Just Your Average Joe
'Professor Cumming also told delegates that they were aiming to stop the rise in GPs doing short-term locum work.'
Older people especially with long term conditions and dementia, are not suitable to stay at home with 2 visits for half an hour a a day, when they can't safely wash/dress, feed themselves or mobilise to the toilet.
Many of these 'People', are left to their own devices, with almost no social care or human interaction.
Unless their are families to support them, they will inevitably end up in hospital unless care provisions improve, as they can't be left on the floor at home alone.
Fit and mobile online fee for capitation needs to reduce by a significant amount, which needs to move to help offset the huge number of appointments and vists the frail and elderly and very young require, as this workload is left behind when you cherry pick the easy to deal with patients from other colleagues lists.
There will not be sufficient funding to support staffing to allow care for those left behind in this stupidly rolled out model.
A pilot with separately funded money should have been set up to evaluate the impact before letting this medico-legal monstrosity of a care model to be allowed to nuke the current primary care landscape, with risk of leaving a scorched earth model of care behind.
Yes some improved access would be nice, but not at expense of caring for the elderly and vulnerable, and no extra funding to prevent the imbalances that are slowly being introduced.
If not resolved soon, it will become too hard to stop the flood of fallout from this disastrously poor;y considered plan from the DOH/JH.
No problem -
Happy to do once enhanced service for £100 per patient for complex medication reviews is set up.
Until then email home office and ask them to check for you.
£3.5bn bill for Houses of Parliament repairs - 50 million to save primary care - split into such tiny chunks, it won't make a difference, as most of the money won't make the front line anyway.
That's politicians for you.
NHS England - your plan on your death involves passing your list onto a larger local practice who have a nice new building and fit our vision of the future better. What can we do to hasten your demise?????
Finally concede - time for a token 10 pound charge per appointment - just to try and reduce demand.
It worked with carrier bags, so change in behaviour can be made, and with money raised finance a visiting service for the elderly.
Do not bend to Managerial incompetence. No manager has the right to force practices to take on patients when it is unsafe. If they try then report them to the CQC and GMC as incompetent, and unfit to hold a post in the NHS.
Enough letters on their HR files will eventually force poor manager to stp working in the NHS or stop making such danger decisions.
It is for NHS England to make a solution for the patients without care, either find money to support practices to take on staff to make the situation safe, or create a new solution to give care to those without.
Once this can't be done it will create media interest and it will be forced onto DOH and JH radar and help make primary care safe for all practices as they will have to act - as those 5000 GPs are not materialising on the front line to replace those leaving/retiring.
All practices should meet and send a letter to NHS England and ask whichever moron decided patient choice trumps patient safety should resign immediately.
If they are not willing to do this, sign a letter saying they take complete managerial and criminal liability for any harm that comes to any patients due to this decision to force GP practices to work in a clinically unsafe environment.
If they won't do this resign and reverse the decision.
LMC if you don't enforce this - please also resign.
The practices should report the CCG to CQC - they should not just disperse 5000 patients to other practices that are unable to cope with this influx of demand - as it endangers the practices and their ability to look after the patients they already have.
Just like in the Dr BG case, extra work above and beyond a reasonable ability to cope when foisted on you, does not earn medals, but a manslaughter charge, risk of imprisonment, and after of a lifetime of effort and learning, appraisals and revalidation, stripping of your licence to practice.
Just say no to the CCG giving these potential hand grenades to you, and force them to go to the DOH and JH and get adequate funding for primary care provision.
As long as practices agreed to allocations, the Russian roulette of seeing who gets a GMC beheading first will continue.
If a basic practice allowance is hard to re-swallow:
Start by paying all indemnity for partnerships.
Then add a resilience payment for taking all the crap.
Add a continuity payment - for taking ongoing responsibility for patient care.
Make a premium for being a partner above and beyond locum/salaried - then the financial swing will move recruitment towards partnership and a sustainable primary care model.
Fund per contact and capitation, not an unlimited access model - otherwise there will be no GPs left to see them.
Remove Home visitation responsibility as the growing elderly population will have no-one left to see them once partnerships die - a centralised CCG service instead.
PS ban on-line vulture services - sucking out funding from practices - destabilising them to point of collapse.
Simple truths - the vast majority of new trainees coming out from VTS are female.
Even the small number of male GPs produced want to work less than full time.
None of them want to work full days slogging from am to night.
They want to do a max of 3hrs am, 3hrs pm and no visits. Most of our female colleagues with children would like to work around the school day, to allow pick up/drop off and see their offspring.
If you get a salaried post - they want BMA contract limits on workload and home - with none of the limitless access cover required by partners.
If as limited workload and hours locums and salaried doctors, earning pretty much the same as partners, there is no incentive to slog yourself to the limit and take all the responsibility, patient demands and general crap from NHS England, DOH and CQC etc.
GP partnership will be dying from chronic starvation of funding, removal of incentives to be a partner, and the constant efforts of sucking out any profit from the contract, while increasing costs, and failing to fund new work adequately.
I love partnership, but see the difference in workload and it is not sustainable, nor is it easy to recruit replacements for those who are leaving.
Large basic practice allowance a starting point, for those willing to take on responsibility and workload for being a partner, and then the tide may change.
Otherwise a work to rule salaried service, where costs will be hugely increased is the inevitable result, and that financial burden will be less than the required increase to make partnership sustainable.
The whole 'QUIP' agenda is cut money, flog dying horse until dead, and call it quality improvement while they cut the funding from under your feet, then get annoyed service delivery is not improved and patients complaining, and spend money to allow patients complaints to be better heard and flog GPs with rising complaints.
QOF may be annoying - but the targets and reminders lead to better patient care, and bring income to practices. Most practices get close to full QOF points.
The DOH want with the help of certain Ivory Tower GPs to scrap it - as they feel it is embedded into GP care now, and will expect all the work to continue now for free - when there was originally money to transfer this work out of hospitals into Primary care.
We have hired staff inc admin/nurses to ensure it is done, but when expected to continue for reduced money/free - we still have those costs, and GP time used to do this.
If scrapped I expect to be able to refer all COPD, asthma and diabetic etc patients back to hospitals to let them do the work again - Nope that will not be allowed.
Big brother CQC/CCG/NHS England etc looking at referral patterns/rates and monitor those who stray from previous historical reductions.
This work however you frame it will become another financial tax/noose around struggling practices, and the 'New menu' to replace it is more work, now taken from Public Health who are failing to deliver it in their budget, to be done by Gps at again a fraction of what Public health are given to do it.
BMA - stand up for GPs - All QOF money straight into global sum, new money for the new menu - or resign from representing us.
If the GMC is an organisation for doctors to self regulate, how does one sack the management including CM who are running it into the ground?
Appraisal should be reserved for those doctors where significant concerns have been raised so they can demonstrate they are reflecting and getting appropriate training in areas where they were lacking.
So DR BW instead of erasure should have been advised to have a 5yr revalidation cycle (Some would see that as a harsher punishment!), and left to continue the profession, where she could continue to help many thousands of patients.
Everyone else should be left to see patients and get rest in between.
MPs get upset GPs earn more than they do.
Its a world where because its considered public service - they envy the pay, and its now a race to the bottom, while people working in the city and financial services, footballers etc can earn telephone numbers, as no-one bats an eye lid.
People will only value Primary care when they have to pay - never believed in it - but co-payments for GP and A&E needed urgently before the services are decimated beyond saving.
'copernicus | GP Partner/Principal27 Apr 2018 1:47pm
Impossible to run a practice on £150/patient gross (globalsum+QOF+LCS+GPFV) without working for free. No wonder they are all going to the wall. All you can eat General Practice buffet 12 months for the cost of 3 tanks of petrol.'
Can I get petrol where you get it - 150 pounds barely tank and a half where I live!
But seriously far more expensive to get 1 year's pet insurance than GPs get per patient!
Never read any 'NICE' guidelines and all my patients over last decade and a half seem to be thriving!
Noxious Intended Consecutive Excrement guidelines simply deserve to be used as toilet paper in emergencies
Easy answer - Continue to prescribe - sort out the fees and charges at the pharmacy level.
If they take prescription and are told 100 paracetamol costs a prescription charge or 1 pound OTC - then the choice to pay more is down to them. The real problem is so many people get free prescriptions - that this is the real issue.
Many with long term heart problems etc on multiple drugs have to pay, but certain people get everything for free whether truly needed or just wanted - ie creams etc - which could be bought OTC.
Back to start - not GP issue - prescribe as required. DOH issue to sort out free prescriptions, and pharmacies to charge the correct amount DOH wants to charge OTC.
Second issue OTC drugs are so expensive they are encouraging patients to go to GP where they will get for free.
Break the cycle of funding issues - GP job to ensure correct treatment given - cost is not our responsibility - though they continue to try and foist it on us.
No problem drop all appointments and adopt a walk in system.
Alternatively a 100% triage system - where they book into a triage slot where you can assess the patient yourself properly and decide what needs to be done.