In 5 years time a satisfaction rate of 63% will be a distant fond memory. Primary Care is in terminal decline.
stop prosecuting GPs for “missing” sepsis.
That patient with a nasty cough you saw on Monday who died from sepsis Thursday. Did you prescribe amoxicillin ?
If “yes”, you did all you could, doctor.
If “no”, it’s GMC and possible gaol time.
The irony is that overprescribing has rendered common antibiotics useless against many bacteria, but they are a vital fig leaf defence against a vengeful, adversarial and blame/shame legal system.
It’s been known for many decades that significant weight loss, exercise and dietary change will put T2DM into remission, and trial after trial using extreme calorie control proves this. The problem is Real World experience, when any initial weight loss is rapidly reversed with a plethora of excuses and a return to former bad habits.
If these low calorie drinks are bought by patients then fair enough as they are cost neutral (they don’t have to buy food). But if they are put on free prescription then patients will rush to demand them, fail to maintain lifestyle change and still end up on expensive medications. It would be an appalling waste of scarce resources.
This insanity could be so easily fixed. If raising the thresholds for annual and lifetime allowances are not politically possible, then at least allow doctors to limit their amount of pensionable pay, instead of the “all or nothing” idiocy we have at present.
But the Treasury thought they were being so clever. After the 2004 contract had (in their opinion) given GPs a far too generous pension deal, they devised these tax thresholds to claw back as much as possible, but without thinking through the consequences. Now we have doctors slashing their hours in a recruitment crisis......utter madness and (sadly) totally predictable.
Excellent article. Another example is the push towards early prostate cancer diagnosis by well meaning, high profile, media friendly individuals, who are clearly unaware of the serious consequences of indiscriminate and discredited PSA population screening.
Re Decorum Est,
Stunning use of “oleaginous”, I salute you!
Kicking a corpse rarely produces positive outcomes, but kudos to CQC for repeatedly trying.
Didn’t think this one through, did we Matt?
I suspect his mandarins will quietly point this out, and we’ll never hear about it again
Our referrals for these services are routinely bounced back or ignored , and if anyone makes it into the service they are discharged tout de suite. So our fall back position of doling out SSRIs, then being criticised for not referring, will continue.
The result of this study will be the usual league tables and graphs from med mgmt naming and shaming high prescribing GPs who will be pilloried again.
The real answer (which will not happen) is to ban GP prescribing of strong opiates, and force Pain Clinics who initiate these drugs to keep patients on their books under a shared care arrangement (similar to rheumatoid drugs).
So, so true!!
I’ve long marvelled at the patient concept of “a while”, which is clearly a specific measure of time that is common knowledge to everyone except GPs .
“When did your headaches start?”
“A while ago”
“How long precisely?”
“Oh.....a good while”
“Is that days, weeks or months?”
“Oh, longer than that, quite a while”
“Oh no, not that long!”
“3, 6 or 9 months?”
“Hmmm, not sure, it’s been a good while though”
We should give these people state secrets, not even the KGB could extract any useful information from them. Well, they might, but it would take a while...
Ban it or can it.
Sinister details lurk behind the positive headlines.
This contract is like an onion. The more you peel it, the more it stinks.
Re Gen Prexit
“Collusion of anonymity”- wonderful phrase, perfectly sums up the pass the buck mentality of the modern NHS, where continuity of care has been sacrificed for short term gain.
Spot on. The labels “cis” and “trans” are gradually being imposed on us by the trans lobbyists, despite the fact that they have fought hard to reject labels applied to them by society for years.
Plus, “cis” and “trans” are such ugly pejorative terms, if I wanted to label people I would suggest “classic” and “nouveau” instead!
And there are plenty more recruitment sinkholes around the UK teetering on the brink. The make do and mend approach of employing non doctors to replace partners is stretched paper thin, and 1 more retirement will topple multiple practices into the abyss.
Other than his ruinous obsession with IT as the answer to all our prayers (wrong, so so wrong), Hancock has exposed the hidden agenda of a nurse led Primary Care Service. Of course, this is already in full swing as older partners are starved out whilst younger GPs wouldn’t touch a partnership with a barge pole, giving practices no option other than to either collapse or employ more non-doctors.
There is the strong whiff of expectation lowering going on here. NHSE sowing doubts that this will be a whitewash, that we will all be no better off than before, then cheer us up with an indemnity deal that is marginally better than now expected, but nothing like as all singing/all dancing as promised by Hunt in 2017.
And when Mum drags their monosyllabic miserable son back in to surgery to tell you the online CBT didn’t work (hint- it never works), what is Plan B? Good luck getting CAMHS to see them.
Increasing antibiotic resistance led to an increase in cases of sepsis. If GPs miss sepsis they face GMC/prosecution/prison. Thus many GPs prescribe fig leaf amoxicillin as a career saving insurance policy against this.
If you seriously want GPs to prescribe fewer antibiotics, take the threat of prosecution off the table, otherwise expect more defensive medicine, more antibiotic prescribing, and more deaths from sepsis.