Are single-handed GP practices safe?

You may have felt a tremble in the force over earlier this month.   NHS England got its revenge or  perhaps better described as a “premptive cringe”, in early ahead of a BMA strike on the Director of Primary Care at NHS England Dr Arvind Madan.   I am no expert but the BMA (the Doctors Trade Union) is not keen on the closure of small GP practices,  I am sure they will comment below if they’re concerned about my lack of understanding here.

But here is some evidence, there’s not much of it, but it’s pretty clear; if you’re a patient stay away from small GP practices. 

Elaine Kelly and George Stoye published Does GP Practice Size Matter?
GP Practice Size and the Quality of Primary Care in Nov 2014. You can read it for yourself.

Here are a few bullets from the executive summary:

  • Single-handed practices have the lowest average (mean) QOF scores
  • For ACS admissions, there is some evidence that smaller practices perform
    worse, on average, than larger practices and are more likely to be among the worst performing.
  • Practices with three or fewer FTE GPs are less likely to refer their patients for secondary care than larger practices. Single-handed practices are also less likely than larger practices to refer patients for treatment by independent sector providers (ISPs)

So what should you do as a patient, well you can make your own mind up?  I look for the largest practice with the lots of doctors and nurses.

It’s a shame that NHS England felt it could not stand up for patients and those GPs that provide better care.  I’m sure their action is counter to the NHS Constitution Principles 3 and 6, but we don’t hear much of that these days.

 

What’s the point of Health and Wellbeing Boards?

You may have been following the changes to the NHS over the last few years. Or perhaps you are just a user of services, going to your General Practitioner and then to a local hospital. Either way, you should know that your local Council has been given some wide-ranging powers to provide local health and social care services. Who cares? It’s a reasonable response to all of the changes. But there are some things should concern you.

Look at these three data points about health services in England.

  • One in two hundred babies are stillborn in England
  • Young people can wait months to receive mental health services
  • In the UK young men die younger than in just about any other European Country.

in the light of these issues I want to look at what Local Health and Wellbeing Boards are discussing. Using a search engine of your choice, you will quickly find the papers of you local HWB on the internet. And that’s where it pretty much turns to rat shit. The jargon and impenetrable language are there in the first paragraph. Here is the explanation of what the HWB does in Brighton.

The purpose of the Board is to provide system leadership to the health and local authority functions relating to health & wellbeing in Brighton & Hove. It promotes the health and wellbeing of the people in its area through the development of improved and integrated health and social care services.

The HWB is responsible for the co-ordinated delivery of services across adult social care, public health, and health and wellbeing of children and young peoples’ services. This includes decision making in relation to those services within Adult Services, Children’s Services, Public Health and decisions relating to the joint commissioning of children’s and adult social care and health services (s75 agreements).

Are you any the wiser? Perhaps the focus on young people caught your eye.

Reading the Agenda and the Minutes of the meetings won’t help you. They are even more Delphic.

However, the most concerning element for any Public body are the meetings they held in camera. They regularly exclude the public from their discussions.

Members are often keen to show they have no conflict of interests, and it’s usually the first agenda item. But no one seems concerned that as mainly elected officials they are in conflict with their electorate for excluding them. You might also reasonably ask why there are so many doctors and so few nurses as members of your HWB. Perhaps too much interest all round.

So, if you have the time to attend an HWB meeting, go and listen to their arcane discussions, see if you understand what they are doing in your name.

The next meeting here in Brighton is in September. I will be there.

Sepsis – NHS England’s Plan A failed!

Did you notice the rise in cases in Sepsis reported by the NHS? You may know that NHS England has an action plan

Bottom line;  the NHS England plan has not worked.   So I guess we need Plan B.

Here are three things that NHS England could do now:

  • Create a Sepsis Registry – we would then know the extent of the problem. NHS England currently doesn’t have a succinct policy for Registries (perhaps they could get round to that).
  • Adopt the international standards of Sepsis treatment. Making sure the poor primary care practices are called out and addressed. (although you need a Registry to do that).
  • Refer every Sepsis death to a Coroner to investigate.

That should cut the number of entirely avoidable deaths.

 

Who pays for local journalism – we do?

You may have felt a little schadenfreude when you read the $Billion reduction in the value of Facebook. Not unlike the 2008 crash, this money has gone to money heaven, and will probably never reappear.

However, something else is also dying as the Facebook and Google scorched earth policy rips the heart out of the paid-for newspaper advertising revenue. It’s journalism, as the business model of newspapers comes under threat, the newsroom can no longer afford a full roster of journalists.

The effect is both National and Local, but the local impact is much more significant as there is no one else to scrutinise local political and public services.

In New Jersey, the state’s lawmakers will begin to  fund community journalism, and this will include for-profit as well as non-profit groups.

I sadly can’t see this coming to our communities anytime soon; who would be prepared to pay for such a subsidy? It’s a real dilemma, failure to scrutinise local political decision making will lead to poorer decisions. In turn, this will lead to a more significant waste of public money. Undoubtedly more than the cost of the subsidy in the first place.

I think there may be three practical steps we can all take:

  • Find our local news site; it may be a newspaper or a community group, sign up and join the discussion.
  • Attend local Council and Public service meetings and remember to ask a question, how they handle the response may tell you a great about how they feel about scrutiny.
  • Support national and regional newspapers through their subscription services, pay a little to benefit a great deal.

Full-time work – it’s over rated

Full-time work is overrated!  It’s also a recent thing.   It arrived with the industrial revolution, and it will leave hand in hand with one of the many trends weathering the way we work today.

Dan Rasmus looks at these trends in his book Listening to the Future published in 2007, he identified the trends as:

  • One World of business
  • Always on always connected
  • Transparent Organisations
  • Workforce Evolution

By looking back at a book written ten years ago, we can get a sense of its insight.   If you’re in the UK, it predicts and explains, the rise of Amazon, Brexit, the advertising domination of social media, WikiLeaks and millennials in the workforce.

But most of all it predicts the way work has changed from full-time jobs for life into a spectrum of work from the precarious to the fully employed.  The balance of that spectrum for many is heading towards low paid, zero time contracts that define poor job quality.   For a few, it’s the sunlit uplands of work anywhere when they want, and for significant reward.

The leadership challenge of the next ten years to manage the quality of that spectrum of work and make sure that work has an innate quality and provides a respectful and decent living for all.   And the one way to begin redressing the balance is to pay the National Living Wage.

 

 

Mobile Banking and the lack of online security.

I left Barclays Bank PLC after their appalling “Online security” screwed me over. I got my money back, others have been less lucky. I see Dr Ben Goldacre seems to be thrashing NatWest on Twitter for perhaps similar reasons.   My advice is to stay away from all Online Financial Services, they are just too insecure at present.

If you must could I suggest the following top 10 tips:

1. Have a separate Mobile and Number for all your Online Banking apps.
2. Only communicate with your bank using PGP encryption. (they hate it but will put up with it. (Proton Mail is good). Never send anything personal information in the clear to anyone.
3. Use a Monzo card or like for all debit card transactions. Top it up with your Current Account. It makes fraud easy to spot.
4. Use a credit agency (although mine Experian dumped my Creds into the dark web).
5. Use haveibeenpwnd.com
6. Don’t use your Mother’s maiden name as the answer to that question. Change your date of birth and don’t answer any of those “your first” questions with anything that is true.
7. Use complex passwords, all different and secure with a password manager like Dashlane or LastPass. (Don’t be mean pay for a good one ).
8. Turn off all the Google spyware on your mobile and computer, or better still use FireFox Quantum. And if you use Safari then you’re beyond help (not really but Really).
9. Use Kill Disk to rewrite your hard drives or better still never throw one away and if you must throw them away Kill them, then destroy the disc and then chuck it.
10. Do not rely on “Phone Reset” to remove information from your phone when you get a new one.

If you do most of this, I think you have a good chance of not being hacked, scammed, tricked or worked over. And if you think I’m paranoid you need to stay in more and have a look at what the internet knows about your promiscuous online behaviour.

Social Prescribing – what are the practical issues for NHS England

Social prescribing enables GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services.  the KingsFund have a helpful article here
I am the Founder and CEO of BriteLives.  BriteLives is about providing activities and connections that help people avoid the NHS and its expensive statutory services. For us, it’s all about staying fit and well.  If someone does become unwell then, of course, they should go and see someone at their primary care practice.  But there are other options that the NHS could offer and signpost.
A comparison between current models of prescribing and treatment in primary care and how social prescribing might work shows some stark practical challenges.
Let’s take the example of someone feeling depressed, it’s common mental health issue that people feel increasingly able to acknowledge.   A doctor could prescribe antidepressants, (64.7 million were prescribed in 2016, 31million in 2006, that’s106% growth)  in fact, the Pharmaceutical companies profits are predicated on this behaviour.
It’s easy for the GP to do so, the workflow is found in the GP System, the Electronic Prescribing System,  the paperwork of the NHS and its Green Prescriptions forms, the Pharmacy systems and NHS payment systems.  All pretty much automatic and easy for the GP and patient to follow.
But, if the Doctor wanted to refer the patient to a BriteLives service; like a wellbeing course such as  http://www.britelives.com/listings/growing-wellbeing-6-week-course/ (this is a practical course that helps people address their depression without the recourse to drugs).   How might the Doctor go about that?
  • There is no listing of local services in the GP system.
  • No method of auto referral, it’s “not at the touch of a button”.
  • No reporting system telling the service provider someone is on the way
  • Not even a referral letter that can be printed or emailed
  • No Payment method for the service provider.
  • No system to make sure the final payment is only taken on the delivery of the service.
  • No Copayment system should the patient want to do more or add services
  • No way of innovating new ideas such as:
    • A reward split, GP pays £20 for service,
      • £1 goes to GP to encourage use of non-pharma
      • £15 goes to the provider for the service
      • £4 goes to the patient for completing the course (it can be seen as covering transport costs or the like if you don’t like the “bribe” aspect of this)
I believe that NHS England needs to become serious about centring social prescribing care around the individual and the local community. Developing an effective social prescribing policy and strategy would be a good start.  At present, there isn’t one and progress will be slow.

Cyber Security in Healthcare – a primer for the Board.

What should  CEOs and boards understand:

  •  Protection of key information assets is critical
  • How confident is the Board that the hospital’s most important information is being properly managed and is safe from cyber threats?
  • Are you clear that the Board members are likely to be key targets?
  • Does the Board have a full and accurate picture of:
    • The impact on the Hospitals reputation, if the existence of sensitive internal or patient information held by the Hospital were to be lost or stolen?
    • The impact on operational services if our online services were disrupted for a short or sustained period?

Exploring who might compromise information and why

  • Does the Board receive regular intelligence from the Chief Information Officer/Head of Security on who may be targeting hospital information and IT, their methods and their motivations?
  • Do the Board encourage the technical staff to enter into information-sharing exchanges with other organisations in the sector and across the economy to benchmark, learn from others and help identify emerging threats?

Pro-active management of the cyber risk at Board level is critical

  • The cyber security risk impacts public confidence, reputation, culture, staff, information, process control, brand, technology, and finance.  Is the Board confident that:
    • They have identified the key information assets and thoroughly assessed their vulnerability to attack?
    • Responsibility for the cyber risk has been allocated appropriately?
    • Is it on the risk register?
    • Does the Board have a written information security policy in place, which is championed by the Board and supported through regular staff training?
    • Is the Board confident the entire workforce understands and follows it?