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’.
Related Post: Planned Changes To CQC Inspections Will Increase GP Workload, RCGP Warns
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
By David Millett on the 30 August 2017
The CQC's proposals to overhaul GP inspections next year will put an extra administrative burden on practices, the RCGP has warned.
The changes to the CQC’s inspection regime, which are due to be introduced from next year, ‘will not reduce the overall impact of regulatory burden on GPs’ and will actually increase practice workload in the short-term, the RCGP said.
Plans to press ahead with making practices provide annual information to the CQC as part of a more collaborative approach to regulation were ‘disappointing’, RCGP vice chair Professor Martin Marshall said.
The warning comes as the CQC sent a letter to all practices on Wednesday, which revealed its new system where practices will collect and submit their own information to the regulator will be introduced ‘during 2018’.
If no concerns are raised by the data, practices that are already rated good or outstanding will be inspected once every five years instead of every year.
But the RCGP said this new requirement would add to practices' workloads instead of reducing the burden of regulation.
The CQC said it was working with the GMC, NHS England and other regulators to 'streamline' requests for data, avoid duplication and share information.
'Inadequate' practices will continue to be inspected within six months of their previous inspection, and 'requires improvement' practices within one year.
Additional details on the CQC plans to overhaul the GP inspection regime will be published this October. with rollout of the changes to be phased in gradually from November, the CQC letter adds. The regulator said it expected the new assessment framework to be introduced in November.
It follows the CQC’s consultation on the plans, which concluded in early August.
Professor Marshall said: ‘The CQC proposals are very disappointing, especially at a time when GPs are struggling to cope with unprecedented pressures of increasing patient demand, insufficient investment and severe GP shortages.
'Effective regulation must add value to the care of our patients, not detract or distract from the quality of it. Nor should it divert already limited resources away from hard pressed GPs who are working flat out to provide frontline care.
‘While some of the proposals may make sense in isolation, collectively they do not address the issue of the growing regulatory and administrative burden on GP practices. In the short term at least, the CQC’s proposals could result in an increase in the administrative burden on practices if they are expected to provide additional information and keep it up to date.
‘Parts of the proposed new approach will be welcomed by GPs and their teams, particularly the longer interval between inspections for good and outstanding practices. However, the overall impact of the regulatory burden on GPs will not be reduced by these proposals and they are not sufficient to make a significant difference to the day-to-day workload and working lives of GPs.
‘We have raised these concerns in our response to the CQC consultation and will be pressing for these to be more fully reflected in the CQC’s proposals.'
Professor Steve Field, CQC chief inspector of general practice, said: ‘We have written to practices to update them on our inspection programme and the consultation on our new approach. In the consultation document we outlined several ways that we think the inspection programme could evolve to do what it needs to do more efficiently, while recognising the pressures faced by GPs.
‘The changes are subject to the outcome of the consultation, so we are not in a position to say precisely what these changes will look like.
‘However, we are working closely with RCGP and BMA on the detail of our proposals so that any changes following the consultation are implemented in such a way that recognises the pressures faced by GPs and minimises the impact on their workload.'
The original post can be found here
Dr Mary McCarthy: (Photo: JH Lancy)
A GPonline survey of more than 500 GPs has revealed that 51% believe the number of patient consultations they provide each day is in excess of what they consider to be safe. More than 80% of GPs said the GPC should negotiate a maximum safe limit to the number of patient contacts they can undertake per day.
LMC representatives voted at their annual conference last month for GP leaders to negotiate a maximum safe limit on daily contacts with patients. Proposing the motion, GPC member Dr Mary McCarthy said GPs were seeing more patients than ever.
She told the conference that GPs in the UK had more daily patients contacts than any other country in Europe other than Turkey, where the health service is dealing with 6m refugees from Syria.
Safe GP workload
GPs in other European countries had fewer than 25 contacts a day compared with 40 to 50 a day in the UK, said Dr McCarthy. GPonline reported earlier this year that GPs in England provide around 1m appointments per week over the level the BMA considers safe.
‘We need to give ourselves some sort of guideline as to the workload we undertake,' she said. ‘Routinely seeing more than 25 patients a day may not be safe for patients or their doctors.’
Other LMC representatives opposed the limit and warned there was little evidence base for determining how to quantify a safe workload.
The special LMCs conference in January 2016 voted for the GPC to negotiate restrictions on the number of patient contacts allowed each day per GP to 'a level comparable to other EU countries'.
The BMA’s annual conference later this month will debate a call for a GP ‘black alert’ system to be set up, with or without government recognition, for practices to indicate maximum safe capacity has been reached.
GPC’s Urgent Prescription for general practice calls for ‘a national standard for a maximum number of patients that GPs, nurses and other primary care professionals can reasonably deal with within a working day.’
Research cited previously by the RCGP suggests more than half of GPs carry out 40-60 consultations per day.
BMA guidance on safe working published in 2016 makes the case that 115 appointments per week should be seen as the 'quantified commissioned activity of an NHS GP'.
Responding to the GPonline survey a Devon GP said: ‘I often work flat out for 11 hours, making a complex clinical decision every 1-2 minutes.'
A Bristol GP said: ‘The main problem is the intensity of sessions not necessarily patient numbers. Because of six-week wait for routine appointments patients demand multiple problems within appointment which simply cannot be achieved safely.’
A Kent GP added: ‘Having to see almost 40 patients face-to-face plus half of dozen of phone calls plus all the admin work on a daily basis, I thinks that is a maximum overstretch with safe consequences. I have no time to think and most of the time I can only react. My job is to think and I am not allowed to do so.’
Another Bristol GP said safe working limits should be for practices to decide, not regulation, but added: ‘Problem is that senior partners are not always good managers of people. Practices need to be flexible and pay scale adjusted accordingly.’
A GP in Edinburgh said safe contact numbers depended on the types of cases. ‘Depends on quality as well as quantity - 20 snotty kids are easier than two suicidal patients back to back.’
A Greater Manchester GP supported a limit, but added: ‘Who is going to see all the other patients [and] meet the rest of the demand?’
Original story publish on GP Online - &th June 2017
Credit: This story was first seen on On Medica
On Medica reports that hourly pay rates for locum staff have continued to rise, despite attempts to cap them, research by NHS workforce management consultancy Liaison shows.
Locum pay rates during the third quarter of 2016/17 were the highest since price caps were introduced by NHS Improvement. Of the hours worked by temporary staff in the third quarter, 80% exceeded NHS Improvement’s capped rates, compared with 64% in the second quarter.
The findings are published in the quarterly Taking the Temperature update produced by Liaison, which benchmarks the last quarter with the previous quarter. The report analyses pay and commission by grade and specialty across the 60 trusts and boards that Liaison supports with its workforce management services, and compares results by size, type, region and agency.
The findings shows that average hourly pay rates for locums increased from £63.30 to £64.17 (1.4%) in quarter three due to average consultant and ST3 rates rising by 1.8% and 2.4% respectively. The average pay for ST3 locums is more than double the core wage cap and the maximum rate of £120 paid this quarter was more than four and a half times the agreed cap.
Average hourly pay rates increased in eight of nine specialties, although rates decreased in radiology which still remains the highest-paid specialty for consultants. Maximum rates paid were greatest in general medicine at £187.50 per hour, almost two and a half times the core price cap.
Related story: - Treating patients closer to home
Vacancies continue to be the biggest reason for booking locums, accounting for 85.9% of all bookings.
However, while the overall average hourly pay rates for locums increased, the average commission rate paid for all grades of staff fell. Commission rates fell by 0.9% to £6.90 overall and for the four main grades of staff, most notably for FY2 locums, where rates fell by 2.9%. Commission as a percentage of the total bill (pay and commission) fell from 9.90% to 9.71% in the third quarter.
As the NHS approaches its 70th anniversary, last month the health service published the plan setting out how it will deliver practical improvements in areas prized by patients and the public – cancer, mental health and GP access – while transforming the way that care is delivered to ease pressure on hospitals by helping frail and older people live healthier, more independent lives.
These measures, probably the biggest national move towards integrated care currently underway in any Western country, will also help to put the service on a more sustainable footing for the future.
With the NHS under pressure this plan, Next steps on the NHS Five Year Forward View, also details an accelerated drive to improve efficiency and use of technology in order to deliver better care and meet rising demand within the constraints of available resources.
Two-and-a-half years on from the publication of the widely-welcomed NHS Five Year Forward View, the plan spells out what has been achieved and the changes which will take place across the health service in key areas:
- Improved cancer care aimed at saving an extra 5,000 lives a year through new one-stop testing centres, screening programmes and state of the art radiotherapy machines.
- Boosting mental health services by increasing beds for children and young people to cut out of area care, more beds for new mothers and more mental health professionals in the community and hospitals to prevent crisis admissions.
- Better access to GP services with everyone benefiting from extended opening in the evenings and weekends, newly designated ‘Urgent Treatment Centres’ and an enhanced 111 service to ease pressure on A&Es.
- Better care for older people by bringing together services provided by GPs, hospitals, therapists, nurses and care staff, cutting emergency admissions and time spent in hospitals.
- Driving efficiency and tackling waste to make money invested in the NHS go further in delivering the services and staff that patients want, including the latest treatments and technology.
Read related: One In Seven Practices Could Face Longer Opening To Avoid £8,000 Loss Under New Contract
Launching the plan, NHS England Chief Executive Simon Stevens said: “Heading into our 70th year, public support for the NHS is as strong as ever but so too are the pressures on our frontline staff.
“Today we chart a course for practical care improvements for the next few years. We do not underestimate the challenges but, get these right, and patients, staff and the tax-paying public will notice the benefits.”
The document outlines significant progress made over the last three years, including record high cancer survival rates, 8,000 extra doctors and nurses, the first ever waiting time standards for mental health treatment being introduced and met, and cutting waste – in particular agency staffing bills.
It also, however, frankly sets out where progress has not been as quick, with rising pressure on A&E and acute wards partly caused by delayed transfers of care.
You can read the full online document here
GP practices in South Kent commissioned a 7-day acute home visiting service provided by paramedic practitioners who liaise with the patients own practice.
As part of the GP Access Fund, the Invicta federation in South Kent contracted the local ambulance trust to provide a paramedic practitioner visiting service to patients in their own home. The aim of the service is to minimise the disruption of home visits to GP surgery schedules and reduce the number of A&E attendances.
The paramedic practitioner service provides a seven day per week visiting service in collaboration with local GP practices and the 8am- 8pm hubs in Folkestone and Dover. The paramedic practitioner is trained to independently provide care that does not require the intervention of a doctor. The paramedic has access to the full GP record.
They report directly back to the GP with the outcome of the visit and any updates on any treatment and medication that was given. The paramedics also work at the hubs during the weekends, triaging and seeing patients who did not require a GP to attend. Referrals to the service are via a GP or NHS 111.
In the long term, Invicta Health is planning to work with SECAmb to integrate paramedic practitioner visits into the overall ambulance service to increase sustainability, stability and primary care integration.
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In the first 3 months of this service, 260 patients were seen. In 11% of cases, it was judged that this intervention at home prevented hospital admission. The service costs £3,000 per week to run. Aside from the benefits for all patients of receiving rapid help, the service pays for itself through reductions in hospital admissions.
It is important to build a strong working relationship with the ambulance trust in advance, and collaborate on planning, evaluating and adjusting the service over time. Expect to need to make a number of adjustments, and to find more opportunities to incorporate the paramedic practitioners input than may originally have been obvious. This may include making follow-up home visits for patients treated out of hospital, for example, or being directly accessible to community nursing staff for assessments before liaison with the GP if necessary.
Not all paramedics are able to provide the care required for this service to deliver best value - it should be provided by a paramedic practitioner.
Avoid delaying implementation whilst trying to design the perfect system; as long as both partners are working safely, improvements can be made as the service develops.
Regular communication with everybody involved is vital. This includes communicating the success of the work to staff. Staff are key to success; chose people who are flexible and can adapt to changing situations and circumstances.