And while I'm at it - how many of us have seen people who book an appointment online to come and see us face to face to say can I have my cholesterol tested / an NHS health check / do I need my thyroxine dose altered, etc etc, which could and should have been done by phone or reception
Beaker has hit the nail on the head here.
Already we have people occasionally making it through to a GP appointment because they refuse to tell reception why they would like to see the GP - only to be redirected to physio, pharmacy, nurse, phlebotomists, or a different GP.
And we have people booking nurse appointments for blood tests that should have gone to phlebotomists, and with HCAs for rashes that should have gone to nurses or GPs.
25% is a huge proportion of appointments to be open to such inefficient usage.
I think it's vital for them to have SOME time in hospital based specialties, if only to see how communication between hospitals and GPs can be improved, and to understand what the situation is like for the hospital juniors.
5 years in GP, straight from med school is not the ideal solution, IMO.
the ICO said that you should NOT give the SAR information to the lawyers, but you should provide it only to the patient themselves. Then the patient can decide what they want passed on to the lawyers.
A subset of the record between certain dates can be a SAR, but a subset of information relating to a certain incident, or medical condition is a medical report.
But it still takes a long time to redact. We routinely say to all SAR requests that they will take longer than 28 days to process due to the clinician time needed to check the notes for third party references.
Govt want us all to provide full online access to notes for patients - but I don't see how this is possible, given the third party info I end up redacting, often from hospital letters which are scanned in...
How does complete access to electronic record help? The bit that takes the time for the GPs (as opposed to the admin staff) is the redacting of third party information - which can't be done to an electronic record (how do you redact info from hospital letters that have been scanned in, for example?
And we are still left with the issue of coercive control and third parties pressuring people into giving up their secure passwords. We have some patients who will never get electronic access because we don't feel it's safe for them to, but we can't identify everyone to whom this applies.
I fully support patients having access to their complete records, I just think that we need to be funded properly to do the redacting, as well as the admin costs.
The issue that the powers that be seem to be missing is that the demand is not for the timing of the appointment, but for the regular GP.
If the appointments being offered were with the regular GP, they'd be filled like a shot - all our internal extended hours apps are taken, and we often see very elderly patients at 7am saying they would have preferred a daytime apt but there weren't any, and they wanted to see that particular doctor.
All these extended hours pilots are on cluster or large group basis, and not staffed by the regular GPs (who are too busy chasing their own tails), but by locums.
These policies are very London-centric, and prioritise the needs of the working well to the detriment of the medium and long term unwell, elderly, mental health, etc.
When we have a health secretary who openly admits to using a health app which unashamedly prioritises the working well over anyone who might benefit from continuity (which we know saves lives, and reduces hospital admissions), what hope is there?
Time to stop these silly, wasteful policies, plough the money back into core hours primary care to increase the number of doctor appointments in hours with regular GPs.
...and what happens when the national press get wind of this?
Are we all going to be inundated with patients asking if their data has been used without their consent?
And how will we know?
Who is the data controller in this instance?
If one of my patients now does a SAR and asks if their data has been used against their will when they had specifically denied consent for it to be used in the sway, is the individual GP practice responsible (as the data controller)..?
I'm sorry are they saying that ALL men with lower urinary tract symptoms should be referred on a 2ww because their chance of having prostate cancer is over 3% ?
How does that work?
IS THIS ACTUALLY TRUE?
The new regs state that you can charge if the request is excessive. The old regs said we could charge £50 because they recognised the request was excessive as it required us to trawl through the notes to check for harm and third party data.
So maybe we can charge and indeed in principle we can charge the full cost rather than the £50.
HAVE ANY LMCs LOOKED AT THIS YET?
Devil's advocate - Here's a thought - why does it matter?
Evidence for use of antibiotics for scarlet fever in developed countries is poor; the rates of glomerulonephritis and rheumatic fever are so low. The situation is different in developing countries, and was different in the 1950's.
Nowadays, the evidence base suggests you probably don't need to treat scarlet fever with antibiotics.
I can't believe you are being so negative about our hospital colleagues. Do you not remember when this consultant contract came in and consultants were suddenly going to be paid for the work they did, because the government thought they were all on the golf course half the week. Productivity went down because the trusts couldn't afford to pay for all the unpaid work they had been doing up till then to keep things going, and they got p'd off with being told they were lazy all the time. In some cases they were told they were not allowed to carry on doing what they had been doing before because the trust couldn't afford the necessary number of PAs (or because it was illegal.
The whole NHS runs on goodwill, not just the GP land.
Yes, the hospitals have some glaring inefficiencies but it is really shameful that you suggest the hospital docs are not working their backsides off like the rest of us.
Don't forget that within the admin PAs they have to teach the juniors, organise rotas, teach GPs, and do all the admin stuff we have to do (but without the advantage we have of being much more efficient due to having decent computer systems).
The comparison of money spent in hospitals per patient contact is also utterly nonsensical. This is apples and pears. I would need a lot more money if I was going to be doing open heart surgery on my patients, just as I would need a significantly bigger drug budget if I was going to be in charge of oncology drugs or new biologics.
Stop being so negative and lets all draw together for the sake of the patients and the NHS. We should be fighting privatisation and fragmentation, not each other.
Too often we are pitted against the pharmacists - the flu jab debacle being a classic example.
But they are doing other things to make money too - like the minor illness scheme where they can claim a consulting fee for every bottle of calpol they sell, where the parents would never have consulted a GP or pharmacists anyway.
Good for them, I say.
And the branded generic which is cheapest this week, is going to be different next week. Far better to stick to prescribing the generics and let the pharmacies take their cut.
I like the analogy about borrowing the neighbours ladder.
Now, how to sort out the issue of having to code the flu jabs given elsewhere for zero income to us..?
Can anyone tell me why the presumption is that the extended hours are offering extra appointments? Surely they are spreading the same resource more thinly. (I know they are supposed to be extra, but they are taking our daytime locums)
And separately, if the A+E attendance rates are linked to being able to get an appointment with your GP (as we are often told), how extended hours fits in with this? Surely it is the availability of appointments, not the timing of them per se, that matters?
Wouldn't it make more sense to provide funding for more daytime cover?
Oh yeah, but that would be logical, and not appeal to the London-centric politicians. Silly me.
At risk of courting abuse here, there are some benefits to limited peer review - which those of us in properly functioning practices have been doing for years.
Huge benefits in being able to say to your colleagues "look, you know mrs so and so, she's got this and I'm not sure if it's right to refer her now or to do something else first, what do you think?"
On an informal basis it is enormously helpful and we do it all the time.
But there is also an argument to improve referral letters to make priority triage easier for the clinicians at the other end (who are as stretched as we are, don't forget). A letter saying "please see and treat" is useless, and may conceal a very high priority case or a very low priority case.
There is guidance being worked on to help us write better referral letters, just to remind people to include basic stuff like what has already been tried (and what dose and for how long), but also the most critical part of the referral letter is frequently missed - the expectation of the GP. Is this a referral for advice, ongoing management, treatment or reassurance.
But a formalised and compulsory peer review committee like this is unlikely to be helpful - more likely to create extra work for all involved, introduce delays and increase risks to patients. Where is the evidence for this?
The argument against crown indemnity is that it still has to be paid by someone, and this pushes the cost back to DoH so they have to make cuts elsewhere to cover it.
I would like to work just half a session extra, but the rise in indemnity (as it would cross a boundary) is prohibitive, so I don't. And that's also why I can't do any out of hours.
Anonymous salaried @ 2.42pm
Beware burnout. Portfolio careers are a great way to avoid the inevitable burnout - general practice is simply not a viable full time option. Buddy up for continuity, and communicate well within the practice, and it works just fine.
What we wouldn't take on is salaried GPs - part time partners are definitely the way forward. The BMA model contract, if stuck to, is in no way a reflection of a GPs job, and the difference creates too much stress in the practice, with the partners feeling like the salaried docs get an easy life and are paid more by the hour for the work they do (which, sadly for us, is true).
Now, let's just try and recruit a few more part time partners...
If I employ a salaried GP straight from training at another practice, and they break their leg on his way to their first day of work at my practice, the model contract entitles them to 6 months full pay and 6 months half pay, even if they never set foot inside the building.
There are lots of issues with the model contract being a cushy number for salaried GPs - and if we all move to a salaried service the NHS will fail pretty much instantly if we al worked to rule on the model contract.
How can you set a target of 60% of appointments filled?
Surely this is evidence that these appointments are not wanted?
So therefore time to stop the pilot as ineffective, inefficient and failed? What am I missing here?
Oh, for goodness' sake!
When they gave the contract to the pharmacists, who did them all quite aggressively, we all started doing them opportunistically wherever we could.
I still have the laminated sign that was on my desk that said "would you like a flu jab? Please ask and we can do it today"
That was the real way giving the contract to pharmacists increased the uptake in the last couple of seasons. Unfortunately it also demoralised us as we made such a loss on the flu jabs 2 years ago that we ordered too few last year...