This will put choice in the hands of HIV individuals. We all talk to each other and recommend things based on positive experience. This may mean people being able to sign up to GP's that have been recommended on the basis of HIV understanding and high care. It also will allow people who don't have a local GP for fear of exposure registering somewhere else. This is important as the health care model is based on everything being passed from the GP.
Plan to scrap GP catchment areas
It was also mentioned by Lord Darzi when he unveiled his review of the health service last summer.
Mr Burnham said: "I want the best to be available to everyone, not according to where they live.
Mr Burnham said people's choice of a GP should be based on their own needs - not by lines on a map.
"Many of us lead hectic lives and health services should be there to make things easier."
GPs agree their catchment areas with local health managers.
HAVE YOUR SAY Aren't we suppose to be saving money? This sounds like more NHS bureaucracy Ian Baildon, Bradford
"We think it is going to be very complicated."
"This is too little too late."
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/8259165.stm
Published: 2009/09/17 09:29:21 GMT
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All 152 NHS organisations responsible for out of hours GP services in England have been ordered to review patient safety following the case of a German doctor who accidentally killed a patient on his first shift in Britain.
Primary care trusts, which commission emergency overnight and weekend care for millions of people, will receive letters today from the Department of Health telling them to re-examine induction and training for foreign doctors, call-handling and prioritising of cases, clinical decisions made by GPs and other staff and the management of powerful drugs.
The instruction reinforces a warning from the NHS watchdog the Care Quality Commission that shortcomings so far identified in its investigation of the incident may be repeated elsewhere .
Government officials and Steve Field, chairman of the Royal College of GPs, have been asked by ministers to consider whether further changes are needed nationally to the system under which local trusts check that doctors are fit to practise and speak and understand English.
The government response reflects concern within the NHS over the case in which Daniel Ubani killed David Gray at his home in Cambridgeshire by administering a tenfold overdose of a painkiller. There are fears that Gray's death highlights systemic failures,
The Guardian revealed details of the case in May, shortly after Ubani was convicted of causing Gray's death by negligence in his own country, a judicial decision that angered the dead man's family as British police were investigating a possible manslaughter charge over the incident in February 2008.
Ubani failed in his first attempt to win the right to work in Britain, but found that the Cornwall and Isles of Scilly NHS set lower standards in checking his language skills and competence. Approval in Cornwall gave the doctor a ticket to work anywhere in England. The trust has since strengthened its rules.
Our investigations prompted calls from leaders of the General Medical Council , the UK regulatory body, and the GPs' college for doctors from the EU and other European countries to face the same clinical and language tests undergone by other foreign doctors.
The letter to trusts from a senior civil servant says: "Working in an out of hours environment poses special challenges …and effective induction processes for new doctors are an essential precondition for safe practice."
The commission investigation concentrates on Take Care Now (TCN), the company that recruited Ubani from an agency, and the five trusts that commission its services in eastern England and Worcestershire.
Its early findings suggest the trusts involved are "only scratching the surface in terms of how they are routinely monitoring the quality of out of hours services", according to chief executive Cynthia Bower. "If their monitoring is not robust enough they may not be in a position to spot early indications of potential problems of poor care.
"Although we are still at an early stage of our inquiries, we believe this may point towards a national problem. We are therefore encouraging PCTs across the country to scrutinise in more detail the out of hours service they commission."
The commission report said TCN had withdrawn 100mg doses of the painkiller involved in the case of Gray, a kidney patient. But it still needed to manage medicines better, reduce problems in filling GP shifts and ensure a consistent policy on treating stroke patients by transferring them without delay to 999 services. TCN, in a brief statement, said it was continuing to work with the commission.
The government's intervention falls short of the independent review Gray's family and GP leaders have called for. Stuart Gray, a GP in Worcestershire and one of Gray's four sons, said: "Although it is important PCTs tighten up their own out of hours services, I still feel it is the responsibility of the government to ensure that EU doctors' qualifications and training meet UK standards … and I will continue to put pressure on the government to act on this. They do seem to be starting to roll but it has taken a lot of shoving."
Another son, Rory, hoped the continuing NHS inquiry would "thoroughly examine the many gaping loopholes and inconsistencies in the out of hours system".
Peter Walsh, chief executive of Action Against Medical Accidents, said: "No one would design the system that exists today if they were starting with a blank page and with patient safety in mind."
Health Minister Mike O'Brien said: "Patient safety is paramount and PCTs have a clear legal responsibility to provide safe, high quality out of hours care."
Case Notes
16 February 2008 German doctor Daniel Ubani accidentally kills David Gray, 70, during his first UK shift as a locum.
29 February 2008 Ubani suspended from the GMC's medical register.
November 2008 Crown Prosection Service decides sufficient evidence to charge Ubani with manslaughter.
March 2009 CPS issues European arrest warrant only to discover legal proceedings are under way in Germany.
April 2009 German legal case "finalised" as Ubani given nine months suspended prison term and fined ¤5,000 for causing death by negligence.
May 2009 Guardian first reveals details of the saga as it becomes evident there will be no further criminal inquiry in Britain. NHS announces plans for an inquiry into the case.
August 2009 UK medical regulators and Royal College of GPs demand rewriting of rules over registration of European doctors.
September 2009 Guardian reveals Ubani had withdrawn a previous application to work in the UK after failing to make the grade in an English test.
October 2009 NHS told to be tougher on checking out-of-hours services.
http://www.guardian.co.uk/society/2009/oct/02/nhs-trusts-review-patient-...
Patients are being encouraged to rate their GP surgeries on a new NHS website designed to drive up standards in primary care.
At www.nhs.uk, patients will be able to post comments ranging from how they were treated to whether it was easy to book an appointment.
But writing abusive comments and mentioning staff by name will not be allowed, say health officials.
The website will compare the 8,269 GP practices in England only.
The health minister Mike O'Brien said the website was part of plans to modernise the health service.
He said: "As we open up real choice in primary care, it is vital we equip patients with enough information to make the right choice for them.
'The patient's view'
"This new tool allows every single GP practice in the country to see the patient's view on what they are doing well and what needs to be improved.
"It will help drive up quality across the board, and is another step in ensuring we have a modern NHS which reflects the needs of the patient," he added.
There are 23 million visits to GP practices and related services every month.
The Family Doctor Association supports the website initiative. Its chairman Dr Peter Swinyard said: "Patient feedback on GP services is an effective way of driving up the standards of primary care even further."
In September, ministers announced they wanted to abolish GP boundaries, allowing patients to register with a practice of their choice.
A similar site to compare the performance of hospitals is already up and running.
Three quarters of GPs have prescribed anti-depressants even though they think another treatment would have been more effective, a survey has found.
The Mental Health Foundation says meditation halves the risk of repeated depression and should be more readily available, but access is very limited.
The Department of Health in England said access had improved.
Depression affects one in 10 people a year, with more than half of those experiencing more than one episode.
The Mental Health Foundation says mindfulness-based cognitive therapy (MBCT) halves the risk of further bouts of depression.
A course of MBCT treatment, which typically lasts for eight weeks, combines meditation with cognitive behaviour therapy and yoga.
It is designed to help the patient develop a healthier, more accepting relationship with their thoughts and feelings.
The Department of Health in England said GPs could now refer patients on to specialists for full assessment of their needs.
It is estimated to cost the UK economy £7.5bn a year and prescriptions for antidepressants have soared in recent years, reaching 36 million in 2008.
But the report finds 75% of GPs have prescribed medication to people with long-term depression believing that another treatment - often less readily available - would be more appropriate.
The National Institute for health and Clinical Excellence (NICE) has recommended MBCT for recurrent depression since 2004.
But the latest report found that just one in five GPs say they can access the treatment for their patients, and only one in 20 prescribe it regularly.
'Huge knock-on benefits'
The report says the training and development needed to increase access to MBCT could be achieved under funding already made available by the government to improve access to psychological therapies.
Dr Andrew McCulloch, chief executive of the Mental Health Foundation, said: "Mindfulness-based therapy could be helping to prevent thousands of people from relapsing into depression, every year.
"This would have huge knock-on benefits both socially and economically, making it a sensible treatment to be making available, even at a time when money is short within the NHS."
Professor Mark Williams, director of the Mindfulness Centre at the University of Oxford, said meditation had been shown to have powerful effects on health.
MBCT has been linked to increased activity in the pre-frontal cortex, an area of the brain associated with positive emotion.
Studies have also shown that areas of the brain linked to emotional regulation are larger in people who have meditated regularly for five years.
Professor Williams said: "We now have a very good treatment for recurrent depression, which urgently needs to be rolled out to all patients that need it."
The report also says MBCT can help treat a range of other conditions, such as eating disorders, anxiety problems and physical problems associated with cancer and HIV.
A Department of Health spokesperson said the Improving Access to Psychological Therapies (IAPT) scheme had expanded the range of talking therapies on offer to patients.
GPs could refer a patient to local IAPT services, and then following assessment, the patient would be offered the most suitable therapy, of which MBCT was one option.
"In 2010, not only will more and more services go live, but they will move to offer a wider range of therapies."
Meditation techniques should be widely available on prescription, say experts today, pointing to evidence that emptying the mind is more likely to help people out of the cycle of recurrent depression than pills. Meditation may for some evoke images of Buddhist chanting and the Beatles bedecked with flowers in their period of devotion to the Maharishi Mahesh Yogi, but today a mental health charity is launching a campaign to make "mindfulness" courses based on meditation available widely on the NHS.
The results in people with depression are impressive and could save the NHS substantial sums of money, according to the Mental Health Foundation.
Antidepressants give people hit by the "black dog" a chemical lift out of their despair. It can get them over the crisis, but there is a risk that depression will come back as it was before they started the pills. Cognitive behaviour therapy is the most widely prescribed and available counselling treatment.
It encourages a depressed person to look at their feelings and behaviour and work out the causes and coping strategies. It works, but is usually used for treatment rather than prevention.
"Mindfulness" is described in the Mental Health Foundation report published today as "a way of paying attention to the present moment by using meditation, yoga and breathing techniques". Instead of worrying at their problems, people are taught to try to empty their minds, focusing on their breathing or parts of their body or yoga movements and noting, but not exploring, the thoughts that drift into the mind, which "creates space for us to make more considered decisions about how to respond to the events in our lives", says the report.
In 2004, the National Institute for Health and Clinical Excellence (Nice) recommended mindfulness-based cognitive therapy courses for people who had had depression at least three times. In two clinical trials mindfulness training halved the rate of relapse for people with recurrent depression ‑ in the first trial, 10 years ago, from 66% to 37% and in the second, in 2004, from 78% to 36%. But in spite of the Nice endorsement, only one in five GPs has access to a course on which he or she can enrol patients, even though 72% of GPs think it would be a good idea.
Depression affects one in 10 people and costs the economy £7.5bn annually, the foundation says. The number of prescriptions for antidepressants has doubled in a decade, reaching nearly 36m in 2008. Yet three-quarters of GPs say they have prescribed drugs for patients they think would have benefited from something else.
"Mindfulness-based therapy could be helping to prevent thousands of people from relapsing into depression every year," said Dr Andrew McCulloch, chief executive of the Mental Health Foundation. "This would have huge knock-on benefits both socially and economically, making it a sensible treatment to be making available, even at a time when money is short within the NHS."
Dr Jonty Heaversedge, a south London GP and one of the BBC's Street Doctors, said he had himself sought out a Buddhist centre to learn to meditate to manage his own stress, but felt uncomfortable to be recommending it to his patients in case they thought he was promoting religion.
He sees patients who regularly go on antidepressants every winter, he says. Not only would mindfulness training help them, he believes, but also the rest of us, who are under stress, working too hard, troubled in our relationships and running to stand still in every part of our lives.
http://www.guardian.co.uk/society/2010/jan/05/meditation-on-nhs-urged
NHS trusts in England must monitor out-of-hours GP care more closely, says a watchdog carrying out a review prompted by the death of a 70-year-old patient.
David Gray died in February 2008 after a locum doctor from Germany mistakenly gave him an overdose of diamorphine.
In an interim report, the Care Quality Commission found primary care trusts may be failing to spot patient safety issues because of a lack of scrutiny.
Most GPs opted out of providing out-of-hours care in 2004.
Since then PCTs have been responsible for providing cover at nights and weekends and have often relied on private firms working under NHS contracts.
In June the CQC launched an investigation into the provision of out-of-hours services by Take Care Now, the company providing evening and weekend cover in East Cambridge and Fenland when Mr Gray died after being accidentally given 10 times the usual painkiller dose.
Dr Daniel Ubani, who was employed by Take Care Now through a locum agency to cover some out-of-hours shifts, was given a nine-month suspended sentence by German courts for causing death by negligence.
After visits to five PCTs which commission out-of-hours care from Take Care Now, the watchdog found trusts were failing to consistently and routinely look at the quality of care provided.
And variations between trusts in how the services are monitored suggest it could be a nationwide problem, it said.
PCTs must look far more closely at details like the quality of clinical decisions, the efficiency of call handling, the number of unfilled shifts and the proportion of shifts covered by non-local doctors, the watchdog warned.
'Scratching the surface'
CQC chief executive Cynthia Bower said: "Our visits to the five trusts that commission Take Care Now's services showed they are only scratching the surface in terms of how they are routinely monitoring the quality of out-of-hours services.
"Although we are still in the early stages of our enquiries, we believe this may point towards a national problem."
Take Care Now has since withdrawn 100mg doses of diamorphine to prevent the same mistake happening again, the CQC found.
But it warned there were still issues with staffing problems and medicines management procedures.
David Cocks, chief executive of Take Care Now, said he welcomed the interim progress report and it would continue to work with the CQC in its investigation.
It is not the first time concerns have been raised about evening and weekend cover.
In 2007, a report into the death of journalist Penny Campbell found serious flaws in the out-of-hours system, which led to her dying of multiple organ failure after consulting eight doctors over four days.
An investigation criticised the actions of one private company, Camidoc, but also concluded there were weaknesses that needed to be addressed nationally.
Health minister Mike O'Brien said: "Patient safety is paramount and PCTs have a clear legal responsibility to provide safe, high quality out-of-hours care and are required to have in place robust performance management arrangements to ensure their out-of-hours services are delivering against contractual requirements.
"A failure to do so can result in investigation by the independent regulator and enforcement action by primary care trusts where providers are not meeting their contractual obligations."
Accountability call
Dr Laurence Buckman, chairman of the BMA's GPs Committee, said PCTs had a duty to ensure doctors were properly trained and that recruitment procedures were robust enough to ensure patient safety.
But he added many have been "too keen to cut costs at the expense of investing in a quality out-of-hours service".
Katherine Murphy, director of the Patients Association said the recommendations from the CQC were important but should not be necessary.
"Why do NHS managers need to be told that they should ensure out-of-hours care is safe?
"Where is the accountability for the managers that use taxpayers' money to employ unsuitable doctors, or pay agencies that do the same thing?"
David Stout, director of the Primary Care Trust Network, said: "All PCT boards should ensure their PCT have robust mechanisms in place to scrutinise the quality of out-of-hours care, with input from local clinicians."
The final report from the CQC is due early in 2010.
http://news.bbc.co.uk/1/hi/health/8285301.stm