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vrijdag 28 juli 2017

RCGP: Clear messages on antibiotics important for patients, says RCGP

Clear messages on antibiotics important for patients, says RCGP
She said: "Resistance to antibiotics is one of the biggest health challenges we face globally. It's important that we take new evidence around how to curb this on board – but we cannot advocate widespread behaviour change on the results of just one study. 

"Recommended courses of antibiotics are not random. They are tailored to individual conditions and in many cases, courses are quite short - for urinary tract infections, for example, three days is often enough to cure the infection.

"We are concerned about the concept of patients stopping taking their medication mid-way through a course once they 'feel better', because improvement in symptoms does not necessarily mean the infection has been completely eradicated.

"It's important that patients have clear messages and the mantra to always take the full course of antibiotics is well known – changing this will simply confuse people. 

"We agree with the researchers that more high quality, clinical trials are needed – and when guidelines are updated, they should take all new evidence into account. But we're not at that stage yet.

"GPs and our teams are playing a huge part in curbing the trend for overuse of antibiotics, and will prescribe in accordance with clinical guidelines, and act in the best interests of the patient in front of us - we would urge our patients not to change their behaviour based on one study."
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Sexual and reproductive health must not become the 'Cinderella' service of the NHS

The College is launching its report Time To Act, highlighting the findings of a College consultation with its 50,000-strong membership.

It found that GPs fear rates of teenage pregnancy and transmission of sexually transmitted diseases will rise – reversing current trends – as vulnerable patients are being excluded from accessing the most appropriate forms of contraception, and that health inequalities are being widened as a result.

Members particularly cited the difficulties patients living in rural areas have in accessing sexual and reproductive health services, as well as younger patients who rely on their parents for transport.

One respondent said: "Reduced numbers of specialist clinics has reduced access for our women, especially those who have cultural and social issues meaning they are unable to travel. Many GPs are feeing unsupported in their LARC fitting services and are giving up. And the young people's services are reduced as public health withdrew the funding to provide them."

The College is calling out the complex and fragmented way that sexual and reproductive health services are currently commissioned in England, as well as the decreasing services available in the community. As it stands, some services are commissioned by NHS England, others by Clinical Commissioning Groups, and yet others by Local Authorities, causing confusion amongst healthcare professionals and patients as to how to effectively navigate the system, and unacceptable variation across the country. 

The report also highlights that the funding GP surgeries receive for providing patients with LARCs does not often cover costs, meaning that practices are making a loss for delivering this service as a time when general practice is already under intense financial strain.

Responding to the consultation, one member said: "We provide a weekly LARC drop in service at our practice but struggle with maintaining funding in practices rather than centrally. For our patients, services close to home are much better suited and this has become more of an issue since the city centre service closed only leaving a service on the other side of the city."

Another concern raised in the paper is training – an issue that affects the whole of the UK. One respondent to the consultation, for example, said: "Many doctors providing LARC services in primary care are nearing retirement and access to training for their successors is a problem."

Professor Helen Stokes-Lampard, Chair of the RCGP, said: "In this day and age, all patients have the right to be provided with sufficient information to make the choice of contraception that is right for them, and be able to access that method without having to negotiate unnecessary hurdles – and GPs and our teams have the right to be properly trained and receive adequate recompense for carrying out these services.

"As one of the most cost-effective services we provide, sexual and reproductive health must not become the 'Cinderella' service of the NHS, especially when it has the potential to save the NHS millions through the prevention of unwanted pregnancies and transmission of STIs, as well as playing such as vital role in helping women control their fertility and therefore their lives.

 "So much progress has been made in this area in recent years and the service is too important to be allowed to fall into decline."

Dr Anne Connolly, Vice President of the Faculty of Sexual and Reproductive Healthcare (FSRH) and Clinical Champion for Women's Health at the RCGP, said: "The healthcare system is undergoing a workforce crisis marked by a difficulty in training, recruiting and retaining staff. Women bear the brunt of this crisis, with reduced access to sexual and reproductive healthcare (SRH). These changes and reduction in access are shortsighted and have happened due to funding cuts across the system. 

"It is unreasonable to expect that primary care services which are already under considerable strain will have the skills, appointments and ability to assimilate additional service provision without extra funding, training and planning. Lack of clear, timely and consistent communication across the system is, in fact, a key challenge for the patient journey. 

"As this report shows, the consequence is that women are not receiving the contraceptive care they need, and the risk of unplanned pregnancies is increased – and this often affects our most vulnerable patients most.

 "It is vital that GPs and other healthcare professionals in primary care are given advice, sustained support and training. Women's Health is a clinical priority for the RCGP and along with the FSRH, we will be working to develop resources to support GPs to deliver the care our patients need."


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GP Forward View falling short on workforce - but it is still the lifeline general practice needs

The College's Annual Assessment of the plan, that was launched in April 2016, recognises that NHS England is making progress in delivering many of its approximately 100 pledges – and that the commitment to spend an additional £2.4 billion each year on general practice by 2020/21 is on track. 

But the College's analysis, based on the most up to date statistical and member feedback, raises concerns that the GP Forward View is not having the positive impact on frontline general practice and patient care to the extent and with the speed that is needed.

Today's report follows an interim assessment by the College, published in January, that found whilst progress is being made, national ambition was not being matched by local delivery and many GPs had yet to see significant change. 

The College is now calling for a 're-think' on aspects the GP Forward View in order to turn things around – specifically around workforce pledges, but also on other key issues for GPs, such as spiralling costs of indemnity.

The GP Forward View pledged 5,000 more full-time equivalent GPs in England by 2020 but latest figures from NHS Digital show that actual numbers have gone down since September last year. 

Research* conducted for the College by Ipsos MORI among RCGP members, published for the first time in this report, shows that 39% of GPs say they are unlikely to be working in the profession in England in five years, sparking fears that unless progress in delivering the GP Forward View is accelerated, the profession could reach breaking point.

The report acknowledges that those entering GP specialty training are actually set to be higher this year than last, with 2,927 foundation doctors already signed up following recruitment Round 2 in 2016, according to figures from Health Education England – so the College is optimistic that the target of 3,250 can be met in 2017. But the RCGP says more must be done to retain existing GPs in the profession.

It also praises efforts to increase staff numbers in the wider practice team as being largely successful with 2,896 full-time equivalent practice staff entering the profession between Sept 2015-Sept 2016. Particularly successful has been the scheme to place pharmacists in GP surgeries, that began as a joint venture between the RCGP and Royal Pharmaceutical Society in 2015.

Professor Helen Stokes-Lampard, Chair of the RCGP, said: "It takes at least three years in specialty training for new doctors to enter the workforce as independent consultant GPs so whilst it's fantastic that more foundation doctors are choosing general practice this year, if more people are leaving the profession than entering it, we're fighting a losing battle.

"Above all else we need to see efforts stepped up to keep hard working, experienced GPs in the profession, and the best way to do this is to tackle workload pressures and improve the conditions under which all GPs and our teams are working.

"The College stands by the GP Forward View – we continue to think that it is the lifeline general practice needs to get our profession where it needs to be. But things are moving too slowly. Our endorsement of the original report means we can hold NHS England, Health Education England, and other bodies to account, and that's what we're doing with today's report."

Other key findings from the report include:

- Short term solutions have been put in place to cover rises in indemnity costs and to support winter out of hours work. The Government has also given a reassurance that GPs will not lose out as a result of changes in the discount rate, although confirmation is still awaited as to how this protection will work.
- After a slow start, £17.2m was invested in a practice resilience programme to help struggling and vulnerable practices – more than promised in the first year of the plan.
- Positive changes to the Induction and Refresher scheme to make it easier to return to general practice after a career break or period working abroad have led to an increase in applications.
- 800 mental health therapists are expected to be in post by March 2018 – the GP Forward View pledge is for 3,000 by 2020 with every GP practice having access.
- The NHS GP Health Service was launched in January this year to help GPs suffering from mental health problems, including stress and burnout. Demand has been high and feedback positive.
- Changes have been made to the GP contract to improve interface between primary and secondary care, but it is unclear whether these standards are being uniformly implemented.
- A pilot scheme to support practices in encouraging self-care in patients with long-term conditions in order to reduce workload has begun across 50 sites.
- Almost 200 projects have been completed through the Estates and Technology Transformation Fund in 2016/17, with hundreds more planned, but feedback is that receiving capital support is too bureaucratic.
- Free Wi-Fi in all GP practices by the end of 2017.

The College has also received assurances from NHS England that proper funding allocations have been made for general practice this year, meaning that recurrent investment is on track to be increased by £2.4bn a year by 2020/21.

Professor Stokes-Lampard continued: "We know we're only one year into a five-year plan, but GPs are desperate – they really, truly want to deliver the best possible care for patients, but the pressures they are under are unbearable. Our members were promised impactful change by now, but unfortunately many are telling us that the difference they are seeing on the ground is not enough and they are feeling let down.

"There has been a lot of good work going on – and it's great to hear that additional funding for our service is on track. We are certainly not suggesting that NHS England, Health Education England and others have been resting on their laurels – we know they are committed to making things better in general practice.

"But it is clear that there is a lot more to do, specifically around building our workforce. We need the GP Forward View delivered in full and in time, and if that involves a re-think of some strategies, then so be it – it's necessary and in the best interests of GPs, the wider NHS and our patients."

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