Posts Tagged “general practice”
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.
The NHS Confederation has published a Primary Care myth buster to raise awareness that GPs already offer 7 day access. The move comes amid calls from academics for the Government to put a halt to 7 day access plans as research has not conclusively shown that 7 day access will reduce A& E admissions. Meanwhile, a small GP-led pilot scheme in Cornwall has reduced emergency admissions by 34% in a high-risk group of patients with two or more long-term conditions.
NICE has backtracked on its claim that 10million prescriptions for antibiotics every year are inappropriately prescribed. The figure was apparently based on ‘the far end of plausability’ of an estimate made by a single expert adviser.
The CQC is to make changes to the way it carries out practice inspections in order to improve the relationship between practices and inspectors. A named lead inspector for each CCG area will carry out the majority of inspections with visits spread throughout the year rather than during a 4 week window.
An error by NHS England has left 30 GP trainees in the Thames Valley and 14 in the West Midlands suspended from seeing patients for up to 3 weeks because they were not included on the performers list.
A survey of practice managers has found that 57% have applied for new jobs and many want to leave General Practice citing bureaucracy, poor pay, and a lack of training and opportunities for progression as reasons to look for management jobs in other sectors. Meanwhile, figures from the GMC show that on average, between 2008 and 2014, 2,852 certificates were issued to doctors enabling them to work abroad. Worryingly, it seems that the doctors most likely to leave are young, newly or recently qualified and without family or financial ties to the UK.
The NHS is seeking to recruit 200 US trained physician associates to four regions in the UK offering £50,000 for a 48 hour working week. The positions are for two years by which time, the first UK trained physician associates should be qualified.
Meanwhile, there are hopes that GPs will be amongst the groups to benefit from an increase on the expected pay rise of 1%. Groups with recruitment and retention issues may receive more than 1% according to the Treasury.
Recruiters are enticing GPs to work abroad by highlighting flexible working in places like New Zealand and contrasting that against plans for 7 day working in the UK. Figures from the GMC reveal that in 2014 over 800 GPs applied for the certificates needed to work abroad.
The cost of indemnity cover is escalating owing to GPs extending their cover for 7 day working. According to the GPC, costs are unnecessarily high as medical defence organisations are basing their calculations on urgent OOH work, though the majority of work is routine and non-emergency care. The rising cost of indemity has led to at least one GP federation to broker their cover directly with an insurance company, saving their GPs an estimated 75%. The RCGP is to offer a federation support programme to help practices start working together, NHS England is funding the project.
Scotland’s Information Services Division have published figures that show Scottish GPs are already providing almost 1 million OOH consultations. Meanwhile, in North Wales, paramedics, instead of GPs and nurses, have been attending home visits at evenings and weekends owing to a shortage of staff. A single-handed practice in Scotland has failed to attract any applicants to replace the retiring GP who left at the end of June. NHS Highland has been running the practice and were offering a salary of £80k, golden hello and relocation package.
The new GP returner scheme has attracted 60 GPs since March, however, the majority of these were in London (18) and the South of England (23). The two areas worst hit by GP shortages, North East of England and East Midlands, attracted only 1 GP each.
The Review Body on Doctors’ and Dentists’ Remuneration has recommended removing a supplement paid to GP trainees that accounts for 31% of their salary (worth £14,328 in the first year of training). The BMA has warned that this would be a “disaster” and compound the shortage of doctors applying to GP.
NHS England is to offer practices a contract with “simple and attractive” conditions as an alternative to the national contract. The move is part of a shake-up of the way primary and secondary care is organised and funded. Practices will be given the ‘right of return’ back to the national contract. Whilst the GPC is looking into ‘payment by activity’ as it prepares for the 2016/17 contract negotiations.
Health 1000: The Wellness Practice is a new practice set up in the King George Hospital, East London, aimed at patients who are at risk of frequent hospital admissions. To be eligible to register, patients must have 5 or more specific long-term health conditions such as coronary heart disease, high blood pressure, heart failure, stroke, diabetes, chronic obstructive pulmonary disease, dementia and depression. Each of the 1000 patients at the practice will have access to a key worker, consultants, physiotherapists, geriatricians, occupational therapists and a social worker in addition to GPs and nurses.
The RCGP and Médecins Sans Frontières (MSF) have joined forces to allow GPs to volunteer for between 6 and 24 months in sub-Saharan Africa and the Middle East. The projects will run for three years and focus on family medicine.
The RCGP has highlighted the pressure of GPs’ workload causing burnout and fatigue and endangering patient safety. Whilst a review of GP workload by Health Education England has recommended pilot schemes to test the effectiveness of a wider range of practice staff including medical assistants and paramedics. NHS England has announced new pilots in eight ‘vanguard’ areas which will see GPs working in A&E and OOH services integrated with ambulance services and NHS 111. The chair of the primary care workforce review has revealed that he was told to ignore GP staffing levels, as the Government claimed it was not required.
A survey of GP Partners has found that 62% of all GPs have taken a pay cut with an average reduction of 5.7%. Whilst the cost of 7 day opening for GP surgeries could cost the NHS £3bn a year, according to calculations by Dr Mortons’, a medical helpline which launched this month.
The GPC has called on NHS England to set up a financial resource for struggling practices in danger of closure. A group of practices in Staffordshire have raised fears of closure after finding that a change in management of their premises has left them with increased bills of up to 900%. A local area team has reviewed its policy of issuing breach notices to any practice that received an ‘inadequate’ rating from the CQC and denying support from the pilot programme run by NHS England and the RCGP.
A quarter of OOH shifts were unfilled in one area in Wales owing to a growing recruitment problem. This year, 85% of training places were filled in Wales after two rounds of recruitment and there will not be a third round.
Brunel Medical Practice in Torquay, Devon, has written to patients asking them to ‘bear with us’ as they struggle to recruit after a number of GPs retired. Meanwhile, St Luke’s Medical Centre in Gloucester has had to close after failing to replace the two partners who have been succession planning since August 2013.
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.
Data from the GP Patient Survey has found that just over a quarter of patients in England were unable to see a GP or waited a week or more to see or speak to someone last time they tried. The survery comes amid news that a quarter of 7 day GP access pilots have cut their opening hours owing to lack of demand.
According to a survery carried out by Londonwide LMCs, 1 in ten London practices face closure within the next three years. Various factors were cited as reasons practices were considering closure, including workforce retirement and difficulties recruiting new staff. One GP explained the difficulties her practice faced and the reasons behind the decision she and her colleagues made to quit. Other GPs at the Limehouse Practice were visited by health minister Alisdair Burt, in a hastily arranged visit after reports that a proposed visit by Jeremy Hunt might not take place until after the practice is forced to close later this year. In Scotland, one area has warned that any unexpected illness or leave amongst GPs could lead to practice closures, as 11 full-time posts have been vacant for between three months and two years and a further 14 GPs plan to retire by December 2016.
The Head of NHS England, Simon Stevens, has annouced that the practice-list based model of general practice could be replaced in future. Another GP has suggested practices receive payments based on numbers of consultations in order to relieve the financial pressures they face.
It has transpired that the £7.5m promised by the Government to support community pharmacists will actually be used to give them access to summary care records – a policy originally announced in 2013. As part of the drive to recruit 1000 Physician Associates by 2020, the Government is considering granting them prescribing powers to relieve the pressure on GPs. The NHS is offering £15m to practices who take part in a pilot scheme to bring pharmacists into their surgeries.
In order to save money and reduce medicine wastage, from next year, all medication costing more than £20 will have the price printed on the label. Jeremy Hunt has also said that he supports the idea of charging patients for missed GP appointments and as a first step, patients will be informed how much their missed appointment has cost the NHS.
After two rounds of GP Recruitment earlier this year, official figures show that 20% of GP Training places remain unfilled with a third round to follow later in the year.
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.