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Gold, incentives and meh

Nick Chiappe

  • Partnership is dead, long live partnerships

    Nick Chiappe's comment 05 Apr 2019 7:57pm

    Ivan. I know not from where you are coming but your criticism of partners as doctor centred, and unresponsive seems unwarranted. As someone working at the cold face of Gp and a partner
    for 25 years, I see changes to give patients what the politicians say they want (rather than what I and other experts believe they need) have gone on apace, and my working life has changed beyond recognition.
    Patients and politicians have champagne taste for beer money.
    Partners will not take the responsibilities and risks without a decent work life balance and income. As an example to the practices you work for of your willingness to be patient centred, rather than doctor centred, perhaps you will work extra sessions for free in the practices in your area where you know patient demand is high. I thought not.
    No one can sustain unlimited demand, and agreeing to every whim of politicians and the unreasonable few patients, would crash the system.

  • GP federations will not count as primary care networks 'in most cases'

    Nick Chiappe's comment 21 Feb 2019 8:32pm

    I agree with all the above. Being a compulsory member of a CCG with no influence or control, a federation and also a network is really going to improve the time and energy available for clinical care! Plenty of opportunities for would be managers and doctors who are bored with clinical practice. It may be best for practices not to take the bribe-responsibility for failing practices would not be worth the money, and might well cause more dominoes to fall.

  • NHS England issues 'letter of comfort' on OTC prescribing for GPs

    Nick Chiappe's comment 13 Feb 2019 8:26pm

    But I am not sure a ban will actually save money. Poor patients will ask for (often more expensive) prescribable alternatives. Voltarol is loved(adverts great!)and substitutes for algesal, which is cheap but banned as a rubefacient for some odd reason. Co-codamol works like paracetamol, so much better free than having to buy paracetamol. Of course the responsible well off few who have to buy prescriptions will choose otc alternatives, but the vast majority of prescriptions are free.

  • Brexit could set NHS back half a billion a year if pensioners are forced to return

    Nick Chiappe's comment 31 May 2017 3:47pm

    What about the much larger numbers of European expats in Britain. Can we not charge them or their countries?
    Neither side of this debate appears to have a monopoly on the truth. There is a great deal of uncertainty in negotiations which will not be helped by completely revealing our hand.

  • Digital repeat prescribing saves GP time and over £200m, says DH

    Nick Chiappe's comment 07 Feb 2017 10:29pm

    Electronic prescriptions do not save doctor time, but they increase Accountability and save administration time. This may change later, but currently many prescriptions have to be duplicated and countless extra consultation time is spent asking patients whether they want their prescription sent to chemists or printed. The default is to go electronic, but patients normally want a printed script which will be dispensed faster. System has potential in future??? (hopefully)

  • NICE recommends introduction of 10% statin threshold into QOF despite GP opposition

    Nick Chiappe's comment 04 Jun 2015 0:10am

    My patients do not believe the "no side effects" mantra, and I am very unconvinced that the small benefit would be considered worthwhile if explained with proper NNT tables for individuals at the lower end of risk. We should prescribe very cautiously to healthy individuals. Our patients, once convinced that a statin is good will want to consider rosuvastatin if they experience side effects. This is not cost effective, but once convinced that a statin is beneficial, the patients won't care about that- "surely you're not going t let me have a heart attack or stroke just because of cost?"

  • Never underrate ‘proper’ doctors

    Nick Chiappe's comment 30 Nov 2014 11:23am

    A comic article with a lot of truth in it. Phil poking fun at menu driven healthcare which produces lots of paperwork but does not enhance patient care. We caring GPs find it funny, and at the same time a sad indictment on the changes in healthcare which do not always make the patients happier/better. I think contributors should identify themselves-This criticism of other systems is not the same as a surgeon telling the Daily Mail that most GPs are inadequate- as I understand it Pulse is a magazine for GPs and Phil is not presenting a critical review of other's care, more helping GPs realise they can and usually do a good job in humorous fashion.
    Those who denigrate GPs will end up with a more expensive less caring and less experienced service- most of my colleagues over 50 are seriously thinking about retirement as a consequence of the endless inappropriate criticism- we cannot be specialists in everything , and if perfection is necessary, we will constantly feel we are failing- a very poor motivator for a caring profession. (same for our over pressurised managers and nurses!)

  • Practices to be fined £600 for failing to display CQC ratings

    Nick Chiappe's comment 17 Sep 2014 11:11pm

    Not always a fan of Roy Lilley but the article Andrew Pilbeam refers to is poignant.
    Publicising deficiencies all over the surgery is not a normal thing for businesses in any other walk of life to do,
    Oddly enough, making patients feel their practice is poor does not improve confidence in their care and will probably be disheartening to staff and clinical workers as well. The (expensive to look after) frequent attenders, elderly etc will know if we are good (or not) . Others may leave. If they do, the work may get harder, care will get worse and appointments will be harder to obtain.
    Hopefully our practice will get a good report. We certainly do our best to give good care. If not , I am likely to move to a salaried job or retire early. I don't think I can work any harder!
    I would suggest an explanation of the reasons for the rating given and the changes made to counteract them (if appropriate) is displayed in the same place. If the rating is basically wrong, again an explanation of why the practice thinks so should be placed with the rating so Patients can be properly informed . As others have said, raw ratings of any sort are a poor guide to the service you get in a practice.

  • GPs should be paid per 1,000 consultations, says Gerada

    Nick Chiappe's comment 31 May 2014 3:10pm

    A good method of recognising workload, but there has to be some recognition for time spent as well as raw numbers. A system based on raw consultation numbers would even more favour your area 1 only , 1 problem per consultation doctor. As a patient, I want to deal with all my problems at once. I hope for enough time to answer my concerns and to understand the logic behind treatments recommended for me. This will improve my compliance and allow me to make the best health decisions. I like to do this for my patients too.--
    Now: what about hourly pay for GPs - what an innovation?

  • At what point does GP-led commissioning stop being GP-led?

    Nick Chiappe's comment 18 Sep 2013 12:14pm

    Telling GPs they are members does not make us feel like members, and certainly it does not feel as if we have control of anything. When the job is to attempt to save cash while giving patients exactly what they ask for, it is clearly impossible. The larger the organisation, the less likely an individual voice makes a difference- giving good advice to a board takes a lot of work and GPs have too much even before the changes- When those who enjoy management (and ran the PCTs) start pulling out, the government should think about whether this is a way to run the NHS. With the constraints on CCGs, the old (smaller) PCTs with their clinical executives had more GP influence, whatever the politicians say. The press need to make the people realise that there is no GP led NHS- leading the NHS is a very energy and time consuming job when done properly, and doctors do not like to do things badly. We are short of GPs, so replacing time out for management is not possible. I do think we have useful skills and knowledge to manage change, but if the most experienced GPs give up (even part of ) the day job, patients in primary care will miss out.