Mass GP resignations 'likely' as union urges LMCs to back crisis conference vote (GP Online: 27 January 2016)

GPs are ready to back calls for the profession to resign en masse from practice contracts at this weekend's special LMCs conference, union leaders say.

Doctors from the Unite union said mass resignation was 'on the cards' as GPs faced a crisis driven by a recruitment crisis, soaring workload and falling income.

East London GP Dr Jackie Applebee, Unite representative on the GPC, urged the 400 GPs who will debate the crisis facing the profession on Saturday at a special LMCs conference in London, to back a motion calling for GPs to hand in undated resignation letters.

The union is also urging GPs to support a motion calling for the GPC to explore moving away from the practice-based contract model to a salaried GP more


Spike in mental health patient deaths shows NHS 'struggling to cope' (The Guardian: 26 January 2016)

A sudden spike in the number of mental health patients dying unexpectedly in NHS care has prompted calls for a wide-ranging investigation into “threadbare” services that are “struggling to cope”.

New NHS figures show that the number of deaths annually among mental health patients in England has risen 21% over the last three years from 1,412 to 1,713. 

The number of those killing themselves or trying to do so has also increased, by 26% from 595 in 2012-13 to 751 in 2014-15. It covers both those being treated as inpatients for serious mental health problems and also those who are being cared for while still living at home.

Figures obtained by Norman Lamb, the Liberal Democrat MP, show that the overall number of “serious incidents” – involving unexpected or avoidable deaths, serious harm, injury and abuse – has climbed 34% to 8,139 a year. They have become so common that one trust, North East London foundation trust, had a total of 633 last year – almost two a day.

Lamb, the mental health minister in the coalition until last May, made the comparison with the Mid Staffordshire scandal in which patients died as a result of poor care....(read more)


NHS watchdog signed off doomed £750m contract despite doubts (The Guardian: 26 January 2016)

An NHS contract worth £750m that collapsed in December after just eight months was effectively signed off by the regulator and NHS England, despite questions about its viability.

The contract – the biggest in NHS history – was the first designed to bring together hospital, mental health services and community care for adults and older people in Cambridgeshire, introducing a single point of contact for patients.

Signed in November 2014 after a 15-month procurement process that cost more than £1m, it was strongly opposed by local campaigners and trade unionists after several private bidders expressed an interest. Opponents feared it would mean transferring thousands of staff into the private sector.

In the end, the contract went to an NHS partnership called UnitingCare. It launched in April last year, promising to cut emergency admissions to hospital, saving millions of pounds. But by early December, all the partners agreed it was not financially sustainable.

In papers submitted to Cambridgeshire county council’s health scrutiny committee, Monitor revealed it had such grave doubts about the project that it only gave it the go-ahead the day before the launch. There were 34 outstanding issues remaining to be negotiated, a hearing of the committee was told last week. 

The senior GP in the clinical commissioning group (CCG) that awarded the contract, Dr Neil Modha, resigned last Friday, citing personal reasons. At the hearing of the health scrutiny committee the day before, he admitted that the obligations in the contract exceeded its value. “There was not enough money to cover all the services that were to be provided,” he said.

Questions will be asked not only about how the contract came to be approved but why it was not rescued. On some estimates, its collapse will cost the already hard-pressed local hospitals, community care providers and GPs up to £20m. The shortfall that had been identified was £9.3m. NHS England refused to find the extra more


A&E departments may be too short-staffed 'almost half the time', says report (Independent: 20 January 2016)

Report recommends that A&Es should build in a 'margin of safety' into their staffing plans

A&E departments may be too short-staffed to cope with demand “almost half of the time”, according to a suppressed report by patient safety experts.

Experts at the National Institute for Health and Care Excellence (NICE) called for the NHS to introduce minimum nurse-to-patient ratios on A&Es last year, but the report was never published and NICE’S research was controversially suspended.

Ministers and NHS chiefs faced accusations at the time that they were seeking to hide the scale of the staffing crisis in the NHS and water down recommendations for more nurses that would have come at a huge cost to the Government.  

In a copy of the NICE guidance, obtained by the Health Service Journal after frequent requests for its publication were denied, experts say that A&E staffing levels set according to historical patient demand leave emergency departments unprepared to cope with frequent surges in demand.

The report recommends that A&Es should build in a “margin of safety” into their staffing plans, even if this meant they were overstaffed during quiet periods... read more


Healthcare group to walk away from five Brighton and Hove surgeries putting care of 11,400 patients in doubt (The Argus: 16 January 2016)

The future care of 11,400 residents has been thrown into doubt after a health group announced it would stop running five GP surgeries.

The Practice Group has announced its intention to terminate its contract for five surgeries in Brighton and Hove following a dispute over funding.

Brighton Pavilion MP Caroline Lucas has urged healthcare bosses to think again and warned other city surgeries could not cope with additional patients if the surgeries did close.

The Practice Group has given notice that they will be pulling out of their contract at the end of June with Brighton and Hove Clinical Commissioning Group expected to take over its running after that if an alternative provider is not more


NHS out-of-hours GP service 12-hour wait 'clinically unsafe' (BBC: 15 January 2016)

Callers to out-of-hours GP services faced waits of more than 12 hours, posing a "significant risk to patient safety", a leaked report has revealed.

The interim report into Integrated Care 24 (IC24), which runs non-emergency 111 and out-of-hours services in Norfolk and Wisbech, found deficiencies in call handling and a shortage of GPs. During unannounced inspections following complaints, staff said they had been asked to alter their records.

IC24 said it had addressed the issues.

The organisation operates NHS 111 services in areas including Great Yarmouth and Waveney and parts of Essex, and took over the Norfolk and Wisbech contract in September 2015.

Assessors from Norwich Clinical Commissioning Group (NCCG) inspected five IC24 bases in Norfolk and one in Cambridgeshire in November following staff complaints.

Their report highlighted issues including:

  • An "emerging trend" of 111 callers waiting to be processed and an IT system that did not allow patients to be triaged effectively
  • The call-handling system was "unclear for patients" with some "waiting in excess of 12 hours from their first contact which is clinically unsafe posing a significant risk to patient safety"
  • Staff "asked to alter or not record accurately their contemporaneous notes"
  • Staff said they had been unable to comply with requests, including "removing unseen patients from their screens in the morning and advised that a non-clinical member of staff had cleared the screen" of callers not dealt with
  • "An element of fear" among staff over reporting concerns.
  • A lack of GPs, having a "direct impact on the quality and clinical safety of the service" and on doctors themselves
  • Staff concerns over "competency skills of individuals recruited to fill the GP shortfall"
  • GPs unhappy at being consistently moved between bases to cover shortfalls

... read more


Industrial action: junior doctors provide emergency-only care (BMA: 12 January 2016)

Tens of thousands of junior doctors are today taking industrial action over their contract dispute with the Government.

Trainees in England are providing emergency care-only cover — similar to a Christmas Day service — in the first of three planned periods of industrial action.

Doctors are taking the action over the Government’s failure to address junior doctors leaders’ concerns about contractual safeguards on safe working, and proper recognition for those working unsocial hours.

Conciliation talks paused last week with both sides saying, while discussions had been ‘constructive’, they were not enough to call off today’s planned action by the BMA.

BMA junior doctors committee chair Johann Malawana said: ‘Junior doctors feel they have been left with no option but to take this action.

'We have been clear throughout this process that we want to negotiate a contract that is safe and fair, and delivers for junior doctors, patients and the NHS as whole.

‘This remains our goal and our door is open to talks, but the Government must address our concerns around safe working patterns and ensure the contract recognises the long, intense and unsocial hours which junior doctors do.’ more


NHS reorganisation causing GP retention crisis, study suggests (The Guardian: 7 January 2016)

The reorganisation of the NHS and increased workload pressures are causing a crisis in the retention of GPs, a study suggests.

Many doctors are leaving general practice early because of rising bureaucracy and reduced time for patient care.

The authors of the study liken the situation faced by GPs as akin to “boiling frogs” - saying internal and external pressures, as well as a tickbox and blame culture, have slowly built up, to a point where for many GPs continuing is no longer sustainable.

The researchers suggest that in order to buck the trend and avert a further crisis in GP retention and recruitment for the NHS, the pace of administrative change must be minimised and the time spent by GPs on work that is not face-to-face patient care needs to be reduced.

They suggest that with the cost to UK taxpayers of the five years of postgraduate training for each GP totalling just under £250,000, there is a real imperative to resolve the challenges faced and to retain these highly trained professionals within the UK primary care more

Care UK wins prison healthcare contract in capital (Nursing Times: 7 January 2016)

Independent provider Care UK has won a five-year contract for healthcare services at Wormwood Scrubs prison in West London. The firm will provide primary care, dentistry, optometry, physiotherapy and podiatry services.Meanwhile, mental health services will be subcontracted to Barnet, Enfield and Haringey Mental Health NHS Trust.

The contract was previously held by Central London Community Healthcare NHS Trust with mental health services subcontracted to Central and North West London NHS Foundation Trust. The contract begins in April and was awarded by NHS England in December. It will be worth £112m if a two-year option to extend the five-year contract is agreed.


GPs forced to close practice lists (The BMA: 6 January 2016)

Increasing numbers of GP surgeries are being forced to turn away new patients owing to immense pressures.

BMA GPs committee chair Chaand Nagpaul has commented in response to an investigation by the BBC into the numbers of surgeries across England requesting a freeze on registering new patients.

The investigation, carried out under the Freedom of Information Act, shows that at least 100 surgeries applied to NHS England during 2014/15 for permission to stop accepting new patients.

Dr Nagpaul said that many surgeries were no longer able to cope with a lack of resources and intense demand, and were having to close their practice lists in order to safeguard patient more


Junior doctor strike set to go ahead next Tuesday after talks 'break down' (Pulse: 4 January 2016)

Junior doctors in England are set to take to industrial action on Tuesday next week, after talks between the BMA and NHS Employers failed to produce an agreement, the BMA has announced.

The BMA suspended strike action over the junior doctors contract in December just a day before it was due to go ahead, after reaching an agreement with NHS Employers and the Department of Health to enter ’direct and meaningful’ negotiations.

The BMA said that the Government had failed to address junior doctors’ concerns about ‘contractual safeguards on safe working, and proper recognition for those working unsocial hours’.

Negotiations will continue in the hope of averting industrial action, but failing this only junior doctors with a role in emergency care will be working between 8am on Tuesday to 8am Wednesday next week.

If negotiations remain in a deadlock there will be a further emergency care-only walk-out – this time for 48 hours – between 26 January and 28 January and a full withdrawal of labour, including emergency care, between 8am and 5pm on 10 February.

BMA chair Dr Mark Porter said: ’Throughout this process the BMA has been clear that it wants to reach agreement on a contract that is good for patients, junior doctors and the NHS. This is why, despite overwhelming support for industrial action, the BMA instead sought conciliation talks with the Government, talks which were initially rejected and delayed by Jeremy Hunt.

’After weeks of further negotiations, it is clear that the Government is still not taking junior doctors’ concerns seriously. Furthermore, the Government has repeatedly dragged its feet throughout this process, initially rejecting our offer of talks and failing to make significant movement during negotiations.

’We sincerely regret the disruption that industrial action will cause, but junior doctors have been left with no option. It is because the Government’s proposals would be bad for patient care as well as junior doctors in the long-term that we are taking this stand.’

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