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.
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).
National Institute for Health Research | April 2019 | Communication problems are top of patients’ concerns about hospital care
A study that provides insight into patient concerns, trained volunteers to ask inpatients about their care aimed to find out what proportion of patients had concerns about their care. The researchers used this data to categorise and understand their concerns, and to assess whether these concerns were in line with the types of patient safety incidents identified by clinicians.
The surveys identified:
The biggest category of concern (21.7%) was communication, either from staff to patient, staff to staff, or patient to staff. Examples included confusion about when patients were due for surgery, with resulting uncertainty about when they could eat, and unnecessary missed meals. One in ten patients raised a safety concern of some kind.
Almost a quarter (23%) of patients surveyed raised an incident of concern, with a total of 1,155 incidents provided by 579 patients.
Staff shortage issues accounted for 13.2% of concerns. The ward environment was a concern for 12.2% of people, with noise and accessibility cited as examples. Other concerns included a perceived lack of compassion, dignity and respect for patients; medication issues including late, missed or wrong medication; delays in treatment, results or discharge; staff training, food and drink and ward management.
The assessing doctors said 406 of the 1,155 incidents reported (35%) qualified as patient safety incidents. They were most likely to identify medication issues as a safety issue, and least likely to flag up concerns about the ward environment. Although communication was the single biggest concern for patients, cited in 251 reports, only 54 of these (21.5%) were seen as patient safety issues by doctors.
Of identified patient safety reports, the doctors said 90% were probably or definitely avoidable. They also said 99% were of ‘negligible, minor or moderate’ severity. Only one incident identified by patients was categorised as of major severity.
NHS England | March 2019 |Clinically-led Review of NHS Access Standards: Interim Report from the NHS National Medical Director
In 2018 Professor Stephen Powis, NHS National Medical Director, was asked to carry out a clinical review of standards across the NHS, with the aim of determining whether patients would be well served by updating and supplementing some of the older targets currently in use. In this interim report, Professor Powis sets out his recommendations for doing so (Source: NHS England).
NHS Improvement| January 2019 | Addressing hospital handover delays: actions for local A&E delivery boards
Addressing hospital handover delays: actions for local A&E delivery boards is advice from NHS Improvement for ambulance trusts and A&E delivery boards on what action to take during busy periods and should ambulances begin to queue. This aims to help reduce delays in handover of patients from ambulance services to emergency departments.
This document sets out the main points from recent guidance documents, and separates them into actions to be embedded as part of normal working practice, and actions to be taken should ambulances begin to queue.
This summary is not exhaustive and local delivery boards should refer to more detailed guidance from NHS Improvement and the Royal College of Emergency Medicine as referenced within (Source: NHS Improvement).
Healthcare Safety Investigation Branch | January 2019 | New report focuses on recommendations to make ambulance transfers safer
A new report from the Healthcare Safety Investigation Branch, Transfer of Critically Ill Adults shows that a lack of national guidance and standard practice for ambulance transfers could be putting patients at risk.
The report puts forward key recommendations aimed at making transfers safer for adults that are critically ill.
This investigation was launched after the Healthcare Safety Investigation Branch were notified of the case of Richard, a 54-year old man, who died during an emergency transfer to a specialist care centre. He had been diagnosed with an acute aortic dissection after experiencing chest pain during exercise earlier that day. Aortic dissection occurs when the innermost layer of the wall of the aorta tears, allowing blood at high pressure to flow in between the layers forcing them apart.
The report sets out two safety recommendations:
The Department for Health and Social Care (DHSC) coordinates the development of national guidance, with the arm’s length bodies, for the transfer of critically ill adults, both in planned and emergency situations.
The Association of Ambulance Chief Executives (AACE) works with partners to define best practice standards for the criteria, format, delivery and receipt of ambulance service pre-alerts (Source: Healthcare Safety Investigation Branch).
The NHS’ 10 year plan outlines how a third or outpatients appointments may be reduced as the current model is “outdated and unsustainable”.
Outpatients traditionally serve at least three purposes, and in each case there are opportunities for redesign. An outpatient appointment can provide: advice and diagnosis for a patient and their GP; follow-up review after a hospital procedure; and ongoing specialist input into a long-term condition. Technology means an outpatient appointment is often no longer the fastest or most accurate way of providing specialist advice on diagnosis or ongoing patient care.
The plan describes the traditional model of outpatient care as being “outdated and unsustainable”. It outlines its intention to redesign services so that over the next five years patients will be able to avoid up to a third of face-to-face outpatient visits, removing the need for up to 30 million outpatient visits a year.
The document also includes a case study of Tower Hamlets Chronic Kidney Disease e-Clinics where a single pathway from primary to secondary care with rapid
access to specialist advice provided by consultant led e-clinics have transformed the way the way this care is delivered.
Four reasons are cited as enabling these technology-driven shifts:
They are already happening
in parts of the NHS, so this is clearly ‘the art of the possible’.
There is strong patient ‘pull’ for these new ways of accessing services, freeing-up staff time for those people who can’t or
prefer not to.
The hardware to support ‘mobile health’ is already in most people’s pockets –
in the form of their smart phone – and the connection software is increasingly available for the NHS to credential from third party providers.
The Long Term Plan provides dedicated funding to capitalise on these opportunities
Read the NHS Long Term Plan at the NHS Long Term Plan website (Source: NHS Long Term Plan)
All.Can UK | December 2018| First findings of All.Can patient survey revealed at UK Parliament event
More than a third (36 per cent) of cancer patients reported the greatest inefficiency as being their diagnosis finds the All. Can patient survey sought patients’ and carers’ perspectives on inefficiencies in cancer care. 40 per cent of people who participated in the survey had been initially diagnosed with something else. A similar proportion (34 per cent) also responded to say that they had a surplus of medication left over following treatment.
All.Can worked with Quality Health to develop the patient survey. Quality Health was responsible for all aspects of survey administration and data analysis, with input from All.Can national initiatives and the international research and evidence working group.
The UK piloted the All.Can patient survey ahead of roll-out in other countries throughout 2018. The survey closed in the UK in August, but continued running until 30 November in Australia, Belgium, Canada, France, Italy, Poland, Spain and Sweden. Data from an international version is also being analysed (Source: all-can.org).