General practice delivers ‘record number of appointments’ in England
NHS England's October GP workforce and appointments data has shown that 40.3 million appointments were estimated to have been delivered by practices and Primary Care Networks in October 2024. Of these, 1.8 million were Covid-19 vaccinations. A total of 40.1% of all appointments in October 2024 were carried out by a GP and 23.2% were carried out by nurses; and 69.9% of all appointments in October 2024 were carried out face to face.
Ruth Rankine, Primary Care Director at the NHS Confederation, said: ‘These new figures show the staggering amount of work that GPs and their teams are doing, with a record 38.5 million appointments in October. This is up significantly on last year and well above pre-pandemic levels. It is clear that general practice is running extremely hot going into winter – just like other parts of the NHS – and is likely to get worse with the expected rise in winter viruses still ahead of us. As recognised in Lord Darzi's report, primary care is doing more work for a lesser share of the NHS budget. This is simply not sustainable and will make delivering on the government's commitments of moving from treatment to prevention, and delivering care closer to home, significantly harder to achieve.’
Professor Kamila Hawthorne, Chair of the Royal College of GPs, said: ‘GPs and our teams delivered more than 40m appointments, when you include Covid vaccinations, in October – a record and a whopping 10 million more than 5 years ago. That's a staggering 30% increase, yet we still have nearly 100 fewer, fully qualified, full time equivalent GPs in the workforce than 2019. Whilst this shows the dedication of GPs and our teams to ensure patients receive the care they need, it is not sustainable. It is, of course, encouraging to see numbers of fully-qualified, full-time equivalent GPs now steadily rising, but there are still fewer than five years ago, against a backdrop of ever-increasing workload, and this is pushing many GPs to burn out. Our recent survey warned that over 40% of GPs are unlikely to be working in general practice in five years’ time, with more than half saying that finding the job too stressful is a key reason they are considering leaving.
‘In his landmark review, Lord Darzi acknowledged that primary care consistently delivers more care, with a shrinking proportion of the NHS budget. We've heard some encouraging proposals from the new government to move more resource into primary care, but the pressures remain – and worsen – month by month, and it is our most vulnerable patients who are bearing the brunt when they struggle to access our care. With winter fast approaching, our services will only get busier – and uncertainty around how the hike in National Insurance for employers will impact on practices is only adding to the pressures general practice is facing. We need action now to alleviate the workforce crisis. This means urgent investment in general practice, including into schemes to recruit and retain the GPs we need, to allow us to continue to provide the high-quality care our patients deserve.’
2024 NHS Maternity Survey highlights ‘persistent issues’
Findings from the 2024 NHS Maternity Survey show areas for improvement in all stages of maternal care – supporting the challenges identified by the Care Quality Commission's national review of maternity services in England 2022 to 2024.
The survey of over18 900 women who gave birth in January and February 2024 highlights awareness of medical history, help from staff, involvement in decisions to be induced, and provision of information in postnatal care as areas for improvement.
Around half (53%) of all respondents said their midwives or doctor ‘always’ appeared to be aware of their medical history during their antenatal checkups. This is an improvement from 46% in 2021, when the question was first introduced, but still leaves many women having poor experiences of staff awareness of medical history.
Three quarters (75%) of all respondents said they were ‘always’ involved in decisions about their care during labour, but mothers reported poorer experiences of decisions about induction.
Only 59% of respondents whose labour was induced said they were ‘definitely’ involved in the decision to be induced. However, encouraging results were found regarding the provision of information and advice on the risks associated with an induced labour. Seventy-four per cent of respondents whose labour was induced said they were given appropriate information and advice (up from 69% in 2023 and 64% in 2022).
Jenny King, Chief Research Officer at Picker, said: ‘Listening to women and families is fundamental to achieving safer care. This survey, which has been carried out regularly since 2007, provides important insight that should be used to drive quality improvement initiatives.
‘We call on NHS organisations to review their detailed local results and use these – alongside involvement from local people – to identify priorities for improvement.’
MHRA approves new diagnostic agent for adult patients showing signs of cognitive impairment for Alzheimer's disease
The Medicines and Healthcare products Regulatory Agency (MHRA) has approved the medicine flortaucipir (Tauvid), a radiopharmaceutical product given to adults with memory problems so that doctors can perform a PET scan.
Along with other brain function tests, flortaucipir may help the patient's doctor find the reason for their patient's memory problems by helping to determine whether they have abnormal forms of tau protein in their brain.
Julian Beach, MHRA Interim Executive Director, Healthcare Quality and Access, said: ‘We are focused on providing UK patients access to safe and effective medicines. We're assured that the appropriate regulatory standards for the approval of this medicine have been met. As with all products, we will keep its safety under close review.’
Flortaucipir is given by injection into a vein about 80 minutes before obtaining an image from a PET scan. Doctors need to use the scans together with clinical evaluation and other diagnostic tools.
Flortaucipir PET scan results on their own cannot confirm or refute a diagnosis of Alzheimer's disease in patients with cognitive impairment.
The MHRA says this approval is supported by evidence from a diagnostic performance study, in which it was shown that PET scans identified 92% of the patients who had significant buildup of tau protein (which are abnormal clusters of protein fragments that build up between nerve cells) as positive. This meant that flortaucipir PET scan had a sensitivity of 92% in the ability to detect significant buildup of abnormal tau protein in the brain. A total of 76% of patients without significant tau protein buildup were correctly rated as negative, i.e. flortaucpir PET had a specificity (the ability to correctly identify absence of the disease) of 76%. A separate study evaluated diagnostic performance of flortaucipir, and the PET scans in this study were shown to have a sensitivity of 89% and a specificity of 77%. This meant that the PET scans were able to correctly identify as positive 89% of the patients who had significant amounts of plaques, and that 77% of patients without significant plaques were correctly rated as negative.
Certain HRT tablets linked to increased heart disease and blood clot risk
Certain hormone replacement therapy (HRT) tablets containing both oestrogen and progestogen are associated with a higher risk of heart disease and rare but serious blood clots known as venous thromboembolism (VTE) in women around the age of menopause, finds a study from Sweden published by the BMJ.
Another HRT tablet called tibolone was associated with an increased risk of heart disease, heart attack and stroke, but not blood clots, ‘highlighting the diverse effects of different hormone combinations and administration methods on the risk of cardiovascular disease,’ say the researchers.
Researchers set out to assess the effect of contemporary menopausal hormone therapy on the risk of cardiovascular disease according to the route of administration and combination of hormones.
Their findings are based on data from 138 emulated trials (observational studies that mimic clinical trials), involving 919 614 healthy women in Sweden aged 50–58 between 2007 and 2020 who had not used hormone therapy in the previous 2 years.
They excluded women with a history of heart disease, stroke, narrowed arteries, or cancer, and who had undergone surgery to remove their ovaries, a hysterectomy, or sterilisation.
Using monthly prescription records, the women were assigned to one of eight menopausal hormone treatment groups: oral combined continuous, oral combined sequential, oral unopposed oestrogen, oral oestrogen with local progestin, tibolone, transdermal combined, transdermal unopposed oestrogen, or no menopausal hormone therapy.
Hospital records were then used to track cardiovascular events over two years, and other potentially influential factors such as age, education level, region of residence, high blood pressure and diabetes were taken into account.
During this monitoring period, 24 089 cardiovascular events were recorded among the 919 614 women in the study. Compared with not starting menopausal hormone therapy, starting oral combined continuous therapy or tibolone was associated with an increased risk of ischemic heart disease. This translates to approximately 11 new cases of ischaemic heart disease per 1000 women who start treatment with oral combined continuous therapy or tibolone over one year.
No increased risk of cardiovascular disease was found for transdermal treatments, which include skin patches, gels and creams.
New joint guideline recommends health professionals prescribe combination treatment rather than ‘reliever’ medications alone for newly diagnosed asthma
A new guideline recommends chronic asthma should be diagnosed by healthcare professionals when people first show symptoms by using simple tests. The guideline also says health professionals should always prescribe maintenance or combination treatments, which prevent and relieve symptoms, rather than the familiar blue ‘reliever-only’ inhaler, when asthma is first diagnosed.
The British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) have worked together to produce a new UK-wide joint guidance for the diagnosis and management of chronic asthma in adults, young people and children. It recommends health practitioners should offer a low-dose combination of inhaled corticosteroids (ICS) and formoterol to be taken as needed for everyone aged 12 and over with newly diagnosed asthma to reduce inflammation as well as relieve symptoms. It recommends not prescribing short-acting beta2 agonists (SABA), the most widely used blue ‘reliever’ inhaler/medication, without inhaled corticosteroids, to anyone diagnosed with asthma. The independent guideline committee looked at evidence which showed using the combined ICS and formoterol inhalers when required led to people suffering fewer severe asthma attacks.
As part of the final guideline publication BTS, NICE and SIGN have also developed a new digital resource which will act as a ‘one stop shop’ online. The digital asthma pathway links to online tools, resources and information, all stored in a central hub, accessible from the website of each organisation.
The pathway has been designed to support health professionals in making accurate diagnoses, promoting good practice, and providing effective, personalised treatment to control and prevent acute asthma attacks.
The asthma pathway includes existing BTS/SIGN guidance on management of acute asthma, non-pharmacological management, and occupational asthma.
Other resources include a joint patient decision aid on asthma inhalers and climate change, all asthma drugs and treatments recommended by NICE and advice from the Scottish Medicines Consortium.