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Campaign Shows the Consequences of Abuse in Primary Care

Date published: Thursday 16 September 2021

Abuse Means Combined (iii) JPG Digital Graphics

A campaign has been launched to help tackle a rise in abusive behaviour towards healthcare workers in primary care across the Humber area.

The initiative is led by Humberside Group of Local Medical Committees Ltd (Humberside LMC) with the support of the Clinical Commissioning Groups in Hull, East Riding of Yorkshire, and Northern Lincolnshire, and a range of partners who are standing together to say that abuse of primary care workers in any role will not be tolerated.

Primary care refers to general practice, community pharmacy, dental, and optometry (eye health) services which are sometimes described to act as the ‘front door’ of the NHS.

Research shows that increased pressures on primary services paired with modified ways of working made necessary due to COVID-19 have led to increased demand in services. Data published by NHS Digital shows a 3.5m increase in the number of general practice appointments provided during June this year compared to June 2019 (26.7m compared to 23.2m), with an additional 4m COVID vaccination appointments delivered on top of that.

To GPs abuse feels like

Despite this evidence, research carried out with practices in the Humber area in July found that many patients perceive that primary care has been “almost closed” or working at reduced capacity over the past 18 months. Whilst primary care staff are working longer hours, some patients say that they can’t get through to practices to make appointments. This is frustrating for patients and in some cases unfortunately results in abusive behaviour towards practice staff members.

Surveys and consultations with workers in a variety of primary care roles uncovered examples of how abusive patient behaviour had negatively impacted upon staff morale and directly led to decreased patient care due to time spent on handling persistent callers and aggression in practice, on the telephone and online.

Repeat instances of aggression, prejudice, threats and offensive language, has led many professionals to feel dread, fear, disrespected, and questioning whether they wish to remain working in the profession.

Dr Zoe Norris #weareprimarycare campaign

Dr Zoe Norris, Humberside LMCs Medical Director and local GP said:
“We understand that patients have frustrations and fears around their own health though it doesn’t help anyone if they are abusive. It affects everyone, though it is particularly unfair that frontline workers who are doing their absolute best take the brunt of this. We’re all humans and need to do our bit to be reasonable and kind.”

“Pressures on primary care to meet demands are not new though are made more challenging by the pandemic. This campaign asks everyone to think about how their behaviour can impact others and understand that if you cross the line you can and will be refused treatment.”

Dr Dan Roper #weareprimarycare campaign

Dr Dan Roper, Chair of NHS Hull CCG said: 
“I know from conversations with colleagues across the spectrum of primary care that this is an increasing phenomenon. It is a constant source of anxiety for individuals working on the frontline in surgeries and health centres across the city.” 

“Being subjected to verbal and (thankfully rarely) physical abuse is extremely traumatic and can cause professionals of any age and experience to question whether they want to continue working.” 

“Hull CCG has supported this initiative from the very beginning, and we are confident that the work Humberside LMC is doing will be well received and successful.”

To patients abuse means 2b

Tackling abuse is the first of a three-phase public awareness campaign around improving experiences for patients and staff. Media created by Hull-based eskimosoup has been developed with the help of primary care workers and features direct quotes taken from surveys and discussions that demonstrate the emotional impact that facing abuse has on workers.

It is hoped that the campaign will encourage patients to consider the impact their attitudes and behaviours have on the health care system and the people working hard to keep it going. The messages will be shared in primary care settings and promoted through targeted online advertising throughout East Yorkshire and Northern Lincolnshire.

More information on the campaign (including resources for practices and primary care providers to download) can be found here

LMC Update 9 September 2021

Date published: Thursday 9 September 2021

Flu Vaccines Delay 
Many practices will have been affected by the delays affecting delivery of the Seqirus flu vaccine. The company have stated that the problem is due to ‘unforeseen road freight challenges’ and told practices not to book any clinics until it has confirmed delivery seven days in advance.

Inevitably this has caused considerable difficulty and frustration for practices and patients, and has resulted in some cases in cancellation of vaccination sessions. Our understanding is that the delay is limited to Seqirus vaccines, and that the three other vaccine providers for the UK – Sanofi, Mylan, and Astra Zeneca – have not reported delays and are not anticipating any difficulties. 

It is therefore advisable for practices which have not already done so to check with their suppliers on anticipated deliveries and make any necessary changes to their plans accordingly. Should you still experience difficulties please report this to the LMC and we will try to assist. 

Blood Tube Supply Disruption 
NHS England and Improvement’s guidance issued on 26 August 2021 regarding actions to protect the supply of test tubes for blood samples from Becton Dickinson (BD) still stands. 

All primary care and community testing must be halted until 17 September 2021, except for clinically urgent testing. Examples of clinically urgent testing include: 
• Bloods that are required to facilitate a two week wait referral 
• Bloods that are extremely overdue and/or essential for safe prescribing of medication or monitoring of condition 
• Bloods that if taken could avoid a hospital admission or prevent an onward referral 
• Those with suspected sepsis or conditions with a risk of death or disability

The guidance goes on to say that if organisations are likely to run out of products within 48 hours, please notify your pathology incident director and your NHS England and NHS Improvement regional team. The guidance advises practices not do any routine blood tests until the situation has been resolved and until then, urgent blood investigations can still be done as supplies allow (the national indemnity scheme, CNSGP, will cover this situation).

Survey of practices' experiences of using PCSE payments and pensions portal in August
The BMA continues to challenge PCSE at national level to ensure that their pay and pensions portal in England is fit for use by both GPs and practices. The portal has now been in use for three months and they are looking to gauge how effective the various ‘fixes’ put in place by PCSE to correct what they have described as ‘teething issues’. 

This is now a critical time where PCSE and NHSE/I will be looking to end the transformation process and return to ‘business as usual’. It’s important to be confident that the many significant issues around payments to practices which blighted the first couple of months of the portal’s use are largely behind us. To this end, the BMA are launching a joint survey, with the Institute of General Practice Management, for practices and practice managers to learn of their experiences of using the system during August specifically. They are also keen to know about experiences of contacting PCSE for support around issues raised around the portal since it came into use on 1 June. 

We know how incredibly busy practices are but completing the survey should take no longer than 10 minutes and will be invaluable in holding PCSE and NHSE accountable for the portal’s performance. The survey will remain open until Friday 17 September.

BMA GP survey 
The BMA also want to hear directly from doctors about their experiences working as a GP. Their new survey asks about the issues affecting you most, including your workload, recruitment and your future career plans. The survey is primarily aimed at fully qualified GPs who are currently working. They will be running a survey for GP trainees separately later in the year.
 
This survey will support the BMA’s negotiations and lobbying. Your responses will also help them better understand the issues affecting GPs. The survey is open until 20 September and will take around 10-15 minutes to complete. 

GPs Asked for Feeback on NHS111 Clinical Assessment Service

Date published: Thursday 2 September 2021

NHS England and NHS Improvement are asking GPs in the Humber area for their feedback on the NHS111 Clinical Assessment Service. GPs are asked to complete a short 2 question survey, which should take less than a minute.

The survey is to gauge GP awareness of the NHS111 CAS, prior to roll out of an enhanced, in-hours pilot of the service locally.

What is the CAS?

• For Yorkshire and Humber, the 111 service is provided by YAS and as part of this service a Clinical Assessment Service (CAS) using nurses and paramedics is provided for patients that need advice from a clinician

• This service supports decision making to ensure patients reach the right disposition/triage outcome for their need as described in the call to 111 or use of 111 online. 

• Patients go through to this clinical assessment service if the disposition is unclear or if NHS pathways tool recommends a clinical review. 

• Through the provider contract with 111 there is a requirement that 50% of all ED dispositions are reviewed clinically by the YAS 111 clinical team. This is in line with national expectation. 

• The YAS 111 service is redirecting about 50% of these away from ED currently.

• So, if 100 people receive an ED disposition, 50 would be reviewed and 25 would be redirected on average from the core CAS run by 111. 

• The wider offer (pilot) would increase this by 45 cases and redirects close to 70 cases having a significant system benefit, in addition increased clinical capacity that YAS would normally utilise for the 50 cases would be redirected to handle the growing clinical queues in core NHS 111.

The survey asks only 2 questions:

1. Are you aware of the CAS?

2. Do you have any comments on the CAS?

Please complete the survey below, by Friday 10 September.

https://www.surveymonkey.co.uk/r/NMNQD55

LMC Newsletter August 2021

Date published: Tuesday 31 August 2021

The latest edition of our regular monthly newsletter is now available, containing all the latest updates and opportunities for general practice in the Humber area. Included in this month's issue:

  • Latest update on the blood tube shortage
  • PCNs and planning for 2021/22 and 2022/23
  • Updates from the LMC committee and also the ICS

Download the August newsletter

LMC Newsletter July 2021

Date published: Tuesday 27 July 2021

The latest edition of our regular monthly newsletter is now available, containing all the latest updates and opportunities for general practice in the Humber area. Included in this month's issue:

  • Update on face masks and infection prevention control rules in primary care
  • PCSE pay and pensions update 
  • ICS development update 

Download the July LMC newsletter. 

Infection Prevention and Control in Primary Care

Date published: Wednesday 21 July 2021

NHS England have confirmed that the existing Covid-19 IPC guidance continues to apply in healthcare settings. The IPC guidance confirms that: “Patients in all care areas should still be encouraged and supported to wear a face mask, providing it is tolerated and is not detrimental to their medical or care needs”. NHS England state in a letter to primary care practitioners that 'contractors continue to have our support in enforcing the IPC guidance'.

The letter also confirms that practices 'should continue to offer a blended approach of face-to-face and remote appointments, with digital triage where possible'. The Standard Operating Procedure for general practice in the context of Covid-19 (Version 4.3) has been withdrawn as of 19 July as much of it has become standard practice or is now redundant. 

You can read our earlier statement on the continued use of face masks, social distancing, and hand sanitising, accompanied by a downloadable poster here. The BMA has also published a poster which can be found here.   

Enhanced Service Specification for Phase 3 Covid Vaccinations Published

Date published: Thursday 15 July 2021

NHS England has published the new enhanced service specification for phase 3 of the vaccination programme

A letter to GPs accompanying the new specification states they have ruled out offering the vaccinations at individual practice level:

‘We have considered carefully whether we could support the administration of the Covid-19 booster vaccines at individual practice level. For a number of reasons, this is not operationally feasible. 

This is largely due to the need to expand the capacity in the delivery network (to deliver the Covid booster programme alongside the flu programme) but it will only be possible to on-board a limited number of new sites during the summer; the supply chain cannot support deliveries to all practice sites; and it is possible the vaccine characteristics will require at scale working.

For these reasons practices that wish to participate in the booster programme will need to do so as part of a PCN grouping. We will also give practices the opportunity to change their PCN grouping in phase three if they so wish, taking account of feedback in phase two.’

In a statement the LMC endorses, the BMA has expressed disappointment at this:

‘Doctors and their teams should be given support and flexibility to take part in a way that works best for their patients… Elsewhere in the UK we have seen GPs giving COVID-19 vaccinations from within their surgery buildings, so there is no good reason for it not to happen in England. And while practices should be able to work together in the campaign, this should not be mandated.’

Practices have been given until 28 July to opt in to the programme, which is provisionally due to start on 6 September. 

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