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.
The problem is,
1. How much of this extra investment is really extra investment? We are used to lots of announcements that end up being pure fantasy.
2. How much of this will be filtered through NHSE Regional Teams and CCGs, top-slicing for their own vanity projects along the way? We are used to significant sums being announced then somehow disappearing before it gets to us.
3. How much will be diverted away from core activity into projects of dubious value, like PCNs.
4. How much actually makes it into the coffers of practices, so we can pay our staff better, employ more staff and genuinely take the pressure off.
I'm willing to bet that - rather like the 'game-changing' GP Forward View - nothing gets to the front line and nobody notices any significant change.
You can make a difference, NHSE: stick the £4.5 billion into the GMS contract directly.
CQC should identify ALL issues in their report, i.e.
1. This practice is significantly underfunded - this needs to be addressed with an immediate uplift of 30% to core funding.
2. Patients in this practice do not get enough time with their clinical team members. All appointments should move to 20 minutes starting tomorrow.
3. The practice medical team are working beyond safe capacity. No GP or nurse should have more than 26 patient contacts per day. Until extra capacity is found in the system, all patients who cannot get same day appointments for urgent care should attend A&E; and all patients who cannot get routine appointments should be enabled to self-refer directly to a specialist.
4. Practice estates aren't fit for purpose. The NHS should buy out existing property-holding partners at a commercial value and immediately engage in an upgrade of all facilities to safe modern standards.
5. Only when all of the above has taken place can we reasonably be expected to start to judge practices over issues such as 'is there a dog bowl for dogs to drink out of'.
But it’s still yet another unpaid extra job done for free for essentially our competitors, even if it comes in electronically as a workflow. In essence, we are paying our staff to work for our competitors and undermine our own service?
‘One day PCNs might be up there with the introduction of modern hospitals, heart transplants, and the organ donor register.’
More likely The Titanic, Gallipoli, and Ebola.
No, they are not, Krish.
They are a way of diverting badly needed investment away from general practice into pretend - and underfunded - organisations that are set up to fail, and then general practice will be blamed and it will become an excuse not to invest in us for another 10 years.
Money will then instead be diverted into people like Babylon, an incredibly reductionist approach driven by corporate greed and the need to make a profit.
Stop the PCN nonsense and insist on proper GMS funding, except, oh no, you have agreed a below-inflation deal that is 5 years long. Pathetic! We receive 30% less funding than we did 15 years ago, we are paid around 20% less, and we deliver almost twice the workload.
Might be helpful in future for the BMA and GPC to separate out announcements about GP Practice and PCN funding.
The two things are not the same, and will be increasingly different as other organisations 'join' PCNs and want their share fo the funding; and practices start to step away from PCNs in increasing nunmbers in around 12 months time as it becomes clear the expectations do not match the funding.
If I worked in this CCG, I would immediately start doing what our hospitals have done for years - stop doing any work that isn't very obviously in my core contract, and refer absolutely everything else in. Ear irrigation, pessaries, ECGs, wound dressings etc etc. The CCG will only come back to the table when they understand the true value (in terms of efficiency, cost and effectiveness) of General Practice.
Since when have providers been able to set up services wherever they like, irrespective of the needs of the population or effects on the local healthcare system?
Service is collapsing, desperate measures. Nothing but sympathy for the poor ambulance teams. Underinvestment everywhere, and poor senior management in some areas.
Answer for us is simple, surely: everything that needs an immediate response is a 10; everything else is a 7. General practice can’t run if we or our staff are expected to sit with patients for 4 hours waiting for an ambulance.
Non-contractual. Why aren’t they asking the pharmacists to do it? Because they wouldn’t do it without payment, and neither should we.
Can Pulse please ask Londwide LMCs what they are doing about this? This diversion of front line GP funding into unrpoven collaboratives without any legal structure is a disaster waiting to happen, and can't be allowed to happen.
Fraudulent: obtained, done by, or involving deception, especially criminal deception.
Is it possible to libel a profession?
They should be ashamed of themselves.
A non-recurrent lure to get us to jump over the cliff, faster. The DES does not contain anywhere near enough funding to deliver the seven specifications, and there isn’t any more coming. I wonder if this falls apart next year, or the year after?