Same thing is happening in North Staffordshire.
Some community beds are already closed, other beds are subject to "consultation".
I previously worked as a partner in one practice for 30 years, more recently as semi-retired locum in the same area, so have the advantage of being able to look at the bigger picture over the last 30 years.
Although most patients would prefer to be looked after at home this can only happen if their are sufficient resources allocated to primary care which requires more GP's, more district nurses, more "other professionals" including physio's and OT's. Just as importantly more resources, ie money for social care.
Working as a locum I can clearly see that most of these boxes are not ticked locally, and in particular there is a big shortage of GPs and district nurses.
I do feel that local CCGs sometimes need to represent the ordinary GP "on the ground" and instead of trying to rush through cuts to community beds, make it clear to the government that present resources don't allow these changes to be made so quickly.
I also have recent first hand experience of my own mother being discharged from hospital directly to home (as was her wish). Fortunately I had a gap in my locum work, so could visit daily. If I had still been a GP partner my old practice would have been even more stretched due to the temporary loss of one partner (me) due to caring responsibilities.
I think whether we like it or not general practice (and the NHS more generally) is increasingly staffed by part time colleagues both male and female. How many times have I phoned the hospital or emailed the PCT/ CCG over the years only to hear an answerphone message which says "I only work part time etc. please phone another number" or alternatively (most recently) "I only work Tuesday to Thursday, please email somebody else", only to receive an automatic email reply which says that the alternative "somebody else" is also not available/ works part time etc.
I am 58 year old male who started out when most GP partners were full time and male. Those days have gone and I think all of us will have to accept that the majority of younger colleagues will expect to have more protected and limited hours of work than used to be the case. The junior doctors' strike is probably another manifestation of this.
The end result is that the NHS will need much better workforce planning AND will cost the tax payer much more to run.
I'm not very optimistic that NHS human relations are up the job and I very much doubt that Nigel Farage's £350 million will make much of a dent in the likely cost.
I previously took 24 hour retirement end of April 2015, retired from my practice end of July 2015, but have continued to work as a locum.
In spite of submitting my AW8 form in good time my lump sum was paid late, and to make matters worse was paid into an account with a bank where I did not have an account.
Fortunately the sum of money was not accepted by the bank concerned.
In spite of complaining I never managed to get to the bottom of what had caused this error to occur.
It was however clear that there was a great deal of room for error since my pension application required to fill in an AW8 form in paper format, the contents of which (including bank details) were then entered manually by one of the officers at the local PCSS Contractor Payments office, before the details were then passed on to NHS Fleetwood and subsequently to Equiniti in Crawley who eventually make arrangements for the lump sum and pension to be paid.
So my advice is to apply in very good time and also keep on the case; ie phone NHS Pensions as often as is needed.
PS I also agree with Dr Swinyard that the majority of GPs should add their details to these posts, DON'T HIND BEHIND ANONYMITY, unless of cause you have something to say which might in some way prejudice your position in the practice where you are working, which would probably be a great shame if the doctor concerned doesn't feel he/ she can speak openly.
The same applies when I read my local paper where the longest letters often end with "name and address provided".
I can remember bringing up this issue ? 2 years ago when I was still working at my old practice as a partner. I had recently attended a meeting hosted by our excellent local osteoporosis consultant who explained her guidelines for treating vit D insufficiency/ deficiency etc.
At the time I said to one of my colleagues (who was the practice osteoporosis lead) that there was a danger of over-treating many patients who are vitamin D insufficient simply on the basis of a blood test result.
Setting aside the elderly/ frail/ housebound who are clearly at risk of fractures I now see that my prediction is coming true.
It would be interesting to see what happens to the same patients'vitamin D levels if they were retested in late summer following a sunny Mediterranean holiday.
At the end of the day we live in a country which is grey, dark and wet during the winter months and when I was previously working as a partner I sometimes hardly saw the light of day between 7.50AM in the morning and 9.30PM at night.
Perhaps I should test myself!
I have recently retired from my practice at age 57 having completed 30 years as a GP partner.
I had previously intended to continue as a partner until age 60.
The main reason for retiring was in relation to workload and in particular the increasing amount of non-patient contact workload.
When I first started as a GP this probably amounted to 20% of my work; at the end it was 45-50%.
One part of this huge increase in electronic "paperwork" is the filing and actioning of blood test results which arise from NHS health checks and other "screening" initiatives.
Some of these initiatives have an uncertain evidence base and more importantly take little account of the resources available in primary care to deal with the consequences of screening.
ie number and availability of doctors, nurses and health care assistants, availability of appointments to discuss the results of blood tests with patients.
Towards the end of my time as a partner I would sometimes end up sitting in front of a computer until after 9PM dealing with test results, DOCMAN, hospital post etc.
I think this type of initiative needs to be looked at in the context of the bigger picture; ie young GP's voting with their feet by not opting for a career in general practice.
Another Bennett, no relation, but I do think that I trained at Manchester about the same time as Ivan.
I don't intend to comment about the research evidence for offering statins at 10%, 15% or whatever, but prefer to reflect on the day to day consequences of this type of target.
Having recently lost the argument with my colleagues about adding an HbA1c to the list of blood tests we already do in relation to our longterm condition patients I now finding that I am receiving more and more slightly abnormal test results which take time to action, require repeating or a letter/ telephone appointment with the patient concerned.
My practice age profile is already heavy with the workload arising from an elderly population, many in care homes, perhaps some who have been enabled to live long enough to suffer from dementia which wouldn't have been the case in previous generations.
Has anybody looked at the long term comsequences of prescribing statins and whether or not there is a downside healthwise in other directions?
Lastly having been a partner in my practice for 30 years I find that we are now finding it difficult to attract new doctors, as are other practices in Stoke on Trent. Does a newly qualified GP really want to spend all his/ her time filing/ actioning results of blood tests, discussing statins endlessly with (mostly) sceptical patients?
I am retiring at the end of July, but will continue to work as a locum after that, hopefully freed from the strait jacket of the worst aspects of NICE, QOF etc.
I already provide good quality typed/ not handwritten/ scribbled reports when asked to provide information for ATOS/ DWP etc.
I also sit in front of a computer sometimes until 8-8.30 PM completing the rest of my work. So not much blood left in the stone to suck.
I am also a member of the public who can be sympathetic to those patients who are genuinely in need who sometimes go against my advice by attempting to return to work against medical advice, sometimes losing benefits which they would have been better continuing to claim.
On the other hand I am less sympathetic when I receive a letter from DWP about a patient who is receiving ESA who I haven't seen for 2 years, who isn't on any medication, who I wasn't even aware was on the sick. Or the patient who claims not to be able to bend/ walk etc. who I then see shopping normally in the same Aldi as me.
At the end of the day we all do occasional supporting letters, but in general terms I feel it is generally best to answer the questions on these forms using the information contained in the medical records (or my own knowledge of the patient's case) instead of being spoon fed the "right answers" to questions by third parties such as Citizen's Advice when I am really in no position to be able to verify what I am being asked to say.
I don't think a blanket refusal to provide further information is likely to be appropriate. However also agree with other contributors who correctly point out that these reports aren't a statutory part of our contracted work.
So at the end of the day I will continue to use my common sense in these matters.
There's no easy answer to this.
On the one hand I have patients who don't know how to work the system, end up losing benefits because they don't know which box to tick, how to answer questions "correctly."
On the other hand I am receiving requests for reports from DWP/ ATOS in relation to patients who I didn't even know were on the sick who are perfectly capable of working.
I've been a GP for more than 25 years and this is a political nettle that the present government has had to grasp because of the financial melt down.
Either way I don't agree with the BMA that I should complete a form for every patient involved in the process. We already have enough electronic boxes to tick!
Sometimes I do wonder why I pay my BMA membership?
nothing new about this. the main reason for the low uptake is that the midwifery community are refusing to jab patients on the grounds that they haven't the time/ resources or aren't trained to do.
the same thing happened with swine flu.
at the end of the day good immunisation uptakes are only obtained if the clinician who sees the patient face to face is willing to explain/ persuade and finally put good advice into action by jabbing the patient there and then.
money isn't the issue. I'm sure my practice would willingly forego the immunisation fee if the midwives were to jab the patients on our behalf.
interestingly the present whooping cough outbreak may be a legacy of the poor immunisation uptakes in the early 1980's when a well respected but misinformed MP in Stoke on Trent raised a great deal of anxiety about the safety of whooping cough immunisation in the early 1980's.
I've still got a cassette tape of a child with whooping cough which I used to play to reluctant parents at the time.
Dr AG Bennett GP in North Staffordshire.