‘Jury is still out’ on success of GP Forward View admits NHS England

Adobe Spark (3)The Director of Primary Care for NHS England, has admitted ‘the jury is still out’ on whether the GP Forward View is working. Speaking at the Health and Care Innovations Expo in Manchester, Dr Arvind Madan outlined progress on the 5-year strategy that aims to stabilise general practice and transform it for the future.

The plan, launched in April 2016, has pledged to increase funding in general practice by £2.4 billion per year and introduce 5,000 extra GPs by 2021. Additionally it seeks to reduce pressure on GPs through a new practice resilience programme.

‘We are in our teenage years and this is where we find out what the character of the programme can ultimately be,’ said Madan. He highlighted early indications suggesting a 5% increase in the number of GPs in training since last year and that they were half way through the 5000 target of other professionals working in primary care.

Madan also highlighted the role of nurses in delivering the GP Forward View: ‘Nursing teams are a vital component of the general practice workforce,’ he said. ‘They provide care and treatment across the life course and increasingly work in partnership with GPs to manage overall demand in practices and treat patients with complex conditions.’

Speaking to Independent Nurse, Dr Crystal Oldman, Chief Executive of the Queen’s Nursing Institute, said there has been some progress following the implementation of the GP Forward Practice View, particularly the introduction of the 10-point action plan to develop the role of general practice nurses.

However, she felt less positive about increases in the numbers of nurses, which she said are ‘not even close’ to what is needed. Additionally, she said she is ‘confident’ there has been no change in the reduction of workload pressures for nurses. According to Oldman, the gap is in the engagement with the nurses themselves:

‘Because they work for individual businesses they are not engaged with the wider movement of general practice nursing,’ she said.

‘I think there is increased hope, and this may mean nurses will stick around in general practices in the hope that this plan is going to make a difference to workforce pressures general practice.’

The importance of nurses to meeting the demands faced by general practice was also emphasised at the same event by Professor Jane Cummings, Chief Nursing Officer for England, who described practice nurses as ‘central to our plan to ensure the NHS is fit for the future’.

Taken from Independent Nurse, published 15 September 2017.

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Do advanced paramedics have a role as independent prescribers?

adobe-spark-3The journey regarding the proposal to introduce independent prescribing by advanced paramedic practitioners has been one focused on patient safety and a strong case for need. The challenge for the profession has been to ensure it’s positioned to respond to any concerns, and that any changes to the law allowing prescribing are made on the basis that patients will benefit.

Ministerial approval to take the proposal forward to the public consultation phase was granted by NHS England on 15 August 2014. The NHS England Allied Health Professions Medicines Project Team, in partnership with the College of Paramedics, developed a case of need for the proposal based on improving quality of care for patients. These improvements related to safety, clinical outcomes and experience, as well as the efficiency of service delivery, and value for money. Approval of the case of need was received from NHS England’s medical and nursing senior management teams in May 2014, and from the Department of Health non-medical prescribing board in July 2014.

Alongside the paramedic proposal, NHS England consulted on proposals to allow three other allied health professions to be able to prescribe or supply and administer medicines, as appropriate for their patients. These proposals were for independent prescribing by radiographers; supplementary prescribing by dietitians; and the use of exemptions within the Human Medicines Regulations 2012 by orthoptists.

At the time, Suzanne Rastrick, Chief Allied Health Professions Officer at NHS England, said:

‘Our proposals will allow patients to get the medicines they need without delay, instead of having to make separate appointments to see their doctor or GP.

‘Breaking down barriers in how care is provided between different parts of the NHS is key to the vision set out in the NHS Five Year Forward View.

‘Extension of prescribing and supply mechanisms for these four professions creates a more flexible workforce, able to innovate to provide services that are more responsive to the needs of patients, and reduce demand in other parts of the healthcare system.’

The public consultation opened on 26 February 2015 and ran for 12 weeks. As well as consulting on proposals for advanced paramedics to become independent prescribers of medicines across the UK, it also proposed that consideration be given to paramedic independent prescribers being allowed to mix licensed medicines prior to administration, and prescribe independently from a restricted list of controlled drugs. Anyone was welcome to respond, and feedback was received from members of the public, patients/patient representative groups, carers, voluntary organisations, health-care providers, commissioners, doctors, pharmacists, allied health professionals, nurses, regulators, non-medical prescribers and the Royal Colleges, as well as other representative bodies.

Why independent prescribing was not recommended

Following the close of the consultation, responses received were collated and analysed. The responses were considered by both the Commission on Human Medicines (CHM) and Medicines and Healthcare Products Regulatory Agency (MHRA), who felt unable to recommend independent prescribing for advanced paramedics at present.

The reasons for this decision were concerns over the wide range of conditions encountered by advanced paramedics and whether they could demonstrate evidence of adequate training and competency to diagnose the conditions that will be prescribed for. Additionally, there were notable concerns over the definition of an advanced paramedic practitioner, as this appears to vary between allied health professionals.

As a result, The CHM felt that independent prescribing might represent a risk to patient safety; for example, and in context with the lack of available evidence of competency at the time, if the wrong diagnosis was made and an inappropriate treatment was prescribed. They also felt that some of the examples cited to demonstrate a need for independent prescribing were not sufficiently robust.

Considering the possibility of independent prescribing

The College of Paramedics expressed disappointment that the CHM was unable to recommend independent prescribing for advanced paramedics at the present time, and has said it will continue its support and commitment to work with the project, and with NHS England this year to address the very legitimate comments made by the CHM. The college also said it would give regular updates to its members on the progress of the work.

Speaking on the possible future for independent prescribing by advanced paramedics, Andy Collen, medicines and prescribing project lead for the College of Paramedics, said:

‘We absolutely think that advanced paramedics have got a role as independent prescribers. The journey for any profession to undertake independent prescribing has to be done so with absolute rigour and consideration for patient safety. We need to provide reassurance that what is being proposed is going to benefit patients completely and that any risks are understood. Although it is disappointing, we absolutely welcome the feedback from CHM and we are continuing to work to answer the concerns the CHM have, and that is being supported by NHS England.’

Gerry Egan, chief executive officer of the College of Paramedics, said:

‘The College has a clear definition of the advanced paramedic role in terms of competencies and education and is working to make this the accepted definition both across the NHS and in the private health sector.

‘The College have no doubts advanced paramedics will deliver a massive benefit to patients in terms of delivering the right care at the right place and at the right time by the use of safe independent prescribing as part of integrated care systems.

‘The College remains totally committed to the proposal to introduce independent prescribing by advanced paramedics and looks forward to continuing supporting NHS England.’

Taken from Nurse Prescribing, published 9 September 2016.

Ambulance service at creaking point

Adobe SparkRecent figures published by NHS England reveal the ambulance service is continuing to fail to meet Government standards for responding to Category A (Red 1 and Red 2) calls. The figures for March 2016 showed only 66.5% of Red 1 calls were responded to within 8 minutes, while 72.3% of Red 2 calls received a response within the same timeframe (NHS England, 2016). This is compared to 73.4% and 69.6%, respectively for the same period in 2015. It marks 10 months that services in England as a whole have failed to meet the Government target of 75% for Red 1 Calls. The response to Red 2 calls is the lowest proportion recorded since the data collection began in June 2012. However, it must be highlighted that Red 2 data from February 2015 onwards are not completely comparable across England due to the introduction of Dispatch on Disposition, allowing up to two additional minutes for triage to identify the clinical situation and take appropriate action.

It has been a tough year for ambulance services, with London Ambulance Service NHS Trust being placed under special measures by the Care Quality Commission (CQC) in November 2015 and East Midlands Ambulance Service NHS Trust being recently rated inadequate by the CQC for safety due to insufficient staff numbers and a consensus that the skill mix of staff deployed was not always safe (CQC, 2016).

The fact of the matter is that demand for ambulance services continues to rise and services are struggling to keep up. The ambulance service in England received 861 853 phone calls in March 2016, compared to 694 188 in March 2015 (NHS England, 2015; 2016), a rise of 24%. However, Trusts have not been able to increase their numbers of staff to meet this demand. This creates greater work pressures and stress for existing employees, brought on by longer working hours and missed meal breaks. The result? High staff attrition within Trusts. Those that remain will no doubt be questioning whether this is sustainable. With staff currently being balloted by unions over industrial action on pay, the possibility of a crisis within the ambulance service cannot be dismissed as hearsay.

If this is to be avoided, a number of things have to change. Trusts must ensure front-line vacancies are filled and staff do not leave. This can only be done by fostering a work environment in which staff are happy to remain. The over triage of patients must be minimised so that appropriate resources are dispatched. And, where possible, patients’ needs must be addressed at the point of contact and unnecessary transfers to hospital must be avoided. If the ambulance service carries on as it is, it is difficult to see how it will continue to operate in 10 years’ time. By focusing on employee welfare, this crisis may be averted.

References

Care Quality Commission (2015) London Ambulance Service NHS Trust Quality Report, 27 November 2015. http://tinyurl.com/hxdhwpr (accessed 26 May 2016)

Care Quality Commission (2016) East Midlands Ambulance Service NHS Trust Quality Report, 10 May 2016. http://tinyurl.com/h5r4wfv (accessed 26 May 2016)

NHS England (2015) Ambulance Quality Indicators Data 2014–15. http://tinyurl.com/zf2p5jf (accessed 26 May 2016)

NHS England (2016) Ambulance Quality Indicators Data 2015–16. http://tinyurl.com/jyls6rt (accessed 26 May 2016)

Taken from Journal of Paramedic Practice, published 27 May 2016.

The need for optimism at a challenging time for the NHS emerges as key theme of Ambulance Leadership Forum

The Association of Ambulance Chief Executives’ (AACE) annual Ambulance Leadership Forum (ALF) took place this year on 9–10 February at the Hinckley Island Hotel in Leicestershire. Designed to stimulate debate and ideas about the on-going development of emergency and urgent care, delegates were encouraged to share best practice and discuss issues pertinent to the sector.

The theme for this year’s event focused around the future look and feel of ambulance service provision and was largely based on AACEs document published last year, A vision for the ambulance service: 2020 and beyond. This vision presents ambulance services as mobile healthcare providers operated in an extended range of care settings, doing more diagnostic work, more treatment, more health promotion, and providing patients with more services that before.

Delegates were welcomed to the conference by AACE chair and West Midlands Ambulance Service NHS Trust CEO, Anthony Marsh, who called on attendees to embrace the new ambulance initiatives on offer and improve outcomes. He noted that ‘the challenge we are confronted with now [in the NHS] offers us a real opportunity,’ and hoped proceedings for the day would help influence national policy.

The landscape of urgent and emergency care: implementing the Five Year Forward View

The opening address was given by Chris Hopson, CEO of NHS Providers, who asked whether the provider sector had the capacity to deliver the changes outlined in NHS England’s Five Year Forward View? Hopson said that all Trusts would be under pressure to achieve their financial targets in 2016–2017 and that one of the biggest debates would be over standards and performance, especially for ambulances. He highlighted that the majority of providers have found themselves in the ‘needs improvement’ box in terms of Care Quality Commission rating, and that we cannot fix many problems found in the NHS unless we have more vertical integration of health and care and horizontal collaboration.

Prof Keith Willett, national director for acute episodes of care for NHS England, then spoke on the new landscape for urgent and emergency care. He started by mentioning he sat on a sharp fence between the clinical world of service providers and Whitehall, and noted it is a sharp fence. The current provision of urgent and emergency care services sees 24 million calls to the NHS and 7 million emergency ambulance journeys a year. Willett said for those people with urgent but non-life threatening needs we must provide ‘highly responsive, effective and personalised services outside of hospital, and deliver care in or as close to people’s homes as possible.’ For those people with more serious or life-threatening emergency needs, he said: ‘We should ensure they are treated in centres with the very best expertise and facilities in order to maximise their chances of survival and a good recovery.’ As we move into the final phase of the Urgent and Emergency Care Review, the focus is on implementing new models of care and ways of working. He stressed that the ambulance service needs to come to the fore and drive change, and that no paramedic should make a decision in isolation, but should have support from whole of the NHS.

Transforming health and social care: innovation and leadership

Following the first coffee break of the day, Bob Williams, CEO of North West Ambulance Service NHS Trust, spoke on devolution in Manchester. After providing a background to the health and social care system in Greater Manchester and the Greater Manchester Devolution Agreement, Williams outlined the principles around the Greater Manchester devolution plan, which include: radical upgrade in population health prevention, transforming care in localities, standardising acute hospital care, and standardising clinical support and back office services. Williams said Greater Manchester devolution offers an opportunity to transform health and social care, and that ambulance service has the tools, the players and the crucial elements to help make the healthcare system changes needed.

Prof Paresh Wankhade of Edge Hill University then spoke on leadership in the emergency services, focusing on interoperability and innovation. Wankhade first set the scene by outlining the leadership challenges faced by emergency services, before highlighting the key issues impacting workforce development, the need for suitable leadership for empowering and motivating staff, provided a critical overview of the state of interoperability, and closed by speaking about innovation in an era of uncertainty. For the ambulance service, he noted an increasing demand but lesser proportion of life-threatening calls, and that performance and quality are unsustainable with current levels of funding. He went on to say that there is very little evidence to suggest that enough is being done to support the workforce for new challenges and performance pressures, and that there is an important role for the College of Paramedics to prepare practitioners for the future.

Leading in challenging times

After lunch, delegates heard a recorded message from Lord Prior of Brampton, parliamentary under secretary of state for NHS productivity, who commended the work that is being done by ambulance services across the country, and apologised on behalf of the secretary of state for health, Jeremy Hunt, who had to pull out the conference last minute.
This was followed by Rob Webster, CEO of NHS Confederation, who gave one of the most engaging talks of the day on leading in challenging times. He began by explaining there has been a 24% increase in activity for Category A calls for ambulance services since 2011. He went on to stress the need for values-based leadership and system leadership, and that leading should come from every seat in the NHS. If senior ambulance managers do not understand the organisation’s values, then it is difficult to expect staff to understand them. He closed by noting that the NHS is made of people, and that it is the collective commitment, drive and energy that make up an organisation, and what makes a successful future.

Janette Turner, director of the medical research unit at the University of Sheffield, then spoke on managing urgent care outside hospital. Looking at data from March 2015, 27.9–57.6% of 999 calls were not conveyed to emergency departments in England. On population utilisation of emergency ambulance services the UK receives 13 calls per 100 population, compared to Belgium, which has the highest number of calls per population in Europe at 33. Turner said that outcomes of evidence on telephone-based service involved accuracy, compliance, satisfaction, costs, service impact and access. While accuracy is high for minimising risk, inaccuracy tends to come in the form of over triage. Considering the role of management by ambulance clinicians outside hospital, Turner said a small number of high-quality studies support extended paramedic roles as they offer safe decisions, reduced emergency department transports, high satisfaction and are cost effective. However, she did note that decision-making is complex and needs to be underpinned by the right education.

Introducing new delivery models

After another coffee break, Richard Murray, director of policy at the King’s Fund, spoke on new delivery models for urgent and emergency care and NHS Planning Guidance. Murray outlined the key features of NHS Planning Guidance before discussing the implications for urgent and emergency care and ambulance providers. He said it was a game of two halves: a one-year plan for 2016/17, with existing organisations as the key building block, switching to place-based plans for 2017/2018 to 2020/2021. Taken together, Murray said they offer a radical re-drawing of the boundaries in the NHS.

The final talk of the day was delivered by Dr Phil Foster, assistant medical director for Yorkshire Ambulance Service NHS Trust, who spoke on the West Yorkshire Urgent and Emergency Care Vanguard. He explained how the service’s collective local vision was for all patients with emergency and urgent care needs within West Yorkshire to get ‘the right care in the right place—first time—every time.’ The aim was to give patients access to urgent and emergency care through 999 and 111 and given an improved experience with care provided closer to home. This would be a standard service offering across West Yorkshire.

Celebrating excellence at the AACE Outstanding Service Awards

The evening saw delegates celebrate the AACE Outstanding Service Awards. Sponsored by Ferno UK Ltd in aid of the Ambulance Services Charity, ambulance service employees form across England who have gone above and beyond the call of duty were recognised and commended for their outstanding service. The Outstanding Paramedic Award went to Abigail Evans, a cycle response unit paramedic for London Ambulance Service NHS Trust. The Outstanding Mentor or Tutor Award went to Chris Mathews, a critical care paramedic with South East Coast Ambulance Service NHS Foundation Trust. Outstanding Innovation and Change Awards went to Adam Aston, a paramedic with West Midlands Ambulance Service NHS Trust and Thomas Heywood, a clinical manager for Yorkshire Ambulance Service NHS Trust. The Outstanding Non-Paramedic Clinician Award went to Steve Wainwright, and emergency care assistant for East of England Ambulance Service NHS Trust. The Outstanding Control Services Employee Award went to Craig Foster, a call operator for North East Ambulance Service NHS Foundation Trust. The Outstanding Manager Award went to Karen Gardner, operations manager for North East Ambulance Service NHS Foundation Trust. The Outstanding Support Services Award went to Tez Westwood, Hazardous Area Response Tram support technician for East Midlands Ambulance Service NHS Trust. The Outstanding Senior Management Award went to Tracy Nicholls, head of quality governance for East of England Ambulance Service NHS Trust and the Outstanding Welfare and Wellbeing Award went to Ben Lambert, a team leader for South Central Ambulance Service NHS Foundation Trust.

Workshops allow delegates to discuss emerging themes

The second day, co-hosted by NHS Confederation, featured a morning of facilitated workshops, concluding with a conference summary and forward view. Delegates were given a choice to attend workshops on the themes of ‘our workforce’, ‘technological and digital enablement’, and ‘vanguards and innovation’.

A summary of the main themes discussed in the workforce workshop include the need to engage with staff meaningfully, understanding culture but also taking change, collaboration, and a recognition of whether or not we are doing as much as we can on mental health and race equality.

The technology workshop had a key theme around innovation, and an emphasis that ambulance services are much more than a transportation service. There was a strong feeling that there needs to be better capture and use of data in technological advancements, that procurement needs to be looked at as a whole-systems approach, and that ambulance services should embrace social media.

Within the vanguard workshop there was a clear sense of the great work that is being done across the country. It was recognised that a lot of the components of a really good system are in place, but that we have to learn from each other’s organisations. There was also an emphasis on ensuring that the right culture is in place within services.

With difficulty comes opportunity

The conference came to a close with Anthony Marsh commending the optimism shared by delegates during what is a challenging time for the NHS. He quoted the BBC programme Inside Out, saying there is ‘no need to be miserable, we are winning the war.’ Martin Flaherty, managing director of AACE, then remarked on how sobering it was to hear about the challenging times ahead, particularly around finance. However, he said with difficulty comes opportunity and that as a sector we are always doing our best when in difficulty.

Delegates left with much food for thought and plenty of ideas for implementing change within their own services. Feedback has been positive, with one delegate saying: ‘Excellent conference, completely relevant to our practice in emergency medicine,’ while another remarked: ‘I think the organisation was superb and the quality of speakers and breadth of subject matter was really relevant.’ Congratulations must be extended to AACE for an engaging two days, and delegates can look forward to returning for another year.

Taken from Journal of Paramedic Practice, published 4 March 2016.

Dental Nursing News February 2016

DN News FebPatients test positive for Hepatitis C

dental nurse who spoke out about hygiene conditions at a dentist’s surgeries in Ayrshire—sparking an HIV scare for 5600 patients—was told by the practice manager: ‘no one has caught anything yet,’ a disciplinary hearing has heard.

The nurse, who remains anonymous and is identified only as ‘Dental Nurse One’, contacted the NHS Ayrshire and Arran health board on 16 September 2013, after she was told of the routine reuse of equipment in an area known for high drug dependency.

Dentist Alan Morrison is accused at a General Dental Council Committee of failing to sterilise instruments between treating patients and reusing dirty gloves at his clinics in Cumnock and Drongan.

An investigation was launched into the dentist’s practices after the nurse blew the whistle, sacrificing her new job. At a hearing in London, the nurse recalled how she was offered a job on the spot, but was told by the practice manager, Lorraine Kelly, of procedures that put patients at risk.

‘She then told me that, “We would do things a bit differently here”…She proceeded to tell me that the practices reuse gloves and matrix bands and did not sterilise aspirators.’

The nurse said that she was shocked at Mrs Kelly’s remarks but that the manager replied in a ‘flippant manner’ that ‘no one’s caught anything yet.’ The whistleblower went on to say: ‘Both practices are in areas of high levels of drug use and therefore are likely to have contact with patients with blood-borne viruses. Although Mr Morrison was not present in this conversation, it was obvious he was aware of procedures and practices as owner of the practices and a practising dentist.’

Many patients underwent testing as a result of being sent a letter. No patients had contracted HIV, however four adult patients tested positive for Hepatitis C. Of these, three had evidence of chronic infection and one showed signs of a previous infection.

It emerged at a health board meeting that two of the patients had received dental treatment on the same day.

However, it could not be established whether the infection was picked up from the practice or from outside their dental treatment.

Mr Morrison has admitted falsifying invoices for medical supplies handed to NHS investigators, which showed phoney purchases of single-use equipment, including matrix bands, but denies the rest of the allegations.

Morrison and Kelly are accused of failing to adhere to infection control guidelines and of being dishonest during the health investigation.

NHS England guide to unscheduled care

NHS England has published a quick guide to unscheduled dental care to help provide practical tips for dental providers and commissioners, and relieve pressure on frontline services.

Within the guide, dental health professionals are advised to ensure accessibility of services by keeping their NHS Choices profile and Directory of Services profile up to date, and ensuring their answerphone provides correct details for signposting to 111 for urgent dental care.

To relieve winter pressures on services, it is recommended that patients are encouraged to seek oral care early. Winter campaign materials should be used to promote oral health and seek early advice for oral symptoms, social media and practice websites should be used to provide information about oral health and access to services, and patients should be advised about taking good care of their own oral health.

The guide goes on to say that self-care advice and management of pain is essential during times when dental treatment services are not available. The dental case mix should be managed by suitably trained dental care professionals (DCPs), who should have the capability to book treatment slots directly with dental providers. Where DCPs cannot provide advice, it is recommended that there should be a mechanism for them to refer to a pharmacist or seek additional clinical advice.

The effective triage of patients with dental problems is also emphasised within the guide. It is noted there are a number of options for triage that could be used and the configuration will depend on local requirements, such as the Dental Nurse Triage service that is being procured in London. This service will receive patient information via NHS 111; return calls and carry out a clinical telephone triage using established dental algorithms; and provide information, reassurance and advice to callers and allocate patients to same day, next day treatment slots or signpost to an NHS dental service.

The service will be delivered by trained and experienced dental care professionals, and is planned to operate between 6pm and 8am during the week. It is also planned to operate 24 hours during weekends and bank holidays. The service will have a phased implementation from 1 April 2016 and align with NHS providers in London.

BDA suspends strike action

The British Dental Association (BDA) suspended industrial action planned for 26–28 January in support of the British Medical Association (BMA), as it seeks to rekindle talks to resolve the differences over the proposed new contract for hospital juniors in England.

The BDA has been following the BMA’s lead in disputing the proposed contract, and supporting hospital junior dentist members to ensure a safe and fair junior contract is put in place. BDA junior hospital dentists took action on 12 January, protesting against the erosion of patient safety and the potential impact on dentists’ working lives.

An announcement from the BDA on the proposed contract, said: ‘We feel it removes vital safeguards for both dentists and their patients. We want to ensure dentists are protected from being required to work excessive hours in a week. We oppose the plans for the extension of standard time from the current 7am to 7pm, Monday to Friday to 7am to 10pm, Monday to Saturday, as we don’t feel this values dentists’ time appropriately.

‘We also object to the proposals on pay progression, which may mean some dentists are discouraged from entering specialist training, due to the plans to increase pay only when a trainee moves to the next stage of training and responsibility. We feel this particularly disadvantages those with families, because of the financial worries of taking time out of training for maternity leave or to work part time. It will also discourage those already in training from undertaking research or retraining in a preferred specialty, to the long-term detriment of the NHS.’

Further action for a full withdrawal of labour is still planned for Wednesday 10 February 2016.

Sound bites

Parliament calls for ‘complete overhaul’ of the General Dental Council (GDC). Members of the House of Commons debated the Section 60 Order which, if laid, will allow the GDC to introduce case examiners into its fitness to practise (FTP) process. This followed a debate in the House of Lords on the same subject, during which Shadow Health Minister Lord Hunt repeatedly called for resignations within the GDC.While the debates in both Houses were held to discuss these changes to the Dentists Act 1984, the main focus of the discussions was the performance, and the fitness to regulate, of the GDC. Shadow Health Minister Justin Madders raised the need for a ‘complete overhaul’ of the GDC, calling it the most expensive and least efficient of the health regulators, and noting the lack of confidence the profession has in the GDC.

The National Institute for Health and Care Excellence (NICE) has published new guidelines on oral health promotion in general dental practice, placing a focus on giving patients the ability to make an informed decision about their care. The guidelines cover how general dental practice teams can give advice about oral hygiene, the use of fluoride, as well as how areas such as diet, smoking, smokeless tobacco and alcohol intake affect oral health in order to help patients make informed decisions about their own care and encourage preventive treatments. Dr Ben Atkins, a dentist and Trustee of the British Dental Health Foundation, was a member of the committee for the NICE guidelines. Dr Atkins said: ‘These guidelines outline a patient-centred approach to ensure patients who are using the services are actively involved in discussions and able to make informed decisions about their care.’

Taken from Dental Nursing, published 29 January 2016.

DN_Feb_2016_News_DPS

Special measures for struggling services

In November of last year, London Ambulance Service NHS Trust (LAS) became the first ambulance Trust to be placed under special measures following an inspection of the service by the Care Quality Commission (CQC) in June 2015. The overall rating given by England’s chief inspector of hospitals, Prof Sir Mike Richards, was that the service was inadequate, and it was acknowledged that improvements were needed on safety, effectiveness, responsiveness and leadership (CQC, 2015b).

Of the key findings, it was noted that LAS had a high number of front-line vacancies, with some employees saying that there were not enough appropriately trained staff to ensure that patients were consistently safe and received the right level of care (CQC, 2015a). As a result of staff working long hours, many reported feeling high levels of stress and fatigue. Additionally, while the CQC recognised that staff were ‘overwhelmingly dedicated, hardworking and compassionate,’ they revealed that ‘some reported a culture of harassment and bullying’ (CQC, 2015a). It was highlighted how until March 2014, LAS was consistently the best performing service in the country to category A calls. However, since then there has been a substantial decline in performance, and the target time of 75% of calls being responded to within 8 minutes has not been met. This is something that has been affecting ambulance services across England, although LAS response times for Red 1 and Red 2 category A calls were reported as being the worst in the country. Serious concerns were also identified about the service’s Hazardous Area Response Team (HART) capability due to an insufficient number of paramedics. The result was the feeling that there was not a safe system of working where an effective HART response could be utilised (CQC, 2015b).

The decision to place LAS under special measures is a considerable blow, not just to the service, but to all members of ambulance Trusts. Fundamentally it highlights the CQC’s belief that LAS is unable to provide the level of care expected of it. This is despite the dedication and commitment that is clearly apparent in front-line staff, alluded to in the report. But while it is easy to consider the negative connotations of the CQC’s report, it is important to remember that one of the key reasons why services are placed under special measures is to ensure they get the support they need to improve. External partners such as the NHS Trust Development Authority and NHS England will give LAS access to a package of additional resources and support.

Ambulance services throughout the country are struggling to deal with increasing pressures, a national shortage of paramedics and insufficient funding. It is hoped that other ambulance services will not suffer similar findings from the CQC, but it should be reassuring to know that there is a system in place to offer support to services that are unable to make improvements required of them on their own.

References

Care Quality Commission (2015a) Chief Inspector of Hospitals recommends London Ambulance Service NHS Trust is placed into special measures. CQC, London. http://www.cqc.org.uk/content/chief-inspector-hospitals-recommends-london-ambulance-service-nhs-trust-placed-special (accessed 4 January 2015)

Care Quality Commission (2015b) London Ambulance Service NHS Trust Quality Report. CQC, London. http://www.cqc.org.uk/sites/default/files/new_reports/AAAD5514.pdf (accessed 4 January 2016)

Taken from Journal of Paramedic Practice, published 8 January 2016.

Reducing winter pressures on the NHS

As the days get shorter and colder weather sinks in, the media has been awash with its usual smear of headlines questioning how the NHS will cope this upcoming winter. The NHS experiences winter pressures every year, as the rise in the number of people admitted to hospital leaves services at breaking point. However, despite planning for this spike in attendance, it remains ever difficult to manage the challenges that are faced and meet the growing patient demand.

This year, additional fears of a looming crisis have been raised after figures were published by Monitor and the NHS Trust Development Authority outlining the financial positions of the NHS for the first 3 months of the 2015–16 financial year. They reported a combined deficit of £930 million for the 151 Foundation Trusts and 90 other NHS Trusts in England, which is more than the entire full-year deficit for 2014–15 of £829 million. As part of these figures, ambulance services in England have run up a £6 million deficit (Monitor, 2015; NHS Trust Development Authority, 2015).

If the NHS is going to avert a crisis this winter, a whole systems approach is needed ensuring coordination across all services to create a manageable flow of patients in and out of hospitals. This year, a number of initiatives have been introduced in the hope that some of this pressure can be alleviated.

The NHS has sought the help of the fire service in a new health partnership aimed at tackling health and social problems and reducing winter pressures. NHS England, Public Health England, the Fire and Rescue Service, Age UK and the Local Government Association have signed a consensus agreeing to work together to prevent or minimise service demand, and improve the quality of life of people suffering from long-term conditions (NHS England, 2015). The fire service currently carries out 670 000 home safety checks each year, assessing the homes of the vulnerable and offering advice on how to make them safer. The consensus will enable firefighters across the country to carry out more ‘safe and well’ checks in people’s homes when they visit. As well as reducing the risks of a fire, the ‘safe and well’ checks will aim to reduce health risks such as falls, loneliness and isolation and therefore reduce visits to A&E, broken hips and depression. Additionally, the NHS’ largest flu vaccination programme has been launched as part of their ‘Stay Well This Winter’ campaign (Association of Ambulance Chief Executives, 2015). For the first time, all of the youngest primary school children will be eligible to receive the free nasal spray vaccine. As in previous years, the adult flu vaccine will be offered for free to those in groups at particular risk of infection and complications from flu.

There needs to be closer cooperation between medical and social care services and attention to wider public health issues if the NHS is to stand any chance of making it through the winter intact. It is hoped that the initiatives highlighted will go some way to making this a possibility.

References

Association of Ambulance Chief Executives (2015) Launch of the largest flu vaccination programme marks the start of NHS “Stay Well This Winter” Campaign. http://bit.ly/1M6PT1K (accessed 2 November 2015)

Monitor (2015) NHS foundation trusts: quarterly performance report (quarter 1, 2015/16). http://bit.ly/1JWukyH (accessed 9 October 20150

NHS England (2015) NHS and Fire Service sign new consensus to help vulnerable and reduce winter pressures. http://bit.ly/1LSGElM (accessed 1 November 2015)

NHS Trust Development Authority (2015) NHS Trusts—Financial Position for Q1 of 2015/16. http://bit.ly/1MjAOxY (accessed 9 October 2015)

Taken from Journal of Paramedic Practice, published 6 November 2015.