Hyperinflation by 2025
‘Housebound’ is not a binary state.
Many patients could be brought to the surgery with accessible transport and an escort but the NHS or social care have not commissioned this, preferring ‘free’ GP time.
Some patients could travel if well but not when ill.
In the UK we, and our housing and benefits system, also encourages patients to stay living at home alone when they should be in residential or nursing care with people who can help them.
This all contributes to requests for visits that, without being reckless, still need to be done after triaging.
And for those practices that smugly say they have no visits - you are either taking clinical risks or you have unwritten working and reception practices that push those patients to your neighbouring GPs.
Translation ‘I couldn’t find any reason to pin in on the doctors - this time’
If I got £80-£150 per appt like hospitals I could have a nice clinic nurse to keep me from loneliness.
‘Today I checked 100 letters full of poor handovers, had to deal with 5 requests for me to refer onwards and respond to 3 ‘referral rejections’. It was MEGA!’
I promise to reduce my appointments as I have to do work for the risk that the hospitals have dumped on us.
For each hour of extra work i’ll send 4 patients to A/E directly!
The main CCG and orthopaedic department learning point from me writing a 'quality alert' about a man who had somehow developed a sinus into his knee join, and who was triaged to physio, and who, when he saw said physio in the orthopaedic department was not fast tracked to a consultant (it being their departments fault in the triaging) but instead was put to the back of the queue, not seeing an orthopaedic doctor until over 6 months from my initial referral, was that I shouldn't have used the word 'muppet' in my complaint, and needed some kind of warning!
The system is utterly broken.
The hospital dementia nurse has asked me to ask you to urgently refer this patient to the community psychiatric team.
Communist services dementia nurse.’
To this day the hospital team still think the worst thing about this episode is that there are a series of letters from me questioning their ability to do their own job if they can’t explain why this referral was needed, why it needed to be from me, and why this was inappropriate given their self assessed urgency.
Only answer is to see fewer patients and advise patients to attend A/e as you have work to do.
I’ve been fighting since May with the local hospital to internally refer someone for the problem caused by them. My first quality alert led to agreement patient would be seen. Unfortunately referral still hasn’t been done despite 2nd quality alert so I’ve had to refer. No one cares about these unsafe work dumps to GPs.
Classic NHS paying £2k for a standing desk. Mine cost £500.
I wonder if complex patients having a social care component to their problems is being conflated with social care being the sole issue by many thought leaders in the NHS.
Political targets ensure ccgs pay for leafleting campaigns to pursuade people they need some IAPT yet patients who present to the GP have their referrals rejected.
Studies that claim massive decreases in a/e visits for target cohorts are usually measuring reversion to the mean or death, both of which reduce a/e visits.
‘but it is cheaper for them to provide care if the patient is dead, so NHS wins, and workload stays down.’
It is sad that I entertain the thought that someone in an office somewhere might have made such a calculation.
Is there a discount if I buy 3?
Who the duck advised the government that a diagnosis is the same as a mental capacity assessment - someone on secondment from the Brexit team??!!!
Presumably those politicians and bureaucrats who invented these obviously ridiculous rules are still gainfully employed?
I’m going to hide in my BMA GP relaxation space...
Oecd hard outcome measures show the NHS is an unimpressive way of arranging health provision.
There are lots of European alternatives with better outcomes that involve patient contributions yet have full coverage.
No one admits they are running a Ponzi scheme!