Back from the dark side
To non-primary care providers
Why aren't you care opening yet? Locally we have a handful of specialties that will accept referrals and these only opened this week - including radiology. I look at my patient list every surgery and the reasons for consulting and am left dismayed that I will be having the same conversation with patients multiple times about how I can't refer them for the care they need. It is demoralising and at times this whole process is feeling pointless.
Other sectors in society have opened up in rapidly when the green light was given - why is the NHS so slow? You have had months to prepare so why aren't you ready?
I suppose there are commercial drivers for shops and businesses to open and the cynical side of me feels that this has been an opportunity to clear waiting lists by discharging patients and not accepting new referrals with no financial penalties. Added to that is the writing off of trust debt.
We have reset now and it is time to open up again. We need to be able to refer again. How those patients are managed should be up to you - we have had to make significant changes to the way we work and so will you. We can't keep all these patients, and all the consequent risk, in primary care indefinitely.
Our patients need your support to manage their conditions because on our own we can't do this.
We can't be 'open' to routine work until this is sorted out. It is becoming impossible to do the job. There is only so much that can be managed in Primary Care. All the risk is now sitting with us and this is wrong. Once a decision has been made to refer it is up to commissioners and providers to sort out how to manage the patient. Still cant even send patients for radiology investigation.
Been getting people booked into appointments wanting physio for back pain - not avaialable, joint replacement for OA - not available, plastic surgery for BCC - you guessed it not available.
It is a waste of appointments in primary care - and it is getting busier now. Add to this the extra issues around PPE and F2F assessments that use tine that we don't have.
Maybe all practices should exception report all patients - this is a pretty exceptional situation. If we all did it then there would be no variation.
Can NHSE work with commissioners on how secondary care is going to open up rather than spending time on this politically motivated twaddle.
We still have little access to imaging and no referral options other than 2ww some of which are triaged and bounced.
We are open to all and workload skyrocketing but limit to what primary care can do for a lot of patients without secondary care support and diagnostics. I appreciate the issues there are but have had very little communication from local trusts as to how and when we can start referring again
Philosopher 1: Agree with comments re German GPs (GP's) including routine tasks in their workload. If I added up all the 'patient contacts' per day for prescription requests, tasks, hospital letters with actions, drug monitoring etc it would add up to 60 per day easily most days. We just dont have the capacity to see this many and tbh most would be inappropriate to see/speak too. Having said that I am probably authorising more script requests than I ever had as there is nowhere to put all these patients if I needed to speak to them all.
Incidentally I have been trialling using AccuRx SMS messages to get information from patients to help me to decide if script needs continuing with some success and not too much additional time.
Not good to see GP colleagues suffer but we may be seeing a re-balancing of the market. Market forces drove up wage demands and locums very much been in driving seat regarding specifying fees and terms of service. In my opinion things had gone too far with the increase in GPs being locums driving the demand for locums due to lack of applicants for substantive posts.
Locums are necessary to cover sickness, holidays and maternity but we were in a situation of needing to employ them just to provide a service. We have had some excellent locums - usually recruited through contacts of partners or local 'chambers'- and some dire ones who we have cancelled after a few sessions.
We have just advertised for one substantive post and within a week have recruited 2 salaried GPs both of whom want to develop services and training in the practice and may well move into partnership in the future. This feels much more 'normal' now and helps us to be confident about practice stability in the future.
I’m sorry but we are now open for normal business and the workload is increasing day by day trying to deal with non covid stuff. Often this is taking more time as previously simple presentations more complex to manage with limited access to investigation and ongoing referral. Our local trust still not taking any referrals and leaving all the risk with us in primary care. It has been strangely quiet but this is changing. There will be no available workforce for this additional work.
Agree we need to protect the most vulnerable. However we are going to have no workforce left soon. 60% of deaths are in men so is being male a factor that should be risk assessed too.
Looking at GP deaths maybe it should be BAME doctors especially older males who really should be considering avoiding the highest risk work.
Utter nonsense. Does this 'digital lead' work in the real world. ICUs are busy but the rest of the hospital system is not. I admitted 2 patients yesterday directly to assessment unit - 1 surgical and 1 covid +ve with ?dvt/pe.
As I have said in previous posts- if patients unwell, and I would normally send for assessment, then hospital assessment is appropriate. ie. if these CCAS patients are so sick they need call within 30mins (which OOH service rarely manages anyway) then they should have been directed to a secondary care assessment. We should only get the milder patients who may need some review over the next few days to ensure not deteriorating or who have some other non-covid symptoms that require assessment.
Only in a state of emergency with secondary care overwhelmed should we be 'stepping outside of our usual limits' to help manage the crisis. Locally this is not happening. We have half full hospitals and ICU departments with capacity.
We don't need these dictats. The most successful changes occur due to need and are driven by the front-line as a response to this. I am not doing video calls because I was told too - in fact when we were told we may have to I felt resistance to this.
Ask practices how they can best help nursing homes and let them get on with doing this the best they can. If they need PCN support then let the PCNs decide how to do this and scrap all the nonsense in the DES that tbh is just there to pad it out and make sure that NHSE gets 'value for money'
How does this impact non BAME, non pregnant GPs without chronic illness. With shielding, social distancing and self isolation this will leave a small number of GPs doing all the face to face work and exposed in turn to increased risk. Soon it will be no males over 60 which will leave 30-60 year old GPs seeing all the patients. Hang on aren’t men at increased risk too? So we have non pregnant often part time female GPs left.
There is going to be some risk unfortunately either due to demographics/co-morbidities but also through exposing a small number of GPs to all the F2F contacts. Has anyone risk assessed this?
Having said all that it seems sensible to protect older and often male BAME clinical staff especially if they have any comirbidities as this group does seem to be at particular risk. Who knows though whether they contracted covid19 at work or from other contact.
I was a sceptic about video but I can see a role for it going forward as part of an array of options. Simple tasks can be dealt with online with systems to delegate work to trained staff. Demand can be triaged online and by phone. If F2F needed then video if possible and F2F if not possible or appropriate. Can be used to decrease home visits if tech savvy or able relatives.
The world has been changing for a while prior to covid and I have been reluctant to change. There is still a definite need to F2F consults when a clinical examination is needed to answer a clinical question and manage clinical risk. However I am feeling comfortable dealing with a lot of stuff remotely. Having said that in current times I have felt like I am often dealing with additional clinical risk as the option to see F2F is limited.
I'm not sure 99% of patients need 'examination' as per one of the previous posters.
So sorry to hear this. Condolences to his family.
I trained with his son and met him on one social occasion that I still remember to this day due to his extreme generosity, hospitality and sense of fun. RIP
Unwell patients should be seen in hospital where they can have tests and supportive treatment. Only if and when this capacity is over-run should we look at how General Practice can be used as an emergency measure. This could involve hot hubs potentially.
On an aside the CCAS is non existent as far as I can tell locally. All the 111 calls re Covid that I have had have been directly from call handler and not been forwarded to any clinician within 111.
There is still a lack of clarity over who should be admitted. The pathways we have been provided with imply that quite sick patients should be managed at home until really sick. We need clear black and white guidance on thresholds for admission I otherwise my assessment is no different to clinician via 111. Is it sats, is it speed if deterioration. In Leeds no patients booked directly f2f from 111 which I agree with but many triaged to gp rather than CCAS for remote assessment. Again not an issue with this if clear what outcome of my assessment should be. The last one I had obviously needed admission as severely breathless at rest, very lethargic, unable to complete ADLs and sleeping all the time. Sent to me though when should have been 999. Need clarity before the shit hits the fan over the next fortnight.
Don’t understand what this service is. Patients are either well and stay at home or breathless and need further assessment. Current advice seems to point towards keeping breathless patients with pneumonia at home until they are almost dead then admitting them. Germany is doing the opposite and actively assessing patients in secondary care earlier in their illness. Compare mortality? All resources and all PPE (Proper PPE that is not a flimsy apron and mask) should be directed to central sites to assess patients properly. These are sick secondary care patients not appropriate for primary care management with inadequate PPE, no bloods no CXR and no obs.
Where did this come from? Does not reflect what is happening on ground. Just had really sick patient triaged by 111 to primary care! She could hardly speak. Typical covid presentation 9 days ago fever and flu like symptoms the increasingly breathless over past week. Not sure what my role was other than to tell her she needed to be in hospital!
When are frontline workers and families going to have access to tests. System will crumble just as the shit hits the fan.
The problem is if there is no one else ‘competent’. Always will fall back to GP. Agree haven’t verified death for ages.