Speaking in Tuesday, Calum Campbell, Chief Executive, NHS Lothian, said the healthcare system was under extreme duress as a result of an increase in the numbers of emergency patients, large numbers of delayed discharge patients and an increase in respiratory illnesses.
He said teams at the Royal Infirmary of Edinburgh, St John’s Hospital, the Western General Hospital and the Royal Hospital for Children and Young People were all being pushed to the limit.
To help free up vital beds, he said that some relatives may be asked if they can provide care to their loved ones as an interim measure while those packages of care to help in their own homes are put in place by their local Health and Social Care Partnership.
He said: “These challenges are unprecedented, but they are also sustained. We need people in Lothian to help their own communities and the NHS.
“We have large numbers of people waiting to be admitted into a hospital bed, so I would urge everyone who is asked to provide care to their loved one to give the request some serious consideration.”
Dr Tracey Gillies, Medical Director, NHS Lothian, said: “Our teams will have carried out a robust clinical assessment before they discuss the temporary possibilities with patients and their families.
“We know that most patients want to return home as soon as they possibly can, especially at this time of year. This would also help our teams and the patients waiting to be admitted.
“Also, if you have a loved one in hospital who has been discharged and requires to be collected, please do so as early in the day as possible.”
The primary care sector in Lothian also experienced one of its busiest days to date on Monday (19th December) as they provided care to increasing numbers of adults and children, especially families with concerns around Strep A following recent increases in the virus.
Jenny Long, Director of Primary Care, NHS Lothian, urged people to remember that there were a number of winter viruses in circulation and to consider NHS Inform and their local pharmacist for help and advice, use over the counter medication, drink plenty of fluids and rest.
Cold-type symptoms such as a runny nose or mild cough are more likely to suggest a viral illness.
If you have a sore throat, but can eat and drink, and don’t have a very high temperature then it is likely to be a common virus and there is no need to contact your GP.
The most up to date information on Strep A can be found at
More than 90 dentists withdrew from NHS Lothian dental list from 2021 to June 2022, a Freedom of Information request submitted by the Scottish Labour has revealed.
Sarah Boyack warns of a health crisis as waiting times for A&E and NHS dentistry continue to spiral, while delayed discharges have gone up.
Scottish Labour’s FOI request revealed that between 2021 and June 2022, 92 dentists withdrew from NHS Lothian dental list. As at beginning of June this year, out of the 163 general dental practices in Lothian, only 51 confirmed that they are accepting patients, with some accepting children only.
Since 8th May 2022 and up until 11th December, there has been only one week during which the percentage of people seen within Scottish Government’s 4-hour target was above 70 per cent – in the week ending 11th December more than 1,756 people were stuck in A&E for more than four hours – only 63.6 per cent of those attending NHS Lothian’s emergencies were seen within 4 hours. In the same week, 353 people were stuck in A&E for more than 12 hours.
This comes as the recent monthly report on delayed discharge shows rates in NHS Lothian for October 2022 soaring to 1,644 compared to 1,420 in September 2022.
This makes NHS Lothian the second-worst performing health board in Scotland, only topped by NHS Greater Glasgow and Clyde, with 3,848 delayed discharges in October 2022.
October recorded the highest average number of beds occupied per day due to delayed discharges in Scotland since the current guidance came into place in July 2016.
Scottish Labour MSP for Lothian Sarah Boyacksaid: “Another month, another set of damning statistics from NHS Lothian.
“On top of the cost of living crisis, which is taking its toll on people’s mental and physical health, we see piling pressure on our NHS, worsening patients outcomes and huge waste of public money.
“With the freezing cold, people will get sick and they will require care. That’s why we need support to GPs to allow them to respond to the rising demand and handle cases, whenever possible, at primary care level.
“These are not just figures – it is someone’s dad, friend or life partner; it’s the NHS staff who is overworked and underpaid; it’s the people who left our health service because they simply couldn’t cope.
“With a general election approaching, now is the time focus on what really matters and make a difference for millions of people.”
NHS medical and dental staff will be awarded a 4.5% pay increase for this year backdated to 1 April 2022. This is for all NHS Scotland medical and dental staff, general medical practitioners and general dental practitioners.
This comes following recommendations by the independent Doctors and Dentists Pay Review Body (DDRB) of an annual pay uplift of 4.5% for NHS medical and dental staff. The Scottish Government has accepted this recommendation.
The Scottish Government, BMA Scotland and other relevant stakeholders all participated and provided evidence to the DDRB to allow them to make their independent recommendations.
This year’s award builds on the 3% uplift that was recommended and applied by the Scottish Government in 2021. This means staff have been awarded a 7.5% pay increase over the last two years – but inflation currently stands at over 9% and rising.
Health Secretary Humza Yousaf said: “The NHS has faced its biggest challenge during the pandemic and staff have been working tirelessly to continue to provide care while under increased pressure.
“The continued hard work and dedication of staff ensures that the people of Scotland continue to receive world class healthcare as we remobilise NHS services and tackle waiting times.
“This uplift demonstrates that we value all our medical and dental staff and the important contribution they make. It’s crucial that we continue to not only recruit and build our future NHS workforce, but also retain expertise within NHS Scotland.
“This announcement means that our senior medical staff will continue to be the best paid in the UK. This will help ensure that NHS Scotland remains an attractive employment option for all medical and dental staff.”
The 4.5% pay uplift will be applied to all NHS medical and dental staffing grades and will be included in salaries with backdated payments to 1 April 2022 to follow as soon as practical.
Scotland’s health union UNISON is balloting 35000 NHS staff across Scotland to recommend they reject the Scottish government’s pay offer and vote to take strike action in the coming months.
The NHS consultative digital ballot closes on 8 August.
UNISON report that their members are angry and feel they are being taken for granted. UNISON say the Scottish government 5% pay offer is well below the rate of inflation – which is 10% – and it is deeply unfair as it will give those at top of the pay bands a pay rise of over £5,000 per year whilst those on the lower pay bands will get nearer £1000 per year.
This ballot is launched in the midst of a staffing crisis in the NHS, staff turnover is higher than ever, waiting lists are at an all time high and the NHS is facing real challenges to recruit.
There are over 6000 nurse vacancies across Scotland. Staff report to UNISON that they are regularly left in wards working with staffing levels below minimum standards. Staff also report they are constantly worried they make mistakes, or fail to deliver basic patient care. The problems were building long before Covid, the pandemic has only exacerbated the issues.
Wilma Brown, chair of the UNISON Scotland health committee said: “NHS staff have been taken for granted, staff have endured over 10 years of real terms pay cuts only to be told by the Scottish Government that, yet again, they will have to accept a below inflation pay rise.
“NHS staff have family bills to pay, food, energy and petrol prices are rocketing. NHS staff are struggling to afford the price of fuel to get them to work. They need more than praise and platitudes from Government, they need a decent pay rise to support their families.
“A 5% pay increase across the board just doesn’t cut it and the Scottish Government need to understand how angry we are. UNISON are urging UNISON members to vote to reject this pay offer and indicate that they will take the very difficult decision to take industrial action, unless of course the Health Minister improves the offer on the table.”
The Scottish Government is to provide funding of £30 million to support GP practices to continue providing a high level of care to patients through winter and into next year.
The funding will help with the provision of existing GP services, including:
supporting more face-to-face appointments
extra GP sessions, practice nurse time and non-core hours covering all appointments
more administrative time and practice manager time
organised cover for reflection, learning and innovation
external GP locum sessions
Health Secretary Humza Yousaf said: “The contribution general practice makes to the health and wellbeing of communities, through continuity of care and meaningful relationships with patients, is invaluable.
“We recognise that, as face-to-face appointments have resumed and demand is increasing, surgeries are working overtime to meet patient needs.
“This support package will allow practices to target investment where it is most required to sustain the high levels of care they have always provided through what is likely to be the most challenging period in the history of the NHS.”
Chair of the BMA’s Scottish GP Committee Dr Andrew Buist said: “BMA Scotland has consistently sought a greater level of support for GPs and we are pleased that the Scottish Government has listened and taken this step in the face of the huge challenges of this winter and beyond.
“With demand continuing to outstrip capacity, this will help support practices in the coming months and plug some of the gaps caused by difficulties in recruiting to practice teams.
“It is particularly good GPs have flexibility to focus funding on what will make the most difference to their practice and their patients. As we look ahead to next year and the ongoing threat to the sustainability of practices, this is a welcome addition we have secured in negotiation with the Government.”
The support package will be given in two instalments of £15 million, in December 2021 and April 2022.
The latest Emergency Department performance figures for September 2021 published today by NHS England show the highest number of 12-hour stays on record, the highest number of four-hour stays on record, and the worst four-hour performance ever recorded.
The latest figures were published on the day the UK Government set out it’s Plan to improve access for NHS patients and support GPs.
The data show in September 2021 there were 1,392,542 attendances to Type 1 Emergency Departments in England.
Four-hour performance has deteriorated for the sixth consecutive month, once again reaching a record low. Just 64% of patients in Type 1 Emergency Departments were admitted, transferred or discharged within four-hours.
A record breaking 5,025 patients stayed in an Emergency Department for 12-hours or more from decision to admit to admission. This is an 80% increase on the previous month, August 2021, and it is the highest number of 12-hour stays since records began and is almost a third higher than the previous highest, recorded in January 2021. The number of 12-hour stays from time of arrival is not published but is likely to be significantly higher.
Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “This data is bleak and is a stark warning of the crisis that we are heading towards this winter.
“Dangerous crowding has returned to Emergency Departments, exit block is preventing a flow of patients through the hospital, and there have been widespread reports of ambulances queuing outside hospitals facing long handover delays.
“For patients, this means long and potentially frustrating waiting times in the Emergency Department. For staff it is incredibly challenging, as they do all they can to continue to deliver care quickly amid rising attendances and pressures.
“At the same time the health service continues to manage covid as cases have been rising steeply, with the NHS now treating around 14 times as many patients as the same time last year.
“Trusts also continue to deliver elective care but there is a real threat that in the coming months this may once again have to be paused to manage pressures on urgent and emergency care and the rising number of covid cases.
“The winter presents a significant challenge for the health service; staff are increasingly worried about the NHS’ ability to cope. The Government need to recognise the potential crisis and support the health and care service as it tackles the challenges ahead.
“NHS England’s Urgent and Emergency Care Recovery 10 Point Action Plan is a blueprint on how to manage these pressures in the short and medium term. Trusts must do all they can to follow this guidance to mitigate pressures across the system and prevent further deterioration in performance.
“But the underlying cause of all of the problems facing the NHS is a decade of underfunding. The health service has for a long time struggled to meet the demand of the population. It is short on staff across the board; capacity has not risen in line with demand. Existing staff are exhausted, with many looking to leave after having to shoulder an ever-increasing workload.
“So far promises to increase the workforce have fallen short. The forthcoming spending review is an opportunity for the government to signal it’s intent to boost staffing with a long-term workforce plan and rescue the NHS in the long run.”
Meanwhile the NHS, working closely with the Department of Health and Social Care, has today published a blueprint for improving access to GP appointments for patients alongside supporting GPs and their teams in England.
Surgeries will be provided with additional funding to boost their capacity to increase the proportion of appointments delivered face to face, as part of a major drive to support general practice and level up performance, including additional efforts to tackle abuse against staff.
The measures, including a £250 million winter access fund from NHS England, will enable GP practices to improve availability so that patients who need care can get it, often on the same day if needed. The investment will fund locums and support from other health professionals such as physiotherapists and podiatrists, with a focus on increasing capacity to boost urgent same-day care. This is in addition to £270 million invested over the previous 11 months to expand capacity and support GPs.
Amanda Pritchard, chief executive of the NHS, said: “Improving access to high quality general practice is essential for our patients and for the rest of the NHS too.
“It is a personal priority and today NHS England is taking both urgent and longer term action to back GPs and their teams with additional investment and support.”
Secretary of State for Health and Social Care Sajid Javid said: “I am determined to ensure patients can see their GP in the way they want, no matter where they live. I also want to thank GPs and their teams for their enormous efforts in the most challenging times in living memory.
“Our new plan provides general practice teams with investment and targeted support. This will tackle underperformance, taking pressure off staff so they can spend more time with patients and increase the number of face-to-face appointments.
“Alongside this we are setting out more measures to tackle abuse and harassment so staff at GP surgeries who work so tirelessly to care for patients can do so without having to fear for their safety.”
The NHS England document makes clear that every GP practice must seek patients’ input and respect preferences for face to face care unless there are good clinical reasons to the contrary.
The extra investment will help to increase the number of appointments delivered, while local health systems will be free to determine how best to tackle particular challenges to access and provision of care in their own community, which could include putting in place additional resource for walk-in consultations.
Local plans will need to deliver these improvements in access, with practices that do not provide appropriate levels of face to face care not able to access the additional funding, and instead offered support to improve.
Under the plan, the NHS will also support upgrades to telephone systems, ensuring that more patients can quickly and easily speak to general practice staff, and help the public avoid long waits when contacting a surgery by phone.
The government will also reduce administrative burdens on GPs by reforming who can provide medical evidence and certificates such as FIT notes and DVLA checks – freeing up time for more appointments.
UKHSA will complete its review of infection prevention and control (IPC) guidance in general practice and set out practical steps on IPC measures in GP settings which could increase the number of patients that can be seen.
As part of this package, the NHS will increase its oversight of practices with the most acute issues in relation to access, and GP appointment data will be published at practice level by spring next year. This will enhance transparency and accountability, as monthly data is currently only published by clinical commissioning group.
In addition, patients will get the opportunity to rate their practice’s performance, via text message, based on their most recent experience of accessing support. This survey, which has been previously agreed with the profession, is being piloted in around 60 practices and will be rolled out next year.
Together with the government and Academy of Medical Royal Colleges, the NHS will also develop a zero-tolerance campaign on abuse of NHS staff, including GP teams.
General practice teams have delivered more than 300 million appointments over the last year as well as delivering the vast majority of Covid vaccinations, saving lives and protecting millions of people against the virus at speed.
Health Minister Maria Caulfield said: “As a nurse on the frontline during the pandemic I know how hard GPs and their teams have worked, while recognising how badly so many people want to see their GPs in person.
“This plan will give our dedicated general practices the support needed to increase capacity, boosting the number of appointments for patients to see and speak to their GP practice.
“I look forward to continuing to work with the sector to ensure patients can get the care they need.”
Patients will also be able to see different types of clinicians in general practice, who can best meet their needs and conditions, including pharmacists, paramedics, advanced nurse practitioners and nursing associates.
NHS England will also work with the government to consider how far and fast the role of pharmacists can be increased in the supply of medication, as part of relieving workload on GPs.
Government’s ‘rescue package’ for GPs is flawed and patient care will suffer as result, warns BMA
“It’s truly frightening that we have a government so ignorant to the needs of such a core part of the NHS”
Responding to the publication by the Department of Health and NHS England and NHS Improvement today, outlining their plans to improve access for NHS patients and support for GPs, BMA GP committee chair Dr Richard Vautrey said: “After weeks of promising an ‘emergency package’ to rescue general practice, we’re hugely dismayed that whilst additional funding has been promised, the package as a whole offers very little and shows a Government completely out of touch with the scale of the crisis on the ground.
“GPs and their teams will now be facing the worst winter for decades, and as a result, patients’ care will suffer. Appointments will be harder to book, waiting times will get longer, more of the profession could leave and GPs will struggle to cope.
“It is also disappointing to see that there is no end in sight to the preoccupation with face-to-face appointments; we need a more intelligent conversation about the variety of appointments and care that are available to patients to meet their needs.
“While in-person consultations are a key feature of general practice and absolutely necessary for some patients and certain conditions, the pandemic has proven that in many other cases, phone or video appointments are entirely appropriate and appreciated by patients, and a crude focus on percentages or targets is completely unhelpful.
“Throughout our discussions with ministers and NHS England in recent weeks, the BMA has been clear that without a concerted effort to reduce bureaucracy, admin and red tape in practices, patient access and care was at risk.
“Unfortunately, today’s offer merely tinkers around the edges, and will not reduce the unnecessary burden practices carry and therefore free up any more time for doctors to see more patients. We need an end to target-driven, payment-by-results, care and allow practices to look after patients in a way that is flexible and right for the person in front of them and the Government have missed an opportunity to tackle this.
“Reducing the administrative burden on GPs by reforming who can provide medical evidence and certificates such as Fit notes and DVLA checks, won’t happen for some time and is a mere drop in the ocean as what is needed is urgent action now to free up sufficient time for more appointments.
“While the additional £250m is welcome, it must be easy for practices to access rapidly and they must not be forced to have to produce reams of plans or try to meet unattainable targets to get it – which has often happened in the past.
“We had four simple asks – and only one appears to have been fully answered. Increased sentencing for assaulting healthcare workers is something we asked for, but meaningless if the same Government refuses to address the crisis fuelling such abuse. The Secretary of State has started to address a second, by talking more positively about general practice but he needs to do much more to publicly support the profession when we are under such pressure and facing a torrent of abuse on a daily basis.
“These proposals will only confirm the profession’s belief that ministers and NHS England fail to understand the dire state of general practice – or that they, not hardworking GPs, are to blame.
“It’s truly frightening that we have a government so ignorant to the needs of such a core part of the NHS. GPs want to improve the care we offer to our patients, but today’s offer will not enable us to do that as we had hoped.
“GPs across England will be truly horrified that this is being presented as a lifeline to general practice, when in reality it could sink the ship all together. There can be no doubt that this lack of action at such a critical time will force many GPs to hang up their stethoscopes and leave the profession for the last time.”
Responding to the latest urgent and emergency care survey published this week by the Care Quality Commission (CQC), Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said:“The survey is welcome as it provides an invaluable insight into the patient experience and confirms that Emergency Departments are doing an incredible job in difficult circumstances.
“We are appreciative of patients engaging and providing this feedback in the middle of the pandemic in September 2020. Managing to continue these core assurance processes is a challenge but continues to be very important.
“It is encouraging to see improvements in many areas compared to previous years. It is particularly pleasing to see one-third of patients using type 1 services rate their experiences 10 out of 10, and also that 94% of patients had confidence and trust in the doctors and nurses examining and treating them. This is a testament to the dedication, commitment, expertise, and compassion of Emergency Medicine staff.
“While there are many positives to highlight in this report, understandably there are some areas for improvement. Many of the areas that are a source of frustration for patients are largely a result of staff shortages and the existing workforce’s ability to dedicate ample time to each patient.
“It is important that patients have the opportunity to talk through their treatment or condition, that all patients receive the help they need when they need it whether before, after or during their care, and that their pain or condition is managed throughout their time in A&E.
“The current challenges facing the health service are no doubt affecting clinicians’ ability to deliver the highest quality of care that they strive to provide. Current workforce numbers do not match current demand, and workforce shortages crossed with increases in demand mean existing staff are stretched thinly.
“To meet current demand the workforce needs 2,500 more consultants in England along with sufficient numbers of nurses, trainees, allied health professionals and SAS doctors.”
Dr Katherine Henderson continued:“It is interesting to see that 41% of patients contacted NHS 111 before going to A&E and 32% contacted their GP before going to A&E.
“This highlights the importance of NHS 111 as a resource for patients. It is absolutely essential that the efficacy of NHS 111 is properly evaluated so we can learn how best to resource it and wider services. Call handlers must have the tools they need to provide sound guidance to patients, and they must have an adequate range of services and pathways to which they can direct patients.
“It is also significant that 32% of patients also contact their GP before going to A&E. This highlights the crucial link between primary and urgent and emergency care and makes clear that both are under-resourced. Plans to tackle the challenges facing urgent and emergency care must include a joined-up approach that include ways of supporting and resourcing primary care.”
Plans for investment and reform to give GPs more time with patients most in need of their skills have been published by the Scottish Government. A new GP contract, jointly designed and agreed with the British Medical Association, will be the biggest reform of GPs services in over a decade. The proposals have been welcomed by the Scottish Greens, who say the plan is a step in the right direction in tackling health inequality.Continue reading GPs offered new contract
