Back from the dark side
Is this including employers contribution that we never receive but is taken into account for annual allowance tapering
Issue we have is that we have been monitored for years on prescribing feeds by medicines management teams with a focus on saving money. I am more than happy to refer my patients on to nonexistent dieticians who like most of the community services have stringent criteria to prevent them seeing patients.
Stuck between rock and a hard place - the favourite place of modern NHS GP.
Looks like the stuff about providing capacity for general practice was an afterthought. There are also no figures in document indicating how many hours work the DES spec is anticipated to require vs the hours available. Even without having to to DES work the impact of this work force across a network of 50+K patients is not going to be of significance. If this was a business plan Lord Sugar or the investors on Dragons Den would laugh it out of the studio. I’m no goin’ te invest ahm oot. You’re fired NHSE
A good idea but I'd argue for 100% paid. Our pharmacists are already quibbling about doing work 'not in their contract'.
If they aren't working for me then I don't want to pay them anything.
Smoke and mirrors.
Extra investment into primary care promised and a shiny new workforce to help us out of the crisis. Instead we get a whole tranche of new work to do and PCNs will have no time or resources left to help practices be more resilient.
OK I have a deal - give us a 100% funded PCN workforce if they are doing work for the PCN -don't expect practices to stump up the cash for a workforce who aren't actually doing our core work. Any extra work incurred by practices remunerated by network DES that practices keep rather than having to invest in this in a workforce that isn't what we need.
As networks we should be able to decide what our local priorities and issues are, put together a business case for investment that includes a description of the workforce required, cost this, and then apply for the funding.
Any other businesses would laugh at the current offer. Anyone signing up for this DES in it's current state have serious business planning issues.
My partners were rightly skeptical about this whole shabang. Local confederation provided us with projections regarding funding the extra workforce over the next 4 years. Unless we all 'bank' our £1.76 DES money each year, ie keep any surplus in the PCN to cover the future costs (ie. 30% funding of roles), we will all have to contribute considerable amounts of GMS core money to pay for the 'new workforce by 2023/24.
This specification now looks like all this workforce will be used for is to try to achieve unrealistic targets and even this workforce wont be sufficient to fulfil the DES specification. It is difficult to 'cost' the amount of practice time that will also be needed, both clinical and administrative, but it will be substantial.
Therefore practices will be giving up all their DES funding for a workforce we dont want, who will be doing extra work that wont benefit us, and will result in extra work for practices.
F**K making practices in a network more resillient by working together. This will destabilise general practice and is a huge threat that needs all of us to stay away from. Whoever wrote this specification is in cloud cuckoo land and has no idea about the real issues facing primary care. This is micromanagement gone mad.
My colleagues will say no thank you. We will keep doing our best to do what we do and avoid this whole NHSE/CCG 'smoke and mirrors' game that will all be pulled in a few years when some new numpties have a bright idea to justify their employment.
Referred pt with iron deficiency anaemia and dyspepsia on Upper GI 2WW as per guidelines. Noctor scoped upper GI and discharged to GP - apparently didn't do lower GI Investigation as on wrong pathway! Had to re-refer and fortunately patient didn't have sinister cause.
Although sometimes things work! Risk averse colleague referred 35 yr old with loose stool and raised faecal calprotectin to lower GI 2WW - no blood or anaemia. Scope showed colitis and now has Gastro clinic follow up booked. Patient has no idea why though as no one spoke to her about her likely Crohn's disease!
If you are suffering please consider referring yourself.
The service is excellent. As a GP for 17 years I had always felt I was self sufficient - should be able to cope despite the pressures and expectations we all face everyday. It wasn't until a tragic event that occurred to a patient that I realised how close to the edge I was. I lost all confidence in my clinical judgement - became hypervigilant and expectant of something serious happening again. The emotional effect on me was extreme and I was struggling to understand why this particular incident had such a profound effect on me.
Asking for help and receiving it was liberating. The opportunity to see a GP for a prolonged appointment and follow up gave me the chance to look at the circumstances that had led to the difficulties I was facing and most importantly the chance to talk openly. Within 6 weeks I saw another clinician - a GP trained in psychological therapy who was excellent. I am now in a better place both at work and in life out of work. I have learnt a lot about myself and feel better placed to face adversity in the future.
I feel so sad for our profession that many of us are ending up unwell due to our work. It is shocking that 1 in 20 of us are presenting with mental health problems as a result of our daily work - heaven knows how many more are suffering.
DecorumEst | Salaried GP14 May 2019 1:57am
Turn out the lights | GP Partner/Principal13 May 2019 10:09pm
Very amusing. made my day!
'She said: 'Every day, locum GPs are working hard to support a thinly-stretched NHS and general practice workforce, with practices relying on these talented doctors to provide high quality care to patients within their communities.'
Any thoughts as to why 'thinly stretched'??
Maybe an example of the solution contributing to the problem. Agree a locum workforce is vital but the balance is wrong and is creating an unsustainable situation in practices.
Our local 'hub' for extended hours is staffed by locums and frequently have to cancel 'routine' sessions due to late cancellation by locums who don't seem to understand that they have a responsibility. I was told that we have no come back other than not employing those GPs again - but there aren't any others available. This lack of professionalism is concerning for the future.
Feedback is welcome but complaints should only be made about significant issues where harm has or may have occurred.
There are also some issues that are systematic or practice related complaints and those that are complaints about an individual clinician. The latter can be devastating for clinicians and result in deterioration of mental health and effect ability to work.
This advice to 'complain more' does not seem to reflect the variety of issues that a complaint may be about or acknowledge the harm that complaints can cause.
If something significant has happened and there is cause to complain then this is expected and fine but if it is to feedback a general concern then this should be via another route rather than the complaints process.
Simple answer - don't do it. I am not trained in providing treatment for alcohol dependency - I will give brief intervention but nothing more. STI I will treat but no contact tracing, and those who really want to quit smoking will have to buy NRT instead of fags. If they want champix I will prescribe the course but will not provide any other intervention. Not likely to be cost effective but we have to be realistic about what GPs can do with limited resources.
Does this include 'employers' superannuation? If so this is not reflective of 'true' income as this inflates what we appear to be earning.
I was recently hit by annual allowance limit which includes the employers superannuation when income calculated and resulted in allowance tapering down.
Agree with Stelvio re useless BMA hence why I now spend my membership fee on something useful.
At age 45 I am already considering freezing my NHS pension due to current employers contribution taking me over annual allowance taper threshold. It is positive that earnings are at this level so probably wont get much sympathy though!
This increase will make my decision for me.
We are moving into the endgame now with any 'investment' into primary care clawed back and little incentive to work harder for diminishing returns. I will be dropping sessions as the stress of current workload not worth the money.
When is the profession going to grow some and finally say enough is enough. My loyalty to the 'NHS' is severely stretched and would support a wholesale move to the private sector. The pension is no longer a good enough reason to remain aligned with the NHS.
i would argue that the present system of patients phoning on mass at peak times and being dealt with by receptionists under pressure to answer next call is more likely to result in patients in the wrong appointments. Started monday with 50 same day appointments within 45 minutes they had all gone! were left seeing 40 extras between us by end of morning. The only way to process that number of patients in our practice in this amount of time is for staff on the phone to book every patient into the easiest appointment for them ie 'the doctor can see you this morning'.
My view is that if you can shift more booking on non urgent appointments online it would free our staff to spend more time with patients helping them to access the right appointment for them.
I think as well a variety of approaches is needed and agree with earlier post about increasing use of telephone for review appointments where clinical examination isnt needed. Another problem we have is patients seeing different clinicians for results than the one who assessed them - we need to be more proactive in following some of these up and consider other ways of communicating results amd what they mean to patients.
The current model is broken - we only do things the way we do them because we have always done it that way.
I agree that we should not be pressured into doing things beacaue the DoH says so - GPs need to be released from autocratic micromanaged and be left to provide the service that suits them and their practice population.
I have an issue where GPs are involved in AQP services that they refer to and are profit focused which opens GPs up to accusations of conflicts of interest. We had this issue when PBC started and one of the first consortia emerged out of a provider formed from a group of practices providing services such as endoscopy. I felt at the time that being involved in this sort of arrangement where an organisation were in effect commissioners and providers was un ethical. However the future we are heading towards is integrated care provided by federations possibly in partnership with acute and community trusts. These services are to benefit patients with the aim also of providing efficient care where providers are accountable for outcomes. The fledgling limited company in our area is limited by 'penny' shares with all profit reinvested in patient care. No partners, shareholders or directors will profit from this. what is really happening is that there are groups of GPs giving up their own time to try and change things in the way they feel will benefit the NHS and the patients of our nation.
i think the Times, Telegraph and Daily Fail need to be shown up as one of the contributory factors in the impending demise of the NHS.. This kind of narrow minded blinkered reporting is not investigative journalism with the aim of protecting 'hardworking family's' it is purely to sell their rags to bigoted individuals who lap up anything that fits their view of the lazy nose-in-the-trough public sector workers.
The reality is that there are GPs who still feel that by changing things we can help the NHS to survive. The self centred option is not what the press thinks - the self centred option would be to collapse the whole frail system and pick up the pieces as private providers which would be a whole lot worse for the public.
The problem is that many GPs refer appropriately but there are many referrals that are not always necessary and the reasons for this are complex. Limiting referrals and incentivising this is controversial and I agree this raises ethical concerns. However resourcing primary care to manage patients appropriately is a way forward. The development of GP provider networks who can operate at large enough scale to employ specialists and other clinical staff, as well as being accountable and responsible for elements of their budget, may be a solution. This also will diversify the business of primary care and decrease reliance on GMS/PMS funding streams which are likely to face ongoing pressures.
As a profession we need to understand that we are private independent businesses that happen to have their main contract for primary care services with the NHS. Any other business that aims to be successful would be horizon scanning, evolving and diversifying in order to take advantage of market conditions. Instead due to funding reductions much of primary care has been reliant on decreasing services (e.g access) and minimising expenditure in order to protect profit.
This is a turning point. No one is going to pour money into primary care so we need to look at how we can access other funding streams and hopefully CCGs will support this as increasing the services available in primary care is the only way that secondary care costs can be constrained.
Increasing levels of mental distress are being caused by issues well outside the control of the NHS ie. the financial crash and ensuing austerity. Many patients don't need mental health input they need help with their social situation. Unfortunately we are also storing up increased future mental health problems as a result of child poverty, social services & public health cuts, and inadequate mental health services for young people.
There is no incentive for DoH to increase GP workforce. Most govt departments are having to make cuts & despite NHS funding being increased there is still a significant deficit predicted over next 5years. From the eyes of Govt GPs are expensive (overpaid?) and independent contractors which are both factors that they find irksome.
I would therefore suggest then that a reduction in GP numbers is what is planned and consequently what we are faced with having to deal with. If this is the case we have to think of other ways of working in order to remain viable (including a radically different workforce in terms of skill mix) or we leave the NHS.
This is the context that we as a profession are having to face. We may have reservations about transforming the primary care workforce without increasing GPs but I suspect that this is the corner that we are being backed into.
Agree that more care plans not necessarily the answer. The 'care plan' should not be central to this rather the process and discussions involved in care planning. To be honest this is what most good GPs were doing to some extent prior to qof - applying medical knowledge to the individual patient who they have built up a relationship with over time and who they have an in depth understanding of.