Just Your Average Joe
As above - the average cost is just that - covering those who work part time and pay far less, than a full timer, and again far less than those with Special interests and OOH sessions.
Pointless numbers like that mask the true cost and problems faced by GPs.
Pointless closing lists when NHS England just allocates them anyway.
What would make sense is they collect them uncared for and set up a service for them outside the current provision - which then highlights the cost efficiency of GP care and then force the DOH to invest more in GP Services so they can provide care.
The current fudge does nothing to help the practices involved and under pressure now.
Contracts are breakable - our pensions are changed, GMS contract unilaterally changed, Junior Dr contract imposed.
MPIG forever - no actually not.
It is just contracts to politicians mates which appear unbreakable!
DOH plan to ruin partnership model, and destabilise consultant and junior doctor contracts coming home to roost.
Now salaried and junior staff lost good will and resilience - so happy to work to rule, call in sick when actually sick (rather than continue to work themselves into the ground), and go home when the much reduced hours clock strikes home time, ushered out of the building bu managers scared they will go over and they may actually have to pay them extra.
We are running around trying to save pennies, while PM May has found billions to bribe herself a majority in government, and another 10 billion to try and bribe young voters who are 1st time buyers.
Just a small amount of money given sensibly to shore up the partnership model and compromise instead of imposing the contracts on juniors would go a long way to rebuild some good will and stabilise the NHS.
National DOH led education campaign needed to encourage self care - however if anyone gets seriously ill or dies - this would open up DOH to being sued.
Much better to let GPs take the risk of trying to reduce demand as we pay our own ramping up indemnity - so DOH gets to blame GPs for A&E attendances as well, w3in/win for them.
Dear Ruth - even if seen - the hospital would deem your BCC as non urgent and are happy to have you wait around 12 weeks to be seen and would process your removal within the 18 week pathway.
The 'You can't earn more than the prime minister' brigade would have a field day if that 130K became equivalent to a real commercial value than market forces are slowly forcing.
However practices can't afford to pay that, which is dragging it down still. Once hospital and APMS practices with no ability to do work themselves, are forced to pay the going rate - all Hell will break loose as it will destabilise the market.
DOH and JH can't allow huge wage increases to be seen to be given to any one group, without cries for rises for all NHS, police and emergency services etc, and treasury can't allow that.
Fun days to come - but don't get hopes up for a pay rise until disaster eventually hits and retirement bulge bursts.
Tried to wean an a Mental health patient off Pregabalin as taking 600mg bd!, and they declined saying started by psychiatrist and so as a GP not appropriate for me to stop.
Went to refer to MH team to review and stop as felt inappropriate - got a letter back saying we asked him to stop in the last appointment we saw him, and he declined so we discharged him to GP follow up. Our recommendation remains the same, so we decline to accept the referral!
Don't start inappropriate doses in pain and MH clinics and dump them on GPs to continue prescribing.
Maybe this is the first seed of change away from privatisation!
Think we should applaud a decision to stop the proliferation of APMS and private contracts.
Just ensure the appropriate funding follows the patients to allow quality to remain, rather than cost saving measures to be attached to this decision.
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)