Just Your Average Joe
PPS - last comment was additional comment - for heart sink presentations, though I might end up there one day too!
PS - ATOS have said I am fit to work even though I have depression and anxiety, so I need another sick note as the thought of actually doing a days work has flared my depression and anxiety.
I left my diazepam, pregabalin and gabapentin on the bus/dog ate it, mum chucked it in the bin, but I still have all my adcal and atorvastatin - that's safe.
I have just been released from prison and I need my diazepam, pregabalin and gabapentin - No I don't have a written discharge summary explaining why these medicines are actually needed.
I known all 486 blood tests I have had are normal and the investigations in the endocrine and rheumatology and chronic fatigue clinics have not found any cause - but I am feeling really tired and I want you to fix it now.
I went to A&E last night and they told me to see you today urgently for 4 referrals.
I have had 3 antibiotics and I am still coughing, and no I haven't got round to stopping smoking yet.
My child has had a fever for half an hour, but the nursey thought I should bring them in just in case, because you can never be too safe!
Just makes you wonder if only 400 came back, which black hole are the other thousands who qualify as GPs disappearing into - never to return!
my clinic this morning only had 1 patient from 20 who had 1 problems - ironically booked after locum day before only dealt with the minor problem she attended for, as 1 problem per consultation for them!
The rest ranged from 3 to 8 problems on lists!
When kept waiting as over-running - several complained only to pull out their own lists or ask to also discuss their sons behavioural issues in depth as well etc.
Patients expectations, and constant encouragement to complain is driving me up the wall, as I for some unknown reason still like to try and help patients.
If only I was left alone to do that, without CQC or some other idiots telling patients to complain when they don't get what they want, or write to complain about how I rushed them when they tried to fit 4 problems in 1 consultation, then they felt insulted when I suggested that I couldn't do an insurance report as well as other patients were waiting when I had left her waiting 35 mins for her appointment.
I love being a partner - but a small part of me is coming round to the DOH privatisation agenda - where we are all employed, but we will work to rule doing 1 patient 1 problem and 15 minute appointments, and see 12 in a session and then go home on time as we am not paid beyond the session time. Love to see how trusts won't have to follow the BMA salaried contract GMS practices have to follow (where PMS and APMS private companies don't have to! Level playing field my A£££)
The 12 week wait for non-urgent appointments will be some politician or hospital trust managers problem, and CQC can beat them around the head instead.
When they try and impose the 'You must see multiple problems because its unethical not to' - watch colleagues go off sick, and write in their own complaints and whistle blowing the bullying management.
Watch the politicians meddle while Rome burns.
Worry guys - as statistics are full of horse dung.
Locally output from VTS was 18 GPs - of which couple went to Australia, 2 wanted to find partnership, 5 taking career breaks to spend time with young children, 2 went into salaried posts, with rest locuming.
So if 18 retiring - replaced by these 18 - statistics say no crisis, but reality is 18 hard working full time GPs lost, and only a fraction actually replaced!
Patients have a right to a script for any treatment required as a result of a consultation. You can suggest otc treatment but if they decline you have no option but to offer a script.
All complaints will go against you in this scenario and no-one will back you.
Plus if patients have free script - especially through pre-payment - they rightfully expect treatment to be given so they don't double pay.
Until banned on FP10 as central decision - but don't expect politicians to risk the wrath of voters, when they can't lay the blame on GPs.
The real issue is demand and the expectations encouraged by succesive governments.
There is no capacity in primary care to see more, but the problem is OOH is so poorly funded and staffed it would implode under more strain, which is part of the dilemma.
Patients have worked out OOH and 111 send them are hours of triage and waiting to A&E so they just skip the middle man and go themselves.
It is what they are turning up with which is the issue, and for things already seen by GP and OOH, walk in centres for a 2nd/3rd opinion on same self limiting issue.
My sore throat is so bad - until antibiotics given etc. My child has a cough or fever, but actually urti.
The elderly need hospital in most cases, it is the younger patients who could be diverted, even the minor fractures to walk ins. most of the kids have been seen, or don't need seeing.
Charging is the only way to rein in demand - but suicide in the next election, and a law suit waiting, when someone dies because they were worried about the charge.
Not completely joking about charge for A&E car park - though really it should be charge for A&E if you haven't called 111 before you go, they give you a code which validates referral was advised.
If it proves visit was a genuine accident/emergency needing attendance it will be waived.
NHS to remain free at point of care.
Charge £50 pounds to enter A&E care park!
That might make people think before they go there!
The lawyer all you can eat buffet of compensation needs to be stopped for compensation claims.
Like the criminal injuries compensation scheme - which is a no lawyer set up, we need to have a legal cost driven system dismantled.
However we still should pay people who have had the wrong leg amputated etc given appropriately compensation - which they receive fully - as no cut taken for ambulance chasing lawyers who drag out proceedings to rack up fees.
With set fees per issue - adjusted by a panel of independent medics/lay people to allow for special circumstances, this would be a fast and much improved and cost effective scheme and could be set up in months.
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.