Political and Parliamentary Monitoring
Week Commencing 17th September 2018
Former Chair of the Royal College of General Practitioners, Professor Clare Gerada, has said that general practice is a “complete and utter and total mess” in a speech to the Westminster Health Forum this week. The Former Chair said that over 1,500 GPs had received help from a specialist mental health and addiction service, as stress levels amongst health professionals skyrocket and morale continues to fall.
Professor Gerada said that general practice now resembled something out of the 1970s, when the health service was in crisis, with doctors forced to take on too much, too often. The 1970s crisis was solved by the creation of a GP Charter which outlined the duties and responsibilities that GPs should reasonably take-up. Professor Gerada is now calling for a 21st century GP Charter to be commissioned.
Her other recommendations included reviewing staff contracts, which she said were “far too rigid”. Many contracts for general practice outline how many patients should be seen in a particular time-frame, thus preventing doctors from spending more time on those patients which need additional care or have complex medical needs. At the same time, such a rigid view of seeing patients has resulted in a lack of reflection in the profession, with little opportunity for doctors to review recommendations and the decisions they had made.
This news will interest the PCF greatly. It is essential to have well-trained and accessible GPs with the ability to diagnose bladder and bowel issues. Without enough GPs, whether because of stress or other factors, this will impact on the time it takes to receive an official diagnosis. At the same time, it is crucial that GPs have the time and resources to adequately diagnose patients. Any delays can cause further funding stresses on the NHS at a later date.
- Standardising support for children with nocturnal enuresis
- Early findings revealed from RCN pay debacle probe
- NHS suffering worst ever staff crisis
A&E appointments system proposed in NHS shakeup
Under a proposed shakeup of NHS targets, patients could have to start booking appointments in A&E units, and those with only minor ailments may be forced to wait many hours before being seen, it has been revealed. NHS England chiefs are examining whether to relax the longstanding obligation to see 95% of A&E patients within four hours.
NHS England is reviewing its core service and longstanding targets to see 95% of A&E patients within four hours as part of its forthcoming 10-year plan, which will outline how the organisation will spend the extra £20 billion it is due to receive by 2023. Senior leaders have been looking at case studies and best practice from around Europe, including the Denmark model in which only the most ill patients are expected to ring to make at an appointment in A&E. If adopted in England, it could force many of the 22 million visitors to A&E every year to pre-book before arriving.
The Denmark model, which was adopted in 2014, led to complaints that patients faced long delays getting through to phonelines and that some serious injuries and illnesses were misdiagnosed because the assessor had no contact with the patient. Professor Keith Willett, NHS England’s Director of Acute Care, supports a move to this system but many A&E staff say it is unclear who would triage and assess patients ringing in. Dr Taj Hassan, President of the Royal College of Emergency Medicine, said he would “very surprised if this worked in the NHS”.
Senior NHS leaders have voiced their concerns over the last few months that understaffing, combined with financial problems, meant that many hospitals could no longer meet the four-hour A&E target. Other ideas being put forward include watering down the 18-week target for planned surgery. Chris Hopson, Chief Executive of NHS Providers, which represents NHS trusts, said many hospitals had already downgraded the 18-week target because that was best approach based on medical need.
This will interest the PCF because it indicates that the Department of Health and Social Care is thinking boldly about where to invest new funding as part of its forthcoming 10-year plan. Whitehouse has already made representation to the NHS about ensuring bladder and bowel issues are at the core of any funding plans.
Early years workforce facing ticking timebomb
The Education Policy Institute has found that the Early Years and nursing sector is facing a “ticking timebomb” with staff shortages and a falling number of professionals taking new qualification crippling the industry. In a set of predictions for the Nursery sector, the EPI found that four-fifth of Early Years staff will not be working towards a higher qualification level.
Sara Bonetti, the author of the report, said that one in five staff qualified at Level 6 or higher are aged over 50 and will be approaching retirement within the next ten to fifteen years. If this trend continues, by 2023 over 80 per cent of the group-based staff will not be working towards a higher qualification level. At the same time, by 2023 the number of unpaid staff will have risen to 13 per cent of the workforce.
This study comes at a time when the Government is under pressure to put in place plans to grow the graduate workforce. Highly-qualified staff are key to raising childcare quality and giving children the best start in life. In response to the study, the Government said that it was investing a record amount in childcare, with an estimated £6 billion to be spent each year by 2020. The Social Mobility Action Plan, announced at the beginning of the year, will also mean an additional £20 million will be spent supporting quality improvement in pre-reception nursery settings.
This news will interest PCF members, as any fall in the number of qualified teaching staff will no doubt impact on the detection rates for bladder and bowel issues, especially given that nursery staff play a key role in tracking the stages of childhood development.
‘Worst yet to come’ for local authorities
Cash-strapped local authorities face further cuts of almost £1 billion next year, local authority leaders have warned. Residents in area run by some of England’s largest councils will face another round of “unpalatable” cuts, according to the County Councils Network, representing some of England’s largest local authorities. Cuts of at least £685 million will have to be announced in February 2019, followed by an additional £233 million unplanned cuts across the year. Over a quarter of cuts have not yet been earmarked, forcing many residents and campaigners to worry about where the axe will fall next.
From April the Government’s “adult social care precept” will end for 13 county authorities, and ministers have chosen not to renew the grant system, which has provided councils with last-minute funding over the past two years. Instead, local authorities will now have to face the choice of either cutting adult social care provision or maintaining funding by diverting resources from other projects, scheme and departments.
The County Councils Network is now calling for an immediate injection of new resources, saying ending the grants systems would put “additional strain” and “intense financial pressure” on local budgets. In a separate, subsequent survey, it was revealed 44 per cent of local authorities were planning to reduce public health expenditure. Councillor Nick Rushton, Leader of Leicestershire County Council, warned that authorities were in a “seriously and extremely challenging” financial position.
In response, a Government spokesperson said that the funding settlement had given a real-term increase in resources for local government in 2018-19, with local councils being provided £90.7 billion over the next two years to help them meet the needs of residents. The spokesperson added that Government was developing a funding system for the future “based on the needs of different areas.”
This news will be of tremendous interest to the PCF. Further cuts to public health may impact on school nurses, who are no longer represented or funded by the NHS. We will highlight the planned cuts to local authority budgets in any relevant correspondence with local MPs.