Although I rarely read the comments (the vitriol and abuse is unpleasant) I am a GP partner in a practice with nurse-practitioners, a clinical pharmacist, psychologists and psychotherapists, receptionists and an admin team - all of who contribute hugely to the work of the practice. Furthermore, patients are very active as educators for medical students and GP trainees, and have helped us redraft the practice leaflet and letters and re-organise our appointments. I think the future of general practice depends on us being less isolated and more connected, and civility in the comments section, rather than selection on the basis of GMC registration would be a better way ahead
There is a long history of doctors being poor patients and neglecting their health with serious consequences not only for themselves and their dependents - stories of neglected sick doctors' children are frighteningly common- but also for their patients. I've summarised it for the BMJ here: http://careers.bmj.com/careers/advice/view-article.html?id=20017843
Although my article doesn't trace the history of neglected doctors' children, anecdotes among my ageing GP partners go back decades and every one of them has a story about the time they medically neglected their children. I don't believe the GMC guidance has anything to do with these older cases (or indeed my own recent neglect) Psychological factors have a lot more to do with it - as you suggest at the beginning of your blog.
I spoke to Andy Burnham's office a couple of days after the announcement. The admitted that they didn't know how 48 could be enforced as a right, and that the money they were offering, which they claimed would fund an additional 3million appointments, was far short of the 40 million extra appointments we need.
Patient's with urgent concerns need quick access to expert advice, and every practice should offer this, with the possibility for face to face assessment according to clinical need. In my practice, for the last few years every patient thinks their problem cannot wait for a routine appointment is called back by a GP within 10-60 minutes. About 60-70% of concerns can be dealt with over the phone and the rest are either seen on the day or booked with their usual doctor at the next available appointment.
48hrs appeals to busy working people (voters), but it is a political target lacking any clinical relevance. As I pointed out to Labour last week, it has alienated GPs but more importantly it will not help patients.
Stereotypes are useful sometimes. Obviously there's no reason why someone with a serious chronic illness shouldn't have a family.
I am concerned by the govt's repeated use of the phrase 'hardworking families' which I think excludes the retired, isolated, unemployed, bereaved, etc. who make up a large part of my work.
Perhaps you should use your name and stand by your comments.
The patients we spend most time with are the elderly (who don't like to come to out after dark) the chronically sick (who are rarely his beloved 'hardworking family' types, and mums with young children. Most GPs have arranged their working weeks to be around to care for these patients. Many (myself included) also work regular weekend shifts and evening surgeries. Forcing us to provide even better continuity during the day and more out of hours access will be impossible.
The proposals to charge immigrants are in order to set up the bureaucracy and technology to introduce charges for everyone. The cost of setting this up will clearly never be met by charging immigrants, but it will never be accepted if the public suspect that they too will be charged. The move towards co-payments, top-ups and an insurance system (where you register with a CCG run by Virgin etc.) needs this infrastructure.
Anonymous is muddling the is/ought distinction. Human contact does affect those involved in ways that are rightly considered therapeutic. If you are of the conviction that they ought not be used in that way, you need to consider whether it is possible to have human contact without any therapeutic value. Perhaps there is, but only if we stop behaving like humans.
All GPs are keen for their patients to manage what they can, themselves. Long gone are the days (at least for NHS GPs) when we could indulge the anxious wealthy with elaborate attention in order to gain their fees and maintain their custom, as described by Bernard Shaw in his preface to A Doctor's Dilemma.
Why then do I hold my patients hands? Why do I go through a careful physical examination that lacks a rigorous evidence-base? How often do patients open up emotionally when they are undressed? Is an anxious patient seeking reassurance wasting a GPs time?
The article above muddles a reasonable plea for GPs to empower their patients to care for themselves whilst relieving the pressure on appointments, with the very complex ways in which GPs and patients communicate. Balint described the doctor (GP) as drug, our interaction with our patients is a vital part of our ability not only to understand eachother, but to heal them. This is in great danger of being lost.
One of Julian Tudor Hart's gifts to the NHS was the insight that planned and proactive care paid greater dividends that unlimited access. If Burnham is serious about a cost-effective NHS he'll not over-burden general practice with ever-longer opening hours. Most medicine is routine, and much of it complex, some medicine is urgent and much of it straightforward.
Most healthcare is routine and much of it complex. Some healthcare is urgent and much of it straightforward.
Continuity of care is essential for safety and efficiency. 24/7 or 7/7 General Practice will risks undermining this.
How do failure rates of IMG tell us the CSA is discriminating on the grounds of ethnicity as opposed to clinical skills/ training/ communication etc.etc.? Surely we need a more evidence than rates of failure? Is there any evidence that the ethnic background of the examiner makes any difference for example? And why do we need 'wise men' to advice the chair? Isn't that sexist?
The Tesco model could work. Patients could stand in long queues in warehouses and scan themeselves. If that doesn't work they could join even longer queues to see someone on a minimum wage who can do the scanning for them. What could possibly be wrong with that?