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GPs want to be at the forefront of technology but need significant investment in core IT services, says RCGP

"However, while fax machines may be terribly old-fashioned, they do work and remain a highly valued and reliable form of communication between many GP surgeries and their local hospitals, nursing homes and pharmacies.

"A wholesale switchover to electronic communication seems like a brilliant idea but for some practices it would require significant financial investment in robust systems to ensure their reliability was at least as good as the trusty fax machine, as well as having the time to embed - neither of which we have at present as GP teams are already beyond capacity trying to cope with unprecedented patient demand.

"GPs are tech fans, not technophobes, and we have been calling on the Government for significant investment in our core IT infrastructure, some of which is archaic, so that all GP practices have technology that improves communication, works for patients and makes the working lives of GPs easier."

GPs need longer consultations to deliver care to patients, says College

She said: "Despite the best efforts of GPs and our teams, who are working incredibly hard to deliver more consultations than ever before, our patients are waiting too long to secure a GP appointment. We know this is frustrating for them and their families, and it's frustrating for GPs and our teams too. We want to deliver timely care to patients, in the early stages of illness, to avoid conditions getting worse, when they can be both more distressing for patients, and more costly for the NHS.

"We also want the time to deliver care for patients - for many who are living with multiple, long term conditions, the standard 10-minute consultation is no longer fit for purpose - but offering longer consultations, means offering fewer, and as this data shows, patients are struggling to get an appointment as it is.

"With this in mind, it's encouraging and a great testament to the hard work and dedication of GPs that more than 40% of GP appointments are made on the same day the patient is seen, so we are confident most of those who are acutely unwell are being provided for.

"Today's data also shows that many patients are not attending appointments when they have made them. There can be a number of reasons for this, and in some cases a patient not attending an appointment can be an indication that something has gone wrong - but this waste of resources is frustrating, and we would urge patients to let us know if they can't attend as soon as possible, so that we can offer that time to someone else who really needs it. To this end, practices are using electronic methods, such as SMS reminders, to encourage patients to keep their appointments, or cancel them in a timely manner.

"Ultimately, we are calling for general practice to receive 11% of the overall NHS England budget as part of the forthcoming 10-year plan for the NHS, so that our service can continue to deliver the care our patients need and deserve, and keep the rest of the health service sustainable.

"On a wider note, it is very welcome that NHS England has started collecting and analysing GP appointment data - this is something we have long called for. There is a long way to go to improve the quality of this data - and the College is working hard in this regard as our own Research Surveillance Centre has recently started collecting comprehensive data on workload in general practice - this will be invaluable for future planning of our services."

GPs concerned about being able to deliver patient care this winter

89% of GPs surveyed are concerned that their increased workload during the winter months will negatively affect their ability to deliver patient care.

This figure is unsurprising given that 95% of GPs agreed that their workload increases over winter.

The College's Patient Group in Northern Ireland is reminding people about the important '3 Before GP' message and urging people to think carefully about the support and treatment they might require from the health service during this busy period.

RCGPNI Patient Group Chair Karen Mooney said: "Despite the pressures in the health service, all year round we can rely on our GPs for support and treatment when we need it. GP teams work very hard in challenging circumstances to meet the demand from patients and do what they can to care for us in the community.

"This winter, we know that our GP practices are going to be under immense strain, and we can do our bit to help support our health service. Think about what you really need; think 3 Before GP. Can you care for yourself and manage minor ailments at home? Can you find the advice you need using safe and reputable online resources such as the NI Direct Stay Well website? Can you seek advice from your community pharmacist?

"We all have a responsibility to help protect our health services and to make sure that those who are the most ill and vulnerable in our society are able to access the care that they need."

RCGPNI Chair, Dr Grainne Doran, said: "GPs strive to provide the very best care to all of our patients. Over the winter period, there is no doubt that our workload hugely increases.

"For more minor conditions such as coughs and colds, patients can get great advice and over the counter medicines from local pharmacies. This will be faster and more efficient and will help ensure appointments with a doctor are available for those who need them most. But it is important to remember that if you think you need medical attention, or if symptoms don't improve, do not hesitate to seek medical advice.

"I am grateful for the insight brought by the RCGPNI Patient Group in supporting and championing the '3 Before GP' initiative this year."

GMC report echoes College findings on workload and stress in medicine

“GPs and our teams are working incredibly hard to ensure patients get the care they need, but this simply isn’t sustainable without a robust workforce or adequate resources - and as this report shows, many doctors across the NHS are moving away from frontline care due to the intense pressures they are facing.

“It supports our own research, released earlier this week, that found a staggering 31% of GPs said they are unlikely to be working in general practice in the next five years - many citing stress and early retirement as the reasons why.

“Workload in general practice is escalating both in terms of volume and complexity. Yet, the share of the NHS budget general practice receives is less than it was a decade ago, and GP numbers are lower than they were two years ago.

 

“As GPs, we want to be able to deliver the best care we can to our patients, but there comes a point when this simply isn’t safe for patients, or for our own health and wellbeing.

 

“NHS England and Health Education England have been doing great work improving recruitment to general practice, but if more GPs are leaving than are entering the profession, we are fighting a losing battle. We need to see initiatives implemented to tackle unnecessary workload in general practice, and make it a more sustainable environment to work in, so that we can keep hard working, experienced GPs in the profession for longer, delivering patient care.

 

“Ultimately, we need to see NHS England’s GP Forward View, which promises an extra £2.4bn a year for general practice and 5,000 more GPs delivered in full and as a matter of urgency, and for general practice to receive 11% of the NHS England budget as part of the forthcoming 10-year plan for the NHS.”

GP concern about lack of funding revealed in new RCGP Wales report, as College calls for 11% of the NHS budget

The College has called on the Welsh Government to commit to "giving general practice 11% of the Welsh NHS budget, in turn giving patients the type of care they need." The call comes on the day Welsh Assembly Members debate the draft budget for 2019-20.

'Transforming general practice' presents a snapshot of the state of general practice in Wales. It shows high levels of stress, concern about the future, and worry about financial sustainability.

The report revealed that 42% of GPs believe it is financially unsustainable to run a practice, with 82% of those citing 'insufficient core funding' as the cause. 85% of GPs say the funding available from all sources for general practice is not enough (43% 'nowhere near enough', 42% 'not quite enough').

Dr Mair Hopkin and Dr Peter Saul, Joint Chairs of Royal College of General Practitioners Wales, said:

"This report highlights the true cost of underfunding in Welsh general practice and demonstrates that things need to change.

"More of the same won't deliver the best results for an ageing population with an increase in multiple, long-term conditions. Patients need to be able to access services in their community and get help before issues get worse.

"Our recommendations for change are geared towards supporting GPs to deliver the very best care for patients. It needs to be underpinned by a step change in funding, giving general practice 11% of the Welsh NHS budget, in turn giving patients the type of care they need.

"This report presents comprehensive evidence that general practice needs more support and outlines constructive suggestions to make it happen. Things need to change. GPs deserve better and patients deserve better."

College calls for greater efforts to keep existing GPs in the profession delivering patient care

The survey of 1,094 GPs in England found:

  • 31 percent of GPs said they are unlikely to be working in general practice in five years with stress and retirement cited as the main reasons for this.
  • 5 percent of GPs* report that their practice is likely to close in the next year. These are not practices that are merging with others.
  • 37 percent of GPs* said that in the practice where they work, there are GP vacancies that have been open for more than three months. 

Efforts to retain the workforce need to replicate the 'excellent' work that has gone into increasing recruitment to general practice, which has seen more GPs in training than ever before, the College is saying.

It has also analysed the latest provisional workforce data from NHS Digital for September 2018, published last month, which showed an increase of 41 from September 2017**. However, looking back to September 2015 – the last set of workforce data before NHS England's GP Forward View was announced, with a pledge of 5,000 more GPs by 2020 – the total number has dropped by 460.

Taking the data at Clinical Commissioning Group-level, it has identified where in the country has seen the biggest increase in GP numbers – with one area seeing an extra 87 GPs since September 2015 – and where has seen the biggest decrease.

Areas with biggest increases in GP numbers between Sept 2015-Sept 2018:

  • NHS Liverpool CCG (87)
  • NHS Northern, Eastern and Western Devon CCG (67)
  • NHS Kernow CCG (54)
  • NHS Lambeth CCG (45)
  • NHS Gloucestershire CCG (41)

Areas with biggest decreases in GP numbers between Sept 2015-Sept 2018:

  • NHS Horsham and Mid Sussex CCG (-52)
  • NHS Walsall CCG (-33)
  • NHS Portsmouth CCG (-29)
  • NHS Hull CCG (-22)
  • NHS Thanet CCG (-19)

The College says that a primary factor in GPs leaving the workforce prematurely is excessive workload, which has risen substantially in recent years both in volume and complexity, yet the share of the NHS England budget general practice receives is less than it was a decade ago, and GP numbers are lower than they were three years ago.

Last month the College renewed its long-standing calls for general practice to receive 11% of the overall NHS budget as part of the forthcoming 10-year plan for the NHS.

The recent announcement that £3.5bn of the promised £20.5bn NHS uplift would be allocated for primary and community care shows a commitment to supporting healthcare services closer to home for patients. However, general practice currently receives 9.5%*** of the NHS England budget, and the College has called for assurances that general practice, specifically, will be a key recipient of this new funding.

It says 11% of the budget for general practice would enable:

  • Larger practice teams, which would enable GPs to spend more time than the standard 10-minute consultation with patients who need it.
  • A wider range of healthcare professionals to provide a wider range of clinical services in GP surgeries.
  • IT systems allowing more surgeries to use video consultations as part of a standard range of consultation options, and to enable joined-up care across the NHS. 
  • Modernised, fit-for-purpose surgeries as the 'hub' of the community
  • A bigger workforce, where more healthcare professionals will choose general practice as a career and are supported by better-funded training placements in the community.

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: "All GPs are overworked, many are stressed, and some are making themselves seriously ill working hours that are simply unsafe, for both themselves and their patients - it is making them want to leave the profession. It is forcing some GPs to hand back their keys and close their surgeries for good.

"This is having a serious impact on many of our patients, who are waiting longer and longer to secure a GP appointment. But it also means we don't have the time we need with patients – particularly the growing number living with multiple, complex conditions – so the standard 10-minute appointment is simply unfit for purpose. GPs often find ourselves fire-fighting by prioritising the urgent cases, whereas the strength of general practice is to prevent disease and identify conditions in the early stages, to avoid them becoming more serious – and costlier to the health service.

"About a third of the GPs we surveyed said they were unlikely to be working in general practice in five years' time. This is gravely concerning. We are talking about highly-trained, highly-skilled doctors, that the NHS is at risk of losing – some will retire, which is to be expected, but many are planning to leave earlier than they otherwise would have done because of stress and the intense pressures they face on a day to day basis, whilst simply trying to do their best for their patients.

"These GPs are the ones we need to be focussing our energy on – to make their working situation safer and more sustainable.

"NHS England and Health Education England have done excellent work, supported by the RCGP and others, to encourage more doctors to specialise in general practice and we now have more GPs in training than ever before. But GP specialty-training takes three years, and if as many GPs are leaving the profession as entering it, we are fighting an uphill battle, when realistically we need thousands more.

"We need to see this level of effort replicated in initiatives to retain GPs already in the profession, to reduce our escalating and often unnecessary workload, and to support GPs and our teams' own health and wellbeing.

"The RCGP is calling for general practice to receive 11% of the overall NHS budget as part of the forthcoming 10-year plan for the NHS. Investing in general practice is investing in the entire NHS. It is an investment in good patient care."

College defends GPs against accusations they 'shunt' mental health patients on to police

Sir,

Her Majesty's Inspectorate for Constabulary Fire and Rescue Services really needs to check its facts (GPs dump mental health cases on us, complain police – November 27 2018). GPs and our teams have the greatest respect for our emergency services, and we collaborate with them on a daily basis, but to accuse hardworking family doctors of 'shunting' patients after closing our doors at 5pm is disgraceful, disappointing and demeaning.

Today alone, over 1m patients will visit their GP surgery, and dedicated GPs and their teams are working harder than ever to try and keep up with rising patient demand at a time when we also have a severe shortage of family doctors.

We are managing complex conditions in the community - including serious mental health issues - that even a decade ago would have been automatically referred to hospital consultants.

My members routinely report working over 12 hours every  day – indeed at my own surgery in Lichfield on Monday, I had over 100 patient contacts - so to say we close our doors at 5pm is completely untrue and unfair.

GP surgery core hours are 8.00-18:30 and all practices in England now offer extended routine services, whether in the evening until 20:00 or at weekends. Outside these hours, GP-led out of hours services will take responsibility for the care of our patients with urgent health needs.

Even when our doors are 'closed', we are still working on referrals, following up test results and all the tasks that were once part of our working day but now have to be done in our own time because we are constantly running to catch up.

Our emergency services are under enormous pressure, but so is general practice,  and we achieve more for our patients by supporting each other and working together, rather than using GPs as an easy target and apportioning inappropriate blame.

Professor Helen Stokes-Lampard, Chair
Royal College of General Practitioners
30 Euston Square
London, NW1 2FB

Increase in diagnostic tests is 'appropriate' given our growing and ageing population, says RCGP

She said: "GPs are in an incredibly difficult position when it comes to making referrals or ordering blood tests and other investigations, in that we get criticised when we do, and criticised when we don't. Ultimately, our priority is to our patients and we will work in their best interests.

"This research looks at the increase of number of requests for tests GPs make, but not the reasons why and whether they were appropriate – and both of those must be key when making a judgement about whether an increase is positive, or not.

"The fact that the last 15 years have seen more varied and more accurate diagnostic tests become available in the NHS is a good thing – but these do come at a cost. It's obviously important to consider NHS resources when deciding to make a request for a test, but GPs and their teams don't take the decision lightly, or if they don't think they will genuinely help in narrowing down what might be wrong with a patient.

"We're now serving a growing and ageing population, and where many patients are living with multi-morbidities, so, as this report shows, there will be a completely appropriate increase in the number of tests being carried out in the community as these conditions and the medications used to treat them are monitored. We would argue that GPs and our teams need far better access to diagnostic tests in the community, so that we can make a more informed decision about requesting more specialised tests or making a referral to a hospital colleague."

Upsides and downsides of drug-based medicine explored in new RCGP art exhibition

What Once Was Imagined (WOWI), named after a quote by William Blake, is the creation of long-time collaborators, textile artist Susie Freeman and Bristol-based GP, Dr Liz Lee – together known as Pharmacopoeia.

WOWI will feature 31 installations, many on display for the very first time and some created especially for the exhibition.

Each piece explores a different health issue, with some works relating to specific patients: Charlie and Lucy, for example, considers the latest gene therapy being used to treat cystic fibrosis, while Miss Essex is a giant handbag adorned with all the pills one woman hoarded during treatment for her mental health.

Many pieces are constructed using real medication and medical devices. For example, Larking About, a handbag decorated with long-acting reversible contraceptives known as LARCS, looks at changing trends in recommended contraception while others, such as Feast, a coat made from the packaging of all the food eaten on Christmas Day, addresses a culture of excess and lifestyle habits that can contribute to long-term health conditions.

The new pieces join two that are part of the RCGP's permanent collection, and already on display at 30 Euston Square: Jubilee, a wedding dress made of the number of contraceptive pills a woman could take during her married life, and Armour, made with the empty packets from medicines one of Dr Lee's patients took in the last five years of his life.

Some key pieces in the exhibition include:

  • Sonia: a cascading silver muslin coat covered in three years' worth of lupus medication packets. Lupus, an autoimmune disease once considered untreatable, attacks the body's immune system causing multi-organ failure: "taking so many pills is a burden, but it's saving Sonia's life,” says Dr Lee;
  • Steve's Scarf, is made from pills prescribed by Dr Lee to help manage her patient Steve's heart disease, arthritis and diabetes – a stark reminder of the UK-wide rise in patients living with multiple, chronic conditions as people live longer;
  • Wave: a depiction of Freeman's own experience of depression - a delicate stretch of blue fabric decorated with the packets of her own medication: "for some people it presents as 'black dog' but for me it was a deep blue," she explains;
  • Bristol Silver: a waterfall of pill packets for common conditions and chronic disease management, collected from one Bristol pharmacy over the course of a month;
  • WOWI flowers: a series of works depicting colourful flowers made from pills to treat myriad conditions from indigestion to tuberculosis.

Using an analogy of her own father to explain the concept of WOWI, Dr Lee, said: "My father, Dr Alan Baskerville Lee, was one of the first College members, and I have vivid childhood memories of him endlessly taking indigestion tablets.

"In the 1980s he tested positive for helicobacter; a bacterium associated with stomach ulcers. He took a one-week course of triple therapy: amoxicillin, metronidazole and omeprazole and his indigestion was cured.

"That's an extraordinary example of medical progress and how it has transformed the miserable symptom of indigestion for many millions of people."

On the other hand, Dr Lee acknowledges the downside of medication: "It can be a burden. I take statins and can't bear it, although I know it's for a reason. Every evening when I take the tablets it makes me feel old, it's a reminder of my mortality.

"GPs are acutely aware that we must be cautious about the medications our patients take. There is an important conversation to be had, and our patients need to be a part of it, about alternatives to medication, as well as what can be done to prevent people becoming sick in the first place."

Freeman added: "We often hear about how bad pills are for us, but modern medicine has worked wonders for millions of people and is the reason why so many of us are still here today.

"Many of the conditions showcased in our exhibition were once a death sentence, but now, thanks to these tiny tablets, people are living healthier and longer than ever once imagined."

Professor Mayur Lakhani, President of the Royal College of GPs, said: "It's an absolute honour to host WOWI at 30 Euston Square, the home of general practice and the headquarters of the RCGP.

"Pharmacopoeia is a unique blend of art and medicine, and WOWI explores several pertinent issues for general practice.

"It celebrates advances in medical research that mean our patients can live longer, and diseases that were once seen as a death sentence are now treatable. But it also explores emerging challenges facing medicine, such as overdiagnosis, and asks important questions such as 'are we simply prescribing too many pills?'

WOWI will be showing at the College from November 28 to May 2019 and is free to visit.

Wearable health gadgets must be reliable, safe, and equitable, says College

She said: "Technology has the potential to transform healthcare, and can play a key role in getting people more involved in their health, and living healthier lives.

"Devices can be used to incentivise walking a certain number of steps a day, for example, or for people living with long-term conditions, to monitor things like blood pressure.

"However, new technology and gadgets can be expensive, and we must be sure that if we are recommending certain devices to patients that we are sure of the reliability and evidence behind them, and that we are not leaving more socio-economically disadvantaged patients, or even just our less tech-savvy patients behind.

"It's also a reality that many patients might not understand how to interpret the data that their devices are feeding to them, and seek help from a healthcare profession to interpret it – in many cases this wouldn’t be a good use of GPs' scarce time.

"When we're talking about patients' data – collected via their technological devices – being used to target preventative health interventions to them, it is the case that the more detailed the data we have about patients, the better. But patients must also consent to it being used, and be completely clear what it may be used for - any interventions must also be handled sensitively, so as not to cause unnecessary alarm.

"Ultimately, any new innovation or way of working should be rigorously and consistently evaluated in terms of its benefit for patient, and its impact on general practice and the wider NHS – and we have called for a rapid evaluation system in order to do this."