Featuring: Making SEA work for you / Dealing with aggressive patients / Texting pitfalls / Ethics: It’s the small things DIY health An award-winning project providing parents with the knowledge and confidence to manage minor ailments in under-fives Welcome Dr Greg Dollman Editor WELCOME to the first issue of Insight Primary Care – one of three new quarterly magazines we are launching at MDDUS to broaden the scope of content we produce for all our medical and dental members (see page 3). I am excited to take on the role of editor and hope you find this inaugural issue both interesting and useful. All comments and suggestions are most welcome. Significant event analysis is not easy to get right and many of the SEAs we see at MDDUS are more description than analysis. On page 10 of this issue, Liz Price offers tips on making SEAs more than just simple box-ticking exercises. On page 6 we look at how to deal with aggressive patients while ensuring practice staff are kept safe, and our regular risk column on page 7 concerns the use of texting to contact patients and the data protection GP APPOINTMENTS implications. In our profile feature on page 8, we hear about a programme helping to ease pressure on GP Million missed monthly practices in Tower Hamlets London by promoting self- care among parents of children aged 0-5. ‘DIY Health’ so MORE than one million people fail to attend GP appointments impressed the judges at the 2019 BMJ Awards that it was every month in England, costing the NHS £200 million a named Primary Care Team of the Year. year, according to analysis of latest figures from NHS Digital Professor Deborah Bowman offers a personal published by The Times. perspective (page 13) on how even “small things” In the period from June to November 2019, 7.8 million can reflect ethical choices when it comes to dealing patients in England “did not attend” (DNA) – an average sensitively with patients. of 42,822 per day. Around half of the appointments were Our Call log on page 4 features common (and not to see doctors, with the rest for nurses or other healthcare so common) advice requests from GPs and practice professionals. managers, and our case study on page 12 concerns The NHS has no formal national policy for dealing with allegations of delayed diagnosis of appendicitis in a persistent non-attenders. Most surgeries use a range of tactics to patient with abdominal pain. tackle the problem, including text reminders, emails or letters, Addenda on page 14 includes some curious cardiac but some may issue warning letters. The RCGP said that the imaging, reviews of Bill Bryson’s brilliant new book The reasons for non-attendance may be complex and practices must Body and the corporate crime film thriller Dark Water, be given the resources for patient follow-up. along with a vignette of Dr Margaret Fairlie – pioneering obstetrician and gynaecologist, and the first professorial chair in Scotland. Dr Greg Dollman Editor WELLBEING EDITOR EDITORIAL DEPARTMENTS What about you? Greg Dollman Medical: Dr Richard Brittain PATIENT care may come first for medical professionals Legal: Joanna Jervis MANAGING EDITOR but how do you look after your own wellbeing? A Jim Killgore MDDUS 2019 British Medical Association (BMA) report found ASSOCIATE EDITOR Mackintosh House that nearly nine out of 10 GP partners are at high or Joanne Curran 120 Blythswood Street very high risk of burnout – and all staff Glasgow G2 4EA are under pressure with increasing DESIGN Connect Communications t: 0333 043 4444 demand. MDDUS has produced 0131 561 0020 e: [email protected] some guidance and resources for www.connectmedia.cc w: www.mddus.com members on keeping well and avoiding burnout. To access the Insight – Primary Care is published quarterly by The Medical and Dental Defence Union of Scotland, registered in Scotland No 5093 at Mackintosh House, 120 Member wellbeing and mental health Blythswood Street, Glasgow G2 4EA. Tel: 0333 043 4444 Fax: 0141 228 1208 page go to the Advice and Support Email: General: [email protected] Membership services: membership@mddus. section of mddus.com com Marketing: [email protected] Website: www.mddus.com The MDDUS is not an insurance company. All the benefits of membership of MDDUS are discretionary as set out in the Articles of Association. The opinions, beliefs and viewpoints expressed by the various authors in Insight – Primary Care are those of the authors alone and do not necessarily reflect the COVER PHOTOGRAPH: DOMINICK TYLER DOMINICK PHOTOGRAPH: COVER opinions or policies of MDDUS. Go digital Read, see and hear more content including coronavirus updates by accessing the premium digital version of Insight Primary Care. Go to Resources > Publications at mddus.com and click on View this issue via digital reader WORKFORCE RCGP sets roadmap GENERAL practice is “running on empty” with ever increasing patient demand and falling GP numbers, says the Royal College of General Practitioners in a statement setting out a new Workforce Roadmap. The plan details what must be done to ensure general practice has enough GPs and practice staff to deliver safe, high- quality patient care if the Government is to achieve its manifesto pledge of 6,000 INDEMNITY more GPs and 50 million more patient consultations. The RCGP points out that from September to November 2019, GPs in Extended cover England undertook 41.9 million patient consultations, which is 450,000 more than for practice staff the same period in the previous year - this MDDUS can provide extended indemnity, legal support and advice/assistance despite a drop in the to non-GP practice staff in England and Wales for activities and risks not number of full-time- covered under new state-backed schemes. Under our Primary Care Team equivalent GPs. m Professional Advice Protection plan all non-GP members on the practice team RCGP chair GP42 CONSULTATIONS can enjoy access to expert advice and support with complaints arising from Professor Martin clinical practice indemnified by state-backed schemes in England and Wales Marshall said: “Unfortunately, general (CNSGP and GMPI, respectively). In England this includes NHS primary medical practice has been running on empty for services delivered on behalf of the Primary Care Network. too long… The impact of these measures The plan is provided free to practices where GP partners are all MDDUS will be to significantly improve the access members. In practices where all GP partners are not in MDDUS membership to our service and the quality of the care we there will be an annual charge of £50 per regulated team member. Non- can give to our patients.” regulated staff (e.g. HCAs) will be covered free of charge. MDDUS also offers an essential extension to the above plan for individual regulated non-GP staff. Find out more at tinyurl.com/y4a2cogl. An Insight for primary care LAST year we launched the first our current range of magazines edition of a new digital Insight, (including GPST and Practice Manager) generated using the premium with three branded quarterly digital digital magazine platform, Foleon. and print magazine titles. The switch to digital was part of a Insight Primary Care is the first of larger initiative to reconsider our these magazines with a secondary publication programme and how care publication launched in April best to communicate with members and a dental in May. All the Insight going forward in 2020. titles will be generated using Foleon We have now decided to broaden and sent out via an email link, but the scope of the content we produce those existing members who opted for medical and dental members. for print will still receive a hard copy Starting this month we will replace in the post. MDDUS INSIGHT / 3 These cases are based on actual calls made to MDDUS advisers and are published here to highlight common challenges within practice management. Details have been changed to maintain CALL LOG confidentiality. Consulting via social media I have a patient being treated for a Qchronic condition and we recently discussed switching medication and agreed to do some baseline bloods first before changing the prescription. The patient has now sent me a friend request via LinkedIn with a link to an article assessing a possible alternative medication. Is it okay for me to reply to this message with a link to another article showing there is no conclusive evidence supporting increased efficacy in the suggested drug? LinkedIn is a “professional” platform and the question is treatment related. It’s best to be cautious about this type Aof communication with patients. GMC guidance on Doctors’ use of social media highlights that boundaries can become blurred when communicating through sites himself. It may be the mother would not want such as LinkedIn. It states: “If a patient her child to be informed of her request. If she Intoxicated contacts you about their care or other is content for this assessment to be professional matters through your private undertaken and he has capacity but refuses, patient profile, you should indicate that you cannot this would ordinarily be definitive. If he does An elderly patient recently attended mix social and professional relationships not have capacity and the mother maintains Qthe practice for an appointment and, where appropriate, direct them to your parental responsibility, the key issue is what having come from the pub. He was clearly professional profile”. The guidance also is in the child’s best interests to disclose. inebriated, smelling of alcohol, stumbling states: “social media sites cannot and slurring his words. The GP refused to guarantee confidentiality whatever privacy see the patient and asked reception to settings are in place”.