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woensdag 11 oktober 2017

RCGP: Measuring waistlines can encourage patients to take an active interest in their health

Measuring waistlines can encourage patients to take an active interest in their health

She said: "Patients should always be encouraged to take an interest in their own health, whether that involves paying attention to their weight by measuring their waistline, or learning how to take and keep track of their blood pressure.

"By getting patients to do this themselves, it is encouraging them to be more interested in their health – in self-caring. And where weight is concerned – we know that obesity is a huge issue – this proactive approach brings it to the front of their consciousness; it isn't just a passive thing that they have no control over.

"Also, when patients come to their GP consultation prepared with data about their health, it can be really helpful – particularly when in most cases we are trying to get through an awful lot in just 10 minutes.

"Of course, it's important to remember that patients aren't healthcare professionals - we do have to bear in mind that they may not have measured something properly, or may have misinterpreted a reading. With blood pressure, or other tests involving some sort of technology, we should also be aware that equipment needs calibration to ensure it is accurate, and some people might not be confident in determining whether to bring the results up in their consultation or not, which could lead to its own form of anxiety that could affect the blood pressure readings.

"It's here that GPs and our teams can play a part in educating patients how to self-care properly and efficiently – perhaps encouraging them to take certain readings in the practice, just before they enter the consultation.

"Some GP surgeries already do it really well. You do need a bit of space and a bit of privacy because most people don't want to measure their waistline in the waiting room they would rather do it in a quiet corner.

"It's not going to work for everyone. Ultimately it needs to be the decision of the individual patient and their GP as to whether they do implement such a system."

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GPs having sleepless nights over patient safety fears, says RCGP Chair

She said: "GPs like many caring professionals never completely leave their jobs behind when they go home, it's a 24/7 responsibility. However, the situation for GPs has deteriorated and I know of GPs – the ones I've spoken to are women in their 30s and 40s, but I've heard anecdotal stories about other colleagues as well - who have told me that they have sleepless nights worrying about their patients, or that they've missed something because they've been constantly up against it all day long, working in ways that don't feel safe.

"It isn't just the hours in clinic, I'm talking about – it's the urgent duties we have to perform long after our patients have all left the surgery; prescription reviews, hospital letters, ensuring records are up to date. These might seem like routine administrative tasks, but they have a major impact on the delivery of high quality patient care - and the more fatigued we are, the more room there is for error.

"It all takes time and, in many cases, its toll on GPs' health and wellbeing.

"Most of time, of course, we haven't missed anything, but when the seed of doubt has been planted, it's hard to get it out of your head.

"GPs are professionals, we do everything we can to be meticulous, that's in our nature and is part of our training, but when you're shattered it is possible to overlook a changed prescription request, or not to update a patient's record as comprehensively as would be ideal - things that can impact on patients' health further down the line. But there are also more sinister things we worry about; did I miss a symptom of something that could be more serious; if I'd have had more time with that patient, would my eventual diagnosis been different?

"These things play on your mind - and it isn't healthy.

"GPs are trying to do more and more, but worn out doctors are no good to anybody and there is a limit beyond which we cannot guarantee that we are practising safely. Workload in general practice has soared over the last few years – 16 per cent over the last seven years according to the most recent research, but investment in our service has declined over the last decade, and our workforce has not kept pace with demand.

"We know GPs are burning out – the GP health service in England was launched earlier this year, and there are already more than 500 GPs on its books.

"That's why we urgently need the promises made in NHS England's GP Forward View – the GP health service being one of them – including £2.4bn extra a year for general practice, 5,000 more GPs, and 5,000 more members of the practice team by 2020, to be delivered in full and as a matter of urgency."


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Break down the barriers stopping overseas GPs working in the UK, demands RCGP

Writing to Home Secretary Amber Rudd today, RCGP Chair Professor Helen Stokes-Lampard highlights how current visa processes for GPs from abroad wanting to work in the UK are contributing to a workforce shortage in general practice, which saw patients unable to make an appointment with a GP or practice nurse on 47.5m occasions last year, according to College analysis of the last GP Patient Survey in July.

Currently professions on the Shortage Occupation List include classically trained ballet dancers, animators, and orchestra musicians - as well as medical professions such as radiographers, old age psychiatrists, paramedics and nurses.

In the letter, she states: "The RCGP has long made the case that GPs should be added to the Shortage Occupation List and the need for urgent action on this matter continues to grow.

"The public's healthcare needs have continued to grow over the last few years, but recruitment of the general practice workforce has not been sufficient to meet demand. Clear goals have been set to increase the GP workforce, as outlined in the GP Forward View for England, and similar aims across the UK.

"Our recent Annual Assessment of progress towards the GPFV so far, we expressed concern that the goal of 5,000 more GPs employed in England by 2020 is unlikely to be met without an urgent re-think of the plan. We have also projected that the workforce needs to expand by 856 whole-time equivalent GPs in Scotland, 485 in Wales and 272 in Northern Ireland by 2021 to meet the needs of their populations."

Professor Stokes-Lampard makes the case that with NHS England's drive to recruit at least 2,000 doctors from abroad to work in UK general practice – which the RCGP supports and has championed - that there is 'likely to be even more pressure on the visa application system and potentially even longer processing times.'

She draws on real-life examples to demonstrate the current concerns and frustrations with the system:

  • A UK-trained GP, unable to take up a job offer due to visa application delays, forcing the GP practice to hire a locum at significant cost;
  • A GP originally from South East Asia, trained in Scotland, and offered employment in England – but who was informed by the Home Office it may take up to 18 weeks to extend her visa, by which time it would have expired;
  • An international medical graduate who described feeling 'discriminated against' and 'unwelcome' do to persistent threats of deportation if he does not renew his visa on time – something he has struggled to finance.


GPs from overseas who have trained in the UK and wish to practise after attaining MRCGP face an additional hurdle in applying for Indefinite Leave to Remain as specialty GP training is only three years – two years fewer than the minimum requirement of five years. Specialty training for other medical specialties is at least five years.

Professor Stokes-Lampard wrote: "There are high vacancies for GPs across the UK and practices are struggling to fill posts. The situation on the ground is probably worse than official estimates, as posts may be being filled by locums in the short-term, or where vacancies are not being advertised as the practices know from experience they are unlikely to get a strong enough field of candidates.

"It takes at least 10 years to train a GP from the UK (from entering medical school); recruitment strategies will not solve the urgent gaps in our workforce in the short-term, and is unlikely meet longer term needs. With a high number of GPs set to retire in the next few years, the future of general practice is a serious concern. We need to do everything possible to make the process for GPs entering the UK workforce as simple and straight forward as possible."

The RCGP has already been outspoken in previous calls for GPs to be added to the Shortage Occupation List – a key ask in the College's manifesto launched ahead of the General Election in June. The College has also consistently called for assurances for GPs from the European Union to have their status protected during Brexit negotiations.

In her letter, Professor Stokes-Lampard concludes: "We would therefore urge action to improve visa processing and support for the RCGP's call for GPs to be added to Shortage Occupation List. This would help us to both keep the GPs providing an essential service to practices and patients across the UK, and to encourage more people to consider moving here and to help keep our health service going."


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