Hyperinflation by 2025
Not having back up when we refer patients is the worst. Even the assistants to the community mental health nurses are happy to bounce work back to us nowadays.
I’m not sure what they want? At risk patients won’t be asked to attend, so this would only be an accidental finding in a consult, in which case you wouldn’t then transfer rooms.
I had a patient yesterday who still hadn’t been tested 24 hours after calling 111 and being told they would arrange this.
More time is wasted by the rest of the NHS ‘family’ than patients themselves.
Bounced referrals, crap discharges, work dumping etc is endless.
We have a queue of patients every morning waiting to get an appointment. My last unused appointment, excluding late cancellations or DNAs, was afternoon of Christmas Eve 2014.
Money for an extra GP session during primary school hours would buy 3 times as many appointments as this bus, but politicians have a fetish for buses, so buses we get.
When would you use ppe under current guidance for covid in general practice?
Well they do sometimes come home with cannulas still in place.
I would love an experiment where old levels of APMS/WIC funding was given to some bog standard gms/pms practices for 3 years guaranteed with the only stipulation being ‘improve your patients’ care’, and no expectation of care plans, KPIs or reporting.
‘if they couldn’t either articulate what they needed CMHT for or sort out the patient themselves.’
The practice received an email from the district nurse to say the community dementia nurse wanted us to know the hospital dementia nurse had told her to tell us we should urgently refer our patient to the cmht dementia team.
No reason why and no contractual or IT bars to this being done directly.
There was an escalation of letters and emails that might have resulted in me questioning the point of the hospital dementia team if they couldn’t either articulate what they needed CMHT for.
Of course the resulting complaints focussed on the rudeness of my tone, rather than the rudeness and clinical delay of expecting a GP to act urgently on hearsay via a message through a trio of nurses!
Great. This will just become another stick to beat GPs with. If you don't raise the alarm the system will claim no knowledge when an error due to the perpetual high workload dumping occurs. If you do raise the alarm the commissioners will create more work and you'll have the CQC on your back.
Perhaps the answer is for all practices to raise the alarm daily on the basis that it shouldn't be routine for practices to be permanently at full capacity for appointments and workload.
All the above is great, but our local public health decimated the smoking cessation funding, so we can ask about smoking then write down a phone number for them to call and they might get seen if they have severe mental illness or are pregnant.
In the past we were funded for smoking cessation in house.
As NHS and PCSE wilfully misinterprets the regulations anyway this doesn’t apply to many cases as they refuse to put dangerous patients in the violent patients scheme to start with!
The ‘zero tolerance’ slogan is a bad joke.
'- UBI doesn't work. Tried in Finland. Go look at the studies. Such a surprise really (being ironic), that its a new concept that throwing money at people doesn't work. Applies to just about most benefits really. Negative income tax, a Friedman idea, is promising though.'
There is effectively a UBI already - you just have to develop chronic pain or depression and fill in the right forms. Do you suggest housing benefit and ESA/PIP is any better?
Negative income tax isn't much different from UBI once you adjust tax thresholds etc, just a different way of accounting for it.
DOI - generally a low government, reduce the NHS supporter and fan of Friedman and Hayek.
Probable new PCN spec:
Social prescribers will deal with 39% of your work.
Pharmacists will do 48%.
Mental health nurse will do 72%.
Physio will do 54%.
Therefore you probably owe us some money back and will reduce all payments to your practice.
Love and kisses, The NHS.
A PCN specification that would reduce workload:
1. Here is some more money
2. Use it to reduce workload as you see fit
Typo: Land not Jane
Money printing has inflated assets and made housing unaffordable. Work is illogical for many compared to benefits but claiming requires papers such as med3.
The answer is negative income tax or universal basic income, a Jane value tax and scrapping of housing benefit that traps people in their area of birth and ensures those with jobs have to move even further out of town.
'Similarly, the practice loses out on the link worker, who could reduce a GP consultations by a quarter.'
I can't believe people really believe this!
Take an individual cohort of high consulting patients, given them some time, usual treatment and a link worker, and consultations fall over the next year.
Unfortunately if you take that same cohort and treat them the same but without a link worker - consultations fall over the next year.
The abuse of stats for high usage patients and ignorance of reversion to the mean is unfortunately influencing national policy and funding priorities in a scandalous way!
I couldn't agree more with this piece!
It's strange that commissioners are happy to 'trust' us with all the work that hospital doctors are told they can't do anymore, including following up their patients, complex prescribing and monitoring, making diagnoses etc, yet we can't be trusted with some extra cash to pay for all the work already transferred/dumped to us over the past decade!
Given the severe lack of funding and explosion of work to do we should be cutting back on extended access (at least 1.5x the cost of a daytime gp appt by my conservative calculations) and ditching care plans, whilst keeping the money to pay for core services.
Institutional distrust of GPs is endemic in commissioner land, yet they look to us for answers!