News
Vital support for GPs to help patients into work The RCGP has been awarded a £1million contract by the Department for Work and Pensions to provide vital support to doctors managing patients with work and health issues to help those patients remain in or return to work. The funding will be used to roll out a National Education Programme of half-day workshops around the country to help GPs increase their knowledge, skills and confidence in dealing with clinical issues relating to work and health. The workshops will be interactive and offer recent evidence about work and health – along with skills and strategies for managing difficult consultations. Chaired by a local leader and delivered by an RCGP-trained GP and specialist Occupational Health Physician, the National Education Programme begins this month and will be rolled out across Great Britain. Around 100 -150 workshops will be delivered over a two-year period with the aim of providing training and support for between 3,000 and 4,500 GPs.
Why it matters There is considerable evidence that returning to work is highly beneficial for the health and wellbeing of patients. Long-term unemployment leads to poorer health and increased inequalities and, after two years on benefits, an individual is more likely to retire or die than return to work. The effects are widespread – evidence suggests that children in families where neither parent has worked for the past six months are more likely to suffer poor health and reduced wellbeing. As well as the personal and social cost, unemployment caused by ill health also impacts on the wider economy and taxpayer in the form of benefits, healthcare and reduced tax revenue. Many patients require active support to be able to return to work and for the majority, their local GP is the trusted first point of contact. But for GPs, such consultations can be challenging and research suggests that many feel
they lack the confidence and specific skills for managing work and health related consultations – issues that the workshops are specifically designed to address.
Background to the programme The National Education Programme is the culmination of a three-year collaboration between the RCGP and the DWP after the RCGP submitted a proposal for an education programme to drive up professional standards in the area of health and work. The scheme was piloted extensively throughout 2007, with workshop content developed and presented by Professor Sayeed Khan and Dr Debbie Cohen. Evaluation by the Department for Work and Pensions was extremely positive, leading to the commitment to a wider rollout. The role of the RCGP has since been expanded to include delivery of the entire project, including content development, trainer training and quality assurance. The programme builds on earlier work by the RCGP, including a joint publication The Health and Work Handbook with the Faculty of Occupational Medicine and the Society of Occupational Medicine. RCGP Chairman Steve Field said: “This is a major boost for the College and for GPs. Tackling health inequalities is a major priority for us and helping people to remain in or return to employment is clearly one of the best ways of improving the mental, physical and economic well-being of our patients. “However, helping patients return to work can put GPs in a difficult and stressful situation and many GPs worry about consultations on this issue. The National Education Programme
will remove many of the anxieties and concerns by giving GPs increased confidence to approach and deal with difficult situations and to make the best decisions for patients in the long term. “As it has been developed by GPs for GPs, those attending the workshops can be confident that it will be time well spent and that they will come away with effective strategies for dealing with work-related issues that they can then share among other members of the primary care team. “My thanks go to our Fellows Professor Nigel Sparrow, Professor Sayeed Khan, Dr Debbie Cohen and the RCGP team who have developed this work. It is great to see College members taking the initiative and creating innovative programmes that support GPs and improve the lives of patients at the same time. “I am also extremely grateful to the Department for Work and Pensions for having the foresight to recognise our concerns on this issue and for its commitment to working with and supporting GPs in finding a solution.”
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Professor Steve Field
MAY 2009
Inside this issue... Election success
RCGP announces new Hon Sec and Trustee Board
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A NICE result GPs trounce competition in QOF indicators bid
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A question of ethics Professor Martin Marshall on his aspirations for general practice
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Inquiry into Quality The King’s Fund spells out what it will mean for GPs
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Log on for Learning New e-learning packages go live
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GPs and the CQC Baroness Young on the role of the new Care Quality Commission
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A lasting tribute New RCGP award celebrates the life and work of Dr Kathy Phipps
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Annual National Primary Care Conference 2009
Excellence in Practice Winning ways for primary care
5-7 November Scottish Exhibition & Conference Centre, Glasgow
ady e r t e G for !
ARE YOU READY FOR REVALIDATION?
n idatio l a v e R
Don’t miss the opportunity to attend this year’s conference and learn more about the College’s role in Revalidation, the development and delivery of the system, as well as key timelines and requirements. The keynote address by RCGP Chairman, Professor Steve Field, 'Excellence through Revalidation' will highlight how Revalidation requires a commitment by all to improve the quality of care for our patients.
Helping patients return to ❛ work can put GPs in a difficult and stressful situation... This programme will remove many of the concerns by giving GPs increased confidence to deal with difficult situations and to make the best decisions for patients in the long term
THE NEWSPAPER OF THE ROYAL COLLEGE OF GENERAL PRACTITIONERS
Delegates will also learn about enhanced appraisal - what it means for GPs, what is required of GPs and support available from your PCT.
Register now and save ££££’s by booking before 27 July 2009 For further details or to register please visit www.rcgpannualconference.org.uk or contact conference organisers, Profile Productions Ltd, on 020 8832 7311 or email: rcgp@profileproductions.co.uk Principal sponsor
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COLLEGE NEWS
Howe is new Honorary Secretary Professor Amanda Howe has been elected RCGP Assistant Honorary Secretary, succeeding Dr Maureen Baker as Honorary Secretary when she steps down in November after ten years service. Professor Howe practises at the Bowthorpe Medical Centre in Norwich and has been Professor of Primary Care at the University of East Anglia since 2001. She has a strong interest in promoting research in general practice and chaired the RCGP Research Group for six years. Her other interests include medical education, primary care mental health and policy evaluation in primary care. She has been a College member since 1983 and a Fellow since 1997.
Following a separate election, Professor Mike Pringle has been appointed as Chair of the newly-established RCGP Trustee Board that will comprise Professor Scott Brown, Professor Jacky Hayden and Dr Helena McKeown. Arrangements are currently in hand to identify the Lay members of the Board. ■ You can hear Professor Howe deliver the William Pickles Lecture Family Practice – Meanings for Modern Times at the RCGP Spring meeting at the Royal Geographical Society on Friday 15 May from 6-8pm. The evening is open free of charge to all RCGP Members and Fellows, and also includes Awards and Fellowship presentations followed by a reception back at the College. Contact cmessent@rcgp.org.uk for further details.
The winning team at last year’s award presentation at the College
Double top for research team Triumphant authors of last year’s RCGP Research Paper of the Year have made it the double with a prestigious award from the British Medical Journal.
Professor Howe becomes RCGP Honorary Secretary in November
GPs victorious in NICE bid on QOF indicators A team led by GP academics and the RCGP has won a major contract from NICE to review and develop indicators for the Quality and Outcome Framework (QOF). The RCGP joined forces with Professor Helen Lester from the National Primary Care Research and Development Centre (NPCRDC) and the York Health Economics Consortium (YHEC) to compete against external management consultants and international companies. The successful bid proposed a rigorous and transparent system for creating new quality indicators. It will include extensive piloting and will take the views of GPs and patients into account. The team will also lead a review of existing indicators. Professor Lester said: “We are delighted to be working with NICE and hope we can encourage an evidence-based approach, not only to the content of the indicators themselves, but to the development and review process. “We can now ensure that new indicators make sense to primary care practitioners and ensure unintended consequences are spotted and addressed before a national roll-out. We hope our involvement will ensure the UK stays at the vanguard of pay for performance in primary care. ” RCGP Chairman Professor Steve Field – who was interviewed along with Professor Lester and Ailsa Donnelly, Chair of the RCGP Patient Partnership Group – said: “This is an outstanding achievement and the RCGP is delighted to have had a role in the success of Professor Lester and her team. GPs are best placed to
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make decisions that will benefit patients and deliver effective healthcare and the fact that NICE has acknowledged this is a major boost for GPs and their teams. “With GPs leading this process – in consultation with other GPs and patients – the profession can have real confidence that the indicators will be relevant and appropriate, that they will be properly piloted, and that the end result will be a major step forward in driving up standards of care for all our patients.” Researchers at NPCRDC have been developing, implementing and evaluating quality indicators since the mid-1990s. During the past 12 months the bid team has tested a number of new clinical indicators in various practices across England, and will now recruit up to 120 practices across England to pilot the new indicators. NICE has also announced the appointment of RCGP Honorary Treasurer Dr Colin Hunter as Chairman of the independent QOF indicator advisory committee. Dr Hunter, who was involved in the original development of QOF, said he was delighted to be involved again with the review of evidence for QOF. “There is now emerging evidence that this framework is delivering better outcomes for patients and I am committed to ensuring an independent fair and transparent process of review prior to the submission to the negotiations between GPC and NHS employers. “The Advisory Committee will work hard to ensure that reviews are based on good evidence of clinical and cost effectiveness and will positively impact on patient care whilst having minimal impact on the interaction between clinician and patient which is the cornerstone of high quality primary care in the UK,” he said.
Lead author Frank Sullivan and colleagues from the Scottish School of Primary Care received the BMJ Research Paper of the Year Award for their paper on managing Bell’s palsy. The competition was open to all disciplines and all journals in any country. Domhnall MacAuley, Primary Care Editor at the BMJ, who shortlisted the paper said: “This is a great win that reflects well on the entire primary care community. The authors should be thanked for putting primary care in the spotlight at this prestigious event.” RCGP Chairman Professor Steve Field said: “This is an incredible boost for general practice research in the UK. The paper is a shining example of the level of scientific excellence that can be achieved and to have it recognised by an external journal of the renown of the BMJ is a major coup.” Originally published in the New England Journal of Medicine, the study was authored by researchers from the Universities of Dundee, Glasgow, Aberdeen, Edinburgh and St John’s Hospital in Livingston and found that early treat-
ment with prednisolone significantly improves the chances of complete recovery. It won praise from last year’s RCGP Research Paper of the Year Award judging panel for giving GPs “reliable guidance for the first time on how Bell’s palsy should be managed.” Professor Greg Rubin, who chaired the panel, said at the time: “Therapeutic studies of uncommon acute conditions are particularly difficult to undertake, and the authors succeeded with a very rigorous study, giving clinicians reliable guidance for the first time on how Bell’s palsy should be managed. This is particularly important for a condition that usually is presented first to the GP, who has to make an immediate decision on management. “ Now in its 13th year, the Research Paper of the Year, sponsored by Merck Sharp and Dohme Limited, recognises an exceptional piece of original research relating to general practice or primary care that has been published in a peer reviewed journal during the preceding year. ■ Early treatment with prednisolone or acyclovir in Bell’s palsy can be downloaded from the New England Journal of Medicine website at content.nejm.org/cgi/content/ short/357/16/1598 Further information on the Research Paper of the Year Award can be found at www.rcgp.org.uk/research
CIRC UPDATE... SFB announces rise in funding awards The Scientific Foundation Board has announced an increase in its grant awards from £10,000 to a maximum of £20,000 per study. The Board’s objective is to support high quality primary care research studies and increase research skills in general practice. This substantial increase recognises the rising costs of undertaking research to a high standard. SFB awards grants for research projects whose findings will be of direct relevance to the care of patients in the general practice setting. Any GP, primary health care professional or university based researcher may apply for a grant Dr Agnelo Fernandes presents the Out for scientific research to be undertaken in the UK – it could of Hours Clinical Audit Toolkit at kick start a distinguished research career. The deadline is Integrated Healthcare conference 30 June 2009. ■ For more information, visit the RCGP Clinical Innovation and Research Centre(CIRC) website: www.rcgp.org.uk/circ
Integrated Healthcare Adastra Conference 2009 Dr Agnelo Fernandes, the RCGP Clinical Champion for Urgent and Emergency Care, will present the Out of Hours Clinical Audit Toolkit at the Adastra Integrated Healthcare conference at the Cotswold Water Park Hotel, on 20 - 21 May 2009. ■ For further information, visit the Adastra conference website: www.adastra.co.uk
The fifth Gold Standards Framework Conference Professor Keri Thomas, the RCGP Clinical Champion for Palliative and End of Life Care, is encouraging RCGP members and anyone working or interested in palliative care to sign up for the fifth national annual GSF Conference in Birmingham on 30 June 2009. Speakers include Professor Mike Richards National Director for Cancer and End of Life Care Department of Health; Dr David Colin Thomé, National Director for Primary Care, Department of Health; and Karen Taylor, Director of Health Value for Money Studies, National Audit Office. RCGP NEWS • MAY 2009
PROFILE
Ethical considerations: The Marshall plan for the future T
O SAY THAT Professor Martin Marshall enjoys variety in his job would be an understatement. Currently Director of Clinical Quality at independent charity The Health Foundation and a part-time GP in London, his career portfolio spans academia, research and even a two-year stint as Deputy Chief Medical Officer at the Department of Health. Now he’s adding RCGP Chair of Ethics to the list and is on a mission to make the Committee’s work more relevant to the work of jobbing GPs. Surprisingly, he says he has never had a grand plan – just been open to opportunities as they have arisen Growing up in a non-medical family in the West Country, he developed an early interest in biology – honed by dissecting animals and insects in the garden – which led to studying medicine in London. “I knew I didn’t want to be a surgeon but other than that I wasn’t sure. At medical school I enjoyed every speciality that I did but I didn’t find the nature of medical school learning particularly exciting and I found the hospital system to be very hierarchical. I also quickly realised that I was more interested in people than diseases.” A two-week GP attachment at a small practice in Marlborough during his fourth year made up his mind. “It was a fifth generation family practice and I felt such a sense of community and an amazing sense of history. My trainer, the youngest member of the family, had tried to break the mould but all in vain after a patient told him ‘your grandfather brought me into the world, your father saw me grow up and I want to die with you looking after me’.” On completing his training on the Exeter VTS, he secured a part-time partnership in Exeter so that he could combine his clinical work with other challenges. As with most of his career turns, Martin fell into research almost by default. An undergraduate degree in immunology had not stimulated an interest in biomedical research but undertaking a social science Masters degree did give him a buzz for socially based research involving ‘real people’. After completing a doctoral degree at the University of London, he made the decision to pursue a more formal clinical academic career, a path he would encourage other young GPs to follow. “I have enormous respect for full-time GPs but I suspect that I would risk burning out and I found that having another string to my bow was both healthy and empowering. Many GPs think that research is not for them but I find it gives you a different perspective on life. As well as the intellectual stimulation you get from developing new knowledge and contributing to the evidence base, it allows time for thought that you just don’t get in busy clinical practice. I am sure this has made me a better clinician in the long run. “I get concerned when I occasionally hear anti-intellectual views from my colleagues. Developing the evidence base for our discipline is key to its ongoing success” Working as a senior lecturer in Exeter, Martin was awarded a Harkness Fellowship in Health Policy in 1998 to study at the renowned RAND Corporation in Santa Monica which “really opened my eyes to policy research in the field of quality of care”. In 1999, he moved to the top academic post at the National Primary Care Research and Development Centre at the University of Manchester,
RCGP NEWS • MAY 2009
Professor Martin Marshall, RCGP Chair of Ethics, may not have planned his wide-ranging career to date, but he has definite ideas on the way ahead for the College, GPs and healthcare in general helping to cement the reputation it continues to enjoy today as the country’s leading academic centre for primary care health policy research. After seven years, his desire to make a practical contribution to policy development led him to Whitehall where he spent the next two years as Deputy Chief Medical Officer and Director General with responsibility for clinical quality and safety and medical education. “Everyone tells you what working in government is going to be like but nothing prepares you properly and it was a very steep learning curve. “Someone once described the Department as being structured like a hierarchy but run like a fiefdom and I think that pretty much sums it up. It was a combination of being really exciting and
extremely frustrating but I worked with some incredibly bright, hard working and committed people.” Somewhat surprisingly, he claims he rarely heard a critical word about general practice during his entire time there. “People working in Government have a lot more respect for GPs than you might think. They may not fully understand the role of the GP but they do appreciate the importance of the clinical generalist and they certainly understand how popular they are with the public. That is why so many policies explicitly put GPs right at the centre. “My time at the Department was a great experience and I’m pleased I did it, but I must say that I prefer working in an environment where
GPs have got to become more outward looking... We can ❛ either be disillusioned with the system or we can help to improve it. Those GPs who want to keep on working solely as clinicians must at least show support to their colleagues who want to shape the future of general practice...
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you have greater control over what you want to achieve.” His latest role at The Health Foundation delivers just that. With a £27m budget and a core staff of 58, it straddles the clinical, policy and academic worlds and acts as a ‘catalyst’ for delivering frontline improvements for patients. He keeps up his clinical practice half a day a week at a practice in South London. “It’s only a small amount but it keeps me in touch with the realities of patient care. I may have grand thoughts in my Health Foundation office but this keeps me grounded and I enjoy it enormously.” He has also been recently appointed as a Commissioner for the new Care Quality Commission, the new health and social care regulator. “It is really important to have a GP voice at the table of regulation. Seeing regulation as a lever for improvement seems to have bypassed general practice and we need to influence how this is addressed in the coming years.” Always an active College member – he has served on various RCGP Faculty boards depending on where he’s been based in the country – he is delighted to be back at the centre of College life, both as Chair of Ethics and as a Member of Council. “I have always admired the work that the College does in leading the profession and on setting standards and I’m looking forward to making a more active contribution. “I want to make the work of the Ethics Committee less prosaic and more relevant, as well as giving our members an opportunity to contribute to the big ethical debates. As GPs, we are making value judgements all day every day. Ethics is central to everything we do, whether it’s prescribing the contraceptive pill to someone who’s under 16 or making a decision on prioritisation.” He is also on a wider crusade to encourage GPs to show greater leadership in shaping the future of healthcare and wider society, making a compelling and powerful argument in his James Mackenzie lecture at the College’s most recent AGM. (www.rcgp.org.uk/pdf/bjgp_09_Marshall_ MackenzieLecture.pdf) “I’m not just an insider absolutely committed to general practice, I’m also a critical friend of the discipline, and I can look at general practice from the different perspectives of Government, other health professions and the media. “I purposely set out (in my lecture) to challenge some of the core beliefs of general practice – the focus on the individual patient, continuity of care – in the hope that it would catalyse and stimulate debate. I don’t profess to have the answers but I do think we need to think carefully about where we are as a discipline. “GPs have got to become more outward looking. We all have our frustrations and it’s easy to sit back and criticise, rather than helping to mould the policies of the future. “I appreciate that it’s not always easy, especially if you don’t understand the policy-making environment and how it works but we can either be disillusioned by the system or we can help improve it. Those GPs who want to keep on working solely as clinicians and don’t want to take on an extended role must at least show support to their colleagues who want to shape the future of general practice. “I’m excited about the future of general practice. The reputation of the College is going up and up; it was a major driving force in the Darzi review and is fighting important battles on behalf of the profession. The RCGP has a key role in moulding our future and I want to ensure that this role is maximised.”
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NEWS
The King’s Fund inquiry into the quality of general practice in England Dr Nick Goodwin Senior Fellow, The King’s Fund EVER SINCE Lord Darzi published his review of the NHS last year the quality of care that patients receive has been top of the health agenda. But despite the introduction of the Quality and Outcomes Framework, the majority of the focus on quality has been concentrated on hospital services rather than general practice. This is despite the fact that GPs, nurses and other health staff carry out nearly 300 million general practice consultations a year – around 90 per cent of all patient contact with the health service takes place in primary care. Lord Darzi’s Next Stage Review did include a Primary Care review and was right to put quality centre stage but the time has now come to bring general practice more into the picture. Already GPs are coming under greater scrutiny – all 8,500 practices in England will be required to register with the Care Quality Commission by 2011; while every family doctor will have to be relicensed and recertified every five years from 2010. At the same time, the expectations of both patients and those who commission services are changing. GPs and others are having to respond to the demand for greater transparency and for information on the quality of services they provide. Despite this, there is little information to enable useful comparisons between the quality of care delivered in different practices in some core areas of general practice, such as patients’ access to care, diagnosing illness, referring patients to specialists and issuing prescriptions. What we do know is that the overall quality of general practice has improved over the last few years. Many GPs up and down the country are delivering outstanding care. But we also know that good care is not universal – there are unexplained variations in the quality of services provided. However, other than the Quality and Outcomes Framework that has led to measurable improvements in care quality in many practices, there are otherwise few measures of what goodquality care looks like for many of the core general practice services that patients receive. The absence of standard measures in many of these areas has led The King’s Fund to commission a major 18-month inquiry into the quality of general practice in England. Our focus is specifically on general practice in England but we believe it will have resonance and relevance elsewhere in the UK and indeed in other systems where they are committed to developing high-quality primary care. To conduct the inquiry we have brought together an expert panel consisting of leading figures within general practice under the chairmanship of Niall Dickson, The King’s Fund’s Chief Executive. They will oversee the inquiry and provide invaluable insight. We are delighted that Professor Steve Field, chair of the RCGP, has agreed to play such a pivotal role on our expert panel alongside other
Niall Dickson, Chief Executive of The King’s Fund, will chair the inquiry
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❛ This inquiry will not be
another stick with which to beat the medical profession... We see this as an opportunity for GPs and other primary care clinicians to lead and influence the debate on quality which for too long has been dominated by secondary care
❜Dr Nick Goodwin
practising GPs, such as Dr Michael Dixon, chair of the NHS Alliance. The first phase of the inquiry has been to commission ten research projects on important dimensions of quality that define the core activities performed in general practice. This includes such fundamental elements as the quality of diagnosis, treatment, prescribing and referral that can dictate the patient’s experience and may determine whether or not their health improves, yet for which there are no standard quality measures. Other research studies will examine the quality in the management of people with long-term conditions; of ill-health prevention and health improvement; and of care continuity – all important aspects of care delivery but where the precise roles and boundaries of the contribution of general practice remain unclear. One of the major objectives of the inquiry, therefore, will be to help identify the most appropriate role for general practice in enabling the delivery of good-quality patient care. Each research project has three core objectives: ● to determine what good-quality care looks like ● to define the role of GPs and general practice in the delivery of good quality care ● to understand how such care can be measured Research projects will also present information on what is currently known about the quality of care in their particular area; how this varies across the country; and the extent to which this reflects good quality care. Our aim from this research phase is to produce a range of measures that can be used to compare and assess the quality of patient care in different practices. Our ambition is to enable GPs, commissioners who buy their services, and regulators to assess how well practices are doing and to drive improvements. Developing meaningful quality metrics for primary care for the first time could represent a major landmark in the move to improve the quality of care patients receive in general practice. However, we recognise that some aspects of care can be measured with greater validity and reliability than others and that there are conceptual and practical problems to overcome when using quality indicators to lever improvements. However, what we are clear about is that this will not be another stick with which to beat the medical profession. Primarily, this will be about helping GPs and other practice staff lead the way in discussing how they measure the quality of care they provide. We see this as a real opportunity for GPs and other primary care clinicians to lead and influence the debate on quality which for too long has been dominated by secondary care. We want to work with grassroots GPs and other
practice staff to enable them to play a fundamental role in discussions around how we measure quality. We expect the inquiry to show that most GPs are providing high quality care for patients, but we also expect it to show that quality of care is variable and that certain challenges will need to be addressed by general practice if it is to fully meet the standards set by the quality agenda. That’s why it’s crucial, as Professor Steve Field said at our recent launch event, that as many of the RCGP Members and Fellows as possible will get involved and ‘put their stamp on the future of quality care’. Therefore, a major feature of the inquiry this autumn will be about engaging with front-line practitioners. We are committed to testing out our findings with clinical staff to make sure what we are saying is relevant, accurate, useful and effective. This represents the second phase of the inquiry – to ‘road test’ the findings of the research through a series of events and surveys with GPs, with other health professionals working in general practice, as well as other stakeholders including patients and the public. We also want to ensure that our work complements other initiatives, such as the work on professionally-led practice accreditation spearheaded by the RCGP. As you will all know, the quality of general practice is being monitored in a number of ways. We will make sure that our work will add value to what is a crowded market place in general practice. Crucially, what makes this inquiry different is not only that it focuses on the quality of care provision from the perspective of the patient but also that it is specifically targeted at improving professional practice to achieve good-quality care. With your help and input we believe this could make a real difference. If we can successfully define what good-quality care looks like, set out the role of general practice in achieving that good quality, and produce measurements that will be useful for GPs themselves, then we will have met many of our key objectives. Ultimately, we very much hope this inquiry will make a significant contribution to helping the NHS improve the quality of general practice for patients and their families.
Further information ■ The inquiry is due to report in September 2010. For regular updates of The King’s Fund inquiry visit www.kingsfund.org.uk/gpinquiry ■ This October and November, The Fund will host a series of events and surveys with GPs and other staff working in general practice to test out the inquiry’s findings and the quality-based measures that are produced. The Fund would like to invite any professionals that would like to take part to register at gpinquiry@kingsfund.org.uk
Research Centre gets new name to reflect role The Birmingham Research Unit (above) has been renamed the RCGP Research & Surveillance Centre to more accurately reflect its work and status as a national rather than regional research and surveillance centre. The Centre was originally established in 1957 as the Records and Statistical Unit of the RCGP and since then has been particularly concerned with the surveillance of diseases as they present to general practitioners. Today, the Centre is fully automated and collects and monitors data from a network of approximately 100 participating GPs well distributed throughout England & Wales. The data are processed to provide incidence and prevalence rates of diseases but perhaps the Centre is best known for its twice-weekly reporting and surveillance of influenza-like illness and other respiratory diseases. The Centre is now in the final stages of upgrading its computer database and IT equipment. The new system will provide exciting new opportunities and expand the research potential of the Centre. It will allow staff to extract a greater part of the patient record whilst still retaining full anonymity, which will in turn allow greater analysis of links between, for example, influenza vaccination and subsequent cases of influenza. The RCGP Research & Surveillance Centre maintains a continuing programme of research in a wide and varied number of fields and in 2008 had seven research papers published including Acute respiratory infections and winter pressures on hospital admissions in England & Wales 19902005 which explored the links between hospital pressures and disease reported in the community. The name change was introduced from 1 April 2009 and will be displayed on all reports and publications but the change will not affect any administrative or informatic arrangements between the Centre and its participating practices. ■ If you would like any further details about the work of the RCGP Research & Surveillance Centre please contact enquiries@rcgpbhamresunit.nhs.uk or visit www.rcgp.org.uk/rsc
Important changes to measurement of diabetes The method of measurement for HbA1c is changing to International Federation of Clinical Chemists (IFCC) units. This will allow better calibration in laboratories and international standardisation and comparisons. The changeover will happen in June 2009 with dual reporting of old and new measurements for two years. The Department of Health, working with Diabetes UK and the Association of Clinical Biochemistry, has produced three leaflets – aimed at healthcare professionals, patients and laboratory staff – to explain the changes. RCGP NEWS • MAY 2009
NEWS
GPs report rise in memory New guidance to help consultations following people with mental Alzheimer’s campaign disorders stop smoking Neil Hunt Chief Executive, Alzheimer’s Society The Alzheimer’s Society’s Worried about your memory? public awareness raising campaign has now been running across England, Wales and Northern Ireland since May 2008. The campaign involved the distribution of leaflets that distinguish between the memory loss we all experience as we get older, and the symptoms that make it necessary to seek help. While aiming to reassure the public that memory loss can have many different causes, it encourages people who have noticed significant changes in their memory, concentration or behaviour to seek help from their GP. The leaflets were sent to GP surgeries across England, Wales and Northern Ireland. An accompanying resource pack was also sent to GPs, including an information CDRom highlighting the key role primary care practitioners play as the first point of call for people who are worried about their memory, or that of someone they know.
The impact Since the launch of the campaign, more than 12,000 people have requested further information about dementia and the materials have been downloaded from the Alzheimer’s Society website more than 20,000 times. A survey of those who responded to the campaign suggests that nearly half went on to visit their GP and up to one in five went on to receive a diagnosis of dementia. Nearly half had been worried for more than a year prior to picking up the leaflet. In addition, one in seven of the 1,800 GPs surveyed noticed a rise in the number of patients visiting with memory problems since the beginning of the campaign. There are 700,000 people in the UK with a form of dementia and one in three people over the age of 65 will die with the condition. Despite its prevalence, there is still a widespread lack of understanding about dementia amongst the general
public which can act as a barrier to diagnosis. Although surveys show that dementia is the most feared condition for people over the age of 55, people often delay seeking help from professionals as they assume their symptoms are just a natural part of ageing and may not realise that dementia is caused by diseases of the brain. Others may believe nothing can be done to help relieve their symptoms or are scared to admit there is a problem due to the stigma associated with dementia. Challenging this stigma is vital to ensure more people seek help when they need it and get access to treatment and support. The recently published National Dementia Strategy for England has highlighted the need to improve access to memory services, and improve the diagnostic process for dementia. Unsurprisingly, over 90 per cent of the GPs surveyed through the Worried about your memory? campaign agreed that it is important to diagnose dementia early. However, once a diagnosis has been made it is important that people with dementia and their carers are not left to deal with the condition on their own. This is where local support and information services have a key role to play. A diagnosis of dementia can be very difficult to come to terms with but the process can be made easier if appropriate support is available. Timely diagnosis and access to dementia services need to work hand in hand if people are to receive the quality care they deserve.
Further information ■ Find out more about the Worried about your memory? campaign at alzheimers.org.uk/memoryworry To request further copies of the materials free of charge, including leaflets for your practice or a copy of the dementia CD-Rom, please email waym@alzheimers.org.uk ■ For more information about Alzheimer’s disease and other forms of dementia, please log on to www.alzheimers.org.uk
10,000 sign up for e-learning Over 10,000 people are now registered to use e-GP: e-Learning for General Practice, the online e-learning resource for NHS General Practitioners and for doctors undertaking specialty training for UK general practice. Now available to all trainees, e-GP underpins the RCGP specialty training curriculum for general practice with content written by over 70 GP authors. NHS GPs can self-register at www.eGP.org. The entire e-GP resource will consist of around 500 sessions of e-learning. Around 50 sessions are now available to use with new sessions added on a regular basis. Sessions recently added include e-learning on Adolescent Health, created by RCGP in partnership with e-Learning for Healthcare (e-LfH) and the Royal College of Paediatrics and Child Health (RCPCH). Subjects of relevance to young people such as health promotion, youth friendly services, self-harm and pubertal development are covered along with issues affecting teenage parents, body shape and body image in adolescence and assessment of eating disorders in young people. RCGP NEWS • MAY 2009
These highly interactive sessions include case-based scenarios centred on the latest knowledge and current guidelines. Video clips capturing the voices and opinions of both young people and health professionals are also featured. The e-GP resource can be used in conjunction with other existing GP educational methods, filling in knowledge gaps, supporting assessment and appraisal preparation, and providing access to consistent and high quality learning anytime and anywhere. GP trainees can record each completed e-GP session in their RCGP Associate in Training (AiT) ePortfolio and certified GPs can print off certificates for their appraisal folder. e-GP differs from other e-learning resources in that it is explicitly GP curriculum-focused, written by GPs for GPs, and is intended to support a blended and strategic approach to learning based on curriculum outcomes. It is intended to be an enhancement to, rather than an alternative to, existing mechanisms of delivering GP education. To find out more about e-GP, visit www.eGP.org or email e-gp@rcgp.org.uk. e-GP representatives will also be on hand at a number of conferences over the coming months to demonstrate the e-learning and answer any questions.
Primary Care Guidance on Smoking and Mental Health – an A4 information sheet to help primary care practitioners support people with mental health problems who wish to stop smoking – is now available. The information sheet is one of a series of practical resources provided for frontline practitioners by the Forum for Mental Health in Primary Care (www.primarymentalwellbeing.org.uk). It supplements the 2009/10 update of the NHS Stop Smoking Services service and monitoring guidance which has a specific section on meeting the needs of those with mental disorders (www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance /DH_096886). The Forum for Mental Health in Primary Care is jointly hosted by the Royal College of Psychiatrists and the Royal College of General Practitioners. It works to encourage communication, collaboration and creativity between individuals and organisations who work to enable day-to-day mental wellbeing in everyone. Co-chaired by Dr Roger Banks (Primary Care Lead, RCPsych) and Dr Carolyn ChewGraham (RCGP Clinical Champion Mental Health), it aims to: ● Influence policy on mental health at all levels ● Influence its parent organisations and other relevant healthcare organisations ● Provide resources for practitioners ● Improve the patient experience in mental health The Forum considers mental health in its broadest definition as the mental health and wellbeing of individuals – not limited to specific mental illnesses. Its work aims to cross-cut the entire primary care agenda. Dr Chew-Graham said: “The RCGP has been working in close collaboration with its sister college the Royal College of Psychiatrists for more
Smoking: The Forum for Mental Health in Primary Care provides resources meeting the needs of those with mental disorders than 50 years. This is hardly surprising, given the degree of overlap between those patients presenting to general practitioners and those being referred to psychiatrists, with care being shared between multidisciplinary community mental health teams and primary care. “Collaboration between the two Colleges in the past has included joint guidelines, statements, reports and training packages. The establishment of the Primary Care Mental Health Forum is the latest exciting development.”
Further information ■ To find out more contact: Dr Carolyn Chew-Graham Clinical Champion, Mental Health, RCGP carolyn.chew-graham@manchester.ac.uk Dr Roger Banks Lead for Primary Care to RCPsych Rogerbanks@doctors.org.uk ● Or if you are interested into contributing to the Forum’s work, please visit the website or e-mail Saqib Ahmad, RCGP Senior Committee and Policy Support Officer sahmad@rcgp.org.uk
Knowledge Update goes live The RCGP Essential Knowledge Update (EKU), formerly Essential General Practice Update (EGP), is a structured learning activity enabling GPs to assimilate and apply new and changing knowledge, relevant to their clinical practice, as part of their Continuing Professional Development. The Update is a key element of RCGP provision of Continuing Professional Development to support revalidation. Having completed two successful programme pilot updates in May and October 2008, the Essential Knowledge Update has now gone live via the RCGP Online Learning Environment (OLE) which uses Moodle – a Course Management System (CMS), also known as a Learning Management System (LMS) or a Virtual Learning Environment (VLE). It is a free web application that educators can use to create effective online learning sites (http://moodle.org/). The Update consists of eight major items: ● Prevention of Osteoporotic Fractures in Postmenopausal Women, ● Control of Pain in Adults with Cancer ● Dealing with Allergic Rhinitis ● HIV Post Exposure Prophylaxis ● Identification and Management of Familial Hypercholesterolaemia
● Prescribing of Antibiotics for Self-limiting Respiratory Tract Infections ● Diagnosis and Management of Headache in Adults ● Attention Deficit Hyperactivity Disorder ● ● ● ● ● ● ● ● ● ● ● ●
12 briefings are also included: Relaxation for Depression Emergency Oxygen Use in Adult Patients Significant Event Audit Stroke Promoting Mental Wellbeing of Older People Evidence comparing Doxazosin XL with Standard Doxazosin Relationship between Gastroesophageal Reflux Disease and COPD How and When to stop Anti-Epilepsy Drugs Oseltamivir etc for the Prophylaxis of Influenza Febuxostat for the Management of Gout Cremation Regulations 2008 Guidance for Doctors Guillain-Barre Syndrome
The Update highlights new and changing information that has been prioritised from a search spanning July to December 2008. ■ Look out for further Essential Knowledge Updates and Knowledge Challenges on RCGP Online Learning Environment (OLE)
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CLINICAL UPDATE
The role of statins in patients with Chronic Kidney Disease PETER BURRILL Specialist Pharmaceutical Adviser for Public Health Derbyshire County PCT
Patients with Chronic Kidney Disease are at increased risk of cardiovascular disease, but the role of statins in CKD is controversial. A metaanalysis analysed the benefits and harms of statins in patients with CKD1. The analysis concluded that statins significantly reduce lipid concentrations and CV endpoints in patients with CKD, irrespective of stage of disease, but no benefit on all cause mortality or the role of statins in primary prevention has been established. Renoprotective effects of statins are uncertain because of relatively sparse data and possible outcomes reporting bias. The accompanying editorial suggests that criteria for treatment with statins for people with CKD should be the same as for people with normal kidney function 2. Low glomerular filtration rate or dialysis alone should not be considered indications for treatment with statins.
Statins and prostate tests A case series study 3 of the records of 1,214 men who were prescribed a statin between 1990 and 2006 at the Durham Veterans Affairs Medical Centre attracted some attention in the national press, with the Daily Mail suggesting that statins could dampen a key indicator of prostate cancer. These men were selected from the original 23,428 who started taking statins at this medical centre in this time period. The average age was 60 years and the majority were either overweight or obese (85 per cent). The median change in PSA levels after starting statins was a decline of 4.1 per cent. For half the participants, this ranged from -22.1 per cent to +12.5 per cent (ie, an increase in PSA levels). The NHS Knowledge Service has reviewed this study 4. They note important points to bear in mind when interpreting the results of this study: ● Firstly, the news report does not mention the alternative explanation of these results, that statins protect against prostate cancer (hence the decline in PSA levels). This is a theory that the researchers discuss at length, and which has also been suggested by other studies. If this were the case, then it would be an additional benefit of statins, rather than the other interpretation that potential cases of prostate cancer are being missed. Only further study in prospective cohort studies that have a proper control group will clarify this issue.
● The point about a ‘control group’ is important. In this study, the researchers used medical records to assess changes in PSA levels from before and after statin treatment. There was no parallel group of similar men not taking statins with whom fluctuating PSA could be compared. PSA levels decline with age and can change for other reasons, therefore in such studies it is important that a similar group of men are assessed to see whether statins really are responsible. The researchers attempted a control, using men from the larger cohort who had two PSA tests before statin treatment. They compared the difference between these with the difference between the pre- and post-statin levels. This is not an ideal control because the qualities that make these men candidates for statin treatment means they have different characteristics from men who are not prescribed these drugs. ● The participants in the analysis do not represent all the men who took statins through this medical centre. This raises issues of selection bias – ie, that this group may be systematically different from the larger cohort. ● The results of this study are important mainly because they bring attention to an area for further research. Men who currently take statins should not be alarmed by these findings. The study does not prove that PSA tests are made less accurate by statins.
Cheaper generic statins achieve QOF targets A study has shown that PCTs that had a high proportion of simvastatin and pravastatin use were just as successful achieving QOF cholesterol targets for patients with CHD, diabetes and stroke as those that used more atorvastatin and rosuvastatin5. The authors conclude that this supports the policy to use the less expensive generic statins. The National Prescribing Centre blog 6 concludes that this study provides reassurance that prescribers can continue to prescribe cheaper, generic statins, with simvastatin 40mg usually being first-choice. They point out that it is important to note that the NICE guidance on lipid modification sets no lipid targets which patients are expected to achieve.
LEARNING POINT: Generic, cheaper statins are as good as expensive non-generic statins
Statins in familial hypercholesterolaemia There are no RCTs with patient-orientated outcomes investigating statin use in people with Familial Hypercholesterolaemia A long-term cohort study7, designed to mimic a controlled primary prevention trial, suggests that simvastatin (mean dose of 33mg daily) is very effective at reducing the risk of CHD in peo-
Appointment of RCGP Clinical Champions 2010–12 The Council of the Royal College of General Practitioners has recently approved four new clinical priority areas to be taken forward for three years from January 2010. In order to support the development of innovative programmes of work the College is inviting applications for the role of Clinical Champion in each of these areas. Appointment as a Clinical Champion offers an exciting opportunity to influence and shape the development and delivery of a clinical programme of work within the College as well as to spearhead collaborative and partnership working with key stakeholders. The RCGP Clinical Champions are supported by CIRC to play a key role in providing leadership for the College in the respective clinical areas as well as in pressing for changes in clinical areas where the College has identified a need for improvement.
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Application Process The closing date for applications for the 2010 – 2012 Clinical Champions is Friday 15 May 2009. To apply, please submit: ● Your short CV (maximum 8 pages with a specific focus on your relevant recent activities) ● A covering letter highlighting your suitability for the role, an outline of your proposed programme of work and an explanation of its relevance to the advertised remit (maximum 1000 words) ● Appropriate letters of support from primary care organisations or other societies or associations as appropriate Please submit applications via email to circ@rcgp.org.uk All applications will be acknowledged on receipt.
The position of Clinical Champion is unsalaried (with set expenses) with a suggested time commitment of two sessions per month.
Shortlisting and interviews Following the closing date, a shortlisting process will take place. Interviews will be held during the weeks beginning Monday 15 and Monday 22 June 2009 (dates to be confirmed) and appointments made thereafter.
THE CLINICAL PRIORITIES FOR 2010 – 2012 ■ Allergy ■ Child Health ■ Learning Disabilities ■ Minor Surgery
Further information about the role of the Clinical Champion To view the relevant clinical priority remits and for further information about the role of the Clinical Champion, please visit www.rcgp.org.uk/circ
ple with FH. The risk was reduced by 80 per cent and the risk of MI in treated patients was not significantly greater than that in an age-matched sample from the general population.
LEARNING POINT: Simvastatin (mean dose of 33mg daily) is very effective at reducing the risk of CHD in people with FH
Statin induced myopathy A comprehensive review has recently been published 8. The mechanism of statin induced myopathy is unknown. Myopathy correlates most closely with dose of statins and is independent of reductions in LDL-cholesterol. The usefulness of coenzyme Q10 in statin induced myopathy is unclear.
LEARNING POINT: Myopathy correlates most closely with dose of statins
Factors that may increase the risk of statin induced myopathy ● ● ● ● ● ● ● ● ● ● ● ●
Advanced age (>80 years old) Female sex Low body mass index Multisystem diseases (eg, diabetes mellitus) Diseases affecting kidney or liver function Hypothyroidism (untreated) Vigorous exercise Excess alcohol Intercurrent infections Major surgery or trauma Diet (excessive grapefruit or cranberry juice) Genetic factors (eg, polymorphisms of the cytochrome P450 isoenzymes or drug transporters, inherited defects of muscle metabolism, traits that affect oxidative metabolism of fatty acids) ● Drug interactions, especially with drugs that are inhibitors or substrates of the cytochrome P450 pathway (eg, fibrates, nicotinic acid, calcium channel blockers, ciclosporin, amiodarone, glitazones, macrolide antibiotics, azole antifungals, protease inhibitors, warfarin)
Tips for non-specialists ● Slightly increased creatine kinase is common in the general population ● Myopathy that develops after a patient has been taking statins for several years is unlikely to have been caused by these drugs ● Thyroid stimulating hormone should be checked in patients on statins who develop a myopathy because hypothyroidism is a common cause of hypercholesterolaemia and raised creatine kinase ● If muscle-related symptoms or raised creatine kinase concentrations persist after statin therapy is stopped, consider further investigations such as electromyography and muscle biopsy, in conjunction with a specialist
Summary points ● Four types of muscle disorders are associated with statins: myalgias, myositis, rhabdomyolysis, and asymptomatically increased creatine kinase ● Although the rate of statin induced myopathy among statin users is low, the high volume of statin prescriptions means that the condition is commonly encountered in clinical practice. ● Statin induced myopathy correlates most closely with the dose of statins, but any factor that increases the serum concentration of a statin potentially increases the risk of myopathy. ● If a patient presents with features suggesting statin induced myopathy, first line management is to stop statin therapy and observe any effect on symptoms and concentration of creatine kinase.
References 1) BMJ 2008; 336: 645-51 2) BMJ 2008; 336: 624-5 3) Journal of the National Cancer Institute 2008; advance access published online October 28 4) www.nhs.uk/news/2008/10October/Pages/ Statinsandprostatetests.aspx 5) J Health Serv Res Policy 2008; 13: 99-102 6) www.npci.org.uk/blog/?p=234 7) BMJ 2008; 337: a2423 8) BMJ 2008; 337: 1159-62 RCGP NEWS • MAY 2009
NEWS
Building relationships: How the new Care Quality Commission will work with general practice Barbara Young Chair of the Care Quality Commission FOR MOST OF US, general practice is our first point of contact with health and social care services and the family doctor is seen as one of the most trusted professionals that people have contact with. The recent announcement from the Department of Health that primary care services, including general practice, will have to be registered with the Care Quality Commission from 2011 looks to reinforce that trust by providing a way for the public to be assured of the quality and safety of the services they get from their GP – though it’s worth being clear that it is practices that will need to be registered, not individual GPs. CQC’s aim is to make sure better care is provided for everyone, whether in hospital, in care homes, in people’s own homes, or elsewhere. The common denominator across these settings is the GP, so GPs will be acutely aware of the need for people to be reassured that wherever they are in the system, they will receive good quality care. Registration is a new idea for the NHS. It is designed to ensure that all services meet essential common standards of quality. Registration won’t tell anyone how to deliver services, but it will spell out the characteristics of a quality service. We want the registration system to promote improvement as well as tackle services that are of an unacceptably poor quality. Registration is not new to social care or to independent providers of healthcare. Introducing it across the NHS creates a level playing field and ensures that everyone is linked by those common essential quality standards. Having a single framework means we are looking at services from the point of view of the person using the service. In turn, this should help to make sure that the different parts of the system work better together. People want hospitals, care homes, GP practices and social services to work together well, and are puzzled and disappointed when they don’t. If things go wrong, it can be at the crossover point of those services. CQC can look at the whole range of services and encourage them to work better together. Despite some lurid headlines, can I reassure you that CQC is not planning a ‘crackdown’ on GPs, nor is it seeking to tell GPs how to treat their patients. Registration is about working with a service provider on their responsibility and commitment to providing a good quality service. It should help them focus on quality and improvement. But with the RCGP working on the new service accreditation system, GPs might well ask why they also need to be registered and whether registration will mean more bureaucracy. We are already working closely with the RCGP to explore ways in which the Primary Medical Care Provider Accreditation scheme could also be used to provide evidence of compliance with the registration requirements. This would allow us to develop a more proportionate approach to registration for accredited providers. Our intention is that registration will not be a burden. If a practice is already accredited, it is unlikely that CQC will seek much additional information from them. Where the accreditation criteria match registration criteria, we will accept accreditation as proof of compliance. We will use a wide range of already available data to check compliance with registration standards, for example QOF data, Quality Accounts and information from the National Patient Safety Agency. The key to the way we work will be RCGP NEWS • MAY 2009
Dr Alan Fisher (right) is presented with his GP award by RCGP Wessex Faculty Honorary Treasurer Dr Kim Daniels
Wessex celebrates success RCGP Wessex Faculty held their twelfth annual Awards Evening in Winchester attended by 100 health professionals spanning the entire spectrum of primary care. The awards are designed to recognise those who consistently perform above and beyond the call of duty. This year’s GP award went to Dr Alan Fisher from the Westbourne Medical Centre in
Bournemouth. Dr Fisher was nominated by his team for ‘creating a highly effective and slick organisation’ through being a strong but fair leader who helps everyone understand and sort out complex problems’. Dr Hugh Bethell from Basingstoke received a Lifetime Achievement Award for research in general practice. The Faculty also presented the Eileen Young Memorial Award – for outstanding contribution to women’s health – to Sister Mary Robinson from St Mary’s Surgery, Andover, for her work in family planning and assistance in the training of GP registrars spanning more than 35 years.
Baroness Young: The CQC is not planning a ‘crackdown’ on GPs using data that already exists to give us a rounded picture of a service, rather than expecting practices to generate new data for us. We are committed to making information on service providers available to the public, but it is too early to say how we’ll approach this for general practice. We expect that the vast majority of GP practices will meet the essential standards, but there will be some who do not. In such cases, CQC has a range of powers designed to promote improvement. These range from a warning notice up to the withdrawal of registration – an extreme sanction only likely to be used where there is an immediate threat to patient safety and when all other avenues to put things right have been exhausted. At the same time, we will want to ‘fame’ practices that demonstrate good practice that can help others to improve. Some GPs have expressed concerns that CQC will force them to use NICE guidelines. Some registration requirements are concerned with clinical standards. We will expect providers to assure themselves and us that they have systems in place to take account of relevant guidelines, but we recognise that GPs care for people with a range of conditions and are best placed to make decisions about an individual’s care and treatment. GPs, their representative bodies and others involved in primary care services are already helping us to develop the guidance that will flesh out and explain the requirements for registration. These discussions will lead to a full public consultation in the summer, which in turn will help to define the final common registration system that will apply to all health and adult social care providers. It is likely that at a later stage there will be additional guidance specific to primary care – the professions will be fully involved in developing it. The journey towards a single system to assure the public of the quality of all health and adult social care providers is underway, but much of the detail is yet to be developed. We look forward to working with GPs on its application to primary care services.
Dr Hugh Bethell (right) receives his Liftetime Achievement award from Wessex Provost Dr Chris Barry
Improving Patient Journeys The RCGP is recruiting enthusiastic GPs to write materials for a new RCGP online e-learning programme, Improving Patient Journeys, that will be made available to GPs in late 2009/early 2010. GPs play a key role in navigating patients effectively and safely through the NHS, coordinating care, helping patients to avoid bottlenecks and minimising inappropriate referrals and investigations. Through practice-based commissioning, GPs also have an opportunity to shape the development of new models of care for their patients and are ideally placed to talk to patients about their expectations and concerns. To be developed in partnership with the 18-weeks Clinical Advisory Group, the Improving Patient Journeys programme will help GPs to better guide their patients through the healthcare system. It will focus on key competencies in relation to referrals quality and management, coordinating the primary care-secondary care interface, dealing with common bottlenecks, and the development of local patient pathways. Authors will be reimbursed on a sessional basis. For further details and a role description, please send an email to smcnabb@rcgp.org.uk Closing date for applications is 15 May 2009 7
NEWS
Remembering Kathy: New RCGP award honours young people’s champion Dr Dick Churchill Chairman RCGP Adolescent Primary Care Society
Launching a landmark: (l-r) Dr Huw Lloyd, Welsh council member; Dr Mark Boulter, Honorary Secretary; RCGP Wales Chair Dr Bridget Osborne; Dr Helen Herbert, immediate past chair of RCGP Wales; Dr Richard Lewis, Welsh Secretary, BMA Cymru Wales; Dr Tony Downes, Welsh Council member
Taking the Next Steps towards the central role of GPs in Welsh healthcare Welsh Health and Social Services Minister Edwina Hart joined members of RCGP Wales for the launch of Next Steps: The Central Role of General Practice in the evolving Health Service in Wales against the prestigious background of the Senet in Cardiff. The Minister applauded the work of College members saying: “I congratulate the Royal College of GPs in Wales on the publication of the Next Steps document and welcome the continuing contribution of the College to service development.” Next Steps sets out an ambitious vision for the future of the health service in Wales, calling for greater recognition of the role of GPs. Dr Bridget Osborne, Chair of RCGP Wales, said: “General Practice is the jewel in the crown of the NHS and provides the hub to connect patients to other services. “It is vital that in the future restructuring of the NHS in Wales, patients, professionals and policy makers understand the central roles that they have to play and that patient centred, holistic and accessible health care is not lost to the citizens of Wales. “At this time of the proposed structural changes to the NHS in Wales, we feel that it is a particularly opportune moment to publish this document and we hope that it will be used to facilitate discussion throughout Wales at all levels.”
Edwina Hart: Next Steps in the right direction The launch event was a great success and provided an excellent opportunity for Welsh Assembly Members and policy makers to discuss the future of patient care in Wales with members of RCGP Wales Council. ■ The full report is available at www. rcgp. org.uk/councils__faculties/rcgp_wales.aspx
Preview of changes to GP Specialty Training curriculum Dr Mike Bewick Professor Neil Jackson Vice Chairs Postgraduate Training Board, RCGP The College has conducted its first formal review of the General Practice Specialty Training Curriculum. This has incorporated changes recommended by the Curriculum Guardians and feedback from users of the curriculum and the public. Our proposed changes were submitted to the Postgraduate Medical Education and Training Board (PMETB) in January and we are very pleased to be able to confirm that the revised curriculum has been approved by them. The new curriculum will come into force from August 2009. However, to give curriculum users ample notice of the changes we have put
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the revised version on our curriculum already, together with a change log. Most of the changes are to update existing information, but there are also some changes to the learning outcomes and these have also been listed separately so that they can be referred to easily.Trainees who are working towards a Certificate of Completion of Training (CCT) from PMETB will continue to train under the curriculum that was in force on the date their training programme commenced. We hope you will find the changes that we have made are helpful and enhance the curriculum. ■ The revised curriculum can be viewed at: www.rcgp-curriculum.org.uk/ rcgp_-_gp_curriculum_documents/ gp_curriculum_statements.aspx
For many years the RCGP Adolescent Task Group (now the RCGP Adolescent Primary Care Society) has encouraged GPs to endeavour to provide ‘young person friendly’ services and to consider the specific health needs of this age group. Members of the group have organised national and local conferences, undertaken and published relevant research, produced training materials for GPs and practices, and worked with a range of other organisations in order to meet these aims. Five years ago an enthusiastic GP from South Yorkshire, Kathy Phipps, joined the group, and rapidly became one its chief activists. Kathy was a full-time GP Principal who had worked in Barnsley for more than 14 years. She was a GP trainer and GP tutor and subsequently moved into the role of Assistant Medical Director for Barnsley PCT. Kathy’s particular interest in adolescent health had been sparked after being ‘volunteered’ to join the PCT’s teenage pregnancy group. As a consequence she became project lead for BITE: Barnsley Interactive Teenage Education, which looked at giving choices to young people with regard to contraception and sexual health. Kathy was passionate about meeting the health needs of young people, and worked enthusiastically to train others to do so. It therefore came as a devastating shock to her colleagues on the Task Group when they heard of her sudden death in a motorcycle accident in the USA last March. Tragically her husband, Dr Walter Rhoden, an eminent cardiologist, was also killed in the accident. Kathy and Walter were survived by three teenage children. As tributes poured in following the tragedy it soon became apparent how greatly Kathy was valued by her family, her friends, her patients, and her professional colleagues from a range of connections. By some she was clearly remembered for her enthusiasm, generosity, caring nature, and sense of humour, whilst others recalled her multicoloured hair, love of shopping and appreciation of good wine. She had travelled widely, and many of the tributes came from abroad. In addition to the numerous condolences that were received at the time of the tragedy, members of the Adolescent Task Group were keen to pay a longer term tribute to Kathy and, in particular, to recognise all that she had done to help promote the health of young people in primary care. As a consequence the RCGP Adolescent Health Award has been established in her memory. This new annual award will be made to a practice or individual GP in the United Kingdom demonstrating significant innovation or improvement in the standard of care provided for young people in the previous two years. The standards must be over and above that which would be expected in usual practice, and will have been subject to evaluation. Entries will be judged by an adjudication panel which will include at least one young person. The award of £2,500 and a commemorative plaque will be presented at a major RCGP meeting. It is hoped that the award will not only encourage and reward general practices who are actively engaging with young people, but will also allow widespread dissemination of models of good practice. More information about the award can be found at www. rcgp.org.uk/ the_adolescent_health_award
RCGP News invites your comments or letters... Please write to: The Editor, RCGP News Royal College of General Practitioners 14 Princes Gate, Hyde Park London SW7 1PU email: rcgpnews@rcgp.org.uk
Kathy Phipps: The Adolescent Health Award is a tribute to her work in adolescent healthcare which was so tragically cut short The award is one of several new initiatives in adolescent health. Kathy Phipps was a key contributor to many of these. They include: ● The establishment of an Association for Young People’s Health (AYPH) which is intended to facilitate networking of all professionals working to promote young people’s health, whatever the setting (see www.youngpeopleshealth.org.uk for more information) ● The Department of Health You’re Welcome criteria for youth friendly services which are being promoted across general practice ● An e-learning package on adolescent health produced by e-Learning for Healthcare and which is available to all GPs (see www.e-lfh.org.uk) ● HEAR, a training DVD produced by the RCGP Adolescent Task Group to facilitate discussion about consulting with young people. Contact ick.churchill@nottingham.ac.uk for more details ● A new edition of the Confidentiality Toolkit for general practices which is due to be published by the Department of Health in the near future Finally the RCGP Adolescent Group will soon be forming an open network of GPs who are interested in young people’s health to encourage discussion and collaboration between them. If you are interested then please contact christine.haneline@nottingham.ac.uk. ■ If you are involved in any initiatives to meet the health needs of young people, you may wish to consider entering for the new award. Details can be found at www.rcgp.org.uk/ the_adolescent_health_award The deadline for this year’s applications is Friday 17 July.
ISSN 1755-7720 © Royal College of General Practitioners. All rights reserved. Published monthly by the Royal College of General Practitioners 14 Princes Gate, London SW7 1PU email: rcgpnews@rcgp.org.uk website: www.rcgp.org.uk
RCGP NEWS • MAY 2009