Scottish National Users’ Group (SNUG) Podcast

How has Covid-19 affected the care of patients with diabetes?

Dr Jamie Hartmann-Boyce is associate professor at the Nuffield Department of Primary Care Health Sciences, and her team published  a paper at the start of the Covid-19 pandemic predicting how care for patients with conditions like diabetes might worsen during national emergencies like the Covid pandemic. 

She also had a paper in Diabetes care looking at the evidence that patients with diabetes were at increased risk of more severe Covid-19, and has also looked at whether Covid-19 infection may itself lead to a higher risk of developing diabetes.

There is now some evidence starting to emerge that a significant number of patients with diabetes may have been lost to follow up during the pandemic, and others may now have poorer control, although there is some variation within different subgroups. We discussed what this might mean for the care of patients with diabetes, and other long term conditions, and how we might now start to address this problem.

Listen to the end to hear whether e-cigarettes are a good thing, and what our favourite film trilogies are!

The Centre for Evidence-Based medicine

Oxford COVID-19 Evidence Service

SNUG Members Day 2022

The Godfather theme song

Digitizing GP records in Scotland

The Practitioner Services Division of National Services Scotland (NSS) supports GP practices across Scotland in a number of important ways. In this episode, we speak to their Business Change manager Annie McDonnell (annie.mcdonnell2@nhs.scot) who describes a project to digitize new patient records coming into practices who have already backscanned their old patient records. We discussed how may practices in Scotland are participating in the project, how quality assurance works, and when the paper records may be safely destroyed. We also reflect a little on what life was like as a GP with nothing but paper patient records, and discover a film depicting life as a Highland doctor in the 1940s.

PSD Area offices details are listed below:

Primary Care Informatics/SCIMP advice for practices on backscanning records

Scottish Government Digital health and care strategy

The Highland Dr film

Nimrod by Elgar

Reviewing long term conditions with Medlink

We have another episode looking at the care of patients with long term conditions, today we are joined by Dr Lorenz Kemper of Medlink Solutions. This is a system for carrying out online clinical reviews and can be used for reviews of conditions like asthma and diabetes, as well as a variety of other uses like medications reviews, submitting blood pressure readings, or reviews of patients on HRT or the contraceptive pill. Lorenz discusses how Medlink started up, how it provides practices with more options for reviewing patients and can prompt an overhaul for the entire approach to review of chronic conditions.  

NHS England is supporting Primary Care to move towards a Digital First approach, where patients can easily access the advice, support and treatment they need using digital and online tools.

In Scotland, the Technology Enabled Care (TEC) programme is looking at a number of Remote Health pathways, including a national DACS solution.

What is Medlink? video

Technology Enabled health Care GP DACS updates.

Barbara Fredrickson: Positive Emotions Transform Us

SNUG podcast on Apple podcasts

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SNUG podcast on Spotify

Scotland’s House of Care

Scotland’s House of Care is based on the Year of Care Programme and as this BMJ article explains, is all about delivering person centred care in long term conditions.

In this episode of our podcast, we discuss how we can offer Care and Support Planning to patients with long term conditions, as we speak to Dr Graham Kramer @KramerGraham and Lindsay Oliver @lindsayeoliver, two of the leading figures in promoting this approach both in England and Scotland over the past few years. We also hear from Alison Fox, the Practice Manager of St Triduana’ s practice in Edinburgh, who have found that Care and support planning really works well for them, and how this has continued to be useful throughout the pandemic.

Angela Coulter video: evidence for care and support planning.

Cochrane Database review of evidence supporting Care and Support Planning.

Many conditions, one life

RCGP Person centred Toolkit

Alliance video: Patient Reps from Greater Glasgow and Clyde Health and Social Care Partnership explain their experiences with the House of Care and having care and support planning conversations with health professionals.

You can contact SNUG by emailing alex.defranco@phs.scot

The wisdom of Doc Martin

Dr Bill Martin is a former co-chair of SNUG and has recently moved on after a long spell in general practice, during which he experienced progressive computerization of all aspects of general practice. We discussed why he still thinks general practice is a great career choice, why he thinks many of the changes which have happened during the pandemic will stick, and why we will have to be careful about “opening up” surgeries again. He reflects on impending GP systems changes, having been through it all before, and recommends lots of planning as many systems are replaced over the next few years. He decides how he might spend a billion pounds on improving GP IT in Scotland, and we discussed whether general practice might benefit from having a spin doctor at the moment!

We also got on to debating whether he might want to consider running for prime minister and, of course, whether Scotland might beat Ireland at rugby?

Email Alex De Franco alex.defranco@phs.scot with any comments on this or other SNUG podcasts.

SNUG regional meetings

BBC News article on face to face GP consultations on Scotland.

Downing Street parties: How many wine bottles fit in a suitcase, and other questions

Summary of The Machine Stops

Read The Machine Stops here.

Neil Young: Rockin’ in the free world

Christmas greetings to and from SNUG

Dr Rob Hamilton is a GP in Snug Medical Centre in Snug, a small town on the South coast of Tasmania. We say hello to Rob and hear a little about what life there is like at the moment, as the border with new South Wales is about to open and they may start to experience Covid-19 for the first time. We also reflect on a hectic 2021 with SNUG co-chair Dr Neil Kelly who gives us some ideas for new year’s resolutions, including a digital detox, or at the very least, switching off notifications on your phone. And of course, we have some book reviews from Dr Chris Weatherburn, who describes SCIMP’s mutation into Primary Care Informatics and gives us plenty of enthusiastic tips on maintaining positivity as the new year beckons.

BMJ Talk Medicine Podcast: Wellbeing – feeling addicted to your phone?

Today FM Christmas Covid Handicap Hurdle

Chris Weatherburn’s book reviews

Positivity – Chris’s Barbara Fredrickson summary Youtube video

See and subscribe to Chris’s newsletters here!

Airplane: re-inflating the autopilot

Have yourselves a merry little Christmas

Artificial Intelligence and Dermatology

Would you trust a machine to diagnose your skin cancer? Or, maybe, to reassure you that a mole is “ok”? We take a dive into the world of machine learning, which is a branch of artificial intelligence based on the idea that systems can learn from data, identify patterns and make decisions with minimal human intervention. The most promising advances in medical image analysis have used a type of algorithm known as a deep neural network. But what happens if the images aren’t of good enough quality?

We discuss both the great potential and also some of the current limitations of work in this area being done on both sides of the Atlantic, with Dr Colin Morton, who is a consultant dermatologist in NHS Forth Valley and is clinical operational lead for a skin cancer AI consortium in Scotland, Professor Mark Davis and Dr Dennis Murphree, the Director of Digital Health and Artificial Intelligence in Dermatology at the Mayo clinic, Rochester, Minnesota, USA.

Artificial Intelligence to help diagnose skin cancers: NHS Tayside project

Embracing the transformative power of digital pathology: Mayo Clinic

Can we open the black box of AI?

Deep learning for dermatologists Part 1  Part 2

The Scottish Digital Prescribing and Dispensing Programme

The Scottish Digital Prescribing and Dispensing Programme, is being led by Ewan Morrison, Director of Pharmacy, NSS and Dr Sam Patel, consultant physician in Respiratory and General Medicine NHS Lanarkshire, and eHealth Clinical Lead for NES Digital Services. This programme is a major national collaboration between  NHS Education for Scotland and NHS National Services Scotland, and aims to revolutionize the way we prescribe and dispense medications in Scotland, which is currently a paper-based process with some electronic elements, involving medical and non-medical prescribers, patients and pharmacists, generating around 5 million items a month.

In one of our previous episodes, we discussed the outputs of a series of NSS workshops held in 2019 looking at processes around prescribing. The findings acknowledged that ePrescribing is one of the key requirements to improve prescribing and dispensing processes. In this episode, Ewan and Sam discuss the outcome of phase 1 of this programme, which aims to find a technical and organisational electronic solution to meet the needs of NHS Scotland in the future, and has produced a paper prototype to inform this.

“Once we have removed the paper prescription, and replaced the wet signature, from in-hours GP prescribing, to community pharmacy, and the process works for everyone in that chain, including the patients, the citizen, that’s when we’ll be cracking open the Champagne”.

They will also be leading a plenary session at our November conference and you can hear more about the programme and ask them your own questions by registering below.

The SNUG Virtual Conference November 2021 agenda and booking details

NHS Digital EPS prescribing System Specification (specification for EPS in NHS England)

Asynchronous Consulting: the facts about DACS

One of the big areas of interest at the SNUG members’ day in May was the increasing use of digital systems for communicating and consulting “asynchronously” and how these are changing the face of general practice. In this episode, we have highlights from two of the talks discussing issues around online consulting. Thomas Dodd is a training partner for AskmyGP and he discussed some of the popular myths about online consultations – for example that patients prefer face to face rather than online contact, yet online services will also submerge GPs with new demand. Dr David Cooper, the co-chair of SNUG and a user of eConsult, describes why he is a big advocate of online consulting and why his practice has found it hugely beneficial in maintaining services throughout the pandemic.

We pose the question: are we now at a similar moment in weighing up the pros and cons of providing a new means of access to care online, as doctors were in the 1880s when the advent of the telephone also offered new and better access to medical care?

These workshops can be seen in full, with slides and questions and answers at the SNUG website.

You can contact us with any comments or suggestions at: alex.defranco@phs.scot

The Lancet on the telephone 1867-1975

Farewell Dr Findlay: the history of general practice: BBC Sounds

NHS England: using online consultations in Primary Care implementation toolkit

BMJ Health and care Informatics: COVID-19 and beyond: virtual consultations in primary care—reflecting on the evidence base for implementation and ensuring reach: commentary article

BMJ How to conduct written online consultations with patients in primary care: visual guide

 

The digital front door to general practice

The way we deliver health care has been radically changed by the Covid 19 pandemic. In an almost Darwinian way, general practices have evolved their systems to try and meet the various challenges, much of it driven by technology and the ability to communicate and provide services by telephone or online. Many practices now have what’s been called a digital front door. The question is, how widely to we want to open up that front door? Practices across the UK have had to make new use of online services and are wondering rather uncertainly what the future implications of this will be. Is there a limit to the demands for health care?

At the May SNUG Members’ day, many of the new digital developments were discussed. Matt Hoghton (@mhoghton) is a GP and Clinical Advisor to Digital Primary Care NHSX in England. He described how services have developed in England in the last 18 months and described experiences with greater use of Digital Asynchronous Consulting Systems, apps and practice websites  to allow patients to access and use services in a new way, the need for remote working, e-Prescribing and how the organisation of health care has had to shift to meet the changed circumstances. There are many parallels with our experiences in Scotland, and also several lessons we can learn.

Andrew Cowie(@DrAndrewCowie) is a GP in Dundee and the deputy chair of the Scottish GP’s Committee of the BMA (SGPC). He led a discussion session looking at the SGPC’s approach to provision of digital services by GP practices in Scotland.

The full videos for these sessions and many more are available for members at the SNUG Website. Are you enthusiastic or apprehensive about the move towards opening the digital front door to your practice? Do let us know. alex.defranco@phs.scot

SGPC information: https://www.bma.org.uk/what-we-do/committees/general-practitioners-committee/scottish-general-practitioners-committee

Rammya Mathew BMJ: https://www.bmj.com/content/373/bmj.n1246

Future NHS Collaboration platform: https://future.nhs.uk/

NHS Inform tools and apps: https://www.nhsinform.scot/care-support-and-rights/tools-and-apps

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