NotNHS != DurrUmmerikahhh Clap Clap Clap
There is a mechanism for negotiating hours, type of work, payment times, risk, organisation, working atmosphere, parking rights and location already - locum directly or via an agency for an agreed price.
If you try to have one price with all the other variables above you will only end up with oversupply at some sites and staff refusing to work at others.
Pension rules could be changed by nhse. The rest of it is down to the market.
So weight loss programs were slashed by public health as their budgets were slashed, despite everyone knowing that obesity contributes to cancer, diabetes, chronic pain, osteoarthritis etc etc etc. But now - 'because Covid-19' - obesity is suddenly a priority.
Apart from weight loss surgery, what are the gold standard treatments for obesity? It seems a pretty resilient condition for many, although mass campaign to push the carbohydrate reduction message might help IMHO.
Can we agree this time around that unwell patients with suspected Covid-19 need hospital assessment and treatment, not community Hot clinics?
We had to tell nhse how we will improve our qof this year but still don’t have the breakdown of how we did, just the totals! Madness!
The most important question is : if the gp call list is full and the a/e call triage says see GP who will be sued and prosecuted for manslaughter?
"Knowing my patients, some cannot afford a loaf of bread but spends £50 a week on cannabis. Some cannot afford a mobile but spends £40 a week on crack coccaine. Same with alcohol. Shocking priorities."
I'm not sure that this is anything to do with the post. Are you suggesting all the digitally disadvantaged patients are crack coccaine users? Why is that even relevant? And if someone self neglects due to drug/alcohol use isn't that just an indicator of the power of addiction? Would it make you feel better if we had one night a year when they can be "Purged" with no consequence? Truth Finder this is a dumb, reductionist comment that adds nothing.
In reality the cohort without email or mobiles includes the isolated frail elderly (not ALL elderly but certainly some), those with learning difficulties and severe mental illness. All groups that are invisible so only attract a few extra pounds / head for general practice, rather than the £100s they require.
I have patients who gave up requesting a test for this reason.
Is this the first bit of proactive work the government has done in this pandemic?
This is actually vaguely sensible, regardless of the uncertainties.
You can have long term condition care or providing access as urgent care - what do you want NHSE? Cos if you drop the money one will have to go (except for in those posh areas where practices feel the need to advertise to patients that they are still open).
Can we have a Hayek day when we clap clap clap and tear down statues of Keynes?
You've missed the fundamental flaw - that a solely centrally funded single customer model of buying healthcare cannot by design draw in funding at the margins where needed and will inevitably lead to an overload of unhelpful bureaucracy.
There are scores of countries that perform better on OECD metrics which include hard data like death from cancer. For those who like to ignore the persistent data regarding our persistent poor outcome look at our Covid-19 results - the worst in the world.
There are about 30 different better achieving countries we could look at for inspiration, yet the narrative, as ever, when discussing alternatives to a system that should have ended when the Berlin wall fell is "errr well look at Ummerrikahhh - clap, clap, clap, #SaveOurNhs".
Never gonna happen!
So doc should I keep taking the chemo?
Er discuss with your oncologist.
Thanks doc, glad you checked in on me.
Haven't NICE worked out we consult be video now:
"But doc it's the camera - everyone knows it puts on 5 pounds doc!"
Will the referral forms for weight management be:
1. A simple self referral that patients use;
2. A 3 page form requiring GPs to demonstrate consent for the referral, record family history, ethnicity, complete a weight chart over time, measure abdominal circumference, ensure various 'baseline bloods' have been done recently, list all medications and that will results in one 2 ring call back to the patient's home phone only with instant discharge if they miss the call - GP to re refer with new form if patient still wants to be seen?
There should be an organisation that looks at lifestyle and social interventions for the ‘public’ to improve their ‘health’ that could do this.
What should we call them?
This will be the end of GPs is deprived areas.
"You can say the same with regards NHS England
And how practices expect to be payed
You can't expect all the benefits without any of the drawbacks and expect NHS England to pay you when there isn't any work done for qoff and access has been significantly reduced"
The customer (NHS England) was paying practices to do urgent primary care work and keep patients away from Covid full hospitals during the pandemic. It wasn't an act of charity by NHS England! Access is better than ever as most practices run a full telephone consulting system. Maybe posh areas are fine but in my most deprived quintile practice last week 7% of the population consulted! We're working our socks off!
"Why is there not much work, if so, why are these small businesses not taking the same hit? Why are theses incomes protected, others are not?"
Income has fallen for various practices. Contracts including those for public health have fallen or stopped. The volume of paid reports has reduced. Where partners did other outside medical roles, using that funding to pay for salaried or locum staff back fill, some of those roles stopped so the partners are doing more work in the practice.
So income has fallen, and the business owners, who as you will know hold unlimited liability, have to reduce costs appropriately.
If a GP partner said to a regular locum "Our income has fallen and but we still have lots of work could you do it for free please?" I suspect the answer would not be yes!
"There is a moral aspect. It’s true we chose to locum and take the risk of self-employment. But the risk is now way beyond what could have been imagined."
I have full respect for locum colleagues and their decision to be self employed. I don't think, however, that a lack of imagination regarding the risks is a reason for practices to start paying locums unless they wish them to do a defined amount of work.
If the risk/benefit equation has changed perhaps the OP should consider applying for a salaried position - there are many available.