This Inquiry will collect and examine evidence on the quality of care and services provided by GPs and other health professionals working in general practice. We want you to join the debate, so click through to the dimensions of care below and leave your comments.
http://www.kingsfund.org.uk/current_projects/gp_inquiry/index.html
PDF version A survey of doctors has found that those with strong religious beliefs were less likely to talk to patients about their end-of-life care or the options available to them.
The study by Dr Clive Seale of Barts and the London School of Medicine said that it was time for greater clarity on how a doctor's faith might influence the level of care provided.
Seale found that more than 12 per cent of doctors said they were very or extremely religious, which is double the number in the general population, while 20 per cent of them said they were very or extremely non-religious. He also found that specialists in the care of the elderly were more likely to be Hindu or Muslim and doctors dealing in palliative care were more likely to be white and Christian. The worrying statistic was that the doctors who said they were very or extremely non-religious were around 40 per cent more likely to sedate end-of-life patients than their more religious counterparts.
Commenting on the research, Professor Mayur Lakhani, chair of the National Council for Palliative Care, said: "Core training in palliative care should be mandatory for all doctors to ensure consistency of decision-making, based on best practice and current evidence. Decisions must be taken in partnership with people approaching the end of life and those close to them."
And the British Medical Association issued this statement: "Decisions about end-of-life care need to be taken on the basis of an assessment of the individual patient's circumstances – incorporating discussions with the patient and close family members where possible and appropriate. The religious beliefs of doctors should not be allowed to influence objective, patient-centred decision-making. End-of-life decisions must always be made in the best interests of patients."
Complaints about NHS hospitals and community health services in England have gone through the roof, according to data from the NHS Information Centre. The government has blamed the previous administration.
In 12 months the number of complaints went from 89,139 to 101,077, the biggest yearly increase since records began 12 years ago. Most complaints (44.2 per cent) were about specialist doctors while half that number were about nurses, midwives and health visitors. A comparatively low 9 per cent complained about NHS admin workers.
More than 40,000 written complaints were about "all aspects of clinical treatment" while another 12,000 letters were about staff attitude and 11,000 related to delays or cancellations to outpatient clinics.
However, NHS Information Centre chief executive Tim Straughan said it was important to bear in mind that there had been a substantial increase in NHS activity in England over time.
"For example," he said, "information from two of our other data collections shows that hospital admissions increased by 28 per cent between 1998/99 and 2008/09, while GP consultations increased by an estimated 44 per cent between 1998 and 2008."
Health minister Paul Burstow commented: ""The biggest annual rise in complaints in 12 years is the public's verdict of the last government's NHS record. The coalition government is determined to put patients at the centre of everything the NHS does. Quality and outcomes will be the measures by which the service is judged."
Giving GPs more responsibility may leave patients out on a limb
Key areas of Andrew Lansley's plan on NHS reform are unlikely to deliver cost savings and getting rid of Primary Care Trusts could create problems for information sharing, writes Gayna Hart, MD of Quicksilva
When the coalition government took power, it promised to make considerable efficiency savings within the NHS whilst still retaining excellent frontline services - a tall order. Andrew Lansley has certainly set out his stall early. The scaling back of the Strategic Health Authorities (SHAs) is a welcome development as they are a huge administrative overhead and an additional layer of bureaucracy that is not focussed on patient care nor on the patients' experience. Management overheads, primarily to support SHAs run up bills of around £1.85 billion a year. Hopefully this money will be used to prevent budgetary cuts being made to patient services.
Other key areas of the plan however are unlikely to deliver the same cost savings. The government is to hand control of budgeting over to local level NHS staff and give GPs the responsibility for the commissioning of patient services. This sounds great, in principle, but giving responsibility for the success of this initiative to a network of GPs is a radical change. Some people might think, why not give control to GPs? After all, who better to decide what services are needed than those living and working within the local healthcare system? However, history tells a different story.
In the 90s, John Major's government tried this tack and whilst there were some tangible benefits of the scheme such as reduced usage of pharmaceutical products, in most areas the initiative failed. Under the last Conservative government the result of the scheme was actually an increase in managerial costs and perhaps even more worrying, a reduction in patient satsifaction.
People often forget that GPs are self-employed healthcare professionals. They are not all carers who have answered a vocational call, many are business people and the government seems to be placing the future of the NHS on their shoulders. Some GPs may be able to take on the role of manager, diagnostician and financier, but most will not. As the saying goes, it is not possible to be all things to all men and GPs are no different.
In order for GPs to do their jobs and fulfil managerial and administration tasks they will require additional staff and office space to manage their new remit. Therefore, if the point of the arrangement is to cut costs then it isn't likely to succeed. Costs will just be re-distributed.
Primary Care Trusts (PCTs) are currently responsible for managing healthcare in the community. This includes everything from procurement, to administering patient aftercare, including home services – a massive job. Even if GPs were to become business managers, the ability to share and transfer patient data which is vital if this idea is to work, is barely off the ground. When a patient is discharged from hospital there is no easy way to transition their aftercare, making communication between agencies vital. The role of PCTs has been to manage this difficult transition, but if they are scrapped then the communication channels between healthcare providers will have to be re-established.
In order for information to be shared locally and for intelligent decisions to be made about budgets, we need support from the local Trusts who have the bandwidth to deal with increased demand for services and can effectively manage patient aftercare. We need to get over the management-bashing attitudes that will see us in a disorganised mess and instead work towards maximising the effectiveness of PCTs.
Health reforms such as this government plan, cause massive disruption which delays any benefits that might result. Getting rid of PCTs will lead to less effective communication within the NHS, at least in the short term. As a patient, I would rather have a well-managed local health service than change for the sake of it.
http://www.publicservice.co.uk/feature_story.asp?id=14748