The NHS- how big should the National Health Service be?

The National Health Service was founded in 1948 with 144,000  health professionals.

The NHS- how big should the National Health Service be?In less than seven decades that figure has risen tenfold to over 1.4 million staff across the UK.

But with all the political parties promising more health workers in the coming years -just how many doctors, nurses, porters, therapists and managers does the NHS need?

Ask the experts and they will say something like 8,000 more GPs, 20,000 more nurses and 3,000 more midwives.

Unsurprisingly, these are the figures that are – more or less – being promised by politicians in this election campaign.

But how certain can we be that this right? After all, we live in an era of huge technological change that surely could revolutionise the way the system works?
NHS staff and workforce pressures in numbers

  • When the NHS was created nearly half of people died before the age of 65, today just 14% do.
  • In 1948 the NHS employed 144,000 staff. There are now about 1.4 million.
  • The consultant workforce grew by 54% between 2002 and 2012 and annual growth of 4% is predicted until 2020.
  • In 2012, almost 50% of the nursing workforce was aged 45 or over, compared to 33% in 2002.
  • The number of over 85s has more than doubled since 1981 to 1.4 million. In 20 years time there will be 3.6 million.
  • The NHS in England spends £5 billion a year on education and training.
  • Currently, face-to-face contact accounts for nearly 90% of all healthcare interactions.

But the potential for digital technologies and even simply increasing the amount of email, Skype and phone consultations could make a big difference.

In the US, the health company Kaiser Permanente has reduced the amount of GP visits being made by a quarter through greater use of phone and email.

Meanwhile, hospital doctors and nurses in West Yorkshire have set up video linkups with local care homes and reduced admissions by 35%.

There is also the potential for more self management of illness, while the use of sensors and alarms in the home can make a big difference to the amount of home visits needed to check in on the frail elderly.

Even so, some have doubts about just how much of a revolution there will be.

Nigel Edwards, chief executive of the Nuffield Trust think tank, says: “It doesn’t look like technology will be the breakthrough it has been in other industries. Health and care is pretty labour heavy – that means having people on hand.”

Instead, he says, perhaps the more pressing issue is what sort of staff are actually needed.

The NHS review is a question posed by Health Education England’s 5 year workforce strategy document published in October and posted by Health Direct at: NHS needs extra cash and overhaul claim health bosses

It doesn’t make any firm predictions and instead acts as a discussion document, listing a host of factors likely to mean more staff have to be taken on, including the ageing population and the high numbers of staff reaching retirement age.

But it says if the drive to move care out of hospital and into the community is to be successful, it will require staff roles to change.

Alcohol detox centre saves NHS millions

The NHS could save £27 million a year by changing the way it deals with alcoholic patients.

Alcohol detox centre saves NHS millionsAlcohol abuse costs the NHS £3.8 billion a year, £145 for each UK household. One in three of all A&E admissions are alcohol related- but on a weekend that can rise to 70%.

Dr Chris Daly, the lead consultant at the unit, believes the NHS is wasting money by often treating people for the effects of alcohol problems without dealing with the underlying problem.

“We were very surprised that a significant proportion, maybe as much as 50% of the patients that we see, were not open to any services and some of them had never been seen by alcohol services before, so it’s almost as if we’re dealing with a different sort of population,” he says.

“These are people who are maybe only using their A&E department as their main source of treatment for their alcohol problems.”

The Radar ward at Chapman Barker is the first of its kind in the UK. Set up three years ago it takes alcohol dependent patients directly from 11 A&E departments across Manchester.

Some 75% of the people who come through the unit do not go back to hospital for at least the next three months.

The Radar ward is split with separate eating and living spaces for both sexes. Four in 10 of the places here are taken by women, from teenagers right up to pensioners in their 80s.

Patients are treated with talking therapies, support and counselling, but also specialist medical care they would not always get in a large hospital.

Around half of all alcohol dependent patients can develop clinical symptoms when they try to quit, including seizures, fits and hallucinations.

Without the right support the most severe cases often end up back in hospital.

An independent analysis of the unit by academics at Liverpool John Moores University published in April 2015 found it saves the NHS £1.3 million a year.

If the same approach was taken across the country the researchers say it could save the NHS £27.5 million in England alone.

This unit has secured funding to operate for another year but the future is always uncertain. The people working there say ignoring these patients will cost the NHS more in the long run.

Health Direct repeats numerous research warnings that alcohol is the drug that causes the most damage to the UK population- so anything that curbs preventable crisis is to be welcomed.

GP services face retirement crisis

GP services are facing a crisis- with a third of doctors considering retirement in the next five years a BMA poll suggests.

GP services face retirement crisisThe survey of more than 15,000 UK GPs also found over a quarter were considering working part time and one in 10 said they were thinking about moving abroad.

BMA GP leader Dr Chaand Nagpaul said the findings showed some of the promises being made about doctors by politicians were “absurd”.

Improving GP care has been one of the major themes of debate in the election, with the Conservatives promising seven day access to services and Labour pledging a 48-hour waiting-time guarantee.

The findings are in the second tranche of results from the BMA’s poll of GPs, in which nearly a third of doctors in the UK took part.

Last week the BMA released figures suggesting excessive workloads were harming care. This batch of results focused on the effect those rising demands were having. It suggests:

  • 34% of GPs are considering retiring from general practice in the next five years
  • 28% of those working full-time are thinking about moving to part-time
  • 9% are considering moving abroad
  • 7% are considering quitting medicine altogether

They also cited various factors that had a negative impact on their commitment to being a GP, including:

  • excessive workload – 71%
  • unresourced work being moved into general practice – 54%
  • not enough time with their patients – 43%Dr Nagpaul said: “This poll lays bare the stark reality of the crisis facing the GP workforce.

“It is clear that incredible pressures on GP services are at the heart of this problem, with escalating demand having far outstripped capacity. GPs are overworked and intensely frustrated that they do not have enough time to spend with their patients.”

“In this climate, it is absurd that in the recent leaders’ debate, political parties were attempting to outbid each other on the number of GPs they could magically produce in the next Parliament. Since it takes five to eight years to train a GP, it is not possible to create thousands of GPs in this timeframe.”

Katherine Murphy, of the Patients Association, said: “We know from the many calls to our helpline that patients are not able to access GP services at times when they need to.”

“What patients want is a clear and firm commitment that GPs now and tomorrow will have the resources to meet their needs.”

“Anything less is just not acceptable. We need a 21st Century primary care service with access 24/7.”

There are currently 9,000 GPs in training, although 14,000 doctors – about four in 10 – are over the age of 50.

Pharmacists could help ease GP pressures

An army of pharmacists could step in to help treat patients at GP practices across England leading health professionals plan.

Pharmacists could help ease GP pressuresThe proposals focus on pharmacists seeing patients with common ailments directly – not on setting up shops within surgeries.

Pharmacists would provide health advice and be able to prescribe medication once extra training had been completed.

Charities welcomed the move but say patient safety must be a priority.

NHS England officials said the idea complemented their plan to increase staffing in GP surgeries. But it is not yet clear whether they will push the proposals forward.

The plans, aimed at every practice in England, have been put forward by the Royal College of General Practice (RCGP) and Royal Pharmaceutical Society (RPS).

It could mean when patients call up their surgeries they are offered an appointment with a pharmacist, general practitioner or practice nurse.

Those who opt to see the pharmacist could get advice about their symptoms and discuss troubling side-effects of medication, as well as getting help with their repeat prescriptions.

People with long term conditions are likely to benefit the most under the plans – those on multiple medications could get help streamlining their daily drugs.

In a handful of practices pharmacists already help with the management of conditions such as diabetes and asthma, for example, helping patients get annual checks.

Under the proposals more practices could do this. And with additional training some pharmacists would prescribe commonly used medicines such as antibiotics.

Any patient who still needed advice from a doctor could still be seen by their GP.

GP and pharmacist leaders say the move is needed as practices face staff shortages and are struggling to meet the demands of an ageing population.

The RCGP predicts that on some 67 million occasions this year, patients will have to wait more than one week to get an appointment.

In contrast, there is currently an over-supply of skilled pharmacists who could ease this burden experts argue.

Initial pharmacist training lasts one year longer than basic nursing qualifications and one year less than medical school for doctors.

Dr Maureen Baker, chairwoman of the RCGP, said: “Even if we were to get an urgent influx of extra funding and more GPs, we could not turn around the situation overnight due to the length of time it takes to train a GP.

“Yet we already have a ‘hidden army’ of highly-trained pharmacists who could provide a solution.

“This isn’t about having a pharmacy premises within a surgery, but about making full use of the pharmacist’s clinical skills to help patients and the over-stretched GP workforce.”

David Branford, of the RPS, said: “Pharmacists can consult with and treat patients directly, relieving GPs of casework and enabling them to focus their skills where they are most needed, for example on diagnosing and treating patients with complex conditions.

“Pharmacists can advise other professionals about medicines, resolve problems with prescriptions and reduce prescribing errors.”

These types of partnership already exist in a handful of practices but experts hope the plan will eventually be rolled out across the UK.

Katherine Murphy, of the Patients Association said: “Any action that can, at the very least, ease the problem is to be welcomed and this plan for doctors and pharmacists to work together is an innovative step in the right direction.

“Of course, there must always be concerns that the pharmacists who undertake this work have the relevant skills and qualifications to treat patients, and with care.”

Simple skin test may diagnose Alzheimer and Parkinson disease

Scientists have proposed a new simple idea for detecting brain conditions including Alzheimer’s and Parkinson’s diseases.

Simple skin test may diagnose Alzheimer and Parkinson diseaseTheir work which is at an early stage- found the same abnormal proteins that accumulate in the brain in such disorders can also be found in skin.

Early diagnosis is the key to preventing the loss of brain tissue in dementia-  which can go undetected for years.

But experts said even more advanced tests, including ones of spinal fluid, were still not ready for clinic. If they were, then doctors could treatment at the earliest stages, before irreversible brain damage or mental decline has taken place.

Investigators have been hunting for suitable biomarkers in the body – molecules in blood or exhaled breath, for example, that can be measured to accurately and reliably signal if a disease or disorder is present.

Dr Ildefonso Rodriguez-Leyva and colleagues from the University of San Luis Potosi, Mexico, believe skin is a good candidate for uncovering hidden brain disorders.

Skin has the same origin as brain tissue in the developing embryo and might, therefore, be a good window to what’s going on in the mind in later life – at least at a molecular level – they reasoned.

Post-mortem studies of people with Parkinson’s also reveal that the same protein deposits which occur in the brain with this condition also accumulate in the skin.

To test if the same was true in life as after death, the researchers recruited 65 volunteers – 12 who were healthy controls and the remaining 53 who had either Parkinson’s disease, Alzheimer’s or another type of dementia.

They took a small skin biopsy from behind the ear of each volunteer to test in their laboratory for any tell tale signs of disease.

Specifically, they looked for the presence of two proteins – tau and alpha-synuclein.

The 20 people with Alzheimer’s and the 16 with Parkinson’s had raised levels of both these proteins in their skin compared to the healthy controls and the patients with other types of dementia.

The people with Parkinson’s also had higher levels of alpha-synuclein protein.

Dr Rodriguez-Leyva, who will soon present his findings to the annual meeting of the American Academy of Neurology, said: “More research is needed to confirm these results, but the findings are exciting because we could potentially begin to use skin biopsies from living patients to study and learn more about these diseases.

“This new test offers a potential biomarker that may allow doctors to identify and diagnose these diseases earlier on.” It could also guide research into new treatments, he said.

Dr Arthur Roach, Parkinson’s UK Director of Research and Development, said: “This work points to a possible diagnostic test that would be minimally invasive and could provide earlier, more accurate diagnosis.”

“There is still a need for more innovation in this area – at the moment there’s no way to definitively diagnose Parkinson’s.”

Dr Simon Ridley of Alzheimer’s Research UK said it was too early to say if a skin test would become available.

He said research into biomarkers in cerebrospinal fluid – the fluid that surrounds the brain and spinal cord – was at a more advanced stage, but that even these methods were not yet close to becoming a routine test.

Health Direct notes that whilst more research is obviously needed a skin test which finds a correlation between alpha synuclein proteins and degenerative brain disease would be hugely significant as it would allow for quick, cheap non invasive testing and diagnosis.

Vulnerable doctors need more support

An independent report recommends that a national support service be set up to help vulnerable doctors- as up to 28 doctors took their own lives between 2005 and 2013 while being investigated by the General Medical Council.

Vulnerable doctors need more supportThe GMC, which investigates about 3,000 complaints about doctors each year, said its processes should be “quick, simple and low stress”.

The independent report, based on a review of GMC cases over eight years, found that 24 doctors undergoing fitness to practise investigations were classified as “suicide” and four as “suspected suicide”.

Many of the doctors suffered from a recognised mental disorder, such as depression, bipolar disorder and personality disorder, or had addiction problems.

Other factors in their deaths may have included marriage breakdown, financial hardship and the impact of the GMC investigation itself.

The report calls on the GMC to treat every doctor as “innocent until proven guilty”.

It also recommends appointing a senior medical officer from the GMC to oversee cases involving doctors with health problems.

The GMC said it has made significant improvements to its fitness-to-practise investigations process in recent years – but recognises that it could offer more support to doctors.

Niall Dickson, chief executive of the General Medical Council, said: “We know too that for any doctor, being investigated by the GMC is a stressful experience and very often follows other traumas in their lives.

“Our first duty must, of course, be to protect patients but we are determined to do everything we can to make sure we handle these cases as sensitively as possible, to ensure the doctors are being supported locally and to reduce the impact of our procedures.”

He said the aim was to handle complaints as quickly and effectively as possible. The GMC will now review it procedures for dealing with doctors with health problems.

Dr Clare Gerada, medical director of the Practitioner Health Programme, a support service for doctors in London, said she welcomed the review.

“They [the GMC] need to continue to show their commitment to reducing the impact of fitness-to-practise investigations on vulnerable doctors whilst always maintaining patient safety – a substantial task.

“Doctors are sometimes patients too and supporting vulnerable doctors is a shared responsibility.”

Dr Gerada said the British Medical Association, the Royal College of Psychiatrists and the Practitioner Health Programme should all be involved in implementing the GMC’s recommendations.

Doctors GPs surgeries ranked by risk

Doctors’ GPs surgeries are now being ranked by the health watchdog the CQC.

Doctors GPs surgeries ranked by riskThe Care Quality Commission (CQC) has ranked almost every GP surgery in England in terms of risk of providing poor care and whilst the majority are of low concern, 11% have been rated in the highest risk band by the CQC.

Many of the elevated risk practices had possible issues with appointments, mental health plans, and cervical cancer screening.

The watchdog said the register did not necessarily indicate poor GP surgery performance.

“It is important to remember that the data is not a judgement, as it is only when we inspect we can determine if a practice provides safe, high-quality and compassionate care,” said CQC chief inspector of general practice Prof Steve Field.

“The data is a further tool that will help us to decide where to inspect and when,” he said.

The health watchdog ranked 7,276 practices out of the total 7,661 in England, and placed 864 practices in the “highest concern” category.

In about 3% of high-concern practices, patients stated they had difficulties in getting an appointment to see a GP or nurse.

However, surgeries that were not at high risk also saw patient dissatisfaction with appointments. In about one sixth of practices, patients had a limited ability to get appointments and services, the CQC said.

Potential issues in elevated-risk practices also included the provision of care plans for people with schizophrenia, bipolar disorder or other psychoses, and potentially low numbers of women aged 25 to 64 who had received a cervical screening test in the past five years.

The regulator used 38 different indicators to calculate the level of risk. Practices were graded in six bands, with Band One being the highest concern, and Band Six the least risky.

Measures including patient experience, care and treatment were taken into account, based on “sources including surveys and official statistics”, the CQC said.

Between April and September 2014 the CQC inspected 336 GP surgeries. At the start of October a new inspection regime came into force, and CQC hopes to have inspected all surgeries by March 2016.

The CQC will look at whether surgeries are safe, effective, caring, responsive, and well-led.

Risk indicators include:
• Unnecessary A&E admissions
• High use of antibiotics
• Coronary heart disease incidence
• Emergency cancer admissions
• Not hitting flu vaccination targets
• How sleeping pills are prescribed
• Dementia diagnosis rates
• Whether care plans for psychoses are in place
• Cervical screening test numbers
• Diabetes care
• Patients being overheard in reception
• Ability to get an appointment

The doctors gps surgery results rankings are here on the QCQ webite

More European doctors in NHS than ever

There are “more doctors than ever” coming to work in Britain from Europe, says the General Medical Council.

RMore European doctors in NHS than everSouthern Europe now provides more doctors than South Asia to the UK- which was previously the main source. The GMC said the tightening of immigration rules for people outside the continent could explain the change.

In an annual report, the regulator also said more women were working in “traditionally male” areas such as surgery and emergency medicine. It said the profession would soon have equal numbers of men and women.

In total, the number of doctors coming to Britain from overseas increased 8% from 5,204 in 2008 to 5,619 in 2013. Of these, in 2008, 18% were from southern Europe and 28% from South Asia. This changed to 33% from southern Europe and 20% from South Asia in 2013.

Overall there were 259,650 doctors in the UK in 2013.

The GMC’s report said: “We do not know all the reasons for these changes but some are already clear – after changes to immigration rules in 2010 it became harder for international medical graduates to secure training and employment here.”

It also said the economic downturn in Europe and the increased opportunity for European Economic Area graduates to work in the UK following changes in 2004 and 2007 were behind the rise.

Meanwhile, doctors working in primary care repeatedly described feeling “overloaded” and “at risk of burning out” said the report.

GMC chief executive Niall Dickson said potential shortages in specialist areas, such as public health and occupational medicine, with diminishing numbers of doctors in postgraduate training and large numbers of those aged over 50 were of “particular concern”.

Mr Dickson said: “Recruitment in some parts of the UK, especially deprived areas and more remote communities, is also a significant challenge.”

He also said the needs of patients were changing with many living longer, with more long-term conditions.

“The challenge for governments, educators and those who commission services must be to work together to make sure we have a medical workforce with the right skills and one which is adequately resourced, trained and supported to meet those needs,” he added.

Patients’ internet diagnoses not useful warn doctors

Many patients are going to their GP and asking them what treatment they want based on research from the internet doctors warns.

Patients' internet diagnoses not useful warn doctorsA third of the UK physicians surveyed said patients would come with suggestions for what prescription they should receive and fewer than 5% of doctors felt it was helpful.

Major technology firms such as Apple and Samsung are investing heavily in tech that can monitor a user’s health.

The survey of 330 UK physicians – 300 of them GPs – was carried out by Cello Health Insight, a medical market research firm.

“Doctors have witnessed an explosion in the quantity and quality of information now available to them and their patients via digital media and technology,” said Dan Brilot, the company’s digital director. “Consumers are increasingly seeking out information (and technological tools such as fitness and health apps) to provide as much information as possible before – and after – consultation.”

However, doctors were finding technology useful for their own needs. Specifically, Cello’s survey said three quarters of those surveyed turned to the internet for research on conditions.

Many GPs would also use the internet to share new information with colleagues.

While self-diagnosis was proving troublesome, most of those surveyed did advocate the use of technology for general monitoring with more than half saying that apps designed to make sure treatment is taken or administered correctly are useful.

The NHS provides a service that suggests apps for patients that have been checked for accuracy. The apps could help diabetics keep a check on their blood sugar and patients monitor their own blood pressure.

New GP contracts to reduce red tape checklists

Changes to GPs contracts will allow them to spend more time with patients.
New GP contracts to reduce red tape checklistsThe money GP surgeries received until now depended on how they performed against 969 different measures but under the new contract 300 measures will be cut- reducing form filling to free more time with patients, says the British Medial Association (BMA).

There will also be new financial incentives to encourage surgeries located close to each other to work together.

The new contract also aims to provide better care for people with early-stage cancer, for those at the end of their lives or the frail or elderly.

The Welsh government also says the changes should also help reduce the pressure on hospital A&E departments.

Charlotte Jones, chair of the BMA’s Welsh GP committee, said the contract has “removed some of the bureaucratic tick-boxing type of medicine and targets that we’ve had to provide”.

Speaking on BBC Radio Wales, she said doctors will be able to return to “looking after the individual patient, which will then mean that there will be more capacity within general practice surgeries to provide more care for the patients”.

“The whole GP practice team will see the benefits of this which should increase additional capacity because, as we know, GP practices are under enormous strain like the emergency departments are at this current time.”

“We do hope that the feedback from patients will be that they have seen the positive effects of it as well as the GPs going back to being able to manage the individual and not chasing targets.”

However the deal, which comes into effect in April, will not lead to weekend surgeries or more out-of-hours opening, but it should mean that patients will find it easier to get appointments with reduced red tape.

Highlighting the 19m appointments made with GPs last year in Wales, she said: “So actually patients are seeing GPs in huge numbers but sometimes you do wait.  In some ways the opening hours issue is a bit of a distraction to the more fundamental question of how people get to see their GPs when they need to.”

The deal should not mean GPs getting more money. In 2011/12 the average salary for a GP responsible for running a practice was £92,300, while the average pay for a family doctor employed by the surgery stood at £55,000.

“The global sum, the total amount of money, remains the same. It’s just that what people get paid for and how they get paid has been re-negotiated to allow us to modernise the contract and to prioritise those things which we know really matter to patients.”