1. The contract allows us to deliver care in the way we see fit. If he wants this he will have to negotiate it with GPC, or impose it.
2. He hasn’t stopped to see if it is more or less efficient, he has just assumed it is more efficient. The only good quality evidence out there suggests it is 8-30% less efficient (some you see anyway, some you have to call three times, phone calls are less efficient delivery mechanisms for complex care etc). So, you will have to increase funding or resources to deliver this, or watch the service deteriorate quickly and significantly.
3. Many patients will hate it. I hope the MPs have lots of time to answer these letters as well as all the ones complaining about delays in secondary care delivery.
4. It will open up the possibility of private GP services, and GPC should now push hard for this so we can do what the dentists did. Matt clearly wants a two-level service, and for our own sanity and health we should stop fighting it and stay planning for it.
It’s just a way to redirect patients into general practice. Now that hospitals are being moved into block contracts they want to see as few patients as possible because they get the same money anyway. Where to dump the extra workload? GP obviously. CCAS has been a Trojan Horse for this. Will the extra workload be acknowledged or funded? Guess.
Replace clinicians with algorithms, and it will be cheaper, but people will die unecessarily as a result.
What level of risk is acceptable to the government and to the public?
How many deaths are 'acceptable' to them?
Will the people who make these decisions use the same system, or will they be actually booking into private GI clinics and colonoscopies?
I will continue to do the right thing for my patients - including using the FIT test as appropriate to inform my decision making but not to replace it - until they replace me with the phone app that Matt Hancock thinks can do my job.
I am told my PCN has £380K to spend on staff. The problem is that the staff we are allowed to spend the money on are not the staff we want or need. If we were allowed to use the money to pay staff more, appoint more admin staff, appoint nurses, even appoint doctors, then it might make a difference. I don't want chiropodists etc - completely useless.
The staff we have employed have not been able to work independently, require huge amounts of training and support, and deliver next to nothing.
We are getting rid of our pharamacist as she is not productive, and we are not allowed to pay to employ a pharmacist who can operate independently because of PCN rules.
Our social prescriber sees patients at a rate of around one per day, yet is paid more than a full time fully trained practice nurse.
PCNs have also taken up a huge amount of unpaid doctor and managerial time.
Furthermore, PCNs haven't really delivered any new funding streams into general practice, and in many areas are being seen as an alternative place to invest money that would have come directly to practices.
LMCs voted against supporting PCNs at the March
Conference, and GPC should have now withdrawn their support for the project... but inexplicably they haven't.
My advice would be - hold your nose and take the money this year, but plan to not sign up next year, before they grow into something we can't control.
Water always takes the route of least resistance. 111 will tell 70% of people that they have to be seen by their GP within two hours, and call ambulances for everyone else. We will be expected to take on all the unfunded urgent care as well as everything else. We are not an urgent care service.
I thnk we need to set reasonable limits on what the government can expect of us. If that means it takes a month to see your GP because of decades of under-investment and workload dump, that needs to be their problem and not ours.
Want to be seen in A&E? Exaggerate your symptoms. Patients will soon realise this.
Let's just allow ourselves to dream for a moment:
End (or radically simplify) appraisal and/or revalidation.
End PCNs, and put the money into the core contract so we can stop the endless pointless meetings and bickering - and employ the staff we need and not the staff you tell us we can have.
The NHS to contract properly and fairly with practices - both the core contract and any other work you want us to take on, like care homes.
The RCGP to take a long hard look at itself - what value does it really bring to the 98% of the profession it doesn't actually engage with, for the huge sums of money it rakes in every year?
Seems pretty simple. Most patients are now contracting Covid from a healthcare setting. Hospitals are hardly different from GP surgeries in terms of exposure risk. If we are no longer social distancing, and post-Dominic-Cummings its clear we aren't, people should wear masks in any and every enclosed space, but especially health care facilities - hospitals, GP surgeries, care homes etc.
NHSE should supply masks for all GP surgeries in quantities enough for everyone to wear one through their F2F visit; and for all staff.
But PPE has been such a mess, and continues to be so, that this isn't really feasible - hence the fudging by NK and PHE, delaying a decision until it's no longer relevant.
If the government hadn't used the Covid-19 crisis to spray lots of public money around to their friends in the private sector, perhaps my surgery might be receiving more than a £2 box of masks every week for a population of 18 000.
Hmmm, a casual observer might think that they don’t actually know what they are doing.
Also, where’s our (admittedly inadequate) PPE? Supply levels are still pathetic, and not enough to allow widespread use of masks.
To take it seriously is to miss the point. None of this will get done, there will be no attempt to fund it, organise it, or make us deliver it. It's all about PR, so they can say publicly that they did something and then plausibly distance themselves from any negative outcome. Sir Humphrey 101: 'something must be done! (by someone else)'.
So, when we run out if our pitiful weekly NHSE supply of substandard ‘PPE’ masks by lunchtime Monday, can we close up for the week?
So, NK’s opinion is so valuable and respected by DOH and NHSE that she wasn’t informed or engaged in the decision making? I fear she is being used as just a government PR person, to channel their latest unevidenced plans to a sceptical profession, and to pretend to the public that everything is under control.
Surprise, surprise. £13 billion hospital overspend quietly wiped out and not a peep about financial incompetence or mismanagement.
General Practice needs a paperclip and the Spanish Inquisition turns up.
All those promises of funding, retrospectively cancelled. Lots of people are going to be significantly out of pocket.
Never mind, we will all be replaced by PCNs shortly. They will miss us when we are gone.
GPC have signed our autonomy away and sold us down the river. Are any of the committee actually partners in a practice? They have not negotiated in our best interests: they have put NHSE’s interests ahead of those of practices or the profession. We are being bullied into PCNs.
Politically driven nonsense. Another fig leaf to cover up the policy failures of this and the previous administrations.
The worse problem is, it will now be an obstacle to proper investment and planning for delivering clinical care to care homes - after all, problem solved, right, Nikki Kanani?
I suspect they are bored and have nothing to do to justify a salary?
Please tell them that we don't have any problems that couldn't be solved by central provision of proper PPE, proper funding, and a near-total clearout of current NHS management: that we are all running the safest possible service in an unsafe, inadequate NHS managerial environment.
Delivering care to patients who are not registered with us, from premises that our not our own registered premises, is not in our contract.
Hot Hubs were always a managerial/political solution to a complex clnical problem (infectivity risk) they were trying to pretend was simple.
The real answer was to have provided proper PPE and to have funded general practice properly.
More control freakery from NHSD leadership, who clearly exist in a parallel universe where we all have enormous spare capacity and resources.
NHSE clearly want to micromanage us.
They don’t want to negotiate or listen to our views, and they don’t respect, or constructively engage with, BMA or GPC.
They seem to prefer dealing with the big IT companies, and appear to be actively working to construct a ‘primary care’ model that replaces autonomous general practice with digital triage, alternative video providers, and a small number of residual F2F.
PCNs are their Trojan Horse for this, a necessary intermediate step to make sure there is some system continuity when practices start to fail, or to hand back their contracts.
Covid is being used as an excuse to push these changes through.
Richard is right to express his concerns, but we have to go further. We should boycott PCNs and insist on a new core contract, before it is too late. This was what the LMCs votes for just before Covid hit us.
NHSDs own research shows 1-3% of people want online or video consultations. They almost have to forced to use them. It’s great for 24 year old arts graduates but not for most people. When asked what they want, most patients (97%) say F2F access (and not telephone or other options). Digital evangelism is not generally evidence based.
Happy to apologise, but what about happy to take responsibility for - and be accountable for - the mess?
Is it too much to ask that we have competent leadership at NHSE?
Will there be a public investigation of NHSE's performance through this pandemic, I wonder?