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Many doctors’ surgeries now employ a Clinical Pharmacist to help the GPs and patients manage their medicines better. Clinical Pharmacists have studied for a minimum of 5 years and are experts in medicines. They work as part of the practice team and may also run clinics to review medicines with patients to help them to manage their conditions. Many of these clinical practice based pharmacists are also qualified to write prescriptions.

The Patients Association and the Primary Care Pharmacy Association are keen to hear the views of patients and carers on the emerging role of Clinical pharmacists in doctors’ surgeries. We are asking for your views and experience of clinical pharmacists who are working in doctors’ surgery as part of the practice team.

Please fill out our latest survey by clicking here.
Helpline case: Fighting for his mother’s care

You may have read that medical staff have placed "do not resuscitate" (DNAR) orders on thousands of patients in England without telling their families. According to a study by The Royal College of Physicians released this week, one in five families was not consulted when doctors had decided not to revive their relative.

A DNAR form is a document that instructs a medical team not to attempt to resuscitate a patient. The form is designed to be easily recognised and verifiable, allowing healthcare professionals to make prompt decisions about treatment. Normally, a DNAR form will only be added to medical records after a consultation between a patient and the healthcare team.

Our helpline recently heard of a particular case surrounding DNAR. Mr R called us, regarding his mother who was situated in a care home. Mr R had only discovered that his mother was issued with a DNAR form after she had a mini-stroke and a different doctor attended. Mr R was extremely upset with the health professionals, as they had not consulted him about the DNAR. In addition, Mr R had a Lasting Power of Attorney (LPA) over his mother, so they had a legal duty to consult with him. It seems understandable why he was disappointed with the health officials.

A lasting power of attorney (LPA) is a way of giving someone you trust the legal authority to make decisions on your behalf if you lack mental capacity at some time in the future, or no longer wish to make decisions for yourself. In Mr R’s case, he had a LPA, and thus should’ve been consulted with on this matter.

Of particular concern in Mr R’s story was that the stated reason for the DNAR was due to ‘underlying health problems prevent resuscitation’, as shown on the form. However, according to Mr R this was not the case with his mother.

Mr R called our Helpline to discuss his options with regards to his case. Our advisor listened to Mr R and with careful consideration explained the various steps he could take in the complaints process. Mr R is now currently going through the complaints process, as advised by our Helpline, and we will be supporting him if he needs further guidance and support.
New report shows the full scale of GP crisis

New research from The King’s Fund released this week has exposed the full extent of the crisis in general practice. The report argued that the Department of Health and NHS England have consistently failed to collect national data that could have anticipated the crisis.

The report analysed 30 million patient contacts from 177 practices and found that the overall number of consultations (face-to-face and telephone) has increased by 15% over the past five years (three times the rate of increase in the number of GPs). It shows that GP workloads have become more complex and intense, including a 13% rise in face-to-face consultations and 63% more telephone consultations. There was also large increase in patients aged over 85 (up 28%), who are more likely to have more than one chronic condition.

The report also underlined the scale of the GP recruitment and retention crisis, finding less full-time GPs, regardless of their gender. The report found that only 1 in 10 new GP trainees plan to be working full time by five years after qualifying. GPs are also retiring earlier – 46% were under 50.

Sadly these statistics are not surprising to us. The picture they paint is one that the Patients Association has seen time and time again. The drive for the public to be treated in the community has placed great pressures on the GP workforce and the allied professions. The Government must now address workforce planning.

This latest report backs up our view that increased life expectancy means that GPs often see patients suffering from complex morbidities which require increased time and treatment. A shortage of full-time GPs, coupled with greater demands on their time as a result of an ageing population, means that the deterioration of patient care will only continue.

We have received an increasing number of calls to our National Helpline about the level of care patients are getting from their GPs, with many patients unable to even access primary care services. It is vital that efforts are now made to train and retain more GPs in the UK. However recent indications suggest that the Government will achieve less than half of its target of 5,000 GPs by 2020.

With fewer GPs going into the profession; many UK-based GPs looking to work abroad, working part-time, and taking early retirement in the next five years, this must ring alarm bells. As demand for GP services increases, funding must be made available to give patients access to the standard of primary care that they need.

The only casualty is the patient. There is an urgent need to look at the provision of NHS care in a joined up way and ensure that the patient comes first in every decision made. A tipping point has now been reached in primary care. The Patients Association calls on the Government to read this report and recognise and respond to the factors which have led to this crisis.
Tackling healthcare infections cannot wait

England is a world leader in the fight against healthcare acquired infections (HCAIs) but still around 300,000 people develop an infection while being cared for within the NHS in England annually. 

It's time for swift and radical action on healthcare acquired infections, writes Katherine Murphy, chief executive of the Patients Association in the new 2016 Patient Safety Campaign published in The Guardian newspaper and online.

The Patients Association has campaigned on HCAIs for many years and has recently been the focus of the our APPG for Patient Safety, which is to meet next Monday 9th May at Portcullis House in Parliament. This will be the final session of the inquiry into infection prevention and antimicrobial resistance.

Mandie Lavin, Trustee at the Patients Association said: “Patients need to know more about antimicrobial resistance. Information and guidance is key and awareness of infections needs to be at forefront of our minds. We are now seeing some very alarming figures in terms of HCAI rates, and not all occurrences are yet recorded.  As a patient where do you go to find out about these infections? If you look up some of these HAIs on the internet the information is all a bit of a maze. It is very difficult when you are patient: they do not know where to look, or what information is out there. This is a topic that still needs greater public awareness.”

Back in October the Patients Association started our inquiry into infection prevention and control. Through our APPG we have heard from some excellent speakers. We are excited to read our final papers, including from Dr Dakshika Jeyaratnam of King’s College Hospital, which will be discussed at our upcoming meeting. We will then review all the papers and come up with a set of recommendations – to professionals, to Government and to the public. What this space.
Appointment of Chief Guardian for Whistle-Blowers Moves a Step Closer

The Public Inquiry into the Mid Staffordshire NHS Foundation Trust, led by our President Sir Robert Francis QC, exposed unacceptable levels of patient care and a culture that deterred staff from raising concerns. This led to Sir Robert’s ‘Freedom To Speak Up’ review, an independent review of how whistle-blowers are treated in the NHS published in February 2015.

The findings of Sir Robert’s report highlighted the shocking fact that NHS staff were still afraid to speak up about poor care and dangerous practices. Furthermore, those who did speak up are often ignored, bullied and even dismissed from their jobs for doing so. Each time someone is deterred from speaking up, an opportunity is lost to improve patient safety.
The report highlighted how important it is for every part of the NHS to develop a culture in which all staff are positively encouraged to raise issues about safety, quality and effectiveness of the service, and supported when they do so. In July 2015, the Secretary of State confirmed the steps that need to be taken to develop a culture of safety, including the appointment of a national guardian and a local guardian in every Trust.

The review also recommended the appointment of a National Guardian, to promote and reinforce best practice in supporting staff to speak up safely through a network of Freedom To Speak Up Guardians. Following consultation, the Department of Health 2016/17 contract with NHS Trusts and NHS Foundation Trusts in England included the provision to nominate a Freedom To Speak Up Guardian in every Trust by 1 October 2016.
High quality safe care that maintains dignity for patients should be the fundamental principle of care provision in the NHS. The Patients Association has frequently called for an open, honest and transparent culture within the NHS where patients and healthcare workers have a partnership based upon trust. Each and every individual in the NHS must take personal responsibility to ensure that no harm is done to patients in their care. Where they do have concerns, they must have the confidence to be able to speak up and report issues without fear. Unless the NHS supports its staff in difficult times, we will continue to lose committed enthusiastic hard-working frontline staff.

The Patients Association has repeatedly called for change from a ‘who to blame’ culture to a ‘what can we learn’ culture. Creating such a change requires firm leadership and management at all levels, with a system in place where individuals and organisations can learn from their mistakes. There needs to be a consistent approach across the whole of the NHS, with a coordinated response to handling complaints and concerns. These are the principles that we have called for in the past. NHS leaders must invest in adequate training and build competence and confidence in their staff. An NHS that doesn’t value its staff doesn’t value its patients.

The Care Quality Commission (CQC) has just written to NHS employers, updating them on the progress of the establishment of the national guardian's office and key priorities over the coming months. The National Guardian’s Office is providing support for the process of appointing FTSU guardians. Recruitment of the national guardian is also underway, with adverts now out in the national press, and interviews expected in June.
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About Us

The Patients Association’s motto is ‘Listening to Patients, Speaking up for Change’. This motto is the basis on which we build all our campaigns. Via our Helpline, we capture stories about Healthcare from over thousands of patients, family members and carers every year. We use this knowledge to campaign for real improvements to health and social care services across the UK.
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