This page shows a summary of the latest news from the Royal College of General Practitioners RSS News Feed.Introducing the new Training Portfolio
Over the past year, the RCGP has been considering options for replacing the current Trainee ePortfolio – and our decision to partner with FourteenFish has been based on feedback and requests from members.
The new Training Portfolio will be easier to use and should save time for both trainees and trainers. It will include an integrated mobile app, allowing trainees to record learning logs and review existing entries on the go, even without an internet connection.
Users will also be able to check their progress towards their next Educational Supervisor Review (ESR), and the system is generally quicker, more insightful and should ultimately make things much simpler for trainees and trainers who are using it.
The Training Portfolio will be piloted by Wessex Faculty members in early 2020, and the College is planning roll it out to all members later in the year.
She said: "This report analyses prescribing data for medications that when prescribed appropriately can be effective and beneficial for many patients – and it shows that the vast majority of prescriptions issued are short term, and that we are seeing a decline in opioid prescriptions for chronic pain, both of which are encouraging trends.
"What it also indicates is the severe lack of alternatives to drug therapies for many conditions – and where effective alternatives are known and exist, inadequate and unequal access to them across the country.
"There are wide-ranging and complex issues surrounding the prescribing of opioids and antidepressants. GPs don't want to prescribe medication long-term unless it is essential and most patients don't want to be taking medication long-term, but there will always be some patients for whom medication is the only thing that helps with distressing conditions such as chronic pain, or depression and anxiety.
"When prescribing any of the medications considered in this report, the mantra for prescribers will be to prescribe the lowest possible dose for the shortest possible time – and to offer regular medication reviews. But the decision to prescribe will also be made taking into account the physical, psychological and social factors affecting a patient's health, as well as clinical guidelines – and in conversation with the patient about the risks and benefits of taking the medication.
"Whilst the vast majority of prescriptions will be appropriate, if we are to reverse the prescribing trends outlined in this report, GPs need better access for our patients to alternative therapies in the community. We also need more high-quality research into alternatives to drug therapies in general – as well as around dependence and withdrawal - and for this to shape the clinical guidelines that GPs use to inform our practice."
She said: "Having a baby is usually a very special time but it can lead to a whole host of physical and mental health concerns for new mothers, and it's essential they feel comfortable discussing these with their GP and other healthcare professionals, and that they receive the appropriate support.
"The routine six-week postnatal check, usually offered to all new mothers in addition to the formal health check of their newborn baby, should be a time for the GP to be able to talk to women about issues affecting their mental and physical health and wellbeing and take steps to address them.
"But, even though six-week checks are generally longer than the standard 10-minute appointment, it is still incredibly hard for GPs to explore all the different factors potentially affecting a new mother's health within the time constraints – particularly at a time when general practice is facing intense resource and workforce pressures.
"Checks for new mothers need to be funded and promoted in the same way that checks for newborns are so that GPs can spend the time they feel they need to with both the baby and its mother. We hope today's calls from the National Childbirth Trust for the Government to fund checks for all new mothers are given serious consideration so that we can continue to give all of our patients, including new mothers, the care they need and deserve."
"Extensive medical evidence has shown that statins are usually a safe and effective preventative measure against heart disease, and thousands of patients already benefit from statin therapy.
"But GPs are also mindful of the risks of overdiagnosis and over-treatment – a concern we expressed in response to recent NICE guidelines that lowered the threshold for eligibility of statins – and we also have concerns about making these drugs more easily accessible, without a prescription.
"Statins, like any medication, have associated risks, and GPs will only prescribe them if we think it is in the best interests of an individual patients, based on their individual circumstances – and after a frank conversation about the potential risks and benefits.
"Nevertheless, it is encouraging that NHS England are conducting this review before implementing a new initiative, and the College looks forward to feeding into it. Prevention is important, but it is essential that any NHS intervention to promote it is evidence-based, and in the best interests of patients."
Currently, there are 3,500 placements for GP training a year - and this year, more junior doctors have chosen to specialise in general practice than ever before - but the College says these numbers must increase to at least 5,000 a year as soon as possible, and for this to be funded appropriately.
It comes as Professor Helen Stokes-Lampard, RCGP Chair, has written to Chief Secretary to the Treasury, Rishi Sunak, urging him to use the forthcoming Spending Review to boost the budget for education and training of GPs and other healthcare professionals by at least 3.6% – amounting to an immediate increase of £160m.
"The Interim People Plan set out laudable aspirations on the development of the NHS workforce, but we are deeply concerned that current levels of funding are not sufficient to deliver this," Professor Stokes-Lampard wrote.
Money for Health Education England's education and training budget is not included in the £20.5bn extra a year promised in the NHS long term plan.
She also called on Mr Sunak to address 'woefully insufficient' funds allocated to encourage existing GPs to remain in the workforce, writing:
"It is crucial that more is done to retain the hardworking GPs we currently have. There has been some success with locally funded GP retention schemes, but the £13m currently allocated is woefully insufficient...expanding the local funding for GP retainer schemes by an additional £72m could have a significant effect in preventing much needed experienced GPs leaving general practice."
The latest figures from NHS Digital, published last week, showed that the number of fully-qualified, full-time equivalent GPs fell by 576 in the year from June 2018-June 2019.
Referring to the Prime Minister's inaugural speech in July, Professor Stokes-Lampard's letter concluded:
"If the new Government is to deliver on its promise to increase access to general practice for millions of patients across the country, it must use the forthcoming Spending Review, as well as future reviews, to provide the funding boost that those training and working in general practice and the wider NHS need to deliver aspirations of the NHS Long Term Plan and the forthcoming NHS People Plan."
Commenting further, Professor Stokes-Lampard, said: "General practice keeps the NHS afloat by making the vast majority of patient contacts for a modest share of the overall funding – this alleviates pressures in hospitals, and keeps our health service sustainable.
"But GPs and our teams are facing intense resource and workforce pressures – and it is causing a growing crisis in our patients' access to general practice services, which the Prime Minister pledged to address when he took up office.
"We desperately need thousands more GPs but despite great and successful efforts to boost recruitment, more family doctors are leaving the profession that entering it.
"We need to think big, and based on current workforce trends, the College estimates that we need to start training at least 5,000 GPs every year to meet the Government's overall target to expand the GP workforce by 5000 full time GPs, over the next few years. We also need to tackle unfair underfunding of undergraduate teaching, and discrepancies around how undergraduate placements in general practice are funded compared to in secondary care.
"We know that many junior doctors want to be GPs, and we are confident that we could fill these places – but this needs to be funded, which is why we have written to the Chief Secretary to the Treasury, urging him to set the wheels in motion now so that this can become a reality in the foreseeable future.
"We also need more people entering medical school in the UK to create the pipeline for the longer-term, and we want at least 50% of them choosing general practice.
"In the shorter term we need to tackle the crisis of depleting numbers of fully-qualified GPs head on by making the workload more manageable and introducing initiatives to help retain our hard working, experienced GPs in the profession – not just to deliver vital patient care, but so that GPs of the future can learn from them
"Demand for our services is escalating, but without the workforce to deal with this, GPs are burning out with many leaving the profession before they planned to – and patients are waiting longer for an appointment as a result. We desperately need to see more funding for the roll out of retention schemes across the country, to tackle this.
"Mr Sunak has an opportunity in the Spending Review to address the significant shortfall in funding for education and training of doctors, and we urge him to take heed of our calls to safeguard general practice for the future, in the best interests of the wider NHS, and the care we can deliver for patients."
Professor Marshall said: “It is disheartening to see these findings by the RVC at a time when we, and other countries across Europe, were on the way towards completely eradicating measles - a potentially deadly but entirely preventable disease.
“While take-up of the MMR vaccination across the UK are still high, it is not high enough, and we have actually seen a small decline in recent years. It is clear that we are still suffering from entirely debunked claims around MMR that were perpetuated in the nineties – and are now resurgent on social media and other online platforms.
“Work is continuing across the NHS to ensure messages about the safety, and life-saving nature of vaccinations are heard, and it is encouraging that WHO has increased its focus on measles elimination and upgraded action to address the challenges which have allowed this deadly virus to persist in countries including the UK.
“This, alongside a commitment by our government to tackle a wave of dangerous anti-vax messages being shared online - particularly via social media - will hopefully go a long way in helping the country get back on track and regain our measles-free status.
“We would remind people that it is never too late to have their MMR jab. They can do this for free at their GP practice, and we urge them to do – particularly if they are planning to visit another area of the world where diseases like measles are still prevalent.
“Everybody has a part to play if we are to successfully combat anti-vaxxer propaganda, not least the technology companies who must take responsibility and tackle confusion around the vaccination information being shared on their platforms.”
He said: “The menopause can be a very difficult time for women, and HRT can help many to control its unpleasant and distressing symptoms, and drastically improve their quality of life.
“The link between HRT and an increased risk of breast cancer has been known for some time. But it is a complex relationship, and only relates to preparations of HRT that contain certain progestogens - the addition of which is necessary for women who have not had a hysterectomy - and it appears that some combined HRT preparations have a higher breast cancer risk than others.
“This research highlights the importance of taking a holistic approach to prescribing, considering all the different factors potentially affecting an individual’s health and wellbeing, which is what GPs are highly trained to do. It also demonstrates how vital it is that patients are involved in decision-making about their health, fully-informed about the various risks and benefits associated with a treatment.
“There is still a lot of evidence to suggest that HRT is safe and effective, and current clinical guidelines recommend it as an appropriate treatment for some women going through menopause. Nevertheless, it is important that clinical guidelines are evidence-based, and that this study is taken into account as clinical guidelines are updated and developed.
“We would urge patients not to panic as a result of this research, and to continue taking HRT as it has been prescribed to them - and we would urge prescribers to do so as normal, until clinical guidelines recommend otherwise. If a patient is concerned about her HRT prescription, she should discuss it with her GP at her next routine appointment.”
He said: “The number of fully-qualified GPs leaving the profession is concerning and reflects the harsh reality of what it’s like for family doctors working in NHS general practice, facing intense resource and workforce pressures on a daily basis.
“Recruitment efforts over recent years have been significant – and it is testament to this important work that we have more GPs in training than ever before, and this needs to be redoubled. But the number of full-time-equivalent, fully-qualified GPs is falling and at a rising pace, so we desperately need to see more funding for the roll out of retention schemes across the country, if we have any chance of turning this situation around.
“Demand for GP services is escalating both in terms of volume and complexity. Paired with falling workforce numbers, it creates a perfect storm that is leaving GPs stressed, burnt out, and leaving the profession earlier than planned – and our patients waiting much longer for an appointment than they should have to.
“General practice is a vibrant, diverse profession, and is great that more junior doctors are joining us in delivering care to more than a million patients a day across the UK – and in turn keeping the NHS sustainable. We need to make it as attractive for existing GPs, so they can have long, sustainable career in the NHS, both delivering patient care, and mentoring the next generation of general practitioners.
“We remain optimistic about the future of general practice: the financial commitment to primary and community care in the NHS long-term plan in England, the recent GP contract that promises funding will get to the frontline, and pledges to ensure greater investment in technology are all a part of making sure that the NHS is sustainable for the future.
“But the decline in GP numbers cannot be ignored, and we urgently need to see further details of concrete measures to retain more GPs in the forthcoming People Plan, including tackling soaring workload, and resources increased to make the working environment more supportive, as a matter of urgency.”
“This drop in cancers being diagnosed as emergency presentations is a testament to the vigilance of GPs and our team members who understand the importance of timely diagnosis, and work hard to strike the balance between over, under and appropriate referral.
“In cases where cancers are diagnosed as an emergency, it’s important to note that some types of cancer, such as pancreatic cancer, are notoriously difficult to spot in the early stages, either because symptoms might initially be vague and indicative of other, more common conditions – or because there may be no symptoms, at all.
“GPs are highly-trained to spot possible symptoms of the disease before recommending patients onto specialist referral. But the best way to further build on the positive progress we’re seeing with cancer diagnosis in this research, is to give GPs better access to the right diagnostic tools in the community - and the appropriate training to use them.
“That’s why we need to see more investment injected into primary care, the delivery of the NHS Long-Term Plan, and further details about how the proposals in the interim People Plan will be achieved, to ensure our profession is properly resourced both now and in the future.
“Cancer is an enduring priority for the RCGP, and we have worked with Cancer Research UK, Macmillan and others to develop resources for GPs and other healthcare professionals to support them in the timely diagnosis of cancer.”
“The opioid situation in the UK is not simple but the NHS - particularly general practice – actually makes it quite difficult for patients to get repeated prescriptions for opioids in increasing doses, but unfortunately, they are too easily accessible illicitly – and GPs have little control over that.
“It is always tragic to hear of drug-related deaths - but it is unclear as to whether these are a result of drugs being prescribed legally, or obtained illegally.
“Oxycodone and fentanyl are some of the strongest opioid-based painkillers available, and GPs will only prescribe them with great caution after considering all physical, psychological and social factors potentially impacting on a patient’s health, and in line with current clinical guidelines. We also aim to fully discuss the risks and benefits of taking opioids with the patient - including the potential for addiction - before prescribing them.
“Opioids should be prescribed at the lowest possible dose for the shortest possible time. GPs don’t want patients to be taking opioids long-term, and most patients don’t want this either, but for some patients, these drugs are the only thing that helps ease their severe pain.
“It is frustrating for all involved that there are so few alternative effective treatments available for chronic pain. We know that moderate levels of exercise can help but for some people, even this is not possible - and non-pharmacological options that do exist are often hard to access at a community level.
"There is a clear need for more high-quality research into pain, and more clinical guidelines for GPs and other healthcare professionals around treating pain, and using opioids - and it is welcome that NICE are developing these. We also need to see better-funded NHS services for people who do become addicted to opioids.”