Posts in Nhs

Reduced number of GP training places advertised for 2018

06 November 17

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.


GP training

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.


Related Post: Why It Makes Sense To Look At Paramedics For General Practice


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

NHS needs more advanced paramedics to ease A & E pressure, says NICE

04 July 17

Paramedics with advanced training can reduce the number of patients admitted to hospital unnecessarily, says NICE.

Single paramedic responder

NICE is recommending the NHS provides more advanced paramedic practitioners (APPs) to relieve pressure on emergency departments, in new draft guidance.

Evidence reviewed by NICE shows that using APPs can reduce hospital admissions by 13% compared with standard paramedics.

APPs are able to treat patients in the community, refer them to a GP or decide if they should go to hospital. They can administer stronger pain relief compared with standard paramedics and are able to assess if a wound need stitches.

A previous British Medical Journal study suggests that for each APP, the NHS can save up to £72,000 a year. They can be used on the ground or by sharing their expertise over the phone.

Professor Julian Bion, consultant in intensive care medicine at Queen Elizabeth Hospital and chair of the NICE guideline committee, said: “It is essential we spend what money we have wisely, investing in areas where we’ll see a real improvement in care for everyone.

“Increasing the number of advanced paramedics we have working across the country is one way we can achieve this. Their skills and expertise can help to ease pressure on emergency departments and ensure patients are cared for in the most appropriate location.”

The draft guidance also makes wider recommendations about emergency and acute medical services to standardise care across the NHS. It supports NHS England’s Five Year Forward View for the future of emergency medical services.

These include providing nurse-led support within the community for people who are at risk of hospital admission, for example, if they have recently suffered a stroke or been diagnosed with heart failure. 

Hospitals should consider daily consultant review of patients admitted with a medical emergency including weekends and bank holidays, the draft guidance says.

These patients should also get automatic, seven-day access to physiotherapy and occupational therapy if they need it, the document says.

Professor Mark Baker, director of the centre for guidelines at NICE, said: “This draft guidance features recommendations that seek to standardise best practice across our emergency and acute medical services. It also highlights where we need more evidence to properly assess what should be done to get the most from the limited resources we have.” 

In total, there are 23 practice recommendations and 17 recommendations for more research, such as whether having GPs working in or near emergency departments can help reduce hospital admissions. 

NICE will be consulting on the draft guidance until 14 August.


Original post: 04/07/2017

How paramedics can help general practice

21 June 17

Original post 

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.

Dr Mark Spencer, co-chair of the New NHS Alliance

Thinking differently

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:

Theresa May accused of failing to tackle growing NHS crisis

30 May 17

Credit: This story was first seen on The Independent

Theresa May has been accused of failing to tackle the growing crisis in the NHS and social care, with a ‘smoke and mirrors’ manifesto that has left future funding in doubt, The Independent reports.

Experts and campaign groups turned their fire on the prime minister as her promise to “get to grips with the great challenges of our time” if she returns to Downing Street drew scorn.

A flagship pledge to confront the social-care time bomb was attacked by the author of a previous review of policy for the Conservatives, who said older people would be “helpless” to plan their futures.

The Tories had also failed to offer hope to the 1.2 million people not receiving the care they need, with no commitment to bail out cash-starved local councils, the King’s Fund and Age UK warned.

And the British Medical Association (BMA) attacked a pledge to put an extra £8bn into the NHS, because it included money already promised. The Independent has learned this could be as much as £3bn.

Related story: -

“The extra £8bn touted in this manifesto for the NHS is smoke and mirrors,” said Dr Mark Porter, the chairman of the BMA council. “Rather than extra money, this essentially extends the funding already promised in the 2015 spending review for another two years and falls far short of what is needed. The NHS is already at breaking point.”

The criticism came after Ms May – in Labour-held Halifax – published an 84-page manifesto that marked a stark attempt to put clear water between her and past Conservative leaders.

“We do not believe in untrammelled free markets. We reject the cult of selfish individualism,” it stated, reflecting the prime minister’s belief that government should intervene to improve people’s lives.

Rejecting laissez-faire conservatism, Ms May said: “While it is never true that government has all the answers, government – put squarely at the service of ordinary working people – can and should be a force for good.”

But she denied a new philosophy, declaring: “There is no Mayism. There is good, solid conservatism that puts the interests of the country and the interests of ordinary working people at the heart of everything we do in government.”

The manifesto was also criticised by the Confederation of British Industry after including another crackdown on immigration, which remained the Conservatives’ “Achilles heel”, the business group said.

“In a global race for talent and innovation, UK firms risk being left in the starting blocks because of a blunt approach to immigration,” said Carolyn Fairbairn, the CBI’s director general.

GPs ‘planning to quit’ over low morale and workload pressure

30 May 17

Credit: This story was first seen on Sky News

Nearly 40% of GPs in southwest England say they are highly likely to quit the profession because of low morale and overwhelming workloads, a survey published in BMJ Open suggests.

The poll of more than 2,200 general practitioners found that 70% intend on reducing their contact with patients in some way over the next five years – through permanently leaving, taking a career break, or by cutting their hours, Sky News reports.

More than half of those polled by the University of Exeter reported low morale – and the professor behind the research has warned that similar figures across other British regions would necessitate robust action “swiftly and urgently” to prevent a staffing crisis.

Professor John Campbell has urged the government to move away from “sticking plaster solutions” and to tackle the workload pressures that GPs face – with younger doctors reluctant to take on a practice because of the financial risks and responsibilities involved.

He said the number of GPs who said they were thinking of quitting was bleaker than expected – not least because the South West is often considered a “desirable” place to work.

Related story: - 

“If the GPs we surveyed fulfil their intentions to leave or cut back their patient contact, and no action is taken to address the issue, the southwest of England will experience a severe shortfall of GPs in the next five years,” Professor Campbell warned.

He also claimed the looming shortage was exacerbated by how the country’s current workforce of GPs is aging – as 30% of them are over 50 years old.

According to Professor Campbell, GPs and their staff are responsible for 90% of patient contacts with the health service, yet receive 7p in every £1 of NHS spending.

Doctors in the region believe the situation is likely to get worse as demand increases because of fewer beds in community hospitals.

Urgent care needs to undergo a channel shift

26 May 17

How to transform urgent and emergency care will be one of the most challenging questions faced by Sustainability and Transformation Plan (STP) footprints.

Against a backdrop of stretched capacity and a system under intense pressure, STPs will want to understand how they can prioritise their local investment to maximise return in terms of activity, system efficiency and the potential for financial savings that can be reinvested in services.

Providers and commissioners will come together with a shared goal of addressing complex challenges and will need the best information to support their decision making.

As part of its Urgent and Emergency Care Review, NHS England aims to connect all UEC services together so the overall system becomes more than just the sum of its parts. This means we need to offer alternatives to A&E that provide access to a clinician closer to people’s homes, whilst making sure that skilled resource in hospitals is focused on the sickest patients.

The current reality is that much UEC activity is not taking place in the setting that is right for the patient and most efficient for the NHS. The interventions the UEC review has set out are intended, when taken collectively, to help shift care to the most appropriate setting.

This is known as channel shift.  There is an expectation that channel shift will always improve quality and, in most cases, that it will be more efficient.  In some cases, channel shift will also result in savings.

To support this, we have described a range of interventions that STPs should consider prioritising within their plans, such as:

  • Supporting local systems to deliver 24/7, clinician-led Integrated Urgent Care Services, accessed through NHS 111;
  • Introducing new ways of working for ambulance services that treat more patients in the community so safely reduce conveyance to A&E;
  • Introducing or increasing ambulatory emergency care services that manage emergency adult patients safely and effectively on the same day, avoiding admission; and
  • Providing education and support for staff in care homes to better respond to events and illnesses.

STP Footprints may have many questions about how to tackle their local pressures, including:

  • How will the interventions set out in the UEC review impact in our locality?
  • What will be the combined effect of multiple interventions?
  • What evidence do we have to support decision making?
  • How can we use local data to reach a collective informed decision of whether shifting activity between different providers / services can deliver savings?

To address these issues NHS England developed a stakeholder group comprising local and national organisations including NHS Improvement and led by Professor Keith Willett, NHS England’s Medical Director for Acute Care.

The group commissioned Capita and the North of England Commissioning Support Unit (NECS) to work with us to develop a “Consolidated Channel Shift Model (CCSM)” that will help commissioners and providers to:

  • understand the system effects of individual UEC interventions on activity;
  • secondly to understand the consolidated system effects of combining different UEC interventions;
  • and thirdly to appreciate the financial implications of system activity shift and the thresholds of activity redirection that deliver benefit.

Working with our UEC Vanguards, models were developed, drawing on the existing evidence base to understand the anticipated financial and activity impact using local information. The models were developed with two vanguard sites before validation with two further sites, to ensure the broadest appreciation of the channel shift impact. Each of the fifteen interventions is then brought together as part of an overarching model which calculates the combined effect of introducing the interventions.

The project team engaged with Professor Gwyn Bevan, an expert in health policy and commissioning at the London School of Economics to provide further, external, confidence on the appropriateness of the modelling.

What is particularly innovative in this work is the way it deals with two key concepts, “thresholds” and “local ambition”.  The threshold sets the level at which some of the semi-fixed cost can be addressed; local ambition describes how confident local managers are that they will be able to extract savings. The use of these approaches allows STPs and health systems to develop a shared approach to understand the costing and activity challenges of change in the next five years.

The channel shift model is now available to be populated by local footprints using their local data, supported by a comprehensive user guide. We will continue to build the model as we develop the evidence base, whether from international best practice, evaluation of our vanguards or wider evaluation of UEC interventions nationally.

Feedback from those who use the tool will be invaluable – we will collectively learn as commissioners and providers work together to plan strategically and facilitate service design.

Get in touch with us on and tell us how you have found using the model  – what you’ve learned,  what  challenges you’ve faced, what you disagree with, any surprises and what you’re going to do locally as a result. We look forward to hearing from you.

Ciaran Sundstrem

Ciaran Sundstrem

Ciaran Sundstrem is the Care Model Lead for the Urgent and Emergency Care Vanguards, and Programme Lead for Urgent and Emergency Care within NHS England.

He has worked in a range of roles within the NHS since starting on the NHS Graduate Management Training Scheme in 2002, with particular experience in urgent and emergency care, health protection, health and justice, and substance misuse.

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