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GP SURGERIES : Closures / Amalgamations : GP Shortages And Government Targets / Waiting Times : Sector News - Page 5 - Carers UK Forum

GP SURGERIES : Closures / Amalgamations : GP Shortages And Government Targets / Waiting Times : Sector News

Discuss news stories and political issues that affect carers.
GPs vote to reduce patient home visits.

GPs have voted to reduce visits to patients' homes, saying they " No longer have the capacity " to offer them.

Doctors supported the proposal at a meeting of English local medical committees in London on Friday.

It means British Medical Association (BMA) representatives will lobby NHS England to stop home visits being a contractual obligation.

Health Secretary Matt Hancock said taking home visits out of GPs' contracts is a "complete non-starter".

An NHS spokeswoman said GPs would still visit patients at home where there was a clinical need to do so.

A local committee of doctors from Kent brought the three-part motion to the conference, arguing GPs "no longer have the capacity to offer home visits".

It said representatives from the BMA should renegotiate with the NHS to "remove the anachronism of home visits from core contract work, negotiate a separate acute service for urgent visits, and demand any change in service is widely advertised to patients".

The group added it did not want to completely scrap home visits, as "more complex, vulnerable and palliative patients" were "best served" by GP home visits.

As a result of the three-part motion being passed, the part of the BMA which represents English GPs - GPC England - will be instructed to negotiate the new policy with NHS England.

Nikita Kanani, the NHS's national medical director for primary care, said GPs and healthcare professionals such as nurses and advanced paramedics would continue to make home visits when patients needed them.

The London GP said an extra £4.5bn was being invested for local doctors and community services, to help fund 20,000 more staff to support GP practices and "offer high quality care for patients".

Health Secretary Matt Hancock insisted there was "no prospect" of GPs removing their contractual obligations to making home visits.

He told BBC Radio 4's Today programme it was "right" that most home visits were made by nurses "but sometimes you need a GP".


The health secretary, Matt Hancock, has ruled out scrapping GP home visits after doctors backed the idea in a vote, arguing that they were too over-stretched to deliver the service.

Delegates representing GPs across England at a British Medical Association conference voted to try to remove the duty from their standard contract, after complaints that they were wasting time driving around the country.

The move clears the way for BMA representatives to lobby NHS England over the measure, but Hancock said the idea was a “complete non-starter”, and he was firmly opposed to the plan.

“The GPs had a vote on what their opening negotiating position should be for the next GP contract. The idea that people shouldn’t be able, when they need it, to have a home visit from a GP is a complete non-starter and it won’t succeed in their negotiations,” he told BBC Radio 4’s Today programme.
There is ample evidence on the forum that some patients will always need home visits.

My own mum could only leave the house if it was by ambulance. Even they struggled because of the design of the front porch.

Social Services would pay for a fixed ramp, not a portable one. A fixed ramp wasn't suitable because there was a big step into the house from the porch. A long enough ramp would have jammed the front door open permanently!!!

Talk about a lack of joined up thinking!!!
Their already point blank refusing to conduct home visits around here, all of them.

They use ECP's (emergency care practitioners) instead. These are essentially a small team of paramedics either approaching, or of retirement age that have stayed on and are completely out of their depth when it comes to community/chronic/palliative medicine.. because surprise surprise paramedics aren't trained as doctors, they are trained for giving patients time in an emergency (while they are transported to physicians/specialists etc)

Our first experience with an ECP came at the reluctance of the GP to attend a home visit for a person who suddenly became bed bound due to an infection - history of past infections of similar kind, and a survivor of near fatal Sepsis.

The ECP did nothing, I was the one that had to deal with getting the person taken into hospital for treatment - and by the way, the impact of the infection on that persons health, was somebody that could previously just about manage (with a bit of help from carers etc) is now living in a care home and can no longer weight bear - they aren't even of pension age.

I have plenty respect for the medical profession but I have to draw the line here.
Its not a case of "offering" home visits, some people just "need" them.
This is passing the buck and will turn the public against them.
If they get their way, this will be the straw that breaks the camels back with hospital A&E's which are barely functional as is, watch admissions go through the roof as avoidable illness spirals beyond any measurable control.

So much for their "oath"
Martin Marshall : GPs need to do less, but it’s not what patients want to hear.

The new chair of the RCGP says doctors are under pressure to overtreat, and calls on politicians to stem the exodus from the profession.

The NHS does too much medicine”. These are surprising words to hear uttered by a GP, given their role as gatekeepers to the NHS – the doctors who send patients to hospital for tests, surgery or other treatment.

But Martin Marshall, the new chair of the Royal College of General Practitioners, firmly believes that part of the reason the NHS is so overstretched is that doctors (GPs and hospital doctors) overdiagnose illness – and as a result patients have too many exploratory tests and too many unnecessary treatments. Getting a grip on that, he believes, would help relieve the pressure on the health service in general and the nation’s overworked family doctors in particular.

Marshall, 58, has just begun a three-year stint as the profession’s leader and main mouthpiece, replacing Helen Stokes-Lampard. He believes “medicine has overstretched itself” and its limits need to be “rethought”, to be scaled back.

So how does overdiagnosis and overtreatment manifest itself? Marshall says that a good example is the way that statins and antibiotics are overused to treat ailments that could be just as well tackled in some other way – or which need no pharmacological or medical intervention at all.

“We’re kind of sheep-dipping the population in statins, with a relatively small benefit,” he says of the cholesterol-lowering drugs currently used by many millions of Britons. “Statins are over-prescribed. That’s what we believe as GPs, though there are quite a lot of cardiologists out there who don’t believe that. That’s where the ethical discussion comes in about whether to intervene or not.”

He believes that while statins reduce the risk of a heart attack or stroke for some, for many the potential side effects – muscle pain, diarrhoea and headaches – outweigh that.

Marshall is a professor of healthcare improvement at University College London as well as a GP in Newham, in the East End. He cites the British Medical Journal’s Too Much Medicine campaign, and similar initiatives in the US and Italy, to show that other medics share his concerns. He is also co-chair of NHS England’s expert advisory committee on the evidence-based interventions programme (EBI), which is encouraging doctors and clinical commissioning groups to reduce, or end, their use of treatments that the evidence suggests do not work – or do not work well enough to warrant the use of expensive and increasingly precious NHS resources such as staff, equipment and operating theatre time.

He cites exploratory operations for knee pain called arthroscopies, removal of nodules that indicate thyroid cancer and treatment for prostate cancer as procedures that could be done much less often, and the patient’s condition managed in some other way, including “watchful waiting”.

But he acknowledges that there are two main obstacles to embedding this “less is more” approach across the NHS: resistance from fellow doctors – and resistance, especially, from patients. With medics, especially those in hospitals, their instinct, their habit and their training tell them to intervene. In the case of knee pain, this might mean undertaking surgery when advising someone to take regular exercise rather than have an arthroscopy may well be better for them. To many doctors, though, it seems counterintuitive, he says.

Pressure from patients is key, too: Marshall admits that they often just want something done. So if a GP is having a typically busy day of umpteen consultations, “the temptation to take the easy way out, to do the quicker thing, even if it’s using unnecessary resources or exposing people to unnecessary radiation, is always there ... I feel passionately about this, but it’s very tricky to persuade doctors to do less and patients to expect less,” he observes.

Ideally, he adds, a GP would take 10 to 15 minutes to persuade a patient that they do not need to start on statins. But, he says, with GPs under so much time pressure, some will take the quick and easy way out and dash off a prescription for the drugs instead.

The state of general practice has become a key issue in the election campaign. Marshall insists that he is a “glass half-full” optimist on the many problems facing this bedrock of NHS care. “[In recent years] general practice has been through a massive crisis. But I think it has hit the bottom and is now on the way up,” he says. NHS policymakers and ministers have realised how fragile GP services have become, he says.

He mentions the extra £4.5bn earmarked for community healthcare services by 2023-24 under NHS England’s long-term plan, the record number of future GPs now in training and the drive to expand GP surgeries’ workforces by adding 20,000 pharmacists, physiotherapists and mental health therapists as evidence that things are changing.

All three of the main parties have vowed to increase the number of GPs in England, even though the total has actually fallen since the government’s pledge to do so in 2015. Wisely, Marshall is skeptical.

“It’s good to see all major political parties making promises about the NHS, particularly general practice, in their manifestos. These pledges are necessary – but delivering them will be a huge challenge. We’re never going to get enough doctors into the system. It’s essential we get those 20,000 extra practice staff. Do I think we will? I’m hopeful – not confident.”

He also wants parties to think much harder about how to stop the brain drain of GPs retiring early because they feel the job has become “undoable”.

“A lot of my peer group are either retiring or working part-time or giving up their partnerships. When I started as a GP 30 years ago, a busy day was seeing 20-25 patients face to face, taking five phone calls and making three or four home visits. Now a busy day is seeing 40-50 patients, probably 20 or 30 phone calls and very few visits.” He worries that too much of what should be a very personal service has become “transactional”.

Looking ahead to the election, he adds: “Whatever party comes to power will need to be on their A-game and take serious steps to achieve their pledges. What’s missing from all the manifestos is detail, particularly about how we’re going to retain our existing workforce. Escalating workload means being a GP can be undoable. Experienced GPs are burning out and leaving earlier in their careers than they planned. That’s not right and it’s not safe – it’s something the future government needs to tackle as a priority.”
A single GP looks after 11,000 patients at one practice, NHS figures reveal amid chronic national shortage of family doctors.

One GP is responsible for up to 11,000 patients at practice in Maidstone, Kent.

Surgery in Walsall, West Midlands, has no permanent GPs and run by 3 locums.

Boris Johnson has promised to hire an extra 6,000 family doctors by 2024/25.

https://www.dailymail.co.uk/news/articl ... eveal.html
Concern over GP home visits must be addressed in a cohesive plan for NHS - The Yorkshire Post says.

If doctors want to limit home visits, they need to persuade people like 73-year-old Janet Berry.

As a young mother, her life was saved by the long-serving GP attending her house as she struggled in indescribable pain, unknowingly suffering an ectopic pregnancy.

Earlier this month, doctors voted to remove the ‘anachronism’ of those very home visits from their core contract work.

They claimed that they no longer had the capacity to offer them, an alarming indication of the pressure and strain on resource that many are facing.

Mrs Berry, a retired university secretary who lives in Hambleton, North Yorkshire, believes such visits are vital, telling this newspaper that she could have died without a GP coming to her assistance.

Though the doctors’ vote was immediately dismissed as a “complete non-starter” by Health Secretary Matt Hancock, who expressed strong opposition to the proposal, the new Government would do well to heed concern from all sides as it looks now to enshrine into law much-needed additional funding for our precious health service.

In Thursday’s Queen’s Speech, Boris Johnson made a commitment to give the NHS an extra £34bn a year, whilst seeking cross-party consensus for long-term reform of the social care system.

Though he and his team cannot also enshrine levels of service, care and compassion, they do need to make sure that there is a more joined up and cohesive NHS moving forward. That means social care providers, GP surgeries and hospitals all working together to provide the best possible support for patients.

Surgery with 6,500 patients placed in special measures after alarming inspection report.

Surgery was heavily criticised by CQC, with 'no mechanisms' in place to ensure infection control measures were adequately carried out.

A damning inspection has rated a Loftus doctors as "inadequate" after a host of failings were uncovered.

Woodside Surgery, based on the High Street, has been heavily criticised by the watchdog, the Care Quality Commission (CQC).

It has now been placed in special measures and is due to be inspected again in six months.

Concerns were also raised about risk management, with "no mechanisms" in place to ensure infection control measures were adequately carried out.

Inspectors said key issues included:

The practice did not have clear systems and processes to keep patients safe.

Receptionists had not been given guidance on identifying deteriorating or acutely unwell patients, they were not aware of actions to take in respect of such patients.

The practice did not have appropriate systems in place for the safe management of medicines.

The practice did not learn and make improvements when things went wrong.

While the service was deemed to be sufficiently caring and responsive, the report found it "requires improvement" over its effectiveness, with areas regarding leadership and safety branded "inadequate".

The practice provides NHS services through a General Medical Services contract to 6,471 patients.

The CQC report writer said: "I am placing this service in special measures. Services placed in special measures will be inspected again within six months.

"If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service.

"This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

"The service will be kept under review and if needed could be escalated to urgent enforcement action."

It also found staff had also not been trained to handle specimens.

Additionally, the provider had failed to ensure the proper and safe management of medicines, with no robust system in place for the monitoring of high-risk medicines or appropriate antibiotic prescribing.

Teesside Live approached Woodside Surgery for comment.

Many years ago I worked in the office of a hospital in Australia, 1,000 miles away from anywhere. (Roebourne).

They had an excellent idea. Newly trained doctors and nurses had to agree to being sent to any hospital in the state that was short of staff, for a set period. There was also the Emergency Nursing Service, experienced nurses and radiologists who signed up to going anywhere for a set length of time, maybe a year or two.

I often wonder if a similar scheme would be attractive in the UK?
If additional staff are employed by gp surgeries , would not the cost come straight off the bottom line ?

Accounts for gp surgeries are complex.

Suffice to say , their income comes from the NHS ... so much for every patient.

https://practicebusiness.co.uk/nhs-paym ... -practice/

Could hire staff to fill temporary vacancies but ... at what cost ???
Chris, the big advantage of the Australian system is that newly trained staff have to go wherever they are sent for the first 2 years after qualifying.
Also, foreign doctors might be attracted to a scheme where they can work within the NHS without committing themselves long term.