Agree with all of above. I've tried this before including patient contract but it just takes time. We are already running at 11.5min/consultation (from BMA study good few years ago, so prob longer now). We can't then add extra 5min every time medication is prescribed.
I'm happy to do this if government can fund 20min GP appointment. Over to you DoH
Whilst it sounds as if these GPs had room for improvement, I think if we apply the same rule to all of the GPs, most of us would be suspended.
How many GPs will refuse opiates to COPD patients? How many will warn patient opiates could kill them? How many will fully interrogate the record from start to finish every time to ensure there are absolutely no contraindications at all??
"This study uses ESPs who are band 7 or 8 experienced physios and independent practitioners."
Here is the problem. There is a national shortage of physio (just like GPs), let alone finding sufficient band 7/8.
Add to this the cost of band 8 ESP (circa £50k if on costs included) and it soon starts to become apparent why we have generalists in primary care rather than many specialists!
Has the Doh told these guys they'll have to attend unpaid and still take on all of the responsibility?
If they are happy with that, welcome to the club :)
I'd love to do this provided
Mr Hancock will be responsible for any network problem
He will also ensure every patient will have email and internet
He will also be responsible for junk box filter problem
He will also be responsible for any phishing scams - yes, they will happen
He will also have a system to prevent replies being sent to generic inbox
There is no doubt the current system isn't helpful. But why?
1) We cannot do unlimited work with limited resources. If we remove either one of them i.e. define how much work or change to payment by activity, you'll see an immediate improvement (and NHS will collapse overnight)
2) Evidence suggests 20-40% of GP work does not need health care at all. Our residents are creating their own problem by using state resource. How many times have we seen "cough for a day, wanted to be check before going on holiday"?
3) 40% of GP work is now paperwork due to government policy - may be cut this down and we can see more patients?
4) under resourced = less admin, less clinicians to provide quicker convenient service. May be Mr Smith needs to think about this?
5) With the workload, most GPs don't have the space/time/resource for "innovation" to improve their practice. Do you blame them? I called home at 18:30 yesterday to say I'm coming home and I got the reply "oh, you are leaving early today"
6) And with yearly changing contract and evershifting government policy, who would want to invest in their practice to make improvement? Only those who are willing to capitalise from their patients will invest as state money is too poor to have any return
Go on Hancock, make my day.
Announce next year's contract will have reduction in global sum and let's see how many practices will hand back the contract
So, for my practice, that's approx 10% of practice list i.e. 850 carers. If it only took 10min/carer, that's 141 hours.
That's roughly a month of work. What would the government like me to drop instead? Not have clinic for a month and direct patients to AED perhaps?
So, lets look at cancer guideline.
There is no longer any reference to timescale on change of bowel habit. We currently exercise clinical judgement and tell pt not to worry about a week's Hx of constipation.
Under above ruling I can't produce evidence to say why I've "deviated" from NICE guidnce. So I can happily refer every Pt I see and flood the fast track clinic.
Is this what we want?
I would have been helpful to work out the cost effectiveness.
3D approach may improve satisfaction - but if it (lets say) costed x5 more then less involved one, can the nation afford it?
We already do this to a very reasonable extent but I suspect these academics want it done in silly - oops I mean "more complere" manner.
I don't mind - but if we are spending 5 min on each medication, each time, we will need atleast 20min appointments. Will the college also advice the government of this and suggest expanding NHS budget by 2 folds and expand clinical work force by 2 folds also?
Thought not. Suggest academics goes back to books and pipes, we at coal face will continue to struggle
Why don't RCN get the government to fund primary care the same rate as secondary care first? Then we talk about pay rise for those that work there - like the GP partners who's seen over 12% paycut over the last 10 years, nevermind inflationary part rise (which my nurses has been getting)
I understand the need for continuity but as Paul points out, that's commissioner problem, not provider.
You watch - we'll all soon get an email asking us to submit business continuity plans on what happens if we all die at practice Xmas party (GPC to negotiate terms of banning this from 2019/20)
Unless the contract had specific requirement to provide chinese speaking staff, I can't see how they are substandard.
Most GP practices in my area use telephone intepretation service, they don't have polish/latvian (our main non english speaking population) speaking staff, and all the changes such as telephone triage mentioned above is quite the norm.
It looks like the population benefitted from having above average service due to having non commissioned language experts in the practice and now they've come down to average service having lost them. May be it's time commissioners pulled their fingers out and paid for the service which they had free for many years?
Why don't they let CCG serve notice? My understanding is, CCG will have to then payout reasonable fee for early termination, as well as carry out impact assessment to the services and commission alternative.
I bet it's a bluff. Don't blink first!
Charles Richards | GP Partner/Principal08 May 2018 3:49pm
Nothing's changed but funding doesn't follow the actual population today - there is always a lag (I'm told about 3 years) between actual population and estimated population on CCG funding.
They might have gone bust by than :)
Commissioners even have a name for this "you do it often enough so you should do it for free". It's called "business as usual" and it seems once they decide the activity is in catagory, they don't have to pay for it.
As already mentioned, CQC will not be giving up the idea. So welcome to doing more work for less.
Last Man Standing | GP Partner/Principal03 May 2018 11:42am
Don't worry, I've already heard us mention in list of people to blame for this on radio this morning.
So, given number of graduates are finite, will this not simply mean less locums/partners/salaried in an area that's currently managing? Sounds like robbing peter to pay paul, whilst spending 20K a pop.....
Its a pitty NICE has come to this. When it started, it was best in the world on balancing clinical evidence against resources of the country. In the last 5 years, it has become a mouth piece for political medics who has little care or understanding of what can be delivered within the current constraints.
NICE should state "primary care" rather then "GP". It will then become commissioning issue for NHSE/CCG rather then individual GPs being held to fault for not being able to do 200% more than what we were originally commissioned to provide.
GPC should grow a pair too - they need to flag up the need for increased funding or termination of other services everytime a new "GP should do...." is introduced by NICE. There are no other union in the country who idly sit and watch whilst their members are being told to do extra work with no recompensation or work plan