Source: Whose care is it anyway?
Continuity of care. It matters. Not for every contact – but for many. Even the times when continuity isn’t essential, getting to see the same doc / patient can help relationships to build over time.
I’m going to have a look at the Emis continuity calculator and see if we can run this at out practice in Pendle.
We do not need any more research about the benefits of continuity of care. The evidence is clear; it is associated with improved preventive and chronic care services, patient and clinician satisfaction, lower hospital utilization, lower costs, and for elderly patients, lower mortality.
What we do need is better continuity of care. According to a recent BMA survey, enthusiasm for continuity of care exceeds that of any other aspect of general practice,
Continuity of care matters more to some patients than others, in particular those with long-term conditions, mental health problems, multimorbidity (several different conditions at the same time), during serious but hopefully shorter term conditions like cancer and during end of life care. Continuity of care makes care more person-centred because getting to know a patient as a person takes time. Continuity of care makes care more efficient because less time is spent repeating a medical history…
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In the run up to the #compassionWL events this week I have been reading around the subject of compassion in health. Lots of material in this article that would lend itself to discussion points about the subject. Many GPs are now using social media platforms such as @resilient GP to cultivate methods of managing their stress & unCompassionate working conditions / working lives.
As the prospect of more GPs being added to the workforce is looking increasingly slim we need to consider what the GPs can STOP DOING so that we have more space for contemplation , compassion & care.
In 2001 Richard Smith, then editor of the British Medical Journal (BMJ) wrote an editorial titled, Why are doctors so unhappy? and found the source of their unhappiness in a bogus contract in which medicine promised too much and delivered too little to the mutual disappointment of doctors and patients.
In 2013 John Launer responded in an essay titled, Doctors as Victims in which he called for doctors to reflect on how powerless they felt despite being in possession of far more power than their patients.
Returning to the theme, and linking these two pieces together, Smith has responded with a much less sympathetic blog for the BMJ this week,
General practitioners have replaced farmers as the profession that complains the most.
I have no sympathy for them. I want them to stop being victims and become leaders, people who solve problems rather than complain about them and expect others…
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Well presented discussion points – in glad I didn’t miss the reference to this article that was made in a tweet. Understanding the system which makes people take the decisions that they select is essential if society is to continue benefiting from a universal health care system. Patients are making Rational Decisions – they just aren’t always the ones the health managers would like them to take
Like many people who spout rhetoric about the NHS, I am guilty of indulging in the blame game. Some professionals and policy makers ‘blame’ patients for ‘inappropriate attendance’ at A&E and we have millions spent on campaigns to urge us to ‘choose wisely’ when thinking about heading that way (assuming that we do not make rational choices).
Likewise, I can blame professional for thoughtless and ineffective policies and practices. Or, I can point the finger at ‘the system’ for being professionally-centric. Note that the notion of blaming ‘the system’ is itself a neat trick that casts a blanket of blame over others, without requiring us to be more precise about where the problem lies. It is also a familiar tactic for the traditional patient movement through which we can maintain an ‘us and them’ attitude and an adversarial posture towards improvement.
However, this one vexes me. I have been active…
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Lots of potential – I wonder if the will be apps linking the data with similar platforms from other mobile devices ?
Does your company or organisation need a #Digital makeover ? Wondering about how to quench the thirst for information and engagement within your sector. Contact john Popham & Helen Reynolds for more info
Well, we did it! The first Digital Makeover is complete. Helen Reynolds and myself are offering organisational Digital Makeovers in which we go in and try to reach every part of the company with some digital magic over the course of 2 days.
We had a great time working with some wonderful people at Yorkshire Coast Homes. The feedback was fantastic, the energy of the staff and board members we worked with was infectious, and it all carried us through the barrier of tiredness which hit us towards the end of the second day. We even managed to fit in a great Tweetup on the Monday evening, which allowed us to make further contact with some of the Scarborough digital community.
Here’s the Storify of the 2 days http://sfy.co/a0Lbe
Having done one, we are desperate to do more. It’s such a fantastic way of working. If you’d like us…
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#Gamification, #Selfcare and Maintaining a Healthy Behavior Change
This post is about New Years Resolutions . How to phrase the goal so you are more likely to succeed. It includes a link from Dr Mike Evans about the reasons why New Year is a good time to make a change, and includes some useful websites and tech ideas that could help us succeed in maintaining those healthy behaviors we have in mind.
Please watch the videos from the links and consider tweeting your New Years Resolution for 2015 with the #NewMe2015 hashtag.
If you know of other sites or ideas that you would like to share then please comment below.
“It all depends on what we do in the next few weeks,” said infectious disease expert Chikwe Ihekweazu, speaking on Ebola at TEDGlobal on Friday. What happens next: will the number of new Ebola cases grow or plateau? And how can the world know the right thing to do?
Reliable news about the outbreak has been hard to find, especially for people fighting the disease in their homes and villages, but also for the rest of us who want to know what’s going on and whether to worry. Which is why, this week, TED Senior Fellow alum Jon Gosier launched EbolaDeeply.org, a curated news feed that mixes journalism, experts and citizen reports to create a more informed global dialogue. We asked Gosier to tell us more:
There’s a lot of mistrust. There’s the belief that “all these people showed up, and then all our people started dying.”
What is EbolaDeeply, and what problem are you trying to solve?
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Good points from this blog by Consultant Kidney doctor. I suspect that it wouldn’t be possible for all admissions & discharges to have a telephone consultation with the patients relative or carer – wonder what it would take to put this idea into action ?
“My father was in hospital for 2 weeks and not once did I get to speak to a doctor”
“All it would have taken was a phone call, I kept asking day after day, but no-one bothered”
“We were watching Mum get sicker day by day and we knew she was dying but we couldn’t get anyone to talk to us about it. They kept changing drugs and trying new things but nothing was working. We knew she was going to die”
These are just a few quotes from recent complaints that I have read and demonstrate a very common theme – we are not very good at communication. There are many aspects to our failing in communication; with the patient themselves, between specialist teams or between primary and secondary care but it’s the communication with families and loved ones I wish to focus on in this blog.
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Activating the #epatient inside us all , young or old , rich or poor is the only way that healthcare can be delivered on a nationwide scale in times of financial restraint. How can we sell the dream – the idea – of what could be achieved ?
Blog post by Leslie Kernisan, MD
How can we, as a society, as healthcare providers and as healthcare leaders, provide good care to vulnerable older adults? Consider this person:
You don’t have to be a geriatrician – as I am — to find yourself taking care of someone like this. Many of us have an elderly relative whose multiplying health problems cause us to worry.
And worry we certainly should, because people like Mrs. A often struggle with health, and with healthcare.
To begin with, the ideal management of most of her chronic conditions requires…
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Social media surgery – where people go to learn & share their knowledge, ideas & experience. Every town should have one – has yours ? #localgov #selfcare #hcsm #nhssm
A year is a long time in social media. The pace of change can for some feel overwhelming. That’s just one reason why Social Media Surgery Dundee has the potential to make a real difference, to help people sharpen their focus.
The surgeries, informal monthly gatherings at Dundee Central Library, can help support you on your journey of digital development. Yet I go along not just to share but to learn.
Last night I learnt, through speaking to Dylan from Humans of Dundee, there armed with his camera, that what I felt social surgeries actually offer was to help people find their voice. And I reminded myself that social media can make change happen. It can change lives. It’s certainly changed mine.
I discovered from Rob you can use Google images to search the…
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So you have a new iPad, and maybe you are wondering just what you could do with it to use the iPad to its full potential ? These are a few suggestions that I hope you will find useful. This article is primarily aimed at GPs who haven’t used iPads before or who are wondering about having a go with some of the different apps that can make life a bit easier – or more entertaining . Please email me or leave comments at the bottom of the page if you have any suggestions of what to add. The apps below are all ones that I use. I have had a variety of apps suggested to me via twitter friends that I am in the process of trying out. Search #GPiPad on twitter to see who their suggestions or click here for the search on google.
In 2013 East Lancs CCG applied to use some innovation funding to purchase iPads with Emis Mobile installed for the GPs working in Pendle. Its traditional for GPs to take a printed summary of the patients records with them when they go a home visit. The downside of this is that it can only offer a fraction of the information that the GPs are used to working with when they are at their regular computer in their GP Surgery. Emis Mobile on the iPad can allow the GP to view and edit aspects of the patients records using a mobile 3G connection whilst at the patients bedside. The Emis Mobile version of Emis Web is expected to develop over the next year to provide a more complete offering to the GP.
Apps Apps Apps – its all about Apps
First steps . Set up an apple ID if you don’t already have one. This is the account that you will use to purchase apps from the Apple App Store. The good news is that many apps will work on all devices, and many have free or basic versions that you can use to “try before you buy”. You will need to link your account to a credit card so that you can pay for apps that aren’t free. It is possible for several devices to use the apps that have been paid for with one account. – more info is available from the apple website – but if you do this – please make sure that the messaging features are set up properly on each device or everyone will see the same notifications etc. This also means that software you may already be using your own apple devices may also be used this NHS device without additional costs.
Next – track down or apply for your NHS Athens Password and ID . You will need it in order to unlock some really useful apps like the BNF .
Apps for Communication
Ask “What’s possible?” not “What’s wrong?”
When considering service design. Imperfect is better than “not done at all”
There is no power greater than a community discovering what it cares about.
Ask “What’s possible?” not “What’s wrong?”
Be brave enough to start a conversation that matters.
One of the many challenges for the public sector is that it must start believing in people and communities again.
If you take the Social Housing sector as an example you’ll see it has spent a long time making life as easy as possible for people.
Free telephone calls , a 24 hours repairs service and if you’re on benefits you don’t even have to worry about the rent getting paid – we’ll sort it for you. Neighbour’s dog barking? Leave it with us.
I exaggerate of course – but only slightly. Huge parts of the public sector have designed services around what people can’t do for themselves rather than nurturing what they can.
Now we have to…
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Job descriptions we used to have don’t hold up anymore. There used to be a dedicated customer services team but as Eddie Coates-Madden has said on many occasions we’re all now customer services now.
Why? Because once you start to use digital channels you open a door to anew world. It’s one where people can talk back to you, ask questions, be snarky, be nice and to ask why haven’t the bins gone out.
Customer services on Twitter really fascinates me. For the first 18 months using @walsallcouncil I was it. When I asked for Christmas Day dinner to be postponed for 10 minutes because we were going out gritting and I had to tweet it I kind of new I was probably in too deep.
There is a rather fascinating new Twitter that has sprung out…
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One GPs View of Their New “Doctor First” Appointment System. Is the grass greener?
Doctor First Appointment system – A 21st century Solution?
“Accept the things you cannot change, and change the things you can”
– Reinhold Niebuhr
No one can argue that current ‘demand’ in the NHS is high.
We can argue until the cows come home, as to why, or who/what is responsible for this ever increasing demand. But unless we think we can alter this demand in the immediate foreseeable future, maybe – just maybe – we should start thinking about how we can manage it.
What if it is time to adapt?
For more than 60 years now – long before the birth of the NHS – General Practitioners have been offering the same traditional style of service: Patient decides on need to see doctor. GP offers a time to be seen. GP sees patient. This has always been considered the gold standard, the very essence of the…
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When was the last time you went out for some food? Was it to a restaurant , a take away or just a bakers? The chances are that you entered into a contract with the provider of the food about what you would consume in exchange for a particular amount of money. It’s a standard transaction for a modern economy.
A few weeks ago I had a fantastic Chinese banquet. Choosing the banquet option meant that we had a bigger selection of things to choose from and savour, but this came at the price of committing to buying a bigger quantity of food than we would have consumed with a traditional three course meal.
The NHS National Health Service in the United Kingdom is in a state of transition, and has been for several years. Budgets are being adjusted ( usually downwards ) which means that there is less money to pay for as many things as before. There are increasing pressures on the remaining staff, and increasing expectation from the consumers of health care about what they choi,d be receiving.
Going back to the food model. I’d like to suggest that hospitals and many aspects of Secondary Care are like the a la carte restaurant – dishes are served up with a pre arranged price tag, except in the health scenario the customer is blissfully unaware of the cost of the item or the experience they are receiving.
General Practice , or family medicine, in the UK has more in common with the “eat as much as you like buffet”. Providing you can get through the front door, you can fill your boots with as much health advice and medication as you wish. I have enjoyed some really great buffets in my time, and some not so great ones. You generally get what you pay for – your expectation of the quality of the food inside is influenced by the expected financial cost.
The blog is good ,links great & the podcast is worth listening to Steve Spangler Is the chap who came up with the idea of dropping a mint into a coke bottle to create a fountain. He trained as a science teacher , then started looking for other ways of making science fun & stimulating. He had approx 61 episodes on YouTube before the coke fountain experiment caught on and went viral.
Looking for a WiFi solution for your waiting room? then check out their site
It Looks great – a cloud based management – self service of access to wifi and logs use from the public bit – stops dodgy stuff being downloaded
Looks like the single location option is free.
Includes features like timed vouchers to limit use of wifi
They sell base stations that are high powdered with 50m radius for £300
Looks very easy to set up and manage.
Can buy extra base stations to extend the range
Their website is very easy to follow to get all the info about how it works ,pricing and security.
Now all we need to do is to persuade the masters of NHS IT systems to let us plug it in …..
New word of the week = Apptamism . The art of being optimistic about what will happen once an organisation develops its own apps.
I agree that apps need to offer more than their parent website – or what’s the point ?
Offline access to info & data can be important for the segments of society not on all inclusive data packages.
I’ll continue these thoughts on twitter … @stuartberry1
Compassion in NHS is big news this week. The Francis report is out, and all branches of healthcare are considering its implications. This article discusses the fragility of compassion once the environment becomes stressful. When resources ( time, nurses, cleaning staff, etc ) are in short supply then group survival mechanisms kick in.
It’s the old nature vs nurture debate, and it had its routes in the biological evolution of societies and culture. Tribes of people & staff develop ways of differentiating themselves from the people who are not in their tribe. This is done through words (jargon & abbreviations), appearance (uniforms), and rules or regulations which may not be obvious to the uninitiated.
Do you have a digital footprint yet?
Is your Buisness or Organisation making the best use of social media ?
These facts may help you to build a case for upping your game in 2013
In the UK, only 15% of respondents said they did not have Internet access
Global attitudes project stated that ;
46% of social media users discuss community issues
52%, of adults using social media services like Facebook, Twitter and YouTube
Wouldn’t it be great if your club, department, patient group or small buisness had a way of sharing useful or interesting news, updates or offers with the Internet users?
Worthwhile Project in East Lancashire offering people a fresh start Green Dreams Project in Nelson
I have been looking at the new look website for this popular resource today. Please take a look at their site and consider if there is anyone you know who may benefit from their help.
Sue Hogg works with patients at Reedyford Health Care in Nelson. She has supported patients with finding voluntary work in a local community centre, getting in touch with Inspire for alcohol issues, securing emergency food parcels and being introduced to social groups. Sue has also worked with patients who want to live a healthier lifestyle, eating more healthily and doing more physical activity, including those with long term health conditions. She has been able to provide information about job search support, eco- therapy placements and benefits advice, working with partner organisations. Many patients are experiencing mental health problems, including stress, depression and anxiety, low self- esteem and confidence, and bereavement.
Notes from http://www.peskypeople.co.uk #Digifutures12 event in Shropshire 2012
3.91 Million people in the UK have never used the internet. That is approximately 1 in 10 adults in the UK.
1 in 6 adults have some form of hearing loss. These people may be reliant on using email, sms or social media channels for accessing your services.
Ken Eastwood of Digital Nomads said…
Radio Shropshire reaches 30% of the target population every day. Half the population is online every day , but 1/3 are never online at all.
What do you want from your local services online ? What are you expecting to see when you look at your local councils website, or try to check out out your doctors surgery website for information about flu vaccine clinics ? Does your local council have a Facebook , twitter, YouTube or website presence?
The digital futures Shropshire conference is taking place on Monday, and I a shall be attending. I am interested in learning more about how to encourage people to use online services or information. What makes a website a hit or a miss? In this age of austerity I believe organisations have a responsibility to be making sure that they are making the best possible use of resources. This means spending some time considering who is actually using the information that is being provided digitally ? Who is looking at their web pages ? Which groups are missing out on this and what could be done to help change the current status quo ?
Internet has a massive potential for helping information spread about society, communities and special interest groups. As a GP I have an interest in helping people to find and use “quality” websites. I’m a big fan of the concept of getting the information out of the reservoirs and flowing down the pipes to the people that want it. I’m interested in using some of the tips and tricks that social marketing can offer to help to nudge people into a more informed position. What can we learn from those who work in the marketing industry? What examples of social media marketing can you spot at your breakfast table ? On the cereal packets?
I don’t know if anyone already produces this – but wouldn’t it be great if there was a nationwide / worldwide chart of telehealth projects with clickable links.
Each project could be presented in a vertical column with key aspects of the projects listed down the side.
For each project we could indicate if it is uses remote monitoring ,video or telephone communications. ( or email, SMS etc)
A vertical column could indicate what parameters are being measured ; bp , pulse oxygen Sats from finger probe, temp, weight, peak flow ( for asthma) bm etc
Could list project start & end date & link to a review / interim report on the progress.
Remote monitoring in COPD ; how much & how often ?
As a GP associated with the East Lancs COPD Telehealth Project I have been considering what evidence there currently is for the model of Telehealth which is being proposed.
I was asked to join this project in spring 2012. The choice of providers & type of teleheath technology had already been agreed. The aim was to explore how the technology could be used in East Lancashire COPD patients, and shed some light on how much impact this could have on the patients experience of COPD and what impact it had on the healthcare workload.
We are planning on using remote monitoring technology to enable remote recording of the patients blood pressure, pulse oximetry and temperature. These readings are taken by the patient ONCE a day and sent to a remote monitoring hub which effectively aims to spot significant changes and decides if the patient needs to have contact with a clinical team member.
Patients will be selected on the basis of those at high risk of needing a medical admission in the following year using the Blackpool NHS Predictive Risk Tool. This tool is being incorporated into the GP patient record systems of practices which signup to working with the project.
“I have a heart condition and have to get my Coumadin (#warfarin)checked regularly,” said Kaiser Permanente patient Richard Miller, 76, of Vallejo, Calif. “I get an alert that I have new test results, and they email me if I need to change my dosage. I also go to the encyclopedia to tell me what my lab results mean, and I can make and change appointments.”
The above paragraph illustrates the potential of mobile health applications to revolutionise the way we interact with our healthcare providers. Wouldn’t it be great if an email could be generated to let the patient know when their blood result is back and has been auctioned by their clinical team? Think of the savings in time and reduction in risk. Emailing the results means that the doctor knows that the result has been received ( could incorporate a read receipt system).
It would be fantastic If we could offer this in the UK. What are your views on this ? Please click on the speech bubble to leave a comment & share the link on your preferred social media. Thanks. @stuartberry1
websites for kaiser permeate blog& apps
Language lessons Via podcast or webcast , YouTube Vimeo site to facilitate language that is used when visiting the doctors. In polish, Lithuanian and Urdu.
Could feature health information so there are several strands to this. I have been approached to work with the community radio in producing some health information podcasts – this could be part of this . Builds engagement in the community , breaks down barriers , and improves communication skills.
Contact me @stuartberry1 or retweet this / share the idea.
We have very limited resources in the nhs to support these ideas. Social media can help to spread the ideas, build the momentum & encourage our leaders and councils to consider them in their plans.
This is the roundup of the suggestions from the twittersphere about how to get the most out of your 10 Minute appointment with the GP. Big Thanks to all the comments and clicks this got … clearly this was worthwhile doing and is not finished yet. #10minsGPguide
Please feel free to post more comments. These have been collated using @Grabchat
Oldham : knee decision aid 6/10 patients modified their expectations of knee replacement as treatment of osteoarthritis after reading the decision aid from nhs direct http://www.nhsdirect.nhs.uk/en/DecisionAids
” if they don’t have Internet access at home they can come one hour early and do it with a helper. One room with pcs costs £20,000 = 3hip replacements”
http://www.pmskp.org/ pendle mak partnership
from Hippocrates to Hugo and back again humanistic lessons
These look like the slides used by Anna louise Kirkengen
So the UK government has decided to launch a three-pronged initiative to help those who have dementia or care for someone who has it. Their plan is to encourage the early detection of memory problems, improve the quality of care received in care homes, and have also pledged to invest in research that may one day offer a cure.
These are great ideals – the problem is that they are coming at a time of NHS cutbacks. Care agencies are businesses working to a model that needs to generate profits in order to continue to deliver the service. If we want better care then we will have to pay for it one way or another.
Dementia clinics or memory assessment clinics have a long waiting list and patients can face intervals of several months between outpatient appointments. Early detection of dementia will be useful for the carers of these patients as hopefully it will enable them to link up with local support groups earlier, but unless extra investment goes into providing more dementia clinic appointment slots the patients will inevitably be looking at an even longer wait before their memory clinic appointments.
Self-care for patients with COPD – Formal Proposal of the Pilot
An estimated 3 million people have chronic obstructive pulmonary disease (COPD) in the UK. Most people are not diagnosed until they are in their fifties. However more people are being diagnosed with COPD at a younger age – from their late thirties to their early fifties. COPD is a condition that makes breathing difficult. COPD is a broad term that covers several lung conditions, including chronic bronchitis and emphysema. It usually develops because of long-term damage to the lungs from breathing in a harmful substance (such as cigarette smoke or chemical fumes). The treatments available for COPD help people to breathe more easily, but they don’t repair the damage to the lungs.
We are knocking about with some ideas for a COPD self-care project. I would appreciate some feedback before getting the idea worked up in more detail. This is the more patient friendly version. The more formal proposal is here ;
Please comment by clicking on the speech bubble.
I am a GP ( family physician ) in Lancashire . I set up a weight loss challenge last year that was a pilot for combining health promotion with an element of competition to make it more fun, and try out some gamification concepts. I have been wondering what we could try next. COPD is another health issue that we are not short of in Lancashire.
COPD is a breathing disease that is much more likely to affect you if you smoke. It starts off as a mild irritating cough but can progress to life limiting dependence on piped oxygen. The only thing that stops the progress of the COPD is stopping smoking. Exercising more can help people with COPD regain some of their quality of life. The “pulmonary rehab” tends to be offered to the patients with more severe disease, once they have had a couple of hospital admissions for chest infections. The patients with more mild COPD may not realise that they have it – attributing their cough to their smoking habit. A special breathing test called spirometry is used to help diagnosis. It is available in many GP practices.
Both are worth watching and offer different takes on an idea that is completely relevant to how we use healthcare systems today
Work in progress
This BBC podcast explains why the environment that your mother was exposed to can influence the health of your children. Your vulnerability to specific conditions seems to be influenced by the conditions your parents were exposed to. Adverse environments can cause genetic damage. The legacy of poor nutrition can span generations. It could explain why heart disease is more common in deprived populations.
There is a suggestion that the higher prevalence of obesity,diabetes and radio vascular disease in the southern states of America can be explained by the hardships the population experienced in the American Civil War.
The environment that the male finds themselves in also has an impact on the vulnerability of their children to particular metabolic diseases.
Click here to be taken to post that suggests what the NHS can learn from the Elinor Ostrom’s book “Governing the Commons. The Evolution of Institutions for Collective Action”