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dinsdag 6 maart 2018

RCGP: No place for cash incentives to reduce referrals in the NHS, says College

No place for cash incentives to reduce referrals in the NHS, says College

"It's high time for commissioners to appreciate that GPs are highly-trained medical professionals, who know our patients, and will act in the best interests of their health and wellbeing.

"We are well aware of the financial strains currently facing the NHS - nowhere is feeling that more acutely than general practice - but GPs will only ever make the decision to refer a patient to secondary care on the basis of a consultation with that patient, taking into account their individual circumstances, and if we consider it necessary to achieve the best health outcome for them.

"Of course, it's important to take measures to ensure that GP referrals are appropriate and high-quality, but payments to reduce referrals would fly in the face of this, and erode the trust our patients have in us to do what is best for them and their health.

"Reviewing referrals is an important part of general practice, and a constructive part of professional development for GPs, but it must be proportionate, safe, and put the patient at the heart of the decision. Our report, launched earlier this week, highlighted that GPs need support to ensure that referrals are appropriate – not ethically-questionable initiatives that prioritise cost-savings over patient care.

"Cash incentives based on how many referrals GPs make have no place in the NHS, and frankly, it is insulting to suggest otherwise."

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Latest RCGP statement on Bawa-Garba case

Dr Bawa-Garba's case has shaken the entire medical community in the UK - it is now essential that lessons are learnt from this case, and are used to shape the future of medical practice in the best interests of NHS staff and patient care.

We must never forget that at the centre of this tragic case is Jack Adcock, the child who died, and first and foremost our thoughts are with his family. But the case has also caused considerable anxiety for GPs, particularly GP trainees, who are worried about the repercussions of the ruling and how it might affect the way they practise in future.

Patients need good, safe doctors, but in order to continuously improve, doctors need the freedom to reflect openly and honestly on the care that they deliver and the systems within which they work.

The implications for general practice, specifically, are significant given that we work independently, largely on our own, seeing the greatest number of patients on a daily basis in the health service. We do this without effective mechanisms to control our increasing workload, and a vital part of our role is to deal with uncertainty and manage risk on behalf of the NHS.

It is essential that supportive systems are in place for GPs and our teams to recognise and report errors that occur, and reflect on them so that we can learn and take steps to reduce the chance of them happening again. RCGP Council is very concerned that instead of promoting an open culture focussed on learning from errors by improving systems, the unintended consequence of this tragic case could be regression to a blame culture.

We have shared guidance with our trainees on how to reflect in the safest possible way, and we stand by our advice that reflecting openly and honestly is an essential part of GP training and continued professional development - as well as the best defence for doctors, if they do make mistakes. We will also be looking at our own processes, to make sure we are providing the best possible pastoral support we can for our members.

Furthermore, this case has drawn attention to the enormous pressures that doctors and their teams are operating under in today's NHS.

GPs are frequently working in challenging environments, at the frontline of the NHS, and errors are more likely to be made in an under-resourced, overstretched workplace.

We believe that this is a time for the medical profession to unite and the College is standing with the Academy of Medical Royal Colleges and Conference of Postgraduate Medical Deans in calling for the resources to ensure that all doctors in training have adequate, high-quality clinical supervision, and that safe staffing levels and functioning systems are in place right across the NHS.

It is important that all doctors have confidence in the organisation that regulates them, and to this end we will be working constructively with the GMC to ensure it is sensitive to the concerns of GPs, and that steps are taken to restore the confidence that has been lost.

There was considerable concern at Council over the GMC's approach to Dr Bawa-Garba's case, and the way it was handled, and the College will be raising this with the regulator directly.

It would not be right for us to comment on the judicial process and verdicts, but we have welcomed the Government's review into cases of gross negligence manslaughter. We will be responding to this and hope the conclusions from this investigation will help us all work together to improve our health system for patients and staff throughout the NHS, both now and in the future.

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Primary Care Workforce Survey highlights need for strong action to tackle GP workforce shortage

RCGP Scotland has responded to findings that the number of 'Whole Time Equivalent'(WTE)GPs in Scotland has fallenby160 since2013 and has called for action to restore WTE GP numbers.


The Primary Care Workforce Survey, published today (06 March) by the Information ServicesDivision of NHS Scotland (ISD) shows a fall in the number ofWTEGPs in Scotland.


RCGP Scotlandhas beenwarningfor several yearsthat the GP workforce is in crisis. This latest survey has found that the WTE number of GPs has fallen below the level it was at four years previously.Itshows thatthere are160 fewer WTE GPs now than there were four years ago.The number ofestimatedWTE GPs – those GPs who workat leasteightsessions(ie40 hours)per week– hasfallenby160,from3,735WTE GPsin 2013 to 3,575 in 2017. This figure represents a fallof over4%.


Worryingly, the surveyalsofound an increase in the number of practices with GP vacancies.Nearly a quarter (24%) of GP practiceswho respondedto the survey reported current GP vacancies – a rise from 22% in 2015 and 9% in 2013. 


This lack of progressin terms of increasingthe numbers of family doctorscomes at a time whenthedemand for general practice continues to rise and the populationof Scotlandcontinuesto grow, with people livingfor longer, with multiple medical conditions. Asa result, general practice services areover-stretched and this is having knock-on effectsonpatient care. 


Reacting to the findings from her practice in Craigmillar in Edinburgh,Dr Carey Lunan,Chair of RCGP Scotland, said:


"The findings from this surveyare very concerning.In the interests of patient care and a sustainable NHS, we must do more to tackle the GP shortage and ensure that we increase the number of WTE GPsacross the countryas quickly as possible.


The drop in the numbers of WTE GPs is being feltin communities across Scotland.Practices are struggling to fill long-standing GP vacancies, which not only causes instability within practices but also has aknock-oneffect on patient care, with many patients facinglengthydelays in seeing a GP.A reduction in WTE GPs makes it more difficult for patients to see the same GP for their health problems, and this can mean that patients experience more fragmented care, which is less efficient, potentially less safe and can be frustrating and confusing for patients.


Scotland is facing increasingly complex patient healthcare needsdue totherise in multiple long-term conditionsthat occur with age. Thishas led to rising demand for GP services, aswe striveto look afterpatients at home rather than in hospital.Itis essential that the Scottish Government continues to address the rising demand for GP services and plans accordingly. In December, RCGP Scotland welcomed theGovernment's commitment to deliver800 extra GPs in Scotlandover the next decade. Although it is encouraging to see recognition of the workforce problems being faced by our profession, this commitmentstillfalls short of the 856 WTE GPs thatRCGP have previously calculatedwill be required within a much shorter timeframe - by 2021. We hope that today's findingswill lead to a commitment from the Scottish Government thatthe800 extra GPs they havepromised to deliver will at least representWTE positions. 


We need action to tackle the GP shortage sooner rather than later to ensure that GPs can continue to deliverhigh quality,safepatient care. Many practices across the country are already at tipping point. Growing the GP workforce is crucial  to ensure that there are enough highly trained medical generalists to provide the community-based, patient-centred care that has provided the backbone of the NHS for decades. GPs coordinate care, provide continuity of care, deliver whole-person medicine and act as advocates for patients. Our teams often offer the first point of contact for patients seeking help from the NHS. Only by ensuring a critical mass of GPs can we ensure that practices have enough GPs to meetthe needs of their communities and allow patients to build up long-term relationships with a trusted doctor, which is often more valuable than any medicine"

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