I get the sinking feeling that this report will be splashed across the news with the usual GP scapegoating, and league tables to name and shame beleaguered practices.
Increasing Pain Clinic provision will only lead to more opiate prescribing dumped on GPs after single consultation and discharge.
The ship has sailed for those patients already consuming/selling their gabbies and opiates, trying to wean them off is maddeningly futile.
The real toughening up should be on new patients. Ban primary care initiation of CDs for chronic pain, if initiated in secondary care then keep on a “shared care” basis rather than discharging back to GP. That will focus the minds of our hospital colleagues, who will drown in follow up patients if they don’t drastically cut prescribing.
Hypochondriac - “Why don’t you just put me through a total body scanner every year?”
GP - “Because we might kill you trying to find the terminal illness you haven’t got”
If the 6 month rule is lifted, GPs will be inundated with speculative requests for a DS1500 from huge numbers of COPD/HFailure/(insert your chronic disease here) patients, many of whom are far from “terminal”. You either refuse (and endure the wrath of the entitled), or you waste many happy hours form filling.
By all means educate GPs that end stage chronic disease needs a DS1500 just as much as terminal cancer, and that our judgement will not be held against us if they live longer, but please don’t make our lives a misery by scrapping the 6 month rule.
Excellent article (as always).
There is a current vogue for discharging surgical patients with a bottle of oramorph and an expectation from these punters for more from their GP.
This oramorph madness has spread to A&E discharges, especially for unexplained abdominal pain.
Even children are being sent home on tramadol, codeine et al.
And don’t get us started on Pain Clinics, who have given up any meaningful intervention, just a cheery note to titrate up the opiates and pregabalin, and goodbye.
This breathtaking nihilism from secondary care is crushing our King Canute efforts to stem the tide of analgesic pharmageddon. Sadly there will have to be many more avoidable deaths (and sued GPs) before any meaningful action is taken.
We have to be careful that GICs don’t become the next CAMHS car crash.
For years we saw raising of awareness to encourage children to come forward with their mental health problems, only to find that CAMHS was so overwhelmed that they now routinely reject nearly all of our referrals , leaving GPs as piggy in the middle.
With trans issues benefiting from far more publicity, there is the inevitable rise in patients attending GPs for referral to GICs. If there is no improvement in GIC provision GPs will be stuck with the problem yet again, with nothing to offer people with raised expectations.
And if the authorities think they can dump all the donkey work on GPs with a “shared care” protocol, think again. This is a highly specialised (and controversial) issue, requiring expert secondary care. No GP worth their salt would touch it with a barge pole.
Hang on, for years now we’ve been hearing that QOF is to be scrapped.
But now they’ve stripped out the easy stuff and replaced it with yet more pointless box ticking time consuming tosh for the same money.
Thanks for nothing.
Other than bigoted entrenched hardcore homophobes and unreachable religious fundamentalists, the vast majority of society isn’t the slightest bit bothered about anybody’s sexuality any more, so put your husband’s picture up with pride. The final phase of acceptance is when people see a person, not an LGBT person, just a person. Perhaps the best way to achieve this is NOT display rainbows and trans flags or go on marches (thus emphasising you are some how “different”, which you are not).
Between the Wild West of the 20th Century (when you could in theory go a whole career without any education) and the infuriatingly pointless annual colonoscopy we suffer today, there was a brief period of common sense appraisal in between.
You would collect certificates from a few meetings and wave them at your appraiser, briefly discuss your future educational needs, then a longer chat/moan to see if you were coping with the job.
There were no online torture chambers, no meaningless “reflections”, no long lists of probably unachievable goals, no week of madness uploading certificates and typing endless drivel that nobody will ever read.
For the love of God, RCGP, please end the madness.
Here’s an idea. Why don’t experienced GPs assess, investigate and treat individual patients appropriately using the knowledge acquired from their expensive education. I know, I know.....totally crazy, it’ll never catch on.....sorry.
Neil Bhatia is bang on.
If the “6 month” rule is lifted there will be a rush of speculative DS1500 requests which (apart from a huge increase in our paperwork) will have a sudden massive financial impact on the already inadequate benefits system.
People are told to request DS1500 precisely because they are terminal. They already know this. There is more of an issue with non-terminal patients making an inappropriate request, which I happily decline with a breezy “That’s for when you’re dying, and I’m glad to say you ain’t dying yet!”
And if someone is palliative we should be happy to complete a DS1500 even if we think they may have more than 6 months left, because none of us have a crystal ball. These patients can pass within weeks if (for example) they develop pneumonia (especially for extremely unpredictable conditions like MND).
The slightly trickier ones are cancer patients undergoing potentially curative treatment who may be struggling financially. If they request a DS1500 I explain that it is designed for patients with less than 6 months to go, reassure them it probably doesn’t apply to them, but fill it in any way on the grounds that cancer therapy is notoriously unpredictable, without stating definitively on the form that I expect them to die soon, and leave interpretation to the department dealing with DS1500........nobody has ever been turned down.
We need a sensible compromise and the current system (whilst not perfect) gets it just about right. I know some people find the decisions uncomfortable, but GPs pride themselves on making these tough calls, it would be a disappointing dereliction of duty if we duck this one.
Anyone with sense will tick the box with pointless meaningless risk-free reflections, (such as that complaint when you refused to issue diazepam 2 weeks early, or learnt a valuable lesson when the fridge temperature dropped a degree) rather than mentioning ANYTHING of substance that could return to haunt you in future years.
Treat it with the contempt it deserves.
The picture accompanying this article is remarkably similar the the My Iron Lung EP cover.
Nitwits Ignoring Clinical Evidence.
These are the clowns who tried to impose FeNO testing and comically ignorant diabetes guidelines on us recently.
But whilst we all laugh at and ignore their “cost effective” demented nonsense, the truth is that these deeply flawed dictats may be used as evidence against you by your local friendly GMC one day.
Depressing and terrifying in equal measures.
Look, we were effectively forced into networks (all the new money is attached to them), how many of us would have joined voluntarily?
Our negotiators failed yet again to have money put straight into practices, so now we have to squeeze another hoop-jumping meaningless meeting into what used to be called our “lunch break” just to break even.
These layers upon layers of expensive and useless bureaucracy eat into precious clinical time, and keep GPs away from their patients.
Please don’t try to dress networks up as a brave new world, we’ve seen too many of these ruinously redundant reboots crash and burn over the last 20 years and we’re thoroughly sick of them. All of them. Just leave us alone....please.
“Your HbA1c is 100. Just to let you know, I’m here for you”
“Oh. Aren’t you going to prescribe me anything?”
“Nope, no need, I’ve checked the research, just know that I’m behind you all the way. I believe in you!”
“Errr, cheers Doc, but I think I’ll see the Locum next time”
Whilst this is FINALLY getting some band width on national media, I doubt there will be any action.
Listened to a radio phone in where call after call consisted of people slagging off overpaid lazy GPs.
15 years of brainwashing with this stereotype has closed the minds of the public to our plight. The partnership purge will continue as planned,
No vaccines = no school
This must be why CAMHS is such a fabulous service that is easy for GPs to access. Job well done.
I can’t take this any more. Pass the pregabalin......mmmm, that’s better
Doctors in secondary care are already cutting sessions and refusing extra work.
Some are even considering setting up limited companies for these extra sessions to avoid the AA trap.
Either way, it is insane. As soon as these senior doctors saw their first massive AA bill they either cut work or starting dreaming up ways around it.
Did HMG think they would happily do extra work (effectively) for free?
If HMG don’t change the rules they will either face (another) workforce crisis or financial meltdown shelling out to limited companies charging whatever they feel like.