27,000 NHS Patients at Risk of Losing GP Practice

Over 27,000 NHS patients run the risk of permanently losing their GP practices following an issue related to a private provider.

Greenbrook Healthcare has rejected a contract agreed with the healthcare authorities, due to the company deeming it to be unfit for purpose.

The provider is currently responsible for five practices in West London under one APMS contract, but is negotiating with NHS England regarding what it considers to be oversights in the contractual terms.

And Greenbrook has also sought additional funding that has not been forthcoming.

The company has now concluded that it must end it’s 10-year contract nine months early, with a view to enabling NHS England to “look at the contract afresh”.

Greenbrook had been contracted to oversee the Hounslow-based Bedfont Practice, Manor Practice, Great West Surgery, Heston Practice and the Isleworth and Grove Practice.

But the company suggested that a combination of increasing demand and GP recruitment issues has ensured that the contract is simply unfit for purpose.

“Demand has increased, and the national shortage of GPs has made finding GPs ever harder,” a spokesperson commented.

It is now expected that the contract will be re-tendered in the foreseeable future, with Greenbrook confirming that it will do all it can to mitigate any impact on patients.

“In the scenario that a new provider takes over these services Greenbrook Healthcare will do everything it can to keep the impact on patients to a minimum, and to ensure high quality patient care remains a focus through to the end of the contract and beyond. In addition, doctors, nurses and other staff would transfer to any new provider (under TUPE rules) minimising any changes that patients may experience.”

Additionally, the company claims that it has made considerable investment in the quality of care delivered in the practices under its jurisdiction, particularly pointing to having increased the opening hours of surgeries.

Greenbrook also noted that QOS scores and the quality of services proffered have improved under their management.

A spokesperson for NHS England (London) noted that the healthcare authorities will be working closely with patients.

“Greenbrook Healthcare has given nine months’ notice on their contracts in Hounslow and the contracts will now terminate at the end of June 2017. We will be communicating with all affected patients shortly to ensure that they have their say on the future of their GP services in the coming weeks. We are working to ensure that disruption is minimal and we want to reassure patients that we will do everything we can to find a solution that provides the best possible care for the local community.”

Greenbrook Healthcare took over the management of the practices from Hounslow Primary Care Trust in 2008.

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Hospitals Ignoring Contract Changes and Dumping Work on GPs Evidence Shows

A poll of doctors suggests that hospitals in the NHS are failing to pay heed to changes in standard contracts intended to prevent work being unreasonably dumped on GPs.

NHS England had published guidance to accompany the 2016/17 standard contract that was intended to ease the workload of doctors working within the NHS system.

Under the guidance, hospitals should refrain from enforcing surgeries to re-refer patients unnecessarily, or to prescribe medication on behalf of hospital doctors.

The changes to policy were aimed at ensuring hospitals issued discharge letters more promptly, and also in a convenient electronic form.

Yet the poll conducted by GPOnline suggests that this guidance is being largely ignored, with 72% of respondents indicating that hospitals continue to operate blanket policies discharging those who miss hospital appointments back into the GP system.

This has been specifically referenced to as poor conduct by NHS England, with guidance from the organisation tbeing that “hospitals will not be able to adopt blanket policies under which all patients who do not attend clinic are automatically discharged back to their GP”.

And only 2% of GPs responding to the poll indicated that trusts deal directly with discharge summaries within 24 hours, while 15% stated that hospitals do not send discharge summaries electronically.

A letter distributed by NHS England to CCGs and NHS trusts on 28th July already indicated that the organisation was well aware that guidance was effectively being ignored.

The letter highlights six new requirements for hospitals “introduced in the 2016/17 NHS standard contract to clarify the expectations across the hospital and general practice interface and reduce avoidable extra workload for GPs and help release time. It is important that they are fully implemented in a robust and timely way and we urge you to do this”.

GPC chairman Dr Chaand Nagpaul had spoken on the issue at the BMA annual representative meeting earlier this year, commenting that GPs were being treated unfairly by existing procedures in the NHS, and that this is leading to needless workload for already burdened professionals.

“The explicit wholesale transfer of care out of hospital continues unabated. GPs are absorbing this burgeoning workload, with 70m more patients seeing us annually compared to seven years ago and with fewer GPs per head, which is drowning our capacity to cope”.

An NHS England spokesman commented that regional healthcare organisations must enforce contractual provisions.

“Recent changes in the NHS standard contract set out clear legal requirements aimed at cutting the burden of bureaucracy on GPs, which is not good for local health services or patients. These changes must be driven at a local level by CCGs, working with their hospital colleagues. NHS England, together with NHS Improvement, has written to all NHS trusts, foundation trusts and CCGs to emphasise these requirements as we implement the support measures set out in the GP Forward View.”

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20% of London GP Surgeries Threatened by Cuts

Evidence indicates that over 20% of doctors surgeries in London are under threat over the next three years due to a combination of financial difficulties and crushing bureaucracy.

In addition, a shortage of family doctors and an increasing demand for appointments is causing massive logistical problems for the health service network.

A survey conducted with almost half the practices in the capital also shows that 40% are relying increasingly on temporary locum GPs, while one in eight is considering scaling back the services that they offer.

Only last week it was reported that the pay being afforded locum GPs is provoking financial problems in the health service.

And the information provided from this GP survey will surely only exacerbate the feelings of resentment often felt towards overpaid temporary staff.

Research among 644 surgeries, 48% of the 1,330 across the city, found that 19 (3%) – which care for 116,491 patients – definitely plan to close by 2019, and another 109 (17%), which between them have 802,384 patients, have not ruled out doing the same.

Michelle Drage, chief executive of Londonwide local medical committees, who commissioned ComRes to undertake the survey, commented that the findings were indicative of widespread problems for NHS GPs.

“These sad and distressing findings tell us that practices are under huge strain, to the point where they are making career-changing decisions to give up. These decisions will impact on patients, who hugely value the relationships with their GPs and the continuity of care they have had, perhaps from when they were born.”

The Royal College of GPs has already waded into the matter, describing the findings as an extremely worrying.

And the existing climate, in which the ongoing dispute over junior doctors’ contracts is becoming war-like according to some sources, certainly complicates the issue further.

Dr Maureen Baker, chair of the Royal College of GPs, asserted that the situation with GP services in London is particularly worrying, but perhaps indicative of brother trends across the country as a whole.

“These figures are extremely worrying, but they are only the tip of the iceberg of what is happening right across the country. Decisions to close practices are always a last resort and, wherever possible, every effort will be made to ensure that patients are transferred to a nearby practice with minimal disruption.”

Baker added that the situation will only get worse due to a pincer movement of doctors both approaching retirement age and others considering leaving the professional due to workload pressures and contractual disputes.

“Unfortunately, the shortage of GPs across the UK is now so severe that some practices have no alternative but to close because there are not enough doctors, nurses and other support staff to provide safe care.”

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Think Tank Research Suggests that NHS GPs are Uniquely Stressed

New data indicates that the NHS has the most stressed GPs in the Western world.

A combination of relentless workloads, coupled with bureaucracy and logistical problems, results in the shortest amount of time spent with patients.

The research was conducted by the Commonwealth Fund; widely considered to be one of the most influential think tanks in the world in any industry.

Data from the study indicated that the stress levels among British GPs are so high that almost 30% plan to quit in the next five years.

It is also thought that new pension regulations will have a significant influence over this number.

The knock-on effect of this issue is that patients will find it increasingly difficult to acquire an appropriate appointment.

And the growing pressures on family doctors in the NHS are such that over 20% have become ill in the last 12 months.

Just under six in 10 GPs (59%) find their work stressful, with 39% of these saying it is very stressful and 20% extremely stressful.

Researchers surveyed 11,547 GPs in 11 countries, including France, Germany and the United States.

Commenting on the issue, Dr Jennifer Dixon, chief executive of the UK-based Health Foundation thinktank, which assisted with the study, suggested that the level of stress in the NHS should be considered as serious as the many other problems facing the health service.

“These worrying findings reveal the scale of the challenge facing general practice. The survey suggests that UK GPs’ unhappiness may be driven by their spending less time with patients than they would like. The relentless appointment treadmill experienced by UK GPs is in stark contrast to that reported by their peers overseas.”

Jeremy Hunt, the health secretary, had pledged in 2015 it to recruit 5,000 additional GPs, yet refused to comment on the findings of this study.

At the time Hunt had stated that “general practice is the jewel in the crown of the NHS and central to the future of the health service.”

Prof Nigel Mathers, the honorary secretary of the Royal College of GPs, was firm in his assertion that excessive stress levels can ultimately lead to poor performance and potentially life-threatening mistakes being made.

“Such high levels of stress amongst GPs in the UK compared to other countries is bad news for the NHS and for our patients, as growing numbers of family doctors are becoming dissatisfied with their working circumstances and consider leaving the profession.”

It seems that in the existing NHS culture that ministers and the Department of Health should prioritise efforts to relieve the growing pressures on doctors.

Additionally, any attempts to increase the workforce working in general practice would obviously be valuable.

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New Targets Set for NHS Cancer Referrals

As the NHS continues its fight against the deadly killer cancer, the health service intends to introduce a new target related to the condition.

MPs have set this deadline at four weeks from GP referral.

The NHS will implement this new cancer target with the intention of ensuring that patients are provided with a definitive diagnosis or the all-clear more rapidly.

According to the Health Secretary, Jeremy Hunt, the NHS has a fundamental duty to ensure that the period of uncertainty for potential cancer sufferers is as short as possible.

Hunt set a success rate for the new policy of 95 per cent, with the intention of ensuring that the new referral system between GPs and cancer referrals is significantly improved.

The new targets are the result of a joint NHS England and Cancer Research UK task force, witch recommended the measures to be implemented across the UK.

Research conducted by the task force earlier this year purports to provide evidence on how the NHS can speed up cancer diagnosis in the future.

By implementing the recommendations of the task force it is suggested that the chances are successful treatment will be significantly improved, which could have a knock-on effect of saving thousands of lives annually.

Figures estimated by the department indicate that the new approach to cancer diagnoses could save as many as 11,000 lives a year.

The government has set a target of five years for the successful actualisation of the policy. Although there is some scepticism about the logistical feasibility of this scheme, the Department of Health has attempted to address with strong fiscal measures.

In response to critics, the Department of Health has already stated that funding related to cancer diagnosis would be allocated from the £8 billion annual increase promised to the NHS in the remaining years of this decade.

A key aspect of the Department of Health vision is the training of 200 extra staff. These newly tooled-up employees will then be employed in the operation of endoscopies.

This central pillar of the cancer policy is a response to recent assertions made by Cancer Research UK.

The charity highlighted a shortage of endoscopy staff, with other cancer diagnosticians also in short supply.

It is proposed by the government that the increase in endoscopy staff would enable 500,000 digestive tract examinations to be conducted yearly by 2020.

In addition, the government also plans to treat cancers genetically on a much wider basis, with the hope of identifying more individualised treatments.

Thousands more patients will have their cancers genetically tested to identify potential individualised treatments under the proposed plans.

Commenting on the cancer plans within the National Health Service, Health Secretary Hunt proclaimed the government policy to be a step in the right direction.

“For people who are worried they may have cancer, waiting for that all important test result is a nerve-wracking time. We have a duty to make sure this period of uncertainty is as short as possible.

“For those who get the all-clear, they will have peace of mind sooner. Those who sadly have cancer will get treatment much quicker and we will save thousands of lives as a result.”

Bowel cancer fluctuates between being the second and third most common cancer in the UK.

In 2010, the incidence rate for bowel cancer was 58 new cases per 100,000 men, and 38 new cases per 100,000 women. This equates to just under 19,000 newly diagnosed cases in men, and just over 15,000 in women.

It is estimated that one in 14 men and one in 19 women will develop bowel cancer at some point in their lives.

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‘Slash red tape’ say GPs in new BMA survey

GPs are calling for cuts in red tape to free up more time for patient care according to a BMA survey published today.

The survey found that more than half of GPs – those with unmanageable workloads in particular – want a reduction in the size of the quality and outcomes framework (QOF).

The survey also found that: (i) just under three-quarters (73 percent) of GPs support the continuation of a national GMS (general medical services) contract; (ii) 47 percent support having the option of a local PMS (personal medical services) contract; (iii) four in five GPs support keeping the option of independent contractor status; and (v) a third of GPs say their practice has joined a network or federation, and 52 per cent feel these models are the best way to develop general practice in their local area.

“GPs struggling with unmanageable levels of workload want to reduce any unnecessary bureaucracy and box-ticking to a minimum”, said BMA GPs committee deputy chair Richard Vautrey. “In consultations that are increasingly pressured for time, GPs want to focus primarily on the needs identified by the patient in front of them, not the prompts to gather more data for the computer.

“GPs working in rural areas are more likely to have stable practice populations and are less likely to feel that repeated annual health checks prompted by QOF for patients with stable conditions are always necessary.”

The survey results are available on the BMA website.

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Heavy workload having “negative impact” on patient care say GPs

More than 15,500 UK GPs believe their heavy workload is having a “negative impact” on the quality of patient care according to a British Medical Association (BMA) survey published today.

“This poll highlights that GPs’ ability to care for patients is being seriously undermined by escalating workload, inadequate resourcing and unnecessary paperwork”, said BMA GPs committee chair Chaand Nagpaul.

“Many GPs do not feel they have enough time to spend with their patients and that these intense pressures are beginning to damage patient care. We need politicians of all parties to stop playing games with the NHS by making glib promises to voters which ignore the reality that many GP practices are close to breaking point.”

The survey also shows: (i) two thirds of GPs – 67 per cent – feel there should be longer consultations for certain patients, such as those with long-term conditions; (ii) one in four feel that all patients need increased time with their GPs; (iii) almost six out of 10 GPs working in out-of-hours services – 56 per cent – feel that their workload is having a detrimental effect on the care they provide; (iv) GPs believe increased funding, longer consultation times, an increase in GP numbers and a reduction in bureaucracy are the solutions to improving the overall care patients receive from general practice; and (v) more than half of GPs feel practices should offer some form of extended hours, particularly by working in networks. However, 94 per cent of GPs do not feel they can offer seven-day opening.

Dr Nagpaul added: “The results also highlight that, while the majority of GPs support properly funded and resourced extended hours, they question the benefit to patients of a politically driven demand to open all practices seven days a week.”

The BMA survey can be accessed on the BMA website.

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Doctors leaders demand greater resources for GPs

Politicians and NHS managers must ensure ‘overstretched and underfunded’ GP services are properly resourced, say doctors leaders.

Referring to figures in a Health and Social Care Information Centre (HSCIC) report which show details of NHS payments made to general practices in 2013-14, BMA GPs committee chair Chaand Nagpaul said that they show how good value general practice is for the NHS but warns that GPs are “finding it increasingly difficult to make funding meet demands.”

The HSCIC figures show that more than £7.6bn was paid to 8,060 practices in 2013-14 and covered a range of costs, such as premises, staffing costs and services to patients.

Dr Nagpaul continued: “Politicians and NHS managers need to focus their energy on ensuring overstretched and underfunded GP services get the resources they need to deliver enough appointments and services to their patients.”

The BMA GPs committee chair said the payments funded unlimited patient access to GP appointments — on average more than six visits per year — as well as: (i) home visits; (ii) care for housebound, vulnerable patients; (iii) immunisation programmes; (iv) cervical screening; and (v) chronic disease management.

According to the figures, registered patients at practices in England cost the NHS on average £136 each per year. Dr Nagpaul said this proved GP services were delivering “comprehensive” care for patients over a whole year.

The HSCIC report is available here.

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