This page shows a summary of the latest news from the Royal College of General Practitioners RSS News Feed.GPs will not prescribe opioids as a 'quick fix' solution, says RCGP
“GPs take prescribing any medication incredibly seriously and will do so based on the physical, psychological and social factors potentially impacting on the health of the patient in front of them, and in line with current clinical guidelines – they will never prescribe simply as a ‘quick fix’ solution.
“Opioids can be very effective painkillers for new onset or longer term conditions. However, for patients living with chronic pain they do have associated risks – including addiction - and GPs will discuss these with patients before jointly making the decision to prescribe them. GPs will also monitor patients to ensure that the treatment is proving beneficial.
“In most cases patients do not want to take medication long-term, and GPs will always try to explore alternatives, such as psychological therapies - but these can be hard to come by at community level, leaving them with few alternatives which are still considered of equal benefit to the patient. GPs and our teams will also advocate modest levels of exercise to patients in pain, but for some patients this simply isn’t an option.
“GPs and our teams will continue to work closely with patients in chronic pain by inviting them for regular medication reviews, and prescribing opioids, when deemed the best treatment option, at the lowest possible dose for the shortest possible time.”
She said: "GPs are highly-trained to prescribe, and will only do so when they feel it is appropriate for the patient sitting in front of them, based on the physical, psychological and social factors potentially impacting on their health.
"It is testament to advances in medical research, public health and the tireless work of our NHS that people are now living longer, however, this also means that people are living long enough to develop conditions such as high blood pressure and high cholesterol. As these conditions are identified more frequently, we have a responsibility to offer patients the right medication to manage them and reduce the risk of a heart attack or stroke in the future.
"For those living with multiple, complex conditions, this can sometimes mean being prescribed a variety of drugs to help them manage their health and reduce the risk of complications.
"Patients should be reassured that while medication can be of great benefit, GPs will always try to explore alternatives to pharmacological treatments, and recommend lifestyle changes for patients, that may also have a positive impact on their long-term health and wellbeing.
"Where medication is appropriate, GPs use evidence-based prescribing guidelines to help them select the right drug and will carefully consider whether those drugs work safely in combination with other medications that a person may be taking - and also undertake regular reviews, in consultation with their patients."
She said: "It is becoming less common as a GP to see patients presenting with a single, long-term health issue. Indeed, as this research shows, more than half of GP consultations are for patients living with two or more long-term conditions.
"This large-scale, comprehensive research is further evidence of the increasing complexity of cases that GPs are dealing with, and the inadequacy of the standard 10-minute consultation.
"GPs need much more time with our patients with complex needs, so that we can properly consider their unique circumstances – including the different conditions they are living with – and develop the most appropriate treatment plan for them. This simply isn't possible in 10 minutes, but offering longer appointments means offering fewer appointments and our patients are already waiting too long to secure time with their GP.
"Today's research also highlights the rising number of cases of physical and mental comorbidity, particularly in young people, and the urgent need for enhanced mental health services, including more mental health therapists and more options for treatment, in the community - and for GPs and our teams to have better access to them.
"Whilst GP workload has increased by at least 16% over the last decade, our work has also increased in complexity - but the share of the overall NHS budget general practice receives is less than it was a decade ago, and our workforce has not risen at pace with demand.
"We need to see NHS England's GP Forward View, which promises £2.4bn extra a year for general practice, 5,000 more GPs, and for every practice to have access to one of 3,000 new mental health therapists, delivered in full and as a matter of urgency.
"These findings also suggest that for general practice to cope with the changing needs of our population, we need to consider alternative ways of delivering care to ensure all patients receive the most appropriate care for them. This should involve implementing systems to free up GPs' time so that they can spend longer with patients living with multiple, complex conditions, who really need their medical skills and expertise."
"The combination of a depleted workforce, intense workload, and chronic underfunding has left our health service on the brink, putting both staff and patient wellbeing at risk.
"In general practice alone, our workload has risen by at least 16% over the last seven years, but investment in our service has not risen at the same pace – something surgeries up and down the country are now feeling on a day-to-day basis.
"We agree with the recommendations made in the report that we need to make the UK more accessible and attractive to doctors from other countries, and that public initiatives to reduce patient need must be properly funded if the NHS is to see any benefit.
"For general practice, NHS England's GP Forward View promises an extra £2.4bn a year for general practice, 5,000 more GPs, and 5,000 more members of the practice team, and we need to see it delivered, in full, and as a matter of urgency, so that GPs and our teams can provide the high-quality care our patients need and deserve."
Responding to the budget, RCGPNI Chair, Dr Grainne Doran said: "The College welcomes the increase in funding for health and social care. The whole health and social care system is under incredible strain and it is essential that the additional investment is spent strategically to help deliver transformation.
"We also welcome investment in mental health services. Waiting lists for treatment are currently unacceptable and we would welcome action to help remedy this - but it is important that any short-term investment is part of a long-term strategy.
"We cannot transform our health service without addressing the significant challenges in primary care – and recommendations to support GP services have been outlined in the GP-led Care Working Group Report. It is well recognised that a thriving general practice sector is a vital component to deliver health care transformation.
"Proposals have been made for implementing new models of multidisciplinary team working in the community – and to deliver this successfully, we must also invest in GP premises and facilities, quality improvement and training in primary care.
"As part of a long-term approach to reform, I would urge the Department of Health to support the essence of Delivering Together and the Systems: Not Structures reports by wisely investing in workforce and services to ensure lasting improvement in outcomes for patients."
"One concern GPs already have is overdiagnosis - where we are giving a label to a situation thereby medicalising it, and prescribing medications when the benefits to the individual patient may be very limited. This can be harmful for patients both in terms of causing unnecessary anxiety, and in terms of taking medication that they might not need.
"We know that weight control, careful diet, and better exercise habits remain key ways to prevent or reduce hypertension. GPs readily advocate healthy lifestyle changes and discuss these with their patients where possible within the constraints of a standard 10-minute appointment.
"Nevertheless, it is important that clinical guidelines are updated to take into account the most current research and make recommendations of how to implement it in the best interests of patients. If NICE review current guidelines and consider lowering the threshold for hypertension, then this will be put forward for consultation and experts in the area will be encouraged to express their views.
"Patients should be aware that clinical guidelines are very useful for GPs when developing treatment plans, but they are not tramlines. GPs are highly trained to prescribe taking into account the circumstances of the individual patient sitting in front of them, including physical, physiological and social factors that might be affecting their health."
"Substance misuse is a very concerning issue for the whole population – it is not the preserve of young people - and GPs understand that addiction to any substance can have serious, negative consequences on our patients' health and wellbeing.
"GPs will look at the physical, psychological and social factors potentially impacting on the health of the patient in front of us – and as part of this we will ask our patients questions about their alcohol intake, smoking and any drug use so that we can determine the most appropriate and effective treatment for them.
"It is alarming to see a doubling in deaths related to poisoning from substances in older people and highlights the very real dangers of alcohol and drug misuse.
"While alcohol is safe in moderation, it is also important to be aware of your alcohol habits at home, in private - as it can be more difficult to keep track of exactly how many units you're having when they are not being measured out in standard sizes - and if you notice it's becoming a problem, you should be honest with yourself and seek help to limit your alcohol intake."
The Memorandum of Understanding between the three organisations permits the disclosure of NHS data to help the Home Office track those suspected of offences relating to immigration, including overstaying a visa.
Professor Helen Stokes-Lampard writes that the College is concerned about the "possible impact of this on patient confidentiality" and that it is the RCGP's view that has there is "no requirement to change the current system, which enables information and records to be obtained via court order."
She continues that since news of the MOU was announced, the College has consistently said that "GPs and other health professionals have a duty to deliver care to patients, regardless of their individual circumstances. This care is provided on the mutual understanding that the information our patients share with us remains confidential. This principle is fundamental to the trust which exists between doctors and patients.
"Any process that undermines this trust will both deteriorate the doctor-patient relationship, and deter vulnerable people from seeking medical assistance when they need it.
"We recognise that the information shared as a result of the MOU is considered to be non-clinical, but any information, even names and addresses, are given by patients in good faith and with the understanding that this remains confidential."
Her letter also cites concerns regarding public health, writing that "it is crucial that vulnerable patients do not stop presenting to their GP fearing the consequence of immigration enforcement."
The College's intervention comes in the wake of correspondence between Health Select Committee Chair Dr Sarah Wollaston, a former GP, and NHS Digital recommending that the MOU be suspended until there has been a thorough review of public interest in maintaining a confidential medical service.
NHS Digital refused on the grounds that it was justified given public concern regarding immigration.
The letter also notes "increasing levels of concern from… the National Data Guardian, British Medical Association, Public Health England, and General Medical Council, about the impact of the MOU on the doctor-patient relationship, patient confidentiality, and public health."
Professor Stokes-Lampard acknowledges that it is "encouraging that the government has commissioned Public Health England to look at the impact of the MOU on public health," but that the College is "concerned that this work will not report until January 2019."
Until the outstanding issues regarding patient confidentiality and public health, the impact of the MOU this on the doctor patient relationship, the potential for this to deter vulnerable people from seeking medical assistance, and the concerns about risk to public health are resolved, the College is urging NHS Digital to take heed of the Health Select Committee's recommendation to suspend the MOU.
She said: "Prostate cancer costs thousands of men their lives every year across the UK, and GPs are working hard to ensure that patients are able to recognise the symptoms of prostate cancer, which if caught and managed in a timely way, can greatly increase their chances of survival.
"GPs have long held reservations about the effectiveness of PSA testing based on previous research findings, in particular with regard to potential overdiagnosis and its associated risks - today's research supports these concerns.
"It shows that PSA testing is not sensitive enough to either detect the subtle variations between prostate cancers or exclude clinically insignificant cancers. The results being that in some cases the need for urgent treatment might be missed, while in others it causes unnecessary worry for patients, who might have to undergo a biopsy and deal with the associated risks of the procedure.
"This large, high-quality study is really useful in backing up our calls for GPs to have better access to a more specific and sensitive test than the PSA test. It is now important that this research is taken into account as new research is commissioned and new clinical guidelines are developed.
"The College does not recommend that the PSA test is offered routinely to men who do not present with prostate cancer symptoms. However, if a patient is concerned about developing the disease or about any worrying symptoms we would encourage them to speak to a healthcare professional."
RCGP Scotland has responded to findings that the number of 'Whole Time Equivalent' (WTE) GPs in Scotland has fallen by 160 since 2013 and has called for action to restore WTE GP numbers.
The Primary Care Workforce Survey, published today (06 March) by the Information Services Division of NHS Scotland (ISD) shows a fall in the number of WTEGPs in Scotland.
RCGP Scotland has been warning for several years that the GP workforce is in crisis. This latest survey has found that the WTE number of GPs has fallen below the level it was at four years previously. It shows that there are 160 fewer WTE GPs now than there were four years ago. The number of estimated WTE GPs – those GPs who work at least eight sessions (ie 40 hours) per week – has fallen by 160, from 3,735 WTE GPs in 2013 to 3,575 in 2017. This figure represents a fall of over 4%.
Worryingly, the survey also found an increase in the number of practices with GP vacancies. Nearly a quarter (24%) of GP practices who responded to the survey reported current GP vacancies – a rise from 22% in 2015 and 9% in 2013.
This lack of progress in terms of increasing the numbers of family doctors comes at a time when the demand for general practice continues to rise and the population of Scotland continues to grow, with people living for longer, with multiple medical conditions. As a result, general practice services are over-stretched and this is having knock-on effects on patient care.
Reacting to the findings from her practice in Craigmillar in Edinburgh, Dr Carey Lunan, Chair of RCGP Scotland, said:
"The findings from this survey are very concerning. In the interests of patient care and a sustainable NHS, we must do more to tackle the GP shortage and ensure that we increase the number of WTE GPs across the country as quickly as possible.
The drop in the numbers of WTE GPs is being felt in communities across Scotland. Practices are struggling to fill long-standing GP vacancies, which not only causes instability within practices but also has a knock-on effect on patient care, with many patients facing lengthy delays in seeing a GP. A reduction in WTE GPs makes it more difficult for patients to see the same GP for their health problems, and this can mean that patients experience more fragmented care, which is less efficient, potentially less safe and can be frustrating and confusing for patients.
Scotland is facing increasingly complex patient healthcare needs due to the rise in multiple long-term conditions that occur with age. This has led to rising demand for GP services, as we strive to look after patients at home rather than in hospital. It is essential that the Scottish Government continues to address the rising demand for GP services and plans accordingly. In December, RCGP Scotland welcomed the Government's commitment to deliver 800 extra GPs in Scotland over the next decade. Although it is encouraging to see recognition of the workforce problems being faced by our profession, this commitment still falls short of the 856 WTE GPs that RCGP have previously calculated will be required within a much shorter time frame - by 2021. We hope that today's findings will lead to a commitment from the Scottish Government that the 800 extra GPs they have promised to deliver will at least represent WTE positions.
We need action to tackle the GP shortage sooner rather than later to ensure that GPs can continue to deliver high quality, safepatient care. Many practices across the country are already at tipping point. Growing the GP workforce is crucial to ensure that there are enough highly trained medical generalists to provide the community-based, patient-centred care that has provided the backbone of the NHS for decades. GPs coordinate care, provide continuity of care, deliver whole-person medicine and act as advocates for patients. Our teams often offer the first point of contact for patients seeking help from the NHS. Only by ensuring a critical mass of GPs can we ensure that practices have enough GPs to meet the needs of their communities and allow patients to build up long-term relationships with a trusted doctor, which is often more valuable than any medicine."