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Updated: 21/08/2019 12:17

Online triage systems work for some patients but are not a solution to GP workload pressures, warns College

She said: "GPs and our teams have always made the most of technology as part of our ongoing commitment to provide the best possible care to patients. "We were the first NHS sector to implement both electronic patient records and electronic prescribing, and we will continue to explore how using new technology in practice can benefit our patients, including through online consultations, which many practices across the country are already using in some form. "There's no denying that online triage systems are convenient for some patients, particularly people who are generally fit and well and work full-time, or for people uncertain if their problem is significant or not, but as this study shows, they do not always reduce GP workload – a major pressure currently facing general practice. "The goal of adopting any new technology is to not only make sure it is safe and effective, but that it actively complements the work we already do. It is good to see robust research emerging about online triage systems in action."

We must never give up on building the GP workforce says College

She said: "We agree with the writers of this report that the GP workforce faces significant challenges but we disagree that these are insurmountable. We must not, under any circumstances, give up on our aims and endeavours to build the GP workforce – achieving these is vital for the future of the NHS, and patient care. "The NHS long term plan has aspirations that will benefit patients, but it will need the right workforce to deliver it, and that includes at least 5,000 more family doctors. "We are extremely grateful to the hard work, skill and dedication of members of the wider practice team - they are pivotal in supporting us to deliver care to over a million patients every day - but they are not GPs and must never be seen as direct substitutes or used to 'fill the gaps' long-term where numbers of GPs are insufficient. "We have already seen that with effective messages, campaigns and innovative thinking we can get across what a fantastic career being a GP can be with the right resources and support, and we currently have more GPs in training than ever before. "The forthcoming NHS workforce strategy does need to include plans to expand the multi-disciplinary team in general practice. But it is imperative that it also includes comprehensive plans to further boost GP recruitment, make it easier for trained GPs to return to NHS practice, and to keep existing GPs in the profession longer. Taking steps to reduce workload to make working in general practice more sustainable and removing incentives to retire early for GPs who might not necessarily want to, would be sensible places to start. "This report also highlights the negative impact cuts to the education and training budget have had in recent years, as well as the inadequate social care budget. It is essential the next - and future - Spending Reviews specifically increase funding for developing the workforce, including for training future GPs. There must be a longer-term plan to ensure the pipeline of staff is there to meet patient needs in the future."

RCGP Wales responds to new GP access standards

"GPs always strive to deliver the highest standard of patient care and we are proud that the overwhelming majority of patients (86%) are satisfied with the service that they receive from their family doctor. We must not forget that all too often GPs and their teams deliver this care in the most difficult of circumstances, with rising patient demand far outstripping the capacity of GPs working on the ground. This situation is concerning for both patients and those working in the service, indeed 31% of GPs have reported to us that they are so stressed they feel they cannot cope at least once a month. We know that GPs are also concerned about what the future will hold for them, with 72% of GPs telling us that they expect working in general practice to get worse in the next 5 years. We have been clear that both patients and doctors deserve better and we share the Minister’s vision for a continually improving GP service for patients. However, this vision will only be achieved through meaningful action. We have consistently called for funding to general practice to increase to 11% of the total Welsh NHS budget, an increase from its current level of 7.30%, which represents the lowest proportion spend on general practice of any part of the UK. Increasing funding to general practice would help to transform the service and would mean that there would be enough GPs and members of the extended practice team in place to ensure that patients are able to receive the care that they need when they require it. We look forward to hearing from the Minister on the financial support that will be made available to GP practices to help them meet the standards that he has put forward today and will of course continue to work alongside the Welsh Government to ensure that patients receive the highest possible standard of care."

Genetic testing should never be taken lightly, says RCGP

"Genomic research will have an increasingly important place in shaping the care we are able to provide to patients in the NHS and advances in medical research must be properly evaluated to ensure that they do benefit patients. But we also need to ensure that genomic data is used responsibly, ethically, and in a way that does not increase pressure on the NHS without the appropriate mitigating measures in place to cope with it. "Many things that will be picked up by genetic testing will be unimportant or of dubious value, and these could leave people unnecessarily confused and distressed. This will undoubtedly lead to an increased number of worried people wanting to visit their GP to discuss their borderline results, at a time when general practice is already struggling to cope with intense demand – and millions of patients are already waiting too long for an appointment. "GPs will also need training and access to high-quality, up to date resources to learn about the implications of various results in a fast-evolving area of medicine, if they are to be able to support patients appropriately. "In the case of a patient finding out they are at increased risk of developing a serious or life-changing illness, such as cancer, it is vital that appropriate specialist support is available to them to help them understand the implications of the results. "Genetic testing should never be taken lightly – we are talking about sensitive patient data, with potentially serious medical and ethical implications for the patient and all their genetic relatives. People really need to consider these implications carefully before they decide to take a genetic test."

RCGP Wales welcomes plans to introduce an 'All Wales Locum Register'

"We welcome today's announcement by the Minister as a positive step forwards in terms of helping to ease the strain on the GP workforce across Wales. All too often GP practices struggle to recruit locum GPs when they need them most. Not only does this mean that workload for other GPs in the practice increases, leading to high levels of stress and professional burnout, but unavoidably this also has a knock-on impact for patients who struggle to get timely appointments with their local practice. We hope that the creation of a locum register will help to provide a practical solution to these challenges, making it easier for GP practices to find available locums in their local area. We also hope that the creation of the register will provide support to locum GPs working across Wales, who we know all too often can feel professionally isolated. In order to achieve its full potential, those designing this new system need to ensure that the process of signing up to the register is as straightforward as possible for locum GPs. Consideration must also be given to the impact that the creation of this register may have on those GPs who work across the Welsh and English border on a daily basis, and all steps must be taken to ensure that these doctors are not negatively affected. We look forward to seeing further details the scheme as it develops and is evaluated."

New NICE guideline on hypertension needs careful consideration, says College

She said: "Taking steps to prevent cardiovascular disease in patients is vital to help safeguard their long-term health and wellbeing, and it is a key pledge in the NHS long-term plan. But many GPs do also have concerns about overdiagnosis and the unintended harms of prescribing medication to groups of patients when the benefits may be limited. "Lowering the threshold for making a diagnosis of hypertension, or high blood pressure – a condition that already affects a very large number of patients in the UK - is likely to affect thousands, if not millions of patients, so this decision must not be taken lightly and must be evidence-based. "Clinical guidelines are regularly updated to take into account the most current research and make recommendations of how to implement it in the best interests of patients. Now that this draft guideline is open for consultation, we would encourage experts in the area to respond to express their views. "We know that weight control, careful diet, and better exercise habits all remain key ways to prevent or reduce hypertension. GPs already advocate healthy lifestyle changes and discuss these with their patients where possible within the constraints of a standard 10-minute appointment. "Patients should be aware that while clinical guidelines are very useful for GPs when developing treatment plans, they are not tramlines forcing us to practise in certain ways. GPs are highly-trained to prescribe taking into account the guidelines but also the circumstances of the individual patient sitting in front of them, including physical, physiological and social factors that might be affecting their health."

New draft guideline on hypertension needs careful consideration, says College

She said: "Taking steps to prevent cardiovascular disease in patients is vital to help safeguard their long-term health and wellbeing, and it is a key pledge in the NHS long-term plan. But many GPs do also have concerns about overdiagnosis and the unintended harms of prescribing medication to groups of patients when the benefits may be limited. "Lowering the threshold for treatment or diagnosis of hypertension, or high blood pressure – a condition that already affects a very large number of patients in the UK - is likely to affect thousands, if not millions of patients, so this decision must not be taken lightly and must be evidence-based. "Clinical guidelines are regularly updated to take into account the most current research and make recommendations of how to implement it in the best interests of patients. Now that this draft guideline is open for consultation, we would encourage experts in the area to respond to express their views. "We know that weight control, careful diet, and better exercise habits all remain key ways to prevent or reduce hypertension. GPs already advocate healthy lifestyle changes and discuss these with their patients where possible within the constraints of a standard 10-minute appointment. "Patients should be aware that while clinical guidelines are very useful for GPs when developing treatment plans, they are not tramlines forcing us to practise in certain ways. GPs are highly-trained to prescribe taking into account the guidelines but also the circumstances of the individual patient sitting in front of them, including physical, physiological and social factors that might be affecting their health."

Workforce boost needed to increase patient satisfaction with NHS care, says College

She said: "GPs and our teams want to provide the best care that we possibly can for our patients, so it's always disappointing to hear that some people are not always satisfied with the services they are receiving. "We know that general practice is currently facing intense resource and workforce pressures, and while GPs are working incredibly hard to combat these, we understand that many patients are still waiting too long to see their doctor – something we find just as frustrating. "Nevertheless, we know from the last GP Patient Survey that the majority of patients (84%) said that they had a good experience of their general practice. "This demonstrates the hard work and dedication of GPs and our teams, who are seeing more than a million patients a day across the country. But working under these conditions simply isn't sustainable for us, or ultimately, our patients. "Our workload has escalated, both in terms of volume and complexity, in recent years but the share of the NHS budget general practice receives is less than it was a decade ago and the number of full-time equivalent GPs in England has actually fallen over the last two years. "The NHS long-term plan has aspirations that will be good for patients - but we will need the workforce to deliver it. There is some great work ongoing to increase recruitment into general practice, and we now have more GPs in training than ever before - but when more family doctors are leaving the profession than entering it we are fighting a losing battle. "The forthcoming NHS workforce strategy for England must contain measures to help retain GPs in the workforce for longer - steps to reduce workload to make working in general practice more sustainable and removing incentives to retire early for GPs who might not necessarily want to, would both be sensible places to start."

Workforce boost needed to increase patient satisfaction with NHS care, says College

She said: "GPs and our teams want to provide the best care that we possibly can for our patients, so it's always disappointing to hear that some people are not always satisfied with the services they are receiving. "We know that general practice is currently facing intense resource and workforce pressures, and while GPs are working incredibly hard to combat these, we understand that many patients are still waiting too long to see their doctor – something we find just as frustrating. "Nevertheless, we know from the last GP Patient Survey that the majority of patients (84%) said that they had a good experience of their general practice. "This demonstrates the hard work and dedication of GPs and our teams, who are seeing more than a million patients a day across the country. But working under these conditions simply isn't sustainable for us, or ultimately, our patients. "Our workload has escalated, both in terms of volume and complexity, in recent years but the share of the NHS budget general practice receives is less than it was a decade ago and the number of full-time equivalent GPs in England has actually fallen over the last two years. "The NHS long-term plan has aspirations that will be good for patients - but we will need the workforce to deliver it. There is some great work ongoing to increase recruitment into general practice, and we now have more GPs in training than ever before - but when more family doctors are leaving the profession than entering it we are fighting a losing battle. "The forthcoming NHS workforce strategy for England must contain measures to help retain GPs in the workforce for longer - steps to reduce workload to make working in general practice more sustainable and removing incentives to retire early for GPs who might not necessarily want to, would both be sensible places to start."

RCGP urges women on HRT not to be alarmed by new study

She said: "Hormone replacement therapy (HRT) can be of greatest benefit to many women who are suffering from some of the unpleasant side-effects of the menopause, such as hot flushes and night sweats - and there is a large body of evidence that shows it is an effective and safe treatment for most women. "However, as with any medication there are risks and it's important that women are aware of them so that they can make an informed decision, with their doctor, before starting treatment. Prescribing is a core skill for GPs and we will take into account the physical, psychological and social factors potentially impacting on a patient's health, along with latest clinical guidelines and the patient's wishes, when developing a treatment plan. "To minimise any risk, best practice for most women is to prescribe the lowest possible dose of hormones for the shortest possible time in order to achieve satisfactory relief of symptoms. "This new research shows an association with very long-term use of combined HRT but does not prove that there is a causal link. Nevertheless, it is a large, independent study and it is important that it is taken into account as clinical guidelines are updated and developed. "We would urge patients not to be alarmed by this research - as the researchers state, any risk is extremely low - and if they are currently taking HRT, to continue doing so as prescribed by their doctor. If they are concerned, they should discuss this with their doctor at their next routine appointment."

RCGP urges women on HRT not to be alarmed by new study

She said: "Hormone replacement therapy (HRT) can be of greatest benefit to many women who are suffering from some of the unpleasant side-effects of the menopause, such as hot flushes and night sweats - and there is a large body of evidence that shows it is an effective and safe treatment for most women. "However, as with any medication there are risks and it's important that women are aware of them so that they can make an informed decision, with their doctor, before starting treatment. Prescribing is a core skill for GPs and we will take into account the physical, psychological and social factors potentially impacting on a patient's health, along with latest clinical guidelines and the patient's wishes, when developing a treatment plan. "To minimise any risk, best practice for most women is to prescribe the lowest possible dose of hormones for the shortest possible time in order to achieve satisfactory relief of symptoms. "This new research shows an association with very long-term use of combined HRT but does not prove that there is a causal link. Nevertheless, it is a large, independent study and it is important that it is taken into account as clinical guidelines are updated and developed. "We would urge patients not to be alarmed by this research - as the researchers state, any risk is extremely low - and if they are currently taking HRT, to continue doing so as prescribed by their doctor. If they are concerned, they should discuss this with their doctor at their next routine appointment."

RCGPNI responds to NI budget statement

Responding to the budget, RCGPNI Chair, Dr Grainne Doran said: "The whole health and social care system in Northern Ireland is under incredible strain. It is essential that the health care budget for the next financial year is spent strategically to help deliver transformation, with long-term change in mind. "It is vital that we invest transformation money in strategic reform. We know we cannot transform our health service without addressing the significant challenges in primary care yet there continues to be a shortfall in the number of GPs we need, increasing levels workload and service demands and urgent need to ensure GP premises and infrastructure can accommodate the reform we need to see. We particularly encourage the Department of Health to confirm that long-term funding will be allocated to the full regional roll-out of the new multidisciplinary team model in general practice and to commit to accelerating roll-out of this model through all federations to ensure equity of service provision across the region for our entire population."

Striking the balance on antibiotics prescribing 'extremely challenging', says RCGP

"Getting the balance right every time is extremely challenging. GPs in the UK are doing an excellent job of reducing antibiotics prescribing overall - but our priority will always be the patient in our consultation room, and we will prescribe based on the unique combination of factors potentially affecting that patient's health at that time. This extends to the length of time we prescribe antibiotics for, in accordance with local guidance, and we would urge patients to take the full course of medication, as recommended by their doctor. "Where sepsis is concerned, its early symptoms are often very similar to other, more common and less serious conditions. Access to rapid definitive tests in our consulting rooms, to clarify whether infections are viral or bacterial would certainly help in some cases. "Growing resistance to antibiotics is a huge threat globally, and it's essential we all - not just GPs and other healthcare professionals - work to curb it, by realising they are not a cure-all for every illness. But antibiotics are also important, life-saving drugs and it's vital that doctors are not deterred from using them when they think it's appropriate to do so. "The College has worked with partners, Public Health England and Health Education England to develop resources for GPs and other healthcare professionals both to support them to prescribe antibiotics appropriately, and to identify sepsis."

Gender reassignment is a specialist area of medicine and treatment should be initiated in specialist care, says RCGP

He said: "Trans patients, like all patients, should be treated in general practice on the basis of need and without bias – it is important that GPs and our teams are mindful of the terminology and language we use when talking to our trans patients, based on each patient's individual preference, as well as any individual health needs they may have. "In the vast majority of cases, trans patients will present to the GP with the same conditions that cisgender patients do. But new presentations of gender reassignment are exceptional in general practice - it is a specialist area of medicine, and treatment should be initiated in specialist care. "We understand that access to specialist gender reassignment services in the NHS is inadequate, and that this is incredibly frustrating for trans patients and their families. But GPs should not have to bear the brunt of poor access to specialist services by being put in a position where they are being asked to prescribe treatment that they are not trained to prescribe or monitor safely without expert support. "This is an important area of medicine, but there is a distinct lack of high-quality research in the area, and a lack of reputable clinical guidance available. "The College is currently funding and developing a new e-learning course for GPs on gender variance, which should be launched later this year. We have also received funding from the Government Equalities Office to develop resources to support GPs and other healthcare professionals to deliver the best quality care for our LGBT+ patients."

UK general practice helps avoid US-style 'opioid crisis', says RCGP

"When pain evolves from being an response to something to being chronic, it frequently becomes a long-term condition in its own right and unfortunately there is no easy cure. The challenge for doctors is to help patients to manage their pain to allow them to have the best possible quality of life and for some patients opioid-based drugs provide relief - sometimes they are the only things that do. "The opioid situation in the UK is not simple – and neither is prescribing opioids. GPs are highly trained to prescribe considering the physical, psychological and social factors potentially impacting on an individual patient’s health, in line with current clinical guidelines. We will also discuss the risks and benefits of taking opioids with the patient – including the potential for addiction – before prescribing, and we will monitor patients to ensure that the treatment is proving beneficial. "We do know that modest levels of exercise can usually help with pain control and GPs and our teams will usually advocate this to patients in pain, but for some patients it simply isn't an option. "The mantra is to prescribe opioids at the lowest possible dose for the shortest possible time. Most patients don't want to take medication long-term – and GPs don't want to prescribe it long-term. It's frustrating for all involved that there is a lack of alternative treatments available – and those that are, for example some psychological therapies that have been found to have benefit for patients with chronic pain, access is patchy across the country. "More high-quality research into pain is needed, and so are more clinical guidelines for GPs and other healthcare professionals. NICE have produced guidance on lower back pain and neuropathic pain, but guidelines on general pain won't be ready until 2020. "The NHS - particularly general practice – actually makes it quite difficult for patients to get repeated prescriptions for opioids, which is one reason why we aren't seeing the 'opioid crisis' that is so prevalent in the US. But unfortunately, opioids are too easily accessible illicitly – and the NHS has little control over that."