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.

Focus on general practice at the heart of local system change

Workforce development and collaboration are the twin themes of the latest issue of Commissioning Excellence, which highlights how local leaders are promoting the development of general practice at scale both to deliver the kinds of services communities demand and the resilience GP practices need.

This issue also focuses on the clinical pharmacists in general practice programme, which is bringing clear benefits to GPs and their patients.

General practitioners’ practices when suspecting cognitive impairment

General practitioners (GPs) play a major role in the assessment of dementia but it is still unrecognized in primary care and its management is heterogeneous | Aging & Mental Health

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Objective: Our objective is to describe the usual practices, and their determinants, of French GPs in this field.

Results: Hundred two GPs completed the study. GPs were in majority men, working in urban areas. Mean age was 54.4 years old. GPs’ feeling of confidence and self-perception of follow-up of national recommendations is linked with their practices. Performing a clinical interview to assess cognitive impairment is linked with good communication skills. GPs feel less confident to give information about resources for dementia. The main reason alleged for underdiagnosis is the limited effectiveness of drug therapy.

Conclusions: This study underlines the importance of GPs’ feeling of confidence when managing cognitively impaired patients with dementia, and the need of increasing training in the field of dementia, which could improve the awareness of GPs about diagnosis and available resources.

Full reference: Harmand, M.G-C. et al. (2017) Description of general practitioners’ practices when suspecting cognitive impairment. Recourse to care in dementia (Recaredem) study. Aging & Mental Health. Published online: 8 June 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

Developing sustainable primary care

Challenges facing general practice are increasing. This comes at a time of increased patient need, high demand for services and growing challenges in retaining and recruiting clinical team members | PCC

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PCC has been supporting practices to prepare for the future by looking at ways they can become more sustainable. From our work so far, the following themes have emerged:

  • The need to ensure practices are well run, claiming appropriately and considering how the practice, as a whole, could work smarter.
  • Planning for the future –how a practice will need to change in the next three to five years and how steps towards this can start now, to achieve early wins and boost morale.

General practices are responding to the increasing demands they face in several ways. Some are merging with other like-minded practices or working with other partners in the health economy. Others are collaborating to share back office or clinical skills to enable them to manage patients and workloads most appropriately. This includes signposting to alternative local services.

Read the full overview here

Reducing antibiotic prescribing for children presenting to primary care with acute respiratory tract infection

Blair, P.S. et al. (2017) BMJ Open. 7:e014506

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Objective: To investigate recruitment and retention, data collection methods and the acceptability of a ‘within-consultation’ complex intervention designed to reduce antibiotic prescribing.

Conclusion: Differential recruitment may explain the paradoxical antibiotic prescribing rates. Future cluster level studies should consider designs which remove the need for individual consent postrandomisation and embed the intervention within electronic primary care records.

Read the full article here