One million appointments a day not enough for the DoH?
..methinks it is time for them to rethink the model entirely. You just CAN'T HAVE ANY MORE, and that's it. The UK public purse can't afford it, you haven't planned for it and you don't respect what you are already getting. Stop bragging about your NHS at the hustings and to your sniggering international mates, and accept that it should be in the history books and not the newspaper.
... and if you're worried about your pension, you will be fine with a Private Pension regulated by the FSA and funded by twice your current income rather than a discretionary one bugger*d around with by a politician every time they are trying to show off to their neo-lib cronies.
I have been asking around for a while. A chambers model would be fine. It would unite and engage those thinking of leaving and set a firebreak between any NHS contract and our fitness to practice. The NHS just becomes a customer and the Chambers members take their own steps to remain revalidated. This finally removes the obligation on GPs to be "Health Economists, Auditors and Rationers of the NHS": these are the nasty parts of the GMS contract and we are not trained or qualified to undertake these roles. It just drags us into confilicts of interest and collusion when dealing with NHS crises not of our making, and not in our gift to fix.
This is a LES. This should be negotiated and priced. The CCG will not be able to afford this, unless it transfers money back from secondary care to fund it and Primary Care can find the staff to do it. We aren't playing golf you know or having "admin sessions"!
Another sad but familiar reinforcement of the divide in the NHS: each thinks the other is not working as hard as they are.
Why don't we point this in the right direction: a failure of central, forward planning by PHE, the DoH, the Audit Commission, the ONS.
Treliske Hospital should be punching up not down (actually I feel it is "across"). Grow up. Time to recruit some proper clinical leadership at the Hospital if you don't mind!
We need to demonstrate some self-respect and tell them to f**k off. Anything less is too ambiguous! We are in short supply, we are cost effective, actually really cheap, and the voters love us... why is the DoH so dumb to treat us like this?
This govt is in the best position to absorb nasty shocks right now as it has this trumpeted majority. Take action now, and this will give them time to fix it, allowing time to absorb lots of sh*t from us, and will still give them room to polish some turds in 2024-5.
PCNs are not the answer to our woes. No meaningful ^resources or, to balance this, any limits on our workload.
Just say no. We are in a very strong bargaining position, by their own description of the NHS Crisis.
Patients (Voters) hate the Cattle-Market ethos of supersurgeies: interestingly so do the clinicians.
Perhaps we should start this rebellion in the North where, at long last, anything that sounds like unrest is met with funding and platitudes!
..in my practice we used to do a visit to all of out 150 patients at NH/RH homes each week: a full day, 40+ contacts. Worthy work, the sickest patients, but our other GMS backlog spiralled out of control and then we couldn't recruit. All of us have left that practice now. Fund it properly....!
I have just listened to a podcast by Patrick Deneen who cheered me up by saying that the "neo-liberal world" wishes to structure, enforce and report the actions of those who work in vocational professions in the mistaken belief that it is necessary and will generate better outcomes. He made it quite clear that this is misguided and patronising and does not help the morale of those same professionals who don't need to be cajoled and who, given the right conditions (ie time and resources), know exactly what to do anyway. Sadly reassuring but very validating when we look at these sort of sudden contract changes.
.. no I didn't dream it (BBC News 19.12.19): "the government says it will enshrine in law a commitment on the health service's funding, with an extra £33.9bn per year provided by 2023/24."
..and I'm upset to hear today that the "big" NHS funding rise might not be until 23-24 (ie in the run up to next election), and if we have the predicted recession, then "prudence" will have her way again... I think we have just been conned by the manifestos again. Oh cr*p!
In 2004 some of my colleagues thought we could become chronic care centres. Good try! Acute non-life threatening illness is however still GMS (GP and OOH). These patients should not go to A&E. A&E should not be accepting them at any time, and the tariff fee they claim for seeing them should be given back to Primary Care as part of annual funding settlements. I sympathise with both: A&E are still seen by patients as the final pathway regardless of illness type and most AEDs don't have the skillmix to do GMS properly or defensibly. They certainly don't have a CCT for this. Back off. If these people need to be seen for these illnesses, GMS (incl OOH) needs to be resourced for them. ...not going to change, I know. A&E see I think 90,000 per day, GMS see 1m. A percentage uplift in the latter gives a lot more capacity very quickly. I have been criticised for an unpopular opinion: no more ^funding in NHS until historical farces like this (which are a huge waste of money) are settled forever.
3 issues: 1. technically the data belongs to the DoH. 2. I agree that detailed med records are as good as dental records for identifying an individual if used for the wrong purposes. 3. The UK GP records are the world's most accurate and comprehensive data set on the planet (READ codes, QOF, QMAS etc) and we should be using them more (in the right hands) to plan and deliver good care. I have always been concerned that they are rather like a set of accounts for a corner-shop up for sale. If I were a BlueChip insurer I could use them to assess risk and market margin if ever I was asked to take on providing NHS care across large chunks of the UK. I'm not sure if that is good or bad.
@ Merlin: I agree 100%. I also do daytime GMS and OOH Car Visits. Nothing wrong with visits: a big opportunity to turn things around for our most vulnerable patients, BUT in hours(like most of a GMS day)it is not prioritised and the time allocation has become really stupid and inappropriate. Please don't ditch this valuable insight into the full perspective of being someone's GP.
If we lose this, we will be running out of reasons to exist. I know I am a dinosaur and I voted against dropping OOH. We played a big part in the collapse of A&E depts as a result from Nov 2004 onwards and lost a lot of professional standing at the same time. Yes, I know: on call was unpleasant and tiring but we made hade it crappy for ourselves by loading our on-call by joining up with local practices for the maximal denominator for nights-off. All we needed to do was to price-in a full day-off the next day. Hate to quote Donald Trump but "really dumb". We have stumbled blindly into undermining our status and can only blame ourselves! I'm 55 and now have a very happy portfolio career to make up for the damage you voted for along the way. I apologise to my successors now: you will never know the real (and sometimes exhausting) joy of being a family doctor. Unless you are "in this zone", you will be contstantly thinking: "well never mind, only 69 minutes before 111 take over.." :(
I have provided mentoring for 3 practitioners in the last 3 years, for "prescribing status". Whilst the clinicians involved were dedicated, hardworking and keen to learn, I realised that the syllabus has many short cuts and assumptions and there is some collusion between th professional and academic bodies involved to "get this pushed thru". In their own words, the clinicians involved (senior Practice Nurses and a very motivated Pharmacist) repeatedly expressed their concern that prescribing is just part of doing a clinical assessment and that a knowledge of the BNF in a chosen field is NOT the same as hours in face to face consultations with peer review. I admire and value their contribution but there is a rush to "release them into the wild" and they and their patients are perhaps more vulnerable than they should be as a result. In my practice(s) I always build in review time and impress that being "immediately interruptable" is part of the evolving role of a GP in our new PCN/ Multidisciplinary world. Practices who employ such staff need to prove in the Job description and to the CQC that these Practitioners are not to be shoved in a Consulting Room and expected to "get on with it regardless" of their knowledge gaps. I still have some of my own gaps after 30 years. It's about HOW these clinicians are employed and how much support they are given day after day.
As many have said before, if they really wanted to fix General Practice they could do it easily. It's just not high enough on the agenda of "voters' national consciousness" to be worth the spend. Small, cheap gestures which will easily be misquoted against us by the Daily Fail if we moan, and not enough to make it worth the misery of carrying on for those of you still in the NHS GMS harness. I still don't feel they 1. will ever understand the merits of what we do and 2. truly give a sh*t! As lkong as we have Cardigans we will not seek a better deal for our profession, and as a direct result one for our patients.
I am outside the NHS now: I do a lot of work for but not in the NHS and MoD and I do what I like with the proceeds including investment. As a 55year old I am grateful for a disincentive to hold down a regular NHS post as it makes it easier to justify my choices. My NHS pension pot has reached that place where it is not a good place to put more money. This has driven me to free up my aspirations: now working on a start-up. I would never have considered this if I was still grinding away in a sh*t partnership post. GET OUT NOW.
Very brave guy to go on the Telly repeating what they failed to do last time around.
I'm not interested. He has no chance of getting any of this done as deep down GPs are still not taken seriously by the NHS / DoH. Labour thinks we are capitalists (self employed, small businesses), Tories think we are lefties (worrying about the poor and trying to stand up for them).
Voters like us, so it is worth pretending to improve something they can see every day, just like potholes and broadband. The latter hasn't got very far either.
Probably won't be mentioned again for another 4 years.
@d in vadar : "Its all about holding on till you either retire, move abroad or accept salaried work or leave and go private like the dentists"
I agree 100%. There is much more of a resigned, transactional relationship with patients at the frontline now: they don't care how it is funded or owned. "I just need an(y) appointment" and in my experience they don't even notice whether it is "my own Drs" (seems to be in name only nowadays..!) a drop in, extended hours, OOH service or a managed care organisation like a PCN.
I think we overstate our model sometimes. Very few patients have had a close, longterm relationship with a particular GP for years. The elderly miss it, but it will never come back now. End of.
Unless the staffing levels are sorted and clinicians have a chance to influence care delivery, it will all deteriorate further and we Brits are too pathetic to speak up.
CQC can always follow their advice to the safest outcome if they are so truly concerned: shut the practices and then they can take the corporate manslaughter risk that follows.
In my current role, I have seen the before and after scenarios: call their bluff, it is great to see their slow and painful realisation of all the work that was being done for free but at great personal cost and just how expensive it is to re-comission it from locums and salaried GPs.
If you can personally afford to walk away, it is a life-changing experience and VERY validating. Recommended on (NHS)Trust Pilot 5 stars!