Nearly half of recently qualified GPs are experiencing rising levels of stress, while over a quarter say they don’t have time to deliver the care patients need.

Of 368 GPs surveyed by the BMA who qualified in 2006 (from a cohort of 435), 40% said their morale had deteriorated in the last 12 months.

The respondents identified the current NHS structural reforms – claimed by the Government to be ‘empowering’ GPs – as a major reason for this decline in the professional experience of primary care.

However, 92% said that interactions with patients improved their morale – showing that patients being more unwell or more demanding was not a major issue.

The 2012 survey found that 44% of respondents said their stress levels had worsened over 2012, 20% reported ‘unacceptable’ levels of stress at work, and 28% said they did not have time to deliver the care that patients needed.

In addition, more than half (54%) identified understaffing as a major problem in their practices, while more than three quarters (79%) said work-related administration duties negatively affected their time outside work.

The BMA said the survey's evidence of declining patient access to NHS primary care of adequate quality was “troubling”.

The introduction of CCGs has not made doctors feel more involved in commissioning decisions, a new survey has revealed.

Research by Pulse magazine found that out of 303 doctors questioned more than half (55%) said they do not feel any more involved in commissioning services now than they did under PCTs.

Only 36% of GPs surveyed said the introduction of CCGs had made them feel more involved in commissioning decisions.

Dr Chaand Nagpaul said the lack of engagement was a result of the Government pushing the reforms through “at breakneck speed” which did not allow for “adequate involvement and organic development”.

The survey also found that a fifth of GPs had not signed their CCG constitution – only days ahead of commissioning groups taking on their new responsibilities. Doctors who had not signed a constitution, claimed they had either not been asked to or that the documents were still in draft form.

Ineffective drugs are prescribed by 97% of GPs as ‘impure placebos’, according to a study by researchers at two UK universities.

A survey of UK doctors found that nearly all admitted prescribing treatments they knew would have no direct pharmacological effect, including antibiotics for viral infections.

The survey findings present strong practice-level evidence that placebos have a real health impact – which has implications for the debate around whether homeopathic medicines should be used in the NHS.

The study authors emphasised that the ‘placebo effect’ is not medically negligible: a placebo treatment can help to stimulate neurological and endocrine reactions to the disease, reducing the symptoms.

‘Impure placebos’ are real treatments whose efficacy for that particular patient is doubtful. It differs from off-label use, where the drug is not approved for that indication but there is trust in its efficacy.

In addition, 12% of GPs admitted prescribing ‘pure placebos’ (with no active ingredient) to reassure patients whose anxiety was itself a health risk factor.

Researchers at the Universities of Oxford and Southampton analysed the responses of 783 GPs to an online survey. The respondent population was analysed and judged representative of registered GPs in general.

The survey found that doctors used impure placebos to induce psychological treatment effects, to counter patient anxiety or to comply with patient choice.

While 84% of doctors judged the use of impure placebos to be acceptable in some situations (and 66% supported the use of pure placebos), more than 80% said their use should not involve deception.

Professor George Lewith, co-lead author of the University of Southampton study, said the two studies showed that “doctors are generally using placebos in good faith to help patients”.

Previous studies “have clearly shown placebos can help many people and can be effective for a long time after administration,” he added. “The placebo effect works by releasing our body’s own natural painkillers into our nervous system.

“In my opinion the stigma attached to placebo use is irrational, and further investigation is needed to develop ethical, cost-effective placebos.”

The use of placebos is discouraged by the General Medical Council. However, Dr Jeremy Howick, co-lead author of the University of Oxford study, argued: “Current ethical rulings on placebos ought to be revisited in light of the strong evidence suggesting that doctors broadly support their use.”

Nefarma, the Dutch pharmaceutical industry trade association, is launching an online ‘transparency register’ on which doctors will declare all industry payments they have received.

The new register, which may be ‘live’ in April 2013, is designed to facilitate collaborative working between doctors and industry by addressing concerns over possible conflicts of interest.

The Netherlands is the first EU country to require this level of transparency, following national guidelines that were set down a year ago, and other member states are predicted to follow.

There is agreement between the Dutch Minister of Health and representatives of the healthcare industry that the role of doctors in the development and early use of drugs is important and merits payment.

To ensure that such professional relationships are not seen as compromising patient care, it has been agreed, full transparency is needed.

Machteld Hiemstra, a lawyer with Simmons & Simmons who specialises in the life sciences industries, said: “Transparency on interactions between industry and healthcare professionals is dominating discussion across Europe at the moment and we anticipate that other member states will follow the Netherlands’ lead soon.

“Stakeholders are likely to monitor the impact of the Dutch transparency register with interest, as it will serve as a test case on the feasibility and effects of such transparency.”

NHS Chief Executive Sir David Nicholson has warned that the Government’s controversial health service reforms may end in “misery and failure”.

Sir David said that politically driven changes to any public sector body usually ends in disaster.

Speaking to doctors at the Royal College of General Practitioners conference, Nicholson said that “carpet bombing” the health service with private sector competition was not the right way to tackle rising costs.

The NHS’ leader said that the reforms would benefit patients by offering them increased choice and improved standards of care through competition. But he added that GPs would only benefit from the reforms if they are free from negotiating new services.

“If we are creating a system where general practitioners feel it is their job to do all that, then I think we have a massive problem,” he told delegates. “We need to create the right kind of people with the right kind of skills, which we are trying to do at the moment through commissioning support, to enable people to focus their attention on clinical decision-making.

“My advice to anyone – and I have been involved in the last five or six years with the national programme for IT, and I have, as they say, the scars on the back around all of that – is that big, high-profile, politically driven objectives and changes like this almost always end in misery and failure.”

Shadow Health Secretary Andy Burnham said Nicholson’s comments were a concern. “David Nicholson is a man who has the NHS at heart, so it is worrying to hear him talk in these terms,” he said. “He has put on a brave face in public, but clearly has private concerns about the real damage this reorganisation is doing.

“His open acknowledgment of the possibility of it ending in failure will send shock waves through the NHS and provide a stark illustration of the sheer scale of the gamble the Government is taking.”

The Government’s controversial Health and Social Care reforms have left the NHS and doctors across England in distress, Dr Clare Gerada has claimed.

The chair of the Royal College of GPs again voiced concerns about the introduction of the Health Act and the consequences of the reforms for the NHS and healthcare professionals.

Speaking at a conference in Glasgow, Dr Gerada claimed the NHS is experiencing the “mother of all top-down reorganisations” – which were the most “radical” in its 60 year history.

Dr Gerada said that as a result of the reforms the health service and GPs had been left “in distress” after the Act was “rushed through at breakneck speed.”

“We GPs will always make the system work for our patients,” she said. “But we will never compromise the founding values of our NHS. And each of us must continue to play our part in raising concerns wherever we see inequalities and unfairness in our health system.

“We’ll show courage, just as our forefathers did as they rose to the extraordinary challenges posed by post-war austerity and the uncertainties of the new NHS.”

“Yet despite her opposition to the Health Act, Dr Gerada called upon doctors to embrace our future with optimism and confidence.” A statement echoed by the Department of Health.

“Local doctors are the right people to lead the NHS,” said a spokesperson. “They will make this system work and make sure the NHS is locally led. They know what their local health and care issues are and will ensure patients are treated as individuals – with dignity and respect – improving services and the quality of care.”

The NHS needs to involve the general public in making important decisions when managing their care and encourage greater interaction in their health and wellbeing, the NHS Confederation has said.

Mike Farrar, Chief Executive of the Confederation, said the NHS needs to go further to meet statements in its constitution to combat future challenges.

Farrar, writing in an editorial in The Guardian, said “NHS organisations need to do more to involve patients and the public” in how services are run.

The NHS Confed leader referred to the statement in the NHS Constitution that: the NHS belongs to the people.

But he admitted that the “daily reality for patients and the public” is somewhat different – and highlighted poor clinical practice and senior NHS leaders ignoring public opinion when making difficult decisions.

He said: “Take all this into account and you sense the NHS is a ‘public service’ with a long way to go.” Farrar added that the solution must change rapidly if the “NHS is to survive its next decade of challenges.”

Farrar pointed towards greater patient engagement in the future to obtain “faster and more sustainable results.” He said this was “business critical” if the NHS is to provide better standards of care and outcomes “for less money as healthcare demands grow”.

“There is no doubt that healthcare issues are complex,” he said. “But NHS managers and doctors do themselves no favours by their attitude of ‘arms around their work, no peeking’. We have to change.

“There is a huge need for more transparency, honesty and openness about why we need to modernise health services. There is an even bigger need for revealing to the public information about the economics, finances, and costs of health and social care.”

NHS rationing is affecting the relationship between doctors and their patients, a new survey has found.

The survey by Pulse Magazine revealed that three quarters of GPs believe the doctor-patient relationship has been tainted by cut backs to certain treatments.

Dr Clare Gerada, Royal College of General Practitioners, said the problems of the Health and Social Care Act have resulted in patients holding GPs responsible.

Typical treatments which have been affected by a rationing include GP referrals for bariatric, hip and knee and cataract surgery.

Out of the 237 doctors questioned, nine out of 10 reported pressure to ration treatments or services over the past twelve months. Two-thirds of respondents admitted local rationing was adversely affecting standards of patient care.

More than 40% of doctors said they had changed the therapy of patients to less effective options due to rationing guidelines in the past twelve months. A third also raised issues with getting patients to guideline-directed targets.

GPs also exposed other forms of rationing with 89% finding patients had been referred back to them after missed hospital appointments and 31% claimed hospitals were overemphasising the risks of surgery in an attempt to off put individuals.

A spokesperson for the Department of Health said they would be writing to the NHS to remind them that rationing on the grounds of cost was wrong.

Acute care services across England are struggling to meet increasing demand and the complexity of patients’ conditions, a new report has said.

The report by The Royal College of Physicians (RCP) found that standards were falling in hospitals due to an increase in emergency admissions, the treatment of elderly patients with a variety of conditions and a reduction in the amount of beds.

Professor Tim Evans, from the RCP, said the evidence was “very distressing” and the Government must make “drastic changes” to improve standards of acute care.

The survey of RCP fellows found that doctors were most concerned about staff shortages, the workload in acute medicine, a lack of continuity of care, and the impact of NHS efficiency savings.

Doctors also raised concerns about how older patients were transferred between wards and that levels of care dropped at night time.

The report suggested that the NHS has been a victim of own success. Contemporary medicines are now allowing people to live longer, but this has resulted in them developing long-term conditions such dementia.

“All hospital patients deserve to receive safe, high-quality sustainable care centred around their needs,” said Professor Evans. “Yet it is increasingly clear that our hospitals are struggling to cope with the challenge of an ageing population who increasingly present to our hospitals with multiple, complex diseases.”

Solutions to tackle the problems, the report said, include concentrating services in fewer, larger sites that are able to provide excellent standards of care, regardless of the time of admission. The report also advises improving community services to stop patients returning to hospital.

Health minister Dr Dan Poulter said it is “completely wrong” to suggest the NHS is struggling to meet demand and insisted that the “NHS only uses approximately 85% of the beds it has available”.

“It is true that the NHS needs fundamental reform to cope with the challenges of the future,” he said. “To truly provide dignity in care for older people, we need to see even more care out of hospitals. That’s why we are modernising the NHS and putting the people who best understand patient's needs, doctors and nurses, in charge.”

The only alternative to a potential “wholesale reduction” in NHS staffing levels is radical changes to employment terms, a trust group has argued.

According to the South West Consortium, the region will need to shed over 6,000 frontline healthcare jobs, potentially endangering patients, unless it rethinks the terms and conditions of nurses and doctors.

Among the measures it proposes are cutting annual leave, incremental pay, sick pay and on-call payments, and increasing working hours for the same pay.

The recommendations will be considered by each trust board later this year.

The Consortium’s proposed solution to the NHS funding crisis has highlighted the health system’s ongoing financial crisis – and to resolve it, suggested that the professional status of nurses and doctors be reviewed.

Health unions have noted that member trusts have so far paid £10,000 each – a total of £200,000 – to join the consortium, whose members employ 68,000 staff.

A report published by the Consortium states: “The alternative to addressing pay, terms and conditions is a wholesale reduction in headcount which, in potentially compromising minimum staffing levels and therefore patient safety, is extremely undesirable and costly.”

Departure from national employment terms would represent a major step towards a localised and decentralised NHS.