A west country GP
The canny Scots at the MDDUS have issued a holding statement . Time for me to join the MDU methinks.
It happens in other countries I understand but just watch the number of 999 calls increase if arriving in an ambulance will guarantee being seen,
Locally here referrals as measured via the RMC are in decline but hospital outpatient activity is up owing to more 2ww referrals (not going to through RMC) because of the new NICE guidelines and more consultant-to-consultant and A&E generated internal referrals possibly due to hospital contract changes. It's just like squeezing a balloon in one place and it popping up in another part. Utterly missing the point.
When the GPs on the BMA were "opposing" the NHS at its inception the chairman said they were all for better health care but that the worry was there would be three people in every consultation. The patient, the GP...and the government telling the other two what to do. Was he wrong? He who pays the piper calls the tune and I reckon much of what has come about since has been driven by HMG resenting the fact that only by conceding self-employed contractor status (as they did private work for consultants) did the doctors play ball with the NHS. So never mind the efficiency and VFM provided by primary car, this is about control and ideology.
5YFV = a bit money to appoint managers and to hold meetings.
Don't worry they will simply increase taxes on higher earners like, er...GPs. The country is already bankrupt (far worse than Greece) because the public has been helped to believe that they can can have whatever they want as long as "someone else" pays for it, hence the current debacle. There's no doubt that the country is utterly fed up with the depressing, lacklustre status quo and is going to give socialism another go when it gets the chance. It'll be lovely...for a year or two.
Half a percent of NHS funding? Big deal. Our "local health community" deficit is estimated at £30m so far this year and we are generally supposed to represent 1% of the national budget. Go figure. Drop in the ocean as long as we have an NHS controlled by short termist, self-serving politicians.
Dr Barry Moyse
GP N Petherton Surgery, Somerset & Somerset LMC
"As short a time ago as February, the Ministry of Plenty had issued a promise (a "categorical pledge" were the official words) that there would be no reduction of the chocolate ration during 1984. Actually, as Winston was aware, the chocolate ration was to be reduced from thirty grams to twenty at the end of the present week. All that was needed was to substitute for the original promise a warning that it would probably be necessary to reduce the ration at some time in April."
Dear Faithful Hound you are totally right. The powers that be either don't understand or more likely don't care that anyone over 55 thinks, "OK, but never again!" And they say they are incentivising older docs to stay on. I've done my last colleague survey and look forward to my last patient questionnaire. Makes it more bearable somehow...
It's all part of the plan. The underlying idea is that we, being fantastically overpaid, should pay for any improvements in our working lives, employing paramedics or pharmacists etc, whilst the money (that isn't double counted, in existing budgets etc) is for "change managers" and meetings for NHSE and NHSI apparatchiks to make sure HMG is getting "value for money." Anything else, for example the concept of less work and responsibility for the same or even a bit more money, was just wishful thinking. Why are we surprised? It's like all these thousands of new mental health workers announced today when out local Partnership Trust is looking for another £7m "efficiency savings" this year. Mind you they are useless, but more contracts always seem to go their way rather than to e.g. our provider group. Why? Because, otherwise, some money might end up in GPs' pockets!
And another thing, that "Ten point plan in full" would not look out of place in Private Eye especially if point nine was "Er..." and ten "That's it." Meaningless manager-speak bollocks. I love the motherhood and apple pie sentiments at the top and the "introduction of successful initiatives..." towards the end. We wouldn't want to introduce any unsuccessful ones would we? That would never do, oh no!
£15m on "change managers" and having meetings to determine "milestones" and "trajectories" as NHSE and NHSI managers scurry around trying to justify their pointless existences, large salaries and generous pensions. And why is the nurse in the picture wearing gloves to look in somebody's ear?
When we have had the builders in from time to time over the years they always end up talking about how difficult it is to see their GPs. I always make sympathetic noises and give advice about how to insist if it's important etc. It then occurred to me as they knocked off at 4:30 (or earlier on a Friday) that their practices were always open for another two hours but that never seemed to cut it. I can only conclude people LIKE to take a day off work to see a GP.
Three Cs to get into Charing Cross in the late 1970s, BBC to go to Westminster, BCC for King's. I got ABC. Bristol wanted 3As even then and wouldn't look at anyone state educated. I was interviewed by some worthies and never a psychometric test in sight. Grade inflation has made this sort of thing impossible now. Thank goodness things are getting better and better every day. Wouldn't want to be young again.
Rebadging the existing Extended Hours DES hours as improved access allowing working towards other practices' patients to book appointments is allowing some CCGs to show compliance with the pilots is working...for now. Politicians really don't understand what happens in the real world so "ticking the box" is being nodded through I hear. I think colleagues who hoped this would go away were naive however.
The House of Commons Public Accounts Committee report into progress on the primary care workforce in the FYFV quoted this figure at the end of April. The sooner the rest of the EU and HMG sort out reciprocal residence rights the better but the prospect of GPs trained abroad being deported seems rather fanciful even for "project fear." On the other hand whether colleagues will want to stay in the NHS is entirely another matter...
Probably best to have a long waiting time then? No point in my busting a gut to see everyone who phones up on my duty day because that means I am obviously coping well and need no more support. What about colleagues who've gone down the "advanced access" route with whom you can't book an appointment without they ring you back? NHSE is stuck in the past yet are in charge.
But don't forget: if you are worried in any way about anything at all then GO AND SEE YOUR GP.
It's all part of the plan! I'd be amazed if income goes up that much and bet NHSE will be disappointed if it is. War of attrition to get rid of self-employed, awkward, independent, patient's-advocate GPs and replace them with easily hired and fired, working to protocol, formulary and strict referral guidelines employees. It'll cost more and be less good but that doesn't matter because it's all part of the plan and, most important, they will have WON the battle that started in 1948.