NHS Providers | February 2019 | On the day briefing: A five year framework for GP contract reform to implement the NHS long term plan
NHS Providers and the British Medical Association’s (BMA) GP committee have reached an agreement for general practice contract reform for the next five years with the aim of supporting the delivery of the NHS Long term plan.
This briefing summarises the changes set out in the contract, and explores the potential implications for trusts and their local partnerships with primary care.
NIHR | February 2019 | New strategies for maintaining blood supplies from donations may be cost-effective
Recent research on blood supplies has been spotlighted by an NIHR Signal. The study used data from a recent large randomised trial in the UK that investigated the safety of donating blood more frequently than current guidance allows. This was combined with current UK donation records, cost data, and the preferences of about 34,000 existing donors who were surveyed for this study.
Opening blood donation centres on weekday evenings and at weekends is a cost-effective way of increasing the blood supply used by hospitals in the UK. Allowing donors to give blood more often could increase supplies in the short term, but it isn’t clear if it would be cost-effective in the long-term.
The NHS Blood and Transplant service is looking for ways to increase supplies of blood types that are in high demand. This study adds to the evidence about which strategies are both clinically effective and cost-effective. This should help to inform future service changes (Source: NIHR).
Plain English Summary
Blood transfusions are important in many aspects of NHS care, including general surgery and organ transplantation. Overall demand for blood is decreasing, and demand for particular blood types is also growing. To increase the supply of high-demand blood, NHS Blood and Transplant is considering potential service changes to encourage donors to give blood more often. The separate INTERVAL study of 45,000 blood donors investigated the safety of donating blood more frequently than currently allowed.
This study looked at the costs of each potential service, and also surveyed 32,924 blood donors, to estimate the impact on the amount of blood collected. The study used data from these surveys, the INTERVAL study and donors’ current donation records, as well as cost information, to report which possible service changes were best value for money.
Donors give blood at either a ‘static donor centre’ or a ‘mobile session’ (where blood is collected by a team who travel around to different venues). The study found that donors at static donor centres would donate more if centres were open on weekday evenings or at weekends, and this would be a relatively cost-effective way of increasing the supply of blood that is in high demand. Giving donors a health report (e.g. with measurements such as blood pressure or cholesterol) would not be cost-effective. Some donors said that they would stop donating if changes to the blood collection service meant that they had to travel for longer to donate blood.
Allowing donors to donate more often could increase the supply of blood in the short term. However, more donors would be turned away from appointments because of low iron, which may lead them to stop donating, and so it is unclear whether or not this would be a cost-effective way to increase the supply of blood in the long term.
The full article is also available to read from the NIHR journals website
Department of Health and Social Care | February 2019 | Learning disability and autism training for health and care staff
The government wants to know how they can make sure that health and social care staff have the right training to understand the needs of people with a learning disability and autistic people, and make reasonable adjustments to support them.
The consultation considers issues around the training and development staff need to better support people with a learning disability or autistic people.
The Department of Health and Social Care want to know what people think about our proposals on:
the planned content of the training
how the training should be delivered
how to involve people with a learning disability or autistic people in training
how we can mandate, monitor and evaluate the impact of training
The consultation will be of particular interest to:
people with a learning disability or autistic people
the families and carers of people with a learning disability or autistic people
Specialist Pharmacy Services | February 2019 | The Future of Aseptic Pharmacy Services in England: Report on Phase 1 of the NHSI Review (Feb 2019)
NHS Improvement undertook a review of the provision pharmacy aseptic services including MHRA licensed, unlicensed an outsourced (both from NHS Providers and non-NHS commercial suppliers) activity. Product categories included in the review are chemotherapy, parenteral nutrition, clinical trials / investigational medicinal products, and pharmacy-led radiopharmacy.
Specific aspects of these services on which information was sought included: geographical location, capacity (staff and facilities), estate & equipment, management structure, staffing establishment, operational costs, service hours, range of products & services provided, and customer base.
This report summarises findings from the first phase of the Review and recommended next steps to be taken in Phase 2, which started in February 2019 (Source: Specialist Pharmacy Services
Taylor, C. J. et al | 2019|Trends in survival after a diagnosis of heart failure in the United Kingdom 2000-2017: population based cohort study | BMJ | 364 | doi: https://doi.org/10.1136/bmj.l223
A study that looked at over 50,000 patients aged 45 and over with a new diagnosis of heart failure using data from the period 2000 to 2017 linking this with inpatient data and ONS mortality data. Over the course of the study’s duration there were 30 906 deaths in the heart failure group over the study period. Heart failure was listed on the death certificate in 13 093 as the primary cause of death. The study’s author conclude that after a diagnosis of heart failure has shown only modest improvement in the 21st century and lags behind other serious conditions, such as cancer.
To report reliable estimates of short term and long term survival rates for people with a diagnosis of heart failure and to assess trends over time by year of diagnosis, hospital admission, and socioeconomic group.
Design Population based cohort study.
Setting Primary care, United Kingdom.
Participants Primary care data for 55 959 patients aged 45 and over with a new diagnosis of heart failure and 278 679 age and sex matched controls in the Clinical Practice Research Datalink from 1 January 2000 to 31 December 2017 and linked to inpatient Hospital Episode Statistics and Office for National Statistics mortality data.
Main outcome measures Survival rates at one, five, and 10 years and cause of death for people with and without heart failure; and temporal trends in survival by year of diagnosis, hospital admission, and socioeconomic group.
Results Overall, one, five, and 10 year survival rates increased by 6.6%, and 6.4%, respectively. There were 30 906 deaths in the heart failure group over the study period. Heart failure was listed on the death certificate in 13 093 (42.4%) of these patients, and in 2237 (7.2%) it was the primary cause of death. Improvement in survival was greater for patients not requiring admission to hospital around the time of diagnosis. There was a deprivation gap in median survival of 2.4 years between people who were least deprived and those who were most deprived.
Conclusions Survival after a diagnosis of heart failure has shown only modest improvement in the 21st century and lags behind other serious conditions, such as cancer. New strategies to achieve timely diagnosis and treatment initiation in primary care for all socioeconomic groups should be a priority for future research and policy.
NHS England | n.d | Staff wellbeing is everyone’s responsibility at Islington iCope
A case study from NHS England highlights how a team at Islington iCope considered and introduced measures to support their own wellbeing. To help patients improve their mental health, NHS staff also need to take care of their own wellbeing. A team of Psychological Wellbeing Practitioners (PWPs) at Islington iCope therapies service was keen to think about how they could support their own wellbeing among the pressures and challenges of delivering Improving Access to Psychological Therapies (IAPT) services. Starting with a Wellbeing Action Day, the PWP team worked with managers to bring about a number of meaningful changes (Source: NHS England).
NIHR | February 2019 | Treatments for depression may help irritable bowel symptoms
A systematic review that looked at the the effects of antidepressants versus placebo in 17 trials and psychological therapies versus a control therapy or usual care (symptom monitoring, physician’s usual management, or supportive therapy) in 35 trials. All of the trials were conducted in middle-income countries, with four of the trials from the UK.
Antidepressants are likely to provide more than a placebo effect for those with symptoms of irritable bowel syndrome (IBS). Antidepressants improve symptoms in about 60% of those taking them, but two-thirds of that effect may be due to placebo. Psychological therapies, such as talking therapies also appear effective in about half of those offered them but may be partly due to expectations because it is not possible to provide a placebo control.
IBS is a chronic disorder of the gut which commonly causes pain, bloating, stomach cramps and diarrhoea or constipation. Despite these symptoms, no structural abnormality is present, so it is described as a functional disorder. People with these symptoms often have coexisting anxiety or depression, and there is a theory that the syndrome, a collection of symptoms, may be due to a disorder of brain-gut function.
This systematic review identified 53 randomised controlled trials. The review concluded that antidepressants are effective in reducing symptoms of irritable bowel syndrome, as the symptoms improved for more people taking antidepressants than those taking a placebo. There is also evidence to suggest that psychological therapies also appear to be effective treatments, particularly where a therapist is directly involved (Source: NIHR).
Public Health England | February 2019 | Health matters: preventing cardiovascular disease
Too many people are still living with undetected and poorly managed atrial fibrillation (AF), high blood pressure (BP) and raised cholesterol. Working with partners, Public Health England (PHE) and NHS England have agreed ambitions which seek to address the A, B and C of secondary prevention and reduce the health inequalities associated with cardiovascular disease (CVD) over the next 10 years.
We know that Canada took just over 10 years to reach its CVD ambitions, but is now the world leader for detection and optimal management of high BP. The CVDSLF believes England has the potential to do the same if we all work together to achieve these ambitions (Source: Public Health England).
The King’s Fund | February 2019 | Working 9 to 5: Poppy Jaman on mental health and the work–life balance
Experts from The King’s Fund and beyond about the NHS, social care, and all things health policy and leadership. This episode features Poppy Jaman OBE, Chief Executive of City Mental Health Alliance, who chats with Helen McKenna about mental health in the workplace, and shares her advice for future leaders.
They consider: What should employers be doing to keep us well? And what language should we use when we talk about mental health?