CQC Publishes Advice on Managing the Risk of Hypothermia in Care Settings

Hypothermia can develop in vulnerable people after a relatively short exposure to cold weather. It can even develop after a small drop in room temperature.

Many people who use health and social care services may be at risk of developing hypothermia. They include:

• older people in care homes and receiving care at home
• people with reduced mental capacity, reduced mobility, or a sensory impairment
• people who cannot communicate that they are exposed to cold

The risks to people are serious.  In one incident a 91-year-old woman died of severe hypothermia in a care home. She had not been given any hot food or drink as she spent her last day asleep in her room. Her body temperature was so cold it would not have registered on a standard thermometer.

The provider was found to have failed in their duty of care, was guilty of systemic failures and was fined £1.6 million. The judge said this was “an accident waiting to happen”.

This incident demonstrates how important it is for providers to have contingency plans to keep their residents warm – particularly over the winter months.

People receiving care at home may be at greater risk. NICE have produced a Quality standard for Preventing excess winter deaths and illnesses associated with cold homes. This includes priority areas for home-care staff to:

• ask vulnerable people, at least once a year, whether they have difficulty keeping warm at home
• consider room temperature when they are making home visits
• ensure good communication between agencies to identify and address any needs and to avoid duplication.

The NHS has also published useful information about hypothermia. Age UK’s Keep well in winter guidance includes what to do in cold weather to keep warm.

Inadequate Safeguarding and Risk Management Systems Lead to GP Practice Being Placed in Special Measures by the CQC

Dr Dauod Yosuf Abdulrahman Shantir’s surgery in Forest Road, Waltham Forest, has been rated Inadequate overall by the Care Quality Commission and been placed in Special Measures.

The practice was rated Inadequate for being safe, responsive and well-led. It was rated Requires Improvement for being effective and caring, following the inspection in November 2018.

Key Issues

• Inspectors found that safeguarding systems were not clear and did not keep patients safe or protected from abuse.
• The practice did not have systems to monitor or manage outcomes and actions associated with risk assessments such as infection prevention and control. 
• The vaccine refrigerator temperature was not effectively monitored.
• Inadequate smear rates were not monitored or managed.
• The practice did not effectively maintain personnel records for some clinical members of staff, including training records, professional indemnity and professional registration status

The provider must now make improvements as it is on breach of regulations are to ensure care and treatment is provided in a safe way to patients and establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. 

The practice has also been told to consider ways to improve confidentiality in the reception area and to continue to review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is available to them.

Save Money on Tuition Fees by Choosing One of a Range of New Two Year Accelerated Degrees

Proposals to increase choice for students and help them save on tuition fees have been passed by the House of Commons.

Students starting university from September 2019 are set to have more choice than ever before about how they study after MPs approved legislation to support the expansion of two-year and other accelerated degrees.

Legislation was passed in the Commons which means students studying shorter university courses – such as three-year courses condensed into two – would save 20 per cent on tuition fees compared to traditional courses. For example, students who opt for a two-year degree will save at least £5,500 in total tuition costs compared to a standard three-year course. The regulations will now go to the House of Lords for approval.

In addition to saving on tuition fees, students will also benefit from a year without paying any maintenance costs through an accelerated course, which would allow them to access the workforce quicker.

Accelerated degrees have been a key part of the Government’s ambition to maximise choice and flexibility for people wanting to study in higher education, and are expected to remove barriers for a number of underrepresented groups, including mature students.

Accelerated degrees offer the same qualifications and are quality-assured in the same way as a standard degree, but delivered over a shorter, more intensive timespan. For example, a two-year accelerated degree will condense 3-year degrees with 30 weeks’ teaching into 2 years with 45 weeks’ teaching.

Proposals allow institutions to charge up to 20 per cent more per year for accelerated degrees (in recognition of the increased teaching time required), but the overall tuition fee cost to the student is at least 20 per cent less than the same degree over three years.

National Theatre Wales and BBC Cymru Wales Competition to Find Wales First Writer in Residence

Applications are now open for the inaugural Wales Writer in Residence scheme from the BBC and National Theatre Wales.

New and established writers are invited to apply for this prestigious new scheme, aimed at furthering a writer’s career across a portfolio of media and which includes a guaranteed broadcast credit.

The new scheme is a partnership between BBC Cymru Wales and National Theatre Wales, along with BBC Writersroom Wales, with the intention of supporting new writing talent.

The winning writer will be awarded a total bursary of £12,000 to cover their year-long placement as Wales Writer in Residence. Over the 12 months they’re in post they’ll be offered two consecutive residencies; an initial 6 months with BBC Cymru Wales including working with BBC Studios, followed by 6 months with NTW gaining bespoke mentoring and training, and access to expertise and contacts. In addition their winning script will be commissioned, developed and produced for BBC Radio 4 and/or BBC Sounds.

This opportunity is open to writers who can represent the culture of Wales with authenticity (for example they may be from, or have lived or worked in Wales). The scheme will be run by BBC Writersroom Wales.

To enter writers must submit a complete original English language audio script that is at least 30 minutes/pages in length and no longer than 50 pages. Your script must be saved as a pdf file.

Entry is via the BBC Writers Room online e-submissions system

The deadline for entries is Monday 3rd June 2019 at 11am - best of luck!

Government Publishes Report on the Way Forward for GP Partnerships

The report gives recommendations to revitalise the GP partnership business model and ensure a sustainable future for general practice in England.

General practice is one of the most important and respected institutions in our communities; it is the foundation of the NHS. It has been credited as a major reason for the NHS being one of the most cost-effective models of healthcare, outperforming many countries in the Western world which spend significantly more on their health care systems. 

The strengths of general practice that deliver these outcomes include: 

• organising care based on a registered list, with the vast majority of the population registered with a practice;
• providing care from cradle to grave; 
• having a holistic approach to care, looking after the whole person and not simply focusing on one disease or a single episode of care; 
• knowing more than one generation in a family, having a lifelong medical record; 
• providing continuity of care where needed; 
• and managing the undifferentiated presentation of symptoms. 

In recent years partnerships have become less popular with GPs and there is a risk that, without both the continued commitment of existing partners and the input of new partners, the model could be lost.

Talking about this possibility Dr Nigel Watson, who lead the review, said: "In my view, and the views of the vast majority of those who have contributed to this review, this would be a real loss to both general practice and the patients and communities it serves. I firmly believe it is important to consider the strengths of the partnership model of general practice, and what value the model offers above and beyond an alternative salaried model."

Strengths of the Partnerships Model

• the freedom to innovate; 
• relative autonomy in decisions relating to patient care, with the ability to act as a powerful independent advocate for patients;
• being part of, and accountable to, a community;
• creating the desire to succeed as business owners;
• providing value for money. 

Weaknesses of the Partnership Model

• GPs do not feel valued as a profession, and that general practice does not feel valued in all local health systems. 
• GPs' workload is exceeding capacity, the working day feels unmanageable, and the intensity of work and the complexity of patients has risen, with inevitable challenges in terms of managing clinical risk.
• The balance between continuity of care and access to services, has been eroded.  Care over a period of time with a person you know and trust ('relational continuity') is at the heart of general practice, valued by patients and GPs alike and shown to deliver better outcomes. 

Looking to the Future

• The NHS is moving towards a team-based multidisciplinary way of delivering care, which must involve general practice working more closely with colleagues in primary, secondary and community care and ensuring we make the best use of all skills. 
• In recent years an increasing share of the NHS budget has been invested in hospital-based care at the expense of general practice, community services and mental health. The additional £4.5 billion of investment for primary and community care recently announced in the NHS Long Term Plan is a step in the right direction to address this imbalance.
• More GPs are entering training than ever before, addressing some of the important concerns around recruitment. 

Recommendations

• The personal risk and unlimited liability currently associated with GP partnerships needs to be reduced.
• There needs to be a wide range and number of healthcare professionals available for services in the community, embedded as part of general practice 
• Funding for GP training places should be increased and a more specialised focus in medical training on general practice as a positive career choice should be introduced.

Students Interested in How Space Based Technology Can be Used on Earth Encouraged to Enter Space Agency Competition

The UK Space Agency is offering young people expert advice and a share of £50,000 for their ideas of how satellites could improve life on Earth.

The SatelLife Competition, now in its third year, is looking for innovative proposals that have the potential to use data collected from space to benefit our economy, health or the environment.

Ideas from previous year’s competition included:

• a wristband that uses satellite location data and communications services to identify the locations of swimmers and surfers in the sea
• a tool that would map change in urban areas using satellites and algorithms, identifying where building is taking place and potential sites for development.
• An app to provide information on coastal flood risks.
• Software that uses satellites and drones to help people in isolated areas who cannot access basic health care such as vaccines, birth control or medicine

Satellites support the economy and everyday life, and this competition gives young people the chance to test their ideas with industry experts and perhaps one day become part of the fastest growing sector of the UK economy. The UK space industry is a success story – it supports 38,000 jobs and generates just under £14 billion in revenue across the country.

Ieuan Higgs, 21, a student at the University of Reading, who has been offered a job in the space sector when he graduates since winning last year, said: "Entering the SatelLife Competition allowed me to develop my critical thinking and problem-solving skills in an interesting, challenging way.

This has certainly helped me to push forwards on my way towards finishing university and provided me with the confidence to pursue my interests as I prepare to launch an exciting career."

The competition, which is open to those aged 11 to 22 and split into three age groups, aims to support the development of science, data handling and technological skills. There are two overall prizes of £7,500 for the best individual and best team. A further seven entries from across the age categories will win £5,000, making a total prize fund of £50,000.

The judging panel will be made up of experts including representatives from the UK Space Agency, the European Space Agency, the Satellite Applications Catapult in Harwell and industry.

Entries can be as teams or individuals and all prize winners will be able to pitch their idea to a panel of ‘dragons’ from the space sector who will offer more prizes. Over the last two years the competition winners have been offered further funding, patent advice and invitations to discuss job opportunities as well as introductions to the other relevant experts for further help.

The competition closes on 3 March 2019. Visit the SatelLife Competition entry page for more information and to apply - and best of luck!

Policies and Procedures Need to be Embedded into Daily Practice if Inadequate CQC Rating is to be Avoided

Halbutt Street Medical Practice in Dagenham, has been rated Inadequate overall by the Care Quality Commission and has been placed into special measures.

The practice, in the London borough of Barking and Dagenham, was rated Inadequate for being safe and well-led, it was rated Requires Improvement for being effective, caring and responsive.

Inspectors found that the practice:

• was not consistently following its own policies and procedures. 
• did not have clear systems to manage risk so that safety incidents were less likely to happen.
• still scored below the national average in the National GP Patient Survey in relation to satisfaction with both doctors’ and nurses’ consultations. The practice was aware of this and had identified themes in patient feedback and had an action plan in place to address lower scoring areas in the NHS national patient survey. 
• had failed to act effectively on issues with telephone access for patients.

The provider must now:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

It should now:

• Improve uptake of childhood immunisations and cervical screening.
• Improve engagement with patients with diabetes.
• Consider how to record verbal complaints and actions.
• Review systems to allow patients with communication needs to access services.

Professor Ursula Gallagher, Deputy Chief Inspector, Primary Medical Services, said: “I am disappointed with the lack of improvement at Halbutt Street Medical Practice. We are placing it into special measures, which will give people who use the service the reassurance that the care they get should improve. The provider will be kept under review and if needed could be escalated to urgent enforcement action.”