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TRUST is an essential element of the doctor-patient relationship, and patients must feel confident their doctor will behave professionally towards them at all times. But what if that relationship changes? Is it ever appropriate to become romantically involved with a patient – past or present? MDDUS medical adviser Dr Susan Gibson-Smith offers advice on this complicated issue in her article on page 4. Ever since Robert Francis QC published his report on the failings at Mid Staffs in 2013, the so-called duty of candour has been much discussed. On page 6, MDDUS medical adviser Dr Barry Parker gives an overview of what trainee GPs need to know about the new rules. Could you tell the difference


between the skeleton of a seal’s flipper and a human foot? These are just some of the challenges


facing rural GP David Hogg on the Scottish isle of Arran. He offers a fascinating glimpse into island life in his article on page 10. Longer patient consultation


times, increased funding, multidisciplinary team working, and better use of technology – these are just some of the key elements that the Primary Care Workforce Commission hopes will form the future of general practice. On page 12 GPst associate editor Joanne Curran looks at the commission’s new report which predicts what lies ahead for the profession. On page 8 our career article looks at the work of GPs with an interest in respiratory medicine, and on page 14 we analyse a case of delayed referral in a patient with testicular torsion.


• Dr Peter Livingstone Editor


NEW SERVICE TO HELP STRESSED GPs


GPs suffering from stress and burnout will be able to access a nationally- specified occupational health service in England from 2016. The scheme will be supported by specialist services for doctors and


build on already successful initiatives such as the London Practitioner Health Programme and House Concern in the Northern region. NHS England chief executive Simon Stevens announced the move as


part of a £5 million drive to improve NHS staff health and reduce sick days. “At a time when the pressures on GPs have never been greater, we


need to extend the local practitioner health programmes that have been shown to help GPs stay healthy and get back to work when sick,” he said. Under the new initiative, NHS staff will also be given the chance to


attend fitness classes such as yoga and Zumba, and there will be a clampdown on the amount of junk food served in hospitals. Health checks will be provided at work for NHS staff aged 40 or over,


and there will be access to physiotherapy, mental health talking therapies, smoking cessation and weight management services.


OVERWORKED GPs RISK PATIENT SAFETY


GP fatigue due to overwork threatens patient safety on a “widespread scale”, says the RCGP in a new consultation paper. The College claims that unrelenting and increasing workload


EDITOR: Dr Peter Livingstone


CONTENT EDITOR: Dr Susan Gibson-Smith


ASSOCIATE EDITORS: Joanne Curran Jim Killgore


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CORRESPONDENCE: GPst Editor MDDUS Mackintosh House 120 Blythswood Street Glasgow G2 4EA


t: e: 0845 270 2034 jcurran@mddus.com w: www.mddus.com


GPst is published by The Medical and Dental Defence Union of Scotland, Registered in Scotland No 5093 at Mackintosh House, 120 Blythswood Street, Glasgow G2 4EA. The MDDUS is not an insurance company. All the benefits of membership of MDDUS are discretionary as set out in the Memorandum and Articles of Association.


pressures are pushing GPs to their limits – having to cope with growing patient numbers and diminishing resources. It says that GPs are working longer days seeing patients, followed by many hours after surgery and at weekends trying to keep up to date with urgent paperwork. The College acknowledges that safety risks in general practice are


inherently lower than those in hospitals but warns that there is considerable potential for patient harm through medication errors, mistaken patient identity and other risks. GP consultations between 2008/9 and 2013/14 rose by 19 per cent in England alone yet the total number of GPs across the UK grew by just 4.1 per cent in that period. GPs are also seeing an increasing number of patients with multiple and chronic conditions which are more difficult to deal with in a standard 10-minute consultation. In the consultation paper – Patient safety implications of general


practice workload – the College offers proposals for protecting the wellbeing of GPs. These include regular, mandatory breaks for staff to minimise the possibility of errors and a mechanism to identify practices under extreme workload pressures – and for measures to be urgently implemented to relieve these pressures. RCGP Chair Dr Maureen Baker said: “GP fatigue is a clear and present


danger to patient safety and we urgently need to find workable solutions that will keep our patients safe now and in the future.”


PHOTO: PAUL GRAHAM


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