Daily Insight: Time to lick envelopes

Back in 2019, NHS England included in its GP contract a commitment to do away with so-called “Lloyd George” envelopes – named after the early 20th century prime minister who introduced a pre-NHS health insurance scheme – and digitise them by 2022-23.

But Freedom of Information requests submitted by HSJ have revealed that thousands of GP practices in England are still storing the envelopes onsite and using them when required.

While they are no longer regularly used by GPs (with electronic patient records now the norm) the older paper records are consulted occasionally for historical reference, or when a patient makes a subject access request.

In total, 32 of the 42 integrated care boards responded to HSJ’s FOI requests. Of that total, 18 ICBs said all their GP practices still stored or used the paper records and had not yet digitised, while 13 ICBs said some practices had digitised and others had not.

Just one ICB – Sussex – said that no practices still used Lloyd George records.

The push to digitise the iconic brown paper records came amid concerns that they posed a “risk” to “person-centred care” due to a lack of “continuity and resilience” within them. Digitisation would also free up physical space in GP practices.

Neil Bhatia, a Hampshire GP whose practice has fully digitised its Lloyd George records, said that digitisation has proved “immensely useful” and that storing the paper records was an “archaic way of doing things”.

The ‘unacceptable’ face of A&E waits

The “unacceptable” treatment of mental health patients in accident and emergency departments has been laid bare in leaked data, with the situation so bad that some acute trusts are buying private beds to plug gaps.

One in five cases in which patients attend A&E needing mental healthcare are spending more than 12 hours in the department – at least double the rate of patients with physical health problems, HSJ has discovered.

Internal NHS data seen by HSJ also suggests the proportion of mental health patients suffering long waits in A&E has almost tripled since before the pandemic from 7 per cent in 2019-20 to 20 per cent in 2022-23. 

This compares to around one in 10 patients who presented with all health problems, of which most relate to physical conditions.

One London hospital has commissioned private mental health beds to cope with growing delays. Meanwhile, the CEO of one of the worst-hit trusts admitted they had a patient stuck in A&E for 21 days.

NHSE said mental health currently accounts for 16 per cent of all 12-hour waits, despite emergency department attendances for mental health accounting for less than 3 per cent of all visits and attendance numbers staying relatively flat.