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Gold, incentives and meh

Had had enough

  • 5% of GPs have sought help from mental health service

    Had had enough's comment 16 May 2019 12:20pm

    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.

  • NHS should provide fitness trackers for vulnerable patients, says think tank

    Had had enough's comment 14 May 2019 11:42am

    DecorumEst | Salaried GP14 May 2019 1:57am
    Turn out the lights | GP Partner/Principal13 May 2019 10:09pm

    Very amusing. made my day!

  • Locum GPs 'guaranteed to be paid for extra work' under new BMA agreement

    Had had enough's comment 18 Mar 2019 10:20am

    '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.

  • CQC tells patients to complain about GP care to improve services

    Had had enough's comment 19 Feb 2019 10:20am

    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.

  • ​Council's drastic public health cuts will leave GPs 'unable to cope'

    Had had enough's comment 07 Feb 2019 12:31pm

    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.

  • GPs on more than £150k a year to be named

    Had had enough's comment 31 Jan 2019 9:17am

    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.

  • GP practices face annual pension contribution rise of around £50,000

    Had had enough's comment 20 Dec 2018 8:52am

    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.

  • Why would we want to encourage patients to book appointments online?

    Had had enough's comment 26 Jan 2016 8:59pm

    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.

  • Greedy GPs? Think again

    Had had enough's comment 12 Nov 2015 11:00pm

    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.

  • GP practices offered payments to cut urgent cancer referrals

    Had had enough's comment 01 Oct 2015 9:54pm

    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.

  • Cameron points finger at GPs over lack of mental health provision

    Had had enough's comment 17 Sep 2015 7:09pm

    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.

  • How can a ‘primary care workforce review’ say so little about GPs?

    Had had enough's comment 23 Jul 2015 4:22pm

    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.

  • GPs to be allowed to drop unplanned admissions DES and retain funding under CCG plans

    Had had enough's comment 17 Mar 2015 10:02pm

    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.

  • NICE multimorbidity guidelines ‘due next year’, announces NICE chief

    Had had enough's comment 17 Mar 2015 9:57pm

    I'm not convinced we need NICE guidance for this. Why not encourage primary and secondary care clinicians to use their clinical judgement without fear of GMC or litigation. It should be made clear that guidance is there to help clinicians as a resource rather than something that should be adhered to at all costs. This should be clearly stated within each guideline issued by NICE. Ideally an open discussion with patients about pros and cons of treatments should be had taking into account their priorities, wishes, and preferences. If only we had the time to do this effectively and the resources to enable this e.g ready access to data on NNT/NNH

  • GPs to be allowed to drop unplanned admissions DES and retain funding under CCG plans

    Had had enough's comment 17 Mar 2015 9:45pm

    disagree with above comments. i think this is what ccgs who co-commission should be doing. the current des is a waste of time in my opinion but the concept of care planning and supporting patient involvement in their care is not. lets focus work on something that addresses a known problem i.e. end of life care. care planning and the 'house of care' model is a significant shift in how people with LTCs are managed and i feel it is better than the current tick box qof, medicate, medicate then medicate again approach to care. We need to engage with complex patients with multimorbidity and work with them on their priorities whilst supporting them, educating them and advising them based on our clincal knowledge and expertise. These changes take time and require funding. these are not u-turns and patch ups but rather an attitudinal change for the health system that mirrors what patients with LTCs need. I do agree however that tick boxing needs to be discouraged as it creates a situation where data recording becomes more important than good clinical care. Next stop - lets have serious discussions about the future of the monster that has become qof

  • Government plans 'minimum standard' for GP mental health training

    Had had enough's comment 20 Feb 2015 6:05pm

    I think the economic downturn and the con/libdem policies of looking after the super wealthy but leaving the poor to suffer have more to do with increased suicide rates than what GPs do. These wider determinants of health make more difference to health, especially mental health, than what is done in primary care. Not to mention the reductions most areas have seen in mental health funding - and the looming catastrophe that the lack of adequate services for young people with mental health problems will cause. Norman Lamb should be looking at himself and his colleagues in Government who are accountable for this.

  • 'Patient dead'

    Had had enough's comment 18 Feb 2015 9:42pm

    One of the funniest things I've read in a while. Love the ferret! Once got a discharge letter stating that a confused lady's 'aim to guess score' was 4 out of 10. I presume was meant to be AMTS but aim to guess seemed apt in this case

  • Treating asthma was a wheeze before NICE got involved

    Had had enough's comment 29 Jan 2015 7:08am

    Peter, I agree that in most cases asthma is a clinical diagnosis but there are instances where it isn't straightforward and if tests are available that can help it would be great. There is also variability in clinicians skills in assessing and diagnosing asthma which is reflected in the reality that across a relatively small population there can be huge differences between practices in terms of asthma prevalence. Ranging from those who underdiagnose and have symptomatic patients and those that over diagnose and often over treat with expensive combination inhalers. As well as improving diagnosis I think we also have a lot to do in terms of educating patients about their asthma and how to use their treatments effectively

  • Treating asthma was a wheeze before NICE got involved

    Had had enough's comment 28 Jan 2015 8:58pm

    Like most NICE guidelines this won't immediately become standard practice. So no need to panic. In terms of new tests, since I have been a GP we now check serum BNP to help exclude heart failure and patients have heart failure confirmed by objective echocardiographic testing allowing the right patients to get the right treatment (whilst preventing unecessary use of treatment in patients who have the diagnosis excluded. Patients with suspected IHD are rapidly assessed and have a prognostic assessment to identify those at risk of MI. Rapid access TIA clinics and prompt vascular intervention is in place to reduce stroke. Patients with COPD have spriometry with reversibilty in their practices helping to accurately and easlily diagnose them. Serological testing for coeliac disease makes it easier to diagnose and exclude coeliac disease. Faecal calprotectin measurement can guide the referral of patients with possible IBD. This is healthcare innovation and will always happen. The tests we offer will change and the way we manage people with suspected disease will change.

    For once Tony, I disagree with what you say.

  • Patients to be allowed to self-refer for cancer diagnostics without going through GP

    Had had enough's comment 13 Jan 2015 9:44pm

    In some conditions, especially where there are potential delays in presentation and referral associated with poor local outcomes, this can be successful. In Leeds there has been a scheme allowing patients to present for an open access chest xray if they are over 50 and had a cough for 3 weeks or more. As a result of this there was an increase in the number of patients attending for xrays and an association with patients presenting with cancer at a lower stage after the scheme was implemented. I think it is unlikely to be relevant to all cancer types but, if properly targeted and based on local issues with cancer diagnosis and outcomes, then there may be some merit in allowing patients direct access to some diagnostic and assessment services.