Had enough to get appts for our patients already- now so many are “ blocked” for 111, A&E, “ 8-8”
It’ll be even harder? Bizarre disjointed thinking.......worsening accessing.....
Agree fully with yellow..... how do they calculate this “ cost”?
We see an average of “5-8 extras” in most clinics- so by the same logic we are owed 100 million extra to cover this?
To care of GP not toxare ?!
Definitely needs a change to reflect activity!
Plus we get NO funding whatsoever for 3,000 of our 15000 patients in London as they’re “ too young”- don’t meet deprivation criteria.....
lots of media attention to “ghost patients “- none to totally Unfunded ones?! Never mind that these young patients present at LEAST 6 x a year MINIMUM and we cover their mental health needs ( all CMHT referrals- discharged back toxare of GP- having offered no input?!!) gynae, neurology- lots of pathology MS, etc etc - but if it doesn’t tick a box for NHSE it doesn’t count?!!
All patients have a “need” and are entitled to good basic care-
Many deprived areas have huge social problems that are the drivers for many of the medical issues that result- as the Black report showed- increasing medical input
Isnt the answer!
What about the healthy individual with a first severe debilitating episode of depression - blights their lives- and takes a lot of GP time....management, support, review- liaison with work, DDA etc
Adolescent mental health.....postnatal depression,
Multiple sclerosis, ovarian Cancer in a young patient with Lynch syndrome - pulmonary embolus, congenital cardiac problems in a sporty young man- (lost his uni scholarship).
Epilepsy , endometriosis, acute psychosis, premature ovarian failure.....lymphoma, ankylosing spondylitis, Angelmans syndrome in a 3 y old, renal failure in a neonate, ectopic pregnancy, drug and alcohol ( occurs everywhere not just in areas of deprivation-)
None of the above are related to deprivation- but none
“ count” under QOF....saw all the above and so much more last week..... make my complex multimorbidity 80+ year olds look positively easy. Why should their care not be funded? East end GPs are v vocal about their deprivation workload - it’s a devicive approach- we’re all snowed under and overworked... 14-16 hours days are the new “norm “!
Unrecognised work load is everywhere -
stupid simplistic funding formulas like Carr Hill aren’t the answer!
Unscepted- don’t insult Sceptic! I fully agree...... all political parties have wrecked the NHS with their short term vote appealing policies..... labour and the PFI outrage, tick box culture etc started the rot which the tories continue....
It is insulting for a publication which we read for MEDICAL need to assume we all think alike just because we work in the NHS! Respect our differing opinions and engage in debate..... not hurling childish insults!
I don’t want to see political posturing in Pulse- for the same reason I no longer read the guardian....
I don’t expect it in Pulse - it’s not the place for it and the arrogance and assumption of it really incenses me.... I’m not allowed to rant at my patients with my views- nor would I dream of inflicting them in people........equally Pulse spare me yours- I don’t share them!
So happy to read these comments and agree entirely...... how bloody dare the RCGP do this?
Arrogant misguided political posturing- no mandate from me either? They don’t speak for us..... we are a disparate group not aligned with one political Opinion - what an arrogant assumption..... none of their bloody business to be even voting on this?! I want it withdrawn!!!!
Mental health issues affect all of society not just the poorer- it is not class specific! A review into postnatal suicides showed it was mainly white middle class women at risk.....a group who can be conveniently overlooked by health visitors etc as “not needing input”.
My plea..... leave politics out of medicine!
Treat what needs treating, however it needs treating for that individual ....... every individual has equal health needs for GPS- maybe different needs but equal needs! GP is NOT the realm for health inequalities or societal problems- that’s a wider public health issue and it is dangerous to fall into that path as GPs.
Eating disorders in teens, self harm, psychosis, alcohol, depression, bipolar........... that’s not bloody austerity related- the push back to GP is enormous- as the reader above commented the most shocking, serious referrals are “ discharged back to care of GP”- no input?! All lies at our door- who do we discharge to?
Public health can do targeted work in communities etc- for sample......but everyone has an equal right to care and treatment too
GPs are uniquely placed to provide individual care to ALL....irrespective of social class/ economic background!
I hate this political posturing.... that’s for public health or MPs!
Add on gastro oesophageal reflux ( ent presentations) and glandular fever and so on.......as well said above...... we don’t just dish out antibiotics or not...... we look at each case and actually diagnose the issue.............take a lot of risk and a lot of flack for doing a damn tricky job?! Damn cheek trying to foist cheap replacements ?!
Just fuck off- load of tosh?! Embarrassing
- what other profession would take on the ills of society?!
I’m busy enough looking after the MANY individuals ( that can actually get scarce appts ) and individualising their cate- my focus is not public health- and for a reason... focussing on the population is not focussing on what’s best for the individual in front of you!!!
Agree- high risk- just needs 1 leg pain seen by MSK which turns out to be DVT - I’ve seen it happen x2 in one of our surgeries in last few months !
Agree with comments- patronising load of tosh......... blame teachers and doctors for all manner of social ills......then their responsibility to address them.... joke!
Takes ages- take test out of fridge- wait 10 minutes.... use and re see patient???
Madness- when a single session is a chaotic 7 hour marathon- I don’t have time for this! I still use clinical acumen thanks!
Too true- and the same for “referral pathways”- excuses to bat back or re direct/ delay referrals .....
I manage my gynae cases to secondary care level- by the time I refer in you KNOW they need to be seen- don’t reduce the individual to some one size ( doesn’t!) fits all pathway tick box Referal form ......
It’s not as simple as deprivation.....we’re considered to be in a wealthy borough in London- but lose out on Carr hill and in deprivation and we don’t get ANY funding for 3,000 of our patients....
However our patients are not “wealthy”- and this certainly doesn’t equate to need......our Katie ta have a very high consult rate- serious morbidity ( we might not H.A. e huge numbers of diabetes/ copd- but we have all sorts of neurological problems, cardiovascular, mental healthy, gynae and paediatric) and 3 x national average for consultation rate and our core payment per patient is very low....( far less than 100)
i question these figures- some of you quoted- does anyone get 200 per patient?! Our salaried docs earn more than partners but partners are doing 14 hour solid days minimum - often 16! We get brushed off with funding diverted to deprived areas..... this is general practice- all patients have health needs!!!! They may be different but they have needs and funding should be fair for ALL! It’s NOT public health which can be targeted!
Before you spout off about less deprived practices- do some research- we provide secondary care level mental health, paeds, gynae and A&E work from damn hard working good doctors- we have lost 25% of our budget yet provide the same service - don’t let them Pitt us off against each other- the funding in general has gone!!!!!
And more state “ regulation”- turning us into cheap replaceable commodities- the more pathways and protocols they enforce- the harder it is to practice autonomously and individualise our patient care ....
all our innovative excellent schemes (A&E avoidance, paediatric care, mental health ) -all disallowed A’s other practices couldn’t offer the same- essentially we have a dumbing down to the lowest common denominator!
The demand is enormous and never ending......expectations are unbelievably high about what people are entitled to and demand.....we have a skeleton service ( colleagues off sick long term- ) currently going 14 hour solid days- no break. The limitations have to come from us- so we bear the brunt of complaints.... despite trying desperately to be all things to all people- A&E, shortfall from hospital, mental health, sexual health- don’t worry- we cover it.....
The secondary care services are watered down cheapest delivery options from lowest qualified staff- as cannot meet the numbers.....
The system needs to learn to say NO- it can not provide everything- and we already pay for it so Dr Ho is right - I’d rather spend the money than the government- )IT billions- for a shit service?! ). Angus the ideas seem sadly idealistic and naeve ..... throwing money at it won’t improve it?! It’s broken.....
we carry on due to our sense of duty and care.....which is why we all work over and above......
But. The new work force coming through won’t stay till 10pm- don’t want to be partners and are used to a different way of working with the new contract!
It is stupid that prescriptions ALL prescriptions are free for people with thyroid disease and diabetes....
Even something sensible such as being able to charge NHS patients for services we are no longer funded to provide ( crap, could for 55y for endometrial protection if HRT, mich minor surgery etc)- we could do this for a small fee- but nooooo the issue of “charging patients” is blanket ban as “ unfair for those who can’t pay”- but its “those who can’t pay” who suffer- as if we can’t otivude the device for a small fee- they take their credit cards to private providers who really overcharge ..... how is that sensible or fair? It’s impossible to have a rational discussion as many senior GPs in GMC/BMA are blinded by the very idea of charges- like crazed zealots!
We’ve had an enormous number of complaints about a Evergreen- a private compan6 the government currently uses as one of the options for digital access.
It encourages patients to sign up for increased e access eg booking more than 2 appointments at 1 time- Patients noted “ small print” advises this is in exchange for Evergreen ( a private company) accessing their medical record- we bore 5he brunt of their fury- but knew nothing about this!
Key point is spot on.... too many MPs and “celebrities”- think -their experience- is -everyone’s experience- and they appoint themselves “ experts”.....
That’s because- My one 1:2 day is actually
7am-5 pm solid- not even time for a wee?!
Hence most of my colleagues are “ part time” ( misnomer)- as full time is minimal 14 hour+ days and not sustainable these days! We’d crack up!!!!