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.”

New survey finds public awareness of pharmacy services as low as 13%

By Integrated Care Journal

Findings from pharmacy tech startup Charac reveals more than half of patients do not use their local pharmacies for anything more than minor illnesses.

A new study from Charac, an NHS-integrated one-stop platform for independent community pharmacies, has provided a new insight into public perception and patient usage of pharmacies. Awareness of the full scale of services is as low as 13 per cent of those surveyed, and 53 per cent are not using pharmacies for anything further than very minor ailments.

With pressure on the NHS reaching unprecedented levels, Secretary of State for Health & Social Care Steve Barclay has acknowledged the importance of a ‘pharmacy first’ policy for England. This is designed to allow pharmacies to act as another entry point into the health service, and to relieve some of the pressure from general practice. However, this is yet to be realised in policy, and Charac’s research has found that patient knowledge of pharmacy services remains worryingly low.

Knowledge of services

More than 50 per cent of patients were not aware of the majority of services pharmacies provide. Most respondents were only aware of 4 out of 15 potential services, being minor illnesses, repeat prescriptions, emergency contraception, and flu vaccination. Knowledge of services was as low as 13 per cent for chlamydia screening and treatment, for example.

Usage of services

The only pharmacy services that more than a third of respondents reported using were for minor illnesses, such as colds, flu, and low-level digestive issues (58 per cent), and for repeat prescriptions (47 per cent). In fact, these were the only two services that the majority of respondents would go to a pharmacy for instead of their GP – 57 per cent for minor illnesses and 52.5 per cent for repeat prescriptions, respectively.

Furthermore, patients on the whole are still using pharmacies for traditional services, such as ordering prescriptions (96 per cent) and disposing of old medication (80 per cent). While satisfaction with pharmacy services remains high, with almost half of respondents giving their pharmacy the highest satisfaction rating, patients evidently remain hesitant to use pharmacies as the first port of call.

Santosh Sahu, founder and CEO of Charac, said: “Though it is great to see patients largely very happy with the services provided by their pharmacies, it’s clear that patient confidence in various services other than prescriptions is low. To push a ‘pharmacy first’ policy, more must be done to provide pharmacies with better resources and increase patient confidence.

“Both funding and improved digital access can make a tangible difference in equipping pharmacies for the future. Charac’s platform is helping pharmacies improve their online presence, as well as helping them generate a steady income by digitising processes such as consultations and prescriptions.”

The NHS must break the cycle on heart failure

By David Duffy

Integrated Care Journal recently spoke to Dr Ashton Harper, Head of Medical Affairs (UK & Ireland) at Roche Diagnostics, to examine the heart failure diagnostic pathway and identify where the biggest opportunities in NHS diagnostics exist.

In the midst of its most challenging period of pressure, diagnostics have a significant role to play in helping to alleviate patient backlogs and free up vital resources across the sector – and nowhere is this more critical than with heart failure.

The health challenge that heart failure, a serious and chronic disease that prevents the heart from pumping blood through the body, poses to the NHS is both immense and relentless. An estimated one million people live with heart failure in the UK, with approximately 200,000 developing the condition every year, creating a profound and multifaceted set of health challenges for the NHS.

Writing in a recently published report by PPP for Roche Diagnostics UK & Ireland, Professor Sir Mike Richards described diagnostics as a “Cinderella” service within the NHS. Yet the UK’s capacity to diagnose heart failure has been consistently hampered by broader capacity challenges in NHS diagnostic service provision, as well as the lack of uptake of, and access to, innovation. A combination of workforce shortages and outdated facilities have historically contributed to late diagnosis and poorer health outcomes. This realisation directly informed Professor Richard’s 2019 report, which led to the introduction of community diagnostic centres (CDCs).

A ‘silent epidemic’

Heart failure is notoriously difficult to diagnose, in part because its key symptoms – breathlessness, exhaustion and ankle swelling – can be caused by a number of other conditions. As a result, late diagnosis of heart failure is unfortunately common, often only occurring once a patient has presented in secondary care following the onset of severe symptoms.

“If heart failure patients are picked up early in the community in primary care, the evidence shows that management of the disease is much better”

“Current estimates are that 80 per cent of patients are diagnosed [with heart failure] after a hospital admission,” explains Dr Harper, “and a significant proportion of those will be emergency cases, and so these patients are at the late stage, requiring more intense and complex treatment.” This matters because heart failure patients who require hospitalisation account for “somewhere in the region of a million inpatient days every year, which is about 2 per cent of total NHS annual bed days”. It is also estimated that between 2-4 per cent of the total annual NHS budget is spent managing patients with heart failure (up to £6 billion in 2022/23) and according to Dr Harper, “the majority of this burden is due to hospitalisation – and hospital admissions for heart failure have increased by 50 per cent in the last decade alone”.

“Somewhere in the region of 70 per cent of the total annual cost [of managing heart failure] is actually utilised by the management of stage four patients alone,” says Dr Harper, “but if heart failure patients are picked up early in the community in primary care, the evidence shows that management of the disease is much better; they have a better quality of life; and significantly reduced requirements of both primary and secondary care services ongoing.”

Diagnostic reform

“The NHS must look to adopt innovative diagnostic tools at a faster rate”

As was made clear in Professor Richards’ report, the NHS must conduct a wholesale rethink of diagnostic service provision. “Early diagnosis is key to effective management and better outcomes for these patients”, explains Dr Harper, “but while the use of medicines which are deemed to be beneficial and cost effective is mandated in the UK, diagnostics aren’t. It can often take 10 or more years for a diagnostic test to be widely adopted across the NHS.” As such, the NHS must look to adopt innovative diagnostic tools at a faster rate.

NT-proBNP tests are fast, cost-effective, non-invasive and recommended by NICE for the diagnosis of heart failure. Recently updated NICE Quality Standards, recommend that this test be conducted on all patients presenting to primary care with a possible heart failure diagnosis, but this guidance is not universally followed with recent data showing that only 18.3 per cent of heart failure patients had an NT-proBNP test recorded.

“Following the NICE guidance for NT-proBNP testing can reduce unnecessary referrals and allow GPs to better identify patients that do need more urgent referrals for echocardiograms”, Dr Harper notes, which is important because “we’ve got massive echocardiogram backlogs, with patients waiting months”, many of whom may not need one at all. The ability to preclude a heart failure diagnosis early would reduce the echocardiogram bottleneck, meaning those who really need one can access one sooner. “I think mandated funding for NT-proBNP would go a long way,” says Dr Harper. “This approach could help to potentially flip the site of primary diagnosis from 80 per cent in hospital to 80 per cent in the community, and therefore reduce pressure on the NHS.”

Reprioritising and reframing the issue of heart failure

Dr Harper believes that “there’s a strong case for heart failure to be prioritised by NHS England in the upcoming NHS Long Term plan refresh with clearly defined targets, such as exist for stroke and cardiac arrest.” Accordingly, “there needs to be increased collaboration between the NHS, industry and patient organisations to tackle inequalities in the diagnosis and management of patients.”

Much of this comes down to a need to educate and raise awareness of heart failure and its symptoms. “It has been described as a ‘silent epidemic’ because it hasn’t received as much attention as other pressing healthcare issues,” Dr Harper remarks. This lack of awareness has produced some alarming disparities, particularly around gender and misdiagnosis.

“Clinicians seeing female patients with the symptom of breathlessness should have heart failure at the top of their differential diagnostic list”

“There is an historical presumption that heart failure is a more male-dominated disease rather than female,” he explains, “when actually it’s about a 50/50 split.” Despite this, women are more likely to be misdiagnosed than men or to wait for much longer than men for their diagnosis. Dr Harper continued, “clinicians seeing female patients with the symptom of breathlessness should have heart failure at the top of their differential diagnostic list.”

Echoing recommendation three of Breaking the cycle, Dr Harper also encourages widespread adoption of the Pumping Marvellous Foundation’s BEAT symptom tracker. If shared with the wider public, this checklist – Breathlessness, Exhaustion, Ankle Swelling, Time for a simple blood test – could increase heart failure symptom awareness and ensure that more cases are identified sooner and treated more effectively.

Conclusion

“Ensuring primary and secondary care professionals share a common goal is key”

A coherent and system-wide approach will be needed if capacity is to be increased across all diagnostic modalities, but especially in heart failure. “Ensuring primary and secondary care professionals share a common goal is key,” Dr Harper says, “[and] the introduction of integrated care systems is a great opportunity to foster this collaboration.”

“By increasing diagnostic capacity in the community, we might be able to reduce the pressure on hospital admissions and NHS bed days,” and the use of NT-proBNP tests to confirm or rule out suspected cases of heart failure will be crucial. Taking the present opportunity to radically overhaul the heart failure diagnosis pathway will help to decrease the societal burden of the disease, create extra capacity for the NHS and, most importantly, help heart failure patients lead longer, healthier lives.

Breaking the cycle: Tackling late heart failure diagnosis in the UK, finds that late diagnosis of heart failure is a significant hindrance to the effective management of heart failure. It makes a series of recommendations to NHS England, Health Education England, and integrated care systems, as well as patient groups and industry to come together to improve heart failure diagnosis across the entire healthcare system.

HEE extends new educational resource to GPs

By Integrated Care Journal

Health Education England is extending a new online tool for clinicians, GeNotes, designed to help them access vital care for their patients.

GeNotes (genomic notes for clinicians) is designed to support healthcare professionals in making the right genomics decisions at each stage of a clinical pathway. It provides educational information which can be accessed during patient consultations, along with links to bite-sized further learning.

In the context of healthcare, genomics is the study of a person’s genetic material to achieve a diagnosis or inform treatment and management. Genomic testing is being used in the NHS for cancer and rare and infectious diseases, and can lead to answers for patients where previously there were none.

“GeNotes will be a vital resource for primary care,” said Dr Jude Hayward, primary care adviser to HEE’s Genomics Education Programme.

“As genomic testing continues to be embedded within clinical care, particularly in rare disease and cancer, our primary care colleagues need quick access to concise, focused information about referral routes and clinical management.”

The web-based resource will help clinicians access genomics testing for their patients. Before the platform goes live, GPs and colleagues in primary care are being invited to try out GeNotes and give their feedback via an online survey. The results will be used to improve the final product.

Dr Hayward added: “In developing GeNotes, we have fine-tuned the resources to offer just the information a busy clinician needs at the point of patient care. Our user research is an important component to help us make further improvements before we roll out the service more widely across primary care.”

Developed by HEE’s Genomics Education Programme in collaboration with clinical experts across the NHS, GeNotes has already been successfully tested by colleagues in oncology and paediatrics. So far, it has scored a 90% usability score (average: 68%) and high praise from clinicians.

Health Inequality, Population Health, Primary Care, Thought Leadership September 30, 2022

Has the government given up on its health ambitions?

By David Duffy

David Duffy analyses Theresa's Coffey's start as health secretary.

Despite the already catastrophic impact of the government’s mini-budget, the first casualty of the government’s short-termist approach to governing was health and care.

Amid the ongoing response to the government’s remarkably misguided mini-budget, recent announcements from DHSC have flown somewhat under the radar of national media. But last Friday’s postponement of the health inequalities white paper is a reflection of a 12-year-old government who have become devoid of long-term strategic thinking in health and care.

Much like how Mr Kwarteng’s budget is being criticised for seeking a short-term growth boost while sacrificing economic stability, Ms Coffey’s health announcements so far seem to be aimed at garnering public support in the short term, and fail to into account the long-term causes of ill health and the enduring challenges facing the sector. Our Plan for Patients, Thérèse Coffey’s first stab at a plan for health and care, is receiving as much attention for what it misses as what it includes, with glaring omissions around workforce strategy and health inequality.

Last week it was reported that new Health and Care Secretary intends to postpone, and potentially scrap, the publication of the long-awaited government health inequalities white paper. It is estimated that health inequalities cost the UK £31 billion to £33 billion per annum before Covid-19 and the paper was a key part of Boris Johnson’s leveling up initiative. When first announced by then Health Secretary Sajid Javid back in February, the intention was to set out “bold action” to deal with disparities in health outcomes based on race, gender and income.

In response, over 155 members of the Inequalities in Health Alliance (IHA) last week wrote to Coffey urging her to maintain the commitment to publishing a Health Disparities White Paper (HDWP) by the end of this year.

The Alliance said: “The DHSC and NHS will be left in the ultimately unsustainable position of trying to treat illness created by the environments people live in”.

The IHA have urged for the government to restate its commitment to health inequalities, warning that “focusing on individual behaviors and access to services alone will not be enough to close the almost 20-year gap in healthy life expectancy that exists in England between those from the least and most deprived communities.”

“that the Secretary of State has so far chosen to ignore the issue almost entirely poses ominous signs for the future health of the nation”

Whether or not you agreed that Johnson’s levelling up initiative was ever truly going to become a reality, it did help kickstart hugely beneficial discourse around health inequality, further prompted by the uneven impact of Covid-19. It was clear from recent Public Policy Projects meetings between system leaders that there is a growing consensus that tackling health inequality is the central objective of integrated care systems (ICSs). With ICS leaders in agreement on the need for action, what has happened to the government’s desire for “bold action” on health inequality?

The obvious answer is that while the economy is rapidly deteriorating and every government department is being asked to find ‘efficiency savings’, long term social and economic rejuvenation is taking a back seat. But in the context of a deepening cost of living crisis, the fact that the new Secretary of State has so far chosen to ignore the issue almost entirely poses ominous signs for the future health of the nation.

Cost of living

Recent polling from the Roya College of Physicians has found that even by May 2022, 55 per cent of people felt their health had been negatively affected by the rising cost of living, with the increasing costs of heating (84 per cent), food (78 per cent) and transport (46 per cent) reported as the top three factors.

Rising costs are creating environments for preventable ill health to manifest in deprived areas across the nation, ultimately impacting health services – but of course, the crisis directly impacts health providers, as well as those delivering care.

NHS Providers have published a shocking new survey from its membership, revealing that some staff are electing to not eat during work hours in order to provide for their children, with some quitting altogether to find better paid work in pubs and bars. Other key findings from the survey include:

71 per cent of trust leaders reported that many staff are struggling to afford to travel to work;
69 per cent said the cost of living is having a ‘significant or severe’ impact on their ability to recruit lower-paid roles such as porters and healthcare assistants;
61 per cent reported a rise in mental health sickness absence;
81 per cent are ‘moderately or extremely’ concerned about staff’s physical health;
95 per cent said that cost of living increases had significantly or severely worsened local health inequalities;
72 per cent said they have seen more people coming to mental health services due to stress, debt and poverty;
51 per cent said they have seen an increase in safeguarding concerns as a result of people’s living conditions.

The health and care community is united in its concern for the wellbeing of its staff and for their capability to respond to the underlying causes of the nation’s health challenges. Unfortunately, the government is failing to match this concern with sound, long-term policy – this epitomised by Our Plan for Patients.

In some ways, it can hardly be a shock that the government is losing its desire to implement long-term health policy; Coffey is the country’s fifth Secretary of State for Health in as many years and must also balance this role with the position of Deputy Prime Minister. Even still, much of the sector has been taken back by some of Our Plan for Patients’ glaring omissions, as well as questioning some of the key commitments within it.

In setting out her key priorities as Health Secretary, the threadbare document published last week attempts to establish Coffey as a “champion” for patients. So far, the plan has achieved little more than alienating much of the health and care community, while simultaneously discrediting the last 12 years of government health policy.

Primary care

“Ministers are quick use the pandemic to excuse ominous backlogs in elective care, yet they do not offer the same leeway for the primary care sector”

One of the central aims of Our Plan for Patients is the expectation for all patients to receive a GP appointment within two weeks of request. In setting this wholly unrealistic, arbitrary national target, without providing additional support for GPs to achieve it, Coffey is seeking to create a doctors vs patients dynamic.

It’s a cheap tactic, designed to pick up votes, and the right wing press immediately came out in support of it. The Daily Mail blamed ‘soulless megapractices’ for ‘Glastonbury style 8am ticket rushes’ – the simple and highly flawed suggestion is that GPs must ‘do more’ and ‘care more’ to improve access to services.

“Targets don’t create doctors,” said Helen Buckingham from the Nuffield Trust, one of many organisations and figures who criticised the target. Former Health Secretary Jeremy Hunt insisted in the Commons that “adding a 73rd national” target for GPs would not address the challenges in the sector. Matthew Taylor Chief Executive of the NHS Confederation simply said the plans “do not go far enough”.

Fundamentally, the UK has a rapidly ageing population with increasingly complex conditions and comorbidities to manage – and it does not have the staff to deal with it. The Health Foundation recently revealed a shortage of full-time 4,200 GPs, with that number projected to rise to about 8,900 by 2030/31. Further, there are 132,000 vacant posts across the NHS. This number includes 47,000 nurses and more than 10,000 doctors.

In the face of these challenges, primary care teams continue to perform remarkably. The latest figures show that GPs carried out 26.6 million appointments in August, up from the previous month and over three million more than in August 2019 – before the pandemic. Nearly half of appointments in August took place on the same day that they were booked and over 80 per cent within two weeks of booking. Almost 70 per cent of these appointments were delivered face-to-face.

Ministers are quick use the pandemic to excuse ominous backlogs in elective care (despite the fact that there were already four million people on waiting lists before Covid-19 hit), and yet they do not offer the same leeway for the primary care sector and continuously fail to acknowledge its achievements.

Primary care was at the centre of the UK’s highly successful Covid vaccine rollout, one of the few genuine achievements of Boris Johnson’s government. All the while the sector maintained impressive rates of service delivery in other areas and managed to rapidly adapt to digital consultations, ensuring that as many patients as possible received care with little to no infection risk.

Rather than support and celebrate a sector that delivered when we most needed it, the government has decided to point the finger at primary care – demanding more from GPs without providing them with the means to deliver.

Unfortunately, initial noises from the current ‘government in waiting’ will have done little to reassure primary care professionals. Shadow Health Secretary Wes Streeting has not only reaffirmed the gas lighting of GPs but has gone a step further, promising same day face-to-face GP appointments to anyone who wants them if Labour were to win power – an announcement already dismissed by the British Medical Association as “not being grounded in reality”.

Even in a political sense, this seems a needless promise to make while the Tories continue to haemorrhage support in all policy areas. A recent YouGov poll suggests that Labour are four times more trusted by the public to manage healthcare – the party should use this political capital to outline long-term health policy that addresses fundamental workforce shortages.

We need our leaders to be realistic and honest with the public about what is possible, and not automatically assume “meeting public expectations” is best for primary care without seeking to manage those expectations.

In the absence of a bona fide, long-term workforce strategy from Westminster, perhaps it is time that we had a government that faced a hard truth: that not every patient should get to see their GP upon request. Patients and end-users should be better engaged with system reform so that they are more aware of the options available to them within health and care and not resort to using GPs for every request – there are simply not enough doctors to see everyone.

Where is the integration agenda?

“This is ‘sugar rush’ politics at its worst. A short-termist approach to governing that is designed to garner a quick dose of public support while the long-term needs of the sector go ignored.”

Political leaders must reaffirm the aims and objectives in the NHS Long Term Plan and indeed the recent Health and Care Bill. In integrated care, there is a principle for care delivery which is designed to segment patients to different parts of the system – delivering them the care that most appropriately addresses their needs while protecting the precious capacity of seriously understaffed and under-resourced parts of the sector.

It is concerning that supporting the development of ICSs, and their focus on addressing health inequality through population health strategies relevant to specific regions, received so little attention in last week’s announcements. If properly supported, ICSs can act as conveners of public services beyond health and care, and so have a huge role to play in revitalising communities and addressing broader inequalities.

The term ‘ICS’ does not appear once in Our Plan for Patients, and the only references to ‘integrated care’ are made in the context of describing integrated care boards as ‘local NHS services’. The whole point of integrated care, i.e., the heart of the government’s flagship health legislation only published two months ago, is to unite a disparate health and care system under a common purpose to improve health outcomes. This of course includes providers within the NHS, but it also includes social care, primary care and wider local government and community care.

As Richard Vize outlined recently in the British Medical Journal, the government has repeated the age-old trope of essentially treating social care as a discharge service for NHS hospitals. Yes, it is true that that a healthy social care sector would alleviate pressure on the NHS, but social care should be so much more than a pressure valve for hospitals.

For many with serious and lifelong conditions, social care is the lifeline that enables them to interact with the world and live with dignity and independence. Politicians who treat social care as a mere afterthought would do well to remember this.

As well as this, the care sector harbours unique insight and intelligence into local health challenges and could provide a hugely meaningful career option for thousands of new recruits. The government should be looking to professionalise the social care sector while helping ICSs to harness the expertise that already exists within it to improve population health outcomes.

There should always be a dual purpose to health reform: addressing immediate challenges while moving towards common, long-term objectives. Immediate problem solving is essential – patients deserve the best possible care that the system is able to give them and right now they are having to wait too long to get it or not receiving it at all. But in purely focusing on the immediate, more visible issues, such as GP waiting times, the government fails to address the root of the problems. The sector needs more staff, better equipment and more resource.

To make matters worse, there are already worrying rumours that the government plans to scrap its obesity targets. Alongside smoking, obesity is one the largest preventable causes of ill health and contributes significantly to cancer rates. Scrapping targets before they have barely had a chance to have an impact makes the promise in this plan to “support people to live healthier lives” ring rather hollow.

This is ‘sugar rush’ politics at its worst. A short-termist approach to governing that is designed to garner a quick dose of public support while the long-term needs of the sector (and ultimately the public) go ignored. It seems that finally the Conservatives have now stopped pretending they have any intention of fixing this very broken health and care system.

It will be of little reassurance that DHSC has already begun rolling back some of these expectations, with the two-week GP appointment target pushed back to the Spring of 2023. The damage has been done, Coffey has drawn her ‘battle lines’, and seeds for a crisis winter like no other for health and care have already been sown. Compounding this is the fact that the government seems incapable or unwilling to provide light at the end of the tunnel in the form of a long-term plan for health and care.

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How Tunstall Healthcare is investing in the leaders of the future

By Tunstall Healthcare

Global market leading health and care technology company, Tunstall Healthcare is investing in the next generation of health, housing and social care professionals with the launch of a new range of Continuing Professional Development (CPD) accredited courses.

Part of ‘Tunstall Academy’, the online courses have been developed by Training Accreditation Programme (TAP) and CIPD accredited trainers. The courses aim to strengthen the knowledge and expertise of professionals in a range of areas related to health and care technology. The first courses available focus on telehealth and a range of other courses relate to the remote management of specific long term conditions including COPD, heart failure and diabetes. A Telecare Assessor course will be available soon, which will be followed by a number of other telecare-focused courses.

Gavin Bashar, UK Managing Director at Tunstall Healthcare, commented: “The role of technology in adult social care has been radically reshaped over the past couple of years, leading to 63% of directors in adult social care reporting that their local authorities are implementing positive investment strategies in digital and technology.

“We must therefore work to upskill staff members in these sectors to improve care service delivery, facilitate collaboration, and build a bigger and better workforce post-Covid. Our specialist training team works closely with participants to help them get the most out of technology for their own organisations and the people they support, and ensure they are ready to make the most of a more digital future as we transition to a fully digital communications network.”

CPD courses enable professionals to stay up to date with current and best practice in their chosen field, enhancing their skills and effectiveness in the workplace. Tunstall also offers a number of non-CPD accredited courses which can be delivered online or in person, designed to upskill people working in monitoring centres and group living environments as well as those delivering telecare and telehealth services.

All courses are designed for a range of learners, from beginners to advanced professionals, and can also be configured to develop skill sets for particular job roles, as well as achieving broader personal and organisational objectives, such as meeting TEC Services Association standards and enhancing customer experiences.

Andy Hart, Head of Technical Delivery and Support at Tunstall Healthcare, added: “People are the greatest asset of any organisation, and at Tunstall we have a responsibility to drive change across the sector as a whole. We are committed to educating and upskilling the next generation of professionals in the use of telecare and telehealth technology to modernise our health, housing and social care systems.

“Technology enabled care solutions (TECS) support individuals to live independently for longer and alleviate pressures on care and health services. It’s crucial that professionals are aware of the benefits of technology within service provision so that it can be deployed effectively, and education plays a key role in achieving this.”

Tunstall Academy brings together a range of initiatives designed to raise awareness of the value and potential of technology across the health, housing, and social care landscape, and to increase the benefits to users, carers, professionals and providers.

To find out more about the training services available, please visit www.tunstall.co.uk/training-services.

Leading health charities highlight “untapped potential” of pharmacy services

By David Duffy

Leading UK health charities have highlighted the untapped potential of pharmacy services in tackling the nation’s major health conditions.

Just one in ten adults in Britain have turned to their local pharmacy for advice and information on lowering their risk of serious health conditions including cancer, heart disease and type 2 diabetes, according to a new YouGov survey.

The survey, commissioned by the British Heart Foundation (BHF), Cancer Research UK, Diabetes UK and Tesco, suggests that many people could be missing out on opportunities to access free advice via their local pharmacies that could help them make life-changing improvements to their health.

The findings come as the BHF, Cancer Research UK and Diabetes UK have been working with Tesco to deliver specialist training to Tesco pharmacists and pharmacy colleagues to support their conversations with the public. The training will help them provide more information and support as to how people can help lower their risk of these serious conditions through small changes to their day-to-day routine.

The survey also found that, of those who had visited a pharmacist for health-related advice or checks, 43 per cent said talking to a pharmacist had eased their concerns around wasting their GP’s time.

Meanwhile, 24 per cent of those who had visited a pharmacist for health-related advice or checks found it easier to speak to someone in a pharmacy than in other healthcare settings, while 53 per cent identified not having to book an appointment as a benefit of using a pharmacy for information and advice about a health-related concern.

The leading health charities say that supporting people to make lifestyle changes and seek referrals for concerning symptoms could “save thousands of lives” every year from some of the UK’s most prevalent and serious diseases.

More than 7.6 million people in the UK are living with heart and circulatory diseases, while 4.9 million are living with diabetes, 90 per cent of which are cases of type 2 diabetes, and it’s estimated that almost three million people are living with cancer (2020). Yet, around four in 10 cases of cancer, many heart and circulatory diseases and up to five in 10 cases of type 2 diabetes could be prevented or delayed.

Dan Howarth, Head of Care at Diabetes UK, said on behalf of the charities: “Thousands of lives could be saved every year through people making positive changes that lower their risk of type 2 diabetes, cancer, and heart and circulatory diseases.

Far more people could be taking advantage of the advice and support available to them from their Tesco pharmacy while they do their weekly shop, this includes tips and information on stopping smoking and weight management services”

The survey also found that only two per cent of adults in Britain had visited their pharmacist for a blood pressure check in the last twelve months, despite an estimated 4.8 million people in the UK living with undiagnosed high blood pressure.

The three leading health charities, in partnership with Tesco, are encouraging people to use their local Tesco pharmacies for information and support on lowering their risk of cancer, type 2 diabetes, and heart and circulatory diseases.

Tesco and the health charity partners hope that shoppers take advantage of the convenience of having their local pharmacist in store. Customers can easily seek advice when they do their weekly shop and get support for making positive changes or seeking information on concerning signs or symptoms.

Experts urge NHS to leverage position as England’s largest employer to help fight health inequalities

By Integrated Care Journal

Public Policy Project’s ICS Network has urged the NHS to leverage its position as England’s largest employer and to realise its potential for social and economic rejuvenation.

The calls came at a recent webinar, where PPP and ICJ released the latest findings from the ICS Futures roundtable series. The series saw ICS leaders from across the country convened for three Chatham House debates to identify challenges and opportunities in integrated care, to scale best practice and provide ongoing practical advice for system leaders and care providers. The series ended with an open webinar discussing the Next steps for integrated care.

The webinar was held to coincide with ICSs taking statutory footing on July 1st, and was chaired by Matthew Swindells, Joint Chair of West London’s four Acute NHS Trusts & former Deputy Chief Executive of NHS England. Mr Swindells was joined by Dr Penny Dash, Chair, NW London Integrated Care System, Paul Maubach, NHS Midlands’ Strategic Advisor on ICS Collaboration and Laura Stamboulieh, Partner, Strategic Advisory for Montagu Evans.

The role of the NHS

There was a particular focus was on the role of the NHS itself in tackling the wider determinants of health. One lesson from the pandemic that was learnt across the country was the impact of low trust – particularly among more deprived areas of the country. As is well documented, vaccination rates were significantly lower in parts of the country relatively high on the deprivation index, and these sectors of the population tend to have poorer health outcomes more generally.

“Part of the problem is not employing people from those areas”, suggested Paul Maubach, contending that a lack of representation from these areas has contributed to low trust of authorities and public services, healthcare included. It was agreed that choosing to adopt more proactive and inclusive recruitment strategies would align with the wider agenda to address and reverse health inequalities.

The need to differentiate between health inequalities and healthcare inequalities was also a central topic of the session, particularly in view of what the NHS and ICSs can feasibly impact upon. Many drivers of poor health are deeply rooted in socioeconomic trends far outside the purview of health and care professionals, but there is much that can be addressed in the short term with the right focus and the right policies.

For example, one of the greatest drivers of poor health in later life are educational outcomes. In turn, a crucial indicator of lower educational outcomes in the future is poor oral health at the age of two, so ensuring better access to NHS dentistry among more deprived cohorts would allow those more at risk to be identified, engaged, and supported by their local health and care systems, as well as improving access to dental services themselves.

This area of discussion highlighted one crucial, but often overlooked point; that all health and care services are interconnected, and ultimately, are trying to achieve the same outcomes. Part of the role of ICSs, therefore, is to create a culture where all stakeholders collaborate to achieve this shared goal (improving population health).

To this end, Dr Penny Dash argued the importance of those on integrated care boards (ICBs) having clearly delineated areas of responsibility and accountability, to create clarity over how different parts of the system fit together and to ensure that decision making does not become bogged down in bureaucratic hierarchies. “If you can’t answer the question related to your remit, you shouldn’t be at the table.”

The importance of data was emphasised throughout the session – both from a population health management perspective, as well as the effective planning and monitoring of estates and facilities.

It was posited by Laura Stamboulieh that “the role of the estate as an enabler is often overlooked. The ultimate delivery of ICSs will rely on a well-developed health and care estate.” On this point, it was noted that NHS estate planning has evolved little since the introduction of digital healthcare and the increase in remote working. As such, an updated, modernised approach to estate planning will be essential to delivering effective, integrated care, at scale.

Report finds white nurses twice as likely as black and Asian colleagues to be promoted

By Niamh Macdonald

White nurses are twice as likely to be promoted as Black and Asian staff in the NHS, new survey results from the Royal College of Nursing (RCN) show.

According to the RCN, the survey results demonstrate that racism is ‘endemic in health and care’. The UK-wide survey of almost 10,000 nursing staff found that across all age groups, White respondents and those of mixed ethnic background were more likely than Black and Asian colleagues to have received at least one promotion since the start of their career.

The survey, which was published at the annual RCN congress in Glasgow, showed the difference is most stark between those aged 35 to 44. While 66 per cent of White and 64 per cent of respondents from mixed ethnic backgrounds in this age group said they had been promoted, this fell to just 38 per cent of Asian and 35 per cent of Black respondents.

The RCN also said that their biennial employment survey showed structural racism is having a ‘devasting impact’ on minority ethnic nursing staff in other ways.

The survey found that Black respondents working in hospital (39 per cent) and community (32 per cent) settings are more likely to report having experienced physical abuse than respondents of other ethnic backgrounds.

The RCN is calling on the UK government to ‘seize the opportunity of its planned reform of human rights legislation’ to ensure that health and care organisations, regulatory bodies and inspectorates are required by law to tackle racism, including in the workplace.

According to the RCN this could include a legal requirement to eliminate disparities in recruitment, retention and career progression, or a greater responsibility for employers to protect minority ethnic groups.

RCN Diversity and Equalities Co-ordinator Bruno Daniel said: “The pandemic has shone a spotlight on structural racism in health and care services and we must seize this opportunity to stamp out this vile behaviour once and for all.

“The UK government and devolved administrations must properly acknowledge and address this problem and the devastating impact it has on Black and minority ethnic staff and patients.”

Responding to the Royal College of Nursing’s (RCN’s) research, the interim chief executive of NHS Providers, Saffron Cordery said: “As the largest employer of Black, Asian and minority ethnic people in the country, the NHS must recognise and confront the structural racism and discrimination that still exists within its ranks.

“These important findings are the latest in a long string of evidence highlighting the unacceptable presence of structural racism within our health and care system.

“Time after time we see similar findings that show ethnic minority staff face higher levels of discrimination, and are more likely to face bullying, harassment or abuse from patients or colleagues.

“It is only by recognising these facts and having an honest conversation about racism, its structural roots and its impact, that change can be achieved.