Category: GPs

The state of medical education and practice in the UK

The workforce report 2022

Source: The King’s Fund Health Management and Policy Alert

This report finds that the number of doctors joining the workforce overall has grown by around 17 per cent over the past five years, but that growth is not consistent. It varies considerably between different groups of doctors, leaving a shortfall in primary care that puts at risk patients’ ability to access GP services. The number of specialty and associate specialty (SAS) and locally employed (LE) doctors on the GMC register has increased at six times the rate of GPs, largely driven by doctors coming from overseas. Current rules actively prevent these doctors from working in areas such as primary care, and the GMC is proposing the government change the Performers List criteria to allow more doctors to work in general practice.

The Health Foundation’s Networked Data Lab

Improving children and young people’s mental health services: local data insights from England, Scotland and Wales

This briefing presents analysis from The Health Foundation’s Networked Data Lab (NDL) about children and young people’s mental health. The analysis from local teams across England, Scotland and Wales has highlighted three key areas for urgent investigation, to help ensure children and young people get the care they need. These are: rapid increases in mental health prescribing and support provided by GPs; the prevalence of mental health problems among adolescent girls and young women; and stark socio-economic inequalities across the UK.

Covid 19

Current awareness updates

Interim Clinical Commissioning Policy: Neutralising monoclonal antibodies and intravenous antivirals in the treatment of COVID-19 in hospitalised patients.
Department of Health and Social Care (DHSC); 2021.
[This rapid policy statement from 24th December outlines the eligibility criteria for the use of casirivimab with imdevimab or sotrovimab for patients hospitalised with COVID-19, and those with hospital onset COVID-19.]

The European clinical research response to optimise treatment of patients with COVID-19: lessons learned, future perspective, and recommendations.
Goossens H. The Lancet Infectious Diseases 2021;:doi.org/10.1016/S1473-3099(21)00705-2.
[We discuss how the clinical research community responded to the pandemic in Europe, what lessons were learned, and provide recommendations for future clinical research response during pandemics. We focused on two platform trials: RECOVERY and REMAP-CAP.]

Remote general practitioner consultations during COVID-19.
Green MA. The Lancet Digital Health 2022;4(1):E7.
[[Letter.] Advances in digital technology had already stimulated debate on consultation methods; despite offering convenience for some patients, there were concerns about widening inequalities for others. Given that the pandemic offered a natural experiment to assess the potential implications of remote consultations, we analysed data from NHS Digital to better understand these implications. Our analyses showed that any suggestion that GPs were not seeing patients in person was not true.]

Delivering outpatient virtual clinics during the COVID-19 pandemic: early evaluation of clinicians’ experiences.[Abstract]
Vas V. BMJ Open Quality 2022;11(1):doi: 10.1136/bmjoq-2020-001313.
[Conclusions: In response to the pandemic, outpatient services across the trust were rapidly redesigned and virtual clinics implemented. As a result, services have been able to sustain some level of service delivery. However, clinicians have identified challenges in delivering this model of care and highlighted enablers needed to sustaining the delivery of virtual clinics longer term, such as patient access to diagnostic tests and investigations closer to home.]

CG Report 6: Effects of COVID-19 In Care Homes: A Mixed Methods Review.
Collateral Global; 2021.
[The report, using national datasets for 25 countries on mortality, provides an up-to-date review of global effects of COVID-19 pandemic in care homes, assessing care home mortality by country, how the deaths compared with previous periods, and how excess deaths may be explained.]

Regulation and use of confidential patient information for genomic and medical research during and post Covid-19.
PHG Foundation; 2021.
[At the start of the Covid-19 pandemic the government in England introduced measures to enable the use of confidential patient information for Covid-19 purposes without consent or another form of approval that would normally be required. This report considers how these regulatory changes to the governance of confidential patient information have impacted genomic and medical research, and whether these changes should be integrated into the regulatory framework longer term.]

Frequently asked questions: Demonstrating Covid-19 and vaccination status.
House of Commons Library; 2021.
[This briefing sets out responses to FAQs about demonstrating Covid status (otherwise called Covid status certification or vaccine passports) and use of the NHS Covid Pass in England.]

Clearing the backlog caused by the pandemic: ninth report of Session 2021–22.
House of Commons Health and Social Care Committee; 2021.
[This report finds that elective recovery plans are threatened by pressure on emergency care with a record number of 999 calls and waiting times in emergency departments at record levels. It concludes that tackling the wider backlog caused by the pandemic is a major and ‘unquantifiable’ challenge. It calls for a broad national health and care recovery plan to include mental health, primary care, community care and social care as well as emergency care.]

Telephone survey two: PCNs and Covid-19.
PRUComm; 2021.
[The purpose of the telephone survey was to try to understand the role primary care networks (PCNs) had played in response to the Covid-19 pandemic, focusing on whether the pandemic had influenced and shaped the development and operation of PCNs and whether PCNs had worked collectively or as individual practices in their Covid-19 response. This short report comprises data collected between August and December 2020.]

Inequality and the Covid crisis in the United Kingdom.
Institute for Fiscal Studies (IFS); 2022.
[IFS Working Paper W22/01. This report reviews the effects on the Covid-19 pandemic on inequalities in education, the labour market, household living standards, mental health and wealth in the UK.]

Effects of COVID-19 lockdown on eating disorders and obesity: A systematic review and meta-analysis.[Abstract]
Sideli L. European Eating Disorders Review 2021;29(6):826-841.
[The majority of individuals with EDs and obesity reported symptomatic worsening during the lockdown. However, further longitudinal studies are needed to identify vulnerable groups, as well as the long-term consequences of COVID-19.]

Public Health

Current awareness updates

Increasing COVID-19 vaccination rates amongst vulnerable groups: summary advice for GPs.
Royal College of General Practitioners (RCGP); 2021.
[GPs will be aware of the disparity in uptake of the COVID-19 vaccine between different population groups; often, the groups most at risk from infection and serious illness are those least represented at vaccination centres. We continue to collect examples, case studies or evidence on what works in addressing this issue.]

Vaccination of people working or deployed in care homes: operational guidance.
Department of Health and Social Care (DHSC); 2021.
[From 11 November 2021, anyone working or volunteering in a care home will need to be fully vaccinated against coronavirus (COVID-19), unless exempt.]

JCVI statement, August 2021: COVID-19 vaccination of children and young people aged 12 to 17 years.
Department of Health and Social Care (DHSC); 2021.
[This statement sets out JCVI’s latest considerations and advice regarding the potential extension of the COVID-19 vaccination programme to children and young people.]

JCVI issues updated advice on COVID-19 vaccination of young people aged 16 to 17.
Public Health England (PHE); 2021.
[The Joint Committee on Vaccination and Immunisation (JCVI) is today advising that all 16 and 17 year olds receive their first dose of the Pfizer-BioNTech vaccine.]

COVID-19 vaccination: resources for children and young people.
Public Health England (PHE); 2021.
[Information for eligible children and young people on COVID-19 vaccination.]

PHE women’s reproductive health programme 2020 to 2021.
Public Health England (PHE); 2021.
[Progress update on the PHE reproductive health programme, including a new return on investment tool and the next steps for 2021 to 2022. ‘Extending PHE’s contraception return on investment tool: maternity and primary care settings’ outlines a new return on investment (ROI) model for contraception in maternity and the provision of long-acting reversible contraceptives (LARC) in primary care, building on the existing contraception ROI tool published in 2018.]

BHIVA guidance for virtual consultations for people with HIV: May 2021.
British HIV Association (BHIVA); 2021.
[This guidance was released in May 2021 in response to the increased proportion of consultations carried out remotely due to COVID-19. The guidance highlights issues important for safe and effective consultation, including awareness of the limitations of remote consultation.]

Expanding access to naloxone.
Department of Health and Social Care (DHSC); 2021.
[Naloxone is a drug that reverses the effects of an opioid overdose and can help to prevent overdose deaths. We are seeking responses to this consultation to assess the viability of proposals to widen access to naloxone by expanding the list of services and individuals that can give it out without a prescription or other written instruction.]

Quality indicators in lung cancer: a review and analysis. [Abstract]
Chiew KL. BMJ Open Quality 2021;10(3):DOI: 10.1136/bmjoq-2020-001268.
[Conclusions: We found a large number of published QIs in lung cancer but they focused on relatively few areas not reflective of patterns of contemporary practice. We identified gaps in lung cancer QIs especially for systemic therapies, radiotherapy, palliative care and patient-reported outcomes. In order to comprehensively assess the care of patients with lung cancer, future efforts should focus on developing readily measurable QIs in these areas…]

Now or never: A systemic investment review of mental health care in England.
Centre for Mental Health; 2021.
[This report, commissioned by the NHS Confederation’s Mental Health Network, sets out ten key areas where strategic investment could solve systemic issues in the mental health system, with significant benefits to the lives of people with mental health difficulties and their experiences of support.]

The role of epigenetics in psychological resilience. [Abstract]
Smeeth D. The Lancet Psychiatry 2021;8(7):620-629.
[In this Review, we propose a new conceptual model for the different functions of epigenetic mechanisms in psychological resilience. After reviewing empirical evidence for the various components of the model, we identify research that should be prioritised and discuss practical implications of the proposed model for epigenetic research on resilience.]

Effect of telehealth interventions on quality of life in cancer survivors: A systematic review and meta-analysis of randomized controlled trials.
Li J. International Journal of Nursing Studies 2021;122:103970 .
[Telehealth interventions are effective and alternative methods for improving quality of life among cancer survivors. The most effective approach was application-based intervention, the most common approach was website-based intervention, and in terms of intervention durations, the short-term telehealth intervention was the most effective. Most telehealth interventions included breast cancer survivors.]

Covid 19


Current awareness updates

The impact of COVID-19 restrictions in the United Kingdom on the positive behavioural support of people with an intellectual disability
Murray G. British Journal of Learning Disabilities 2021;49(2):138-144.
[It has been suggested that COVID-19 and the associated restrictions are likely to have a negative impact on the provision of positive behavioural support (PBS) to people with an intellectual disability. Participants reported a neutral or somewhat positive impact on all the areas measured and the learning from their PBS programme as helping them cope with COVID-19. Many staff developed creative solutions that allowed them to provide PBS despite COVID-19 restrictions.]

VacciNation: Exploring vaccine confidence.
Healthwatch England; 2021.
[Our new research explores vaccine confidence amongst people from African, Bangladeshi, Caribbean, and Pakistani backgrounds. We want to understand these barriers to ensure key lessons are taken forward for future public health campaigns.]

Lateral flow device performance data.
Department of Health and Social Care (DHSC); 2021.
[Analysis confirms lateral flow devices (LFDs) are successful at identifying infectious cases of coronavirus (COVID-19) and real-world data shows Innova LFDs are capable of detecting the Delta variant.]

COVID-19 surveillance and immunity studies.
Department of Health and Social Care (DHSC); 2021.
[Updated 01 July 21: Added link to Schools Infection Survey research findings – round 5.]

JCVI issues interim advice on COVID-19 booster vaccination.
Public Health England (PHE); 2021.
[The Joint Committee on Vaccination and Immunisation (JCVI) has been asked to consider the options for a potential coronavirus (COVID-19) booster programme.]

COVID-19 and adult congenital heart disease services: impact on support and advice from nurse specialists.
Anthony J. British Journal of Nursing 2021;30(12):730-732.
[Although the focus on service provision in response to the COVID-19 pandemic has mainly been on acute and particularly intensive care, it is important to consider other services that are still needed. This is especially the case for vulnerable patients with long-term conditions, such as those under the care of an adult congenital heart disease (ACHD) service.]

Use of Telehealth in Mental Health (MH) Services During and After COVID-19.
Molfenter T. Community Mental Health Journal 2021;:Online ahead of print.
[COVID-19 social distancing guidelines caused a rapid transition to telephone and video technologies for the delivery of mental health (MH) services. The study examined: (a) adoption of these technologies across the MH service continuum; (b) acceptance of these technologies; and (c) intention of providers to use these technologies following the pandemic based on a sample of 327 MH organizations from 22 states during May-August 2020.]

Persistent symptoms following SARS-CoV-2 infection in a random community sample of 508,707 people.
Imperial College London; 2021.
[Random samples of the population between September 2020 and February 2021 found that nearly 27,000 (around 6%) reported experiencing at least one of 29 symptoms linked with COVID-19 for 12 weeks or more.]

Potential Coronavirus (COVID-19) symptoms reported through NHS Pathways and 111 online (18 Mar 2020-30 Jun 2021).
NHS Digital; 2021.
[Data published on potential COVID-19 symptoms reported through NHS Pathways and 111 online Dashboard shows the total number of NHS Pathways triages through 111 and 999, and online assessments in 111 online which have received a potential COVID-19 final disposition. This data is based on potential COVID-19 symptoms reported by members of the public to NHS Pathways through NHS 111 or 999 and 111 online, and is not based on the outcomes of tests for coronavirus. This is not a count of people.]


Coronavirus Shielded Patient List Summary Totals, England – as at 01 July 2021.
NHS Digital; 2021.
[Snapshot on 22 Jun 2021 – England only.]

Primary Care Workforce in Alternative Settings – General Practitioners in the Covid Clinical Assessment Service.
NHS Digital; 2021.
[28 Mar 2020 to 31 Mar 2021.The COVID-19 Clinical Assessment Service was operative from 28 March 2020 to May 2021 and there were fluctuations in the demand for patient appointments during this period according to the COVID-19 infection rates. Recruitment to the service ceased in January 2021 and all GPs were onboarded by March this year.]

Remote home monitoring (virtual wards) for confirmed or suspected COVID-19 patients: a rapid systematic review.
Vindrola-Padros C. EClinicalMedicine 2021;37:Vindrola-Padros.
[A rapid systematic review on models led by primary and secondary care across seven countries (US, Australia, Canada, The Netherlands, Ireland, China, UK) identified 27 articles. Monitoring was carried out via online platforms, paper-based systems with telephone calls or (less frequently) through wearable sensors. No substantive conclusions regarding patient safety and the identification of early deterioration due to lack of standardized reporting and missing data.]

Bridging the uptake gap – COVID-19 vaccination toolkit for Black African and Black African Caribbean communities.
NHS England; 2021.
[Evidence-based good practice for increasing vaccination confidence and uptake among Black African and Black African Caribbean populations.]


Toolkit

Remote working for general practices and primary care networks

Source: The King’s Fund

This toolkit is aimed at leaders in general practice. That doesn’t just mean GPs or partners, but all staff in the position of supporting others and making change. It provides insight, tips and guidance for getting the best out of the increasing options for teams to work separately from each other and at different locations, with colleagues simultaneously at home, in the practice, and elsewhere.

It provides support to answer the following questions:

Toolkit

Deafness and Hearing Loss

Source: KnowledgeShare

Produced by the Royal College of General Practitioners (RCGP); 2021; the resources developed aim to educate GPs and GP trainees on deafness and hearing loss, help reduce variations in accessibility to GP practices and ensure deafness and hearing loss are considered across all aspects of primary care activity including consultations and continued care. The toolkit supports GPs and GP trainees to implement the latest NICE guidelines and NHS Accessibility Quality Standard and guidance across the UK.

To access the toolkit click here.

GPs and Nurses new to practice programme

Operational guidance 2020/2021

This guidance supports Integrated Care Systems and Sustainability and Transformation Partnerships, Primary Care Networks, training hubs and other local partners to understand and continue delivery of the General Practice Fellowship programme, supporting newly-qualified GPs and nurses working in primary care.

Top tips for telephone triage and video consulting

Resources to support your practice

Total triage is important to reduce avoidable footfall in practices and reduce the risk and spread of infection. How to establish a remote total triage model in GP using online consultations available here.

Support for telephone and video consulting, GP’s, dentists, mental heath patients and cancer patients can be accessed here.

Strengthening the frontline: Investing in primary care for effective suicide prevention

Centre for Mental Health, May 2019
This report explores the role of GP and primary care services in helping people who are at risk of suicide. About 6,000 people die by suicide each year in the UK. Only a third are in contact with mental health services in the year before their death, but many visit their GP in the months before their death. The report identifies five areas for improvement to help GPs to offer life-saving support:

  1. The provision of effective, ongoing training for GPs
  2. Investment in the capacity of primary care services to enable longer appointments and continuity of care for patients needing ongoing support
  3. Emotional support for GPs themselves
  4. More effective care pathways for people who feel suicidal to clinical and social support
  5. Opportunities to refer patients who need more specialist support.

Click here to view the full report.