetite among those not currently in a formal role to take up such a role in the future. CCGs were set up as ‘membership organisations’ but only a minority of respondents reported feeling that they had ‘ownership’ of their local CCG and these were often GPs with formal CCG roles. However, respondents generally agree that the CCG has a legitimate role in influencing the work that they do.

Conclusion: CCGs need to engage in active succession planning to find the next generation of GP leaders. GPs believe that CCGs have a legitimate role in influencing their work, suggesting that there may be scope for CCGs to involve GPs more fully in roles short of formal leadership.

Full reference: Moran, V. et al. (2017) General practitioners’ views of clinically led commissioning: cross-sectional survey in England. BMJ Open. 7:e015464

Mental health and new care models

GPs need to prioritise mental health more, say experts. | Mental health and new models of care | Kings Fund | OnMedica

While some of the vanguard sites developing new care models report promising early results from adopting a whole-person approach, the full opportunities to improve care through integrated approaches to mental health have not yet been realised.
This Kings Fund report draws on recent research with vanguard sites in England, conducted in partnership with the Royal College of Psychiatrists. The report found that where new models of care have been used to remove the barriers between mental health and other parts of the health system, local professionals saw this as being highly valuable in improving care for patients and service users. But there remains much to be done to fully embed mental health into integrated care teams, primary care, urgent and emergency care pathways, and in work on population health.

The main vehicle for rolling out what vanguards are trying to achieve are England’s sustainability and transformation plans (STPs) and there are concerns, said the authors, that some STPs had limited content on mental health.

‘It is vital that STP leaders are encouraged to make mental health a central part of their plans, and that they are able to take heed of the emerging lessons from vanguard sites,’ says the report.

More mental health support is needed in GP surgeries, said the authors. They recommend strengthening mental health capabilities in the primary and community health workforce by improving the confidence, competence and skills of GPs, integrated care teams and others.

Access to General Practice

Concerns persist over patients’ access to GPs and staffing levels

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The House of Commons Public Accounts Committee has published Access to general practice: progress review. This follow-up report finds that the Department of Health and NHS England now have objectives to improve and extend access to general practice and have made some effort to understand the demand for extended access.  However, the committee notes that extended hours are being introduced without an understanding of the level of access currently being provided, or how to get the best from existing resources.

The report also notes that despite the government’s target to recruit 5,000 more GPs, the overall number of GPs has reduced in the last year, and problems with staff retention have continued.

Health Education England has increased the number of trainee GPs recruited, but still did not manage to meet its recruitment target last year.

New report aims to make General Practice Nursing a top career destination

Improving training available in GP practice settings and raising the profile of the role  is key to helping to retain and expand the General Practice Nursing (GPN) workforce | Health Education England.

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Image source: HEE

Key report recommendations include:

  • improving training capacity for the general practice nurse workforce by providing access to accredited training to equip them for each level of their role;
  • raising the profile of general practice nursing, to increase the uptake of the role as a first-destination career;
  • developing GPN educator roles to cover all CCG areas, including the promotion of mentor training for all GPNs  to retain the knowledge and expertise of existing GPNs; and
  • the development of a sustainable and easily accessible ‘how-to’ toolkit and web based resource to support the implementation of general practice nursing workforce initiatives.
  • a nationwide standardised general practice nursing ‘return to practice’ education programme which includes a general practice placement, mentorship and appropriate support to meet the NMC requirements for ‘return to practice’.

Read the full report here

New care models: now available in GP-friendly packages

There are a number of reasons for general practice to change – it is often small and called inefficient, with wide variations in quality from one practice to the next | PCC

There are also things GPs and patients are desperate not to change – general practice is local, personal and often delivers exceptional care as well as excellent value for money for taxpayers.

The scaled up version of general practice imagined by policymakers makes complete sense: organisations big enough to cope with changes in demand, able to expand the range of services they provide, able to benefit from economies of scale, and able to make more creative use of the wider primary care clinical workforce to free GP time and add value for patients.

However logical or inevitable big general practice may appear, practices are left with a number of questions:

  • How do we grow big without losing the benefits of being small?
  • What are the longer term gains and what might we have to give up for them?
  • How do we retain a voice in the new bigger enterprise?
  • How practical is it to share patients and workforce?
  • How do we bring patients along with us?
  • What about governance – who is ultimately responsible for care when patient lists are shared?

And the biggest question of all: how do we find time to make the changes we need to make when we’ve never been busier?

Read the full article here