Majority of public would use health tech to avoid hospital, research finds

By Integrated Care Journal

Survey highlights increasing public acceptance of healthcare technology to self-manage care and take greater individual responsibility for health.

The majority of people would use health technology if it meant they could avoid going into hospital, new research carried out by Ipsos on behalf of the NHS Confederation, supported by Google Health, shows.

The same proportion – more than 7 in 10 people (72 per cent) – would also use technology including wearable and health monitoring devices to help better manage and monitor their health and would also be willing to share the information and data gathered with their doctors and other medical professionals.

The survey of 1,037 members of the public highlights people’s increasing appetite for using technology to self-manage their care, and more broadly, to take greater responsibility for their health and that of their families.

Nearly 4 in 5 people (78 per cent) also said they would be happy to use different types of health monitoring equipment to help manage their health if an NHS professional recommended it to them, with nearly 9 in 10 (89 per cent) people aged over 75 willing to do so.

The results have also found that just over half (53 per cent) of the 92 people included in the survey who have been diagnosed with a long-term condition resulting in them interacting with the health service four or more times a year, are already using the NHS App to access personal health information, compared with one third (33 per cent) of the general population.

The government recently announced a target for patients at more than 90 per cent of general practices across the country to be able to use the app to see their records, book appointments and order repeat prescriptions by March 2024.

Commenting on the findings, Matthew Taylor, chief executive of the NHS Confederation said: “This research shows the potential of technology in empowering patients to better manage and monitor their own health, especially if it means they can avoid being admitted to hospital.

“There is clearly an appetite amongst the public to use technology to self-manage their long-term conditions, and more broadly, to take greater responsibility for their health and that of their families.

“The government’s recent commitment to accelerate and widen the use of the NHS App should also help to strengthen the public’s understanding of the benefits of digital engagement.

“However, the decisions we make now as a society will determine whether technological change means we can make continuous improvement in the offer we make to everyone through the NHS, or whether it will divide ever more widely the ‘healthy haves’ from the ‘unhealthy have nots’. We must always deliver greater digitisation with equity in mind.”

Elsewhere, the survey findings showed that just over 8 in 10 (83 per cent) adults already use some form of technology to manage their health, and this increases to nearly 9 in 10 (89 per cent) people living with one or more long-term condition. However, only just over half of those surveyed were currently satisfied with the technologies and tools available for them at present.

The research also showed that that nearly three-quarters (73 per cent) of patients want their doctors to provide them with the “best technology available”, with three-fifths (58 per cent) wishing “their doctor provided them with technology to monitor their health”.

Ease of appointment booking and the ability to communicate via messaging services with healthcare teams are also high on the list of priorities. The research also found that more than two thirds (68 per cent) of people believe that healthcare in the future will include more technology and less reliance on healthcare professionals, although this comes with the concern that without access to the right technologies, access to healthcare could be limited.

Susan Thomas, UK Director, Google Health added: “Google Health has been privileged to partner with NHS Confederation and Ipsos to drive this piece of research; the findings have resonated with our mission to help everyone, everywhere be healthier through products and services that connect and bring meaning to health information.”

One in five people in the UK say fear of wasting doctor’s time would stop them getting tested

By Integrated Care Journal

Widespread publicity of NHS woes likely contributor to hesitancy over seeking medical attention.

One in five people in the UK (22 per cent) would put off getting health tests for fear of wasting their doctor’s time, new research from Roche Diagnostics has revealed – a barrier that is not reported by the general public in any of the other countries surveyed.

The finding comes after a Roche survey of the public and healthcare professionals in the UK, USA, Germany, Switzerland, India, Taiwan and Thailand showed that this fear of time wasting was unique to people in Britain.

The survey, designed to understand attitudes to diagnostic testing and the barriers to timely diagnosis of illness, also found that nearly half (49 per cent) of those surveyed in the UK said they received no explanation, or an inadequate explanation, on the role of or reason for testing.

This is despite the fact that the UK public demonstrated a high awareness of how valuable diagnostic testing is with just over half (51 per cent) of respondents saying they thought that the most important role of testing was in helping them to avoid more invasive treatments later down the line.

Lynsey Gate, pre-eclampsia patient, said: “When I first started experiencing symptoms like hand swelling, I phoned triage and told them about it and my concerns. I was about to travel, and they said to come in when I got back. But by the time I got home the swelling had gone down so I phoned them again and they agreed I didn’t need to go in to be checked. I felt like I was being a burden and worrying about potentially nothing. I regret it in hindsight because it could have changed things for me had they caught it earlier.”

Rachel Power, Chief Executive of the Patients Association, said: “We would always encourage people who are concerned about their health to seek advice. That doesn’t have to be from your GP – there are other health professionals who can help. None of them will think you’re wasting their time. A conversation with a pharmacist, for example, could put your mind at rest or point you in the direction of another healthcare professional who can support your health.”

NHS pressures

Also unique to the UK, was the finding that more than a quarter of those surveyed cited “cancelled appointments” as a reason for missing a diagnostic test – a further symptom of the challenges the NHS is facing.

However, despite these challenges, trust in healthcare professionals was high among members of the UK public and globally doctors emerged as the most trusted and widely consulted information source for diagnostics. Even in countries where the general public are dissatisfied with the information they are given on diagnostics – such as the UK and Switzerland – they continue to believe that their doctor is their best source of information.

Emergency Medicine Consultant, Professor Rob Galloway said: “I understand when people are bombarded with messages about long waiting lists and how much pressure the NHS is under they might be reluctant to seek medical help. But that’s exactly why you should come forward if you feel something is wrong. The sooner you are diagnosed, the quicker you can be treated and the better your outcome is likely to be.

“Too often in A&E we see patients who have ignored or lived with their symptoms for so long that their condition becomes an emergency – and this might have been avoided if they had come forward sooner. There is no doubt the NHS is currently under a huge amount of pressure and we do want people to use healthcare services wisely. But we definitely don’t want people who are experiencing symptoms to avoid seeking help for fear of wasting our time.”

Improvements to access

The survey also revealed some reasons for optimism. Fewer people cited a fear of catching COVID-19 as a reason to stay away from seeing the doctor, when compared to results from previous years. As well as this, more respondents said they were eager to prioritise testing appointments in their diaries over other commitments when compared to the same question last year.

Roche is always looking for ways to help the NHS improve access to testing and overcome the barriers that exist for some patients and the insights provided by this survey, about how public attitudes to diagnostic testing vary or overlap in different countries, will inform that work.

Geoff Twist, Managing Director of Roche Diagnostics UK and Ireland said: “The enormous pressure the NHS is currently facing has been widely reported so it is not entirely surprising that people in the UK are conscious of not wanting to waste the time of doctors. However, I would urge people not to delay talking to a healthcare professional if they feel something isn’t right.

“The right diagnostic test, done at the right time, can actually help to reduce pressure on the NHS by ruling out serious conditions in some patients and ensuring those who are unwell receive the treatment they need sooner rather than later. In many serious or life-limiting diseases or conditions, such as cancer, cardiovascular disease, sepsis and pre-eclampsia, early diagnosis can result in more targeted treatment and fewer healthcare appointments, as well as better quality of life and outcomes for patients.”

New drug combination twice as effective for some ovarian cancer patients as next best treatment

By Integrated Care Journal

Findings suggest new hope for patients suffering with disease that has a poor response rate to current treatments.

A targeted drug combination for patients with a type of ovarian cancer could be nearly twice as effective as the next best treatment, according to interim results from a Phase 2 study.

The international RAMP-201 study, has been led by researchers from The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, and sponsored by Verastem Oncology. The study has tested avutometinib alone and in combination with defactinib in 29 patients with low-grade serous ovarian cancer (LGSOC). Both drugs are designed to block signals that encourage cancer cells to grow.

Researchers hope these results, which are being presented at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting, will lead to a new option for patients with advanced LGSOC, a rare form of the disease that has a poor response rate to current treatments.

Approved treatment options available for patients with advanced LGSOC in the UK are currently limited to chemotherapy and hormone therapy, with response rates typically ranging from 0-14 per cent. Alongside standard treatment, LGSOC patients in England can access trametinib, a targeted treatment, via the Cancer Drug Fund, which has a response rate of 26 per cent.

Improvement on current treatments

According to the study’s interim results, nearly half (45 per cent) of patients treated with avutometinib in combination with defactinib saw their tumours shrink significantly, suggesting the new combination could be almost twice as effective as the next best treatment.

Responses to the drug combination were particularly promising in those with a mutation in a gene called KRAS, with six in 10 (60 per cent) patients experiencing significant tumour shrinkage. However, nearly a third (29 per cent) of patients without the mutation also had an encouraging response, which is also an improvement on standard treatment.

Patients previously treated with other types of targeted therapies, including MEK inhibitors, also saw their tumours shrink following treatment with the drug combination.

Avutometinib is a dual RAF and MEK inhibitor, a type of targeted drug that blocks certain proteins that help control cancer growth and survival. Studies have shown the drug can become ineffective over time as tumours develop resistance to treatment.

However, when combined with defactinib – which is designed to combat a protein that encourages drug resistance – researchers believe avutometinib works more efficiently. This is confirmed by these results, which demonstrate that the drug combination is over four times more effective than avutometinib alone.

RAMP-201 follows the phase 1 FRAME trial, which tested avutometinib (then known as VS-6766) and defactinib on a slightly smaller cohort of patients with advanced LGSOC and was led by researchers from the Oak Foundation Drug Development Unit at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London. While survival data is not yet available from RAMP-201, results from FRAME indicate that this patient group lives an average of 23 months following treatment with this drug combination before their cancer progresses.

LGSOC accounts for about one in 10 cases of ovarian cancer, with around 700 women in the UK and 80,000 worldwide diagnosed each year. Compared with other forms of the disease, LGSOC tends to affect younger women.

Global lead investigator of the study, Dr Susana Banerjee, Consultant Medical Oncologist and Research Lead for The Royal Marsden NHS Foundation Trust Gynaecology Unit and Team Leader in Women’s Cancers at The Institute of Cancer Research, London, said: “These initial results could be fantastic news for women with low grade serous ovarian cancer, indicating a far more effective option than current treatments may be on the horizon.

“It’s wonderful to see so many patients experience a meaningful response to this innovative drug combination and I’m so grateful to all who joined the trial, making this research possible. Low grade serous ovarian cancer does not respond well to currently approved treatments, so these results could represent a significant breakthrough in treating the disease.

“We are hopeful this drug combination will one day become a standard of care for women with low grade serous ovarian cancer.”

The reality of the world: anticipating failures to achieve success

By Emil Bernal

Emil is a former British Army officer who now specialises in change and transformation in complex environments, including the NHS. He is currently Head of Transformational Programmes and Projects at NHS Shared Business Services.

I recently walked into my local high street bookshop. I counted dozens of books telling me how to succeed at project delivery. There was no shortage of people offering their tips for success. I couldn’t find any books about how to avoid failure.

This is odd but not surprising. From childhood, we’re conditioned to be uncomfortable with the thought of things going wrong. No-one likes making mistakes. Our education system is built on telling us ‘how to do things’, and punishes us for getting things wrong. The world is filled with motivational speakers talking about the sunny uplands. Can you think of a single modern motivational speaker who talks about avoiding the dark abyss?

Emil Bernal, Head of Transformational Programmes and Projects, NHS Shared Business Services

Programmes and projects are no different. We start with optimism and marvel at the promise of a brighter tomorrow. And, for sure, optimism is needed to motivate a team to take on challenging goal. But excessive optimism in our ability to shape and influence the future has led to spectacular failures.

Things can and do go wrong. The NHS has the dubious honour of hosting one of the most expensive failures – the world’s largest civil IT programme, the £12.4 billion National Programme for IT.

In their book, “How big things get done”, Bent Flyvbjerg and Dan Gardner researched the outcomes of over 16,000 projects in 136 countries. Their data shows that 92 per cent of projects overrun on time, cost or both. And cost overruns can be dramatic.

The average cost over-run for every Olympic Games since 1960 is 157 per cent. NASA’s James Webb Space Telescope was 450 per cent over budget. Scotland’s Parliament building was 978 per cent over budget.

The private sector doesn’t do any better. In 2000, Kmart launched two IT projects. Costs exploded, contributing to the company going bankrupt in 2002. Even families get it wrong: you only have to watch Grand Designs to see people’s home renovations go over budget and run late.

We need to learn what went well with previous projects. And we need to understand what went wrong – “how not to” repeat the same mistakes. So, when wide-ranging reports are published – like Patricia Hewitt’s recent review of Integrated Care Systems – I start, as many people do, by thinking “how are we going to get this done”? The next thought is perhaps less common. How do we avoid things going wrong?

Here, then, are five ways to stop things going wrong:

1. Go to the cinema. Or, rather, think about projects in the same way as the film industry: get the balance right between planning and delivery. There’s often a push to start “doing something”. This misses the point that planning is doing something. The film industry understands this, and gives film producers time to plan. During planning, costs are relatively low while film producers explore ideas, produce storyboards, and redraft scripts. Costs explode when production starts and Hollywood stars and crews are working. The work that producers put in upfront means that filming follows a well thought-through plan and avoids costly delays.

2. Find experience and expertise. Very few projects are genuinely unique. There will always be something that makes a project different from others. But, in many ways, your project will be “another one of those”. People who worked on “one of those” will have valuable experience and expertise. Find those people.

3. Listen to that experience. Having found your experts, listen to them even if – especially if – it’s something you don’t want to hear. Listen when they tell you that the project will cost more than the figure you have in mind. Listen when they tell you the project is likely to be more complex and take longer that you ideally wanted. Listen when they tell you about the issues and risks you’re likely to face. It’s better to be told a painful truth early, rather than push ahead in comfortable ignorance.

4. Ask four questions. There is a cultural tendency to shy away from disagreement. So, be explicit and ask for alternative views. As we start to form an outline solution to a problem, I’ll often ask four interrelated questions: what’s good about our solution that we should keep? What needs to be changed? What’s not needed? And – probably the hardest question to answer – what’s missing?

5. Get hindsight in advance. Lessons learnt – or after-action reviews – are standard practice. Flipping this on its head is a useful way of identifying where things could wrong. This approach was popularised by psychologist Gary Klein and Nobel laureate Daniel Kahneman and is often called a ‘pre-mortem’. It’s simple but powerful. Get the team to imagine that their project has already failed. What caused the failure? Work backwards to figure out the causes. Run through a few scenarios. The time spent visualising different outcomes will bring to life the future for the team. And, after the pre-mortem session, make sure that you re-energise the team’s belief in the project.

By taking these steps, you can give yourself the best chances for success. But even the best planning won’t stop issues from cropping up. A supplier lets you down. A team member falls ill. A pandemic. A ship getting stuck in the Suez canal. You’ll have to be ready to manage issues and find practical solutions. But, by getting the planning right, the window of time when risks can come crashing into your world will be smaller – like the film industry which spends time in planning so that the costly production phase can zip along from start to finish.

Learning from your mistakes is called experience. Learning from other people’s mistakes is called wisdom. I wonder how long it will be before I start to see the shelves of my local bookshop filling up with stories about things that went wrong and how to avoid making the same mistakes?

Poor work/life balance driving NHS exodus

By Integrated Care Journal

As vacancies hit record levels, doctors and nurses want more flexible work arrangements to carry on working in healthcare, study from Deloitte finds.

Poor work-life balance is a key driver of job dissatisfaction for healthcare workers, and improvements are within the power of employers, according to new research from Deloitte’s Centre for Health Solutions.

The findings come from the report, Time to Change: Sustaining the UK’s clinical workforce, which looked at the experience and resilience of front-line clinicians, based on a survey of 1,286 UK public healthcare workers. The study examines how attitudes within the profession have changed since 2017, when a similar piece of research was conducted, and includes input from doctors, nurses and other clinical staff working in primary, community and secondary care.

Having a ‘sense of fulfilment/making a difference’ (42 per cent) and a good ‘work-life balance’ (41 per cent) are the top two drivers of job satisfaction for healthcare workers, the study found. By contrast, pay (60 per cent) and having a poor work-life balance (42 per cent) were found be the two main drivers of job dissatisfaction within the professions.

The high ranking of work-life balance for job satisfaction and dissatisfaction is in stark contrast to five years ago, when work-life balance was the fifth-biggest driver of job satisfaction, according to Deloitte’s 2017 study.

When asked how their feelings on job satisfaction and dissatisfaction has affected career intentions, the most common response, among 53 per cent of all respondents and 59 per cent of doctors, was to reduce hours and move to part-time working in healthcare. In addition, 40 per cent of clinicians overall, including 35 per cent of doctors and half of nurses and midwives had considered leaving the profession and changing career.

The study follows a slew of unwelcome news in recent days, including (now-confirmed) speculation that the government’s long-awaited NHS workforce plan (due to be published Tuesday 30th May) is to be delayed as it is considered too costly and the admission from the Health Secretary, Steve Barclay, that the 40 new hospitals will now not be built by 2030 – in contravention of the Conservative government’s flagship pledge.

Additionally, NHS vacancies remain at record levels as the health service continues to struggle to attract and retain staff. One-fifth of all nursing posts in England are estimated as vacant, and NHS trusts fear that the situation will not change until the government sets out a fully-costed workforce plan.

Karen Taylor, Director and Head of Research at Deloitte Centre for Health Solutions, said: “The problem has worsened over the past few years and our findings mirror recent staff surveys from the industry. There is a clear need to address the physical and mental health needs of staff if employers are to build a resilient workforce.

“Many solutions are in the hands of local health organisations to address and several have implemented effective solutions, just not at the scale needed.”

Sara Siegel, Partner and UK and Global Head of Health at Deloitte, said: “The most vital asset in healthcare is its workforce. Our study shows that the availability, accessibility and quality of care available to patients depend on having the right professionals, with the right skills, in the right place, at the right time.

“Healthcare leaders have a real opportunity to make a long-lasting impact in this crucial area. Those that have adopted new ways of working and technologies, have already realised the benefits to empower their workers. Not only will this help patients, but it will have a positive impact on job satisfaction that supports individuals to build rewarding, long-term careers in healthcare.”

Implications for physical and mental health

The study also revealed that 87 per cent of clinicians had experienced an increase in their workloads since March 2020, including 90 per cent of nurses and midwives and 84 per cent of doctors, with serious mental health and wellbeing implications for those staff affected; 46 per cent of clinical staff reported experiencing a negative impact on their physical health, including 50 per cent of hospital doctors and 45 per cent of hospital nurses. The study also found 57 per cent disclose a negative impact on their mental health, including 58 per cent of hospital doctors and 59 per cent of hospital nurses.

This contrasts with the 2017 study, in which 30 per cent of hospital doctors and 32 per cent of hospital nurses said that their workload had a negative effect on their physical health; and 23 per cent of hospital doctors and 33 per cent of hospital nurses said that it affected their mental health.

Digitisation will help – eventually

Numerous policy documents and reports, including the NHS Long Term plan, have identified the importance of adopting technology across healthcare. Deloitte’s study therefore asked healthcare workers which technologies they think are helping to improve the quality of patient care. The top five technologies included Electronic Health Records (EHR) (87 per cent), e-prescribing (78 per cent), patient apps (73 per cent), at-home diagnostics (70 per cent) and remote consultations (70 per cent).

Adoption remains low, however, and only 64 per cent of clinicians said they are using EHRs, while fewer than half of respondents have adopted e-prescribing (46 per cent), patient apps (33 per cent), at-home diagnostics (22 per cent) and remote consultations (39 per cent). Likewise, automation of human resource and occupational development services is lagging behind other industries and the study points out the crucial need to modernise these areas.

Dr Karen Kirkham, partner and Chief Medical Officer at Deloitte added: “While healthcare workers know that technology-enabled care models, systems and processes can improve outcomes and safety for patients, simplify tasks and reduce the significant administrative burden for clinicians, adoption remains fragmented.

“Healthcare leaders need to modernise and unlock better ways of working that improve the employee – and employer – experience. More efficient HR and people policies that focus on equality, diversity and inclusion, investing in leadership and professional development, and accelerating the digitalisation of healthcare infrastructure, will go a long way towards developing new ways of working that release time to care.”

NHS must seize upon growth in physiotherapist numbers

By The Chartered Society of Physiotherapy

Growth in the physiotherapy workforce should be the solution to the workforce crises in the NHS community rehabilitation services.

The physiotherapy workforce is ripe for expansion, which is good news for the public, policy makers and service providers. But this good news is not resulting in a high-quality rehabilitation service for all with a well-resourced physiotherapy workforce.

Many people do not know what good quality rehabilitation should look like, and there exists a growing unmet population need, combined with historic understaffing of community services, particularly of rehabilitation services.

At present, nearly a third of people in England has a long-term health condition. People with long-term conditions are being pushed into the most expensive and overburdened parts of health and care because they are not being supported in the community to manage their conditions effectively.

The needs of people with long-term physical conditions account for half of all GP consultations, 70 per cent of bed days in hospital and 70 per cent of total health and social care spending, while more than 60 per cent of patients admitted to hospital as an emergency have one or more long-term conditions.

Lack of access to high quality rehabilitation services

Narrowing the gap in healthy life expectancy will only happen with better access to quality community and primary care services for people with long-term conditions and for these services to be integrated around their needs.

NHS community rehabilitation services have been developed in a piecemeal way, often siloed by medical condition, with varying criteria for access. Furthermore, poor access to rehabilitation is particularly concentrated in areas of deprivation and among marginalised groups, resulting in more demand for GP appointments, increased A&E attendance and admissions.

Delivery plans for NHS policies have been also undermined by the lack of calculations on the additional staff capacity needed. For example, policies on urgent community response and discharge to assess have been implemented at the expense of rehabilitation, because they are delivered by the same group of staff. This has meant the policies have failed to reduce emergency admissions or the harm from delayed discharge.

However, for the last five years, additional roles in primary care have improved access to expert advice and diagnosis within primary care.

The value of Musculoskeletal first contact physiotherapist roles

An example of this is the establishment of the role of the Musculoskeletal first contact physiotherapist (MSK FCPs). MSK FCPs are improving patient outcomes, reducing demands on GPs, cutting medicine prescribing and reducing unnecessary onward referrals and tests.

The initial target provided in the Interim People Plan 2019 was stated as 5000 MSK FCPs, but currently there are only 1376 posts covering many GP surgeries and population sizes several times more than originally modelled. Due to these issues, GPs report that they don’t feel the impact of MSK FCPs, and issues of MSK FCPs retention are emerging.

This dynamic undermines implementation and has slowed down the evolution of the MSK FCP role which would support integration with community services.

How can we expand the physiotherapy workforce?

Community rehabilitation services are experiencing difficulties with recruitment and retention, but even greater issues are a lack of established posts and gaps in provision. 15 per cent of physiotherapy staff are leaving the NHS each year and almost half of them are leaving within the first five years of qualifying.

Many are moving to the private sector, but some newly qualified physiotherapists are seeking positions in low-skilled roles in the commercial sector citing less stress, flexible working hours and better pay. There is also the worrying issue of support workers retiring; a 2019 CSP survey of support workers shows that approximately 24 per cent of the current physiotherapy support worker workforce are over 55 years of age.

To compound this, a recent CSP staffing survey, showed that 93 per cent of physiotherapy managers reported that there were insufficient staffing numbers to meet patient needs and 39 per cent of physiotherapy staff reported that this was something they were very concerned about. CSP members also reported having less time to spend with patients, longer waiting times and a lack of available time to improve services, while issues around staff retention and an inability to fill vacant posts were also highlighted by members as contributing factors to insufficient staffing levels.

In the UK, there are currently nine registered physiotherapists for every 10,000 people compared to Denmark, where there are 26.8 physiotherapists for every 10,000 people and Norway, where there are 25.3 physiotherapists for every 10,000 people.

What are the solutions?

Over the years, the NHS has not grasped that, if done well, an increase in physiotherapy provision can help to meet patient needs and reduce pressures on the most overstretched parts of the system.

Insufficient staffing levels are contributing to recruitment and retention problems, which has led to a vicious cycle of high workloads and too few staff.

Change can happen but this requires increased staffing as well as doing more to attract and retain the physiotherapy workforce. The growth in the numbers of registered physiotherapists is increasing, but a sustainable and long-term workforce solution is urgently needed.

The NHSE Long Term Plan must support integrated workforce planning, with targets across primary and community sectors based not on the status quo but on Government and system policy objectives to improve provision to meet population need.

Support workers also have a vital role to play – they need expanding in number and should be upskilled through Rehab Assistant Practitioner apprenticeships to take on greater responsibility, making it possible to safely expand the support worker workforce as a proportion of the workforce overall.

As well as addressing under-staffing, community services also need more strategic leadership, consistency of provision and visibility within the NHS. The lack of leadership in community services is worrying; where Trusts have Chief AHPs at a senior level, community service leadership is strengthened, improving visibility. As well as ensuring this is the case within all Trusts, there need to be more clinical therapy roles within the community working at an advanced practice or consultant level to drive up consistency in standards, lead integration across pathways and partnership working with primary care.

The good news is that the number of registered physiotherapists is growing, alongside a supply of students. Now is the time for the NHS to utilise this rise in numbers. Doing so will go a great way towards tackling the current workforce crisis in NHS community rehabilitation services.

The Chartered Society of Physiotherapy will be joining ICJ and Public Policy Projects at the Integrated Care Delivery Forum in Manchester, this Thursday 25th May. The event is free to attend for relevant healthcare professionals, so come and say hello!

News May 19, 2023

Mental health transparency is on the rise, says new report

By Integrated Care Journal

More than 1 in 4 people (29 per cent) now feel comfortable enough to openly disclose to their employer if they need time off due to poor mental health.

A new survey of 8,000 UK adults conducted by Nuffield Health has highlighted an increase in mental health transparency in the workplace. Nuffield Health’s 2023 Healthier Nation Index finds that while workers are more likely to discuss mental health concerns with their employers, there are indications that stigma around mental health is still prevalent across workplaces.

In this year’s survey, 35 per cent of UK employees said they called in sick due to poor mental health but gave another reason. While this is a significant percentage, it is lower than the findings from Nuffield Health’s 2022 report, with the percentage previously being 39 per cent.

This is especially significant given that Nuffield Health’s 2023 Healthier Nation Index, also revealed that more than 1 in 4 people (29 per cent) now feel comfortable enough to disclose to their employer if they need time off due to poor mental health*. These latest findings suggest a positive shift in how employees are communicating with their workplaces about their emotional wellbeing.

Whilst this still indicates that stigma remains a barrier for people talking about their Mental Health at work, it is a promising sign that people are beginning to speak out when they need more rest, emotional support, and time away from their desks. The findings have been released to coincide with this year’s Mental Health Awareness Week, which focuses on anxiety. Employees are being urged to ‘#Find5’ to tackle anxiety this Mental Health Awareness Week.

Lisa Gunn, Mental Health Prevention Lead at Nuffield Health commented: “We are passionate about building a healthier nation and know that challenging work environments and stress can have a huge knock-on effect on both our physical and mental wellbeing.

“As well as the day-to-day worries that come with our personal and working lives, employees have also had to deal with the impact of a global pandemic and now the ongoing cost-of-living crisis. All these stressors combined can significantly affect the mental health of employees, so it’s more important than ever that businesses find ways to create open, transparent, and connected workplace environments.

“When people feel supported and able to reach out to their employer, this can have a positive impact on their mental health alone and help them better address feelings of worry and anxiety.

“That’s why we are calling on other UK workplaces to #Find5 minutes to look after their bodies and minds. Just spending five extra minutes on personal wellbeing a day can significantly boost mental and physical health.”

Below, Lisa offers advice on how employers can play their part in creating a connected and transparent workplace, which prioritises both physical and mental wellbeing:

1. Notice when anxiety takes over

In the past year, 48 per cent said their work had negatively impacted their physical/mental health, so it’s imperative that companies are equipped to recognise signs of mental distress, like anxiety, in others.

The symptoms of anxiety can be seen in various ways. Physical signs include heart palpitations, shortness of breath, headaches, tiredness, and dizziness. You might notice heightened emotions in the workplace such as irritability or tearfulness.

Employees experiencing anxiety may find it hard to maintain a healthy work-life balance. They may cancel annual leave last-minute – claiming they have too much on, to take holiday – work from home late at night or insist on coming into work when unwell.

However, spending too much time at work is counter-productive, as it can result in us overlooking our physical and mental health. According to this year’s findings, 59 per cent of Nuffield Health respondents said they were also less productive at work* when their mental health was poor.

Just five minutes of conversation from employers reaching out to employees presenting with signs of anxiety or distress can have a positive impact. This could be as simple as asking ‘Are you OK?’ or offering more regular meetings to catch up on how they’re feeling about their workloads.

2. Keep talking

It is encouraging that more employees feel comfortable sharing with their employers when they are having problems with their mental health. However, 18 per cent of us will still go to work one or two times a year when our mental health is poor, and 19 per cent will go to work more than ten times a year when experiencing poor mental health.

It’s good for managers to try and understand why individuals come to work despite experiencing reduced mental wellbeing. The more we know about the actions of our teams, the more support we can put in place to help them and reduce behaviours like presenteeism.

Aim to spend at least five minutes with employees each week, practising ‘active listening’ – a skill that requires a genuine understanding and reflection of what’s being said and providing a considered response, especially for those experiencing symptoms of stress and anxiety.

Active listening means listening attentively to what’s being said and showing understanding by paraphrasing and asking open questions to demonstrate your understanding.

Employers may also consider offering Emotional Literacy Training to staff – equipping them with the skills needed to recognise signs of distress in others and themselves and the confidence to approach them. This way they can nurture a workforce capable of recognising and tackling signs of anxiety in both themselves and others.

3. #Find5

Our 2023 study revealed 38 per cent of people in the last 12 months have dedicated no time to supporting their own mental health, which includes everyday self-care, activities like meditation or speaking to a medical professional.

This Mental Health Awareness Week, Nuffield Health is extending its ‘#Find5’ campaign to encourage individuals to ‘find 5 with 5’ – spending five extra minutes a day focusing on their physical and mental wellbeing for body and mind.

In the same way, employers can play a huge role in creating an environment where employees feel a sense of connection and belonging by promoting campaigns which foster connectivity, team building and reduce stress.

Our study shows individuals are becoming more aware of the benefits of exercise on overall wellbeing, with 27 per cent saying that exercise lifts their mood and helps them feel less anxious or depressed.

Encouraging employees to #find5 throughout the working day could also be as simple as promoting regular exercise in morning meetings or creating ideas to be distributed around the office or over email.

In just five minutes, managers can also arrange, or raise awareness of, physical health screenings available in the office to uncover any underlying issues among employees.

4. Be open about formal support

While meaningful social interaction plays a key role in reducing feelings of anxiety, professional support can also be invaluable. This may include Cognitive Behavioural Therapy (CBT) and Employee Assistance Programmes (EAPs) that offer direct and confidential access to a mental health expert.

Offering these services can help employees to understand and address feelings of anxiety using techniques such as challenging negative thoughts.

It only takes five minutes to signpost employees towards the support on offer, along with guidance and encouragement on how to access the help available. This may be via email to employees, an office huddle or a virtual ‘wellbeing hub’.

We want mental health transparency to keep increasing beyond the 4 per cent we have seen within the past year and openly communicating the options available shows employees that conversations about mental health are both welcomed and expected.

5. Allow individuals to pick what’s best for them

Finally, it’s important to remember that no single intervention works for everyone. The key to supporting the workforce is flexibility.

Employers should be flexible with letting staff choose five minutes of self-care each day, whether it’s simply stretching at their desk, going for a brisk five-minute walk between meetings or finding five minutes to do a short, guided meditation or breathing exercises.

Similarly, employers need to be flexible in how their teams choose to communicate with them. Encourage individuals to use a communication style that works best for them – whether it’s an in-person meeting or a phone call – this will make it easier for people to come forward and share their experiences.

More flexibility means workplaces can cater to the individual and allow everyone to thrive and overcome feelings of anxiety.

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Trusts driving progress on patient flow through collaboration and innovation

By Integrated Care Journal

New report from NHS Providers features practical approaches taken by trusts and partners to improve patient flow and quality of care.

NHS trusts are driving significant improvements to patient flow through in the face of significant system pressures, a new report by NHS Providers has found. Providers Deliver: Patient flow presents a series of case studies where trusts across the acute, community, mental health and ambulance sectors have developed effective approaches to improve patient flow in the face of unparalleled system pressures, including unprecedented workforce shortages, rises in poor health and in complex conditions, and a lack of funding.

These types of approaches will be central to plans to recover core performance standards across the whole health and care system. The report sets out the wider context behind obstacles to patient flow that cause delays, and argues that work to address them requires a joined-up approach based on close partnerships between different types of providers.

Key themes that have emerged from the case studies include:

Admission avoidance – delivering more out of hospital procedures and walk-in (ambulatory) care to reduce unnecessary admissions, freeing up hospital capacity for those who need it.
Care at home – virtual wards, remote monitoring of patients and developing the mental health and community care workforce.
Working to improve health as well as treating illness.
Collaborative working with other providers.
Leadership that protects and promotes the autonomy of clinical staff.

The report includes a contribution from NHS England’s national director of urgent and emergency care and deputy chief operating officer, Sarah-Jane Marsh, who wrote: “It will take strong partnerships between acute, community and mental health providers, primary care, social care and the voluntary sector, to ensure a system that provides more, and better, care in people’s homes; gets ambulances to people more quickly when they need them, sees people faster when they go to hospital and helps people safely leave hospital having received the care they need.”

In a foreword for the report, the Chief Executive of NHS Providers, Sir Julian Hartley, said: “All too often attention is drawn exclusively to headline waiting times in urgent and emergency care, but we know the drivers of long waits and delays are extremely complex with no one, single solution.

“The case studies in this report show how trusts are working collaboratively to prevent avoidable admissions, manage demand more effectively, build additional capacity sustainably, use technology to deliver more care outside of a hospital setting and deliver real improvements in the health of the populations they serve.

“In the most challenging of circumstances trusts have shown great resilience and innovation. As the NHS works towards sustainable recovery from the pandemic and to reduce waiting times for core services, it is clear a preventative, whole-system approach will be key and that trusts are well positioned to deliver.”

GPs urged to join rapidly growing digital registration service

By Integrated Care Journal and Gabriel Blaazer

More than 240,000 online patient registrations have been completed through new national online service designed to make registering patients quicker and easier.

More than 900 GP practices – around one in seven nationally (14 per cent) – have already enrolled for the digital Register with a GP surgery service, which is managed by NHS England. The service, which enables patients or carers to go online to find and register with a local GP practice, is now available via the NHS App, with more than 240,000 new registrations processed.

GP practices process around 6 million registrations a year, with many still using paper forms, which prospective patients often have to collect themselves. Feedback from the 2020/21 GP Bureaucracy Review identified GP registration as a high volume and difficult task for practices and patients and the new service has been designed to simplify the process for both service users and practices.

The new online service has been trialed at GP surgeries across the country and has been shown to save practice staff up to 15 minutes per registration, by helping to reduce paperwork and administration time. The service, available to all practices, has been rigorously tested with users and a wide variety of patient groups, including charities who support homeless people and asylum seekers.

Patients can access the service using individual practice websites and the NHS website’s Find a GP service (which is also available through the NHS App), with the service automatically checking they live in the catchment area of a given practice.

The patient’s information is then automatically emailed to GP practices in a structured format aligned to their IT systems, helping reduce the time it takes staff to process registrations. The service is fully integrated with NHS login, which enables people to use one login to access several health and care services, verifying their identity. It also matches patients to their NHS numbers, with a 90 per cent first time match rate, further cutting administration for practices.

The service is fully compatible with translator services, ensuring accessibility for patients and a new-look paper form is still available for those who wish to use it.

Stephen Koch, NHS England’s Executive Director of Platforms, said: “This service reduces the administrative burden for general practice as well as making GP registration even more accessible to the public, offering patients more choice, convenience and consistency.

“We’re pleased to see a growing number of GP practices are coming on board, helping them save time and money. By recently integrating the service with the NHS App, we hope even more GP practices will take advantage of this new digital tool.”

Dr Shanker Vijay, Digital First Clinical Lead for London and a practising GP, already uses the service and assists other practices to introduce it. He said: “We live in a ‘one-click’ culture and we recognise that many busy people want online solutions.

“Vulnerable patients and those with physical access needs don’t need to visit the GP surgery to register, and people can access the service at any time, including outside of working hours to fit around their other responsibilities.”

There are also plans to make the service compatible with a number of Robotic Process Automation (RPA) solutions, which use bots to enable registration information to be automatically added into GP clinical systems at the touch of a button, as an optional extra. Full clinical system integration is also planned for next year.

More information on Register with a GP surgery is available here. Practices interested in offering the service can self-enrol or contact the dedicated support team, or attend the upcoming webinar on June 14, 2023 by registering here.

English pharmacies to offer prescriptions for seven conditions under GP access plans

By Integrated Care Journal

Patients to receive quicker, more convenient access to NHS care from high street pharmacies, in a major expansion of services under new plans to improve access to primary care.

Patients who need prescription medication will be able to get it directly from a pharmacy, without a GP appointment, in plans announced by the government today. Published as part of the government and NHS England’s primary care plan, the policy forms part of the government’s efforts to free up 15 million GP appointments in England over the next two years.

The reform means that, by next winter, people suffering from seven common conditions, including earache, sore throat, or urinary tract infections, will be able to access medication directly from a pharmacy, with the government investing £645 million over two years to expand community pharmacy services.

Almost half a million women will also no longer need to speak to a practice nurse or GP to access oral contraception and will instead be able to access it directly from their local pharmacy. There are also plans to more than double the number of people able to access blood pressure checks in their local pharmacy to 2.5 million, up from the 900,000 carried out last year.

Ending the 8am ‘rush’ for appointments is a key part of the plan. This will be supported by investment in better phone technology for GP teams enabling them to manage multiple calls and redirect them to other specialists, such as pharmacists and mental health practitioners, if more suitable. During trials, this has increased patients’ ability to get through to their practice by almost a third.

Extra training will also be provided to staff answering calls at GP practices, so that people who need to see their family doctor are prioritised while those who would be better seen by other staff such as physiotherapists or mental health specialists are able to bypass their GP.

Prime Minister, Rishi Sunak, said of the plans: “I know how frustrating it is to be stuck on hold to your GP practice when you or a family member desperately need an appointment for a common illness. We will end the 8am rush and expand the services offered by pharmacies, meaning patients can get their medication quickly and easily.

“This will relieve pressure on our hard-working GPs by freeing up 15 million appointments, and end the all-too stressful wait on the end of the phone for patients.”

In another significant step, up to half a million people a year will be able to self-refer for key services, including physiotherapy, hearing tests, and podiatry, without seeing their GP first.

The plan also commits to further reducing bureaucracy for general practice and building on the work of the Academy of Medical Royal Colleges. Local health systems are being tasked with making fit notes available via text and email to patients, to avoid unnecessary return trips to their GP.

In the run up to the NHS’ 75th birthday on 5 July, the new plan aims to support primary care services to continue to adapt and innovate to meet patients’ needs, with nine in ten people able to access their GP records, including test results, on the NHS App within the next year.

Demand for access to GPs is steadliy increasing, with the number of people over 70, who are five times more likely to need a GP appointment than teenagers, growing by a third since 2010. GP teams are already treating record numbers, with half a million more appointments delivered every week compared to pre-pandemic.

The NHS Chief Executive, Amanda Pritchard, said: “The care and support people receive from their local GP is rightly highly valued by patients and so it is essential that we make it as easy as possible for people to get the help they need.

“GPs and their teams are working incredibly hard to deal with unprecedented demand for appointments. But with an ageing population, we know we need to further expand and transform the way we provide care for our local communities and make these services fit for the future.

“This blueprint will help us to free up millions of appointments for those who need them most, as well as supporting staff so that they can do less admin and spend more time with patients.

Health and Social Care Secretary, Steve Barclay, said: “This plan will make it easier for people to get GP appointments.

“By upgrading to digital telephone systems and the latest online tools, by transferring some treatment services to our incredibly capable community pharmacies and by cutting unnecessary paperwork we can free up GPs time and let them focus on delivering the care patients need.”

Responding to the announcement of the GP Access Recovery Plan, Nuffield Trust Chief Executive, Nigel Edwards, said: “These are practical measures which should make getting treatment easier and more convenient for patients. Enabling pharmacists to provide more care to patients and take some pressure off general practice is long overdue.

“However, it will need to be implemented carefully. The number of community pharmacies has actually been shrinking as their workload has risen. We will need to check there is genuinely new funding and serious support so that patients aren’t just shuffled between two overloaded parts of the NHS. If not many pharmacists are actually able to take this up, it could become confusing for the public, and the new digital systems which the plan intends will help allocate patients to different services won’t have enough options.”