I think this might be the last straw for many. Just when you thought it could not get any worse.
" We can't provide continuity - which is the only unique feature of general practice and the tool of our trade. "
To that I would add, that we have less and less places to refer patients who need more than the ten minutes of care that we can give.
When that happens, our job satisfaction breaks down. We know that we are failing that patient, but we have no other choice.
30 patients a day would be luxury for most of us.
Does this not discourage established salaried GPs from taking on any extra adhoc GP work. Surely the Government would want GPs to be flexible and do extra work.
The way this is set out will discourage any salaried GP from taking on any extra sessions. Bizarre !
Money needs to follow the patient with a fee per service. That way if demand increases, so can capacity be created.
The fee needs to be adequate for it to work.
If I complete this survey it may give a skewed idea as I have already been driven out of General Practice by the very workload that Lucy Marchand describes.
I now do one session a week and I feel so much better.
If the notes have to be redacted to make past notes fit for patients to see, aren't we in danger of losing their purpose for medical decision making ?
Also we are losing the historic record in its unadulterated form.
What about the patient with undetected Von Leiden deficiency ? The patient whose BP rises with oestrogen ? The patient who develops focal migraines ?
For the majority this will be fine , but not for all patients.
Food for the week would have been about £25, so the cost is not as high as it first seems.
We will be doing ' The Cambridge Diet ' out of business. They are set up to provide psychological and motivational support.
In the past I have directed patients to them, in fact I have successfully used them myself. It took a good few years for the weight to come back, but I had learnt a lot about the ability of my body to experience hunger and not succumb.
I now successfully maintain weight loss with a low carb diet and exercise. These are approaches I prefer for patients but many are so wedded to their cereal for breakfast and sandwiches, that it does not work. It is a rare few that succeed. I tend to be less evangelical now, as I know it is futile, and I do not have time to waste.
I agree a calorie deficit is needed, but a low carb diet makes it easier to achieve because of the lowered insulin levels and thus lowered appetite.
Christopher Ho ,
Are you seriously advocating an American Style Health System ?
I cannot think of any model that is worse.
I agree with zero tolerantz,
We all have our own threshold for leaving. Mine was exceeded some time ago and I have looked around for other medical work, with less stress. It would take a lot to tempt me back.
Please use the letter to tell it like it is in General Practice. Enlighten the MP on how close to collapse general Practice is.
How can you examine for guarding if you do not examine in abdominal pain ?
I sent in a lady who was apyrexial, whose pulse rate was only 90, but she had definite guarding. I suspect she had some abdominal catastrophe going on. I shall have to wait until Monday to follow her progess. This happens often enough, to make video consultations dangerous, other than for trivia, which is often a retrospective diagnosis.
Ivan, your a better man than me if you can name all the guidelines on all the conditions.
How I work is that I read the guidelines when I am introduced to them, perhaps at an educational half day, or an article in the BMJ or Pulse. What ever sticks is what I use when I see that patient in my allotted ten minute slot.
To suggest that we all can all be up to date with the latest guideline for everything suggests a degree of perfection that we can aspire to, but sadly are unlikely to meet, due to being human, and not having the resources that we need for a perfect consultation. Perhaps you are more perfect than I.
The threat, of course, is that they will find a more up to date guideline and crucify us with it.
So we are expected to follow 'guidelines' in the ten minutes we have for a consultation.
For every condition there are a plethora of guidelines, some conflicting. Also patients usually have more than one condition. They may be presenting with a symptom rather than a condition.
The NHS are paying for a trabant but judge us as if they had purchased a Rolls Royce. Glad I am leaving early.
They are cheaper than smoking. The NHS should not get involved. I can see us being the 'pushers' for e-cigs. There is the potential for the workload to be huge and displace patients with serious illness.
Actually I have to take that last comment back, as i have just found them on google and so far I have read about a year's worth. They don't seem too controversial.
However, the comment he has resigned over, showed a complete lack of respect for his hard working collaegues. How can he think that the majority of GPs would welcome other GPs going under. How could he think that it is acceptable for a GP to give 20 or 30 years of service to their communities and be rewarded with personal bankruptcy, just because they are the last partner left in their practice.
If the Government has decided it wants to change General Practice, then it should be paying for the liabilities in winding up a practice. To do otherwise is to have a massive conflict of interest, namely forcing a change by deliberately underfunding the smaller practices.
Yes, please publish all his Devils advocates posts in one article.
I suspect they are all about to be cleansed from the internet.