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woensdag 1 februari 2017

RCGP: Insomnia can have very real and negative effects on quality of life of our patients, says RCGP

Insomnia can have very real and negative effects on quality of life of our patients, says RCGP
She said: "Insomnia can have very real and negative effects on the quality of life of our patients - and GPs are highly trained to take into account the physical, psychological and social factors that might be contributing to it.
"While sleeping tablets might seem like the mostobvious treatment to many patients, they are rarely effective and may actually cause other longer term health consequences, so GPs will only use them as a last resort, once other treatment options have been explored.
"Stress, anxiety and lifestyle factors, such as drinking alcohol or caffeine, can all contribute to insomnia and effective treatments can include looking into a patient's 'sleep hygiene', asking them to conduct sleep self-assessments and, in some cases, cognitive behavioural therapy (CBT).
"Achieving parity of esteem between physical and mental health is an enduring priority for the RCGP and we have developed toolkits to support GPs and other healthcare professionals to deliver the best possible care to our patients with mental health conditions, including insomnia. The Collegealso continues to call for enhanced GP training to include mandatory specialist training in mental health."

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Progress is being made on GP Forward View - but much more must be done urgently to support frontline GPs and patients

That is the verdict of the Royal College of GPs, nine months on from the launch of NHS England's 'lifeline' for general practice.
In its interim assessment of the GP Forward View published today, the College says that on crucial issues such as practice resilience, local implementation has been far too slow.

The 44 Sustainability and Transformation Plans – intended to shape the NHS at a local level – also come in for criticism for prioritising NHS hospital trusts over general practice, and in some cases even planning to reduce GP numbers.

The GP Forward View promised £2.4bn extra a year for general practice, 5,000 more GPs, and 5,000 more practice staff members by 2020. It also includes a number of short and medium term initiatives to support general practice as the profession struggles to cope with growing patient demand against a backdrop of a decade of underfunding in the service, and an intense shortage of GPs.

The report acknowledges that substantial national progress has been made, with a number of key successes, including:

  • A £16m NHS GP health service launched this week for GPs and GP trainees to access free, confidential advice if they are experiencing stress, anxiety or other conditions affecting their mental health and wellbeing.
  • Important changes made to the Induction and Refresher scheme to make it simpler and more affordable for trained GPs to return to practice after a career break or period working abroad – there are now over 200 doctors on the scheme, most of whom have joined since the changes.
  • Short term measures to counter the soaring indemnity costs that GPs face have been implemented, worth £30m for rises in 2016/17, plus an additional £5m winter indemnity scheme.

NHS England has also assured the College that it is on track to spend £322m extra on general practice this year – a 4.4% increase on last year – which includes a core contractual uplift of 3.9%. However, the College will not be able to confirm this until official figures are published by NHS Digital in Autumn 2017.

However, of particular concern in the report is the lack of impact of the £16m resilience programme, announced in July 2016 designed to support struggling practices that are finding it difficult to recruit, and in many cases facing closure. The RCGP has found that although £16m was assigned to the programme for this year, only £2.5m had been spent by the end of December. Of the 1,453 practices that have been identified as being eligible to receive help, only 219 have so far received any of this resource.

The College is now urging for this significant underspend to be rolled over to the next financial year.

As well as rating the short term commitments in the GP Forward View, which were expected to benefit practices within 6-12 months, the report also includes an analysis of the 44 Sustainability and Transformation Plans across England.

The College concludes that it is 'alarming' that some STPs fail to mention the GP Forward View at all, others simply refer to it in passing – and some actually plan a reduction in the GP workforce.

This is despite official guidance for STPs stating that they must 'develop and implement a local plan to address the sustainability and quality of general practice, including workforce and workload issues' and recommendations from NHS England that they should invest 15-20% of Sustainability and Transformation Fund allocations on general practice.

The RCGP is reiterating its calls that any STP that does not do this must be rejected by NHS England – and warns that a significant proportion should be rejected in their current form.

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: "The GP Forward View is a lifeline for our profession, if it is implemented correctly at both a national and local level, in the best interests of GPs and patients. This review is a stocktake of where we are at, what progress has been made, and what still needs to be done.

"There has certainly been some positive progress – and schemes like the NHS GP health service, and the improved I&R scheme will have tangible benefits on GPs, and in turn their patients. But there is a huge amount of work to do at a local level to ensure that family doctors begin to notice improvements on the ground.

"It's incredibly frustrating to hear that pots of money are just sitting there waiting to be spent – money that has been earmarked for struggling practices. NHS England needs to be out there, making sure the practices who could benefit from this money know about it, and making it easy for them to access it.

"Also extremely concerning is the lack of recognition for general practice in many STPs – this is against all common sense, against all the evidence about how to run an efficient health service and against NHS England's own guidance.

"GPs and our teams conduct the vast majority of patient contacts in the NHS for a fraction of the budget. We provide the most cost-effective form of care, keeping our patients safe, in the community, and out of hospitals where care is more expensive. We can't see how any STP that does not recognise general practice can realistically claim to be either sustainable or transformative.

"The overriding message to government and decision makers is to prioritise general practice as they push forward in shaping the NHS for the future of patient care. We are seeing progress at a national level – we need to see it at local level, we need to see it having a positive impact on the front line of patient care in the community, and we need to see it benefiting our patients."



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Prevention better than cure when it comes to falls in elderly patients, says RCGP

"Caring for elderly patients is a very substantial part of a GP's workload, and we see the terrible effects of falls on a daily basis – not just in terms of physical harm, but knock on effects, such as anxiety and decreased confidence.

"The NICE standards released today highlight the importance of preventing falls in elderly patients, where possible, which is welcome. There are relatively simple things that elderly people, their carers and families can do to avoid falls, such as wearing appropriate footwear, fastening down rugs in their homes, and making sure hallways and stairs are appropriately lit.

"But implementing this new guidance will undoubtedly be hampered by the standard 10-minute GP consultation, which is increasingly inadequate, particularly for older patients who are often living with multiple, long term conditions.

"GPs want to spend longer with our older patients so that we can discuss things with them like how to avoid falling - but in many cases this won't be the reason a patient has come to visit the GP, and it's incredibly hard to do everything that we should do whilst respecting the patient and their reason for visiting us.

"Nevertheless, it is essential that we do use all the opportunities we have with our older or more frail patients to establish whether they are susceptible to falling, and work with colleagues across health and social care to ensure they receive the most appropriate care and support. We also welcome initiatives that allow GPs to spend longer with patients with multiple health problems."


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