Section 75 Health and Social Care Bill
Behaviour of private companies
Read this if you have time :
‘The bigger the better’( same as merging CCGs?)
Working by scale
Sacrificing continuity of care ( COC)
Ultimately, survival is ‘victory’ .
Caveat with a lower CQC rating ( well , is that really important as overcompensating always comes with a price?)
Question is : why ?
Austerity is really finished ? What about its aftermaths , hence , post apocalypse?
Again , what was the intention of NHS England at the time ? Remember what Dr Madan’s infamous saying about small practices?
Incompetence or malevolence?
The next government after this historic Christmas general election has a big decision to make on these issues ......
You can read Jaimie’s editorial below ( with my long comment)
As I wrote my comment under the original article of this matter(with expletives):
(1) The GP hospital referral system has become an egregious caricature of itself; (a)Enormous number of GP referrals are being rejected and bounced back everyday( we already have stories of two teenagers who died during referrals to children mental health services) . (b) It is getting more unpredictable and user-unfriendly as far as electronic referrals for patients are concerned. The risk of failing to get the referral through increases as the referral process becomes more and more cumbersome. (c) Then one has this highly suspicious incompetence of mislabelling patients as ‘DNAs’ (of course , benefit of doubt being reserved as some patients DNA without good reasons) and immediately discharging patients back to GPs , incidentally against the hospital contract with NHSE as reported by Pulse .
(2) Incompetence is worse than malevolence. I am questioning the intentions , conscious or unconscious , of NHS England on this matter , especially not too long after the infamous resignation of Dr Madan( I called it Madangate) .Am I right to say that the consequences of this totally dysfunctional referral system include driving a big wedge between primary and secondary care in NHS ? Do not forget that the new ideology of PCNs is also about developing integrated care systems (ICSs) with multiple integrated care teams (ICTs) ; PCNs/GPs are supposed to form alliances with their local service providers where acute trusts/hospitals are ‘big players’ . The harm and hypocrisy of this referral system is already well rooted before one can consider any ‘integration’ . Based on the trilemma theory , the system is totally obsessed with ‘integration’ while it is willing to sacrifice either democracy or sovereignty of both primary and secondary care .
(3) We are heading towards a historic Christmas general election (incidentally on my 20th marriage anniversary!) , the political fiasco goes back to the starting point : Brexit or no Brexit , hence , sovereignty together with democracy but no integration Versus integration with sovereignty but no democracy (could be with democracy but no sovereignty in some instances ).
It is ironic that we have a similar mess in NHS between primary and secondary care under the watch of this government and its Ministry of Plenty .
An NHS England spokesperson said: ‘Good communication and co-operation between primary and secondary care is a vital part of delivering high-quality care.
'Where there are remaining concerns, local GPs should ensure their CCG – whose governing body they elect – takes appropriate action in line with the national contract.’
Do you seriously think that this ‘spokesperson’ had ever existed ? Or some kind of f***ing AI driven , automatic statement aiming at insulting our intelligence . After Madangate , you would have thought NHSE had learnt a lesson . What it had done was driving a wedge right between primary and secondary care making the gap even wider . This referral system mess is becoming an egregious caricature of itself : Rejecting referrals back to GP , making it user-unfriendly for patient to book actual appointments and mislabelling those receiving no actual appointment notifications as ‘DNA’ , hence dumping back to GPs immediately.
Disgraceful , unscrupulous, precarious and precipitous .
Totally , unethically .’Something’ needs to be f***ing shot in NHSE.
Indeed ( not Need)
.....short and medium-term effects to the oil prices .....
(1) While I am all for cleaner energy to reduce carbon emission, one has to be pragmatic and realistic . Politics indeed , often is about being realistic. Doing the wrong thing at the wrong time could easily become ‘right’ thing at the right point of time in history.
(2) The rise of Elizabeth Warren in the other side of the Atlantic leading up to the Democrats’ primaries for next year ‘s presidential election epitomises the pros and cons of the radical reforms the left wing politicians wanting to endeavour. The latest edition of The Economist got her on the front page and dedicated a few pages about her story so far . The abolition of fracking , tougher regulations on energy companies, short and medium-term to the oil prices , hence global economy etc . These are the complexities of the issue of the ultimate goal of reducing carbon emission which undoubtedly has been detrimental to our environment (as I believe) . Read this as well:
(3) Coming back to UK , I am not sure whether our politicians have been equipped with enough knowledge about exactly how to implement greener policies to deviate from fossil fuel combustion, given the fact that we ,as a country , have been in limbo for three years due to Brexit with nothing other than economic uncertainties .
Need , there are plenty of dilemmas in this subject of protecting and saving our environment . I just hope people should discern all the facts accurately before applying one’s moral compass and principles. And as a doctor/GP , just like Brexit ,I strongly stand by the argument that we should not immediately position ourselves into this highly politicised matter .
With all due respect, Dr Bennyworth , if you are reading these comments from our colleagues on this platform , you need to understand why there is such an amount of negativity towards what you said . I would even understand if you thought the title of this article was rather unfair and judgmental on CQC.
But ( always a but) , deep frozen ice three feet below is never down to one day cold . Every story has its beginning and ending .
The reality is that there is a deeply frozen relationship between CQC and our frontline GP colleagues and ,
the government and your establishment need to do far better than this to repair the damages. The retention and recruitment crisis of GP and the recognition of the how important GPs are , simply reinforce my slogan , ‘ the government needs GPs more than we need it.’
I would not have any doubt .....
Fine , I would have any doubt that HEE is working very hard to increase the number of GP trainees in the forthcoming years and at least , the official number is going up .
But where are these GP trainees going potentially after they have completed the training ? I would like to see the statistics, especially a ‘conversion rate’ , if ever existed, into full time equivalent frontline GPs .
Remember Second Law of Thermodynamics?
Entropy is a thermodynamic quantity representing the unavailability of a system's thermal energy for conversion into mechanical work, often interpreted as the degree of disorder or randomness in the system.
"the second law of thermodynamics says that entropy always increases with time"
‘Compassionate leadership and improved workplace cultures can contribute to improved retention of doctors. That also helps doctors’ wellbeing, which in turn benefits patients. It will help make sure we have the workforce we need now and in the years ahead.’
Seriously ?Is that really all you can come up with as answer , Mr Massey ?👿
I accept the argument that we should not judge these catastrophic cases purely on where the final responsibility lied as far as primary and secondary care are concerned. But the reality , as I wrote before , increasing hospital referral rejection(not just mental health ) has become a social norm and pattern in NHS . There is certainly problem of recruiting consultant psychiatrists nationally (as well as numerous unfilled consultant vacancies in different parts of the country ) and of course , we are very short of full time equivalent GPs . The ‘system’ itself is dysfunctional and no longer safe enough . That is the reality. The government and its recent predecessors cannot shy itself away from this reality under its watch despite all the claims of investing more .
Primary and secondary care are like lips and teeth , question is why their ‘owner’ failed to keep them in healthy shape ?
I have nothing against social prescribing. But it is always about knowing honestly what you are talking about when you talk about ‘something’ . Like PCN ideology , social prescribing has been deemed as the new magic potion to solve all these problems and inequalities currently existing in NHS . As a clinical director of a PCN , I am still yet to know exactly what and how the social prescriber we suppose to employ in PCN , is going to deliver . The generic job description is more rhetorical and ideological than being tangible and practical.
Perhaps, social prescribing in its ‘true’ nature is going to be therapeutic for some patients with certain medical problems. The common sense tells you that it is not universally life-changing (not even to mention life-saving yet) . I believe the evidences in literature are rather debatable and inconsistent. I would like to know the details of what type of social prescribing helps which type of medical problem definitively.
The caveat is that we ultimately had ‘helped’ politicians like Mr Hancock to shift attention away from the real problems in NHS which actually require more hard core solutions.
This is not Margret.
Should be called ‘ Arnie’ instead .
Do not miss the forthcoming Terminator: Dark Fate , if you are a fan
(1) Once again , there is always a risk of an ‘one size fits all’ argument as far as merging-protagonists and antagonists are concerned. Yes, ‘more opportunities to share resources and expertise’ is sound , enticing and worth pondering.
Question is , have you really got so much ‘surplus’ to be shared from the outset , putting these individual CCGs together under one roof in each case ? If only nine lids are currently available to cover ten teacups( hence , one short) , it does not make sense to gather eighteenths lids together to cover twenty teacups because it will become two short instead .
(2)The geographical spread in every region of concern(with how many CCGs within) is a valid point for debates . Clearly , too many practices away from the ‘centre’ means less practical representation. CCGs with rural practices are likely to be disadvantaged if the boundary of the CCG is being pushed further outwards . Nevertheless, we all know the demographic (and hence, epidemiological)variation in health inequalities and diseases will accentuate as the ‘region’ is getting bigger and bigger . Financially, it may be more convenient for NHS England to fund by writing ‘one single cheque instead of many’ . The truth is , we all know that this always offers NHSE advantages to impose more draconian measures effectively and efficiently.
(3)The relationship between CCGs and PCNs is already rather extraordinary. CCGs are constantly under the cloud of NHS England to save so many millions of pound every year while the new kid on the block , aka PCNs are supposed to be fed directly by NHSE( whether the feeding ‘enough’ is another matter ) . As I wrote before , CCGs and PCNs had virtually become a caricature to each other as they are both formed by GP membership fundamentally. Will today’s PCNs become tomorrow’s CCGs ? History will be the judge .
(4)My gut feeling is that the voices of GPs within currently existing CCGs have already been diluted by layers of top-down bureaucracy laid down by the hierarchy in the system . When you merge more CCGs together , the caveat of further dilution is only logically apparent. And it is quite right to say the bigger providers , hence , players , are the acute trusts in an integrated care system (ICS) . Everybody (every provider) has its own needs . It is always about individual interests superseding ‘common interests’ .If one ICS means one CCG , the acute trusts clearly want to be on front foot to run the show . As a ‘reluctant’ clinical director of a small PCN , I can already smell dissatisfaction of some providers against ‘dominant’ providers within the same system . The bigger the system goes , the more friction can potentially arrive .
(5) The bigger the better , I will always express my scepticism (rather than detesting immediately) as much as like remaining as a PCN-sceptic . I always believe in Trilemma Theory : Integration , sovereignty and democracy, you can only have two out of three but never three together at the same time .
Brexit , Catalonia , Hong Kong , Kashmir etc . What a wonderful world 🤓😈
This is now becoming a ‘pattern’ , no matter what . My worry is people will try to use the new kid on the block namely , GP networks, PCNs , to get them out of jail . Rejection of GP referrals is also a social norm in NHS sleepwalking into more medical disasters at all levels . And I cannot see how Department of Health and Social Care can spin by saying how much money they had ‘invested’ mental health services to have an impact .
Mr Hancock , I suppose you wanted to consult all your tech-advisors and AI fanatics to help you out on this one??
I would choose not be distracted by our hitherto sentiments towards GMC(CQC , NICE as well ) :
(1) Given GMC some benefits of doubt , the phenomenon observed could be subjected to ‘normal fluctuation in cases’ . On the balance , I had a bit more confidence to MPTS than GMC actual . This is obviously derived from the story of Dr BG . Hence , more referrals to MPTS , at least , is better than more draconian investigations by GMC .
(2) Problem is trust ; trust comes from track record before credibility can be established. The credibility and reputation of GMC , at least in the eyes of our medical colleagues, was seriously impaired and compromised. How is it to repair this big gap between itself and us is a task not to be underestimated any more . If GMC remains incredulous and intransigent as far as this is concerned, it will put our medical profession and hence , the whole health service in harm’s way . The superhero complex of GMC to protect the public as their first duty needs a lot of introspection and soul-searching .
(3) As I was taught by the readings in Analects:
The hierarchy or establishment would not stand if people’s trust in it no longer exists , no matter how ‘noble’ it tries to be . （民無信不立）
Chaand , only hope you do not fall into the same abyss as Corbyn facing anti-semitism in his party .
It is amazing how long it takes for NICE to come out with an updated and amended version of this guidance since these controversies arose last year( and still yet to publish this long overdue guidance ).
It is kind of alluding that it was caught off guard completely in the first place and did not foresee and expect such a level of backlash from colleagues. Once again , another example in a professional establishment of having a blind spot keeping it out of touch with our frontline colleagues.
One wonder how many more lessons NICE has to learn before it is introspective enough to change its ‘culture’ and mechanism of arriving at any new guidance?