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Clinical Updates

36 ‘minor conditions’ GPs will no longer be allowed to treat

The NHS is looking to save 100 million pounds a year on the prescribing of medications to treat ‘minor ailments’.

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Funding changes mean GPs will no longer be allowed to prescribe medications to treat some minor ailments.

NHS England has published guidance to free up to almost £100 million for frontline care each year by curbing prescriptions for ‘over the counter’ medicines. The news comes after official figures show the NHS spends £22.8 million per year on constipation, £3 million on athletes foot and £2.8 million on diarrhoea.

Patients will, however, still be allowed to see and be assessed by a GP but they won’t be handed a prescription and instead signposted to where to buy medicated products.

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People who receive free prescriptions, such as those on a low-income or pregnant, will not automatically be exempt from the new rules. However, changes will not affect vulnerable patients or those with long-term or complex conditions or where the symptom could be associated with something more serious.

The controversial changes will come into force at the end of May.

GPs will no longer be allowed to treat.

  1. Acute sore throats.
  2. Cold sores.
  3. Conjunctivitis.
  4. Coughs and colds.
  5. Nasal congestion.
  6. Cradle cap (seborrhoeic dermatitis).
  7. Haemorrhoids.
  8. Infant colic.
  9. Mild cystitis.
  10. Mild irritant dermatitis.
  11. Dandruff.
  12. Infrequent diarrhoea or constipation.
  13. Dry or sore eyes.
  14. Earwax.
  15. Excessive sweating (Hyperhidrosis).
  16. Head lice.
  17. Indigestion.
  18. Heartburn.
  19. Infrequent migraines.
  20. Insect bites and stings.
  21. Mild acne and/or dry skin.
  22. Sunburn or the need for sun protection.
  23. Mild to moderate hay fever.
  24. Seasonal rhinitis.
  25. Minor burns and scalds.
  26. Mild pain, discomfort and/fever (e.g. aches and sprains, headache, period pain, back pain).
  27. Mouth ulcers.
  28. Nappy rash.
  29. Oral thrush.
  30. Prevention of dental caries.
  31. Athletes foot
  32. Teething.
  33. Toothache.
  34. Ringworm or threadworm.
  35. Travel sickness
  36. Warts or verrucas.

Think like a taxpayer. Act like a taxpayer.

Simon Stevens, Chief Executive of NHS England, said: “Across the NHS our aim is to: ‘Think like a patient, act like a taxpayer’. The NHS is probably the most efficient health service in the world, but we’re determined to keep pushing further. Every pound we save from cutting waste is another pound we can then invest in better A&E care, new cancer treatments and much better mental health services.”

John O’Connell, Chief Executive of the TaxPayers’ Alliance, said: “It’s great news that NHS England will save a vast amount of taxpayers’ money by curbing prescriptions for basic items that are much cheaper to buy in the supermarket than they are to prescribe. Taxpayers should not be footing the bill for items like anti dandruff shampoo or athlete’s foot powder, so cutting out wasteful spending like this will mean that precious resources can be focused on frontline services. Patients too must remember that these items are not “free” – the money comes out of taxpayers’ pockets, so NHS England should be applauded for this move.”

Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Nurse with patient in bed

Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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Observations

A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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