GPs are failing people with eating disorders, says charity

Half of people with experience of condition rate GPs’ care as poor, survey finds | The Guardian

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GPs are routinely failing to provide adequate care to patients with eating disorders, with one in three not referred for specialist assistance, a leading charity has warned.

Beat, the UK’s primary eating disorder charity, found that half of people with some experience of the condition rated GP care as “poor” or “very poor” and 30% were not referred to mental health services after their appointment.

The charity polled 1,700 people, the majority of whom had sought medical help for an eating disorder. Of the 1,267 who had gone to a GP for help, only 34% said they felt their doctor knew how to treat them.

Read the full news story here

Read the survey results from Beat here

Transforming community care with digital technologies

Chris Gregory, head of clinical systems for LGSS Local Health and Care Shared Service explains how mobile solutions are transforming the work of community-based health teams | NHE

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As the IT provider to Northamptonshire Healthcare NHS FT, LGSS has been involved in delivering mobile working solutions to a number of community-based health teams, including health visitors and district nurses, and for providing similar solutions in local government.

The trend towards delivering care closer to home to meet both patient aspirations, and the need to deliver savings through the reduction of estate, means that increasing levels of flexible working are being demanded across the NHS. If done successfully, mobile working can help to deliver the type of service that patients tell us they would like from their health service.

As with many IT services we’ve had a few attempts at delivering practical mobile working solutions, each based on and constrained by the technology available at the time. Prior to our latest deployment, we asked staff what they needed from a mobile device. Overwhelmingly, those who responded wanted:

  • A small form factor: There is plenty of other equipment a district nurse needs to carry so devices need to be small, as light as possible and certainly no more awkward to carry than the files of paper notes previously used
  • Sufficient battery life to get through an entire working day
  • A fast start-up: Ensuring that as little of the precious contact time with the patient was spent waiting for the technology
  • Versatility: Multiple means of inputting data, suggesting the need for both touchscreen and keyboard input

Read the full article 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

Reducing hospital admissions by improving continuity of care in general practice

This briefing summarises research that analysed data from over 230,000 anonymised patient records for older people aged 62 – 82 years | The Health Foundation

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Image source: The Health Foundation

  • Continuity of care is an aspect of general practice valued by patients and GPs alike. However, it seems to be in decline in England.
  • Our analysis, published in The BMJ and summarised in this briefing, looks at the link between continuity of care and hospital admissions for older patients in England. We looked specifically at admissions for conditions that could potentially be prevented through effective treatment in primary care.
  • We found there to be fewer hospital admissions – both elective and emergency – for these conditions for patients who experience higher continuity of care (ie those who see the same GP a greater proportion of the time). Controlling for patient characteristics, we estimate that if patients saw their most frequently seen GP two more times out of every 10 consultations, this would be associated with a 6% decrease in admissions.
  • To improve continuity for patients, general practices who are not already doing so could set prompts on their booking systems and encourage receptionists to book patients to their usual GP. Patients could also be encouraged to request their usual GP.
  • Clinical commissioning groups and NHS England Area Teams could work with general practices to support quality improvement initiatives that maintain or improve continuity of care.
  • Future national initiatives should have a well developed understanding of how and why the policy will impact on continuity in a particular context.

Read the full overview here

Read the full report here

A qualitative study exploring use of the surprise question in the care of older people

Elliott, M. & Nicholson, C.A. (2017) BMJ Supportive & Palliative Care. 7:32-38.

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Objective: The question “Would you be surprised if this patient were to die in the next 6–12 months?” has been included in UK palliative care guidance with the aim of supporting the identification and care planning of those nearing the end of life. Little is known about how the surprise question is utilised in the care of older people within primary care. This study sought to explore the perceptions and experiences of general practitioners (GPs).

Conclusions: Greater understanding is needed as to the difficulties experienced by GPs when assessing prognosis in older people. We propose a thematic model which could support GPs by focusing assessment on the supportive and palliative care needs of older people nearing the end of life.

Read the full article here

Saving Sustainability and Transformation Plans

Saving STPs: achieving meaningful health and social care reform | Reform

Current ambitions for NHS reform rest on Sustainability and Transformation Plans (STPs). These aim to bring local leaders together to create cohesive systems of care that are proactive, not reactive, with a focus on prevention and care being delivered in the community rather than in hospitals. They also aim for health and social care systems to properly exploit technology. All this will save time and money and deliver better quality care.

In their current form, however, STPs are not going to work. This paper identifies the three key barriers to success and sets out the five changes that need to be made if the plans are to succeed.

Recommendations:

  • STPs should design their own local health outcomes for which every organisation in the STP is accountable.
  • STPs should take a ‘one-system, one-budget’ approach. NHS, social care and public health budgets should be merged across the STP and commissioned by a single body.
  • Commissioners need to regularly evaluate whether providers are delivering on outcomes. Where these are consistently not delivered, services should be decommissioned and broken up to allow smaller providers to bid. Contracts should come up for renewal at regular intervals.
  • NHS Improvement should publish guidance clarifying how current legislation surrounding competition applies in the context of STPs.
  • STP footprints should have elected leaders who are held to account by the public.

Full report available here

The Sustainability And Transformation Plans: A Critical Assessment

This report assesses the published drafts for STP plans and it raises concerns around the credibility of the implementation measures outlined in the plans | Centre for Health and the Public Interest (CHPI)

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Image source: CHPI

Many members of the public, and even some politicians, are only just becoming aware of Sustainability and Transformation Plans, which were imposed in a policy directive from NHS England just 3 days before Christmas in 2015 as part of a major shake-up of the NHS. 1 The dramatic reorganisation of England’s NHS into 44 ‘footprint’ areas, and the requirement for all NHS bodies to collaborate with local government social service agencies on these new 5-year plans, seemed like NHS England’s best hope of balancing its budgets by 2020-21. But the variegated and inconsistent series of 44 documents that have been published since the end of October have clearly fallen far short of NHS England chief executive Simon Stevens’ hopes a year ago.

Read the full report here