Category Archives: Medical Education

How did we get to this? What manpower planning failure. Please let Health Service visas be dependent on good language and cultural awareness.. and integration

There is an enormous and decade long shortage of doctors. A temporary fix, as in the 1950s will be needed, but how is it that we have let history repeat itself? The media should be asking what is wrong with the process whereby we reject 9/11 applicants for medicine (rationing), and then are recruiting 40% from overseas. NHSreality feels the answer lies in short term politics, whereby the next mang=date is all that matters. There is no gain in spending more when the results will not benefit you….. Proportional representation would help, as would depoliticising the Health Services, but a revolution is needed whereby local graduates can enter for medicine, but learn locally. They can use on line learning tools, and exams, but their practical assessments need to be centralised as now.

The Times leader 2nd June opines:

Theresa, Please, a Visa – The prime minister should stop refusing entry to doctors and nurses

The health service desperately needs more doctors and nurses. According to NHS Improvement’s quarterly performance report, published two days ago, by the end of last year there were more than 35,000 nursing vacancies, more than 9,000 vacancies for other medical staff, and nearly 47,000 vacancies elsewhere in the service. The NHS is trying to fill some of these posts with qualified applicants from abroad, but its efforts are being frustrated by the government’s insistence on keeping migration numbers down. The prime minister should rethink.

This week it emerged that dozens of Conservative MPs had put their name to a letter, written by Heidi Allen, urging Theresa May to relax immigration rules in order to address these shortages. Between December and March, the letter said, 1,518 doctors were refused a tier-two visa to work for the NHS. The government has capped these visas at 20,700 a year and so grants requests sparingly.

The NHS has a serious staffing problem and it is not getting any easier to fill vacancies. After Britain’s vote to leave the European Union, the number of EU nurses joining the British register plummeted, and the number of EU nationals leaving the health service rose. This, combined with nearly a decade of wage pressure and inadequate workforce planning, has intensified pressures. Such shortages have an impact on quality of care. In January a poll of GPs revealed that 71 per cent of those working in hospitals had seen shifts left uncovered.

The same month The Times reported on a memo written by the head of chemotherapy at the Churchill Hospital in Oxford warning that a shortage of trained staff would force the hospital to cut the number of chemotherapy cycles offered to the terminally ill. Limiting access to foreign labour affects certain specialisms, and certain parts of the country, in particular. According to a report by the General Medical Council, more than half the workforce in obstetrics and gynaecology are non-UK graduates. In the east of England the figure is 43 per cent.

Amber Rudd, before she resigned as home secretary, sensibly argued that doctors should be excluded from the tier two rules. She was said to be rebuffed by Downing Street. All too predictably. Mrs May has spent the last eight years of her career, first as home secretary and then as prime minister, wedded to a fundamentally misguided policy of bringing net migration down to the tens of thousands.

Even in her own party, few people think this is a good idea. Ruth Davidson, leader of the Scottish Conservatives and a possible future leader of the national party, said this week that she sees “neither the sense nor the need” to stick to the original target. The prime minister can hardly doubt Ms Davidson’s judgment as a Conservative political strategist: Scotland was the only part of the country in which the Tories picked up seats in last year’s general election.

The Conservatives ought to have an immigration strategy that reflects the needs of the labour market, public services and the economy as a whole. This means abandoning the promise to get net migration below 100,000. Whatever the government’s overall immigration policy, it should stop turning qualified medical professionals away. The health service needs them.

See the source image

Comment:

Leadership and management!

Should not boredom be addressed regarding the NHS saga? Otherwise constant repetition about the country’s health system will surely dull the public’s psyche, eventually.

The question is: Should not Leadership be crucial to establishing, progressively, for a large and well-deserved organisation such as the NHS? Leadership is not about style, but about substance. So, vision, action and spirit are the starting point for the country’s long-term wellbeing.

It seems that leadership is absent for the success of the NHS, regrettably, besides the style of  Management within that world renowned organisation laisse beaucoup à désirer.

Can The Times investigate in-depth, and report to the country?

Hands up – who want’s to be a GP today? Recruitment is at an all time low despite rejecting 9 out of 11 applicants for the last few decades..

Medical Schools: your chances – applications-to-acceptance ratio was 11.2.

Facing an understaffing crisis….. Those rejected during the last 30 years should be asking why?

The Training of doctors…. unfortunately it is too late to recover in even the 5 years promised by government… Decommissioning of operations

Nursing degree applications fall by a fifth – a two tier service is evolving by neglect.. State basic, and Private enhanced.

 

 

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The shortage of diagnostic and filtering skills is costing us dear. GPs retiring especially.

 It is the duty of a government first to protect the realm, then to avoid insurrection and protect the rule of law, then to protect the health of it’s people. Successive UK governments have shown they have no long term view or ability to manpower plan. We need to change the rules of the game that the politicians play, so that they have incentives to plan properly, or we need to take health away from them. The shortage of diagnostic and filtering skills is costing us dear. GPs retiring (or emigrating) especially. Add to this the parlous state of health services finance, and there is going to be trouble ahead… Image result for doctors  emigrate cartoon

Chris Smyth reports May 30th in the Times: Million patients hit by closure of GP surgeries

More than a million patients have been forced to change GP surgery in the past five years, with closures up tenfold as family doctors abandon the NHS.

Last year 458,000 patients had to find a new practice because their existing surgery shut, up from 38,000 in 2013, according to official data.

Patients are losing personal relationships with a GP and care is suffering, senior doctors warned.

The network of family doctors which props up the NHS is in danger of crumbling as GPs tire of staff shortages in a “serious failure of the system”, professional leaders warn.

Jeremy Hunt, the health secretary, has promised to recruit an extra 5,000 GPs by 2020, saying that hospitals will be overwhelmed if the NHS does not get better at looking after elderly people locally. However, more than 1,000 family doctors have been lost since he made his pledge.

Data gathered under freedom of information law by the GP magazine Pulse shows that at least 202 practices have shut down completely and 243 have closed branch surgeries since 2013. Last year 57 practices closed and a further 77 satellite surgeries were lost. Since 2013 this has displaced almost 1.4 million patients, the data suggests.

Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “A GP practice closing can have serious ramifications for the patient population it served [and] neighbouring surgeries . . . For those living in isolated areas, this can mean having to travel long distances to get to their nearest surgery, and is a particular worry for those who might not drive and have to rely on public transport.”

She said some centralisations into larger hubs could improve care, but warned that when a closure “is because the practice team simply can’t cope with the resource and workforce pressures they are facing, it’s a serious failure of the system.”

GPs are typically independent contractors paid by the NHS for each patient they look after. As older, sicker patients need a doctor more often, this model has become less viable and Mr Hunt has conceded GPs are on a “hamster wheel of ten-minute appointments, 30 to 40 of them every day, unable to give the care they would like to.”

With Britain short of GPs and younger doctors working fewer hours, there are fears of a spiral of decline as the overworked ones who remain become exhausted. Recent taxes on high pension pots also make it less lucrative for GPs to continue to work into their 60s.

Richard Vautrey, head of the British Medical Association’s GP committee, said that family doctors built up long-term relationships of trust with patients “but when practices close this important foundation can be put at risk and patients’ experiences may suffer as a result . . . Without proper investment in primary care, the knock-on effects on the rest of the health service and society as a whole will cost the government dearly in the long run.”

In Plymouth, one of the worst affected areas, a fifth of practices have closed in the past three years, leaving 34,000 patients without a GP. Local doctors say that they get only four hours’ sleep a night as they try to deal with remaining patients and one, Mark Sanford-Wood, said the city’s plight was “a warning of what the rest of the country faces”.

A spokeswoman for NHS England said: “More than 3,000 GP practices have received extra support thanks to a £27 million investment over the past two years and there are plans to help hundreds more this year. NHS England is beginning to reverse historic underinvestment with an extra £2.4 billion going into general practice each year by 2021, a 14 per cent rise in real terms.”

Katherine Sanz in N Ireland reports 10th May 2018: Shortage of GPs as third set to retire

Revealed: 450 GP surgeries have closed in the last five years – Pulse today

 

I may never witness another quality service in primary care. Over 1000 or 4% leave GP in two years… predictably.

The result of long term rationing of medical school places, too many part time doctors, and poor manpower planning, have led to the current situation. My life expectancy at 68 is some 10-15 years, so I may never witness another quality service in primary care. The solutions lie in longer term planning, graduate entry to medical schools, and a virtual medical school whereby potential doctors live and work in communities rather than cities. Even then we would need adverse selection as a policy to address the dominance of large city suburban schools.Image result for retiring GPs cartoon

Nick Bostock reports in GPonline 15th May 2018: GP Workforce falls 4% in two years as shortage continues to grow.

…Excluding registrars, retainers and locums, figures published by NHS Digital on Wednesday reveal a total full-time equivalent workforce of 27,773 in March 2018, a 1,260 fall compared with March 2016. This represents a 4.3% drop in just two years.

Numbers of GPs in partnership roles continue to drop sharply, the latest data reveal. In March 2018 there were 22,593 GP partners, down 6% compared with March 2016 – showing that 1,563 partners were lost to general practice over this 24-month period alone….

and Katie Osborne of  Pulse 10th May reveals that, during this period, only “Just 85 GPs recruited from overseas”.

Chris Smyth reports in the Times 16th May 2018: 1,000 GPs leave despite recruitment drive

More than 1,000 family doctors have been lost since ministers set out plans to hire 5,000 more, official figures show.

GPs are continuing to abandon the NHS as they become fed up with rising numbers of appointments, in what professional leaders called a “hammer blow” for patients. They warned that a spiral of decline risked making remaining GPs even more fed up, threatening the family doctor system with collapse.

Jeremy Hunt, the health secretary, promised in 2015 to recruit 5,000 extra doctors by 2020, warning that hospitals would be “overwhelmed” if the NHS did not improve at caring for the elderly locally. However, despite schemes to stop doctors retiring early and golden hellos to tempt them to parts of the country with shortages, numbers have continued to decline. Figures published yesterday showed that there were 34,435 GPs in March, excluding locums and trainees, down from 35,516 two and a half years ago.

Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “The stark truth is that we are losing GPs at an alarming rate at a time when we need thousands more to deliver the care our patients need, and keep our profession, and the wider NHS, sustainable. It is clear that substantial efforts to increase the GP workforce in England are falling short — and we need urgent action to address this.”

A Department of Health spokeswoman said: “We are committed to meeting our objective of recruiting an extra 5,000 GPs by 2020. This is an ambitious target and shows our commitment to growing a strong and sustainable general practice for the future. More than 3,000 GPs have entered training this year, 1,500 new medical school places are being made available by 2019 and NHS England plans to recruit an extra 2,000 overseas doctors in the next three years.”

The GP recruitment farce – Mr Hunt never said the 5000 would come from the UK!

Its going to cost you – approximately £450 per month or £5000 per year – and that’s for starters. Denial of need to ration will lead to nemesis..

Meltdown in South Pembrokeshire will extend across the Haven. What reassurance can the minister offer now?

Nick Bostock also reveals “How GPs fell out of love with partnerships”.

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Meltdown in South Pembrokeshire will extend across the Haven. What reassurance can the minister offer now?

Update 18th May. The Western Telegraph: “Health Board reassures after Tenby doctor quits” May 11th and not yet on line. How can the people of Tenby, who pay more tax per head than the rest, and are elderly, be reassured when there will be paramedic cover, rather than diagnostic skills.?

I know there are many other places like South Pembrokeshire in the country. North Wales has already hit headlines. The area I know is symptomatic of a general shortage of GPs that cannot be replaced quickly. This means diagnostically trained physicians are not available easily: the health board will try its best, and the practice will be “under special measures”, like many others in South Wales.

Dr Damian Kelly has resigned, and he was the last GP partner left standing in Tenby. He may well work a “locum” for his former patients, whilst the health board tries to plug the gaps. Tenby is one of the most elderly populations, ( approximately 5000 souls ), but the practice covers a wide surrounding area and has up to 10,000 registered patients. In the Pembrokeshire Herald the headline reads “Health Board reassures after Tenby doctor quits. This is not a new problem: it has been festering for years. ( Thomas Sinclair reported in 2014: First Minister reassures over Tenby GP services ) What reassurance can the first minister offer now?

In the summer, Tenby and Saundersfoot populations treble, and holidaymakers often overrun the clinics. These visitors, and the registered patients, will have to be distributed in the surrounding practices at Saundersfoot, Pembroke Dock (Argyll Surgery) and Narberth.

Argyll  medical group has also covered part of Neyland as St Clements Surgery, across the estuary but this will end in a few months time. Patients there ( @ 2000 souls) will need to register at either the other surgery in Neyland, or Haverfordwest or Milford Haven.

Goodwick surgery near Fishguard is already under special measures.  Solva is trying to recruit…

20 years ago there would have been competition to work in such beautiful places, but now there is a shortage of GPs which will last 10 years. The pressure on already stretched GPs will only increase, as there is no way to appoint quickly. Bribes are irrelevant as all trusts are now introducing them.

In addition, the majority of GPs are female. Their intention is often to work part time, and the solution, to appoint post graduates to medical school, has not happened other than in a small way. 

In Fife there is also a shortage: Clare Warrender in the Courier reports 12th May: GP recruitment crisis leaves several practices at risk.

Even in London they have problems, but there it is because of the cost of housing, and premises.

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Jan 2016: Gender bias. The one sex change on the NHS that nobody has been talking about

May 2018: Any shortage of oncologists is due to manpower mis-planning over decades, not a lack of visas over months.. America needs over 1000,000 more than currently planned, in 12 years time.

Comment on the New Medical Schools. How will continuity of care improve?

March 2018: Another form of rationing: restriction of GP access should be blamed on politicians

Jan 2018: Its more than a thin front line, as half timers take over from deserters…

Just cry at the bribery, and the Death of the Goose that used to lay the golden eggs that used to make the Health Service(s) so efficient, and the envy of the world.

Should there be lighter regulation in order to reduce inequalities? How high earning professions lock their competitors out of the market. Old style GPs are becoming extinct.

In Wales they really can waste money: £68m unveiled for health and care hubs

 

The ageing workforced will soon be gobal crisis, warns IMF. Should we be encouraging larger families?

The ironic side of bureaucracy is revealed in the headlines today. Firstly, a global look at our “caring” workforce, which includes services such as plumbing and electricity repairs for elderly people, palliative care, nursing and residential home care, and many other general facilities. Many elderly people for example, are excluded from on line deductions, because they have not learnt to use a computer or mobile phone. Recent suggestions that we need a cybersecurity government advisory service are addressing a real risk that many systems could break down in a cyber warfare or even a serendipitous situation. This is not just a business and commercial risk, but also for the Health Services.     Especially the rich and famous…    Importing English language speakers will be much better than importing non English speakers, but will we resent all incomers to the point where The cost of care is so great that we may end up exporting our elderly….  I would very much like to have a doctor and a nurse I can communicate with, but also one who understands where I come from, when I am ill. Its not very likely.. Makes me wonder about the UK government incentives to keep families smaller…

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The Times reports 10th April: Doctor faces deportation over late visa

The British Medical Association (BMA) has urged the Home Office to rethink deporting a Singaporean doctor on the verge of qualifying as a GP because he applied for his visa 18 days too late.

Luke Ong, 31, who has lived in Britain for the past ten years while training for his medical degree, is five months away from becoming a GP. His parents paid almost £100,000 for his medical training in Britain, which was also part-funded by the UK government.

Dr Ong applied for the right to remain in September 2017 but was refused for being 18 days late, an error the BMA called “an honest oversight”…..

Philip Aldrick reports, again in the Times 10th April: Ageing workforce will soon be global crisis, warns IMF

Policies to encourage immigration and deter retirement may be needed in wealthy nations to deal with the looming challenges of an ageing population, the International Monetary Fund says.

The Washington-based financial watchdog has warned of a potential crisis among advanced economies as the baby boomers retire and an expanding pensioner population has to be supported by a dwindling workforce.

The issue is critical because pensions and healthcare costs are paid for by taxes levied on the income an economy generates. A shrinking labour force relative to the population can lead to higher taxes and lower benefits.

“Because older workers participate less in the labour market, the ageing of the population could slow growth and threaten the sustainability of social security systems,” the IMF said in its World Economic Outlook report.

For the average economy, it calculated that dependency ratio, which measures the number of over-65s as a proportion of those aged between 20 and 64, rose from 27 per cent in 2008 to 34 per cent today. By 2050 there will be just two workers for every pensioner on current trends. Governments will have to “rethink migration policies to boost their labour supply, alongside policies to encourage older workers to postpone retirement”, the IMF claimed.

To maintain a balance between working and retired people, pension ages may need to rise further and greater incentives be provided to work later into life. The safety net state pension should be protected but the fund suggested measures such as adjustments to “the implicit tax on continued work” to reward those who delay retirement.

The IMF hinted that some pension plans may be too generous. “Incentives for retirement have a powerful effect. Raising the statutory retirement age is associated with delayed exit from the labour market, whereas greater pension plan generosity seems to encourage early retirement.”

Migrants should be helped with “language and labour market programmes” to “enable their swift integration”. The IMF pointed out that “any efforts to curb international migration would exacerbate demographic pressure”.

Who is going to be the last nurse standing?

The cost of care is so great that we may end up exporting our elderly….

Katherine Griffiths in the Times 10th April reports: Investors ‘must pay closer attention’ to cyber threat

The potential risk for blackmail – think about your medical records when you are young. Are you ambitious to be famous?

Some good news on new medical schools. Lets hope the politicians sieze the real opportunity for virtual medical schools living in local communities

Bearing in mind that only 2 years ago, 9 applicants out of 11 were rejected for medical school  and that thousands have been disappointed when we really needed them, we now have politicians acting. They need to do more. The new places need to be graduates, rather than undergraduates, , and there needs to be additional “virtual” medical schools attached to each Deanery. If everyone is subjected to the same assessment exams, we could see whether community based training is as good as centralised raining. Careers officers should have been listened to. We have wasted a whole generation of disappointed talent.

Five medical schools are created in England in bid to increase home grown doctors BMJ 2018;360:k1328  21st March 2018

Five new medical schools have been created under government plans to increase medical student numbers in England.

In 2016 England’s health and social care secretary, Jeremy Hunt, announced a 25% expansion in medical student places in a bid to expand the number of home grown doctors rather than recruiting from overseas.1 He said that as many as 1500 more doctors would be trained in England every year from September 2018.

Health Education England (HEE) has now announced the creation of five new medical schools offering undergraduate places.2 The new schools will be at the University of Sunderland, Edge Hill University in Lancashire, Anglia Ruskin University in East Anglia, the Universities of Nottingham and Lincoln, and the Universities of Kent and Canterbury Christ Church.

“>Figure1

In 2017, 500 new medical school places were allocated to existing medical schools. The remaining 1000 places have now been allocated after a bidding process run by HEE and the Higher Education Funding Council for England.3

Ian Cumming, chief executive of HEE, said that the allocation of places was prioritised in areas “with a relative shortage of doctors overall, or in certain specialties, and also to widen the social profile of new medical students.”

Overall, the south and south east of England are receiving the largest increase in student numbers, with 200 student places allocated to the region, 100 of which went to a joint bid by the Universities of Kent and Canterbury Christ Church.

Excluding London, which received 137 additional places, the north east received the smallest allocation of 147 medical school places. Figures from HEE published in 2017 showed that the north east had a sufficient number of doctors per weighted population.3

References

  1. Medical Schools: your chances – applications-to-acceptance ratio was 11.2.

    Comment on the New Medical Schools. How will continuity of care improve?

Five new Medical Schools: better late than never. Lets hope selection criteria are different from before..

Child health declining: just one of the indicators – losing our first world status?

Just as overall life expectancy is set to fall, so child health is declining, and the life expectancy of ill children depends more and more on your post code, and your income group. We are losing our first world status.. Our main natural resource is our people and our children. With no significant underground resources we are in trouble if we don’t invest in education and our children more.

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Jacqui Wise reports in the BMJ: Child health crisis: calls for urgent action must be heeded (BMJ 2018;360:k1270 )

The data pointing to a reversal in the health of British children are mounting, reports Jacqui Wise

After years of progress the UK is stalling in areas such as infant mortality and immunisation levels and is lagging behind similar countries on mortality, breastfeeding, and the prevalence of obesity.

Several new reports detail the worrying state of the nation’s child health. Health professionals say that the latest figures are cause for alarm and are calling on the government to act urgently to develop a comprehensive child health strategy.

Rising infant mortality

Latest figures from the Office for National Statistics show that the number of babies dying in the first year of life is rising,1 a reversal of several decades of the NHS’s success in reducing infant mortality. In England and Wales the rate has increased to 3.8 deaths per 1000 live births, up from 3.7 in 2015. Neonatal death rates have also risen, from 2.6 per 1000 births in 2015 to 2.7 per 1000 in 2016.

Furthermore, the ONS figures show that the infant mortality rate in the most deprived areas of England was 5.9 per 1000 live births, more than double the 2.6 per 1000 in the least deprived areas.

The news comes after findings in a report from the Nuffield Trust and the Royal College of Paediatrics and Child Health that the UK is falling behind most other high income countries in many key areas of child health.2

The report’s author, the paediatrician Ronny Cheung, warned, “The recent changes to the UK’s trajectory on life expectancy, premature deaths, and immunisation should set alarm bells ringing for policy makers about the effects of cuts to public health and early years services.”

The analysis, which compared the UK with 14 other countries—10 in Europe and also the US, Canada, Australia, and New Zealand—found that in 2014 the UK had the fourth highest infant mortality rate. The UK also has the second highest prevalence of babies born with neural tube defects.

The UK’s rates of breastfeeding are among the lowest in the world: only 34% of UK babies receive any breast milk at six months, half the 62.5% in Sweden. The UK’s proportion of children and teenagers who are overweight or obese is considerably above the average among high income countries.

Diphtheria, tetanus and whooping cough, and pneumococcal vaccines have all seen their uptake fall in the past year, and the UK lags behind Sweden, Spain, Germany, and the Netherlands in the uptake of measles vaccine.

Poverty set to increase

The report said that inequality, which has been proved to have a negative effect on child health, is rising. Last year a report published by the Royal College of Paediatrics and Child Health showed that UK children from deprived backgrounds had much worse health on 24 of the 25 indicators measured, including higher rates of mortality, obesity, non-intentional injury, maternal and adolescent smoking, and emergency hospital admissions for asthma or poor diabetes control.34

The situation is likely to get worse, because child poverty rates look set to rise even further. Another new report, from the Equality and Human Rights Commission, looked at the effects of changes to taxes and social security between 2010 and 2018. It concluded that children will be among the hardest hit by the changes.5 One and a half million more people will be in poverty by 2022, it predicted, and the proportion of children in lone parent households who will be in poverty will rise from 37% to over 62%.

Russell Viner, president of the Royal College of Paediatrics and Child Health, argued in The BMJ last week that the problem was that NHS England didn’t prioritise children and teenagers.6 In contrast, Scotland and Wales have both recently announced new national strategies to improve the health of young people.

In a press release accompanying the college’s report Viner said, “We want to see the UK government develop a comprehensive, cross departmental child health strategy, which includes a ‘health in all policies’ approach to policy making. It’s also crucial that some of the biggest threats to child health are tackled boldly—for example, tighter restrictions on junk food advertising to tackle obesity, the reinstatement of child poverty reduction targets, and, crucially, the reversal of damaging public health cuts.”

Michael Marmot, director of University College London’s Institute of Health Equity and a leading expert on health inequalities, told The BMJ, “The worrying part is when a downward trend that has gone on for years stops. While the increase in infant mortality has been small, we should be doubly concerned. First, because one extra death that might have been avoidable is a tragedy for the family concerned. Second, because a rise in infant mortality is an indicator that things are perhaps not going well in society, as well as in the healthcare system.”

He added, “Child poverty rates are set to rise in the UK, and growth in funding for the NHS is way below historical trends. The Nuffield report shows that breastfeeding rates are low in Britain. The government needs to pay attention to all three of these with a good deal of urgency.”

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