I understand and sympathise that practices had to merge together and let another organisation to take over the governance ,as the last desperate move to survive under this hostile environment created by this government.
But the reality is candid and cruel : merging together and working by scale simply swept the dirt under the carpet. The running model of general practice before these austerity measures imposed by the government(s) remains the most cost-effective, in my opinion . That obviously takes into the account that the crisis of retention and recruitment is also directly caused by this ‘hostile environment’.
On a serious tone.
Remember ABC’s famous song ?
‘ When you judge the book by the cover , then you judge the look(of love) by the lover .’
Things are never what they seem . Politicians only know they have to behave differently at different times in different places in history. This moment of time is unique historically, without any doubt. A government totally ‘kidnapped’ by a nation-split agenda concerning its identity/independence, can provide no tangible solutions to its domestic problems. The Health Secretary , loyally defending his PM(he was the one responding to the media’s strident questions immediately after the historic defeat of a government in House of Commons two days ago), will obviously have to speak like the most understanding and empathetic politician on earth ,especially about issues under his watch. The fact is this government needs us the most to gate-keep and just hold the infrastructure of NHS. What else would you expect him to say ?
Ha ha ha
I was almost misled by your title ,’Hancock might not be a **nt’
On one hand , you have to cut him a bit slack : Robocop is learning to talk like a human being . On the other hand , whether you believe him and more importantly , this lame duck government is another matter , totally.
We should consider that this is an ‘insult’ to our intelligence.
The model we have been running on (GMS GP partnership)is clearly the most cost-effective , at least historically , with preservation of continuity of care .
But in face of austerity, it would appear to be ‘easier’ for politicians to control and cut cost of there were only 20 humongous GP practices in the whole country .
Today , they are talking about a size of 30,000 to 50,000. What will it be tomorrow? 100,000 to 500,000 , easily !
Please , give us a break, we all know where politicians want to end up.
Ever since an experience when the ambulance did not ever arrive after I home-visited a patient about 18:30 ( the patient with liver failure and called my practice the next morning when we open again) , there is no such thing called one hour or two hours ambulance request in my dictionary.
We have to be careful who and which organisation we are targeting. The austerity imposed by government(s) had created this ‘hostile environment’ for GPs and that is what we must campaign and fight against.
And I dedicate to all (particularly those who are disillusioned)the lyrics of this beautiful song written by Gary Lightbody from Snow Patrol ( flawlessly sung by Leona Lewis) when he was ‘down in the dump’:
Light up, light up
As if you have a choice
Even if you cannot hear my voice
I'll be right beside you, dear
And we'll run for our lives
I can hardly speak, I understand
Why you can't raise your voice to say......
Yes , we are stuck for a long time and it is time to light up and run( not away).....................
I am open- minded about this .
However , my motto is everything has its advantages and disadvantages. And more importantly, it is about doing the ‘right’ thing by the right ‘people’ at the ‘right’ time , ‘right’ place.
(1)This is an unique time in our(NHS GP) history . Thanks to the politicians, they have created a ‘hostile environment ‘for all of us with undoubtedly, further uncertainties brought along by Brexit . Retention and recruitment issues are widely publicised (even my elderly mother knows about that ).
So , if one wants to create new breed of GPs, they have to be trained to, somehow, survive this hostile environment.
Have we got the right type of trainers ? I do not know .
(2) One advantage of this ideology of training GPs entirely in general practice environment is to make our youngsters even more primary care orientated , hence , think , learn and behave as a primary care physician. But obviously, the other side of the coin is the risk of developing some blind spots about the actual circumstances faced by our secondary care colleagues . This is reciprocal as we tend to complain about consultant colleagues having the same unconscious bias . Obviously, certain behaviour is often about fighting for resources ( Money , Time , Manpower And Expertise) between primary and secondary care .
(3) With all due respect,I believe that it is harder to be a ‘capable’ ( or rather adaptable) GP than hospital consultant . How much specialist knowledge we need to be a ‘good’ GP could be more ideological than realistic. Nevertheless, recognition of this issue is essential as it can potentially turn into a weakness in this new GP training programme . Ultimately, it is about how one would structure and design the chronology of the training scheme.
(4) In addition to all the necessary knowledge for essential medical and surgical specialties, I dare to say we need to expose our youngsters more to medical politics , economics and philosophy for survival. Simply put , GPs might not be interested in politics but unfortunately, politicians are always too interested in NHS GPs. To me , it is a battle against politicians from Day 1 when I walked into general practice.
(5) There is a Chinese saying ,’ the waves from behind are always pushing the front-waves on Yangtze River’ (長江後浪推前浪）. As a front-wave myself , I am willing to put down my baggages of longing for the ‘good old days , good old ways’ and help our hind-waves to push me forward and finish the time left on my journey........
Confucius wrote in Analects, in face of adversity ,’ if this matter can still be tolerated , nothing worse will not be tolerated by people’ (是可忍，孰不可忍）
If this is not war time , I do not know when it is .
Bear in mind , one has to look at the whole world situations with butterfly effects on each other :
( in no particular order )
(1) US- China ‘war’ ( already moved beyond trade issues)
(2) Russia’s secret agendas
(3) Trump’s everlasting unpredictability
(4) The ‘brotherhood’ between (2) & (3)
(5) The reality China has to face ( including its One Belt , One Road , arguably over-ambitious project)
(6) South Asian countries , Japan as well as Taiwan’s responses to (5)
(7) North-South Korean dilemma
(8) Iranian issue(s) and an imminent US campaign against it.
(9) The contradictions and ambivalences within EU and hence its overall integration with Russia knocking on the door all the time .
And , Brexit is clearly on this list
As I always like to use as analogy , this is Mexican stand-off with multiple players pointing guns in different directions.
All I would say , after all these years in general practice as well as reading about human history , things are not always what they seem . Battles of survival , should you choose to fight , are always long.........
A couple of interesting points :
Firstly, it seems that the narrative of NHSE and NHSD is spinning towards financial penalty on these patients??
Secondly, some arithmetic; £216 million divided by 2325 which gives a reference annual salary of a full time GP £92,903.
Happy New Year , folks.
Madangate , I called it.
Ha ha ha
Hard , old habit to rid . I have said many times that the superhero complex of GMC will never stop as long as the law allows it to carry on such behaviour. Where is the government? Oh , I have forgotten we are having a lame duck government lost in the mist of Brexit.
You see , together with these new NICE guidances on COPD diagnostics , Prostate Cancer follow ups and this ‘dirty work’ of telling off our patients( and oh! of course , seven day access), it only converges to my philosophy:’ this bloody government needs us more desperately than we need it.’
It is an incentive to develop full primary care spirometry and even FeNO services( for asthma)
But I am sorry , No Money , No Talk.
‘The study, published last week in the BJGP Open, suggests that GPs should lead prostate cancer patient follow-ups to reduce workload for urologists and improve continuity of care.’
Fine , but who were the ones saying that continuity of care
was ancient and working by scale (so as to increase access) would be the social norm in general practice? I accept the political reality that eventually all GPs could be salaried working by scale one day but then certain things would have to be sacrificed. Please don’t fool us with your new clothes , emperor.
Ha ha ha
I see an argument coming from the seven-day- GP opening protagonists : that is exactly why we can do more and achieve more by increasing GP access substantially!!
Of course , urologists are under extreme pressure and need some rescue but then what about us ? Who is actually rescuing GPs realistically and honestly?
Ha ha ha
The way this whole story pans out is so indicative of this government led by Auntie May who is currently dragging her limping legs through the mud of Brexit. For those seven-day-GP opening ideology protagonists , tell me what concrete achievements you have acquired, given the huge amount resources diverted to these vanguard sites . What have they done to help (or NOT help) the whole big picture? But unfortunately politics is always like that : sacrifice the big picture for one’s personal crusade ..,,,,,