Just Your Average Joe
Dear Prof Field - Your comments lack humanity due to the strain CQC inspections are putting on practices at such a difficult time for primary care.
Our CQC reports was clearly cut and pasted from one done on a practice in the same premises - as some of the answers were not even ours but from their report.
Most of what is written is either fiction or garbage.
The comment from Big and small makes the article worth reading!
Its what most of us sadly know looks like satire but is dangerously close to brushing true reality.
If patients were not told they could have everything they want, and a right of referral for a specialist opinion under NHS charter, then referral team reject the referral which I resend twice, how is it the practices fault.
Why does getting a 2 page letter full of grievance on not getting the referral fall on our doorstep wasting precious time to respond to which could be better spent on patient care.
Let's start patients to not complain unless they have actually come to harm.
If you felt the GP was rude and dismissive - see someone else, or change your GP instead as maybe there is a personality clash.
Waited 12 minutes to see the GP,(probably because GP was answering complaint of person who waited 10 mins or) see Dr X who has you out of the door before you sat down instead - the patients all know who is who. Want to be heard feel free to wait, as the others wanting the same service have already done that.
Life would be better for all!
Can't wait for the robot to see Mrs Bloggs with her list of 8 problems in a 10 minute consult while having to do several examinations!
Its welcome to see her while I see the coughs and colds!
At least online - as this is free for the BMJ online, although I understand printing space issues may make this impractical in the actual journal.
BMJ should make job adverts last until post filled for 1 fee - if practices renew it by confirming post unfilled still.
That would be helping - not a lot, but more than seems to be happening, and probably help lots of practices who can't actually afford to continue to advertise for unfilled posts due to cost being prohibitive with such limited return.
We had no responses to the advert we put out - and we are in leafy areas outside london
'A spokesperson for the trust told Pulse that the practices has employed a mix of skills in the practice to ease the pressure on GPs.'
In other words - 'We can't recruit GPs, so we use anyone else we can find to pretend they can do the job instead, at a reduced price of course which is great.
If only we could get those pesky patients to be happy seeing Noctors.
We are aware that on occasions these Noctors may be suitably skilled to deal with the problems they face, but don't actually care that often they are not appropriately skilled and may miss stuff which could be actually really dangerous for patients.
What is important is that we have provided someone for them to see (It was the practice cleaner - who is a key member of the team), and let's forget about the potential disasters that could be waiting down the road until they actually hit, as I as a NHS manager will hopefully be in another job by then setting up more of these special NHS saving schemes in other areas on a juicy bonus.'
Great £48 per patient year one extra - drown year 2 once additional support funding runs out.
Its OK as manager at NHS England promoted out for resolving GP impasse the previous year, and works elsewhere now!
Who cares if list closed?
NHS England managers will just allocate the 4700 patients - accross the practices and you can't refuse them. So what's the point of a closed list.
If the list is truly closed then NHS England has to find and fund alternatives GP care provision for the 4700 patients at high cost and risk to them of poor publicity especially if any harm comes to those without routine care.
Now that scenario of NO care for 4700 patients would get headlines.
There is essentially huge discrimination being perpetuated here with an open door policy on EU doctors and GP entrants compared with any other doctor from around the world.
Working in any system other than the NHS is different, especially in countries where it is not state funded.
Prescribing, investigation and referral practices and pathways are the tip of the differences.
How can you justify letting an EU GP come pretty much straight in when they speak limited English etc, vs someone (though may be unlikely to happen) from Australia where language is no barrier and some GP like services match to a fair degree.
Also hugely unfair to anyone sitting through the CSA and UK GP training program to be told an EU doctor can walk straight in and start work.
Although the RCGP will object as they would loose vital income for their building fund, the best solution to the CSA is, to return to trainees passing to become GPs, and return to the MRCGP being a standard of excellence that all GPs may wish and be encouraged to attain, but not mandatory.
This would also end the debacle of good doctors who have completed training being stopped from working due to an exit exam which is still haunted by bias.
Here's a saving of 21 million. Don't hire management consultants.
A few tips for free - sack a random manager a week, and when no-one notices or cares, keep going until we have stripped out all the bean counters.
Save money by sacking CQC and all its bureaucracy and revalidation would be another great move.
Finally add a bye law banning ambulance chasing law suits for anyone using the NHS, and set up a compensation board that gives compensation appropriately when harm was done, without all the lawyers fees, and unnecessary indemnity hikes.
The rigorous standards of UK GPs needs to be met - all candidates need to have MRCGP and speak English fluently.
They must have evidence of annual appraisals, or be placed in retainer schemes to ensure they are of adequate quality before being allowed to roam free practising independently (With no knowledge or experience of working in the NHS environment and the current rationing and prescribing strangleholds imposed by NHS England and CCGs)
I worked in a prison - until they tried to renegotiate our practice contract to save money, so we left as it was not possible to run it at that price without subsidising the care.
A private company took the contract at that cost, then turned around and said it couldn't run it safely and asked for almost double what we were paid originally or they would walk away - and THEY WERE PAID IT as they could not leave the prison without a healthcare service and didn't want to go through another costly and pointless tendering process as no one else had been interested.
Just another example of double standards bias towards private companies and stup!d NHS mangers pouring money down the drain for worse care - we had a regular named GP every day - the private company uses locum cover, when they can find a GP!
THEY SHOULD BE forced to actually maintain minimum standards of care - ie doctors not any person who can pass themselves off as a health professional because it's cheaper and THEY can get away with it.
The NHS should return to being a closed system, WITHOUT private profit making companies which have no interest in the patients or quality of care, and whose only loyalty is to the shareholders or the bottom line.
The NHS is being hollowed out slowly, so eventually just the shell will be standing.
20 odd years ago, all chronic disease pretty much was done in hospitals and everyone was seen and got their ops done, though long waiting lists. There was no back door rationing being done. And the funding was far less than now.
The money has been increased by huge amounts, the chronic disease has been farmed out to primary care in much cheaper costs. There is rationing and overspends and though wait lists are much better, why can the NHS not cope?
Partly PFI black holes that NHS trusts are throwing money into to cover costs that are long paid, but PFI profits must continue for years to come. Locust like layers of exc3essive management brought in to the NHS to monitor targets and each other - who could all be lost to the NHS tomorrow and the world would still function and patient care may even improve!
Many private companies are coming into the NHS and being offer sweet heart deals which pay them huge premiums over and above the funding on offer to routine NHS services to do the same work - so they can make a profit large enough to make coming into the NHS worthwhile. In almost all cases the services on offer are worse.
The cherry picking of easy surgical cases means the NHS is left with all the difficult and costly cases with reduced funding as the easy patients are seen elsewhere, unbalancing the books.
The NHS should return to being a closed system, where private profit making companies which have no interest in the patients or quality of care, and whose only loyalty is to the shareholders or the bottom line. They have no qualms dropping contracts leaving patients in the lurch with practically no notice when profits fall.
The private companies should only be allowed to stay if they swallow the deficits and continue to provide a high quality service even if they run a loss - until the end of the contract - so they are forced to actually maintain minimum standards of care - ie doctors not any person who can pass themselves off as a health professional because it's cheaper and we can get away with it.
That is not helpful - closing a list is pointless where relatives are allowed to join, and any newcomers will be allocated anyway.
The reality is when people will be left with no healthcare provision then the worm will either turn or die.
Overworked practices which are at the point of breaking and unable to provide safe care will be flooded with more patients as others collapse around them, and eventually serious harm will occur as you can't be in 3 places at the same time.
Whoever awarded the contract to the company should be fired.
The contract given was a GP contract - so they 2 Drs who run the company should if unable to find GPs for this practice take a sabbatical and go into this new practice and work there until new GPs to replace them are recruited, and find locums to backfill their Ealing practice.
Yes using a pharmacist to do some of the work is not unreasonable, but here it allows the private company to milk out profit while providing a service not fit for purpose.
Once this is allowed to run - it lowers the bar for everyone - and set the privatisation of the NHS 1 step further - so next the bigger private companies running APMS practices can dilute their staff following this model and increase profits.
Corporate manslaughter charges should be filed by any family who feel their loved ones died due to substandard care provided by any one of these private companies running Sh!te non GP - GP services.
Start by stopping this culture of encouraging complaining patients to waste prescious time and resources, answering menial complaints about service provision issues outside the control of practices.
Only genuine complaints of harm should be left which warrant investigation and learning.
Stop the pushing of expectations and patient demand, and pushing unfunded services from hospitals (and even funded ones as there is no spare capacity),and then the services won't be under such strain that both doctors and patients struggle.
Just a simple fix and start to making things better, and its FREE!
Funding is the issue - all parts of NHS in dire straits.
If you refer this type of patient to mental health services in my area - they are assessed by them and the referral inevitably rejected as not meeting their referral criteria - advise redirect referral to local IAPT services.
You give the numbers and the patient could wait months before actual therapy begins.
Even if you give double/triple time to counsel/support, and overrun, what else can you really do without better MH support services?
There should be a no win, complainant pays all fees. This will stop ambulance chasers in their tracks, and all reasonable claims deserve their compensation where genuine harm done.
Win/win for all.