This page shows a summary of the latest news from the Royal College of General Practice RSS News Feed.Ghost patients 'nothing sinister' – and the insinuation GPs are complicit in fraud is 'shocking’, says RCGP
"The insinuation that GPs – some of the most trusted professionals in society - are complicit in defrauding the health service is shocking and will be incredibly hurtful for hard-working GPs and their teams who are struggling to deliver care to more than a million patients a day across the country, with insufficient time, resources or workforce to do so.
"It is, of course, important to make sure that patient lists are kept as up-to-date as possible, so that resources are used where they are most needed – and our administrative staff already spend a lot of time processing patients' notes when we are informed that they have died, left the surgery or moved elsewhere.
"But so-called ‘ghost patients’ are nothing sinister - they are the result of a records management issue, not a case of surgeries deliberately profiting by keeping patients on their lists when they shouldn't be there.
"People's circumstances, and therefore, our records, change all the time. Some practices, particularly in inner-city areas, have quite a high rate of turnover, and patients don't always tell us if they are moving on. It’s just an inevitable consequence of having a list in the first place.
"It's also important that whilst we work to ensure patients who shouldn’t be on the list are ‘removed’, it’s equally important to make sure those who should be there are protected and not taken off without good reason, or before notifying them beforehand.
"We appreciate that it is NHS England's responsibility to review patient lists and put the appropriate measures in place to ensure that methods of doing this are safe. But to publicise that they are getting their in-house ‘fraud squad’ involved, as well as outsourcing the task to a company that many healthcare professionals across the country have little faith in to do a good and fair job, is demoralising for GPs and a questionable use of scant NHS resources."
She said: "Exercise can have a hugely positive impact on our physical and mental health, so making it easier for people to be more active as part of their daily routine – both at work and in their leisure time - is key to helping patients live a long and healthy life.
"This new quality standard from NICE offers useful advice for professionals and commissioners across society – and for employers, it includes pragmatic suggestions that can be tailored to workplaces of different sizes and with varying resources available. We would urge employers to seek to swiftly implement the recommendations in some capacity as ultimately, a healthy workforce will be a more productive, and hopefully happier one.
"Physical Activity and Lifestyle is a clinical priority for the RCGP and we have developed resources to support GPs and other healthcare professionals to encourage their patients to live healthier lifestyles. We will soon launch our own scheme to tackle sedentary behaviour in the workplace, which should complement NICE's new quality standard."
It will look at the impact of physical injury and associated mental health issues on veterans – and the impact on their families – bringing together GPs and the wide range of health professionals 'under one roof' for clinical conversations on the care of those leaving the Armed Forces community.
Critically, it will be an opportunity to network with veterans themselves who will talk about their own experiences. It will also showcase the College's 'veteran friendly' GP practices initiative, supporting GPs and their teams so that patients who are veterans of the armed forces and their families get access to targeted care where appropriate.
The event is being supported by the Ministry of Defence and NHS England and NHS Improvement and will feature a video message from Veterans Minister Tobias Ellwood highlighting the importance of good quality care for veterans and their families, and what is being done at Government level to support those returning to civilian life after serving in the armed forces. Kate Davies CBE, NHS England and NHS Improvement Director for Armed Forces Health will also speak about what the NHS has done and is continuing to do to support the military community.
There are around 2.6 million veterans in Great Britain, and 18,000 service people move back into civilian life every year, including 2,000 who leave the armed forces on medical grounds.
The event will look at the links between physical and mental health, especially in the treatment of chronic pain, and how to provide services that will accommodate the different health needs of 'different'generations of veterans – World War 2 era, Falklands and Northern Ireland age groups and former Yugoslavia, Iraq and Afghanistan.
Dr Jonathan Leach, Joint Honorary Secretary for the RCGP, said: "Our veterans have differing and complex injuries as a result of their military service and they may need targeted advice, treatment and support: This forum will reflect the importance of the relationship between patient, GP and specialists across the NHS pathway.
"GPs want to do the very best for all our patients, but one of the challenges we face in general practice is that we are not always aware of how many veterans we have on our practice lists, especially when patients choose not to divulge their veteran status.
"This event will support family doctors and other health professionals in becoming more aware of the needs of their patients who are armed forces veterans, and make sure that healthcare professionals are aware of the various referral pathways to specialist help, including Veterans Trauma Network and Veterans' Mental Health Transition, Intervention and Liaison (TIL) Service.
"These people have served our country, often the detriment of their own health and the stability of their family life. We owe them a great deal, not least in making sure that they have access to high quality NHS care and services."
The important event is part of ongoing activity to improve the care and treatment of veterans. This includes the recent distribution of a comprehensive package of resources for GPs covering how to identify veterans and make sure their service is recognised by hospitals and other services, as well as how to access mental and physical health care tailored to their needs.
The call comes as RCGP Scotland launches a new report, From the Frontline [PDF], which draws on feedback from GPs across Scotland and their thoughts and experiences within the profession.
RCGP Scotland Chair, Dr Carey Lunan, said:
"General practice is at the frontline of the NHS, playing a crucial role in providing care to patients in the heart of communities across Scotland. GPs tell us that workload pressures, rising patient demand and underinvestment in general practice are having a significant impact on them and their patients.
"Nearly forty percent of GPs report that they feel so overwhelmed by their daily tasks that they feel they cannot cope at least once per week. A quarter also report that they are unlikely to be working in general practice in five years' time.
"General practice is the backbone of a sustainable NHS. Our patients deserve better and it is time to renew general practice in Scotland. We are calling on Scottish Government to commit to urgently bolster the GP workforce and increase the level of spending in general practice to 11% of the overall Scottish NHS budget. Taking these steps will help ensure that general practice is able to provide high quality patient care that meets the current, and future, needs of patients in Scotland. This is fundamental to meeting the Scottish Government's own aim of delivering more healthcare at home, or in a homely setting.
"With an increase to 11% of the NHS budget, additional GP funding would flow to the areas of highest patient need. This will help to tackle the root causes of health inequalities, improve GP recruitment into areas of deprivation which traditionally struggle to attract GPs, and reduce pressure on vital hospital services."
Also welcoming the new report, Dr Andrew Buist, Chair of BMA Scotland's General Practitioners Committee, said:
"General Practitioners work tirelessly to ensure that their communities are living healthy lives, and even against the backdrop of underinvestment in healthcare, rising patient demand, and increased workload, they do a sterling job.
"They are the first line of defence for our country against ill-health, and they need more support in tackling health inequalities. This report underlines why addressing GP workload, which has in recent years reached unsustainable levels, is so vital if we are to protect and grow GP numbers. That has been the BMA's priority in negotiating the new GP contract and now it is essential that the promises made to GPs on additional staff and services are delivered by health boards and the Scottish Government."
From the Frontline is accompanied by a new campaign from RCGP Scotland called #RenewGP. In addition to calling for 11% of the Scottish NHS budget to make Scottish general practice fit for the future, the campaign identifies six key calls:
- Provide time to care. GPs must be given the time they need to care for their patients. 10-minute appointments do not work for an increasing number of patients or GPs. Minimum 15-minute appointments as standard would enable patients to have more choice over their care, especially when they have multiple conditions. This would be achieved only by the introduction of more GPs into the system in Scotland.
- Safeguard the future of the NHS in Scotland. We need a National Conversation, led jointly by politicians, healthcare professionals and patients, to promote sustainable use of the NHS and safeguard its future.
- Tackle health inequalities. GPs serving areas with high socio-economic deprivation should be appropriately resourced to ensure that the NHS is at its best where patients need it most. This will be possible when 11% of the Scottish NHS budget is allocated to general practice.
- Planning for the future workforce: As our population lives longer with more long-term conditions, Scotland needs more GP capacity to build and lead our community healthcare teams. In order to accurately assess and plan the workforce needs for Scotland's future, the Scottish Government must collect figures and report on Whole Time Equivalent GPs, not simple headcount figures, so that workforce plans of the future are accurately and reliably informed.
- Improve healthcare systems for the benefit of patients and GPs. Urgent investment in IT is required to ensure that systems work more effectively together, improving reliability for clinicians and patients.
- Promote Scottish general practice to a new generation of doctors. Investment is required to enable 25% of the undergraduate medical school curriculum to be delivered in primary care.
Reflecting on the new campaign, Dr Lunan said:
"General practice in Scotland needs to be properly funded if it is to continue to provide the high-quality care that meets the current, and future, needs of patients. We have identified key areas where improvement needs to happen and will continue to work with colleagues in Scottish Government, BMA Scotland and the NHS to ensure the best outcomes for both patients and GPs."
She said: "Some sexually transmitted infections (STIs) can have life-changing consequences for patients if not identified and treated early, so it's deeply concerning to see a rise in the number of STIs in England.
"Some of this rise may be due to better and more vigilant STI testing, which is good, but it is also likely, as the report notes, that more people are practising unsafe sex, or not using contraception correctly.
"It's important that patients never feel embarrassed to seek help if they think they have an STI or if they want to discuss contraception as GPs and healthcare professionals working at sexual health clinics are highly-trained to have open, non-judgemental conversations about a wide variety of problems and the best way forward.
"But today's report also highlights some dire consequences of cuts to sexual and reproductive health services in England – and the fragmented way in which they are commissioned, meaning that access to these vital services is difficult and confusing. There is a currently a postcode lottery in the UK on whether comprehensive sexual health services are available. The consistent cuts to local and public health budgets are putting some of the most vulnerable patients at risk, when their service closes and they cannot find another.
"Sexual and reproductive health services are too important to be allowed to fall into decline – as well as being essential for patients, they are some of the most cost-effective health interventions in the NHS, potentially saving millions through prevention of unwanted pregnancies and transmission of STIs, as well as helping women control their fertility and therefore, their lives.
"This is something we have highlighted in our Time to Act report, and more recently in our joint statement with the Royal College of Obstetricians and Gynaecologists and Faculty of Sexual and Reproductive Health on streamlining commissioning for these services. We will continue our work to ensure all of our patients have easy access to and receive the best possible sexual and reproductive health care."
"We welcome the focus on retaining existing, experienced GPs in the workforce, and appreciate the commitment in today's plan to address barriers to this, such as current pensions rules, and on making the NHS a workplace that people want to work in.
"We also know that providing appropriate support to GPs in the first few years after training is vital to keeping them in the workforce, so we welcome the concept of a two-year primary care fellowship scheme and look forward to more details as to how it will be delivered and funded.
"In general practice, increasing retention will furthermore be contingent on tackling GP workload and making our roles sustainable, so that hard-working GPs stay in work longer, and we can truly deliver the safe care our patients deserve.
"There is clearly still lot of work to be done over the coming months to flesh out the details in this plan. We are pleased to see that the report already acknowledges Fit for the Future – the College's vision for the future of general practice – and look forward to working with NHSE&I as to how our recommendations can be implemented.
"Whatever the next iteration of the plan looks like, it's essential that the forthcoming Spending Review ensures there is sufficient funding to deliver it.
"Training capacity in primary care must be developed, and the funding must be provided so that hard-pressed GPs have the time, resources and suitable premises to deliver the training for the future generations of GPs and the wider team.
"To this end, we have written to Health and Social Care Secretary Matt Hancock outlining the current unfairness in the way undergraduate GP placements are funded compared to secondary care placements and made clear that this must be addressed urgently.
"GPs and our teams deliver the vast majority of patient care in the NHS, and in doing so we keep the rest of the NHS sustainable, and we keep patients safe. This must be at the forefront of decision-makers' minds as this interim plan is developed."
She will take over the post from Professor Mayur Lakhani, who will demit office at the College's Annual General Meeting in November, after completing his two-year term.
The RCGP President is the constitutional head of the College. Unlike the other Medical Royal Colleges, it is the Chair who sets the strategic direction and policy. The current RCGP Chair of Council is Professor Helen Stokes-Lampard.
The role was contested by seven College members: Professor Rodger Charlton; Dr John Chisholm; Dr Sunil Gupta; Professor Amanda Howe; Professor Roger Jones; Dr Imran Rafi; and Dr Carter Singh.
Professor Howe is Immediate past-President of the World Organisation of Family Doctors (WONCA), and is Professor of Primary Care at the University of East Anglia and RCGP East Anglia Faculty Provost. She has previously served as RCGP Vice Chair for Professional Development and Honorary Secretary.
She will serve a two-year term from November 2019 until November 2021."
Election results for six Nationally-Elected Council Member candidates have also been announced. The successful candidates are:
- Dr Kirsty Alexander
- Dr Lucy Henshall
- Dr Abrar Ibrahim
- Dr Margaret McCartney
- Dr Imran Rafi
- Dr Catherine Tichler
Nineteen candidates stood for election. The successful candidates will begin their three-year terms of office from the College's governing Council meeting in November 2019.
RCGP Chief Operating Officer and College Returning Officer Dr Valerie Vaughan-Dick said: "Congratulations to Amanda, and many thanks to the other six candidates who stood for the role of RCGP President. It was a truly fair and open contest.
"Amanda brings a wealth of experience of the College, academic primary care and frontline general practice. We very much look forward to working with her."
The elections were conducted officially and independently by Electoral Reform Services (ERS). Turnout was 14% of College Membership with the eligibility to vote.
She said: "These figures are sad but, unfortunately, not surprising. GPs and our teams are working to our absolute limits to provide safe, high-quality care, while general practice is under intense pressure, and this is resulting in some GPs leaving the profession, and in other cases forcing them to close their surgery doors.
"In some areas, practice closures are the result of surgeries merging or joining federations in order to pool their resources and provide additional services in the best interests of their patient population. But when a practice closes because resource and workforce pressures mean that it is no longer safe or sustainable to keep running, it's incredibly serious – and heart-breaking for everyone involved, especially those patients who have to travel long distances to their new surgery and get to know new teams, which is particularly difficult for the more vulnerable members of our communities and those who rely on public transport.
"The last thing that GP and our teams want to do is close their premises, and it will only be considered once every other alternative has been ruled out.
"Further closures must be avoided wherever possible. That's why we need to see the promises made in the NHS Long-Term Plan delivered as a matter of urgency, to ensure general practice has the people, resources, and investment we desperately need to continue providing world-class patient care, both now and in the future."
She said: "It's encouraging to see a rise in full-time equivalent GPs over the last quarter – and an even more pronounced rise in members of the wider practice team – but the reality is that we still have fewer GPs in practice than we did a year ago, despite our workload continuing to escalate.
"A lot of hard work has gone into boosting recruitment into general practice and as a result, we have more GPs in training than ever before. But it takes at least 10 years to train a family doctor from entering medical school, and we need more GPs now.
"If more GPs are leaving the profession than entering it, we are fighting a losing battle. We need to see initiatives being implemented to help retain our existing, experienced workforce and key to that will be addressing workload to make working in general practice more sustainable.
"Expanding the wider practice team is an important element of this, and something that features heavily in Fit for the Future – the College's vision for general practice – so it's great that overall numbers of these roles are increasing, but they must not be seen as substitutes for GPs, and numbers of some of our colleagues in vital roles, such as practice nurses, also continue to struggle.
"The government promised in the GP Forward View that we would see 5,000 more GPs by 2020, as well as 5,000 more members of the wider practice team. While the latter has been exceeded, and it’s imperative we keep this momentum up, it is the number of GPs that we remain desperately short of and without resolving this we will struggle to continue providing the world-class care our patients expect and deserve.
"Being a GP can be the best job in the world – it's intellectually stimulating, hugely varied, and rewarding – but we need to make it a more attractive career option for those who, because of the pressures, feel disenchanted, as well as doctors who have already taken the decision to leave.
"NHS Improvement's interim workforce strategy needs to include comprehensive plans to further boost GP recruitment, make it easier for trained GPs to return to NHS practice, and to keep existing GPs in the profession longer – as well as initiatives to expand the multi-disciplinary team in general practice."
She said: “The College has long been campaigning for GPs to be added to the Shortage Occupation List (SOL), so we’re delighted to see that this is now being recommended by the Migration Advisory Committee, along with the inclusion of all other medical professionals, that are desperately needed in the NHS.
“GP workload is escalating both in terms of volume and complexity, but GP numbers are falling and whilst we currently have more family doctors in training than ever before, it takes at least 10 years to train a GP and we simply cannot wait that long.
“We welcome any GP - or other medical professional - from the EU or further afield who wants to work in UK general practice, as long as they meet the rigorous standards set by the College, General Medical Council and other bodies to ensure safe clinical practice, to contribute to delivering care to more than a million patients a day.
“Indeed, thousands of overseas GPs and members of our wider practice teams already work in NHS general practice, and we are incredibly grateful for their skills and expertise.
“Making it easier for appropriately trained medical professionals to come to the UK and work here is imperative to the future of our workforce and profession, and we hope our long-fought addition to the SOL will help make the process simpler and more straightforward.
“The NHS long-term plan has aspirations that will be good for patient care, but we will need the workforce to deliver it and adding medical professionals, including GPs, to the SOL is an important step to achieving this, so it’s vital that the government implements this recommendation.
“We now await the NHS People Plan for details of further initiatives to recruit more GPs, retain the existing workforce and make it easier for trained family doctors to return to practice after a career break or period working abroad – as well as plans to build the wider general practice workforce.”