Monthly Archives: November 2014

Crisis in recruitment to less popular rural areas of Wales: a “head in the sand approach”. Why not train doctors with General Practice as their base, instead of a city?

Mark Smith reports 27th November 2014: Moves made to avoid a looming GP crisis in rural Wales

There is a crisis in recruitment to less popular rural areas of Wales: a de-facto “head in the sand approach” which will not be solved without emergency immigration and/or training more and differently. Why not train doctors with General Practice as their base, instead of a city? They can still be part of a university and travel irregularly to that city for those parts of training which cannot be delivered by internet, GPs and DGH staff. Dissection and anatomy could be on computer (as it is already in some medical schools) and in the local pathology department. If students “live” in an area during their formative year, then they are more likely to stay, especially if recruited as graduates. A solution to these headlines is 15 years away…

Doctors have warned of a ‘looming crisis’ in Powys due to a lack of recruitment and retention of medical professionals

NEW measures are being rolled out in parts of rural Wales to ensure a “recruitment crisis” of GPs and nurses is avoided.

Powys Teaching Health Board says it plans to work closely with GP surgeries which are finding it increasingly difficult to appoint skilled staff.

Following a workshop held earlier this year, which was attended by a cross-section of primary and secondary care delegates, ideas have been developed to bring young medical professionals to the region to plug the shortfall.

A spokesman for the health board said: “We have tried to reflect the wide range of ideas that could be considered to try and improve the recruitment and retention of the medical and practice nursing workforce. These ideas, together with other suggestions, will be looked at by the health board to support practices in creating a plan for the future.”

Suggestions were presented during a debate on rural GP recruitment on the eve of the Rural Primary Care Conference held at Gregynog Hall, near Newtown.

Delegates suggested that a “rural medicine experience day” should be held in Powys for all second year medical students from Cardiff University.

There were also calls to increase incentives for medical students from Powys to train and work as GPs in the county.

They urged placements – or taster sessions – to be brought in for medical students early in their training with Powys medical practices, including exposure to minor injury units, district nursing and BASICS trained GPs.

Related: Health board blasted for closing Aberaeron GP surgery

Julia MsWatt on June 16th 2014 had already warned: GP profession in Wales at risk of crumbling within five years, leading doctor warns 

Dr Paul Myers, chair of the Royal College of GPs in Wales, said the problem is ‘really serious’ and that the system needs greater investment

….The RCGP said that 23% of GPs in Wales are over 55, with many choosing early retirement due to the pressures and lack of resources… Dr Charlotte Jones, chair of the British Medical Association’s Welsh General Practitioners Committee, warned that general practice in Wales was in “intensive care”.

Dr Jones told the annual Local Medical Committee Conference: “I stand here before you today – a damsel in distress.

“Distressed because general practice in Wales is in intensive care.

“The tubes are in, the monitor pings away and the ventilator is working flat out. Will the patient survive? Who knows?

“The workforce situation, unless urgently addressed, will further exacerbate the problems we face. If it sounds like a crisis, smells like a crisis, feels like a crisis then it is a crisis and that needs to be said.

“Welsh Government cannot simply stick its head in the sand hoping it will go away.”…


Doctors’ fears over midwife birth centres – “higher transfer distances (times) increase perinatal mortality”

Sarah-Kate Templeton in The Sunday Times 30th November 2014 reports: Doctors’ fears over midwife birth centres

The promise of more money for roads and infrastructure in marginal seats such as my own is helpful. Lets hope it really happens, and before there are too many deaths on the road between rural District General Hospital and specialised unit.

If Pembrokeshire was “labour” and Mr Drakeford did not come from Carmarthen, I suspect a different decision would have been made about where to concentrate services. Carmarthen is only 20 minutes from Swansea, but we are over an hour away, until a new road is built, and then it will  still be 40 minutes. On the other hand, 6 years ago, the people of Pembrokeshire and Carmarthen rejected the compromise deal of a new build at approximately half way… which would have been 20-30 minutes travel time on today’s roads.

IT IS safe for women to give birth in midwifery units miles from the nearest hospital, controversial new guidelines will say this week.

The National Institute for Health and Care Excellence (Nice) is expected to recommend that even first-time mothers can safely use the centres, which are staffed only by midwives.

The guidelines are supported by the Royal College of Midwives (RCM), which says they will encourage women to give birth without medical intervention such as an epidural or forceps delivery.

But some doctors fear babies will die when mothers get into difficulty during labour and have to be transferred sometimes long distances to hospital by ambulance.

Dr Peter Milewski, a retired surgeon who has campaigned against the closure of maternity hospitals, said: “I would disagree with any advice to first-time mothers that it is safe to deliver in freestanding midwifery units. In my opinion, that is not safe.

“There is good evidence that higher transfer distances increase perinatal mortality. That is why I shall not be willing for my daughter, who is due her first baby shortly, to be persuaded to use a free- standing midwifery unit.”

Milewski said that in Pembrokeshire, west Wales, where he lives, transferring a mother from a midwifery unit to a hospital could take up to an hour.

Nice will make the recommendation despite objections from the Royal College of Obstetricians and Gynaecologists (RCOG). The professional body says first-time mothers, who are at higher risk of suffering problems, should give birth either in hospitals where they can be treated by consultants if they require medical help or at midwifery units alongside hospitals.

In a letter to the British Medical Journal (BMJ) in 2011, the RCOG wrote: “Transfer for [first-time mothers] was up to 45% for mothers delivering at home or in midwifery units into obstetric units. Based on these findings, the RCOG advocates that first-time mothers should be advised of the benefits of delivering in obstetric units or alongside midwifery units.”

Nice will base its recommendations on the Birthplace study, (BMJ 2011;343:d7400) which analysed data from all freestanding midwifery units. It was published in the BMJ in 2011 and concluded there was no significant increased risk when a baby was delivered in a midwifery unit.

However, an analysis of only those units that had submitted at least 85% of the required data — about three quarters of the total — found a baby had more than double the risk of suffering serious harm or death if born in a freestanding midwifery unit rather than a hospital staffed by obstetricians.

Maureen Treadwell, cofounder of the Birth Trauma Association, which campaigns for women to be given the choice of a hospital birth, said: “There is no robust evidence for this [recommendation] whatsoever. If it is deemed to be both ‘safer’ and ‘cheaper’, health commissioners will only commission places [in hospitals] for high-risk women.”

Many maternity hospitals that were previously staffed by consultant obstetricians have been closed or downgraded to freestanding midwifery units. Many of the consultants have been moved to larger specialised maternity hospitals.

Louise Silverton, director for midwifery for the RCM, defended the validity of the research. “For many women, what had been their local obstetric unit has now become midwife-led but they want to have their baby in their own town,” she said.

“I do not see any reason why, if they have no complications, they should not have their baby at that same unit but under midwife care. If things don’t work out, she transfers.”

Kate Stanton-Davies died six hours after she was born at a freestanding midwifery unit in Shropshire in March 2009. An inquest ruled she could have survived had she been born at a hospital and that being born at the midwife-led unit had contributed to her death.

Her mother, Rhiannon Davies, had suffered complications and her daughter fell ill soon after birth. By the time she was transferred the 40 miles by air ambulance from the midwife-led unit at Ludlow Community Hospital in Shropshire to Birmingham Heartlands Hospital, it was too late.

Davies said: “Absolutely, categorically, no first-time mother should go anywhere near a stand-alone unit. If they want low intervention they should be in an adjacent midwifery-led unit. If anything goes wrong you have then got an operating theatre, obstetricians and your life and your baby’s life can be saved.”…..

Additional reporting: Sanya Burgess

Why not use helicopters whilst the road is built? Expense..

emergency room cartoon humor: 'Maintenance to the O.R....Maintenance to the O.R....'

Trying to make everyone think something is being done….

Today’s headline in The Sunday Times is just deferring the honest debate that Mr Stevens has been asking for and trying to make everyone think something is being done…. until after the election if our politicians (of all parties) have their way… The NHS confederation says “NHS net expenditure (resource plus capital, minus depreciation) has increased from £64.173 billion in 2003/04 to £109.721bn in 2013/14. Planned expenditure for 2013/14 is £113.035bn.” But it is a 1.1% boost… for England.. Will it apply to the other Regions, and will they spend it wisely in their smaller mutuals?

Francis Elliot & Sonia Elks report: Osborne pledges an extra £2bn annual boost for the NHS

George Osborne will this week try to protect the government from the political damage of an NHS crisis by promising an extra £2 billion a year for the health service.

The increase, which is to be part-funded through fines levied on banks found guilty of manipulating foreign exchanges, falls well short of the £30 billion hole that health chiefs say will become clear in NHS finances by the end of the next parliament.

The Tory NHS funding boost is among a package of spending to be announced this week as Mr Osborne tries to woo voters in advance of the May general election, in which the health service will be a key battleground.

NHS bosses have warned that increasing demand and flat-lining budgets have left the service at breaking point.

Confirming the annual funding boost, the chancellor said that the country could afford to pay into the health service as the UK economy recovers….

…Not all the Chancellor’s £2 bn NHS commitment is new money. Sources told the BBC that £0.7bn would be diverted from other parts of the health budget to the NHS frontline, and only £1.3bn was new spending.

An additional £1.1bn to upgrade GP surgeries, spread over four years, would come from bank fines.

Mr Osborne’s pledge of extra cash does nonetheless increase pressure on Ed Miliband over Labour’s mansion tax, which the party says is needed to fund NHS spending.

Ed Balls, the shadow chancellor, promised that Labour would keep the mansion tax, and spend the £1.2 billion that it was projected to raise on increases to health spending over and above the coalition’s plan.

He accused the Chancellor of making “unfunded commitments”, warning that the deficit remained huge and that Mr Osborne had not clearly explained how he would find the money to fund his pledges.

“The Tories are really putting the NHS in danger,”Mr Balls told the Marr show. “We need a long-term plan. We have a winter crisis because the Tories have mismanaged and privatised and caused chaos in the NHS.”

Labour’s questions about whether the figures could be justified followed claims by economists that Mr Osborne had failed to meet his planned spending cuts and would have to slash budgets to meet austerity targets in the next parliament.

“Things haven’t gone as well as hoped since March,” Paul Johnson, of the Institute for Fiscal Studies (IFS), told the Sunday Politics programme on BBC One.

“The consequence will be that by 2018 we are looking at spending cuts of one-third in a whole slew of public services – local government, police, justice, police environment – all of these things.”

Mr Osborne is preparing to announce another spending boost for major road improvements in the government’s infrastructure plan, which will be unveiled tomorrow, ahead of the autumn statement on Wednesday.

“You are going to see major improvements on key roads, to the south-west of England, through Norfolk, up through Northumbria. So we are investing in our economic infrastructure, we are backing our businesses,” he said.

The government is also set to pledge tax cuts worth £7 billion through an increase in the untaxed personal allowance if the Tories are re-elected.

Mr Osborne said that the government would squeeze the welfare budget once again to raise cash for his pledges as it faces up to “tough decisions”. He had already pledged to introduce £12 billion worth of extra welfare cuts after the election to help to reduce the deficit.

“I think we should be making savings in welfare to spend money on economic infrastructure like roads and to sharpen work incentives, giving support to our working taxpayers by increasing tax-free allowances,” he said.

The IFS last week said that the chancellor had achieved only one tenth of the welfare cuts planned because increases in pensions, housing and disability benefits almost cancelled out the cuts.

NHSreality’ view of the future as there is less and less to balance with:

Cartoon of tightrope walkers

The reality of the Regional Health Services is that they are going bust, and this without a political debate about the pragmatic options to design a situation….

Honest reporting by Dennis Campbell in The Guardian. He has two reports on 28th November 2014: Hospitals under pressure as ‘bedblocking’ hits record levels . This follows the suggestion from Bournemouth that patients should be “evicted” once social issues had superseded the medical ones..

Big rise in number of beds hospitals cannot use for new patients because occupants cannot be discharged

Dennis’ second report “NHS can save billions with small rise in spending on GPs, say researchers

Extra £72m a year could cut A&E visits, hospital stays and ambulance callouts, and allow doctors to focus on patient care

The reality of the Regional Health Services is that they are going bust, and this without a political debate about the pragmatic options to solve the situation….

‘Do more to monitor GPs vacancies’, says Plaid Cymru – but don’t do anything about it..

BBC News 27th November 2014 reports: ‘Do more to monitor GPs vacancies’, says Plaid Cymru

GP recruitment is a good example of denial, and not even bolting the stable door … It looks like recruitment from abroad again for Wales… In my own Vocational Training Scheme, in the last 5 years, about 30% of those trained have left to go abroad.. or are not doing General Practice.  What do the politicians plan to do about the worsening situation?

More must be done to monitor the number and location of GP vacancies in Wales at a time of “crisis” in recruiting and retaining doctors, says Plaid Cymru.

Health spokeswoman Elin Jones AM said it was “incredible” that no national figures were kept on the GP data.

The Welsh government said it was the responsibility of health boards to keep track of the issue.

It added it was working to promote Wales as an attractive place to live and work.

BBC Radio Cymru’s Manylu programme submitted a Freedom of Information Request to find out how many GP vacancies there are in Wales, and which areas are struggling to recruit doctors…..

…Nefyn surgery, in Gwynedd, is one of those experiencing difficulties having failed to recruit a partner for the last three years

Letter to minister over GPs shortage

Rural healthcare standards worry

GP service facing ‘crisis’ warning


Drug trails: how much obligation ha the state to support unproven treatments?

A recent “about turn” by government and politicians on an important issue reveals the lack of clear thinking in their circles. It also leads NHSreality to ask “how much obligation has the state to support unproven treatments?” NHS choices tells patients about the different phases of drug trials. Is it all these phases which the state will help with, or just phase 3/4? Of course we have not had sight of the letter sent to London PCTs, but it is referred to in the Western Daily Press 29th November 2014: NHS England: Funding cut for drug trial patients was incorrect information.

I suspect the original letter makes very good sense, but it is a tacit admission of rationing. Therefore it is politically unacceptable. After all, these are unproven treatments, and the profit from them, if successful in trial, will go to private companies. If successful, as with other new treatments, the state will not fund them until at or near the date when their patent expires. Note: The U-turn described by Hugh Pym only applies to England..

On 29th October BBC news reported: Cancer Drugs Fund ‘papers over cracks’, says charity and then on 29th November Hugh Pym reported on BBC News:  NHS ‘U-turn’ over drug trial money

NHS says no to breast cancer drug 08 AUGUST 2014, HEALTH
Leukaemia clue in breast cancer 27 JUNE 2014, HEALTH


GPs should have ultrasounds, and be trained to use them. Resistance to change..

Jane Dreaper reports for BBC News 27th November 2014: Early detection of liver disease by GPs ‘non-existent’

The reason GPs use blood tests is that they are readily available. Ultrasounds have a waiting list, and are difficult to get in some parts of the country, and travelling is an important expense and overhead in rural areas.

Some 20 years ago our hospital (DGH) was upgrading it’s ultrasound service with a new machine. My partners recognised the need for GPs to have this facility on site, and even offered to send one of the partners on training if we could buy the old machine second hand. It had little or no value… and was eventually discarded. Why were and are we so resistant to change? This same request from GPs is now being requested of us all, when we have too few staff, too few doctors, poor recruitment and undercapacity of both space and people…

Resistance to change is in all of us, and without rationing by co-payment even Mr Hunt takes his children to A&E inappropriately! A letter in The Times from Emma Rowley-Conway today is seminal:

Sir, What hope is there for the NHS when Jeremy Hunt shows ignorance of parts of the health service (“Health secretary takes children to A&E”, Nov 26)? Millions of pounds of taxpayers’ money are spent to provide GP out-of-hours services which are open whenever the GP surgery is closed — and yet he chose to attend A&E. He chose to see a junior doctor instead of an experienced GP, and he chose not to contact the 111 service set up to advise on which services are appropriate. Mr Hunt also seems to be unaware of the £150 million initiatives being funded by the prime minister’s challenge fund to support GP working seven days a week 8am-8pm. Why is he so poorly briefed?

Dr Emma Rowley-Conwy
Chairwoman, Seldoc (out of hours
GP services in Lambeth, Lewisham, Southwark and Sutton)