Casebook March 2023

Casebook March 2023

Posted: March 13th 2023


In Casebook this time reflections on key challenges facing GPs an primary care, some budget decisions and their likely impact on rural health and care and two very positive stories linked to virtual wards and robots in the operating theatre….In other stuff a bit more information about our latest board members.

Northumberland loses 10 GP practices in a decade

This article points to the scale of the challenge facing primary care providers in rural settings. Read alongside the next article it points to the real malaise in the very sector which offers the greatest hope of sustainable and improved outcomes in rural health and care in rural settings. It tells us:

Northumberland has lost 10 GP practices in the past 10 years, with the number of patients increasing, figures show.

The county currently has 36 practices operating from 61 sites, 10 less than in 2013-14.

The figures, given to Northumberland County Council's Health and Wellbeing Board, show remaining services serve 333,900 patients, an increase of 12,000 since the same period.

They also show 75% of surgeries are more than 30 years old.

A maintenance backlog of £250,000 has also been identified, the information given to Friday's meeting showed, while 68% of surgeries are deemed as too small.

Despite this, board members were told NHS staff across Northumberland were delivering more appointments than before the pandemic.

However, demand has also risen significantly, the Local Democracy Reporting Service said.

The figures were presented as part of a drive to improve patient experience for those accessing primary care in Northumberland.

GPs ‘in crisis’ as one in four fear surgery is in danger of closing

This article takes on the theme of the challenges facing GPs across the piece but particularly strongly in our experience in rural settings. It tells us:

GPs are facing “insurmountable pressures”, experts have said as they warned that the NHS “will not survive” without general practice.

A new report into GP pressures suggests one in four staff fear their practice is in danger of closing because of unmanageable workloads and rising demand.

The document, from the Royal College of GPs (RCGP), says general practice is “in crisis”, and makes a series of calls to help ease pressures and stop the growing number of GPs from quitting.

Speaking to PA, RCGP chair Professor Kamila Hawthorne said the situation on the ground is so intense that GPs themselves are requiring care for stress.

“I’ve certainly heard of colleagues of mine becoming so stressed during their days of work that they’re developing chest pain and needing to be seen themselves,” she said.

“If you’re seeing 40 to 60 patients a day and making that number of clinical decisions, it is extremely stressful and worrying because each one of those clinical decisions is important.”

A previous RCGP poll of GPs found that 39% were seriously considering leaving the profession within the next five years. This could mean more than 22,000 GPs leaving the workforce, the college has previously estimated.

In the latest poll, 27% of 2,649 UK general practice staff surveyed by the RCGP between December and January said their practice was at risk of closing.

Nine in 10 of this group said the reasons were unmanageable workload and rising demand, while others expressed concerns about staff leaving the sector.

Lincoln surgery robot treats 270 patients in first year

I’ve tried to capture some more positive news in the next three stories. This article highlights the fabulous outcomes which can be achieved with robot surgery, through the lens of an acute trust serving a large rural population.

More than 270 people have benefitted from a new £3.2m robotic surgery system introduced in Lincoln a year ago.

The arrival of the equipment at Lincoln County Hospital has meant urology and colorectal cancer patients can receive treatment sooner and closer to home.

Consultant urologist Aris Alevizopoulos said the system provided "equal if not better outcomes" to traditional surgical techniques.

He said he hoped it could be used to treat even more patients in future.

The system mimics the hand movements of a surgeon as they operate a console linked to the robot, enabling them to perform delicate procedures through the smallest of incisions.

United Lincolnshire Hospitals NHS Trust said, on average, patients who undergo robotic surgery are expected to "go home earlier and have a faster recovery".

Mr Alevizopoulos said: "As a result of this new service, our patients have been able to access their care in a more timely manner and closer to home, with equal if not better outcomes.

"For cancer patients, apart from the expertise, and the level of training of our surgeons and theatre staff, time efficiency is equally important."

Hunt likely to save spending spree for polling day, not budget speech

The budget will undoubtedly have an impact on rural health and care and this snippet from the Guardian reveals new action on pension tax which could impact on workforce issues in the NHS. We also know that issues such as heating costs and pay rises have an indirect impact on the health and well-being of rural dwellers and measures linked to them are profiled here.

Business and consumer groups want a short-term extension of support for energy bills, to cover the period before the fall in wholesale prices starts to feed through. They also want the chancellor to ease planned increases in tax, and especially corporation tax, which they say will limit investment.

Public sector workers have demanded a pay rise above the 3.5% Hunt has budgeted for, and households more generally will want an extension of the energy price guarantee at its current level until July, especially now that it will cost the government less than £3bn.

Hunt is expected to offer some giveaways, including cash for childcare schemes, and a cut in pension tax for the better-off has also been signalled, which pension experts describe as a clumsy effort to prevent GPs and surgeons nearing retirement from quitting the health service.

More than 100,000 treated on ‘virtual wards’

The concept of virtual wards enabling people, particularly in a rural milieu to live independently at home for longer is really important and evidence of the success of the concept is profiled in this article.

More than 100,000 patients, including children, have been treated in so-called virtual wards over the last year, NHS officials have said.

Leading medics said that the use of the system to monitor patients at home has been a “real game changer”.

Officials say virtual wards can help patients avoid unnecessary hospital trips altogether, or enable them to be sent home from hospital sooner.

A virtual “ward round” can involve in-person visits or video consultations with clinicians from various specialities, who can provide a range of tests and treatments – including blood tests, prescribing medication or administering fluids through an intravenous drip.

The initiative is a key part of NHS plans to recover services after the pandemic – and the NHS eventually aims to have 50,000 people treated on virtual wards every month.

Other Stuff

The National Centre has recently recruited a number of new Directors and whilst you can read about their credentials in detail on our website I thought you might find it interesting to see a high level description of them here:

Nikki Cooke (Chief Executive Officer, LIVES)

Nikki Cooke is the Chief Executive of Lincolnshire-based emergency response charity LIVES.  Originally from New Zealand, Nikki has a broad background in the private and VCSE sectors and has worked in the NHS.

Professor Mark Gussy (Global Professor in Rural Health and Social Care)

Mark's research and professional activity is about making significant contributions to the evidence base for oral health and its interface with general health and wellbeing with particular emphasis on vulnerable and marginalised people. Professor Gussy has experience and academic success that transcends professional boundaries and is now firmly located in transdisciplinary action and rural and community-centred health.

Andrew Dickenson (Chief Dental Officer for Wales)

As a clinician Andrew holds dual qualifications in dentistry and medicine. He undertook postgraduate surgical training across the North East of England and the Midlands regions. In 2003 he became a consultant in oral and maxillofacial surgery. He has worked in medical and dental education, joining Health Education England as Dean of Postgraduate Education in 2014. Andrew holds a visiting professorship in health and social care at the University of Chester.

Mark Cooke (Regional Director of Strategy and Transformation, NHSEI South West)

Mark is a CIPFA accountant. In the 1990’s Mark was involved in establishing NHS Trusts. He moved Heartlands NHS Trust in Birmingham as Deputy Finance Director, ultimately becoming its Finance Director and Director of Strategy. He subsequently moved to the Birmingham and Solihull Mental Health Trust as Deputy CEO and CFO. His first Chief Executive post oversaw the merger of two PCTs in Dudley where he also chaired the Dudley Local Strategic Partnership. He also chaired various West Midland Specialised Commissioning Groups and hosted the West Midlands Commissioning Business Support Agency. He chaired the West Midlands HFMA in 2002 and was the first Chair of the HFMA Mental Health FD Network.