I'm just a simple man trying to make my way in the universe
It is a it rich that the chair of RCGP - a partner in a two star practice and in the lowest quartile in overall satisfaction in the the whole on England calls other practices as pariah practices.
Pot calling the kettle black.
My understanding is the new NHS Indemnity scheme would NOT cover
1) Good Samaritan acts
2) Non NHS work (Any private or fee paying work undertaken)
3) GMC proceedings
4) Coroners cases
5) Criminal investigations
6) Patient complaints from past medical treatment provided
This is a tentative list and we await for clarification of the scheme as it is made up as we go along.
Agree with Dylan,
There are not enough doctors to sit and explain every test face to face. Although it is not our fault that the situation is that way, we have to make the best of the available resources and arrange for follow up via any appropriate medium - including Nurse clinics, Phone calls from junior doctors, SMS to inform scan/test was normal etc etc.
What is NOT acceptable is allowing patient to be on tenterhooks about a result with no follow up booked in as it seems to be often the case at present
Partnership model is not contributing to the OOH crisis, is it?
Used carefully this can be an useful tool in select patients in selected circumstances.
However To a man with a hammer, everything looks like a nail - should not apply it indiscriminately.
I offered to pilot Skype/ Conference consultations between patient, GP and lipid clinic consultant who almost never needed to examine a patient more than a GP can.
The hospital was not interested as they don't get paid HRG tariff!!!
NICE has accepted that Mirtazapine and SSRI combination in its previous guidelines as one of the few exceptions where 2 antidepressants are used together.
Obviously we need to consider the study effects.
We need to note that SSRI`s themselves have very high placebo effect (in excess of 50%) and we still use them, so I hope the study had enough numbers to be statistically significant
Common sense prevails at last.
However few caveats on this conclusion- its only 40,000 patients which for a low risk population by definition does not a high confidence interval of accuracy for the billion people worldwide who are estimated to have hypertension.
Data from GP records is based on in clinic readings. In future validated measurements from patient held machines which can generate lot more data (?accuracy) would be used to model outcomes with a bigger dataset.
I think the CMO of Push doctor Dr.Dan Bunstone has resigned as chair of a CCG after majority of practices in the CCG expressed no confidence in him according to HSJ.
Also interesting to note the comments from LMC on this compared to their choice of words when Babylon wanted to start recruiting in Birmingham.
Don't we live in interesting times
Most of my GPVTS cohorts went to Australia ,New Zealand or Canada.
Most are not coming back even if they roll the red carpet out.
As long as they have a the latest iPhone/android phone with unlimited data package, speak fluent English and have private Insurance.
This is a retrospective decision. What we need is a prospective trial of triaging into alternate practitioners and then see how many they are able to manage and what proportion is reverted back to GP`s.
One should also look at vicarious liability.
I have come across patients with unusual presentations like a heartburn which was a acute MI (in a 40 yr old lady), a sore throat which was acute leukaemia, an "asthma flare up" which was Eisenmengers reversal, 2 shoulder pains which were lung malignancies etc. Admittedly these are rare but the medical negligence costs will have to be weighed up against the saving. 1 significant missed diagnosis would offset years of savings by offsetting workload to alternate health professionals and GP`s carry the vicarious liability now.
Obviously if the government underwrites all medical negligence then this becomes more interesting.
The "doctor as a medicine" concept is also lost but some patients prefer 20 min with the nurse rather than 10 min with GP partially offsetting this.
Today I have been told
"There is a national problem with Patient Access in that it is very slow and patients struggling to access it today. Being investigated"
The app would be single point of failure for primary care for the entire country and single point of infrastructure attack for any hostile entity which wishes to cause chaos in England.
20% of our patients are booking their appointments online and this will increase with time. However there are several access points such as telephone, a visit to the surgery as alternates to book appointments.
There are positive sides to this as well as there is standardization of access to practices, albeit for digitally enabled citizens.
As with anything new, it does not flatten the playing field but creates new winners (app developers, IT staff, more control of primary care by NHS) and new losers (GP surgeries, elderly patients).
We are trialling e-consultations in our practice very very carefully.
This may increase, decrease or have no effect on available appointments.
Extremely small reductions have be noted in some studies while in others it had no statistical improvement.
Significant reductions in appointments are likely to be fantasy of some vested interests.
If it were so successful NHSE should pay practices extra 40-60% of primary care budgets ASAP to implement this
even resolved AF has risk of recurrence and increased risk of CVA (exception being lone atrial fibrillation which has no evidence). So yes this consistent with known evidence regarding AF.
Advantage- GP`s and staff can be paid as independent contractors which NHS Organizations and surgeries are prevented from doing(IR35).
Freedom to organize as they see fit
Private providers have to pay VAT (charities are exempted I think, as are NHS trusts.
Form should follow the function and the function is presumably to be ready for ACO contract!
Don't we live in interesting times
Medicine is not an exact science- if it were algorithms would have replaced us by now.
Unplanned/unexpected weight loss is always a very important symptom when assessing the elderly.
NNH (unnecessary tests and worry) maybe more than NNT (actual cancer) and would need to be formally assessed in a study before including it in guidelines.
*.*, the consultant on-call on the day Jack Adcock died. Did he review patients in ward rounds?. Why was he away from the hospital that day. How come his notes were used when he should be questioned as well?
The judge and Jury make decision on the information provided to them.
I am not sure the information provided was accurate, without bias (of self preservation) and complete.
I suspect the original manslaughter verdict may not stand the rigor of retrial.
I agree that no one should be allowed to openly discriminate like this new service.
Vinci Ho is as usual right on the theology of the need (as determined by us) and want ( as determined by patient).
Never the twain shall meet!!!
However in a changing society how to improve access to "want" without pushing the overall financial envelope?
I disagree anyone is allowed to openly cherry pick (I say openly as I have seen some GP`s have practice areas which exclude the deprived areas....)
However managing patient want is a issue esp in cities where continuity is important for lesser number of patients.
Also if the cost of healthcare is not reaching the working population who by definition will contribute to productivity of the country (which is lower than most comparable countries)then the cost spent is not recovered indirectly via productivity, taxes etc.
Maybe they can have a new iPMS contract for internet only companies which can have such exclusions but be paid far less to increase the GMS value to traditional brick and mortar (B&M)GP surgeries. iPMS contractors should pay the going market value whenever their patients attend a B&M surgery to compensate for their loss of business. It brings it own issues as there will less B&M surgeries due to the same.
Very true and also patient satisfaction drops off after about 15-16 k patients. #
Smaller practices have better overall satisfaction, less admissions and less referrals but have more variability between the group more due to sample size being smaller than in cohort of larger practices.
It would be interesting to study other outcomes such as OPD referrals, inpatient admissions, Overall cost per patient in relationship to partnerships vs APMS, limited companies and also size!
Well this is one good thing from NHSE and I support the same.
I hope to be able to put it on our practice display in the waiting room.