Why does it take 3/12 or more to do a check? I'd like to know what is involved in the performer's list check and I'd bet everything in it can be done within a week if done properly
I'm afraid I couldn't agree with Steve's comments.
As you stared L&D model isn't simply putting a GP in AED and we know evidence of this is poor. My understanding of that model is not seeing the patient in AED but to redirect them to appropriate service.
I also disagree with notion it is never the patient's fault. Whilst I agree the healthcare has become unneccesarily complex due to government's desire to constantly change/pilot/re-invent healthcare, patients must hold some responsibilty. After all, no other country would use tax to suppliment patient's failure to selfcare/navigate the health system their outcome are often better then UK.
I'm sure you know from your own assertion of well children in paediatric AED. We see huge number of patients who do not need but want health care. Personally, decades of treating patients like children who are incapable of making decisions and hold no responsibility of action has led to the state we are in now.
What I think we need is;
1) patients to be educated on correct use of healthcare
2) inform patients how much health care costs for individual episodes
3) health care being protected from litigation when agreed and approved pathway of re-direction is followed
4) shared patient record so each organizations can understand and manage episodes of care
5) single point of access run by senior clinicians to triage appropriate service (sorry NHS111 doesn't cut it!)
and yes, all of the above needs some form of collaborative work
This is a difficult one.
I've seen very poor documentation from my colleagues which will definitely loose a case and I've also seen excellent notes which was perfectly written and probably saw the Pt too early in the disease process to be able to spot a diagnosis.
It also causes practical issues for us - how often have we answered a phone call at 5pm (yes, just after Pt finished work) "Doc, I had this back pain since last week....." - are we now obliged to insist on seeing all of them rather then telephone advice if no red flags?
And the indemnity? We are effectively subsidising UK healthcare's limitation to resources via higher indemnity paid from our own income. If we all practiced defensive medicine, NHS will go bust within a year!
Patients should be asked to take some responsibility as well- if they have no symptoms of cauda equina and properly saftinetted, they should not be allow to sue. Otherwise the whole UK healthcare will fall.
I agree it is discrimination and we should fight against it. Patients should be seen on clinical needs, not their age.
If they impose, I can think of various methods to make it unworkable - easiest thing to do is to reserve all appointments for over 75s and send everyone else to AED stating government mandate (and give your local tory MP's office number to complain whilst you are at it)
That's strange. Simon said the other day he's demolishing CCGs and giving power to STPs soon. Anyone sane in CCG will be looking to wind down and transfer the power over the next couple of years just like PCTs did only 4 years ago!
So I suspect CCGs will be commissioning this in smallest way possible to satisfy the mandate - not through their choice butto comply with NHSE's own rule!
Devil's Advocate | GP Partner/Principal10 Mar 2017 10:37am
Bot sure if you are inexperienced or naive but demand is limitless over period of time. Many many industries and services has proven this. You don't need to look any further then our social service - once respected and utilized as benefit for those in need, now seen as "right".
Those who tried Dr First will tell you the same too, as I suspect one of the poster above has tried.
I'd caution my colleagues to be careful here. GMS contracts are deliverately vague and there is little in there which exempts us form providing medical care.
Having said that, I think it's reasonable to argue warfarin initiation/maintenance is outside of core activities as that requires phlebotomy/finger pric, INR machine and a specialised software to calculate INR (long gone are days of HO deciding dosage on a whim), all of which is not part of GMS.
Don't think NOACs could be argued - it needs no specialist knowledge or monitor (if I remember right NICE speciafically mentions primary care initiation). Most health economists would argue price of providing warfarin (with it's complications and monitors) is not that different from most NOACs.
Personally, I', recommending NOACs more now - little reasons against it TBH
Vinci - I haven't suggested we discount the services offered by those in certain profession. But if we are going to do it, we need to do it for all the professions/job.
And what about those which is not classed as a "job" but still very important to the society? Should a spouce of important profesison be allowed to stay? What if they have kids who needs education (and hence in need of public funds). What if they are a professional but has criminal record? etc etc
Dr Wollastone's suggestion, whilst I can see her reasons, is far too simplistic and descriminatory. If we are concerned, we need to find a logical reason for immigration pronto or - dare I say it - delay Brexit till such time as we've figured how it may affect the work force/economy/health/international relationship and how to deal with them? Right now, it sounds like a broken marriage where both parties is in a hurry to divorce, they forget what they'll be loosing at the end (ask a 1/2 decent solicitor, they'll tell you the only winner in a divorce settlement is the solicitors!)
Being a bit of an devil's advocate, why should health care professionals get a different immigration rules? Are we some how more important then the bankers (most successful secotr business in uk), police, social workers, etc. Clearly some profssions are needed more then the other but this will not be static.
We should either goto point based immigration system or allow none.
"Safest" to share nothing
That's not what Caldicott2 says!
It is sad to see there are so much vitriol against anyone in any form of establishment that people loose the logic.
What Peevs and many on here is suggesting is we'd have a better healthcare system if it was run entirely by non clinicians. Seriously? You'd rather be told how to work by Business Studies graduate in their 20s and 30s what you need to do every day and whole system governed by ex-bankers?
Not sure if you guys realize the irony but as GP partners, we are a mini managers ourselves. If we extended Peev's view a little more, you are eluding to having an entirely salaried profession as that will mean no time "wasted" in doing non clinical work.
God help us all.........
My receptionists already do them. Happy to call them GP assistants if that floats your boat.
Don't expect me to start paying them £15/hr though - I'll have to shut my surgery as there won't be enough income left for me then. Or may be that's the DoH's plan?
Does EU need Britain?
Not really as we are already loosing our function as financial capitol of Europe. Ask any bankers from Franfurt/Brussels (or even Paris) and thgey'll tell you they are innundated with quieries on relocating from UK.
Are we a big manufacturer? No
Do we have better infrastructure? No - one of the worst road in the europe, internet/power supplies/transport being average at best.
We do have one of the best Unies outside of USA, probably about the only thing going for us (though usefulness of top education in country's economy is debatable).
Do we need Europe? Hell yes! It is our biggest exporter and the only reason financial institutation in London have flourished.
The only reason Europe wanted UK to remain was for financial instution and to keep the membership stable. Now the horse has bolted, no reason for them to keep the friendliness. Haven't you noticed we've been sidelined already? The only leader who is putting us on agenda is derranged Trump.
So good luck on negotiating hard Brexist Teresa "I ditch my principle to cling onto political power" May. If I was a European leader I'll be negotiating a hard - Britain stands to loose a lot more then Europe!
And this was a surprise?
People (though I have to keep on reminding everyone only 2% difference) voted to segregate ourselves from rest of Europe and those who voted for Brexit didn't think it might cause the Europeans in UK to feel insecure and unwanted??
Although I'm not from Europe, as we seem to be going a head with this, I too am seriously thinking of doing my own "Brexit" - only I'm quitting Britain.
Good to see you Peevs, but oh dear what's happened? You used to show great insight and humour in your blogs but this article is woefully uninformed and biased, to the point humour has evaporated and left bitter burnt bits of your previous wits.
Before anyone asks, I do 1 day a week for my CCG, elected by my peers to represente them to ensure we are not shafted.
No doubt there are terrible doctors in managerial position. But my experience is, the propotin is quite the opposit. Those in leading position often have far better knowledge of medicine (as they often deal with new guidance, secondary care etc) and have just as good consultation skills if not better (as they have to deal with board of people and other stakeholders). Certainly in my local area, I would not claim to be a better GP then them.
And since when has general practice ever been free of politics? Is your aging brain altering the memory of internal politics played by the senior partner and his favourite PM to belittle younger partners to much more rosy memory? Do you not remember parity? As we run our practice, we've never been free of dealing with management - its just that it is more externalized and done on a bigger scale now.
I suppose you belive standing still is the bestprotection against changing times? Do you not realize the once Great Britin, who ruled more parts of the world then Genghis Khan and took lands from China now ranks way below it's former colony in economical ranking precisely doing that? Repeating what we do everyday tomorrow will not stop the growing demand and aging population. If you belive clinicians stopped influencing management the managers will somehow disappear and leaves us alone, you might want to think back to PCT times. It wasn't great and that was when NHS had abundance of money.
As many of my colleagues do, I get paid for 1 day a week but essentially do 2.5 days for the CCG, eating up most of my weekends and evenings. Unfortunately, uninformed blogs likes yours will only turn GPs against it's own organization which is trying to balance protecting primary care and protecting local health economy.
I am sorry to see once wise and witty Peevs has come back blinkered and bitter. I truely do feel like I've lost an old friend.
Oh yes, it's that really helpful guidance that said;
‘non-specific, non-localised presentation, for example feeling very unwell, and may not have a high temperature’
So, on the basis of Sir Keogh's recommendation to treat suspected sepsis as urgently as chest pain, should I be asking all patients who says they are feeling very unwell to call 999? That'll be the logical conclusion from comments from those political academics.
Sorry AED and ambulance trusts, I'm just following my guidelines as GPs are no longer allowed to exercise our judgement :)
I can't believe GPC cannot see this. I suspect (and I'm not a conspiracy theorist) they do know the intentions but they are either hopelessly incapable of addressing it or they are choosing to service their own personal agenda and selling the profession down the river.
You'd know latter is the case if the GPC chair gets a gong. Oops, hasn't this happened already?
I'm not discounting the effectiveness of the visits but some perspective is needed here.
Trust is failing in it's primary function (responding to emergencies) whilst using staff to service a subcontract. Unless they are doing it for free, it's a bit like builder not finishing off the job they are being paid whilst the labourers are working on another job.
That doesn't feel right
Do people get this? I've not had a single valentine wish, never mind a card and pressie. Best I get is reminder from my patients to go and see my family at 6pm as it's valentine!
I must try and put a nicer aftershave........
Extract from GMC on unlicensed meds;
Decisions should be made in collaboration with the patient by discussing the options with them and ensuring that they have sufficient information about the medicine to allow them to make an informed decision.
where prescribing unlicensed medicines is supported by authoritative clinical guidance, it may be sufficient to describe to the patient in general terms, why the medicine is not licensed for the proposed use.
You should also consider discussing the options with colleagues or experts and getting advice from them on the appropriateness of the treatment.
You are responsible for all prescriptions you sign and your decisions and actions