Couldn’t agree more. It’s madness. We all have to accept that to accept health care is to accept a degree of risk. The risks are not being reduced by extortionate payouts. There needs to be root and branch reform, particularly in hospitals. Spend the money on anonymous surveying of doctors on patient safety matters, and an independent patient safety team in every hospital.
Vanity projects. They need clinicians (ideally elected by the GP workforce) running the show. Enough greasy pole to top of NHSE. Too much self interest, not enough common sense or experience of the job.
A little bit of extra money, promises of a few more staff. But still, a herding exercise? Getting GPs to work in larger organisations with large numbers of noctors providing less than perfect care, under our supervision. The large groupingenious are designed to take the power away from GPs, facilitating a model where OOH can be unceremoniously dumped back on us. Make no mistake, the future holds more work, more liability, less autonomy and precious little extra resource. We will be powerless ‘lords’ over teams of other clinicians - forced to flog the workers, yet hold the responsibility when things inevitably go wrong. Whichever way I look at the PCN model I see punishment coming our way. We should keep our eyes wide open to this. And do people like working in superpractices? Has anybody bothered to ask?
Too little, too late
How many times does it need repeating - it’s not the numbers you train, it’s the working conditions you offer. The government has an idea that doctors are too middle class (they don’t need to work as hard), if only they could recruit the lower-middle classes, then they might actually have to slave away in a thankless job. The reality is many doctors come from professional families where parents worked extremely long days as hamsters on a wheel E.g. in a law firm or financial sector. We have been indoctrinated that this life is to be expected. There are many from other backgrounds who expect to have time for family and friends and a normal work-life balance where you clock off at 5. The same issues will surface. No one wants to be flogged relentlessly. On my graduate course I trained alongside a physio and pharmacist. They both quickly saw the job on offer was worse. One went back to pharmacy, the other moved into teaching. Better conditions needed. End of story.
How about £140m for addressing the workforce crisis in general practice? This guy has got to move on from his tech obsession. Simple medical care provided by a well resourced and supported GP- with moderated demand (through fees). It’s not complicated Mr Hancock.
We are unlikely to collectively have the backbone to see this one through. The DES will be passsd in altered form, and then, by increments, NHSE will remodel general practice in the image it wants. Lots of superpractices that can jump to its diktats and through its hoops. They will offer existing GP partners cash to agree to merge (those in their fifties will jump), and no sensible people going forward will join such partnerships. Then they will claim that selling the practices to private providers, and having a whole scale salaried model, will be the only solution. GPs will work in ‘Boots the GP surgery’ style branches, or patients will be sent to central hubs for on the day treatment. The quality of care will be poorer, referral rates higher, continuity will be non-existent, and the whole system more expensive overall.
Wow. Comment removals? Can I ask - is it self harming to have a penis, or breast tissue surgically removed, for a condition which is essentially mental in nature? First do no harm?
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I agree Copperfield. Drawing more and more of normal human activity into the health service is madness. Take social prescribers. Someone is sad and lonely, ‘don’t worry the health service can help you!’. We need to persuade the public that the health service is there to deal with health matters, not normal life events, daily misery, loneliness. These problems need to be firmly placed in the remit of other public services or charitable organisations. Otherwise we can’t hope to manage the genuinely sick. And yes, a bit of prevention - encouragement of the support of public health schemes like sure start - but don’t open toddler groups in our waiting rooms - please!!
Lincolnshire GP: are you really a GP? That sounds very much like the musings of a daily mail reporter (or reader)? Many work LTFT due to pension, tax and other financial penalties. That coupled with levels of stress that have them questioning on a weekly or monthly basis whether they really can continue in the profession as it stands. And agreed, once employer pension contributions are included the salary of a GP partner is comparable to a hospital consultant’s. Yet theirs aren’t bandied about in the press on a weekly basis. Walk in someone’s shoes for a mile, then tell us how comfortable they are.
Really, he needs a focus group of sensible GPs on hand to shoot down his latest foolhardy plans. Managing risk is not something done by computers (or clinical advisors, noctors, or whatever you want to call them). Train up more doctors, give them the freedom to manage the demand as they see fit, and support them to redesign structures to help them work better. Do not hoist onto them untested ideas, which would be scorned in a straw poll. I am all for technology, but for F’s sake test it in a small pilot, prove it works, then consider rolling it out. Econsults seem like a total waste of time and resource.
I think you should be applauded for trying to stand up for the values of our profession. No one would do anything constructive if they were all left drowning on the front line. We need sensible people representing our views to the RCGP. If not, we will end up with a branch-style general practice where patients go to 'hubs' for anything urgent, and see a GP in a supermarket style organisation, salaried, but powerless to control their working life. Carry on you too, and ignore the negativity. I don't have a face for video, however.
I could have told you this. A year or two ago, my kids and lots of the kids of friends of ours came down with it, and it spread round my family like wildfire (a slow one!). This year, I suspect there may be an increase in whooping cough, large numbers of kids with prolonged coughing bouts at night persisting for weeks to months. Anyone else seeing more of this than usual for the season?
I perceive an undertone of suspicion towards PCNs if they plough head first into dismantling smaller practices and forcing mergers. Continuity of care will be lost, and policy makers fail to recognise quite the damage that could do to patient outcomes and staff morale (to name a few). A top down reorganisation of services could prove a nail in the coffin to primary care. We need fewer ‘yes men’ representing us in leadership roles, and more honest debate. And, for God’s sake, why not test a few PCNs over a number of years. Some impartial evidence for patient or staff benefit wouldn’t go amiss. This is a gimmick and could be a deeply damaging one which takes decades to come back from.
We need to think long and hard what we remove from the GPs workload. And I agree, part of this is about protecting the GP, and making the job tolerable. Pill checks, waxy ears, UTIs. Some of this simple stuff gives us a lighter moment in a day filled with stress, decisions and complexity. Especially if you have an appreciative patient with it. Take away the lighter stuff, the patient appreciative of a simple remedy, and you leave a GP despairing at the seemingly endless intractable problems. I have said this before - we do not need to be the providers of low level mental health services. This would remove a huge burden from the GP. Patients could see trained mental health practitioners who could dole out citalopram just as well as I can, and they could have a closer working relationship with the mental health services and psychiatrists when needed. I had approximately 2 weeks teaching in psychiatry and 1 hospital placement as an SHO. This could easily be replicated for mental health workers with the back up that higher risk patients (poly pharmacy, older etc) could be seen by a GP with a special interest in mental health working in the same team. Give these teams half an hour appointments, and the resources they need and you could remove 10-20% of the GPs work load, and a great deal of stress associated with our inability to satisfactorily refer into MH, or engage support for these patients.
Some of the comments insinuate that young doctors are not ‘tough’ enough to do longer hours or more days. Society has changed significantly over the past few decades. Where some years ago a young male doctor might be married to a nurse who gave up work for five or more years to raise their children, often now male and female doctors have partners with demanding and stressful jobs. Add children into the mix, and someone needs to cut back some work time. Children need care. House prices are such that younger doctors often cannot afford to have a partner stay at home to raise the kids, but likewise our salaries are not enough to support a full time nanny or pay for the childcare needed to do the gruelling hours. The most affordable thing for us is to reduce our hours, share the childcare, and hopefully get through the early years of having children intact. Younger docs today are NOT having an easier time, many doctors are seriously hard up trying to juggle it all. And if you recruit a majority of women into a profession, you have to expect to make it family friendly, or they will go. Simples.
It is obvious to any GP with half a brain cell. Economies of scale do NOT work within GP practices. Autonomy lost, continuity of care lost, incentives to go the extra mile lost, close knit team with support from colleagues lost. The only gain is a duty system which would put any sane person in a mental institute after battling with it for a few years. We need to resist the autocrats in Whitehall from reshaping primary care into a monster which will destroy us all. More research needed on patient and staff satisfaction in super practices. Where I work the feedback is dire from nearby practices who have gone down this route. And can they ever go back? Almost impossible to imagine how.
Haven’t yet had a look at the app. But just reflecting, there’s apparently been a huge rise in mental health problems in the past decade (true and reported). This coincides with the ‘worlds’ toxic obsession with smart phones and social media. And we are directed to our smart phone for the solution? How about children are kept from using phones and devices during the day? And only allowed strict time limited access for less than an hour a day? Adults the same during leisure time? Would there be a swift reversal of the deteriorating mental health of the nation? Do we need to see hand held devices and social media as bad for our health as smoking?
Tragic. If a profession allows itself to be overwhelmed - with work, responsibility, liability... the end point is the destruction of its members. The NHS could destroy all of us if we are not united, vocal, and deliberate in our protests. As general practice cracks and fails, we should be standing and shouting for better... there are so many elements of general practice that could be easily (and better) performed by an outside organisation (properly funded). Take mental health. I did approx two weeks at medical school in psychiatry. The sum knowledge of my prescribing in mental health could be learnt in a day. A prescribing mental health worker, with close links to (properly funded) psych teams could easily manage the depressed and anxious patients who make up 10-20% (my guess!) of our workload. Just because the mental health services are failing due to underfunding, does not mean solutions to our failing service should not be tackled. The life expectancy of the UK will continue to decline while GPs are too nice to say ‘no’.