Just Gone Part Time
So ... Poled up for the usual "can't get to the surgery " visit (its 400m away).
Lady with poor vision is on the doorstep... all dressed nicely..
Oh , sorry Dr , I thought you were my taxi to my hair appointment ...... please do come in , can I get you a cup of tea .
Its not malfeasance , its just they don't get it !
Its a hangover from a bygone era of the Dr and his "rounds"
Remove home visits from the contract , and we suddenly have 4 hrs in our working day for appropriate work... go do the math
Or what about ..... A chess clock. Pts have 2 hrs preloaded annually. Click at start and end of consultation. Once time up - gotta re-register. Most will never get close , a select band will be 3 strikes and out !
So , Leeds CCG , been doing this for about 1 yr now . CCG provide the dermatoscope , and ipod , the training is c 10mins long
Its really easy to do. Clinical responsibility lies with the consultant - if they feel they can be sure its benign , then they inform the patient directly and the 30% of 2WW referrals in Leeds that were for Seb k's don't even need an appointment
And yes , to those who might refuse , if I send it in "on the back of an envelope they will triage the patient to face to face within 2 weeks
Really sorry , but I just don't see what is not to like. Not everything new in GP is rubbish , sometimes they are improvments
Personally ... our practice has and no doubt will continue to have excellent colleagues from different ethnic backgrounds .
If you had applied to our practice .... I suspect we would have been quite intimidated by x2 royal college memberships , with distinction, and extensive leadership roles.... coming in a a junior partner.
You might not have been a "good fit" at our practice.
I am not saying , at all , that racism is not rife in our country ,and sadly our profession , but sometimes there are other reasons for non-appointment, and to play the racism card might not be it.
Just my 2 pennyworth ... you may or may not have been appointed out our practice (as we obviously have never met!) but I guarantee you , failure would not have been due to the color or your skin
Of course soddin GP referrals have stopped going up , now that secondary care no longer send us "please refer on 2WW pathway for suspected angina" stuff
Same old Same old
Luckily for me I am old enough to get out before it becomes really 5H1t...
Feel really sorry for any fool mad enough to embark on this a career for the next 25 yrs like I did
I think Dr Copperfield has eruditely set out the current dilemma....
In my view it is not quite that simple...
Whilst agreeing wholeheartedly with the sentiment expressed , I would add that this is also exacerbated by the fact that within the 10 min consultation , when we could , in the past have easily dealt with examples 1,2 & 3 above without the need for referral anywhere else ....we are now also expected to deal with problems 2, 3 , & 4 that the patient has brought with them, as well as problems 5 ,6 , 7 & 8 that comprises the Qof , the Quip , meds management software, etc , AND problems 9,10 & 11 relating to issues from secondary care ... appointment not received / good enough , my CT scan result the hospital did please Dr , and "GP to chase results"
Is it really any wonder the default option is "refer" .. .next problem please