Following the publication of the NHS Long Term Plan the government and GPs agreed a new contract, which involves a number of substantial changes. One of the mainstays – designed to allow the plan to be realised – is the introduction of an army of medical professionals other than doctors to work within practices and act as first point of contact for patients needing their particular skills.
That includes thousands of physiotherapists who will deal with patients presenting with musculoskeletal problems, which currently account for around one fifth of GP appointments. The idea is it will free up GPs to deal with problems requiring their generalist skills. It is also expected to substantially reduce the number of secondary referrals to physiotherapists by GPs.
In a rare show of solidarity between the medical profession and government, the scheme was welcomed by GPs and the Chartered Society of Physiotherapists.
• Another major development for GPs is the establishment of a state-backed indemnity scheme, such as enjoyed by their colleagues in hospitals. It has long been seen as an anomaly that, while the NHS picks up the tab for sometimes huge compensation pay-outs, GPs have been left to fend for themselves.
The scheme as announced in the Long Term Plan covers only England. Wales is to have its own scheme, launching in April, and plans for Scotland and Northern Ireland have yet to be seen.
• GPs have been in the news a lot recently. The Royal College of General Practitioners has also become the latest medical professional body to call for the decriminalisation of abortion. Currently, abortion is still subject to the criminal law and a woman can be imprisoned for having a termination without the consent of two doctors. Doctors, understandably, believe that in an age of internet prescribing, the regulation of abortion should be the remit of medical authorities, not the police.
• Freedom of choice is a cherished liberty, not least the freedom to decide on whether we want to live in a care home or hospital. That freedom is set to be undermined with the passage through Parliament of major changes to the Mental Capacity Act, the Law Society says. According to the lawyers’ body, the changes will strip away protection for many more vulnerable people from being deprived of their liberty.
The measures the Law Society takes issue with include excluding parents from involvement in the care of 16 and 17-year-olds, and passing on the job of assessing whether people should be detained in care homes to the managers of those very care homes: people without the clinical skills to make those decisions, and with a potential conflict of interest.
• Stories about the activities of the Care Quality Commission in this publication are usually prefaced with news that a hospital or trust is being subject to investigation or sanction. So it’s nice to be able to report an optimistic view from the CQC, which reports finding improvements to the way care is planned for people subject to the Mental Health Act. The recent attention being paid to mental health has brought more scrutiny of mental health services and the service has responded.
Sadly, the optimism regarding the standard of care planning is blended with concern about the state of the actual mental health wards themselves. Many, says the report, are of poor quality and some are unsafe.
• Another good news story appeared in The Lancet. Researchers in Bristol found that around 80% of hip and knee replacements are still going strong after 25 years. Hitherto, there has not been any data available to draw a generalised conclusion from regarding longevity of replacements.
The good news for lawyers? You now have a yardstick to measure how long they should last.