Oh dear, it seems our foolish and uncaring actions have finally been revealed.
I too remember the "Defeat Depression Campaign" and the other big cultural push to treat pain effectively.
No data I have seen this week on how many patients are on analgaesia because:
1. they are currently waiting for a long time for definitive treatment (eg joint replacement)
2.they have been to clinic, "nothing more I can do for you, go back to your GP"
3. anecdotally, outcome from Pain Clinic is not great "nice people but I still have a lot of pain, Dr" Some great individual results but not the norm.
4. "If I take this painkiller I can sleep / move/ go to work and pay taxes/ look after my frail relative". (delete as applicable)
Sorry to tell you that they help a lot of people to function.
As soon as there is a well thought-out , accessible, effective pathway for patients who are taking opiates and antidepressants "wrongly", I'll gladly refer. I'm waiting, and waiting...
Can't have opiates, can't have antidepressants, mustn't take NSAIDs, can't have "gabapentinoids" : we are entitled to some defence and clinical leadership here.
I have just come back form visiting family in USA.. I was horrified to see complex and poweful meds being advertised to the public on TV: " if you have joint pain and your golf swing is worsening, go ask your Physician for Etanercept" WTF. We have a lot to be thankful and thanked for!
Rees-Mogg is just a caricature and the less oxygen of publicity we give him the better. The sad thing seems to be that he lacks self-awareness.
I’m still not convinced of NHSE’s overall commitment to us. Deep down they would like to be rid of us in a scenario where we get the blame (like with the dentists)!
Hanging on to us with minimal financial cost to them is a reasonable transitional place for them to be.
Compared to other professionals we are still
cheap and VERY institutionalised.
If this helps to case-find within the “lost cohort”, then bring it on. They have little access to GMS at present: a ticking cardiovascular time bomb.
If this leads to an increased workload, it will be something that the NHS cannot deny as they arranged the programme.: ammo for an uplift in resourcing.
“Have” not “gave”
Right on there, Terry! Until we press our advantage, our conditions and the resulting service to the patient will not improve. Our folly in this respect will be our own suicide note. ...and let’s gave a televised debate with the Daily Mail... they would sh*t themselves.
I was guilty of this. As a partner, we hired salaried colleagues. One was very astute at managing her role and arrived after us in the morning and left 2 hours before us in the evening. We were faithful to her workplan and respected her careful if slightly Teflon commitment to "our" patients, who she didn't seem to engage with as "hers". It was comical to witness how she shirked visits.
The other was keen on partnership but seemed to change his approach as soon as we invited him to join us and burned out and was suspended by NHSE within 12 months.
This is not a scientific sample but we learned and hired partners at all times from then onwards.
Now the practice is run by a corporate and we have all long since left: just about to be passed on to another keen Ltd company owner without any useful look at the crap DGH and huge number of NH beds or poor CCG funding which remain unaddressed.
I would recommend CBT for anyone turning up right now for a partnership interview. New models yes please. Current model is utterly wrong for 2019". The BMA are clinging to it for lack of creativity or lateral thinking.
Still nothing like what it will take.....tokenism. I perceive we are being written out of primary care..perhaps one or two GP clinical leads in each mega-centre. For the rich it we be a totally invisible private GP network. Perhaps we can assuage our guilt with doing some Charity sessions OOH or in A&E. If the NHS tries to keep us on board with a bitchy revalidation package, then that will be a luvverly court case for the Competition and Markets Authority to pay for . I won't expect BMA to take a position as they are useless!
I heard that the shortage is financial: the NHS plays hardball due to its sheer volume in the market and three outcomes are related to this:
1: there is more money to be made by uk manufacturers by selling to those paying a better price.
2: wholesalers are under no professional or contractual reason to promise a supply to the NHS
3. Some faithful meds are no longer profitable to make: some have been designed to be expensive to manufacture to keep the generics houses at bay when the patents expire.
As usual, led by donkeys.
Bring it on. Chambers for the brave, Salaried drudgery for the meek. Either way, costs will go up and productivity will go down. We have already seen this since 2004 when the motivation to "get it all done before we go to bed" changed into "ask them to call back at 6-30pm" I've done both.
..and still, no-one seems to understand the way we hold it all together when every one else walks away (secondary care, Social Services, Paramedics).
..what interesting times.
I still don't feel that this is anything like a big priority for the self-interested Westminster-bubble brigade. There are so many weaknesses in the public sector now: I think the Govt and Civil service is quite bored with us asking. If you fall behind in a race, you end up walking. If this is ever seen as a priority, I know that the govt can fix it quickly if it is motivated. Sadly all of these changes (PCNs etc) are designed to appear to be improvements but are actually cheap and slow and will be too late.. a bit like the NHS.
Just listen to the think-tanks..."In any case, as with all the levers for supplying and retaining staff, urgent and concerted action is needed if the NHS is to have the number of staff if needs. With that in mind, our report with the other health think tanks reiterated that staffing is the make-or-break issue for the NHS in England – setting out a series of policy actions that, evidence suggests, should be at the heart of plans to address current and predicted shortages."
Nothing useful in any of the new contract changes that I can see: the Morris Marina in 1981 gets a facelift but under the surface it is still a Morris Minor from 1948: a bit nerdy but such a close analogy. What happened to British Leyland in the end? Do we miss them?
Too early to tell about Matt. However, Simon Stevens has started to grow on me...watching the Commons Health Select Committee I was shocked to find that he seemed to be talking sense and I had to turn it off as I started to like him. My CPN will be coming later..
I did an audit for my appraisal (yes I know, a bit geeky) about return trips. Once a patient has booked for one problem (even if it has resolved), they often "extend" the agenda and what with some medicolegal bloods or xrays and wanting "to see the Dr to discuss the results", they will have a foot in the door for probably 8-9 contacts in the following 2 months. Outcome rarely any pathology and a lot of resources used. Now that a GP appointment is a golden ticket not to be wasted in the eyes of the patient, it is inevitable that they don't want to miss a chance to "discuss everything I can think of".
Working now as a sessional (pension maxed-out and 25 years of GP partnership experience behind me) I can observe by comparing Practices that this monster will not be tamed unless access calms down a bit. When a practice has "a spontaneous availability of appointments" and the locals are not anxious, then this behaviour rarely happens. I hope that our new (and welcome) colleagues (PAs, Pharmacists, ANPs)will help to calm appointment anxiety. Hope is sometimes all we can have!
Price Waterhouse Coopers... why do I suddenly feel more anxious about this...oh yes, they really messed up with Carillion!
I agree that we should choose our battles carefully and this one seems lost.
If I come across a urology letter with specific PSA advice then I just add an alert onEMIS.
I reckon that about 20% of my pathlinks inbox requires me to “contextualise” by looking into the notes: most lipid and Hba1c results require this.
I think this more about recognising that Pathlinks and Docman are real work and not a bit of a hobby to check “when the real work (ie surgery) is done for the day.”..
I know of one practice who outsource this work via remote access to a part time GP who works from home... we need to measure and seek recognition for this work as a key part of primary care, en bloc, not piecemeal!
Running out of money not "menu"... sorry
I work for Primecare as part of my portfolio after leaving my partnership. A group of us made a tentative bid for OOH in 2016 but withdrew once we identified the moronic underpricing and the "disqualification if the tender bid exceeded a maximum figure".... It didn't fit the outside world's definition of a tendering process! We estimated running out of menu 2 years in.
It takes 2 parties for a contract like this to fail: inappropriate price-fixing (the NHS's epic fail) and a Zombie company's inappropriate optimism. All they need to do is to meet up on a blind date and this is the neglected baby that follows. https://www.economist.com/britain/2018/06/28/britains-outsourcing-model-copied-around-the-world-is-in-trouble
Oh and by the way, the 2004 contract does not pass this responsibility back the the GP when it fails but it was worth trying to bluff it to hide the CCG's failure here! Ha!
Would I go back to partnership? Just 2 things: LLP and respect from the NHS about our true value: not just the financial one but our clinical and organisational contribution to the NHS which is never acknowledged or respected.
Like many of you, I have worked both sides of this. Locum work is easier generally, and a welcome pleasure compared to partnership. every time, UNLESS you are deliberately (and disrespectfully) overbooked. This is rare in my experience. I try to work in familiar practices and I think this means that I also bring some added value as I understand I will likely be seeing the patient again.
If you're reading this, HMRC, yes I have used your IR35 online tool and I'm OK, so b*gger off.