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GPs in England threaten industrial action over in-person appointments

industrial action

GPs in England threaten industrial action over in-person appointments

GPs in England are threatening industrial action in protest at the government’s attempt to force them to see any patient who wants a face-to-face appointment.

The British Medical Association’s GPs committee voted unanimously to reject the plan by the health secretary, Sajid Javid, which included “naming and shaming” surgeries that see too few patients in person.

The doctors’ union has decided to hold a ballot on possible industrial action, which could result in family doctors at the 6,600 practices in England reducing the work they undertake.

“GPs have been left with no alternative but to take this action. All efforts to persuade the government to introduce a workable plan that will bring immediate and longer-term improvement for doctors and their patients have so far come to nought,” said Dr Richard Vautrey, the chair of the BMA’s GPs committee.

It is a dramatic escalation of GPs’ increasingly bitter war of words with ministers and comes as soaring Covid cases put increasing strain on the health service.

It could herald the first major clash between the medical profession and ministers since the year-long junior doctors’ dispute in England in 2015-16, which involved a series of walkouts by trainee medics.

GPs have been angered by Javid’s instruction last week that they should see many more patients in person, and a plan to publish monthly data showing what proportion of each surgery’s appointments occur in person or virtually. They are also frustrated by what they say is a lack of action to reduce their heavy workloads.

Family doctors are also furious at a separate plan to compel those who are paid at least £150,000 a year for NHS work to declare their earnings, announced in 2019 and starting next month. The BMA has said this could imperil family doctors’ safety because “forcing GPs to publish their earnings provides no benefit to patient care, yet will potentially increase acts of aggression towards GPs and will damage morale amongst the profession and only worsen practices’ ability to recruit and retain GPs.”

It is unclear how much of an impact industrial action by GPs would have on the care patients receive. But if family doctors vote to forge ahead, it could lead to GPs:

  • Declining to comply with Javid’s insistence that they see patients in person who request it.
  • Visiting care homes less often to check on residents’ health.
  • Undertaking fewer or less regular medication reviews of the drugs being taken by patients with a long-term health condition.
  • Refusing to issue Covid medical exemption certificates, which will allow people who remain unvaccinated to continue working in environments such as care homes because they have a medical reason not to have been jabbed against the disease.

The BMA sought to reassure patients by pledging that any changes to usual working patterns would not affect GPs’ involvement in the rollout of either winter flu jabs or Covid booster vaccines. However, the decision has prompted fears that patients could find it harder to see a GP at their surgery.

“This shows the government’s deliberately provocative plans to name and shame GPs has backfired,” said Daisy Cooper, the Liberal Democrats’ health spokesperson. “Sajid Javid must now dial down the rhetoric and get round the table with doctors and patient groups to find a way forward. It would be unforgivable if, as we enter a winter crisis, people are unable to access their local GP.”

The BMA and Royal College of GPs are deeply frustrated that Javid’s plan contained few of their proposed steps to help to reduce GPs’ “unsustainable” workloads.

They had asked him to suspend the Quality Outcomes Framework (QOF) under which surgeries are paid agreed sums for monitoring the health of people with conditions such as asthma and diabetes, saying it takes up too much time and that removing the QOF system in Scotland has not damaged patient care.

It is not certain that GPs will hold a ballot because the BMA’s ruling council has to approve that course of action. But Dr Chaand Nagpaul and Dr David Wrigley, the union’s chair and deputy chair of council, are appalled at Javid’s stance.

Nagpaul has insisted it is the lack of GPs in England – the number of full-time GPs has fallen by 1,800 since 2015 despite a rising population – that has limited rapid patient access, not family doctors’ willingness to see all those seeking a consultation.

Vautry said: “The ultimate outcome should be to end the current crisis in general practice, to properly support practices to manage their workload pressure, including safely getting through the backlog of care caused by the pandemic, and deliver a safe service to patients, allowing time to create an agreed long-term plan to make general practice sustainable for the future.”

A Department of Health and Social Care spokesman said: “We want patients to be able to see their GP promptly and in the way they choose. Our plan will improve access and drive up face to face appointments, it includes providing a further £250m to GPs in order to boost capacity.”

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Health

Lagos to convert General Hospital to eye centre

The Lagos State Commissioner for Health, Prof. Akin Abayomi, says the state government will designate one of its general hospitals as a centre for ophthalmic specialty to improve care for patients with eye conditions.

Abayomi said this during the 4th Annual General Meeting and Scientific Conference of the Africa Retina Society on Thursday in Lagos.

The News Agency of Nigeria (NAN) reports that the event was themed, “Upscaling Retinal Services in a Resource-Constrained Economy.”

Abayomi said the centre would provide a world-class diagnostic, medical, surgical and ophthalmic services in Lagos and Nigeria.

He stressed that the state would prioritise eye health, noting that the state was working on developing screening capacity of all its primary healthcare facilities to detect eye diseases early.

“The conditions that affect the eyes very much reflect the conditions of the community in which you live. HIV, for example, was a major problem in South Africa, and I certainly experienced the impact of HIV on our day-to-day medicine and practice.

“Here in Nigeria, we have other things. We have hypertension, diabetes, sickle cell, and lots of trauma. These are the kinds of things that we see in our clinics here in Lagos and in Nigeria.

“We need to be able to understand how these prevailing conditions really affect us,” he said.

The commissioner further said that efforts are ongoing to promote eye screening, especially in schools, starting with the training of teachers to detect students exhibiting challenges with their vision.

He added that the state would leverage the social health insurance to screen, detect and treat eye diseases as patients presents at health facilities.

The commissioner further said the state would strengthen public awareness and understanding on eye health, especially glaucoma and visual acuity.

Abayomi disclosed that the state through its Ministry of Health had forged a partnership with the Chagoury Group
to develop a specialist eye hospital in Lagos to boost access to eye services.

He acknowledged that ophthalmology was equipment-intensive, stressing that government would pay attention to that and human resources to enable practitioners make appropriate diagnosis, and treatment to reverse medical tourism.

Earlier, Prof. Linda Visser, Head, Division of Ophthalmology Stellenbosch University, South Africa, called on policy makers to formulate policies that would integrate eye screening into diabetes care from the primary healthcare level, noting that cases of diabetic retinopathy was on the increase among Africans.

Diabetic retinopathy (DR) is a chronic progressive disease of the retinal capillaries (small blood vessels) associated with prolonged raised blood glucose levels in people with diabetes.

Visser cited data from International Diabetes Foundation that showed that 537 million adults aged 20 to 79 years are living with diabetes globally, a number that was predicted to reach 1.3 billion in 50 years.

“The high prevalence of type 2 diabetes continues to rise worldwide and is particularly rapid in low- and middle income countries.

“Most of these countries have limited availability and affordability of healthcare services for screening and treating diabetes-related complications, such as retinopathy, to prevent vision loss,”

According to her, all persons with diabetes are at risk of developing DR, however, those with poor blood glucose and blood pressure management and hyperlipidaemia are most at risk.

Visser, Past President, Vitreoretinal Society of South Africa, emphasised that early detection would lead to timely treatment of DR, which could prevent 95 per cent of vision impairment and blindness.

Also, Dr Asiwome Seneadza, Chairman, Africa Retina Society, said that the theme was timely and critical as efforts are made to navigate the complexities and challenges in delivering advanced retinal care across the continent.

Seneadza said, “That’s why we are advocating for improved diabetes care and regular retinal screening made available and accessible for every individual living with diabetes,” he said.

Similarly, Prof. Bassey Fiebai, Chairman, Vitreo Retinal Society of Nigeria, said the meeting was critical to proffering solutions to the challenge of offering standard retina care, improving outcomes and reducing visual loss from retina related disorders among low to medium income countries.

Fiebai said that the government plays a critical role in providing funding, training of personnel, provision of equipment to improve screening, detection and treatment of retinopathy disease.

The professor noted that retina specialists are few in Nigeria, placing the figure at about 100, stressing that it was inadequate to cater to the teeming population who require eye care.

“Right now in the country, we have just a little over 100 retina specialists. And we know that the population of Nigeria is about 230 million.

“So we’re looking at a situation in which one retina specialist is supposed to cater for 2.3 million people. How does anyone cope?” she queried.

NAN reports that the Annual General Meeting and Scientific Conference of the Africa Retina Society which began on June 26 to June 28, had participants from various African countries brainstorm on enhancing retinal care.

(NAN)

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Health

Cholera outbreak: Tinubu sets up presidential committee to oversee emergency operation centre

President Bola Tinubu has directed the setting up of a presidential committee to oversee the Cholera Emergency Operation Centre, operated by the National Centre For Disease Control.

The Minister of Health, Ali Pate, made this known on Tuesday after the Federal Executive Council meeting chaired by President Tinubu at the State House, Abuja.

He added that the committee’s effort is in addition to state government support to ensure Nigeria makes progress in reducing open defecation.

“The Council then approved a cabinet committee comprising the federal ministries of Health, Finance,Water Resources, Environment, Youth, Aviation, Education because some of our children will be returning to school . In addition to this, the state government, we will co-opt, so that Nigeria makes progress in reducing open defecation because cholera is a developmental issue that requires a multi-sectoral approach.

“The President directed that a cabinet committee be set up to oversee what the emergency operation centre led by NCDC is doing and for the resources to be provided complemented by the state government,” he said.

Pate further disclosed: “At the moment about 31 states have recorded 1528 cases and 53 deaths in Nigeria. That is what we are working through the Emergency Operation Centre that was activated by NCDC on Monday.

“Now we have a cholera outbreak and we discussed extensively in the Council in addition to a new emergence of Yellow Fever specifically in Bayelsa State.

“On cholera we are in the middle of the 7th pandemic globally which is decades in the making. In 2022, the world had almost 500,000 cases of cholera so it is not only peculiar to Nigeria. In 2023 almost 700,000 cases of cholera were reported by the World Health Organization.

“This year more than 200,000 cases have occurred in five regions of the World.”

He emphasised that a multi sectoral approach is required to tackle the outbreak .

“Resources were deployed to 21 states to help them respond to cholera. We are improving awareness of population, handwashing, hygiene sanitation, in addition to treatment with drugs, and intravenous fluids,” he added.

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Health

NCDC reports 1,598 cases of cholera across the country

The Nigeria Centre for Disease Control and Prevention, NCDC, has reported 1,598 suspected cases of cholera across 107 local government areas.

The cholera outbreak is characterised by a case fatality rate of 3.5 per cent, significantly higher than the national expected average of one per cent, underscoring the severity of the situation.

The Director-General of NCDC, Dr Jide Idris, disclosed this on Monday in Abuja while providing an update on the cholera epidemiological situation in Nigeria and ongoing prevention and response efforts at the national and sub-national levels.

Cholera is a severe diarrheal illness caused by the bacterium Vibrio cholerae. The disease remains a significant health challenge, especially in regions with inadequate sanitation and clean water access.

Understanding the transmission mechanism of cholera is crucial to curbing its spread and implementing effective prevention measures.

Idris said: “Government is deeply concerned about the rapid spread and higher-than-expected mortality rate, indicating a more lethal outbreak.”

He emphasised that the fatalities represented significant personal losses, including those of family members, spouses, parents and healthcare workers.

“This situation can be compounded as the rainy season intensifies,” he added.

He disclosed that Lagos State accounted for the highest number of deaths with 29, followed by Rivers with eight, Abia and Delta with four each, Katsina with three, Bayelsa with two and Kano, Nasarawa and Cross River with one each.

He added: “This alarming trend highlights the urgent need for coordinated response to prevent further escalation of the crisis. Sixteen states accounted for 90 per cent of the confirmed cases, with Lagos being the epicentre of the outbreak. Lagos State, having the highest number of cases, has received significant focus, with ongoing support and resources directed to manage the outbreak effectively.”

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