NIHR: Decision support tools can help GPs reduce antibiotic prescriptions for respiratory conditions

NIHR | May 2019 | Decision support tools can help GPs reduce antibiotic prescriptions for respiratory conditions

National Institute for Health Research (NIHR) funded a trial which has shown a 12% reduction in GP antibiotic rates for respiratory conditions through electronic decision and training tools. The Signal from NIHR indicates that there was a reduction in prescriptions for patients between 15 and 84 were but there was no observed difference in younger children and older adults.

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Read the full Signal from NIHR 

Gulliford, M. et al. 2019| Effectiveness and safety of electronically delivered prescribing feedback and decision support on antibiotic use for respiratory illness in primary care: REDUCE cluster randomised trial| BMJ |364 | doi: https://doi.org/10.1136/bmj.l236 

OBJECTIVES: To evaluate the effectiveness and safety at population scale of electronically delivered prescribing feedback and decision support interventions at reducing antibiotic prescribing for self limiting respiratory tract infections.

DESIGN: Open label, two arm, cluster randomised controlled trial.

SETTING: UK general practices in the Clinical Practice Research Datalink, randomised between 11 November 2015 and 9 August 2016, with final follow-up on 9 August 2017.

PARTICIPANTS: 79 general practices (582 675 patient years) randomised (1:1) to antimicrobial stewardship (AMS) intervention or usual care.

INTERVENTIONS: AMS intervention comprised a brief training webinar, automated monthly feedback reports of antibiotic prescribing, and electronic decision support tools to inform appropriate prescribing over 12 months. Intervention components were delivered electronically, supported by a local practice champion nominated for the trial.

MAIN OUTCOME MEASURES: Primary outcome was the rate of antibiotic prescriptions for respiratory tract infections from electronic health records. Serious bacterial complications were evaluated for safety. Analysis was by Poisson regression with general practice as a random effect, adjusting for covariates. Prespecified subgroup analyses by age group were reported.

RESULTS: The trial included 41 AMS practices (323 155 patient years) and 38 usual care practices (259 520 patient years). Unadjusted and adjusted rate ratios for antibiotic prescribing were 0.89, respectively, with prescribing rates of 98.7 per 1000 patient years for AMS (31 907 prescriptions) and 107.6 per 1000 patient years for usual care (27 923 prescriptions). Antibiotic prescribing was reduced most in adults aged 15-84 years, with one antibiotic prescription per year avoided for every 62 patients (95% confidence interval 40 to 200). There was no evidence of effect for children younger than 15 years or people aged 85 years and older; there was also no evidence of an increase in serious bacterial complications.

CONCLUSIONS: Electronically delivered interventions, integrated into practice workflow, result in moderate reductions of antibiotic prescribing for respiratory tract infections in adults, which are likely to be of importance for public health. Antibiotic prescribing to very young or old patients requires further evaluation.

The journal article is available from the BMJ 

RCGP Scotland: Calls for new GP recruitment target

Royal College of General Practitioners | June 2019 |Call for new GP recruitment target

Royal College of General Practitioners Scotland has called for new recruitment targets to be set to boost GP numbers in Scotland. Alongside this RCGP Scotland have launched a new campaign #RenewGP as well as 11% of the NHS budget being used to ensure GP practice in Scotland is ‘future for the future’. As part of this RCGP calls for a minimum 15 minute appointment per patient but recognises that this can only be achieved with more GPs in the system. 

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Image source: rcgp

The report explores what RCGP consider to be the most important issues facing the profession and patients, as well as makes a series of recommendations at the end of each chapter.

The report makes six key calls:

  • Provide time to care. GPs must be given the time they need to care for their patients. 10-minute appointments do not work for an increasing number of patients or GPs. Minimum 15-minute appointments as standard would enable patients to have more choice over their care, especially when they have multiple conditions. This would be achieved only by the introduction of more GPs into the system in Scotland.
  • Safeguard the future of the NHS in Scotland. We need a National Conversation, led jointly by politicians, healthcare professionals and patients, to promote sustainable use of the NHS and safeguard its future.
  • Tackle health inequalities. GPs serving areas with high socio-economic deprivation should be appropriately resourced to ensure that the NHS is at its best where patients need it most. This will be possible when 11% of the Scottish NHS budget is allocated to general practice.
  • Planning for the future workforce: As our population lives longer with more long-term conditions, Scotland needs more GP capacity to build and lead our community healthcare teams. In order to accurately assess and plan the workforce needs for Scotland’s future, the Scottish Government must collect figures and report on Whole Time Equivalent GPs, not simple headcount figures, so that workforce plans of the future are accurately and reliably informed.
  • Improve healthcare systems for the benefit of patients and GPs. Urgent investment in IT is required to ensure that systems work more effectively together, improving reliability for clinicians and patients.
  • Promote Scottish general practice to a new generation of doctors. Investment is required to enable 25% of the undergraduate medical school curriculum to be delivered in primary care

Full details from Royal College of General Practitioners

News release:

Royal College of General Practitioners Scotland’s GPs call for 11% of NHS funding to tackle health inequalities in communities

See also:

OnMedica Call for new GP recruitment target

 

Half of GPs working unsafe levels

More than half of GPs say they are working above safe limits, on average completing 11-hour days and dealing with a third more patients than they say they should be | story via Pulse

Full-time family doctors are on average dealing with 41 patients in a day – when GPs said the safe limit should be 30, according to Pulse’s survey of 1,681 UK GPs.

Some are seeing far higher numbers of patients – around one in ten deal with 60 patients or more in a day. Meanwhile, they reported the intensity of work was high, with GPs saying 29% of their patient contacts – a mixture of face-to-face, phone, online appointments and home visits – were ‘very complex’, and 37% were ‘fairly complex’.

Full detail at Pulse

GP leaders said the findings showed the profession ‘was working far beyond their capacity’ and warned the level of workload was affecting GPs’ own health and posing a risk to patient safety.

See also: The full story of how GP workload is jeopardising patient safety | Pulse

Number of GPs in the UK

The Nuffield Trust has carried out an analysis of the number of GPs in the UK   

Key points

  • Across the UK, the number of GPs relative to the size of the population has fallen in a sustained way for the first time since the 1960s.
  • The fall in number of GPs has been particularly marked in certain regions of England such as North West London and the East of England. These regions also have the lowest total number of GPs per 100,000 people, whereas Scotland has the highest.
  • The fall in GPs per person reflects insufficient numbers previously being trained and going on to join the NHS; failure to recruit enough from abroad; and more practitioners leaving for early retirement.

Full detail: Is the number of GPs falling across the UK?

The Nuffield Trust has also produced an explainer The NHS workforce in numbers.  This summary provides facts on health care staffing and highlights the extent of current shortages and their effect.

See also: GP pressure: Numbers show first sustained drop for 50 years | BBC

GP scheme frees up half a million hours for patients

NHS England | April 2019 | GP scheme frees up half a million hours for patients

The Time for Care programme- a programme to help practice teams manage their workload, adopt and spread innovations that free-up clinical time for care, and develop the skills and confidence to lead local improvement- has enabled GP practices to find more time for patients during the last year.

 

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The programme, which will now be rolled out across the country after success in pilot sites, such as in Pickering, North Yorkshire and  Chiswick Health Practice, Hounslow;  has been extended for three years beyond its initial March 2019 end date and aims to cover three quarters of GP practices by 2022.

The saving of 205,00 clinical hours is the equivalent of 1.23 million GP appointments of 10 minutes each. At an average of £30 an appointment, that represents close to £40 million in time saved. If the same number of clinical hours saved are achieved over the next three years, it would represent around 3.7 million GP appointments – or around £110 million in terms of appointment time saved (Source: NHS England).

Further details are available from NHS England

See also:

NHS England  Releasing time for care

GP scheme frees up half a million hours for patients

Royal College of General Practitioners Time for Care ‘one part’ of much bigger solution that is needed on GP workforce and workload

BBC News More GP appointments available due to success of pilot scheme

GP contract directions 2019 to 2020

Department of Health and Social Care | March 2019 | GP contract directions 2019 to 2020

The Department of Health and Social Care has released guidance  setting out the legal framework under which GPs operate and are paid.

The primary medical services (directed enhanced services) directions 2019

The general medical services statement of financial entitlements (amendment) directions 2019

The general medical services statement of financial entitlements (payment in respect of indemnity fees) direction 2019

Full details from the Department of Health and Social Care

Campaign to attract GPs to return to general practice

Health Education England & NHS Return| March 2019 | Campaign to attract GPs to return to general practice

Health Education England (HEE) and NHS England have launched a new campaign to encourage GPs to return to practice. The GP Induction and Refresher (I&R) Scheme provides a safe, supported and direct route for qualified GPs to join or return to NHS general practice in England. 

The scheme is open to qualified GPs working abroad or living overseas, who may even be able to start the scheme before returning to England.

General Practitioners on the scheme can expect:
  • a placement bursary of up to £3,500 a month
  • help towards indemnity costs and other fees
  • a dedicated account manager
  • a tailored programme to meet learning needs, experiences and personal commitments
  • access to training and development support
  • no fees for I&R assessments or the Portfolio Route
  • up to four fully funded attempts at the I&R assessments
  • relocation support for GPs relocating from overseas up to £18,500
  • help with visa costs and sponsorship for non-EEA clinicians
  • options to complete most parts of the scheme before moving back to England, if you are living overseas.

Full details of the scheme are available from the NHS Return website

Return brochures can be downloaded from NHS England

Further details from HEE 

In the news:

OnMedica Campaign to attract former GPs back to general practice

Of interest:

OnMedica  BMA sees hope for rebuild of general practice