The number of GP specialty training places on offer across the UK in the first round of recruitment for 2018 has shrunk compared to the number offered this year, official figures suggest.
The General Practice National Recruitment Office (GPNRO) is advertising 63 fewer places for GP ST1 training in 2018 compared to the same time this year, analysis of places on offer shows.
There appear to be 70 fewer spots in England and 30 fewer in Scotland, according to figures on the GPNRO website, which prospective trainees must use to apply for posts.
This contrasts to Wales and Northern Ireland, which are respectively offering 25 and 12 more places than they did in 2017.
Health Education England (HEE) warned that the numbers should be treated as ‘indicative’ and could be subject to change. It added that the total number of places on offer had ‘not dropped’.
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But according to the GPNRO site, there are 3,187 GP training places available in England in round one for 2018, alongside 320 in Scotland, 136 in Wales and 97 in Northern Ireland – 3,740 overall.
This compares to 2017, when there were 3,257 in England, 350 in Scotland, 111 in Wales and 85 in Northern Ireland – amounting to 3,803 overall.
The numbers suggest that most regions in England are offering a similar number of places as they did in 2017.
But there appear to be large drops in the West Midlands where places are down by 34, and London where 12 fewer places are listed.
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The places on offer are for training posts commencing next August, and mark the opening of the first round of recruitment for 2018 training. Applicants have until the end of this month to apply, with interviews due in January.
The figures come as Health Education England (HEE) has yet to release the final figures on GP recruitment uptake for 2017. Deadlines for 2017 applications have passed and the cohort who applied in round two are due to commence their training in February.
But interim figures from the summer suggest recruitment may have suffered this year across the UK, with more places vacant following the first round of 2017 recruitment than in 2016. In Scotland, a significant number of places remained vacant after the two 2017 recruitment rounds, but the total number of GP trainees recruited was the highest since 2010.
On the UK figures, an HEE spokeswoman said: ‘These are indicative numbers and subject to change. We publish this information to help trainees see where the vacancies are, the total number of places on offer has not dropped.
‘This is an ongoing recruitment process and we will have a full picture on fill rate once this process is complete.’
This post was originally written by David Millett on the 3 November 2017 for GP Online.com
This post was originally posted on GP Online by Neil Roberts on the 27 September 2017
Over 60% of GP partners plan to cut their practice's use of locum GPs in the next year, and half could reduce their own pay to keep their practices sustainable.
GP consulting room (Photo: Robert Johns/UNP)
In a GPonline poll of 217 partners 61% said their practice would consider reducing the use of locums in the coming year to maintain profits or sustainability. Just under half (47%) will consider cutting their own take home pay.
Over a third (35%) of partners said they would consider reducing patient services, while a fifth said they could freeze staff pay. More than one in 10 respondents said they may have to consider staff redundancies.
Practices are considering the drastic measures despite evidence from official data last week that GP funding rose by 3% in real terms across the UK in 2016/17.
GP leaders said that despite increased funding secured by the BMA in contract negotiations practices across the country were still ‘struggling to cope with rising patient demand that is far outstripping current resources’. The GPC is calling on the government to speed up promised additional investment, and has warned that current projections suggest the profession will remain £3.4bn short of the funding it needs by the end of the decade.
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GP partners also told GPonline in the survey that they will also consider delivering services differently in the next year to cope. Over half said they could increase the skill mix at their practice, while over a third (34%) said they could increase the amount of non-NHS work they take on. A quarter said they could merge their practice with another.
One GP partner said: ‘I think most practices are only one GP away from a crisis - whether that be retirement or illness. We have spent a fortune on locums and are limited when we take annual leave.’
Another added: ‘Core services not enough to sustain profitability. Additional services commissioned by the CCG are needed but they are now being devious by linking these additional services to work not wanted by practices like poorly funded extended hours work. You have to do all or nothing. This is an underhand way of making practices do work that they do not want to do and is non-profitable.’
But another GP said: ‘I am ever optimistic that we will make it work for the future.’
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Patients will wait more than a week for an appointment at their GP practice on more than 100m occasions by 2022 - posing a 'genuine risk to patient safety', the RCGP has warned.
Professor Helen Stokes-Lampard (Photo: Pete Hill)
Soaring pressure on general practice - with a growing workforce crisis, rising workload and a decline in funding over the past seven years - is undermining practices' ability to offer timely access to appointments, the college warned.
The college said the crisis facing general practice was a 'case of national concern' that would increasingly put patients at risk.
In 2016/17 there were 80m cases when patients had to wait more than a week to see a GP or a nurse at their practice, but by 2021/22 this figure will rise to 102m if current trends are allowed to continue, the college warned.
Analysis of NHS patient survey data by the college also revealed significant variation between CCG areas in access to general practice.
More than a third of patients wait a week or more on average for an appointment in some CCG areas, the college warned - including Corby and Fareham and Gosport. In around one in 10 CCG areas across England, a quarter of patients wait more than a week to see a GP or a nurse.
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In Bradford, where GP access figures are the best, one in 10 patients are still waiting more than a week for an appointment, the college warned.
The college called on the government to accelerate investment promised in the GP Forward View, warning that the profession was struggling to cope with a 16% rise in workload and a fall in funding since 2010.
RCGP chair Professor Helen Stokes-Lampard said: 'Our patients should be able to see a GP when they need to, so we’re highly concerned that patients are finding it so difficult to make an appointment, and that in so many cases they have had to wait more than a week to see a GP. This is a clear risk to patient safety – and if nothing is done soon, it is clear that this is set to get worse.
'If these patients can’t secure an appointment with their GP when they need one, it’s probable that they will return at some point to another area of the NHS, when their condition may have worsened, and where their care will cost the health service significantly more – something which could’ve been avoided if they’d been able their GP in the first instance.
'GPs and our teams are now making more patient consultations than ever before - over 370m each year - and with workload continuing to escalate, and with continuing resource and workforce pressures, the worrying outcome is that we will be unable to see all our patients who need to be seen.'
Original post by Nick Bostock on the 24 July 2017
Practice closures and mergers are at record levels (Photo: iStock)
New analysis published by NHS DIgital showed that 202 practices were closed or merged in the year to 30 June 2017. Just 8 new practices were opened in that time.
A regional breakdown of the figures showed the north of England suffered most losses, around 64, with the south of England losing 54, the Midlands and East losing 45, and London 39 GP practices.
More than half of CCGs, 53%, had no practice closures or mergers in the last year.
GPC acting chair Dr Richard Vautrey said: ‘This confirms what we've been repeatedly saying and provides further clear evidence of a service at breaking point.
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‘With over 200 practices closed or merged in the last year and many more struggling to manage their workload pressures it is time for government and NHS England to step up their efforts to resolve this crisis before even more patients lose their much loved local GP service.’
The NHS Midlands and the East region saw five new practices open over the year, with two in the North of England region and one in London.
The new official data confirm recent estimates by GP leaders and GPonline.
GPonline analysis of official data in June concluded that 671 practices had been lost since 2013. Analysis in April suggested that over 220 had been lost since January 2016.
An investigation by GPonline in August 2016 revealed that the total number of contract terminations increased from 54 in 2013/14 to 158 the next year and up to 192 before the end of 2015/16.
Vulnerable GP practices
Figures obtained by GPonline in March 2016 revealed that 811 practices, over 10% of the total number in England, were identified by local NHS England as vulnerable, with some areas reporting more than 20%.
The BMA began balloting practices on Monday on their willingness to participate in a co-ordinated list closure as a form of industrial action in response to what they say is the faillure of NHS England's £2.4bn GP Forward View to ensure sustainability of the service.
Polling by GPonline suggests a majority of GPs would be prepared to take part in a co-ordinated list closure to highlight pressure on the profession.
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RCGP chair Professor Helen Stokes-Lampard said: 'It’s not clear with these figures why practices have closed – some may have merged, and others may have closed as a result of working "at scale", which can bring benefits for patients through pooling resources to provide additional services or better appointment access.
'But this won’t always be the case and when practices are being forced to close because GPs and their teams can no longer cope with ever-growing patient demand without the necessary funding and resources, it’s a huge problem.
'More research into why practices are closing would be really useful – but ultimately, we need the pledges in NHS England’s GP Forward View, including £2.4bn extra a year for general practice and 5,000 more full-time equivalent GPs by 2020, to be implemented in full and as a matter of urgency.'
Original story by Neil Roberts on the 14 July 2017 @ GPOnline.com
Acting GPC chair Dr Richard Vautrey
Analysis by the King's Fund, based on data from the Department of Communities and Local Government, shows that councils in England will spend £2.52bn on public health services in 2017/18 compared to £2.60bn the previous year, on a like-for-like basis.
Once inflation is factored in, the think tank estimates that planned public health spending will be more than 5% lower in 2017/18 than it was in 2013/14.
GP leaders condemned the cuts as a 'national scandal' and warned that they could see money diverted away from practices and create short- and long-term workload problems for GPs.
Public health cuts
The £85m reduction in spending comes on top of cuts worth £200m made to public health in 2015/16. Funding for sexual health services has dropped 10% over the last four years.
Sexual health services are set to be slashed by £30m as part of the cuts, a 5% reduction on last year’s budget, the King's Fund report said.
This comes alongside a projected 5.5% cut to tackling drug misuse in adults – equivalent to £22m – and a 15% cut worth £16m to smoking services.
Most services are facing cuts, it warned, bar a few – including promoting physical activity and some children’s services.
Acting GPC chairman Dr Richard Vautrey said: ‘It’s a national scandal that the government is allowing such significant cuts to public at a time when we need investment far more than ever before.
‘We will pay the consequences in the long term if we cut funding now – it’s completely foolish to cut these services at this stage.
‘These cuts could take money away from GP services – many practices are reliant on money that comes from public health sources, doing important work around smoking cessation and reducing alcohol. Sexual health and contraceptive services are also funded through public health sources from local government.
‘In terms of GP workload – in the short term, there's always the risk practices will try to maintain services even though they have funding, which will impact on the services they can provide.'
GPonline reported earlier this year that GP practices deliver services that should attract enhanced services payments worth millions of pounds a year for free.
Dr Vautrey added: ‘And if we’re not offering basic services now, it is bound to increase workload pressures on GPs and community-based healthcare in the long term.’
Frontline GP services
RCGP chair Professor Helen Stokes-Lampard described the cuts as ‘incredibly concerning’.
She added: ‘We know that difficult financial decisions need to be made but it makes no sense to make cuts to these frontline services, and other valuable services for patients, that will only be to the detriment of the wellbeing of so many and could adversely impact on the health and wellbeing of some of our most vulnerable patients in society.’
Shirley Cramer, chief executive of the Royal Society for Public Health, said: ‘Short-sighted cuts to sexual health, drug misuse and stop smoking services are a false economy – saving money in the short term but costing far more over coming decades, while jeopardising precious gains we have made to cut the number of smokers and efforts to tackle our growing crisis of drug-related deaths.’
Izzi Seccombe, chair of the Local Government Association's community wellbeing board, said: ‘Councils are clear – the government needs to look to prevention, not cure, for delivering long-term savings and better services.
‘To take vital money away from the services which can be used to prevent illness and the need for treatment later down the line is counterproductive.’
A DH spokesman said: ‘We have a strong track record on public health – cancer survival and dementia diagnosis are at a record high whilst smoking rates and teen pregnancies are at an all-time low.
‘Over the current spending period we will invest more than £16bn in local government public health services. Moreover, we have shown that we are willing to take tough action to protect the public's health – introducing standardised packaging of cigarettes, a soft drinks industry levy and a world leading childhood obesity plan.’
By Dr Mark Spencer on the 25 May 2016
Dr Mark Spencer, co-chair of the New NHS Alliance, employs a paramedic in his practice. He explains what the role involves and how it benefits the practice.
Paramedics are fleetingly mentioned within Dr Arvin Madan’s introduction to the recently published GP Forward View. They are also included again in the ‘Ten High Impact Actions’. Blink, though, and you would miss those references.
So, what is their role and what are they currently doing within day-to-day general practice?
At FCMS, the healthcare provider of which I am medical director, we have had paramedics filling urgent care shifts for over a decade. Way back in 2002 we were awarded the Health and Social Care Award in the emergency care category for our development of a multidisciplinary team in the GP out-of-hours setting. The team included GPs, primary care nurses, mental health nurses, pharmacists, dentists, social workers and paramedics.
So, what about ‘in-hours’ GP practices?
The past two years has seen my own practice move from predominantly GP dominated provision of day-to-day appointments, to a more multidisciplinary approach. Practices nurses have stepped up the mark for the provision of care for patients with long-term conditions, but seeing patients who request an appointment has, until recently, pretty much remained the domain of the GP.
Our change came out of adversity and need. In the past two years we have lost two whole-time equivalent GPs as four part-time partners either retired or moved on. This meant we were only left with four whole-time equivalent GPs for over 12,000 patients in an area of high deprivation and high demand. Failure to recruit new GPs left us with no alternative but to think differently.
We developed a strategy that includes an acute access team, led by an on-call GP, but with the bulk of face-to-face delivery being undertaken by a full-time nurse practitioner, a full-time clinical pharmacist and a full-time paramedic.
Our paramedic has three basic elements to his job. First, he carries out a morning minor ailments surgery, working alongside, and being supported by, the other members of the acute access team. Late morning he then sets off on home visits, covering the vast majority of acute visits that would otherwise have been undertaken by a GP.
Use of technology
The use of telephone support, but more importantly, video support between the paramedic and the on-call GP, has significantly broadened the range of conditions that can safely be managed by the paramedic, with the on-call GP remaining back at surgery. The live video link allows the GP to see the patient, and also allows the patient and carers to interact directly with the GP as if they were in the room.
To date, the feedback from patients and carers has been excellent. To cover information governance, the patient signs a written consent form prior to, and immediately after, the video consultation. We have also had written confirmation from our local coroner that they would accept a death certificate from the GP following a video consultation should the patient pass away, in exactly the same way as they would if the GP had visited in person.
Releasing the GP from having to undertake acute visits has not only freed up a considerable amount of GP time, but has had a substantial effect on reducing GP stress levels.
Thie post was originally aired here: