well done, Lostthewilltolive and all the other Glasgow GPs who have chosen not to continue to prop up a dangerous service. No doubt it is a combination of underfunding and poor management. But what is happening there quickly is just happening to the rest of us slowly.
Proper funding would solve all of these problems - it's just that HMG don't understand or value general practice and OOh and will sit back and watch it collapse.
An absolute nightmare, a glimpse of the future, and the beginning of the end.
Strip all the Specs out of the PCN DES - including extended hours - and make them all separate DESs, all funded with real not imaginary money. Make the PCN DES only about collaborative working.
Our contractual ‘duty to cooperate’ conflicts directly with our Data Protection responsibilities. Who will share personal information with us, knowing that an untrained unregulated social prescriber they have never met has pretty much open access to their medical record? Or any other member of the future PCN? In Germany the patient record is still Sacrosanct, a fundamental pillar of trust between patient and GP - and it should be here as well.
I bet the Queen’s NHS medical Record isn’t being shared like this, or Boris’...
GPC: get yourself priorities straight.
Ditch PCNs and insist on negotiating more money into the core contract - but for no more workload. Core contract is woefully underfunded and that needs sorting out. Tell NHSE if they don’t agree we will all work to safe numbers of appointments, and send everyone else to A&E.
Sort out reimbursement for unsustainable rises in service charges; sort out estates generally.
Tell NHSE that only when they find 10k more front line WTE GPs can we talk about extended work roles like PCNs, and will be willing to negotiate more funding for more work.
PCNs are a five year plan to end the Partnership Model and replace it with a Hospital-led PCN system.
NHSE's vision of the future is an obligatory AI front end, an options for Babylon-like video, and a trip to hospital as the only three options for care.
GPC have negotiated a 'duty to co-operate' with our own demise.
First thing they will come after - the LCS money.
‘While the creation of primary care networks should facilitate more patients being seen...’ - what nonsense, will barely make any impression; our leaders have to stop spouting this nonsense as it raises expectations that can’t be met. PCNs are not the solution - better investment in the core contract is. The only way we are going to recruit 6k more GPs is by improving the terms and conditions we work under - and that means a large investment in the core contract and better paid and supported GPs.
This isn’t what GPC promised. They said the specs would require no more extra work.
This is unmanageable: there isn’t anywhere near enough resource in the PCN DES, and there isn’t the workforce.
GPC must take aN immediate and very public stand; individual LMCs must stand up and be counted - and if there isn’t an immediate retraction and redrafting of the specs into a radically improved form, they must advise all practices to step away from the PCN contract until it is made fit for purpose.
Fight back, for heavens’ sake, before you take down general practice and the NHS with it.
Chaand, Richard, Krish - this is what we pay you for.
GPC and Cardigans must stop colluding in the managed end of general practice.
New contract - now; or we do wha the dentists did, and the nhs can buy from us whatever services it can still afford after it has paid for its Apps, algorithms, social prescribers, pharmacists etc.
The problem and the solution are simply the Terms and Conditions we work under. Give us the resources we need to employ enough staff and deliver a good service; pay us better; sort out our pensions. Problem solved.
So the cost to the NHS of hiring these untrained unregulated pretend social workers is now around 30% more than a fully trained and regulated practice nurse. At around £500 per ‘intervention’ this hardly seems like good value for the NHS pound.
Perhaps the definition of FTE should state 37.5 hours paid work, and 11-30 hours unpaid work. Might remind our commissioners what they stand to lose once ICPs force us all to become salaried.
Or, rather than mis-selling the job to smart people who will quickly leave for better options, perhaps we could just improve the funding and terms and conditions of the job through a new contract?
Dear Pulse: your first paragraph isn't correct. Hancock said
'We will create 50 million extra appointments in GP surgeries each year' not 'to create 50 million more GP appointments'.
So these appointments could be delivered by anyone - PAs, pharmacists, nurses, HCAs, cleaners, social prescribers, that chap that sits outside on the bench drinking White Lightning etc. This is how he will weasel out of it.
5000 promised by Hunt
1600 down in that figure at this moment
Estimated population growth over 5 years needs 2000 to maintain current ratios
6000 extra now promised by Hancock
5000+1600+2000+6000 = 14600
There is a way to solve this - it involves improved terms and conditions including pay and pensions. All the meaningless promises and wringing of hands needs to stop.
It would be interesting to see
1. the hospital stats. we get monitored only because they can monitor us, because our record keeping is so far superior to hospitals - this needs sorting out if we are to improve quality in our hospitals; and
2. what has happened to the numbers of deaths by preventable infections or episodes of sepsis in the same period.
Stick this into the next hospital contract: every contract breach should mean a £50 fine, every penny of which should go into a pot to be distributed amongst local practices to pay for the work that has been incorrectly pushed out into general practice.
Then watch the breaches drop 96% in 6 months.
NHSE passing the buck. CCGs are not responsive to GPs in real life, and most of the board are appointees.
These are contractual breaches but are being ignored. Treat them as breaches. Tell the hospitals to get their act together or fine them, and invest the money in general practice. They would soon change their mechanisms. They continue because they know they can get away with it.
Hospital admin - and especially appointments - are absolutely appalling. This leads to lots of confusion and frustration. This needs sorting out. Do this, and many DNAs will no longer happen.
As for sending them back after one DNA: this is a contractual breach. Two contractual breaches in a GP surgery usually triggers significant contract action. if commissioners would treat it as such - fine them, or downgrade their CQC assessment so that the best they can get is ‘required improvement - then the hospitals would take action. At the moment they just shrug their shoulders and carry on, as they know CCGs won’t do anything.
CQC needs to stand up and be clear that many problems are outside of the practice’s ability to remedy. Almost all problems in recruitment, capacity, retention, facilities and estates would disappear if only we were decently funded. We need to return to 11% of total NHS funding ASAP, and - given that 90% of all patient contacts with the NHS are in general practice - preferably more.
CQC support would be invaluable in this, if only they had the courage to draw the right conclusions and state the obvious. Instead their published reports are damaging to the reputation and morale of each practice, and are essentially perpetuating the NHs habit of victim-blaming.