Rollout for Scheme to Free Up GP Time for Patients

Peter Russell

April 15, 2019

An NHS scheme that enabled GP practices to free up more time for patients is to be rolled out across England.

The Time for Care programme was designed to help practice teams manage their workload more effectively and create more clinical time for care.

NHS England said that innovations such as allowing patients to book appointments earlier, reducing paperwork, and offering faster access to different specialist health professionals helped free up more than half a million hours of time for patients.

It said Pickering Medical Practice in North Yorkshire had reduced appointment waiting times by nearly half, while efficiency improvements at the Chiswick Health Practice in Hounslow in London had freed up 600 hours of GP time.

The programme has been extended for 3 years beyond its initial March 2019 end date and aims to cover three quarters of GP practices by 2022.

Dr Nikita Kanani, NHS England's medical director for Primary Care, said: "This programme has had significant benefits for patients and GPs alike, freeing up doctors' time and NHS resources to ensure people get the care they need as quickly as possible, as part of our long-term plan for the health service.

"GP services will continue to be at the heart of our health service, and it makes sense to invest for another 3 years in a programme that is delivering so much for patients while helping us to be more efficient."

The 3-year extension was part of a £30 million package in a national programme for general practice development committed to in the GP Forward View, NHS England said.

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said: "NHS England's evaluation of the Time for Care programme suggests it is making a real difference to some GP practices, and it is reassuring to know that NHS England are listening to our concerns about GP workload and taking action to help tackle this.

"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."

Abortion Services

The National Institute for Health and Care Excellence (NICE) said that women seeking an abortion in England should be offered greater choice of services and improved access.

Draft guidance said that termination of pregnancy services should be able to offer women a choice of medical or surgical procedures appropriate to gestational age, or be able promptly to refer the woman to a service that can.

The guidance said that women should be given an initial appointment within 1 week and that the procedure should be carried out within a week of the appointment.

It also said that women should be able to self-refer themselves to termination of pregnancy services without having to first see their GP.

Also, women should not be required to have compulsory counselling or be required to undertake a period of reflection before accessing abortion services.

Paul Chrisp, director of the Centre for Guidelines at NICE, said: "Integrating and streamlining services should help improve access for all women, leading to shorter waiting times and allowing earlier terminations. This provides multiple benefits to the woman, including being able to have a medical termination at home."

The new guideline, which is open for consultation until 31st May 2019, said that termination of pregnancy training should be undertaken by all healthcare professionals in appropriate specialities, unless they opted out due to a conscientious objection.

Iain Cameron, chair of the guideline committee and emeritus professor of obstetrics and gynaecology at the University of Southampton, said: "The evidence suggested that a shortage of staff trained in termination of pregnancy services was making it harder for some providers to offer all procedures.

"Giving trainee healthcare professionals the opportunity to gain experience in termination of pregnancy services should enhance access to this essential aspect of women’s care."

Prof Lesley Regan, president of the Royal College of Obstetricians and Gynaecologists which helped to develop the guideline, said: "Abortion care is an essential area of women’s healthcare and it is crucial that women are given a choice of medical or surgical treatment options and have access to safe, timely and compassionate care.

"These guidelines will help to address significant barriers that women experience across the country, by reducing waiting times and making it easier for them to access services. It’s also absolutely vital that more healthcare professionals are trained in this key area of women’s healthcare to ensure services are sustainable in the long-term."

'No' to Breast Cancer Drug

In other announcements, NICE issued draft guidance which did not recommend ribociclib (Kisqali, Novartis) used with the oestrogen antagonist fulvestrant (Faslodex, AstraZeneca) to treat people with advanced hormone-receptor positive, HER2-negative breast cancer.

It said that clinical trial evidence suggested that compared with fulvestrant alone, ribociclib with fulvestrant increased the length of time before the disease progressed in people with previously untreated advanced disease, and in people after a prior endocrine treatment.

However, appraisers said it was not known whether ribociclib increased longevity ahead of clinical trial results.

The committee also rejected the treatment for inclusion in England's Cancer Drugs Fund (CDF) on cost-effectiveness grounds.

Myeloma Treatment

NICE approved daratumumab (Darzalex, Janssen-Cilag) in combination with bortezomib (Velcade, Janssen-Cilag) and dexamethasone for use within the CDF as an option for treating relapsed multiple myeloma in people who have had one previous treatment.

It said clinical trial evidence suggested that patients lived longer with the combination compared with usual treatment, although long-term trial data was currently lacking.

The final guidance was subject to the treatment being made available under a managed access agreement.

Green Asthma Inhalers

People with asthma should be able to choose a preventer inhaler with a lower carbon footprint than alternative devices, NICE said.

A patient decision aid said using the correct device for their condition was important but that people should be aware that some inhalers were more environmentally-friendly than others.

Metered dose inhalers contain propellants known as hydrofluorocarbons, which are powerful greenhouse gases, it said.

Metered dose inhalers, which contain around 100 doses, have estimated carbon footprints of 500g carbon dioxide equivalents per dose, compared to 20g in dry powder inhalers, which also have around 100 doses.

Professor Gillian Leng, deputy chief executive of NICE, said: "This aid will help people make shared decisions on which inhaler is right for them, and help them use that inhaler effectively. This can help them to control their asthma, rather than have their asthma control them.

"People who need to use metered dose inhalers should absolutely continue to do so – but if you have the choice of a green option, do think about the environment.

"Cutting carbon emissions is good news for everyone, especially those with respiratory conditions."

Surgical Site Infections

NICE updated its guideline on preventing and treating surgical site infections in adults, young people, and children.

It focused on methods used before, during, and after surgery. Topics covered with new and updated recommendations were:

  • Nasal decolonisation before surgery

  • Antiseptic skin preparation during surgery

  • Antiseptics and antibiotics before wound closure

  • Methods of wound closure

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