Posts Tagged “7 day access”
GPs are now legally required to have indemnity cover in following a Department of Health ruling to bring UK GPs in line with a European Union directive. Previously, GMC guidance stated that GPs were only required to have cover where necessary, the move comes at a time where the cost of indemnity cover is rising. An ANP in Weston-super-Mare has found her cover rising from under £900 last year to nearly £8000 this year despite there being no problems with her work over the last 12 months.
NHS Employers have said they will continue with plans to remove a supplement paid to GP trainees, which brings their pay in line with junior doctors working in hospitals, that could see GP trainees’ pay cut by a third. The RCGP has launched a petition to demand that the health secretary guarantees that GP trainees pay will not be cut. The implications of the new contract due to be forced on junior doctors have led to unparalleled numbers of doctors applying to the GMC to register to the certificates needed to work abroad. Tom Tugendhat, Conservative MP, has called for GPs to work for a set period of time, or pay off their training costs, before moving to work abroad. The proposed ‘return of service’ commitment would be similar to that of Armed Forces staff, for example, fighter pilots who have to serve 12 years before they are allowed to work in the commercial sector.
With the initial funding for the Government’s flagship 7 day access pilots due to run out this month, it transpires that 8 out of the 18 providers have either cut weekend or evening hours, or stopped running the service completely. Earlier this year, another 4 schemes reported similar changes meaning less than half of the pilots are still running as originally planned.
The Priory Avenue surgery in Caversham, Berkshire, one of the first practices to be placed in special measures, has now been rated ‘requires improvement’ following a re-inspection by the CQC. Meanwhile, Professor Field, CQC Chief Inspector has announced that practices rated ‘good’ or ‘outstanding’ may be inspected less frequently than every two years as planned.
The GPC has revealed its vision for the future of General Practice calling for practices to either federate into larger networks or build ‘super practices’ offering a range of services to patients. The GPC also called for the Department of Health and NHS England to increase GP funding, launch a campaign aimed at patients to reduce inappropriate appointment requests and establish an infrastructure fund to upgrade premises and technology.
Jeremy Hunt has called for all GP Practices to ensure their patients can access a 7 day service by 2020, even if they don’t provide the care directly themselves. Responding to a petition calling for a vote of no confidence in him, the health secretary said that doctors would realise 7 day access was “the right thing to do”. At the debate, which was amended to discuss contracts and conditions in the NHS, GPs were told they need to be ‘more flexible’ with regards 7 day access. Meanwhile, one of the Prime Minister’s Challenge Fund 7 day access pilots has been delayed owing to the length of time needed for CCG registration. NHS Cambridgeshire and Peterborough CCG planned to start the pilot in July but it is now expected that early morning and evening appointments will be phased in with most areas covered by late October.
The CQC has announced a change to the way it operates with aims to work ‘in partnership’ with healthcare providers and a ‘lighter touch’ approach. This follows a practice in Bristol which has successfully challenged the ‘needs improvement’ rating it received after its CQC inspection. The regulator admitted ‘due process’ had not been followed and the practice was rated ‘good’ on re-inspection.
A pilot scheme in London will provide careers advice to long-term unemployed patients in a bid to help them overcome health-related barriers to work. The ‘Working Better’ scheme launched at the beginning of September and is a joint venture between Islington Council, Jobcentre Plus and NHS Islington CCG. NHS England has also announced plans for firefighters to carry out basic health checks when visiting people’s homes to carry out safety checks. Pilot schemes will be run in Manchester, Staffordshire and Gloucestershire to test whether falls, broken hips and hospital admissions can be reduced.
London GPs are struggling to cope with demand and cite cuts to community staff, social services, mental health services and both an aging and increasing population as causes for the crisis. There are also 140 practices at risk of closure over the next three years.
Plans to extend GP training to 4 years are in doubt after comments made by Jeremy Hunt at a recent health committee meeting. The health secretary said that four year training would make it more difficult to meet the target of an extra 5,000 GPs by 2020. Meanwhile, the RCGP has called for training places in Northern Ireland to be nearly doubled from 65 to 111 as part of a range of measures it wants the Northern Ireland Government to examine.
The Chief Executive of NHS England has said that 7 day access is needed to reduce health inequalities as the current system discriminates against low-paid workers who cannot get time off for mid-week appointments without losing pay. Meanwhile GPC Chair Dr Chaand Nagpaul has said he is happy to discuss extending access as part of GP contract negotiations but will not agree to 7 day access. Conservative MP and former GP Dr Sarah Wollaston has said that 7 day access is ‘completely unrealistic’ whilst the RCGP has claimed that 7 day access could cost £1bn a year.
Physician Associate trainees will be guaranteed jobs at the end of their training under a trial proposed for mid-Wales. Official figures have revealed that Salaried GPs earn less than 10% more than Physican Associates with GPs earning on average £54,600 a year versus £50,000 for Physician Associates with two or more years experience. Labour MSP, Elaine Murray has said that scientists should be able to retrain as GPs via shortcut courses to help ease the GP recruitment crisis.
Figures have shown that practices’ use of Locum GPs has increased by nearly 20% over the last year with many GPs choosing to work as ‘career locums’ or supplementing their income via locuming.
The RCGP has called for A&E funding to be redirected to General Practice whilst 5 practices at risk of closure are looking to merge with local hospitals to secure their future. Practices in Wales are able to apply for support from the Welsh Government under a new scheme to help vulnerable practices at risk of closure. Meanwhile, practices in the south-west can access a sustainability assessment developed by the regional team to help them look at ways to increase efficiency and succession planning.
The Family Doctor Association (FDA) has found that indemnity fees for GPs have increased by a quarter in one year. The BMA has hosted a summit to discuss the issue with NHS England making it a priority.
Another super-sized practice is set to be created in the East Midlands when 4 local practices merge with an existing large practice in the new year. The resulting practice will have a patient list of 100,000 cared for by 62 partners. The practice has further expansion plans to eventually care for around 300,000 patients.
NHS England has announced plans for an emergency GP support framework comprised of 21 providers who will be pre-contracted to step in and take over the running of struggling practices at short notice. Amongst the providers 10 are GP-led organisations, there are also 2 NHS foundation trusts, small private companies and social enterprises as well as Virgin Care.
A survey has revealed that fewer than 30% of GPs would hire Physician Associates, with 40% ruling out employing them altogether. This will come as a blow to the Government whose ‘New Deal’ promised 1000 Physican Associates to be working in general practice by 2020. A recent advert for a Community Physician working across GP practices in Shropshire as part of the Government’s Challenge Fund seven-day GP access pilot provoked a backlash as it appeared to invite FY2 doctors to apply and work as an ‘unqualified GP’.
Part of the £1bn fund pledged towards improving GP premises over four years is to be used by NHS England to run the second phase of GP Access pilots. The news come after the fund has also been relieved of £10m to support struggling practices (part of the flagship ‘New Deal’ policy) and £15m to employ pharmacists in practices. Unrealistic expectations from patients and inappropriately booked appointments are adding to GPs workload, according to one GP, who has been asked to prescribe glasses, new shoes and ‘energy boosting medication’.
The health secretary has claimed that he has never met a doctor not in favour of 7 day working. However, he was subsequently challenged by Dr Emon Farrah Malik who told him he was ‘driving GPs out of the country’. Meanwhile, an anaesthetic trainee has started a twitter campaign highlighting that the NHS does run a 7 day service with the #ImInWorkJeremy hashtag. Simon Stevens, head of NHS England, has said that practices should not be forced to open on weekends if there is no demand for appointments.
GP Trainees in Wales are to be employed by the Government throughout their training in a move to encourage more doctors to enter GP Training. A pilot scheme was launched in April 2014 and the changes are set to be implemented as soon as possible. Newly qualified Welsh doctors choosing a career in General Practice will also have their medical school fees reimbursed as part of £4.5m of funding for primary care. Half of GP training places remain unfilled in some areas with a third round of recruitment to follow this year, this is the second year that a third recruitment round has been required. The RCGP has announced that it may allow some trainees to have a fifth attempt at the AKT or CSA in exceptional circumstances and provided candidates had ‘undertaken appropriate additional educational experience’.
Student nurses in Solihull are being offered placements in General Practice in order to generate more interest in the career. Six second-year students are being trained at six local practices to give them an insight into practice nursing and tackle the shortage of practice based nurses.
The controversial CQC inspections have proved beneficial for some practices rated outstanding who used the process as an opportunity to reassess ways of working, identifying weaknesses and ensuring information provided is up-to-date.
The Government’s flagship 7 day access policy is in the news once again with a mixed response as to its efficacy. Official evaluation showed that A&E admissions were reduced by 3% and said the scheme was set to be extended. However, CCG leaders in Yorkshire have scrapped the pilot scheme citing poor take-up of weekend appointments as one of the main reasons for abandoning the scheme. A joint report by the Patients Association and the Royal College of Emergency Medicine has found that same-day GP appointments do not stop patients from choosing to attend A&E instead. Meanwhile, according to research by the financial regulator for the NHS in England, a third of patients find it difficult to get an appointment. Although a smaller YouGov poll found apparent public support for 7 day access.
One of the biggest stories this month was Jeremy Hunt’s ‘New Deal’ for GP which has prompted a backlash from GPs and a petition with nearly 3000 signatures. Remarkably, Mr Hunt has also called for GPs to move away from the mentality of clocking off at 7pm.
Staffing in General Practice is still a cause for concern with promises of 5,000 more GPs and 5,000 support staff including 1,000 physician associates by 2020. Although the Government has since distanced itself from the pledge for 5,000 extra GPs. In Leicester, the CCG is spending £600,000 to bring over 10 US-trained Physician Associates to work in local practices. Recruiters have said more foreign GPs are essential in order to meet this target. Whilst regulations were changed this year to allow GP training applicants who failed the Stage 2 exam in the first round to re-apply in the second round. The Welsh Government is investing £34million into GP recruitment whilst the Scottish Government has announced that a new £50million fund for GP recruitment and retention is to be spread over 3 years, replacing a one year £40million fund.
Also in the news has been practice closures. One doctor explains why she and her colleague were forced to resign from their practice after a replacement for the retiring partners could not be found. A practice in Brighton was closed with no warning, following a CQC inspection, leaving nearly 10,000 patients to use local walk-in facilities. The entire patient list was subsequently transfered to one neighbouring practice. In Essex, a third sector provider has been commissioned by NHS ENgland to take on an APMS contract for 12 months after all partners at the GP practice resigned. Meanwhile a practice in London has been saved from closure by local campaigners who persuaded NHS England to use locums to keep the practice open whilst looking for a new provider to run the practice. Jeremy Hunt has agreed to shadow a GP at a practice in Tower Hamlets, but Limehouse Practice is facing a funding crisis and may close before he gets there.
The RCGP has called for an immediate halt to CQC inspections as it emerges that nearly half of GP practices spend more than 20 staff hours to prepare for them.
A pilot scheme in Glasgow is to offer 30 minute appointments to its most vulnerable patients with researchers from the University of Glasgow measuring the impact on hospital admissions.
The Government’s flagship 7 day access pilot looks set to be abandoned by CCGs after NHS Canterbury and Coastal CCG found Saturday morning opening did not help local A&Es meet the four-hour target. Dr Maureen Baker, Chair of the RCGP, has described plans for 7 day access to GP surgeries as “coming from cloud cuckoo land”. The Chair of the BMA’s GP Committee, Dr Chaand Nagpaul, has also called on the Prime Minister to “jettison the political pipedreams of tomorrow”.
The Northern Irish Government is concerned about GP numbers with too few graduates entering GP training and only 33 trainees qualifying in 2014. Data released by the GMC shows that ‘elite’ university students shun general practice with only 16% of Oxford graduates applying for GP Entry. Researchers have found that the amount of time undergraduates spend in general practice has fallen by almost two weeks between 2002 and 2012.
A single-handed GP in London is suing NHS England after they terminated his contract despite loyal patients’ calls for the surgery to be re-opened. The practice’s 3,700 patients have been forced to register at other local practices at great inconvenience. In Derbyshire, a local hospital has stepped in after the closure of group of practices serving 27,000 patients. Another GP who has managed a 4,500 patient list for two years on his own, owing to problems recruiting a partner, has been hit with a breach of contract notice after going off sick from burnout. In the East of England, NHS managers are to identify practices at risk of closure owing to problems with finances, recruitment issues, sickness absences and applications for list closures. It is hoped that NHS England, working with LMCs, can offer support to practices and prevent closures. Over the past two years, 160,000 patients have been displaced by practice closures.
GPs working part-time have spoken out about how intense and draining the workload is and warned that GPs are ‘all out’. Whilst a report from Citizens Advice has found that GPs are spending nearly a fifth of their consultation time dealing with non-medical issues at a cost of nearly £400m.
One village surgery has hit the jackpot after a local businessman donated £1million to pay for new, purpose-built premises to prevent the practice closing.