I am not adverse to new ways of working and trialling new technology. But given the limitations and recommendations of who this on-line service is suitable and not suitable for, how come it has been awarded a "General" Medical Services contract? It clearly is only providing "limited" medical services and it should therefore be contracted completely separately to GMS and not in direct competition.
How does the service meet contractual requirements, GMC requirements, CQC requirements and not fall foul of anti-discriminatory law? RCGP, BMA, GMC, CQC and patient support groups should be jumping all over this.
“You may on occasion develop an urgent illness which requires a face to face appointment, and not be able to visit one of our GP clinic locations. In this circumstance, we may ask you to call 111 who will direct you to the most appropriate local service which may be a GP practice near to where you live, the local walk-in or urgent care centre, A&E or minor injuries unit.” So, other practices and A&E will have to see their urgent patients and other practices will be badgered for a home visit by non-registered patients, with no source of remuneration for those contacts.
If people want to pay money for this service as a top up for NHS care, that’s fine. But this is not an NHS GP service that offers cradle to the grave universal care and should not be allowed to practice in a way that is advantageously different from the 99+% of other GP practices who contract their services to the NHS.
Has my support.
Given that data is extracted on a regular basis from our computer software systems, a possible solution would be:
In applying for a gun licence, person gives consent for aspects of their medical record to be downloaded on a regular basis. A code is entered on the patient's record that acts as a trigger for the regular extraction for the duration of the licence. The extracted data pertains only to information that is deemed a potential risk for owning a gun. Independent police/medical experts review the data and decide whether it is appropriate the person to continue holding the licence or as appropriate call the person in for a re-assessment. A regular extraction of data would be far more accurate than hard-pushed GPs trying to add something else to their never-ending list of things we "should" be doing. Everyone happy. GPs not involved apart from entering one code. Gun holders get to hold their licences. A more robust system for cross-checking unstable gun-holders is in place. A far more useful purpose for GPES than most of the other things it is used for.
This requires GPs to notify patients of this objection in advance, and if the service is not easily available from another doctor, ‘the GP that objects has a professional duty to put in place alternative arrangements for the provision of the relevant services or procedures without delay'.
Would someone at the BMA like to clarify what this aspect of the new guidance means? Assuming all partners at a practice wish to conscientiously object, what alternative is being recommended? I need to have an alternative course of action that I can invoke otherwise I am being forced to engage in a process which I disagree with, which presumably infringes on my human rights.
I have just read this very interesting paper all the way through, which sheds a lot more light on the so-called weekend effect. From my reading, the weekend effect mainly arises because during the week we GPs have a tendency to refer more of the less sick patients to hospitals for assessment and likewise hospitals tend to admit them – I suppose these are the “just in case” patients (which are increasing year on year because of our concerns over receiving complaints and/or being sued for missing something significant and/or because we are trying to follow condition based guidelines more closely to the letter). These less sick patients admitted on weekdays cause a statistical skew in the 30 day mortality rates and make weekday admissions look safer than at weekends. We could go along with the rhetoric of increasing more routine community and hospital care at weekends. And yes, this would certainly help drive up hospital admissions of this cohort of less sick patients at weekends and thereby help dilute out the so called weekend effect and give mortality rates that are similar over every day of the week. Or, and my preferred solution to the weekend effect problem, we could all work less hard during the week, see less patients (study after study seems to show that a not insignificant amount of our work could be done by others anyway), admit less of the patients that probably don’t need to be in hospital anyway and even up the weekend to weekday mortality rates that way. Government and patients happy – hospital mortality rates same across all the days, so hospital care must be “safer”. GPs happy – working less hard during the week and managing to have some sort of work-life balance. (This solution is somewhat tongue in cheek, clearly there is much more behind the data which needs explanation and a proper planned response, but it is no more insensible or illogical than the government’s current obsessional drive to increase more routine medical services at the weekend to make patient care and hospitals “safer”.)
He said: ’I want to thank the thousands of dedicated nurses, doctors, paramedics, GPs, therapists, care workers and other healthcare professionals that have planned for weeks..'
Funny that. I thought GPs were doctors. At least that's what my degree says. In JH's workforce planning we seem to fit between paramedics and therapists as a separate group entirely to doctors. Explains a lot of his thinking about general practice.
Oops, typo! Should read "make the locum option more unattractive".
I would think it is obvious what the rate will be use for. The government wants a 7 day a week routine service for healthcare without wanting to pay for it. Terms and conditions will become increasingly intolerable for doctors employed in the NHS or contracted to the NHS. Consequently, doctors will be looking for "routes of escape" - one of which would be locum work. So if the government can distort the market and make the locum option less unattractive, there will be less of an incentive for doctors to jump the NHS ship.
We received requests to be involved in the detailed assessment and management of patients with eating disorders and the reason given was that the service didn't have access to a specialist medical practitioner. I have put out reply below, feel free to adapt and use as appropriate.
Thank you for your letter requesting our involvement in the detailed assessment of _____’s eating disorder. We would like to respectfully remind you that general practitioners are generalist physicians and whilst we have experience over a breadth of medical areas, we do not have in-depth expertise, including the assessment and management of patients with eating disorders.
We refer you to the Guidance for Commissioners of Eating Disorder Services published by the Joint Commissioning Panel for Mental Health published October 2013 (co-chaired by the Royal College of General Practitioners and the Royal College of Psychiatrists), where clear guidance is given on what constitutes an acceptable community eating disorders service in terms of services offered. The content of your letter indicates that the local eating disorders service does not fulfil some of the basic requirements for such a service as outlined in the above document. Unfortunately, we are not in a position to provide non-commissioned specialist assessment and management of patients with eating disorders. Respectively, therefore, we decline your request to assess and manage the patient as per the content of your letter and request that you contact the patient to this effect and that you make alternative arrangements in collaboration with _____ Clinical Commissioning Group to provide appropriate full specialist assessment and management of this patient and their medical problem.
Extracts from the above guidance.
Eating Disorder Services for Adults (p.14)
Anyone with an ED in England should have access to a comprehensive multi-disciplinary ED service.
A community ED service should be able to provide the following:
• Comprehensive psychiatric assessment to include ED psychopathology and identify comorbid mental health and physical conditions. Diagnosis should be discussed with patient, carer and referrer.
• Risk assessment, both psychiatric and physical. This will include organising relevant investigations (e.g. blood tests, ECG, bone densitometry). Clear arrangements should be made with a patient’s GP agreeing responsibility for ongoing physical health monitoring. (As with any patient, as general practitioners, we are willing to be involved in reasonable non-specialist shared monitoring of patients after an initial comprehensive assessment by the specialist has occurred and after a specific management plan has been individually detailed for the respective patient).
• Nutritional counselling and psychoeducation.
Well said. Happy to support your letter.
GP Partner. Coventry.
Issues regarding safety should be introduced anyway and shouldn't be tied in by the government to junior doctors accepting a new contract. If this was HGV driving or industry or flying a plane, employers couldn't take tie in acceptance of a new contract to getting rid of poor safety practices.
In order to prevent "preventable" disease, you have to provide health promotion, treat risk factors and monitor conditions which increases clinical workload. By preventing early death from "preventable" disease, patients live longer and morbidity in the very elderly increases i.e. dementia, frailty and there are just more patients which also increases clinical workload. I see several flaws in the argument put forward by PHE. Clearly, I am not saying we shouldn't push health promotion but to say preventing disease reduces overall gp workload is a nonsense.
Awful. Too much scrolling. Not clear. News articles take up too much web-page space. Prefer previous look.
When I see a gp signature on the consent form for an arthroscopy, I will take this group more seriously. Until then, I would suggest they sort their own house out first before casting stones at others. By definition, specialists are specialists and should be leading on any new changes in management. If all they are going to do, is carry out a procedure because the patient happens to be in front of them, then I would suggest they shouldn't be practising. If the procedure isn't appropriate for the patient, don't to it. As well as potentially doing harm by carrying out a needless procedure, you re-enforce to the generalist, the gp, that the procedure is appropriate and hence the generalist keeps referring in. Once a few letters start going out from the hospital, that this type of patient doesn't need this procedure, gps will follow. To imply that gps should be leading the way in a specialist field misses the point of being a specialist!
Interesting JH's personal story for GPs being available after 7pm. He says he was needed to communicate between Macmillans and the DN and implies his father's GP should have done it. Don't think it needs a GP to that. The Macmillans and DN pick up the phone and talk to each other, at least that's how it works where I am based. They are professionals in their own right - they don't need a go-between. And if a dr input was needed, there is ooh cover. Let's get this clear, a single dr cannot work 24/7 and be available at any time of the day or night as much as patients and government think we perhaps should. The only way most GPs survive in this job, is the opportunity to get away from it for a time and be able to think "it is not my problem" for a while.
£10 million support for ailing practices – as pointed out already, pennies per patient for a country of £60 million + people.
10,000 extra staff, including 5,000 GPs. Where from?? Medical students are shunning general practice, retirement crisis gaining momentum.
“New data…on staffing levels” and “explore targeted financial incentives” – code for actually doing very little but it sounds good.
Recommitment of previous premises funds – can hardly call a recommitment a “new deal”.
General practice will be the “biggest growth area of the NHS in the future” – not based on the commitments to general practice over the past 5-7 years it won’t.
Flexibilities to encourage working part-time. I do that anyway – due to existing extreme pressures.
“Support for those who wish to return to the profession” – a psychiatric assessment?
And in return, we roll over and beg to work 7 days a week.
Keep these “Jokers” Mr Hunt and please deal again. Not interested.
Sorry. So incensed, didn't proof read properly! "day you die"
Seems you have to be working 24/7 to be entitled...but I forgot, that's what the government seem to want. This is a complete disgrace and completely unfair to those who provide locum service. Surely if you are still contributing towards your pension with regular superannuation contributions, you are still in service, whether you are at work on the die you day or not. I think Pulse ought to arrange for a petition!
There is also good evidence that GPs are effective and safe and liked by patients and...they can prescribe. Unfortunately, if we expect PAs are going to be the knights in shining armour for the crumbling NHS - we are deluding ourselves. I have no doubt there is a place for PAs, in the same way as there is a place for HCAs instead of nurses. However, for a clinician to really help out in GP land at the moment, then they need to be able to independently manage a patient and that includes prescribing. Out of interest and perhaps James can enlighten us, are the home grown PAs able to prescribe?