LMC Email update Part 2 - February 2015
Date sent: Tuesday 24 February 2015
LMC EMAIL UPDATE - Part 2, February 2015
It will come as no surprise to anyone reading this email that with less than 100 days to go before a general election the subject of the NHS has become a focus of political discussion.
We should be celebrating the successes of the most cost effective healthcare system in the Western World. This is the assessment of the Commonwealth Fund, an independent organisation based in the USA that assesses many aspects of health and social care in the OECD countries.
Link to Commonwealth Fund Report - "Mirror, Mirror on the Wall"
It is interesting to note that despite the significant additional investment the NHS received during the period 1996 – 2007 the UK still spends less that half the £/capita that the US does and 20-25% less/capita than France and Germany. In fact the only OECD country that spends less/capita is New Zealand - this is probably explained by their age sex profile.
This does not mean we should be complacent. The NHS can deliver better quality care and improved outcomes but that requires increased resources and reduced bureaucracy.
- GP Workload
- The BMA's "No More Games" Campaign
- Personal Independence Payment (PIP) and Disability Living Allowance (DLA) Claimants
- CQC Guidance
- GP Networks
- Potentially Avoidable Appointments
- Sessional GPs Newsletter
- Antibiotic Resistance
1. GP Workload
All GPs report that their workload has increased over the last few years. This is supported by the data that shows GPs are currently conducting over 340,000,000 consultations per year, an increase from 240,000,000 in 2007.
Every practice I speak to works harder than every other practice and they have the most demanding and challenging patients. So if we take that as a given, are you aware how your workload compares to others?
This week the GPC of Northern Ireland published some workload data which I am sure you will be interested in.
This looks at data for 2013/4 compared to 2003/4:-
1. Consultation rate: 6.6/patient/year - increased by 63%
2. Acute prescriptions rate: 5.43/patient/year - increased by 28%
3. Repeat prescription rate: 12.27/patient/year - increased by 41%
4. Lab tests: 3.65 /patient/year - increased by 216%
5. Admin work: 5.01 tasks/patient/year - increased by 115%
6. Incoming mail: 11.3/patient/year
7. Total patient contacts: 25.8 /patient/year - increased by 66%
This would mean, on an average day, a GP would expect to have:
- 47 consultations (inc home visits and telephone consultations),
- deal with 35 lab results, and
- "sign" 172 prescriptions.
This may explain the problem we are facing.
What is also clear is that general practice is barely coping with the workload today and there is no capacity to cope with the sort of increases that have been seen over the last 10 years in Northern Ireland.
2. The BMA’s" No More Games" Campaign
This week, the BMA has launched its ‘No More Games’ campaign calling on all political parties to stop playing games with the NHS, focusing on three areas:
- No More Games with the public’s health,
- No More Games with NHS funding, and
- No More Games with who is providing healthcare.
The NHS is one of the UK’s towering achievements and for too long it’s been used to play political games. The BMA believes this must end now and is calling for an open and honest public debate about the future of the NHS. The BMA has not run a major public campaign for some years. The fact that we’re doing so now shows how strongly BMA members feel about what’s happening to the NHS.
Most BMA members work in the NHS. Decades of political game playing, including successive disruptive and wasteful re-organisations, have taken their toll on the health service. The Punch and Judy politics over the NHS have a direct impact on the care which doctors can provide to patients, as well as on doctors’ morale.
These games have been played by politicians across the political spectrum for short-term gains over decades. In the run-up to a general election and at a critical juncture for the health service, the BMA is calling for all members and doctors to help get the message heard by adding their voices and saying "No More Games" with the NHS.
The launch of the campaign was received extensive news coverage and there has been widespread billboard advertising. A programme of further activity is planned over the coming months.
The GPC is fully supportive of the campaign and urges GPs to get involved and add their voices to the campaign. Full details of how to get involved and campaign materials to download are available on the BMA’s website.
3. Personal Independence Payment (PIP) and Disability Living Allowance (DLA) Claimants
From 23 February 2015 the DWP will extend the areas in which existing Disability Living Allowance (DLA) claimants will start to be reassessed for Personal Independence Payment (PIP).
From that date the DWP will further extend the rollout of PIP natural reassessment to some DLA claimants living in the postcode areas beginning AB (Aberdeen), BB (Blackburn), BD (Bradford), DD (Dundee), DN (Doncaster), EX (Exeter), HX (Halifax), KA (Kilmarnock), KY (Kirkcaldy), LS (Leeds), PH (Perth), PL (Plymouth), PO (Portsmouth), PR (Preston), S (Sheffield), SO (Southampton), TS (Cleveland) and WF (Wakefield) where:
- an existing DLA claimant’s fixed term award is coming to an end, or
- they are approaching age 16, or
- the DWPs receive information about a change in their care or mobility needs, or
- an individual chooses to claim PIP instead of their DLA.
The DWP has said consistently that it would take a controlled approach to the introduction of PIP, including the reassessment of existing DLA claimants, continuously learning lessons from live running. In the areas chosen to extend the natural reassessment rollout, the assessment provider has sufficient local capacity to handle the increased volumes.
Extending rollout in this gradual way ensures that the DWP can continue to focus on reducing delays and improving the service to claimants. DWP will continue to monitor progress before making any decisions on extending natural reassessment further.
Existing DLA claimants who have a lifetime or indefinite DLA award will not be affected until at least October 2015, unless the DWP receives information about a change in their condition that would affect their rate of payment or if they reach the age of 16.
4. CQC Guidance
GPC has issued two separate pieces of guidance on the CQC registration and inspection procedure and these are available on the BMA website:
There will be additional detailed guidance on how to prepare for and deal with a CQC inspection, which will be available on the BMA website shortly.
5. GP Networks
The GPC is continuing actively to engage in the topic of GP networks (also known as GP federations).
As a part of that programme of activity, the GPC recently launched guidance covering the different legal forms that GP networks can adopt. The guidance is available on the BMA website.
Additional guidance, including work covering key steps to setting up a GP network, is currently being developed and will be launched soon.
6. Potentially Avoidable Appointments
The Primary Care Foundation has been commissioned by NHS England to look at ways of reducing GP practice workload. They are carrying out an audit of avoidable GP appointments, as well as a survey on reducing bureaucracy.
They need a better response rate from practices and the LMC encourages practices to carry out this short audit, since the data will provide much needed information in objectifying the scale of inappropriate appointment demands on practices.
Please see the Primary Care Foundation website for more information on the audit tool and to access a paper or spreadsheet version. Completion of the tool could be included within personal development plans.
7. Sessional GPs Newsletter
The monthly e-newsletter for sessional GPs was sent out yesterday afternoon. It focuses on the findings from our recent appraisal and revalidation survey.
The newsletter is available on the BMA website.
8. Antibiotic Resistance
This topic is reported on a regular basis and the blame for prescribing 90% of all antibiotics is usually laid at the door of GPs.
This, of course, is associated with the fact that GPs clearly do not see any really ill patients because we send all of these to hospital. Is that a fair or balanced view?
Of course it isn’t, but could we prescribe fewer antibiotics? The answer is probably "yes" for most of us.
It is interesting to note that over 50% of all antibiotics are use in farming, to combat the increased risk of disease associated with intensive farming. Perhaps this is an area that should also be addressed.
Public Health England published guidance called "Managing common infections: guidance for primary care" and this was updated in November 2014.
The RCGP produced an antibiotic toolkit that is very helpful and can be found on the RCGP website.
There are some very useful tools to help practices including:
- Leaflets for patients
- Audit toolkit
- Training resources
- Posters, self care leaflets, video for waiting room
Wessex is a very important part of the country in terms of antibiotics for three reasons:
1. Sir Edward Abraham
Edward Abrahams is probably not well known to many, but he was a biochemist who was born in Shirley in Southampton and was educated at King Edwards School in Southampton.
He was part of the team of scientists that developed penicillin and its medical applications. He then went on to develop cephalosporins.
His legacy included a Trust which has made significant donations to King Edwards School which has benefited the children of many GPs locally.
2. Professor Paul Little
Paul is the professor of primary care research based in Southampton. He is one of the most respected primary care researchers in the country and has published many papers on common self limiting illnesses including sore throat, otitis media etc.
His work is frequently referenced when there are discussions about the use of antibiotics in general practice.
Link to Professor Paul Little
3. Antibiotic Guidelines
Locally some excellent guidelines have been produced for primary care. These have been distributed in hardback form but are also available for iPad, iPhone and android.
Declaration of interest: I was involved in the development group for the guidelines.
Link to the Hampshire and Isle of Wight antibiotic guidelines:
Dr Nigel Watson
Churchill House, 122-124 Hursley Road
Hampshire SO53 1JB
Tel. No. 023 8025 3874
Mobile: 07825 173326