I worked in Australia. Home visits rare, and if you want (say terminal patient) and there is no out of hours visiting...Services that tried to set it up were made insolvent by medicare changes in fees, as there was no evidence they improved health. If anything increase Casualty use. For seven years in UK I did my own on call for 2,400 patients and seldom woken up.
Such a shame GP have to refer and not deal with these lesions as GPs do in Australia where I have worked. There was a study eons ago from Liverpool that suggested GPs were better at it anyway (better margins). But it is the description and history that counts. If photo needed use dermascope, if you have that kit might as well do all in house.
They should have sought legislation to prevent such requests. Worse thing now is Trusts now demanding Appraisal Outputs, printouts from Clairty as a reference and part of thier contracts. I refused as should all GPs. I think NHSE will put a stop to this nasty habit
The funny thing is that GMC, under pressure no doubt from the medical education industry, has made it more diffuclyt for UK trained GPs in Australia or abroad to return to the UK, in its latest (May) guidance to Responsible Officers. I have no idea why they have made this change, and I doubt they do, as never replied to my asking. Gory details:
What is it that the NHS has had against small practices,against the evidence, when every study shows they offer good or better quality, preferred by patients and offer better continuity of care. Of course there have been bad inner city small practices. But that problem is due to GP payments system whch pay on list size as if static. Inner cities have huge turnover of up to 30%: looking after 10,000 patients and hitting tagets is easier in static village, than inner city with a turnover, so in there looking after 12,500 but paid to 10,000
Cannot be undone. But NHS needs to move to Australin type of pay systemm with fee for service, so those practices that offer telephone or skype like consults only get a different fee from face to face or those able to visit.
It's the profession that is killing GP land. Part-time working, giving up out of hours so we no longer had the monopoly of primary care. Then we gave up being responsible for the computer systems and GPs in Scotland are now giving up being responsible for their premises. Most GPs now seem to prefer a part-time salaried service. GPs are specialising increasing the number of appointments needed, continuity of care is falling. I do not think the Government can go against the tide of what the profession seems to want. there is no plot to break General Practice, if there was the simplest thing is let the profession, now increasingly a trade, get on with its own demise.
Not-for-profit concept assumes that income, as in earned, is not a profit. There are all sorts of mechanisms wherby those inside can indeed profit in such organisation by way of salaries and fees. There can be subcontracts with a profit making management company, or with teams which could inculding run for profit GP practices.
Yes, many complain of vested interest, a tactic to block all innovation in the health service. Vested interest means that you are extra interested, it is entirely beneficial concept; the only caveat being it must be open and everyone know who owns what, and who has an interest.
Unless formed as a Community Interest Company, a not-for-profit organisation can be unwound for profit to members later, as did building societies when becoming banks.
I worked with a trendy CIC (SecureHealth Ltd) which had heart in the right place, ambitions in the prison service. Failure to consider margins, indeed to have the discipline of that wicked profit, meant it went bankrupt with £1.4M debt and PCT had to take over running Wandworth priosn healthcare over immediately and take over the debt. SecureCare had been awarded the contract because of its saintly not for profit status; it had not won the competitive tender. Before it was given grants to tender probably outside EU rules. Finding out what really happenned is too easily blocked https://discoversociety.org/2017/08/02/on-the-frontline-challenging-secrecy-in-the-nhs-through-research/
Apart from running a village hall, a not for profit company organisation can be a shield. They are dishonest and creepy things. Virtue signalling. Avoid them.
QOF may be past is sell by date. It's not as if it has made a difference to patient outcomes, despite the alleged evidence base of the QOF ideas (such as in diabetes) which makes you wonder about the evidence base of all we have been told to do.
I am not sure that the NHS should abandon Fee for Service, indeed it should develop some more. There are merits to parts of the Australian system which could be used here. You could pay one fee for a telephone consult, another for a Babylon/telemedicine and proper one for a face to face. Fees arranged to discourage patient churn, such as aa much higher fee for seeing a patient you have not seen for a year and lower fee if seen last week.
Appriasals would be Ok if they were every two or three years. Once a year is pointless.
The lastet blurb from GMC really stuffs it up for doctors who want to work overseas (that includes British overseas territories), with loss of license even if you keep up appraisals. Loss of license means loss of place on perfomers' list and getting back on that might be very costly.
I am not sure why GMC have made subtle changes to the wording giving such a devastating effect; seeking to discourge GPs to work abroad and gain experience, or work most of the year abroad and in then UK, and also discouraging GPs in Australia New Zealand and Canada to come back. Very odd. https://gerardbulger.com.au/revalidation.html
The new wording would also seem to prevent superspecialists such as those coming over from for a few days (say from USA)
The thing is that young people, if they ever went to a GP, do not see a GP get up out of their chair and examine them. Nor understands the importance of a relationship and contact is in a consultation. But since most GPs are part time, and are glued to the computer screen, it is not surprsisng to me that younger punter takes up the lazy option of using GP at Hand. Do not even have to get out of bed to use it. Of course it will be popular, until patients are ill.
Agree++ At my pracitce I almost abolished the concept of a repeat preciptions, with three months supply or 6 months supply. My nurse or I would see the patients for a renewal. I am sure that saved wastage, and reduced polypharamcy, and certainly reduced risk. However we were later banned from prescribing more than 28 days at a time. I suspected the driver behind this ruling came from lobbying by pharmacists who were losing dispesning fees. I do not like the risks of repeat precriptions. It is worse as a locum glaring at the computer screeen trying to see of scipt justified, ACR/HBAC done or whatever. Terrible. Repeat dispensing has not really worked to save time and reduce risk.
It's rubbish that there is Malign Intent by Tories grappling with the NHS, and that all other parties are goody two shoes. Any politican has to face the real problems. The NHS needs a big rethink now other models of health service around the world are surpassing the NHS. Perhaps we need a non party Royal Commission to come up with ideas and take evidence from around the word and so we have a proper debate. This is not 1948, trhe current system has done its job and now past its sell by date. What's interesing is that 20-40 years olds are signing up to GP at Hand and Babylon, and they are supposed all to by Cobynistas.
GPs gave up with relationship with patients years ago. This is the result. We went part-time, gave up being responsible for out of hours when in effect stopped being GPs for 3/5 of the week. Of course Babylon and GP at hand are disruptive, that the point as it seems it is what 18-40 years olds want from their health service. Most never knew the GP service use used to provide, hands on, take history, examine, and know the family and patient. It's over. I have to work in remote Scotland to practice as a GP in the way I know and prefer.
I am looking forward to the papers that show that analgesia using opioids and gabapentinoids locks people into having chronic pain. These meds are blocking pathways (that must exist) that normally phase out the discomfort of pain with movement and time. Have you noticed that all those which chronic pain are on chronic repeat meds? Funny that.
CQC is pointless, as every aspect of what it does is covered by other legislation, such as employment law, GMC, let alone tort. It definitely has different standards. I was astonished that is passed a prison healthcare service which is so dangerous, daily incidents, that some doctors refuse to work there. If it was a GP surgery it would have been correctly shamed and closed.
Since QOF has been shown not to improve outcomes, and is a waste, this is just further jobs for the boys and further nationalisation of GP services. I do not see the point, nor do I see how you can separate chronic disease management out from diagnosis and treatment and complex care. Each patient is a day older, things happen. By splitting up GP appointments into specialty groups and QOF teams you simple create more appointments, forcing patients to attend more often, annoying them and GPs Then everyone whines that we are too busy, demanding more and more.
So simplistic. Public sector debt has to shoot up without PFI and similar schemes let alone the COST to pay them out. GP cost rent was the first PFI which improved so many surgeries without adding to national debt.
Higher public debt means higher interest rates in the end, or use Labour's favoured scheme to print money, which is so last decade as a solution. In the end it leads to inflation, as shown clearly in Hitchiker's Guide to the Galaxy, so we all pay. Printing money only worked recently because everyone else was in recession, the inflation was in capital costs as in house prices to the delight of the chattering classes.
It wont work again.
There is so much other waste in the NHS to deal with.
You are too pessimistic about chronic pain. It can be resolved, providing the brain's pathways to phase out unpleasant sensations are not blocked by the junk medication. The medication locks people in to permanent pain. Reduce to stop the meds, some CBT and MOVEMENT will rid most people of pain. Those with pure dependency are using these drugs for other effects, nowt to do with pain. Pain that they have to declare to be offered a script.
It is not so much that they are addictive, its that they do not work in the long term. Have you noticed that those with chronic pain are on chronic medication? The medications locks the patients into permanent pain, and give hyperathesia. It blocks the brain from phasing out the pain, a process that must happen in normal people who have avoided such meds. If we look at MRI of people complaining of nothing, their backs look just as terrible as those in agony.