Retired Partner. Now GP locum (part of a chambers) & OOH Medical Director.
We are not even able to put IUDs in unless we can do at east one a month. That is a relatively easy gynaecologist procedure. I take it that these would be emergency procedures and not elective ones at the most risky times. What support is proposed? Anaesthetics, Paediatrician for flat babies, urgent blood supplies, qualified theatre nurses! You really could not make this up
I completely agree with Dr Swinyard. The principles of the NHS that it meet the needs of everyone, that it be free at the point of delivery
and that it be based on clinical need, not ability to pay were idealistic at the time in 1948 and the politicians were worried then. Expectations of the NHS are unrealistic, and it is about time that it was no longer used as a political football. In addition we should make a distinction between want and need. In no other section of society can we always have what we want. We are victims of our own success. People also need to understand that with rights go responsibilities. Should the tax payer fund self inflicted lifestyle consequences? or at least not without some kind of change? There are many difficult and unpalatable questions which we dodge. In a National Health Service the decisions should be the same everywhere. We all know that the NHS is inefficient - appointments are missed without any consequence (often because the appt has never reached the the patient) and that huge amounts of money are wasted. Politicians can't just pour money into it. So much needs fixing. As far as GP is concerned I still believe that continuity is the jewel in the crown
There has been a recent patient survey. A brief totally unscientific look at local practices that I know suggests that the smaller practices achieve better scores than the large ones. It would be interesting to see if this is actually the case. I have no doubt that NHSE policy is to allow small to medium practices who are failing to do so.
This is very disappointing, but hardly surprising as it has been obvious for some years. My own practice had absolutely no support from NHSE since 2009 and the PMS review was designed to make it fail. I jumped before I could be ruined. Now that this is clearly official policy there is something to fight against rather than continuous denial. It is time to fight for what patients want and value, and also what is proven to be more efficient - Continuity of Care and knowing a doctor well and the doctor knowing a patient well. This cannot be provided in large 50,000 practices who have to open 7 days a week. General Practice is not about providing instant care to the worried well. It is about good chronic disease management and getting to know families and their issues. Cradle to grave medicine. If we don't reverse the current trend soon we will have lost everything that is best in UK General Practice. I am soon to retire, but I am moving towards the next phase of life as a patient. I want to know my GP well in the future, and I don't want to keep going over my history time and time again
It is down to a multitude of factors. As a partner I left my practice as I did not want to be the last man standing as a result of a catastrophic reduction after a) PMS review and b) unacceptable service charge hike. I had already decided to take my pension at 55 as I had reached my LTA and owing to the intensity of the work i was going to go part time. Finances (the loss of seniority plus an unfair PMS review with poor Carr Hill formula) made the practice unviable, and self preservation pushed me into the world of locuming. Why would any GP taking on the risks of being a partner.
What I could never understand was that despite being quite open with NHSE, and involving MPs, councillors etc they were quite happy to see a good practice fail
The PMS review was started during the labour government, and CCGs came into being in 2012 during the coalition - setting GPs up to fail. The focus was was always on saving money and anything that secondary care wanted to pass off onto General Practice was meekly accepted. Money never followed the patient.
Ultimately it was inevitable that senior GPs would have had enough and if you are a junior GP and are "left holding the baby" you would want to go. With this background why would any newly qualified GP want to be a partner with the risk!
I am also not sure where they get the figures from, as I do not think there is a register of locums.
It is the individual out of hours providers who will not be able to comply with their contracts who will be blamed.
He could have avoided it, but didn't. Protecting Patients, Supporting Doctors. The GMCs actions have failed on both counts. If Doctors feel that they can cannot reflect on their actions without putting themselves at risk that has put patient safety at risk. Clearly doctors do not feel that they are getting any support from the GMC. I was one of the LMC representatives in Liverpool last Friday.
I am concerned "up to 25 routine doctor-patient contacts a day could be deemed ‘safe’, with GPs only reaching "unsafe" working levels at 35 or more routine patient contacts per day". The key word here is "routine". There does not seem to be any limit to unscheduled appointments, telephone calls, additional visits etc. This seems to therefore condone the status quo.
Joe is absolutely right. It is time to have the debate that no politician wants to have. Currently the NHS is expected to provide everything to everyone. At its inception I am sure that this was not anticipated, simply because we can do so much more and it is technologically more advanced and expensive. Politicians have expected somebody else to do the rationing!! We now need to have the debate starting with 1) How much are we prepared to pay and 2) What does that mean we can afford?
If the population wants everything for everybody, the bill will go up exponentially and it is simply unaffordable. So far the NHS has survived on the goodwill and professionalism of the staff. Staff can only take so much. The sustained intensity of the workload will lead to burnout, and staff will leave. This at a point where more staff are needed. It was inevitable that at some point there would be a flu epidemic and that there would be a crash!!
The problem is always going to be the numbers of doctors who are actually available to do the work. The more different ways you create to access these doctors (apps, telephone calls, Urgent Care Centres, GPs in casualty, triage etc) which involves doctors the less time they will have to see patients and sort them out properly. I am surprised they needed "a pilot" to find out something that was blindingly obvious to anyone with a brain. We need to invest in our existing workforce and pamper them so that they feel valued again. I am off next year.
GPs are human beings. Most of them start medicine with an aptitude for science and maths and the knowledge that they are in the top two percent of the population academically. So what does the average medical student want in a career? Intellectual Challenge, job satisfaction, good remuneration, respect, a degree of professional autonomy, job stability? All of the above I suspect. As GPs we recognise that if you put excessive strain on any system it will break. Many of us have obsessional tendencies and try to be perfect in every possible way. When we can no longer conform to our own expectations of how we practise we break.
Too many GPs are realising that they cannot continue in the present system as it is, and as each GP leaves the remainder are put under more pressure. I was in a Practice this morning and my overriding impression is that secondary care was putting obstacles in the way of GPs doing their job rather than trying to facilitate. Could you get an ECG before accepting a referral to a rapid access chest pain clinic! Please make sure that all the boxes in our referral form (4 pages long and different for each hospital/speciality) are filled in otherwise we won't accept the referral.
It is just easier to stop rather than continue to fight. Add into the mix annual appraisal, indemnity etc, annual mandatory training. Society will only realise what a jewel we had when it is gone
It was the wrong motion and turned political. It should have said that BMA would support practices for whom introducing private practice in parallel with their NHS practice would enable them to survive where it was possible. I voted for the motion
Dr Chand is correct that we do need a significant injection of cash in order to maintain a safe service in the short term, and we have been squeezing the pips for too long. Yes demand goes up and we can do more.
However this is not the only answer and it is a fact that the NHS is completely mismanaged. So much money is wasted and there are huge numbers of people who are not contributing to productivity at all.
We need to get back to basics. The greatest expenditure in the NHS is on staff. Management costs as a percentage have increased more than clinical costs. The NHS needs
1) to reduce management costs
2) to make clinical staff feel valued and empowered to do their jobs to the best of their ability and management should exist to support clinical staff not to control them.
3) We should aim to get to a point where we do not have to contract with as many bank staff or locums and we should try and staff to excess capacity allowing for the fact that there will be maternity leave, sickness etc. It is a false economy relying on expensive contracted staff
4) properly staffed departments will lead to less errors and complaints and therefore less indemnity payouts. A huge amount is put aside from the annual budget
5) There are far too many processes and tick boxes and dare I say it audit for audits sake. We have become process driven and so much data is collected that is never used. When I first started s a doctor spreadsheets were not in existence and we managed without them
6) We waste so much and we are also having to pay far too much for much of what we use. If you are practising in the NHS you should be made to buy from a central procurement agency which sources from companies and uses economies of scale for the benefit of all NHS providers
7) We should be paying reduced rents for NHS properties which are being used by NHS providers - not market rents
I could go on! I am an ex GP partner who is about to retire from locuming etc. We can't just keep asking for more money without dealing with these problems as well.
Esher, Surrey. Ex Partner (Practice no longer viable after PMS review). Retired but locum and OOH Medical Director. Will have to stop locums next year due to indemnity
I do not understand why this is not happening everywhere. I can only suppose that GPs have forgotten that CCGs are membership organisations, or that they have become apathetic. Talk to each other in CCGs and exercise the power you have before it is too late
There is only so long that one can carry on at the intensity and hours that partners require. Given that doctors of this age probably did a 1 in 2 or 3 in 5 as junior doctors and have probably already worked more hours in total than the vast majority of the population. GPs were not expecting the current conditions in the twilight of their careers and to be frank their experience does not appear to be valued. It seems that partners no longer support each other like they used to - probably because they are all under the cosh! The fact that no one feels valued, we are constantly put down as a profession and all the goodwill has gone must have had impact on mental and physical health
If a referral of a young person is rejected by CAMHS and harm comes to that person then the medico-legal consequences should be borne by the clinician who made the decision. GP referrals should never be rejected
I seem to remember, and it is a long time ago so I could be mistaken, that the old red book (GP contract) stipulated that a full time GP had to show that they were open for direct patient contact (including visits) for 20 hours a week.
The problem is that the whole service is not functioning properly. Working in it is like wading through treacle. As people leave (GPs or secondary care) the remainder are put under more strain and snap!
I qualified in 1981 and lived in during house jobs with over 120 hours a week on call - 3 in 5! It left no time for a social life and we often worked until 10pm on our "evenings off". It was exhausting but not as intense as currently. I think that we did it because there was light at the end of the tunnel but it was not right. When I qualified doctors were valued and well respected. People even thought then that the NHS would not last.
For me the problem is that no frontline staff are valued in the NHS. Managers/politicians continuously go on about QIPP (quality, innovation, productivity and prevention) which as we all know is a euphemism for cuts and squeezing the system until "the pips squeak " If it is not easily measurable by ticking a box, or using the right code, it is not valued. Continuity and caring has been sacrificed on the alter of accessibility. In all all organisations the greatest assets are the staff that they have trained, often at great expense along with the corporate memory and skills they have. However, the current culture in society no longer seems to work like this and loyalty and integrity are ugly words. Senior managers are only judged on short term gains and the higher the better.
As long as GP is set against GP, and Primary Care is set against Secondary Care, and even hospital department against hospital department etc ... we will never be valued. Each sector is just doing its best to survive, which means looking after number one, and saying no when possible.
Doctors need to unite, put aside self interest and work towards a common goal. Unfortunately this is too idealistic and will never happen.
As a doctor who has been the Medical Director of a GP Out of Hours Service, I have piloted several GP projects front ending A&E. Most failed, but one worked extremely well. My observations are
1) GPs do not really like triaging - they prefer to deal with the whole problem and either refer or treat and discharge
2) Success or failure depends upon the attitude of the hospital staff to the GP being there
3) Indemnity is a major issue - ideally GPs should have honorary contracts with the Trust and be covered by their indemnity BUT GPs should act as GPs and not hospital doctors. There is a real danger of them going native and becoming "hospital" doctors and over investigating. This is because senior members of the A&E department see clinical governance as eliminating and not managing risk.
4) GPs in A&E must be seen as part of the team, but they should be responsible for taking what they feel they can deal wth. The danger is that someone triaging at the front has no understanding of what GPs can do - they then either sit and read the paper or are swamped.
So, yes it can work if the hospital A&E staff really want them there! Now, should they be there at the moment? If there were enough GPs to manage General Practice, and we were coping well I would say "absolutely". I can't help feeling though that at present we would be better keeping people out of hospital with good chronic disease management, continuity of care and preventing the crises that eventually end up in Hospital.
My solution is that A&E should be received for Accidents and Medical Emergencies. General Practice should probably now take the place of what the General Physicians did but predominantly should be the co-ordinators of excellent community care. The question is "who is best to see unplanned/unscheduled care"? This may or may not be medically urgent but is perceived by the patient to be so. Clinicians in this service need to be available probably 15 hours a day, 7 days a week. GPs could be part of these and they could be sited alongside acute trusts.
Time we rethought the model!?