Yes, let’s move increasingly rare GPs away from frontline care of the unwell and instead get them to pander to the immediate access demands of the worried well and those with trivial illnesses. It’s not as if there is a workforce crisis.
More idiocy, that is likely to sink the whole system.
I have no problem with people expressing views I find personally unpalatable. I have no problem with the RCGP providing a platform for people to voice or promote views I find personally unpalatable, though I regret the offence it is likely to cause many of my brother and sister GPs.
If the College dignitaries feel giving a right-wing professional troll a platform to voice controversial views to a audience who are probably feeling rather vulnerable, that's fine. I personally wouldn't do it, but that's me; I wouldn't have accepted money from the Sultan of Brunei and showered him with honours either. Two things do bother me though: using the fact that she is the daughter of a GP to defend their decision is more RCGP idiocy; and I wonder if the College is paying her usual speaker fees, which I believe amount to quite a few thousands of pounds? If so (Pulse, please check) then members surely have a right to decide (and complain about) who the College invites to speak to them (and who the College offers significant financial inducements to).
For the record, I gave up my membership after 10 years when HSL told the House Of Lords Select Committee that the Partnership model was not fit for purpose.
The point of PCNs is that they are locally based with a sensible geography and population that an integrated team (consisting of a range of providers) can deliver care to - both in a physical and virtual manner. Babylon can’t deliver that, and so shouldn’t be allowed to form their own PCN. The criteria in the DES makes that very clear.
I often struggle for months to contain or reduce opiate or gabapentinoid usage in patients, only to refer them to pain clinic and have them return on massive doses of the same - presumably because its the easiest thing to do to get them out of clinic quickly, and with no responsibility for ongoing care.
ObiOne is spot on: they are cutting services and making it Somebody Else’s Problem.
The irony here is that the NHS Plan, and every STP/ICS strategy, continually emphasises that prevention is at the heart of their strategy. It’s all just empty words. And no one expects to be held accountable for the lies, or the deaths, so nobody in leadership positions cares.
So, lets see the evidence...
1. it is safe
2. it improves the current dire workforce problems rather than shifting them around
3. it is cost effective and won't destabilise and/or replace existing practices
Can anyone get hold of the business case or model? Pulse - got any investigative journalists?
We need to know that this isn't just private providers trying to wreck the existing system before it burns through its investor capital, leaving the government with no other option but to use them to deliver primary care.
Behold the Future of General Practice!
We are all forced into At Scale Providers. Individual Practices are allowed to wither.
As a result of this entirely artifically-generated 'crisis', General Practice At Scale is taken over by Hospitals and Community Trusts.
More GPs retire or step away or just go private.
Mysteriously it turns out that Hospitals and Community Trusts can't manage general practice terribly well; it also turns out that Multidisciplinary teams can't replace GPs and don't save money; and it turns out Apps are a terrible way to deliver care.
Everyone one is unhappy, some people die unecessarily, there is lots of wailing and hand-wringing, and no-one takes responsibility.
But we can expect CBEs for those responsible for creating and delivering the underlying narrative.
The problem is that the above - very good - article doesn't support the simplistic narrative that Matt Hancock wants to hear and believe.
He wants to believe GPs are backward in IT and the systems are poor, so that he can rush in and 'rescue' the system. Of course, because the systems are generally fine, there will be a few minor inexpensive tweaks and he will declare it a success, job done.
As the article sets out, the real problems are in the other parts of the service, who are using fragmented outdated and unintegrated IT, and who are slow to innovate because of the intransigence of existing cultures and the poor leadership and management. But that doesn't match the preferred politician's narrative of 'GP bad, Hospitals good'.
This is all SO frustrating...
All nice stuff (though PCNs seem shoe-horned in for no good reason other than the author supports them) but it’s not going to encourage the next generation of GPs to sign up as partners - and the NHS can’t afford the productivity drop that comes from losing partners, and seeing management of the primary care system taken over by the usual low-quality NHS managers that run the rest of the system.
The answer is actually very simple: offer better terms and conditions. There wasn’t a partnership crisis or a GP crisis for a few years after the 2004 contract.
‘This is all about flexibility. The answer is to create greater flexibility.’
No, the answer is to improve the terms and conditions currently suffered by the GP workforce.
Insist initially that suppliers should open their databases to API interrogation or they wil no longer be allowed to supply the NHS: we would get interoperability across all systems in 12 months. Gradually insist on a single standardised database for the NHS, used to hold all information, and allow competition on the front ends used to access the data - which would drive quality up and encourage innovation.
'I firmly believe we need a range of solutions to solve the workforce crisis.'
And I firmly believe that if they paid GPs appropriately (in line with solicitors and dentists) and made sure we worked under reasonable terms and conditions, there wouldn't be a workforce crisis.
The shift towards other staff delivering healthcare is largely an attempt to deliver care more cheaply at the cost of quality, while pretending it is a positive and inclusive development.
As a result, we will soon end up with a two tier service, I suspect, with GPs seeing those patients who make it through the layers of non-GPs, or those who shout loudest, or those who can afford it. When my kids are sick, I know who I want them to see, and it's a GP.
Everyone else will have to make do with Apps, Call-centre employees using algorithms, and Healthcare Assistants with 6 months' training. Pharmacists, Pharmacists and Nurse Practitioners will quickly prove too expensive for the Brave New World (as they sensibly generally see far fewer patients for almost the same money as a Salaried GP).
Because at this moment of crisis, this is the sort of helpful, decisive intervention we really need? Honestly, doesn’t anyone in the DOH understand what is going on, or have a sense of perspective?
Surely the contract doesn't let them pull out at such short notice? Most contracts have a 3-6 month notice period.
It is not clear if the £3.5b - reaching that figure in SIX years’ time - is in excess of any inflationary uplifts, or uplifts to account for increasing demand. If not, it is just more work for the same money, with most of the money being diverted away from core general practice to ‘community teams’ and networks. Can our Great Leaders please clarify these things before publicly offering warm words to the government (I mean you, HSL).
Time for a new contract, and a fair deal for General Practice.
We are talking about two things here, and the unclear language being used is unhelpful.
We appear to be talking about zero tolerance for violence and assault; but we should also be talking about zero tolerance (within the GP’s discretion, to allow for upset and reasonable but agitated patients) for threats and verbal abuse.
Nonsense designed to confuse everyone. The only investment that counts is directly into practices to deliver core services. That has declined more than 30% in real terms over 10 years. Everything else is PR fluff and nonsense so it looks like someone else’s fault when it collapses.
I wonder why, of all the struggling practices in TH, a Hurley Group practice gets the funding? Is it because they have the managerial capacity to liaise with the council? Is it because it is the practice with the outstanding estates and population problem in TH? Also, who owns the building and will benefits from the investment in the long term (if the council is investing significant 106 monies will it gain a stake in the value of the property as an asset?)? Genuine questions.
NHSE wants them digitised, then fine. But they pay for them to be digitised, along with any practice costs and any movement costs etc.
If they are actually delivering GMS services, then fine. I guess open-access to patients bookable through our front desk might mean this qualifies, as it might reduce GP workload a little. Though most of my MH workload is managed alongside physical health in a whole-person standard-GP sort of way that this can't deliver.
But if it is just housing another (secondary care) service in GP premises (ie one we refer into) then I can't see any real benefit to the sustainability of general practice as it won't reduce our workload (though it may improve MH access a bit simply through offering more appointments).