No political party will back this. It’s a vote loser. This is a Pyrrhic victory. In fact, it puts home visits back in the minds of patients who may have thought that ruthless triaging had effectively banished them in all but name. Many GPs only visit when they deem it necessary (mainly palliative) and stiffly reject/divert/admit/ bring to surgery the rest. If we all did this the problem would rapidly recede, without all the negative publicity we will receive if this is enacted.
Grow a spine, filter out 80% of requests, regain control, after a while patients stop asking. Only visit if you want/need to at a time that suits yourself. Can’t wait? Then go to A&E, we’re not an emergency service. Study the 2004 contract, we have control if we choose to enforce it.
My understanding from hospital colleagues is that there will be no “paying the bill”, but that the AA charge will be “scheme pays”. Then on retirement the AA amount will be knocked off. Of course, this means the Treasury claws some money back in increased Lifetime Allowance, but might attract doctors back to work this Winter without shelling out millions settling their tax bills.
Quite clever, really, but scrapping the taper and increasing AA to former levels would be far more effective.
I’m all in favour of a bit of optimism in these dark times, but focusing on “medical feminism” or “inclusivity and kindness” does seem to be missing the point.
As us old, knackered full time (mainly) male partners are worked into extinction, the young, spirited part time(mainly) female salaried doctors are (quite rightly) not willing to bear the yoke of 8am - 6.30pm 5 days a week with bottomless workload that we are/were subjected to.
Which begs the simple question. How will Primary Care survive?
The sexist point is well made but is rapidly becoming historical. Kicking the pale male stale corpse may give some satisfaction, but it’s already dead.
And being kind and inclusive is difficult when chained to your desk for 10 hours or more.
We need radical new ideas, not just empty Woke sloganeering.
“What a beautiful building! May I see a doctor please?”
“Sure. Here’s a map to show you the way to A&E”
“Oooh! It’s laminated too! Wonderful!”
Just a small piece of the chronic pain polypharmacy Pharmageddon jigsaw. These patients are hooked on the strongest opiates, return in more pain, then demand the next cab off the rank....duloxetine, pregabalin, NSAIDs and eventually tricyclics. It’s frightening how many of these patients take the lot, often backed by a Pain Clinic (discharge) letter. I suspect these stories will become more common, and GPs will take the blame as usual. Time to start rowing back on these drugs.
Excellent article. Agree with all of it, but probably political suicide to put it in a manifesto if comments like BonesFromStarTrek are anything to go by (“I’m a doctor, Jim, not a damned nanny!”).
If we’re serious about zero tolerance concerning racism then the guilty patients should be either removed from the list, or given a final written warning that any repeat behaviour will result in their immediate removal (and possible prosecution). If everything is properly documented then I don’t see PALS or any other patient rights groups being prepared to defend racists.
GPs have to be prepared to follow through with action, rather than letting this odious behaviour continue. Receptionists must record and report every “I only want to see the British doctor” incident for further action. Zero Tolerance is an empty slogan if we don’t.
Whoaml 12.22 - quite right!!
GP IS exciting! It’s a white knuckle ride every day....will your partner stay or leave? Will CQC treat you kindly? Will there be enough money in the account to pay the staff this month? Will Capita get their sums right just once? Will the extortionately expensive locum do any admin today? Who will you be lumbered with in the Home Visit lottery? Will you have a lunch break? Will you make it home before the kids are in bed? tick, tick, tick, tick......BOOM!!
Every day is like Mission Impossible. Step aside, Tom Cruise, the GP partner is in the front seat.......GO!!! WOO-HOO!!!!!
Health Minister - “Hmmmm, GPs want to give up home visits. How much does this currently cost us?”
Lackey- “nothing, Minister”
HM - “And how much would it cost to provide a visiting service?”
Lackey - “Many many millions, Minister”
HM - “Right, issue the the usual BS about how we “really value GPs”, reheat the 5000 more GPs promise.....no, make that 6000, it doesn’t really matter, there’s none any way....., and butter them up with all that “jewel in the NHS crown” crap, that usually fobs the moaners of for a year or so. Oh, and don’t forget the “out for consultation” tripe too”
Lackey- “Yes Minister”
Laugh or cry?
Which one did you do after reading this garbage?
I laughed, then felt miserable all morning. Didn’t cry, though. They’ve broken me already,
Copernicus is bang on, no chance of ever becoming policy.
We need to remember though, we are NOT an emergency service, we do visits at our (in)convenience, so if a request comes in after 2pm and really can’t wait until the next day, then it is clearly an emergency which should be passed to the emergency service.
Spot on. Last Man Standing bankruptcy dodged, its the Trust’s problem now. Must be a massive relief for Dr Fowler.
“These are not appointments. These are disappointments”
Quote of the year!
HMG will never scrap GP visits from our contract. Why would they, it’s fabulous value for (no) money.
Fortunately we have final say on visits, not the patient.
Ruthless triaging, dragging into surgery, diverting to another service.....other than palliative care and possibly care homes (at our discretion) visits can be pruned back, mainly by having the spine (and medical defence cover) to say “no”.
Take back control.
And as others have said, if an early evening visit cannot wait until the next day, then by definition it needs to go to A&E. It mysteriously becomes less urgent when you tell them that.
The bitter irony here is that experienced older GPs and Practice Managers wasted months of precious clinical time pointlessly box ticking to pass a CQC inspection, then decided to throw in the towel rather than drag themselves through the whole Sisyphean task again.
This has been a major contributor to the exodus of senior GPs, leading to inevitable falling standards on subsequent CQC inspections.
Drastic reform/simplification of the inspection system is urgently needed or CQC will continue to have a diametrically opposite effect on standards.
It may not be healthy, but the unwritten rule of partnerships is “thou shalt not go off sick”.
None of us wants to be the one to dump on the other partners, who are left with double workload if we don’t show up.
By struggling in when dying from terminal man flu you set a high bar to the others, who won’t dare go off with their URTIs. Equally, if one partner starts to take a few sickies , you suddenly don’t feel so bad about taking a duvet day yourself.
Within reason this stoicism is a strength of partnerships, not a weakness. But once we’ve all been swept away and replaced by salaried docs, I suspect there will be a sharp rise in sick leave.
Was the placebo fluoxetine?
Should make for some interesting consultations.
“Well Mr Bloggs, you are clearly depressed. I suggest you buy some aspirin from Asda. Just don’t take them all at once....”
Hammond flatly and repeatedly refused scrapping the taper and restoring AA and LTA to previous levels, despite the fact that it’s a blindingly obvious and rapid solution to a deepening crisis. Will Javid have the foresight to avoid a Winter of NHS chaos that could scupper his party’s election chances? I wouldn’t bet on it.
It has been stated many times by Pulse readers that children will have to die before the scandal that is CAMHS policy of rejecting most GP referrals (to reach their access targets) is exposed and condemned. There is zero pleasure in being proved so brutally right.
But what really sticks in the craw is CAMHS “Crisis? What crisis?” stance. Instead of highlighting their chronic underfunding to deal with a huge increase in referrals (encouraged by decades of “increasing awareness” campaigns aimed at improving GP detection), CAMHS repeatedly claim they have everything under control, other than the annoyance of having to reject and divert 80% of “inappropriate” GP referrals. Hitting targets has superseded the proper assessment of suicidal children.
If CAMHS can’t come clean about their rank inability to deal with workload, then those at the top need to be removed from their posts, and quickly.
The article makes it clear that this is a voluntary request, not a compulsion. As Primary Care is free for all who attend, our only duty is to the patient in front of us. If a decision is made to refer, then it is Secondary Care’s responsibility to check if fees are required.