...“use your clinical judgment to decide whether it is more appropriate to get the patient to hospital in some other way, such as in your car.”
Is this a f*^%ing joke?! Taking someone in our own car is beyond dangerous for them and us. I can’t believe the MDU is even saying that this should or could be considered! So the patient arrests and died in my car, and in court the ambulance service say “oh we probably would have been there about 2 minutes after that GP took that huge risk with the patients life such a shame” and then I’m the a$$hole getting hung out to dry, as per usual. People please, I know it’s a life in front of us, but strained resources are forcing us to think things way outside our training and responsibilities and no one will be there to have our back when it goes sideways. Just operating within our roles there’s enough risk, and enough antipathy towards us, on a day to day basis to end our careers and put us in jail even when we do everything right, don’t step so far outside of the role, for anything.
This will not end easily. Holding institutions to account is ultimately opaque and dissatisfying, people want a head on a plate. And institutions run by white males are biased against putting white heads on plates. The NHS and it’s corollary organisations suffer the same subtle but vital and extensive racism that is rife within the otherwise relatively tolerant UK. White leaders just have more empathy and sympathy for their white colleagues. In a way this is perfectly natural. It’s a base bias written into human development to have sympathy and empathy for those that look like you, but this results in a lack of that same sympathy and empathy for non-whites, creating a very real predilection to scapegoat and destroy non-whites for circumstances and issues that whites walk away from unscathed on a regular basis. It’s not an overt placard-holding racism so it’s hard to see: it’s hard to realise that one is doing it and it’s hard to realise that one is benefiting from it, and that’s why it is so hard to point at it and eradicate. If you’re white and you don’t believe this is racism, this is why you are missing it, and without necessarily meaning to at all, this is how you are helping to maintain it.
@David Banner; so true
@IDGAF; he’s obviously joking
I don’t understand the people disagreeing with Zoe. The article states that she feels loss of continuity is a shame, and then lists a number of ways that continuity is better. It seems Zoe is just being practical about accepting that continuity is completely untenable with today’s resourcing, and thinking about how to adapt to try to maintain some semblance of it. I regularly tell my patients, “yes, continuity is not possible in the manner it used to be, you don’t like it, your doctors don’t like it.” I then say that we try to create some continuity now through good note-keeping, and I then advise them to try to get to know a couple of the GPs well in order to try and create a collaborative continuity of sorts. Adaptation. I don’t find Zoe saying that loss of continuity is alright, so what’s to disagree with? This is just realpolitik.
Notice how the doctor promoting working with pharma has zero peer-reviewed references, and the doctor against it has four...
“Am I nearly there yet” you are part of the problem and one of the many reasons, as “Pulse Power(less) 50” points out, that the job got this bad, and remains so. The profession fails to hang together and look after its own and too often it’s because older GPs have the attitude of “I had it hard so f%
GPs failed to receive?! “Trust failed to send” is shorter...so why “GPs failed to receive”?! Whyyyyyy?
Well said, great article, locuming is great but boundaries are really important, maintain them, people will only respect them as much as you do.
Tip that headline the other way: Patients aren’t blaming GPs for stretched resources. Oh woopti-fr***ing-doo.
Missed out the systemic pressure of being a non-white female in a head dress
The frankly astonishing level of incompetence makes me want to throw my phone across the room. NHSE, why did you allow the training of these GPs if you hadn’t already ensured that they could stay?! Now you’re reaching out to the very practices that you’re squeezing all of the time! Why do you always create problems even when you’re trying to solve problems, which by the way, were also of your creation!?
*trying to out them!
This is great, Babylon have bypassed all the standards required of actual scientific research, and managed to push all their home-made uninterrogated numbers in front of the public with the guise of authenticity; and even when their fakery is pointed out in a GP-publication that no member of the public will see, in the interest of being “fair and balanced” they are asked to respond and get to restate their over-inflated “facts” at the bottom of the very same article that’s trying to put them! They get the last word! The truth will not win.
"Isn't patient-centred"??! Being "patient-centred" isn't meant to to make all GPs crawling b****s to our patients most exploitative whims, it isn't meant to mean that we don't have basic rights to not be broadcast without our consent, or to even JUST TALK formally about how we might respond to such violations. What has happened to us, to out leadership? When did caring for our patients become complete prostration? We count damnit, we are people too.
456 deaths after opioid use without appropriate clinical indication, and she quietly deregisters herself with zero consequences. Whether this was actually reasonable palliative or not, if her name was Dr Jane Bhutan this would have been a very different story. Being white is awesome in this system. Being non-white is a serious error in judgement.
It is disappointing but unsurprising how many major institutions have given completely double-speak advice and “reassurances” regarding reflection in recent times. Thanks for being so straight.
I reckon Babylon is also going for the old too-big-to-fail model. They're trying to soak up as many patients as possible despite their host CCG saying that their finances are getting thrown out of whack by all these out-of-area registrations (haha suckit naive and greedy CCG), so what are they going for? Some kind of bail out from NHS England or central gov when it starts to look like they'll collapse and cause a massive shockwave in suddenly unregistered patients.
Alberto & Tony
Overall I do agree with Alberto guys. The issue of risk is context-specific. Sure, in other countries patients move around, so that means the risk is largely the same for all the drs, and all the patients. Here that is not the norm. So the risk is greater, relative to "normal" practice here in the UK, with medical records and the higher likelihood of longer relationships. Additionally it is getting very litigious here in the UK, and as we have all seen recently, indemnity does not stop the GMC taking a knife to you the practitioner, regardless of any failings in the system within which you are working which may have contributed to a negative outcome. Babylon is therefore a more dangerous place to work than any other established primary care setting.
Drs who work for them are choosing to look away from that risk for their convenience, fair enough, that is their choice. Patients however, they are now informed. UK patients aren't used to acting like consumers and in their healthcare, and the may young who will be signing up for Babylon, who are preferred by Babylon, they don't know any better either, because (good-for-them) a lot haven't suffered much ill health yet. But when they do, they are likely to suffer from much worse continuity problems than current primary care. This kind of care is untested and that is a problem. People do tend to assume that the NHS wouldn't allow these services if they weren't tried and tested, and that's a shame, because their trust is clearly misplaced. They deserved services with an evidence-base.
“There is no pleasure for me – I’ve been training doctors for 35 years – in seeing a young, idealistic doctor have their career ruined”
“Have their career ruined” clearly implies that the ruination was done to them, so who did it Prof? YOU DID IT! Both the system that put them in that terrible situation, and the regulator that would have crucified them if they’d walked out of an unsafe situation and then crucified them for the inevitable tragedies that took place in that unsafe situation.
It’s like murdering someone and saying “there’s no pleasure in it for me seeing someone have their life taken”
Typical GMC doublespeak.
I dunno. I see the potential pitfalls if diverting is going to hit income, but surely starting to define safe workload is a step in the right direction? I like the idea of headlines stating that “80% of GP practices are on black alert”, maybe then the state of primary care will finally get some proper attention?