GP News

Latest News from the Royal College of General Practitioners
https://www.rcgp.org.uk/
Updated: 17/04/2019 06:15

'Complex reasons' why patients choose not to take prescribed medication, says College

She said: "GPs are highly-trained to prescribe and recommend drugs if they think they will genuinely help the individual patient, based on the specific circumstances affecting their health and their personal risk factors – and then after a frank conversation about the potential risks and benefits. "When we prescribe medication, we have to rely on patients to make sure that they take it, both at the recommended dose and for the duration of time that we think will benefit them most. "There is a substantial body of research showing that statins are safe and effective drugs for most people, and can reduce the risk of heart attacks and stroke, when prescribed appropriately – but controversy remains around their widespread use and their potential side-effects. "There are complex reasons why patients choose not to take their prescribed medication, and mixed messaging around statins could be one of these. "We would encourage anyone who is on regular medication to attend their scheduled medication reviews and to raise any queries or concerns they might have. But given the widespread GP shortages and intense workload pressures that we currently have in general practice, it’s hard to know what more we can do to encourage greater compliance with medications that have been recommended in good faith."

Time for Care 'one part' of much bigger solution that is needed on GP workforce and workload

"However, most of our hard-working, hard-pressed GPs will still tell a different story of working longer and longer hours and seeing more patients per day to try and cope with demand, which continues to increase in both volume and complexity. "The impact of Time for Care has to be seen as just one part of a much bigger solution that is needed, in the overall context of GP shortages and long-term underfunding of primary care. The investment announced in the recent NHS Long-Term Plan and GP contract framework will take time to be felt on the ground. "We are pleased to have more trainees in general practice than ever before, but this trend must be sustained and built upon, as well as continued urgent action to boost the GP workforce in the short-term. It is essential that the forthcoming workforce implementation plan launches effective strategies to boost the pipeline of GPs, protects and supports those who are struggling, and has robust solutions to expand the wider practice team - and that all this is properly funded."

RCGP urges Sultan of Brunei to revoke 'abhorrent' sanctions or lose College honour

The Sultan was awarded a 'Companion of the College' honour in 2013 in recognition of his support of the RCGP's work to provide primary healthcare in Brunei. But in her letter, Prof Stokes Lampard says that the latest developments in Brunei 'contravene our values and everything that the College stands for'. "Laws that persecute and punish individuals on grounds of their sexuality, and which carry sentences such as flogging and death by stoning, are completely contrary to these principles and will create an environment that is inimical to the comprehensive provision of safe, person centred, patient care for all. For these reasons, we oppose such measures in the strongest possible terms," she says. "We are a diverse and inclusive international organisation that is proud of its strong LGBTQ+ community of doctors and staff. Promoting equality and valuing diversity are central to the professional values of general practice and to the RCGP’s work to encourage, foster and maintain the highest possible standards of patient care." She continues: "When the College bestowed the honour of Companion of the College in 2013, these laws were not in place and we acted in good faith in recognition of your Government's commendable commitment to developing primary care in your country. "Latest developments have jeopardised this good work and we implore you to revoke these measures as a matter of urgency, or the College will be forced to act on the recommendation of our Fellowship and Awards Committee to rescind our honour to you." The College's Trustee Board will be holding an extraordinary meeting on Wednesday 17 April to discuss this. Read the letter to the Sultan of Brunei [PDF]

RCGP update on Sultan of Brunei and 'Companion of the College' honour

The recommendation will now be discussed at an extraordinary meeting of the College's Trustee Board next Wednesday (17 April) and Council members will then be asked to confirm their support for the decision. RCGP Chair, Professor Helen Stokes-Lampard, said: "We fully understand that our members want rapid action and a clear decision on this and we are working as fast as we practically can to deliver this. "The fact that we are calling an extraordinary meeting of our Trustee Board shows the level of our concern on this issue. "We ask for our members' support and forbearance over the coming days and will of course keep everyone updated as we follow our processes. "Meanwhile, we reiterate that we categorically condemn the recent change in the laws in Brunei and are proud to be a diverse and inclusive College that values our large and vibrant LGBTQ+ community."

RCGP update on Sultan of Brunei and 'Companion of the College' honour

The recommendation will now be discussed at an extraordinary meeting of the College's Trustee Board next Wednesday (17 April) and Council members will then be asked to confirm their support for the decision. RCGP Chair, Professor Helen Stokes-Lampard, said: "We fully understand that our members want rapid action and a clear decision on this and we are working as fast as we practically can to deliver this. "The fact that we are calling an extraordinary meeting of our Trustee Board shows the level of our concern on this issue. "We ask for our members' support and forbearance over the coming days and will of course keep everyone updated as we follow our processes. "Meanwhile, we reiterate that we categorically condemn the recent change in the laws in Brunei and are proud to be a diverse and inclusive College that values our large and vibrant LGBTQ+ community."

CBT offers hope for patients with irritable bowel syndrome, but more funding and services needed, says College

She said: "Irritable bowel syndrome is very common and can or those most severely affected it can be an incredibly debilitating condition. "This research is certainly interesting and will offer hope to many people who are living with what can be very distressing and embarrassing symptoms. "However, we also know that even when new innovations are accepted by the NHS, referral times for any form of cognitive behavioural therapy can be long, so we need to make sure that all new therapy services are properly funded and resourced to ensure our patients can access them as promptly, equitably and effectively as possible."

Asking GPs to take pictures of skin cancer referrals 'implies doubt' about clinical judgement, warns College

She said: "Deaths from malignant melanoma, the most serious form of skin cancer, are increasing more than any other cancer, so identifying skin cancer at the most timely stage possible leads to better health outcomes and, potentially, saves lives. "However, introducing this extra step to the process of urgent referrals implies doubt about GPs' clinical judgment and risks adding substantial delays to the process. "It is vital that all new initiatives are piloted carefully and appropriately funded before roll-out to ensure patient safety and prevent significant adverse impact on GP workload. "Unlike many other cancers, skin cancer is often visible, and  better access to diagnostic tools like dermatoscopes in our practices, along with the training to use them, is welcome. "GPs are already doing a good job of appropriately referring patients we suspect of having cancer, but we need proper resources if we are to continue to deliver the best possible care to all our patients, both now and in the future."

Asking GPs to take pictures of skin cancer referrals 'implies doubt' about clinical judgement, warns College

She said: "Deaths from malignant melanoma, the most serious form of skin cancer, are increasing more than any other cancer, so identifying skin cancer at the most timely stage possible leads to better health outcomes and, potentially, saves lives. "However, introducing this extra step to the process of urgent referrals implies doubt about GPs' clinical judgment and risks adding substantial delays to the process. "It is vital that all new initiatives are piloted carefully and appropriately funded before roll-out to ensure patient safety and prevent significant adverse impact on GP workload. "Unlike many other cancers, skin cancer is often visible, and  better access to diagnostic tools like dermatoscopes in our practices, along with the training to use them, is welcome. "GPs are already doing a good job of appropriately referring patients we suspect of having cancer, but we need proper resources if we are to continue to deliver the best possible care to all our patients, both now and in the future."

High-quality patient aids are welcome, but treatment still needs to be tailored to individual needs, says RCGP

She said: "Asthma can be incredibly debilitating for some patients if not well-controlled, so anything that helps to improve the lives of our patients living with the condition is a good thing. "Giving patients more control over how they manage their condition can make a real difference to their quality of life, and high-quality patient decision aids are a really welcome additional tool for GPs and their clinical teams when helping patients select the best treatment. "Also, most people want to 'do their bit' to help the planet, so many patients will welcome this opportunity of actively selecting medication that is proven to have the least effect on the environment. "However, GPs will only recommend treatment based on the unique circumstances of the person sitting in front of them, and patients and clinicians should not feel pressured to choose a particular type of inhaler if it will not properly fulfil the patient's needs."

High-quality patient aids are welcome, but treatment still needs to be tailored to individual needs, says RCGP

She said: "Asthma can be incredibly debilitating for some patients if not well-controlled, so anything that helps to improve the lives of our patients living with the condition is a good thing. "Giving patients more control over how they manage their condition can make a real difference to their quality of life, and high-quality patient decision aids are a really welcome additional tool for GPs and their clinical teams when helping patients select the best treatment. "Also, most people want to 'do their bit' to help the planet, so many patients will welcome this opportunity of actively selecting medication that is proven to have the least effect on the environment. "However, GPs will only recommend treatment based on the unique circumstances of the person sitting in front of them, and patients and clinicians should not feel pressured to choose a particular type of inhaler if it will not properly fulfil the patient's needs."

College Chair doing 'all I can' to hasten process on Brunei

She said: "We would like to clarify the action that the College is taking in light of the latest developments in Brunei. "We are all shocked by the situation and have said publicly that we categorically condemn these actions. "We are urgently reviewing the situation at the highest levels. The challenge we have is that it takes time to get the necessary advice and to get the relevant people together to make decisions about all the options we have to consider. As the College is a registered charity, we also have to comply with charity law and governance. "I appreciate that this is frustrating, but I promise our members that I am doing all I can to hasten the process so that we reach firm conclusions as swiftly as is safe and responsible to do so. I will, of course, communicate the decisions to all our members as soon as we can. "We are a diverse and inclusive College and are very proud of our strong LGBT+ community of doctors and staff. We abhor any form of human rights abuse."

College Chair doing 'all I can' to hasten process on Brunei

She said: "We would like to clarify the action that the College is taking in light of the latest developments in Brunei. "We are all shocked by the situation and have said publicly that we categorically condemn these actions. "We are urgently reviewing the situation at the highest levels. The challenge we have is that it takes time to get the necessary advice and to get the relevant people together to make decisions about all the options we have to consider. As the College is a registered charity, we also have to comply with charity law and governance. "I appreciate that this is frustrating, but I promise our members that I am doing all I can to hasten the process so that we reach firm conclusions as swiftly as is safe and responsible to do so. I will, of course, communicate the decisions to all our members as soon as we can. "We are a diverse and inclusive College and are very proud of our strong LGBT+ community of doctors and staff. We abhor any form of human rights abuse."

College welcomes plans to extend HPV vaccine to boys in NI

"We are delighted to see the HPV vaccine extended to young boys in Northern Ireland. This brings us in line with other areas in the UK. "The vaccine helps to protect young boys and girls from a virus that can trigger a range of cancers and is proven to be very effective in protecting women against cervical cancer. "We hope that parents will take the opportunity to have their children vaccinated as soon as the vaccination programme is offered come September." Welcoming access to the Faecal Immunochemical Test (FIT) for screening bowel cancer, Dr Doran said: "It is great to see two very positive announcements coming from the Department of Health today. "Anything that helps improve the rate of identifying bowel cancer is welcome. Patients will be contacted directly if they fall within the age category for the screening programme once available and we encourage people to respond if they are contacted."

College welcomes plans to extend HPV vaccine to boys in NI

"We are delighted to see the HPV vaccine extended to young boys in Northern Ireland. This brings us in line with other areas in the UK. "The vaccine helps to protect young boys and girls from a virus that can trigger a range of cancers and is proven to be very effective in protecting women against cervical cancer. "We hope that parents will take the opportunity to have their children vaccinated as soon as the vaccination programme is offered come September." Welcoming access to the Faecal Immunochemical Test (FIT) for screening bowel cancer, Dr Doran said: "It is great to see two very positive announcements coming from the Department of Health today. "Anything that helps improve the rate of identifying bowel cancer is welcome. Patients will be contacted directly if they fall within the age category for the screening programme once available and we encourage people to respond if they are contacted."

Widespread debate needed on 'disease mongering' and overdiagnosis of patients, says RCGP in response to BMJ Evidence-Based Medicine paper on definitions of disease

"Disease mongering is scaremongering and it has the potential to cause huge strain for the NHS and  other healthcare systems around the world. "Giving people unnecessary medical labels causes anxiety and distress and, in the worst cases, causes harm that can ruin lives. It also leads to unnecessary workload burdens in general practice and secondary care, and consumes funding that could be much better spent elsewhere on the care of patients who really need it. "This is a controversial but ground-breaking paper that should spark a widespread debate on the entire industry that has grown up around disease mongering and overdiagnosis. "GPs and our teams see over 1m patients a day in England alone. We understand how overdiagnosis adversely affects people - and the associated workload and costs - and we would welcome the opportunity to lead neutral and unbiased discussions with our specialist colleagues and members of the public about how we tackle the issue. "We also welcome the idea of 'diagnosis reviews' similar to the medication reviews that GP teams already have in place. "It is ironic that at a time when the health service is buckling under the strain of unprecedented demands, we live in a society where 'want' is increasingly prioritised over genuine 'need'. "This paper could be just the impetus we need to re-evaluate our priorities for some aspects of patient care." Read the RCGP response to BMJ Evidence-Based Medicine