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dinsdag 1 augustus 2017

RCGP: Reducing stigma around HIV testing is a good step forward - but GPs need more resources to do this

Reducing stigma around HIV testing is a good step forward - but GPs need more resources to do this

"Consideration of HIV testing can be an important part of a GP's investigations of unexplained symptoms, especially when the patient is unaware that they are at risk, and late diagnosis of HIV is a major public health priority.

"GPs will recommend a patient for testing where appropriate and according to NICE guidelines, and these were updated only recently.

"Normalising testing for HIV to reduce stigma is a good step forward and we urge patients who believe they may be at risk to be tested.

"However, It is difficult to see how hard pressed GPs and their teams could actually do this without significant additional investment in screening services in the community, including more GPs and members of the practice team as well as additional support for all sexual and reproductive healthcare services.

"Today alone, over 1m patients will receive care from their GP surgery but we have a severe workforce shortage and are already heaving under the strain of trying to provide safe care to our patients."


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GP Forward View falling short on workforce but 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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Important to get risk scores right on statins, says RCGP

"We need to get the risk scores right. If we find that all men over 60 and all women over 75 are going to be eligible for statins with new risk scoring, regardless of any other risk factor, then it should ring alarm bells – because it is not clear that every 60 year old man or 75 year old woman is going to benefit from statin therapy.
"As with any drug, taking statin medication has potential side-effects, and taking any medication long term is a substantial undertaking for patients. Many don't want to take statins once they have learned all the facts – and GPs will respect patient choice.
"We also need to remember that whilst clinical guidelines are useful tools for GPs when developing a treatment plan for patients, they are not tramlines. GPs are highly trained to prescribe based on the individual circumstances of the patient in front of them – obviously taking age into account, but also any other medication that the patient is using, and all the physical, psychological or social factors that may be impacting their health.
"It's important that as new evidence becomes available, it is taken on board as guidelines for healthcare professionals are updated – but NHS resources and workforce must also be a factor. We agree with researchers that the workload implications for GPs and our teams with so many people being potentially eligible for statin therapy is enormous, so this must be matched with appropriate resources."must also be a factor. We agree with researchers that the workload implications for GPs and our teams with so many people being potentially eligible for statin therapy is enormous, so this must be matched with appropriate resources."

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