Monthly Archives: April 2017

Even the most confident, dedicated, altruistic, obsessive and motivated professionals are making mistakes..

I have no specific evidence for this statement – only the anecdotes I am hearing from former colleague and friends. It appears that now, even the most confident, dedicated, altruistic, obsessive and motivated  professionals are making mistakes.. In one year alone these pressures have helped close 181 practices. A year ago NHSreality reported on “The sick parade – of GP closures. This list heralds the end of the health service as we knew it. ” Private Medical Practice is becoming more attractive. Patients should make alternative arrangements before premiums are raised in view of the change in the Ogden discount rate formula “Now the Ministry of Justice has decided to reduce the discount rate from 2.5% to minus 0.75%.”,,,, As for the professional indemnity insurance for doctors, don’t believe the government when it says it will address this and compensate doctors. It has not got the tools (rules of the game)  and it cannot afford to even if it had changed the rules and bought in no fault compensation…..

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Hospital doctors are leaving and  General Practice is closing down.

Nick Bostock for GPonline reports 19th Jan 2017: Nearly 200 GP practices closed in 2016 alone, NHS data suggest – Up to 181 GP practices closed in the 12 months to January 2017, official data show.

Data on GP practice populations released by NHS Digital this month list just 7,532 GP practices – down 181 from the total a year earlier in January 2016.

Part of the drop in GP practice numbers in the NHS Digital data is likely to be driven by mergers, which could mean that some of the practice locations no longer listed in official figures remain open, but under the wing of a larger group.

However, BMA leaders have warned that closures are at ‘record levels’ and the latest figures suggest that the trend is not slowing down as GPs wait for government pledges of investment through the GP Forward View to take effect.

GP funding

Health minister David Mowat pledged in November that 1,000 practices would receive support in the current financial year from a £16m tranche of the GP resilience fund that CCGs must spend by the end of March. But since the GP Forward View was launched in April 2016, GPs have repeatedly warned that support is not coming through fast enough.

Responding to the latest figures, GPC deputy chair Dr Richard Vautrey said: ‘This is yet more evidence of the crisis facing general practice right around the country and is a direct result of unsustainable and unsafe workload pressures, and failures to attract enough doctors in to general practice so that it’s increasingly hard for practices to replace retiring GPs.

‘Every closure will impact on groups of patients who will worry about the loss of the relationship they had with their GP. There is now all the more urgency to invest in general practice and deal with unsafe workload levels.’

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GP crisis

GPonline warned in November that 5m patients in England could be forced to look for a new practice because one in 10 GPs said their practice was at risk of being forced to close over the coming year.

A GPonline investigation published last summer revealed that one in 20 GP practice contracts in England had been terminated since 2013. The findings showed that 140 contracts ended because of practice closures in the three years to March 2016, while 264 contracts were terminated because of a merger. A further 26 contracts were terminated and reprocured under a new provider.

Brian Milligan for BBC reports 27th Feb 2016: Insurance premiums ‘set to soar’ after compensation changes

Ben McLure in Investopaedia: Discount Rate Accounting

Paul Lucas in Insurance Business 30th Jan 2017 : What’s going on with the personal injury discount rate?

GPonline: Guide to new care models and your medical indemnity

Record Level of claims Inflation – £1000 each taxpayer per annum: How to solve the indemnity crisis

The public will only miss what they had – when its gone. GP indemnity fees spiral out of control with 25% rise last year..

Time to stop the indemnity circus

The Medical Press is scathing – and acknowledges the deconstructed Health Service(s)

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Natural childbirth lobby putting babies at risk, warn parents

Medical students find it difficult to get meaningful access to pregnant women, and even harder to perform deliveries. The “protection” that the midwives offer to patients is worse for male medics than for female, but exists for all. As more women have fewer children at an older age it gets more risky… It is safer to concentrate care… Junior doctors are being deskilled in Maternity… and this needs to be reversed.

Chris Smyth reports 20th April 2017: Natural childbirth lobby putting babies at risk, warn parents

Babies are dying because maternity services have been “hijacked by militant natural childbirth promoters”, bereaved parents claim.

An investigation is under way into a cluster of baby deaths involving the same avoidable mistake by midwives at an NHS trust that has been accused of being “in denial” about repeating the error.

Campaigners say the failings illustrate broader problems of a “deep-rooted ideology” in midwifery that prioritises “normal” childbirth, without medical intervention.

Last week Jeremy Hunt, the health secretary, ordered an investigation into seven avoidable baby deaths in two years at the Shrewsbury and Telford NHS Trust.

Five of the deaths involved failure to monitor the baby’s heart rate properly and regulators will look at whether the deaths were investigated properly to help avoid repeating the problem.

The deaths took place between 2014 and 2016. The parents of Kate Stanton-Davies, who died at the trust’s Ludlow community hospital in 2009, said action should have been taken long ago.

An independent review concluded last year that Kate’s death had been avoidable but the trust “abdicated its responsibility” by failing to investigate properly.

“What these deaths show is that this trust is in denial and from what they are saying they honestly don’t believe there is a problem,” Kate’s mother, Rhiannon Davies, said. Deaths include those of Ella and Lola Greene, twins who were stillborn at the Royal Shrewsbury Hospital after delays in spotting heart-rate deterioration.

A baby’s brain can be starved of oxygen if doctors do not hasten birth when its heart rate deteriorates, causing death or brain damage. The Times revealed two years ago that a quarter of NHS maternity negligence payouts involved such failures, costing the health service £268 million in 2015.

Ms Davies said: “This is not just about how a heart monitor is used, this is all about a top-down toxic culture. As well as understaffing there is a seeming disregard for mothers’ wishes during childbirth. The midwives’ role has been hijacked by militant natural birth promoters. They are not listening to mothers’ concerns and are pushing for natural birth at any and all cost. Babies are dying . . . because of the agenda.”

Midwives are taught to encourage women to have “normal” births, without anaesthetic, forceps, induction or caesarean. Many such births happen in midwife-only units or at home.

A major review concluded the practice was generally safe but two years ago a review into the death of 11 babies and one mother at the Morecambe Bay trust condemned midwives’ pursuit of natural childbirth “at any cost”.

James Titcombe, who pushed for that inquiry after the death of his son Joshua, said the events at Shrewsbury and Telford “have all the hallmarks of being another Morecambe Bay”.

The trust declined to comment yesterday.

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If maternity care is getting riskier, it seems safer to concentrate it..

Short journeys become longer: 40% of maternity units are inadequately staffed (and some are so old they need replacing).

This weeks rationing. The elderly, Maternity care and IVF. Abolish the Welsh Assembly?

“Reducing the ratio (of maternity staff in Surrey) to balance the books is the worst of all decisions.”

Its the start that matters. Maternity and child care is important and plans to fund child care will help… but “Britain has one of the lowest breast-feeding rates in the world, with only 50 per cent of mothers managing it for six weeks”

75% of “minority staff” are not bullied…

Surprised? NHSreality is surprised that the bullying is not much higher!

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Chris Smyth reports in the Times 20th April 2017: Quarter of minority staff in NHS are bullied

Patient care is suffering because ethnic minority NHS staff are so fed up with routine discrimination and bullying, an official report has warned.

Health service data revealed that ethnic minority staff in the NHS were 56 per cent more likely to be disciplined than their white counterparts. More than a quarter said they had been bullied by their colleagues in the past year, with one in seven saying their boss had discriminated against them.

Simon Stevens, chief executive of NHS England, said that “no one should yet be comfortable or satisfied with what these figures show”. He ordered the health service to do more to harness the skills of minority staff, who make up almost one in five of the health service’s 1.2 million staff, but just one in 15 of top managers.

An official report on race equality in the NHS asked for data from all hospitals and local trusts and analysed data from the staff survey of more than 400,000 workers, which defined race by skin colour alone, with many foreign staff counted as white.

Yvonne Coghill, who oversaw the project, said: “We are concerned because if you have a more engaged workforce it improves patient care.”

NHSreality response to the RCGP Questionnaire into the future of Welsh health and social care

This is NHSreality (my own) response to the questions asked by the RCGP in Wales:

1. What matters most to you about health and social care services, and what should we concentrate on to make things better?

An honest language in health and social care rationing. We need to make it clear to citizens what is not available. This might be different for people of different means, but it needs to be overt. (We also need exit interviews conducted by an outside and independent Human Resources body, reporting both to the WG and to the Media in a depersonalised way.)

We need more doctors and nurses, physios and psychologists, all trained in the UK.

2. What do you see as working well?

Very little. Every service is under strain. What continues to work well is the denial of politicians and administrators, the gagging of staff, and the inability of the press and media to sustain a debate on a complex subject.

3. Can you think of any new ideas and good practice you have seen, that could be copied more widely?

I was in the habit of offering “open access” to psychiatric patients before I retired, on a Friday afternoon. I believe all practices would reduce their suicide attempt rate if this was accepted as normal practice. In hospitals I found that Friday afternoons were inadequately staffed (Flexitime?) and so if I was a CEO I would ask that all departmental meetings were ion a Friday afternoon, and have random phone checks on staff to see if they were present.

4. What problems are there in the current systems, and how do they show through in the services people get?

Everyone educated knows that the health systems of the Uk are unsustainable. What they do not know is the different rights of patients, outcomes, mortality and complication rates. These will become more evident over time as the WHO reports on 4 rather than one health system. Devolution has failed for Wales. Free prescriptions discourages autonomy. These problems show through in a disengaged staff, gagging and bullying, lack of exit interviews, particularly for consultants, top nurses and trust board members, but in general for all staff.

5. What do you understand by integration of health and social care and what do you think a fully integrated service looks like in practice?

There are risks in integration. These are made worse if rationing is not overt. Whilst the average citizen feels that he is covered for “everything for everyone for ever”, we will not get progress, or reality. I think that if we continue down the way we are, civil unrest is likely as systems fail, and important treatments are unavailable. Elderly, terminal, palliative, and mentally ill people are politically soft targets compared to those who will vote for many years.

6. What do you think stops improvement from happening and how could this be overcome?

Dishonesty and lies. Top officials unable to lead by articulating the truth. Disengaged staff who realise the whole of their health safety net is founded on sand, and holed.

This can only be overcome by new leadership, an honesty which is seen as a summary of the “hard truths” of a society where the technology is advancing faster than our ability to pay for it. This needs p[political permission and a long term approach to subjects such as manpower provision. The long term means longer than one or even two terms of office. Giving the people of Wales the opportunity to vote on reversal of devolution, returning to England and Wales, and having more money for health and education might help.

7. What more can people do to look after their own health and well-being?

Bring back prescription charges. Introduce ID cards with tax status on them, and a scale of fees related to income. This means waiting lists will have to be mush better/shorter and therefore such a  system can only be introduced once there is an “excess” or overcapacity in trained UK doctors. (preferably graduates)

8. What improvements can be made to information and advice to help patients make decisions with professionals about care?

The rules of the game need to change.. Look at NZ and Scandinavia.. for sustainability.

A limited list of drugs. if patients prefer off the list they pay. Many more therapists as an option instead of (not as an adjunct( to drugs. More public health consultants. One IT notes system in Wales, starting with General Practice, and then expanding into A&E, etc. It will spread like a cancer.

9. Please tell us about any ideas you may have that you think could deliver real improvements to services.

Focus on Friday afternoons. Have a Full Time service until 17.00 at least, and until 22.00 hrs for Psychiatry. Allow GPs to escape from QOF. Performance related pay is all very well for a short period of time (2-3 years) but after that it demotivates.

10. What do you think should be covered by national rules and what should be left for local managers and professionals to decide?

Local rationing of services has to come, and should apply to high volume low cost items. National rationing should be about (as few as possible) high cost and low volume services. In this way there is local “choice”, but as little post code rationing differences of important and fearful conditions as possible. Co-payments according to means could work once waiting lists are short and there is an oversupply of doctos. If patients are on the lowest possible income and unemployed they should still pay something for everything, but get it back in their next Social Security payment. the cost of all services should be on the obverse or at the bottom of the paper. Eg Out patients, Scans etc.

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£8.60 needed to help save the Welsh Health services and bring them back to reality. “Free prescriptions ‘saving Welsh NHS money for 10 years’!!!

£8.60 (for each item) needed to help save the Welsh Health services and bring them back to reality. Pull the other leg Mr Gething. Free prescriptions is the opposite of rationing – ?profligate?

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Free prescriptions ‘saving Welsh NHS money for 10 years’ is reported by BBC Wales

Ten years of free prescriptions for all in Wales is a “long-term investment” in people’s health, a minister has said.

Health Secretary Vaughan Gething said since April 2007 it had kept people out of hospital and cut overall NHS costs.

The Welsh Government said the £593m cost of free prescriptions in 2015 was only £3m more than the bill in 2007.

Conservative spokeswoman Angela Burns said the cost was still too high, saying people should pay for their medicine if they could afford to.

Prescription charges were the same across the UK until 2001, when they were frozen at £6 in Wales by the then Labour-Lib Dem administration in Cardiff Bay.

Welsh ministers also made prescriptions free for all aged under 25.

They were already free for children, pensioners, people on benefits and pregnant women – accounting for about 90% of the total.

The charge was subsequently cut before being abolished altogether in 2007.

Northern Ireland followed suit in 2010, and Scotland in 2011.

Mr Gething said free prescriptions were “progressive and an integral part of our health services in Wales”.

“It should never be the case that people with serious chronic conditions can not afford to collect their prescription,” he said.

“Ensuring patients have the medication they need not only improves their own health and wellbeing, it also benefits the health service as a whole by reducing hospital attendance and placing fewer demands on general practitioners.”

For the Welsh Conservatives, Ms Burns claimed the cost of free prescriptions had soared by 45% since the idea of dropping all charges was proposed in 2000.

She said the NHS should not be “treated like a buffet cart”, calling for a “more just and affordable model”.

“It cannot be right that £5.1m was last year spent on paracetamol alone – which can be bought for mere pennies in supermarkets – while some patients were denied potentially life-saving cancer medication on the basis of cost,” Ms Burns said.

“People who can afford to pay for their medicine should pay, while those who cannot afford to pay, or live with long-term chronic conditions, should still be able to benefit from free medicine.”

Plaid Cymru AM Dr Dai Lloyd said his party supported free prescriptions for all, saying the policy “frees up NHS resources away from the bureaucracy required to administer a means-tested system as in England”.

“The fact that Northern Ireland and Scotland have also introduced free prescriptions following Wales demonstrates this has been a successful policy,” he added.

The Welsh Liberal Democrats said they “remain committed to free prescription charges as part of a package of ways used to tackle the significant health inequalities we face”.

In England, prescription charges rose on Saturday from £8.40 to £8.60.

However, the Department of Health said that due to the range of exemptions, 90% of prescriptions were dispensed free of charge.

Abandon the Health Services – it looks as if Mark porter’s letter to BMA members will be ignored

Politicians are distracted. They are, by neglect, abandoning the Health Services – so it looks as if Mark porter’s letter to BMA members will be ignored. But I am sorry Mark, there is no NHS, which is partly why there is no concerted, National, response.

In calling today for a general election, the prime minister refers more than once to the ‘national interest’.

The BMA is not a partisan organisation, and has never given its support to any political party.
But as doctors, we have a long-established view on what constitutes the ‘national interest’. And I think the vast majority of us would agree that this includes a health service that is well run and properly resourced, and does not have to lurch from one crisis to the next.
But as doctors, we have a long-established view on what constitutes the ‘national interest’. And I think the vast majority of us would agree that this includes a health service that is well run and properly resourced, and does not have to lurch from one crisis to the next.

As to which party is the best at delivering that health service, that’s a matter for you and you alone at the ballot box. But our job in representing doctors is to ensure that the health service is a central issue in the election campaign over the seven weeks between now and 8 June.

There was a time when we could take this for granted. Healthcare has always been a political issue, although sometimes not in the way we would have chosen. Just as hard cases make bad law, a politicised row over a single patient’s treatment, as we have seen in some general elections, achieves little overall.

General elections are the moment when the overall direction of our state is set, how we define and fund public services in the UK, for up to five years. But this election could all too easily become the ‘Brexit election’, and little else, at precisely the time when the health service in which we work is under unprecedented stress and needs the unrelenting focus of politicians from all parties to rescue it.

We are seeing the organisations in which we work being pushed into intractable deficit, treatments rationed and access-time promises shelved. They are the unmistakeable signs of an NHS at breaking point.

We have seen consecutive governments in denial about the state of the health service, and when it comes to elections they have treated it as little more than a political football. Our health and social care systems can simply no longer cope without urgent and coherent action.

Patients want, vote for, and deserve better. We need politicians of all parties to stop ducking the crisis and come up with credible and sustainable plans for safeguarding the future of the health service. When it comes to securing the health of our nation, there could hardly be a stronger national interest.

Litigation has the potential to kill the Health Services: More than 800 women sue NHS and manufacturers over vaginal mesh implants

NHSreality says Bring in No-fault compensation ASAP.……. but also feels that the standards for Instrumentation are too lax and should be aligned with those for new drugs: tested over a longer time, and peer confirmed. All doctors are taught that foreign bodies should be avoided whenever possible….

Hannah Devlin in The Guardian 18th April reports: More than 800 women sue NHS and manufacturers over vaginal mesh implants

Women report that implants, used to treat incontinence or pelvic organ prolapse, cut into the vagina, causing agonising pain

More than 800 women are suing the NHS and the manufacturers of vaginal mesh implants after suffering serious complications.

Some women reported that implants had cut into their vaginas, with one woman saying she was left in so much pain that she considered suicide. Others have been left unable to walk or have sex, according to the BBC.

However, the medical regulator said that the best current evidence supports the continued use of mesh implants to resolve health conditions that could themselves cause serious distress to patients.

The implants are used to treat incontinence after childbirth or pelvic organ prolapse, where the womb or bladder bulge against the walls of the vagina.

Between 2006 and 2016, more than 11,000 women in England were given vaginal mesh implants to treat prolapse or incontinence, NHS data shows. About one in 11 women suffered complications. The issue reached prominence in Scotland last year after women with painful and debilitating complications formed a support group.

Claire Cooper began to experience pain three years after her operation. Doctors initially thought the discomfort was related to the removal of her womb, a procedure she had undergone aged 39.

When the pain continued, she said a GP told her she was imagining it. This, and the severity of the pain, resulted in suicidal thoughts, which she said she only overcame because of her children. Her constant pain has forced her husband to become her carer.

Cooper said she and her husband have not had sex for more than four years. “This stuff breaks up marriages,” she told the BBC. “I wouldn’t at all be surprised if there are mesh-injured women that have taken their own lives and didn’t know what the problem was.”…

…Rachael Wood, a consultant in public health medicine for NHS National Services Scotland and the lead author of the Lancet study, said: “The results were quite clear that women do suffer a higher complication rate and that it is no more effective. You can make quite a clear recommendation that it shouldn’t be the first line of treatment for prolapse.”

However, Wood said that the results on incontinence surgery were less clear, and for incontinence the study found fewer short-term complications when mesh surgery had been used compared to traditional treatment, which involves major surgery.

She said: “There’s no doubt that some women have had very poor outcomes. It is worth saying that nothing is without risk. There are also bad outcomes from traditional surgery and from doing nothing.”

Immoral Science (and research) – e.g. NHS to ban ‘toxic’ metal-on-metal hip implants

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