NEWS DIGEST VIEWPOINT


By Dr Barry Parker, medical adviser at MDDUS


Abolishing practice boundaries brings risk


GOOD communication is one of the cornerstones of high-quality patient care. As a defence union, we see the outcomes of communication failures, such as delayed referrals, result-handling problems and prescribing errors, on a fairly regular basis. Whilst some of this may be attributable to the highly demanding nature of work in the health professions and the inevitability of human error, risk can be minimised by ensuring that systems are tight. The benefits of having a core primary care team with good communication where everyone understands each other’s roles and is aware of the systems in place and how to operate them, need hardly be emphasised. We have developed this model of primary care in the UK over many decades, and it is still the envy of the world. The latest assault on this tried and


tested model comes in the form of the Government proposal in England and Wales to relax practice boundaries for


patient registration. In the first model proposed, out of area patients will be allowed to register with a participating practice, presumably near their workplace, and cease registration with their home practice. A separate service will require to be provided should out of hours care be needed when at home. The second model allows attendance as a ‘day patient’ in a participating practice out of area, but retaining registration at the home practice. These models are to be piloted in


London, Manchester and Nottingham and are heralded as examples of increased convenience and patient choice. This may be the case, but if one were tasked with creating confusion, fragmentation of care and communication failure, it would be difficult to think of a better plan. There are clear and obvious concerns


whenever Dr A does not know what Dr B is doing, and they are both trying to treat patient C. Systems for investigation, referral and follow-up may vary between practices, and there may be lack of clarity in terms of accountability for the overall care of the patient. The BMA has emphasised the value of one GP practice knowing a patient well, understanding the social context and environment behind an illness, and if necessary assessing in the


home. There may be particular problems in patients with drug addiction in terms of monitoring supply of prescriptions, and there may also be difficulties protecting vulnerable patients such as children at risk due to lack of continuity and proper support and monitoring. It seems likely that for those who are


not too severely ill and still able to get to work, it may be convenient to be seen for treatment of a short-term acute problem while out of area. For those with complex problems, whether physical or psychological, the fragmentation of care could be positively damaging. Patients may be treated under two separate management plans with either duplicated or conflicting medication regimes. Unless the sharing of medical records between all participating practices is extremely efficient, the potential for confusion and mismanagement is considerable. GPs are a resilient and adaptable


group, and I am sure those in the pilot sites will do everything they can to make the system work. It can only be hoped that they will be given sufficient support in terms of communication technology to keep fully informed of each patient’s progress in a timely manner, so that the inherent risks of this new venture are minimised.


More changes in dental fitness to practise


THE GDC is proposing the appointment of case examiners with statutory powers to make decisions in fitness to practise cases. The case examiners would be drawn


from a pool of dental professionals and lay people and would have powers to conclude a case without further action, issue a letter of advice or warning, or refer a case to a relevant GDC committee.


found that women in their forties comprise the demographic most likely to be incapable of having a filling, extraction or even a routine check-up without general anaesthetic or other sedation. “Dental anxiety is very real and complex and it should never be


SPRING 2012


Details are provided in a consultation document and the proposed changes will require legislative amendment. They follow a range of measures already introduced to help improve the FtP system. The case examiners would not replace


the Investigating Committee (IC) but, over time, would be expected to reduce the numbers of cases referred to the IC. The overall aim of this new role would be to ensure that resources are properly applied


downplayed,” said study co- ordinator Dr. Avanti Karve. She hopes the study will help identify specific triggers of dental phobia with a view to finding a drug-free remedy. Source: Dentistry.


to cases of impaired fitness to practise and that process are transparent and sufficiently flexible to enable a tailored approach according to seriousness. The consultation will run until 30 April


2012 and the GDC is keen to hear from all stakeholders who have an interest in the future of fitness to practise procedures, including patients, registrants and professional organisations. Respond to the consultation on the GDC website.


l NEW NICE GUIDANCE APP A new app has been launched allowing users access to NICE guidance


from Android or iPhone smartphones. The free app can be downloaded from the


NICE website (www.nice.org.uk) and features over 760 items of NICE guidance arranged topically by conditions and diseases, and public health topics. Users can rapidly search and bookmark sections, and also receive updates and new guidance as soon as it’s published.


7


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24