Category Archives: Diet & Fitness

The US healthcare system is at a dramatic fork in the road | Adam Gaffney

The US healthcare system – and with it the health and welfare of millions – is poised on the edge of a knife. Though the fetid dysfunction and entanglements of the Trump presidency dominate the airwaves, this is an issue that will have life and death consequences for countless Americans.

The Congressional Budget Office’s (CBO) dismal “scoring” of the revised American Health Care Act (AHCA) on Wednesday made clear just how dire America’s healthcare prospects are under Trump’s administration. But while the healthcare debate is often framed as a choice between Obamacare and the new Republican plan, there are actually three healthcare visions in competition today. These can be labelled healthcare past, healthcare present, and healthcare future.

Let us begin with healthcare past, for the dark past is precisely where Republicans are striving to take us with the AHCA. The bill – narrowly passed by the House on 4 May – is less a piece of healthcare “reform” than a dump truck sent barreling at high speed into the foundation of the healthcare safety net.

Wednesday’s CBO score reflects the modifications made to the AHCA to pacify the hard-right Freedom Caucus, changes that allowed states to obtain waivers that would relieve health insurers of the requirement that they cover the full spectrum of “essential healthcare benefits”, or permit them to charge higher premiums to those guilty of the misdemeanor of sickness, all purportedly for the goal of lowering premiums.

In fairness, the CBO report did find that these waivers would bring down premiums for non-group plans. This, however, was not the result of some mysterious market magic, but simply because, as the CBO noted, covered benefits would be skimpier, while sicker and older people would be pushed out of the market.

In some states that obtained waivers, “over time, less healthy individuals … would be unable to purchase comprehensive coverage with premiums close to those under current law and might not be able to purchase coverage at all”. Moreover, out-of-pocket costs would rise for many, for instance whenever people needed to use services that were no longer covered – say mental health or maternity care.

Much else, however, stayed the same from the previous reports. Like the last AHCA, this one would cut more than $ 800bn in Medicaid spending over a decade, dollars it would pass into the bank accounts of the rich in the form of tax cuts, booting about 14 million individuals out of the program in the process. And overall, the new AHCA would eventually strip insurance from 23 million people, as compared to the previous estimate of 24 million.

It’s worth noting here that Trump’s budget – released Tuesday – proposed additional Medicaid cuts in addition of those of the AHCA, which amounted to a gargantuan $ 1.3tn over a decade, according to the Center on Budget and Policy Priorities.

The tax plan and budget – best characterized as a battle plan for no-holds-barred top-down class warfare drawn up by apparently innumerate xenophobes – would in effect transform the healthcare and food aid of the poor into bricks for a US-Mexico border wall, guns for an already swollen military, and – more than anything – a big fat payout to Trump’s bloated billionaire and millionaire cronies.

What becomes of this violent agenda now depends on Congress – and on the grassroots pressure that can be brought to bear upon its members.

But assuming the AHCA dies a much-deserved death – quite possible given the headwinds it faces in the Senate – we will still have to contend with healthcare present.

Last week, the Centers for Disease Control released 2016 results from the National Health Interview Survey, giving us a fresh glimpse of where things stand today. And on the one hand, the news seemed good: the number of uninsured people fell from 48.6 to 28.6 million between 2010 and 2016.

On the other hand, it revealed utter stagnation: an identical number were uninsured in 2016 as compared with 2015, with about a quarter of those with low incomes uninsured last year (among non-elderly adults). It also suggested that the value of insurance is declining, with “high-deductible health plans” rapidly becoming the rule and not the exception: for the privately insured under age 65, 39.4% had a high-deductible in 2016, up from 25.3% in 2010.

Healthcare present, therefore, is an unstable status quo: an improvement from healthcare past, no doubt, but millions remain uninsured and out-of-pocket health costs continue to squeeze the insured.

Which takes us to the third vision, that of healthcare future. As it happens, another recent development provided a brief glimmer of hope for that vision. As the Hill reported, the Democratic congressman John Conyers held a press conference yesterday (Physicians for a National Health Program, in which I am active, participated) to announce that his universal healthcare bill – the “Expanded & Improved Medicare For All Act” – had achieved 111 co-sponsors, amounting to a majority of the House Democratic Caucus and the most in the bill’s history.

This bill – like other single-payer proposals – is the precise antithesis of Paul Ryan’s AHCA. Rather than extract coverage from millions to provide tax breaks for the rich, it would use progressive taxation to provide first-dollar health coverage to all.

Which of these three visions will win out is uncertain, but the outcome of the contest will have a lasting impact on the country. We can only hope that the thuggish, rapacious vision championed by Trump and his administration does not prevail.

12 Jours review – a devastating glimpse into broken souls

A young woman stares across a table at the judge who is reviewing her case. Her gaze is both searingly intense and curiously blank. Holding herself preternaturally still, muscles tensed against the turmoil of emotions, she pleads to see the two-year-old daughter who has been removed from her care. “Not all the time, I accept that. But just to change her diaper, to love her.” If there’s a more achingly sad moment in any film of the 2017 Cannes film festival, it’s hard to imagine what it could be. For 12 Jours, veteran documentarian Raymond Depardon (Modern Life, Journal de France) turns his lens on to the desperate, broken souls of the patients who have been involuntarily committed into the care of a Lyon psychiatric institution.

By French law, anyone admitted into the hospital without their consent must be seen by a judge within 12 days. The cases of long-term patients are also assessed on a regular basis. The patient, accompanied by a lawyer, sits on one side of a table in a hospital office; the judge on the other. And the conversation between them will determine whether they can be allowed to take personal responsibility for their own liberty.

Depardon protects the identities of the subjects by changing their names and other details, but their faces are shown. The extraordinary level of access and intimacy begs the question, if someone is not deemed fit to leave a psychiatric ward, can they really agree to participation in a documentary? It’s a legal and moral conundrum and it is part of a larger issue which looms over any factual film which focuses on the most vulnerable members of society. However empathetic the approach and honourable the intent, questions of consent and the spectre of exploitation lurk at the edge of the frame.

Moral questions notwithstanding, this is a remarkable piece of work. A brittle woman, voice choked up by the tears that fall as soon as she starts to talk, is stretched to breaking point by her work. She is glad to stay in the hospital, acknowledging that she needs to heal. “I’m an open wound,” she gasps.

All the other patients ask to leave. One, a young woman hollowed out by a lifetime of loneliness, wants to go home to kill herself. Another says he has a political party to start, funded by Bernie Sanders, which is going to “wipe out psychiatrists”. Another, a hollow-eyed 20-year-old man who slurs through a list of paranoid delusions in agonising slow motion, ends the interview with a promise to become a professional footballer when he gets out. The camera rests on the face of the judge for a moment as he looks into a future which is likely to include many things, none of which will be professional soccer.

The distressing momentum of scrutinising shattered psyche after shattered psyche is broken up, firstly by slow shots that roll through the corridors of the hospital like a gurney, and secondly by three sections of wrenchingly lovely music, composed by Alexandre Desplat. It’s a quietly devastating film.

Nurse job interview tips: top nine questions and answers

Compassion and communication, respect and resilience, accountability and adaptability – a good nurse possesses a daunting set of qualities. If you’re newly qualified, how can you convince employers you have what it takes?

We asked those responsible for hiring band five nurses to tell us how they identify the right candidates. Here, they reveal some of the most common interview questions, as well as tips on how to answer them.

Why do you want this job?

The first question is usually broad. Candidates shouldn’t go into lots of detail but obviously shouldn’t give an answer that’s too short. If they’re newly qualified, they should think about what brought them into nursing in the first place. Why that specific branch of nursing … did they work there on a placement?
Wendy Preston, head of nursing practice, Royal College of Nursing

Why do you think you’re a good nurse and how can you evidence this?

They have got to show integrity and honesty, and also courage – we want to know they’re going to be a good advocate for their patients. They need to show they work according to the values of the six Cs – care, compassion, competence, communication, courage and commitment.We incorporate scenario question during the interview that will assess a nurse’s integrity. For example: “If you witnessed a nurse administering an incorrect drug, what would you do?” We ask for examples and to provide evidence from their career to date. Their answer will show their thinking processes and whether they know the right procedures to follow.We also understand the value of a happy team, so we want someone who can demonstrate they work well in a team and have a positive, can-do attitude. We want enthusiasm to shine through – you can see when someone’s energised by the work they do.
Ann Duncan, matron, Royal Marsden hospital, London

What does compassionate care mean to you and how do you deliver it?

I’m looking for someone who wants to care. I can teach you any skill, with help from my team, but caring and compassion is inherent. Answers often include kindness, empathy, treating the person as I would want myself or my family to be treated, listening to what it is the patient perceives as the problem and addressing that issue (often different from the clinical issues requiring nursing care).
Jo Thomas, director of nursing and quality, Queen Victoria hospital, Sussex

It is often good to ask a nurse if there has been a time they felt they were unable to give compassionate care and explore their answers. This can give us a good insight at interview. Examples staff have given include exhaustion, abnormally busy, low morale, poor skill mix/staffing levels, poor teamwork, challenging or abusive patients or relatives. Clearly we do not want this to be the norm for a nurse but understand there may be barriers to giving compassionate care all the time. We are looking for honesty and self-awareness. It is important to listen to what they say and how they say it.

Ann Duncan, matron, Royal Marsden hospital, London

How have you dealt with conflict in the past?

Interviewers are looking to see that the nurse can de-escalate a situation, that they know some basic conflict resolution strategies – such as taking people away from the area, sitting them down, finding out the root of the problem – and that they know when they need to escalate to a senior member of staff.
Wendy Preston, head of nursing practice, Royal College of Nursing

What makes a good shift?

We want to hear about the delivery of safe, effective care, and we want it to be documented and evidenced. We don’t want them to believe that high numbers of staff always equates to the best care. Some days, you will be short, but that doesn’t mean they are the worst shifts. It’s good when they say they know the importance of breaks and having catch-up time with staff.
Ann Duncan, matron, Royal Marsden hospital, London

There’s usually a question on resilience. We have to bear in mind that retention of staff is difficult and we want to encourage nurses to stay in the profession. Interviewers will want to know how they manage their time, cope with stress, stay hydrated. The best answer would be about work-life balance.
Wendy Preston, head of nursing practice, Royal College of Nursing

What are you most proud of in your nursing career to date?

Even though some of them have been student nurses they will have moments they are proud of, and we ask them to give an example of when they went above and beyond for a patient. We want to hear a personal story and we want them to be illustrating that they are kind, caring and compassionate, and that they are prepared to do everything they possibly can to ensure safe and effective care.

The stories can vary from nurse to nurse, but we will be able to hear and see if a nurse has genuine pride in their work, and we’ll gain an understanding of what is important to them.
Ann Duncan, matron, Royal Marsden hospital, London

Tell us about a mistake you have been involved with

Often they will talk about someone else’s mistake, not theirs. It’s good if they talk about their mistake, what they’ve learned from it, what they’d do differently, how they have changed their practice, how they have worked with others to change their practice. Interviewers will be looking for how they use evidence in their practice and how they learn from things.
Wendy Preston, head of nursing practice, Royal College of Nursing

What would others say about you in three words?

This is an end-of-interview question. I’m looking for someone who is self-aware, but also whether the three-word description matches the answers and examples they have given to the other questions. Some answers I’ve had in the past include loyal, compassionate and fair; genuine, caring and professional; equitable, passionate and reliable.

The point of the question is to assess how effective the individual is in seeking feedback and reflection, and whether they can articulate this in single words. Being able to answer can demonstrate that you have the insight and maturity to seek the opinions of others. A follow-up question, depending on the seniority of the role, might be: have you changed your practice as a result of feedback from others?
Jo Thomas, director of nursing and quality, Queen Victoria hospital, Sussex

Do you have any questions for us?

Often people are flummoxed and say no, but it’s good to be prepared with a couple of questions. A good question to ask, if it hasn’t come up, is about what kind of preceptorship programme, or learning and development, can they offer. If you have got any holidays booked, this is the time to say it.
Wendy Preston, head of nursing practice, Royal College of Nursing

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NHS faces staggering increase in cost of elderly care, academics warn

The NHS and social care system in the UK is facing a staggering increase in the cost of looking after elderly people within the next few years, according to major new research which shows a 25% increase in those who will need care between 2015 and 2025.

Within eight years, there will be 2.8 million people over 65 needing nursing and social care, unable to cope alone, says the research – largely because of the toll of dementia in a growing elderly population. The research, published by the respected Lancet Public Health medical journal, says cases of disability related to dementia will rise by 40% among people aged 65 to 84, with other forms of disability increasing by about 31%.

The new figures follow a furore over the Conservative manifesto and Theresa May’s U-turn on social care this week. In a bid to keep the costs of care down, the manifesto said those needing care at home would have to pay until they had £100,000 in savings left, including the cost of their home.

After accusations that the Conservatives were imposing a “dementia tax”, May promised a cap on the amount any person would pay for care – although without specifying what the cap would be.

The new analysis will make grim reading for whichever party gains power. “The societal, economic and public health implications of our forecast are substantial,” say the researchers, led by academics from the University of Liverpool and University College London.

“Public and private expenditure on long-term care will need to increase considerably by 2025, in view of the predicted 25% rise in the number of people who will have age-related disability. This situation has serious implications for a cash-strapped and overburdened National Health Service and an under-resourced social care system,” they added.

The figures take account for the first time of the changing disease burden as well as the increasing elderly population and longer life expectancy. Cardiovascular disease, which can cause heart attacks and strokes, has gone down, but dementia is rising as people live longer. This makes the research an advance on previous studies, says Professor Stuart Gilmour of the department of global health policy at the University of Tokyo in a commentary published alongside the paper.

“The results show starkly the growing burden of disability that the UK National Health Service and social care system will face over the next decade,” he writes.

“[It] faces a rapid increase in the number of elderly people with disabilities … at a time when it is uniquely unprepared for even the existing burden of disability in the UK population. This important research should be taken as a warning and a strong call for action on health service planning and funding, workforce training and retention, and preparation for the ageing of British society.”

The government urgently needs to consider the options, says the paper. Firstly, more care homes are needed, it says. Secondly, there must be more support for informal and home care – they suggest tax allowances or cash benefits. “Affected individuals and their families pay an estimated 40% of the national cost of long-term care from income and savings,” they write.

But prevention is also vital. Poor diet, smoking, drinking heavily, high blood pressure, diabetes and little physical activity are risk factors for both heart disease and dementia, they say. Immediate investment in improving people’s lifestyles would pay dividends, they say. “We seriously need to protect the future of older citizens through prevention,” said lead author Dr Maria Guzman-Castillo of the University of Liverpool.

She said political parties had not so far been looking at the true scale of the crisis to come. “We think they are not looking at this. There is a gap between the academic community and the government,” she said.

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said more investment in the NHS and social care was desperately needed. “It’s a great testament to medical research, and the NHS, that we are living longer – but we need to ensure that our patients are living longer with a good quality of life. For this to happen we need a properly funded, properly staffed health and social care sector with general practice, hospitals and social care all working together – and all communicating well with each other, in the best interests of delivering safe care to all our patients.”

Margaret Willcox, president of the Association of Directors of Adult Social Services (ADASS), said: “As most people expect to need some form of care in their lifetime, there is an urgent need for the whole country to consider how best to ensure people with care needs are funded and how their care is delivered.

“The need to future-proof adult social care should be a national priority for the new government. Unless a long-term sustainable solution is established to tackle significant sector pressures, a rising number of elderly and disabled people living longer and with increasingly complex needs, along with their families, will struggle to receive the personal, dignified care they depend on and deserve.”

NHS faces staggering increase in cost of elderly care, academics warn

The NHS and social care system in the UK is facing a staggering increase in the cost of looking after elderly people within the next few years, according to major new research which shows a 25% increase in those who will need care between 2015 and 2025.

Within eight years, there will be 2.8 million people over 65 needing nursing and social care, unable to cope alone, says the research – largely because of the toll of dementia in a growing elderly population. The research, published by the respected Lancet Public Health medical journal, says cases of disability related to dementia will rise by 40% among people aged 65 to 84, with other forms of disability increasing by about 31%.

The new figures follow a furore over the Conservative manifesto and Theresa May’s U-turn on social care this week. In a bid to keep the costs of care down, the manifesto said those needing care at home would have to pay until they had £100,000 in savings left, including the cost of their home.

After accusations that the Conservatives were imposing a “dementia tax”, May promised a cap on the amount any person would pay for care – although without specifying what the cap would be.

The new analysis will make grim reading for whichever party gains power. “The societal, economic and public health implications of our forecast are substantial,” say the researchers, led by academics from the University of Liverpool and University College London.

“Public and private expenditure on long-term care will need to increase considerably by 2025, in view of the predicted 25% rise in the number of people who will have age-related disability. This situation has serious implications for a cash-strapped and overburdened National Health Service and an under-resourced social care system,” they added.

The figures take account for the first time of the changing disease burden as well as the increasing elderly population and longer life expectancy. Cardiovascular disease, which can cause heart attacks and strokes, has gone down, but dementia is rising as people live longer. This makes the research an advance on previous studies, says Professor Stuart Gilmour of the department of global health policy at the University of Tokyo in a commentary published alongside the paper.

“The results show starkly the growing burden of disability that the UK National Health Service and social care system will face over the next decade,” he writes.

“[It] faces a rapid increase in the number of elderly people with disabilities … at a time when it is uniquely unprepared for even the existing burden of disability in the UK population. This important research should be taken as a warning and a strong call for action on health service planning and funding, workforce training and retention, and preparation for the ageing of British society.”

The government urgently needs to consider the options, says the paper. Firstly, more care homes are needed, it says. Secondly, there must be more support for informal and home care – they suggest tax allowances or cash benefits. “Affected individuals and their families pay an estimated 40% of the national cost of long-term care from income and savings,” they write.

But prevention is also vital. Poor diet, smoking, drinking heavily, high blood pressure, diabetes and little physical activity are risk factors for both heart disease and dementia, they say. Immediate investment in improving people’s lifestyles would pay dividends, they say. “We seriously need to protect the future of older citizens through prevention,” said lead author Dr Maria Guzman-Castillo of the University of Liverpool.

She said political parties had not so far been looking at the true scale of the crisis to come. “We think they are not looking at this. There is a gap between the academic community and the government,” she said.

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said more investment in the NHS and social care was desperately needed. “It’s a great testament to medical research, and the NHS, that we are living longer – but we need to ensure that our patients are living longer with a good quality of life. For this to happen we need a properly funded, properly staffed health and social care sector with general practice, hospitals and social care all working together – and all communicating well with each other, in the best interests of delivering safe care to all our patients.”

Margaret Willcox, president of the Association of Directors of Adult Social Services (ADASS), said: “As most people expect to need some form of care in their lifetime, there is an urgent need for the whole country to consider how best to ensure people with care needs are funded and how their care is delivered.

“The need to future-proof adult social care should be a national priority for the new government. Unless a long-term sustainable solution is established to tackle significant sector pressures, a rising number of elderly and disabled people living longer and with increasingly complex needs, along with their families, will struggle to receive the personal, dignified care they depend on and deserve.”

UEA course cut a blow for mental health work | Letters

All the parties in the general election have adopted mental health as a key issue. But this enthusiasm is not reflected on the ground and the electorate should not be fooled. We are students and former students on the internationally renowned counselling programme at the University of East Anglia. We trained to be counsellors, or “shrinks”, to quote Prince Harry in his recent interview. But now the university has closed the course and even made it impossible for some students to complete their professional qualification. As part of this draconian process, in which consultation was at a minimum, responsibility to students, staff and the wider local community has been completely deprioritised. This is exactly the opposite of what the princes, applauded by the government, were calling for.

The impact is not only on the course itself, but also on those therapy organisations where students have for many years worked as volunteers on placement and beyond, and on the availability of the kind of in-depth listening relationship – described as so crucial by the princes – in the university’s own counselling service. The management-speak reason given by the university for this closure is “a need for greater alignment of courses and a more coherent portfolio of activity centred on the teaching of education theory and practice”. What is the point of accenting mental health if there won’t be any counsellors to deliver it?
Sara Bradly, Dr Rachel Freeth, Bridget Garrard, Nikki Rowntree
Norwich

Join the debate – email guardian.letters@theguardian.com

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As a GP I feel powerless to help elderly people struggling to survive

Recently a patient brought home to me how inadequate the help I can provide my elderly patients as a GP can be. Among more than 50 phone calls I fielded one day as one of the GPs dealing with urgent requests, there were two from a patient in her 80s who is the main carer for her husband who has dementia. She also has health issues and he is unaware of the problems they face. The receptionist learned far more about the difficulties they were having from the woman’s phone calls to the surgery and from observing them in the waiting room, than I did from my snatched telephone conversations and the scrawled note left for me. I found out later that the only way she could get to the surgery to bring the sample I requested was by locking her husband in the car outside. I knew that things were difficult, but this was a new low.

Over the last year I have been increasingly involved in the care of a man who is in his 80s and moved into my practice area to be nearer to his family. He enjoys telling me about his past when he gets the opportunity and I recall how his eyes sparkled as he told me that adopting his daughter was the best decision he and his late wife ever made. He knows his dementia is worsening and was the one who recognised the initial symptoms, well before these signs were noticed by others around him. He looks crestfallen as he recounts to me how he sees the frustration and sorrow in his daughter’s eyes when he asks the same question another time. He is annoyed by his failing health and memory and feels he is a burden to those around him. At times he is too proud to ask for help.

The population is ageing, with the number of older people with care needs likely to increase by more than 60% in the next 20 years. One in three over 65s will die with dementia, and it is the leading cause of death of women in the UK, yet dementia research is poorly funded, with combined charity and government research significantly lower than cancer research. Every day as a GP I see patients in difficult situations, where an elderly person is struggling to care for themselves and their spouse, with implications to the health of both. I see families trying to maintain their jobs and daily activities, while providing increasing support for their elderly relatives. At the end of a long day yesterday a son called me in distress; his mother was already an inpatient and he was left to look after his father, but felt getting involved in intimate personal care was a step too far.

As a GP I am the person that people often turn to, but at times I feel I have little power to make positive changes for these patients. I can only provide brief intervention, refer and signpost to over-stretched services – this is not the level of care and support that they need. Those that come to me are often at crisis point, having struggled without any input from outside services until they cannot continue any longer. There are undoubtedly those that I’m not aware of perhaps until an emergency admission or mishap alerts me. These patients may come into contact with many services; as health professionals we often see an aspect of their lives, dealing with high blood pressure, an arthritic knee or continence issues, but do not realise the enormity of the situation or assess it properly.

Older people’s mental health services and social care are limited. Yes, I can refer, but these services are overloaded and don’t provide much help. We need more resources, more time, more services, more people available to provide assessment, listen and support. We need to start focusing on ageing and older people and encouraging planning for the future, or this situation will only get worse.

*Some details have been changed to preserve patient anonymity

Join us on 23 May to discuss how the public and voluntary sectors, retail and service industries can recognise and support people with dementia.

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NHS chief tells ministers: face up to the pay crisis

Ministers should address mounting disquiet among NHS staff about pay and recruitment if the health service is to avoid a full-blown staffing crisis, the head of the official body that represents hospital trusts and mental health services says today.

The stark warning from Niall Dickson, chief executive of the NHS Confederation, comes as GP leaders predict that 2,000 European-born doctors could leave the country because of uncertainty about their status caused by Brexit, with disastrous consequences for patient care.

Writing on theguardian.com, Dickson says nurses who complain about pay increases being capped at 1% – meaning they suffer real terms decreases– “have a point” and suggests the government think again about the effects of stagnating pay on morale and rates of staff retention.

“There may now be a case for looking again at pay,” he writes. “Given the financial and demand pressures on the service in recent years, some pay restraint has been necessary and inevitable. But it is also obvious there will be a limit on how far this can be taken before it affects recruitment and morale.”

The intervention by the confederation, whose chairman is former Tory health secretary Stephen Dorrell, is significant on an issue as sensitive as pay rates for NHS workers.

Last weekend, the Royal College of Nursing announced that nearly four out of five of its members (78%) who had taken part in a consultative vote backed a walkout in protest over pay while 91% favoured industrial action short of a strike.

Dickson says the RCN should not resort to any form of action that would harm patients but highlights rising vacancy rates as evidence of a problem that must be addressed. Nearly a quarter of NHS trusts now have a vacancy rate for registered nurses of more than 15%, he says. Specialities such as psychiatry face a constant struggle to fill training places and the number of child and adolescent, and old-age psychiatry posts. has declined.

Parts of the country, Dickson says, are finding it “almost impossible” to entice GPs, while some hospitals are being propped up by doctors in training because they can’t fill consultants’ posts.

The Royal College of GPs, the professional body for family doctors, says today that the manpower problems will be exacerbated as GPs from EU countries return home, because of Brexit. A total of 2,137 GPs in surgeries across Britain are from countries in the European Economic Area: the other 27 EU members plus Switzerland, Norway and Iceland.

Dr Helen Stokes-Lampard, chair of the RCGP, said: “We risk losing well over 2,000 family doctors from the NHS if their position is not secured as part of Brexit negotiations, and that is just not safe or acceptable.

“Our greatest fear is that hardworking, dedicated doctors from EU countries will simply cut their losses and leave, instead of waiting to have their fate determined for them. This would be a disaster for patient care, and it also makes long-term workforce planning for GP practices impossible.”

The RCGP wants the next government to stem the potential outflow of EU national GPs by guaranteeing their future status. Ministers should add family doctors to the migration advisory committee’s shortage occupation list, as happened several years ago with nurses, to make it easier to recruit GPs, it argues.

The British Medical Association claimed last week that general practice “is on the brink of collapse” because it is “several thousand GPs short”, and that family doctors are buckling under an “avalanche of work”.

Research published last week by NHS Improvement warned of “future supply problems” in many parts of England in which large proportions of GPs are over 55 and thus likely to retire in the next few years, including Kent and Medway (24.2%) and Somerset (24%).

Jonathan Ashworth, shadow health secretary for Labour – which has said it will end the pay cap for public sectors workers – said: “The NHS should be an absolute priority in the Brexit negotiations. The Tories’ chaotic approach to workforce management in the NHS has already left us thousands short of the number of GPs we need, and we simply can’t afford to lose the 2000 European GPs working here. Labour are pledging … to guarantee the rights of EU citizens working in our health and care system.”

A Conservative spokesman said only that: “Our manifesto said explicitly that we will make it a priority in negotiations with the EU that the 140,000 health and care staff from EU countries can carry on making their vital contribution.”

Christy Turlington: ‘The closest I’ve come to death? The birth of my daughter’

Born in California, Christy Turlington Burns, 48, was scouted to be a model at 14 and went on to become one of the original supermodels. After suffering a postpartum haemorrhage in 2003, she took a masters in public health and set up non-profit organisation Every Mother Counts, addressing global maternal health. The charity has partnered with Toms shoes. She is married to actor Ed Burns, has two children and lives in New York.

When were you happiest?
Before kids, when I was 13 or so, on the back of my horse, running at full speed in an open pasture. Post kids, happiness happens often, but in more subtle ways. I now prefer the word “content”.

What is your greatest fear?
I don’t fear anything but fear itself. Fear makes humans behave inhumanely.

What is your earliest memory?
I have a collage of memories beginning around age four: my first walk alone to a store or to school, and early trips to Central America with my mom to visit her family.

Which living person do you most admire, and why?
A midwife named Jennie Joseph. She is a tireless activist for women, family health and equal access to quality maternity care.

What is the trait you most deplore in yourself?
I sometimes set unreasonably high expectations of myself and those around me.

What was your most embarrassing moment?
There are too many to name, but none of them keeps me up at night.

What makes you unhappy?
Government policy decisions that negatively impact the health and wellbeing of women and families.

What do you most dislike about your appearance?
Having to talk about it.

Who would play you in the film of your life?
The world does not need a film about my life.

What is the worst thing anyone’s said to you?
A boyfriend once told me there was always going to be someone smarter, funnier and prettier than me, which at the time felt pretty mean, but it was true.

To whom would you most like to say sorry, and why?
To strangers. Living in New York, I see individuals every day who are invisible to so many. I want to say sorry that so many of us think their pain and suffering is not our own.

What was the best kiss of your life?
The first kiss from my husband and every one since.

What has been your biggest disappointment?
My father’s death before my marriage, and motherhood.

If you could edit your past, what would you change?
I might speed up a few details, but wouldn’t change anything, other than my dad still being here.

How do you relax?
Yoga, running, recreational reading.

What is the closest you’ve come to death?
The birth of my daughter.

What keeps you awake at night?
The fact that at least 300,000 women die every year from pregnancy and childbirth-related issues that are largely preventable.

What is the most important lesson life has taught you?
That I am more than I thought I was.

How would you like to be remembered?
As someone who didn’t waste a minute.

Christy Turlington: ‘The closest I’ve come to death? The birth of my daughter’

Born in California, Christy Turlington Burns, 48, was scouted to be a model at 14 and went on to become one of the original supermodels. After suffering a postpartum haemorrhage in 2003, she took a masters in public health and set up non-profit organisation Every Mother Counts, addressing global maternal health. The charity has partnered with Toms shoes. She is married to actor Ed Burns, has two children and lives in New York.

When were you happiest?
Before kids, when I was 13 or so, on the back of my horse, running at full speed in an open pasture. Post kids, happiness happens often, but in more subtle ways. I now prefer the word “content”.

What is your greatest fear?
I don’t fear anything but fear itself. Fear makes humans behave inhumanely.

What is your earliest memory?
I have a collage of memories beginning around age four: my first walk alone to a store or to school, and early trips to Central America with my mom to visit her family.

Which living person do you most admire, and why?
A midwife named Jennie Joseph. She is a tireless activist for women, family health and equal access to quality maternity care.

What is the trait you most deplore in yourself?
I sometimes set unreasonably high expectations of myself and those around me.

What was your most embarrassing moment?
There are too many to name, but none of them keeps me up at night.

What makes you unhappy?
Government policy decisions that negatively impact the health and wellbeing of women and families.

What do you most dislike about your appearance?
Having to talk about it.

Who would play you in the film of your life?
The world does not need a film about my life.

What is the worst thing anyone’s said to you?
A boyfriend once told me there was always going to be someone smarter, funnier and prettier than me, which at the time felt pretty mean, but it was true.

To whom would you most like to say sorry, and why?
To strangers. Living in New York, I see individuals every day who are invisible to so many. I want to say sorry that so many of us think their pain and suffering is not our own.

What was the best kiss of your life?
The first kiss from my husband and every one since.

What has been your biggest disappointment?
My father’s death before my marriage, and motherhood.

If you could edit your past, what would you change?
I might speed up a few details, but wouldn’t change anything, other than my dad still being here.

How do you relax?
Yoga, running, recreational reading.

What is the closest you’ve come to death?
The birth of my daughter.

What keeps you awake at night?
The fact that at least 300,000 women die every year from pregnancy and childbirth-related issues that are largely preventable.

What is the most important lesson life has taught you?
That I am more than I thought I was.

How would you like to be remembered?
As someone who didn’t waste a minute.