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The waiting game

Sceptic Monkey

  • 'Dr Google enters 80% of my consultations', warns RCGP chair

    Sceptic Monkey's comment 03 Oct 2017 4:01pm

    ‘I feel we need to raise that particularly with patients and mystify that we don’t have Dr Google in the room with us and we have to work with it and we have to be bold and that’s a challenge for all of us I think.’

    What the heck does mean? I have no idea what practical solution the professor is offering here. Sounds more like jargon on top of jargon to nudge the patient off. A bit like "Brexit means Brexit"

  • GPs 'risk destabilising police services' by charging fees for non-contractual work

    Sceptic Monkey's comment 03 Oct 2017 11:14am

    shows staggering lack of understanding by DCC Glen. I wonder i she have any clue what she is talking about?

    1. As peter pointed out, we are independent contractors. Any work we do comes out of our pocket and we cannot simple do jobs out of "good will". None of my reception staff, nurses work for free, and energy/water suppliers don't give us free supply. In fact we even have to pay for recycling to the council now!
    2. Even if we wanted to do it for free, we don't have the work force. Which part of my duty does she wishes we drop? Seeing diabetics perhaps? Or may be children with temp?
    3. We already have regulation in place to share confidential information. Police do not seem to understand the difference between "possible crime with no serious public safety issues identified" against "serious crime with positive identification (or very likely) threat to public safety". Our regulation says w can breach confidentiality for latter. Having investigative query alone is not enough to breach this.
    4. Even within public sector, different departments will charge each other - just not in direct and obvious way

  • GP locum reliance caused half a million overspend in one area

    Sceptic Monkey's comment 23 Sep 2017 10:14am

    I knew someone that worked in Shetland's healthcare and I'm not surprised they can only get locum. She described isolation (nearest hospital is several hours away!), no local collaegues, no career progression, long dark winter, no recreation that's available in mainland, alcohol problem rife etc. She left after a couple of years.

    Can't really compared the recruitement difficulty here with mainland.....

  • Short-term GP contracts discontinued 'because patients want continuity of care'

    Sceptic Monkey's comment 23 Sep 2017 10:10am

    "Asked whether the practices, which are all based in the Manningham area of Bradford, had the capacity to take on the added workload, the CCG told Pulse that all of the practices currently have open lists accepting new patients"

    Wow, if this was their assessment of capacity, it shows remarkable lack of intelligence. I'm surprised Bradford's GPs are not asking if their CCG is capabale of commissioning on their behalf!

  • GP pilot set to test if earlier home visits reduces admissions

    Sceptic Monkey's comment 19 Sep 2017 6:16pm

    The problem with this scheme is obvious; a lot of visits are requested near lunch time of afternoon when the carers/relatives come in. Quite often they completely refuse to accept any responsibility and expect the medical team to be blamed if the visit was not done on the same day.

    As such, this scheme'll either be reviewing reasonably well that can wait till the next day (i.e. doesn't need admission anyway) or dangling their legs waiting for visits to come in. Seems a waste to me.

    What they need is a late pm visiting service with support wrapped around it (such as carers and intermediate care beds) which can respond with in couple of hours. It may sound like a pipe dream but far cheaper to provide then hospital admission

  • Practices forced to offer £130k salaried jobs in bid to attract GPs

    Sceptic Monkey's comment 19 Sep 2017 1:36pm

    I assume this doesn't include on costs so true cost inc indemnity, is more like 146k.

    If it's on BMA's model contract, GP will have 6.5 + 6.5 week's annual leave + study time i.e. 6-7 weeks more lave then a partner. With locum cover at £350/session, for 6 weeks extra, it'll cost further 19k.

    So, in total it's more like 165k when equated to a partner. Now, how many partner in UK earns that much in a year?

  • #GPnews: GMC wants to shake perception that it is 'anti-doctor'

    Sceptic Monkey's comment 19 Sep 2017 1:24pm

    I think GMC is right. It's not a perception, it's a FACT they are anti doctor!

  • GPs could be investigated by new patient safety whistleblowing watchdog

    Sceptic Monkey's comment 15 Sep 2017 5:26pm

    Lets see who can "investigate" us;

    GMC
    CQC
    CCG (where fully/partially delegated comissionning is in place)
    NHSE
    Courts
    Not to forget public trial by media - as many local so called newspaper likes to do.

    And worryingly, rules of double jeopardy doesn't apply, we can be sanctioned by all of the above for the same problem. No wonder no one wants to be GP?

  • GP practices see sharp increase in written complaints from patients

    Sceptic Monkey's comment 15 Sep 2017 4:41pm

    "Good complaints handling procedures are crucial in helping to ensure complaints are resolved effectively, locally and without the need for legal recourse."

    What effing tosh. This is prescisely attitude which is fueling the complaints as it's pandering to the demand rather then culture of having appropriate concerns for appropriate problems. What we need isn't better complaint handling procedure/pathway/communicator/expert. We need our patient to complain when there is a genuine problem which is below the standard expected of from general practice in 2017 UK, not when they are not having their demands met.

    Bearing in mind MDOs needs complaints to sustain their income, are we surprised of the advice? I'm not...........

  • CCG defends 'necessary' decision to freeze access to free fertility services

    Sceptic Monkey's comment 10 Sep 2017 10:43pm

    This is what I hate about the government;

    To the public it tries to be a goodie and tells the public they can have all they want. Behind closed doors, the government tells commissioners they must provide all of the above performing better then rest of the world but with less money then rest of the world.

    UK already have one of the most effective (if not the best) health care in the world. We can't get any more efficient without cutting services! See http://www.commonwealthfund.org/~/media/files/publications/fund-report/2014/jun/1755_davis_mirror_mirror_2014.pdf

  • Health anxiety talking therapy 'reduces unnecessary GP appointments'

    Sceptic Monkey's comment 07 Sep 2017 1:53pm

    This may be true for those who have clinical anxiety or chronic problems. But vast majority are no where near being pathological worrier. Many will come once or twice/year and are easily reassured but still causes significant amount to NHS

    If I get a pound for every "just wanted to make sure my child/parent/myself don't have a chest infection", I'd be able to pay my mortgage off!

  • PSA-based screening reduces deaths from prostate cancer, finds new review

    Sceptic Monkey's comment 05 Sep 2017 11:53am

    Paul - unless it's rolled out nationally, you would not have the real world data. So of course it will be done on mathematical model with assumptions made.

    Or we can ignore such academia and have a go at rolling out without thinking of it's clinical/cost effectiveness. I hear PSA costs around £20 a pop?

  • GPs submit vote of 'no confidence' in CCGs

    Sceptic Monkey's comment 15 Aug 2017 5:28pm

    sceptic | GP Partner/Principal15 Aug 2017 11:49am

    I'm not connected with Stoke on Trent or Staffordshire CCG in anyway but I must say your comment shows worrying lack of understanding.

    NHS runs on rules set by DoH. Budget book has to be submitted before start of he year (try making spending plans of 300mil to balance in 12 months). This is constrained by naionally set tarrif on hospital activities (unless block contract), need for 1% reserve + 1% headroom, certain funding attached with specific requirements (e.g. must be spent in out of hours access), required shared resource with LA (Better Care Fund), statutory requirements to be full filled as well as in year changes forced by DoH.

    Granted some areas such as Manchester has had extra extra extra funding (I wonder how much more money per capita they've had in the last 7 years) but most CCG's budget are less then what is required to balance the book. CCGs try to address the funding shortage by making "innovations" - obviously this cannot succeed every year. If CCG execs can suddenly save 3% budget (circa 5-10mil) year on year, they should be managing bigger companies with much better pay then 170k (about average take home for Accountable Officer).

    So the reality is, DoH is setting CCGs to fail. It's with regret I'm seeing colleagues like you dancing to their tune.

  • GPs forced to get approval before referring patients to hospital

    Sceptic Monkey's comment 11 Aug 2017 2:19pm

    Whilst I can understand some of the concerns, it's odd those who are refusing to take part in managing health economy are also complaining about their work load and pay.

    Is it difficult to realize more you refer, more funds will follow to secondary care and then more work will come back to us? You might argue that's not your problem and it's CCG to manage but the reality is NHSE cut it's proportion of funding from 11 - 7.5%.

    We can of course choose to work in what you would perceive clinically safe, do nothing and accept continued increase in work load and inverse drop in your income.

  • Sensei will see you now: how Japan reinforced my faith in general practice

    Sceptic Monkey's comment 08 Aug 2017 1:40pm

    Having experienced the Japanese system first hand, I can tell you UK is miles ahead.

    Unnecessary tests and treatments are done at hospital with no controls. It's not infrequent to hospitalize patients with no thought to the cost or need (My dad was admitted for 3 days post routine successful cataract op just so that drops can be instilled!). After 3 months, hospital will kick out it's patient as government funding will drop. There is no continuity care. EPR is sporadic at best with no inter-system connectivity. Commissioning at scale doesn't seem to exist with individual hospital (?or department) looking after their political agenda.

    Generalist in true form doesn't exist, no is there clinicians with task to maximize efficiency and provide continuity of care. Home visit is rare in cities and if it did exit, it won't be free.

  • Stress of training forces four in ten trainees to consider quitting

    Sceptic Monkey's comment 07 Aug 2017 1:10pm

    Call me old fashioned but 20 years ago, GP trainees had the same stress in a different way. Back then it was doing 1 in 3 oncalls (yes, including night), oncall during the day, trainers never providing close support etc.

    I guess some would find that more stressful, some will find the current system worse.

    What has changed though is the reward at the end. Back then, you could become a successful partner and be your own boss (financially never as good as consultants). Now, you get to be micromanaged after CCT, all the way to your early grave.

  • GPs told to ask patients if they require over-the-counter prescription

    Sceptic Monkey's comment 15 Jul 2017 2:11pm

    Gosh, shows how many of us above are out of touch and lost the art of general practice.

    You don't have to force patients to accept this. However it's very reasonable to explain and negotiate with your patients on how this will benefit everyone. It is still our responsibility to use public fund (which drug nudget is part of) effectively. If the patient declines, you have done your bit. When enough patients participate, it will eventually become the norm - just like patients no longer expect AB for common cold (remember the time when this idea was floated and some older GPs said exactly what you guys are saying above?)

    I can understand why people are acting to preserve themselves - but haven't we forgotten why we are GPs and not top down managed hospital doctor?

  • GP-in-A&E scheme will not be sustainable in the longer term, hospital leaders warn

    Sceptic Monkey's comment 04 Jul 2017 10:56am

    Apart from the obvious (not enough GPs and should be invested into primary care), wasn't this scheme meant to liberate capacity and hence improve efficiency? i.e. cost of having GP service should be serviced by saving they make on not seeing inappropriate patients.

    100m this is year should be for transformation (make changes happen) rather then paying for service

  • Labour to force vote on end to 1% pay cap amid ’10,000’ GP shortage

    Sceptic Monkey's comment 28 Jun 2017 4:48pm

    Another pay cut for the partners.

    I suspect all will happen is the uplift in global sum will not reflect the wage rise (as it has not done so and partner income going down for 8th year running) all the while we get pressure from our staff to increase their wage. Given May is giving 1b to stay in power (why are we having to pay for her political incompetence??), there is no chance NHS budget will increase next year.

    Labour might want to recognise this will further exacerbate NHS problems, not cure.

  • A third of GPs considering quitting over indemnity fee rises

    Sceptic Monkey's comment 26 Jun 2017 2:44pm

    I'm sorry to hear your plight.

    I agree with job becoming unsustainable. We do well at might practice but that's because we have made a decision not to rely on NHS income and about 1/4 of our take home is from non NHS work. If we lost non NHS, we'll struggle.

    As for complaints, completely agree. I got a complaint today because I declined to call USS dep during surgery to double check a very small cyst is definitely not cancerous. Explained at length how unlikely it is to be a cancer and why it will take more then 10min for USS to be re-reported and offered to write to clarify. Still patients has the "right" to complain, don't they?