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.
..this week's fresh excuse for not investing in Primary care!
Top marks to alanalmond:right on the nail :"claiming the CQC is some how responsible for the fact that 96% of GP practices were fund to be good or outstanding. They were already"
..at least they have openly stated that "now we know we can invest in primary care"....quick, someone in the DOH needs to come up with another (expensive) delaying policy. Sir Humphrey, get on it right now.
..so another thing we "mustn't do". I hope that our clinical betters (those amazing hospital and pain clinic docs) will stop asking us to prescribe them.
It wasn't long ago that they were the answer to opiate overuse (also a mortal prescribing sin..)
As a frontline GP I would say that they seem generally useless for chronic neuropathic pain in a majority of cases altho the few who find them helpful keep me trying for a few weeks with every new case.
I don't mind if Nurses are to lead on gatekeeping, but secondary care will feel the result of this. If someone with an annoying NHS lapel badge would like to say my 30 years of hard lessons was pointless, then I will train as a plumber after all and gladly leave you all to get on (better) withjout my stupid interference!
Meagre money, spent on the wrong plan. Sir Humphrey strikes again.
If they want GP at Hand and Practices fail: so sad but so be it. At least it becomes their fault. We warned them. The patients have an entitlement to Primary Care from their CCG: if they can't procure this via local contractors they get the final corporate manslaughter wrap....stop propping them up. The hard bit is stepping away, especially in a last man standing scenario. I did it and I now sleep well! Stop feeling responsible. Some CCGs really understand this balance of power. If they do, stay put and it will be fine. If they don't, walk away and come back as a sessional on double pay. Take control of your work / life/ responsibility. You are supposed to be smart for g*d's sake....
Great news: on one hand we are told that there is a demographic tidal wave of deserving frail elderly for whom the government made no plans and who are unintentionally drowning the health and social care system, and now the answer is to give immediate access to commuters who might have an illness that Pharmacists can (and always could) treat.
Having watched some episodes of "yes minister" on holiday recently, I thoroughly support the establishment of a special committee to look into this in detail to make sure of course that nothing happens. This tried and trusted method has happily facilitated the current status quo for 60 years.
Under govt procurement rules, Matt Handjob (I like his new epithet!), can't just appoint a single provider like Babylon anyway....not without asking G4Stupid or Crapita to put in a suicide bid, too..
It would be fun if he did put non-existent money into this and all the NHS finally folded up due to another dumb*ss government decision. This after all is where the blame lies.
Sadly, how demoralising though that our new Health and Social Care minister is ready to change things despite showing no realistic insight into what we actually do all day.
To paraphrase Sir Humphrey: "the trouble with politicians is that they are looking to do something, so if something can be done, then it has to be done even if it isn't the right answer"
Time to emigrate!
...just to add, I'm not a nerdy locum. I picked up a few scars dragging my partners huffily from Lloyd George to paper light about 20y ago. We were all surprised by the gain in productivity (yes more income from dispensing and claims and then QOF 5y later). But yes, I also wasted evenings and days off sitting through some utterly stupid local NHS IT initiatives so there is no blind evangelism here either..
I work as a GP in England and Wales each week, and for 2 separate OOH providers each month. I waste what I would estimate to be about 1/3 of ALL f2f time trying to clarify information about recent and past healthcare events for each patient. What is available on the "spine" is almost useless, I find and on mobile shifts there is no smart card reader provided anyway. In hours, the communication with secondary care is almost nil (consultant answerphones permanently switched on , and never after 5pm = GP evening surgery time).
Yes the new Minister will not solve everything with just an IT revolution but in the real world we are not going to see any extra GPs for at least a decade.. It feels like we have a moral obligation to help stop wasting GP appointments with things like " I had my scan 2w ago (and although the consultant booked it anyway.....let's not bother with that line again today) and I have come to discuss the results with you" .....pause, patient looks crestfallen and then "as I'm here we could talk about that crinkly bit on my little toenail that is going to engulf my family" ( according to the TV advert...) And then mission creep rolls on to another avoidable sequence of poorly used GP appointments.
When GP IT systems started in the 90s, we went through a serious "interoperability" process to make sure we could do stuff like QOF in 2004. Please Mr Minister don't wreck the worlds biggest consistent and validated healthcare database and don't alienate those of us who gave our spare time to support things like primis.
I have tried to send this to the doh but I could not find a way to contribute yet via their website. Hmmm!
I don't care. People still get sick and I'm still a Dr. It's way out of my sphere of influence. Our service is cheap and I suspect will only become more valued. win:win :)
I will quote Captain Blackadder when asked by Baldrick how the war started: " There was only one flaw with the plan. It was bollo*cks"
I've left my partnership, too. What a pleasant feeling to focus on clinical work and not worry about CQC or sit through fatuous GP Parliament meetings any longer. Hurrah!