Primary Care and Health Tech News Blast ep 3

January 19, 2019

Hello eGPlearners,  in this news update- covering the big stories for primary care over the past week….

lets tech-enhance your primary care

If the first time we are meeting Im Dr Gandalf of eGPlearning where I look at supporting you with technology-enhanced primary care and learning so don't forget to subscribe and ring the bell to be the first to get notified of all these updates.

https://egplearning.co.uk/

Let us start

GP partnership review

This piece of the future of General practice was released on Monday 14.1.19 as led by Nigel Watson with seven recommendations at the heart of the review.

Recommendation 1: There are significant opportunities that should be taken forward to reduce the personal risk and unlimited liability currently associated with GP partnerships.

Recommendation 2: The number of General Practitioners who work in practices, and in roles that support the delivery of direct patient care, should be increased and funded.

Recommendation 3: The capacity and range of healthcare professionals available to support patients in the community should be increased, through services embedded in partnership with general practice.

Recommendation 4: Medical training should be refocused to increase the time spent in general practice, to develop a better understanding of the strengths and opportunities of primary care partnerships and how they fit into the wider health system.

Recommendation 5: Primary Care Networks should be established and operate in a way that makes constituent practices more sustainable and enables partners to address workload and safe working capacity, while continuing to support continuity of high quality, personalised, holistic care.

Recommendation 6: General practice must have a strong, consistent and fully representative voice at system level.

Recommendation 7: There are opportunities that should be taken to enable practices to use resources more efficiently by ensuring access to both essential IT equipment and innovative digital services.

From a digital perspective recommendation 7 is key. Updating systems and allowing innovation must happen, Digitising records would be a major support to practices and help to tackle another uncosted area on subject access requests. Taking this burden away from partners would be very useful. Also working better with statutory organisations for reports for DWP and DVLA would be helpful and reduce considerable administrative burdens on practices. In this past week I have done three reports for the same patient all relating to the DWP- one unified system would reduce unnecessary workload.

Updating our IT infrastructure and policies more in line with consumer tech is also a must. Tackling the ‘computer says no’ mentality due to a reliance on legacy IT would allow primary care to truly innovate, and I eagerly await the day I do not have to use internet explorer 8 in practice.

Many will know I have been critical of the interim review which was published last year. The final review is, however, a good document that identifies the challenges facing partnership and also commends the positive impact the partnership model has in primary care.

Several of the recommendations are high quality and call on other pieces of work to deliver an improvement for partnership in practice- particularly the call for a sort out of indemnity and the premises review.

I do still feel strongly that a key piece lacking is a direct request to increase the global sum funding for practices, as this would significantly and rapidly improve the partnership the workload impact for partners and attract more staff making it more viable and sustainable. I do still see this as a major omission of the review which is in the terms of reference. It should have been requested and using the long term plan as the vehicle to suggest increased funding does not directly help as this still requires increased work for new money, rather than offer a stabilising impact.

However, I do feel continuing to state the review is not fit for purpose is not true. The case studies are useful. I do maintain that much of the data collection could have been done rapidly online and not needed a UK wide roadshow to deliver on the review, but accept that the data and narrative is helpful. A key question moving forward is how much of this review will be implemented moving forward.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/770916/gp-partnership-review-final-report.pdf

As an addition for those in Nottinghamshire, see this excellent summary by the Nottinghamshire LMC chief exec - Michael Wright with useful supportive links.

https://www.dropbox.com/s/bc641eq5gilm0da/Checkpoint%202019.docx?dl=0

The difference in GP access across England is shocking

Speaking of Nottingham according to a breaking story today Rushcliffe (where I live) is the most well-covered GP area in the country. A stark contrast to where I work- St Anns which is in the second worse category for coverage- areas only 2 miles apart.

While many, especially will claim this is shocking news, to those who work in primary care it will be obvious. People work where there is a better work-life balance or income. The challenges of working in rural and inner-city areas in comparison to suburbia can be ignored and tackling health inequalities is paramount.

https://www.bbc.co.uk/news/health-46912055

The patient who objected to 'Asian doctor' silenced by the receptionist

After a patient objected to seeing a Doctor because she was Asian this excellent reply by the reception team highlights the challenges many people still face.

See this tweet: https://twitter.com/DrPunamKrishan/status/1085161089699069952

One area to consider is the institutionalised prejudice about choosing the gender of the clinician you may see. While there are many cultural and preference reasons for a woman to want to see a woman and similarly for a man to see a man, it can be argued this is still prejudiced that in some areas is supported by some CCGs and area teams insisting practices offer daily appointments with both male and female clinicians regardless of the organisation size.

Is this appropriate? As seen in this story when chosen by race it is abhorrent but choosing gender is more acceptable? What a confusing way to define prejudice.

https://www.bbc.co.uk/news/uk-scotland-glasgow-west-46894843?fbclid=IwAR2BU0qFAtCgkYuvGDfKuFjapiHSlNzz0cBVnijBjepsySg6VBozV7BewFQ

Pharmacists warn of a 'surge' in shortage of common medicines

This has been a hot story over the week and likely to develop further. Anyone working in primary care will know about the challenges of obtaining certain medications, whether a doctor, nurse pharmacist and indeed patient. Last week I commented on the challenges about Rivaroxaban. Now this story has broken to the wider media.

The article shows some of the challenges such as:

increased global demand

the increasing cost of raw materials

new regulatory changes causing the closure of factories

fluctuations in exchange rates making it more attractive to supply Europe than the UK

generic companies unwilling to keep creating unprofitable items.

Part of the challenge is also created by the brand switching and use of branded generics by medicine management teams to bring down the costs for CCGs. While this has led to an ‘on the books’ reduction in cost, the opportunity cost to primary care is not factored in for the workload of GPs and pharmacists in dealing with switches and the potential health damage and costs caused by patients who have not had their medications on time. If this was to be factored in I would estimate it would obliterate the savings made, hence the cost to the system rather than individual pots may need addressing. This is potentially where PCNs may help, however, on a national stage there is little I feel the new changes will do.

There is also commentary by many pharmacists about the gaming of suppliers and warehouse companies who deliberately withhold stock to drive up prices, then release them with a short use-by date to increase profits. Much of this is caused by the poor way pharmacists are renumerated for the cost of items particularly with the drug tariff rates which are often out of date when published due to the rapid changes.

For this reason, I again state my challenge to our Secretary of State for Health and Social care @matthancock to work with organisations like the RCGP, BMA, GPC and RSPh to be bold and create clear guidelines for all how to manage these issues rather than pointless statements asking people not to stockpile, - given few seem to be listening and we are likely to be hit with challenges as Brexit progresses.

https://www.bbc.co.uk/news/amp/health-46843631?__twitter_impression=true

Don't forget to check out this week’s TipThursday on the best haematology app - Buku Haematology. I like this app and see why on the video below.

YouTube: https://www.youtube.com/watch?v=X-HWDNKaM4Y

Subscribe to or follow the eGPlearning platform for more videos, app reviews and content to support technology-enhanced primary care and learning.

Facebook - https://www.facebook.com/Egplearning/ Twitter - https://twitter.com/egplearning

Twitter - https://twitter.com/drgandalf52 Website - https://egplearning.co.uk/

Support: https://patreon.com/egplearning

NHS Long term plan - Primary Care and Health Tech News Blast ep 2

January 13, 2019

Hello eGPlearners,  in this news update- covering the big stories for primary care over the past week….

lets tech-enhance your primary care

If the first time we are meeting Im Dr Gandalf of eGPlearning where I look at supporting you with technology-enhanced primary care and learning so don't forget to subscribe and ring the bell to be the first to get notified of all these updates.

https://egplearning.co.uk/

Let us start

Long term plan

Called the 10year plan or 10YLTP released on 7.1.19. This video is a review of the executive summary, as the full document is 136 pages long as will take some time to digest.

What are the headline points?

https://www.longtermplan.nhs.uk/online-version/overview-and-summary/

Split into seven chapters.

Chapter 1

Spend an increased amount of funds on bringing successfully implemented changes to healthcare of care to other areas.

Right to digital GP consultations. (doesn't say video).

Focus on networks of practices (likely to be called either neighborhoods or PCNs) to deliver care in communities for primary, community and social care to prevent hospital admissions.

Focus on social prescribing, personal health budgets and the voluntary sector.

Guarantee of a greater rate of funding for the first time ever under a Tory government for primary care using the previously announced £4.5b for community care by 2023/4.

Shift away from hospital-based care for both outpatients (maybe video consultations for outpatient to reduce infrastructure costs like estates/parking etc).

Video Consultations in primary care:

https://www.youtube.com/watch?v=Jw0ehthmFN0

Focus on urgent treatment centres instead of emergency departments and same day discharge from acute wards.

Chapter 2

Prevention.

Focus on prevention ie stop smoking, obesity programme, supporting reducing alcohol - much of this seems public health territory no longer funded by local councils - sharing the costs or shuffling the money?

Focus on deprived groups with outcomes like smoking rates in pregnancy, learning disabled /autistic patients and homeless patients to name a few based on locally supported programmes.

Chapter 3.

This identifies priorities for care quality and improvements, particularly on mental health. Focus on cancer survival, maternity-related deaths, increasing planned (elective surgery) and ring-fenced funds for mental health (2.3bn a year by 2023/4)

Chapter 4

Looking at Workforce, reintroducing training budgets for health education England (taken away in recent reforms) and a workforce implementation plan for later this year. Increased funding for nursing training and routes into training including recruitment from overseas. Also new roles with a focus on professional development especially in primary care based on networks.

Chapter 5

Details the focus on technology including digital access for all, interoperability of data and use of new technology like AI. This chapter will be covered in more detail in our in-depth look later in the month.

Chapter 6

Looks at changes to the financial structure of the NHS to maintain funding increases to prevent challenges in the future including various efficiencies ie saving £700m in administrative costs.

Chapter 7

The final chapter explained the implementation of the plan including legislative changes to enable rapid implementation. It recommends changes to: create publicly-accountable integrated care locally; to streamline the national administrative structures of the NHS, and remove the overly rigid competition and procurement regime applied to the NHS. This includes the shift to integrated care system models by 2021.

5y GP training

Straight from med school - pilot not really 5y as same time in training just different spread

http://www.pulsetoday.co.uk/news/gp-topics/education/five-year-gp-based-training-could-start-in-2021-says-nhs-england-adviser/20038049.article

Man shots GP with a crossbow

Lone worker risks - Zero Tolerance or not?

We provide a health care service but are not servants.

https://www.bbc.com/news/uk-england-beds-bucks-herts-46759669

Rivaroxaban shortage

Furosemide, naproxen, most eye drops,

Impact on workload is unaccounted and risk to patient care being held by GPs and pharmacists.

Look at formal joint guidance from NHS England/RCGP/BMA/Royal Pharmaceutical Society for how clinicians can safeguard patients should further short or long term shortage supplies hit.

Don't forget to check out this week’s TipThursday on a must own GP app- Nottinghamshire LMC app, useful guidance, tools, and resources for any GP regardless of the stage of career or location.

YouTube: https://www.youtube.com/watch?v=ANFl2GzlLYM

Subscribe to or follow the eGPlearning platform for more videos, app reviews and content to support technology-enhanced primary care and learning.

Facebook - https://www.facebook.com/Egplearning/ Twitter - https://twitter.com/egplearning

Twitter - https://twitter.com/drgandalf52 Website - https://egplearning.co.uk/

Support: https://patreon.com/egplearning

Primary Care and Health Tech Newsblast ep 1

January 5, 2019

Hello eGPlearners,  in this news update- covering the big stories for primary care over the past week including a really valuable resource to analysing appointment usage at the end.

 

lets tech-enhance your primary care

If the first time we are meeting Im Dr Gandalf of eGPlearning where I look at supporting you with technology-enhanced primary care and learning so don't forget to subscribe and ring the bell to be the first to get notified of all these updates.

 

https://egplearning.co.uk/

 

Let us start

 

GP IT shake-up by Matt Hancock - GP IT Futures framework
move data to cloud so by 2024 all patients can access GP services digitally, with
practices able to offer online or video consultations.
S1 and EMIS market leaders EMIS X already announced how will others respond?

Switching providers

Outdated IT - IE 8

 

http://www.pulsetoday.co.uk/news/gp-topics/it/gp-it-systems-set-for-major-overhaul-as-dhsc-launches-procurement-process/20038019.article

Boots UK acquires Wiggly-Amps
- change in delivery and better tech interface
- take on Pharmacy2u

 

https://www.thehtn.co.uk/2019/01/04/boots-uk-acquires-wiggly-amps/

Test your breath to check cancer
Pilot at Owlstone Medical practice to use Breath Biopsy to check for unstable molecules as
part of 2y trial lung cancer a likely focus but possibly others.

 

https://www.thehtn.co.uk/2019/01/03/tech-trial-hopes-to-detect-multiple-cancers/

GDPR - government rule out exempting GPs from SARs
MP Margot James feels would weaken the rights of patients
However the increase in the number of requests is fuelled by Lawyers who make a profit from fewer costs
Siginifcant workload increase- not mirrored by other organisations like gas/ banks etc
no guidance on excessive req no one wants to be the test case for ICO

 

http://www.pulsetoday.co.uk/home/finance-and-practice-life-news/government-rules-out-exempting-gps-from-gdpr-subject-access-requests/20037913.article


DNA

Big story of the week possible £200m saved  1 in 20

Cost of £30 an apt  PSSRU- not paid by the individual but a cost to the system

Variety reasons, sometimes can't be helped

The overall cost to the system as a buffer sometimes it just nice- chaos and a break

 

http://www.pulsetoday.co.uk/home/finance-and-practice-life-news/patients-miss-one-in-20-gp-appointments-at-a-cost-of-200m-warns-nhs-england/20038021.article

 

NHS Digital GP practice data hub - area, time to apt, which healthcare professional, apt type ie f2f/tele
https://app.powerbi.com/view?r=eyJrIjoiYzU2OTA2ODktZTIyNy00ODhmLTk1ZGEtOGVlZmRlZDNjYzY3IiwidCI6IjUwZjYwNzFmLWJiZmUtNDAxYS04ODAzLTY3Mzc0OGU2MjllMiIsImMiOjh9

 

Subscribe to or follow the eGPlearning platform for more videos, app reviews and content to support technology-enhanced primary care and learning.

Facebook - https://www.facebook.com/Egplearning/
Twitter - https://twitter.com/egplearning
Website - https://egplearning.co.uk/

Support: https://patreon.com/egplearning