In last two years I have given references to three GPs who have emigrated to Oz and Canada, and I personally know two more who have also done so. That's probably around a quarter of GPs I know personally or work with. Good luck to the rest of us who are still here for whatever reason
Should Carr-Hill formula include not only patient demographics, morbidity eyc, but also doctor's posh factor? What impact on funding should it have?
It's a very good and thought provoking article. But it takes us to questions with no answers
Great! I shall carry on with my usual practice, which is not to prescribe this bs pseudo-medicine, as per usual
Harry, thank you, for typical examples of reasons for (home visits) requests. Few years ago, we agreed a policy that in our practice reception and triage nurse discussed requests for visits with duty Dr before it was offered to patients. It has cut numbers of home visits by some 90%, just asking if patients are really housebound or had real medical need. Like someone said, grow a spine and decide where you are needed most...but work would be better if this unnecessary distraction (visits) was completely removed.
I am glad that some of us enjoy the support of community nursing, palliative care, frailty teams, as evident from Dr Cannon's article. But what about areas that do not have such support? Where I work, in Wiltshire, there is no functioning social services or district nursing team. We don't know who our palliative care nurse is and local Hospice ignore our referrals. Acute services are so crap that patients choose not to bother with attending AE even with barn door obvious life threatening symptoms like collapse/bradicardia or cardiac chest pain. We spend endless hours seeing these patients and trying to magic up some safety nets around them. I simply don't have time to drive half an hour each way any more.
way I see it, there's no problem with the duration of training. Learning doesn't stop after qualifying. There's a problem with unrealistic ludicrous standards of RCGP assessments, which give trainees a skewed view of real practice. Turning them into protocol droids, portfolio social workers, anything but GPs. Of cause we also live, and practice, in the age when it is incredibly difficult to act as good doctor. Much easier, and safer from medico-legal prospective, to follow a policy, guideline, protocol.
Populist and short sighted idea. So when wanacry 2 strikes and all fancy new software is down, and I am unable to send an urgent referral digitally or by fax machine, I will suggest my patients who is responsible for delays in their assessments or treatments.
Matt, mate, my best advice, go back to playing Fotnight, this is all you seem to know. Best to leave grown ups to do grown up job.
thank you Prof Majeed for highlighting this abhorrent practice by our regulator. Just illustrates what I thought all along: GMC do not consider Doctors rights to be as important or equal to Patient's rights.
I don't know... just because (mostly) poorly educated on the topic of European integration majority voted to leave, doesn't mean that any opposing views should automatically seize to exist. And it is reasonable for body like RCGP to be concerned with questions of workforce planning in general practice and with patient safety too. Both would probably be adversely affected by Brexit. Brexiteers seem to show a lot of concern about democratic process where it comes to respecting the result of the referendum in 2015, but have no problem shutting down any (democratic) debate about very legitimate concerns about problems that Brexit will bring.
Headlines should say: "UK patients ten times as likely to eat pork pies (in massive quantities), smoke and drink excessively as those in Japan"
Bet dreaded GMC would make one reflect and convince themselves that it's all their fault for daring to disagree/upset/not fully satisfy the client. After all, Client is always right.
After gimmicks of BG case, I expect anything from that bunch.
Stabbed in your surgery?!!!
That's indescribably horrible
dumping will continue, but may change from direct requests to more of "I hope your GP would be agreeable to refer/book/follow up"
This boy visibly enjoys his toys. Doubt he understands much about healthcare or NHS (with its many problems). Doesn't really inspire confidence.. no more than Teresa's brexit preparations
I am glad this is turning into a sort of a good debate. I still remember writing, however, that I shred discharge summaries (with mostly stupid requests within them) after I've read them, not before (although, maybe should reconsider)'
Now that I think about the issue... here we are lucky if we get any discharge summary at all. They've been replaced by discharge medications summaries that contain no useful information about why patient was admitted, and where, and under who's care, and what was found etc. CCG had no interest in influencing this nasty habit to change, by the way. Maybe that's the reason why seeing a discharge summary (with inevitably unworkable/unrealistic/unnecessary recommendations) is sort of a novelty, so I read them
many thanks to the previous comment author for sharing your wisdom with us. unfortunately I see very little value in being smug about that not so elegantly worded example of picking up some rare pathology of indeterminate significance. Haemolytic anemias due to inherited membrane defects are mostly mild and require no treatment or a little folate, or if not mild- will be picked up anyway.
I am sorry to hear that you also seem to need to focus hard to see "hospital clinicans reasoning", so that you can carry on with doing.. "due diligence". So I'll explain. Vast majority of their requests for referrals to other specialties/more tests/GP follow up are due to:
a. them not knowing the patient
b. not knowing condition/not being comfortable with managing anything outside their specialty (examples- GP to refer to gastro for management of reflux, refer to ENT for chronic perennial rhinitis, refer gynae for irregular periods, refer dying patient for CPAP or respiratory rehab)
c. not having time or resources to deal themselves.
Because of this last point I still have sympathy with the stupidity of most requests on discharge summaries that come to me and give them consideration they deserve (usually means shred them AFTER I've red them).
Should read: 2 in 5 have admitted experiencing mental health problems. 3 in 5 haven't admitted yet, or have no insight (yet)
Ok. sounds like they think they could ensure continuous supply of meds. But should we be stockpiling GPs and nurses?
I think Francesca is spot on right. Mental health services have been underfunded into nearly non existence. I see no point in referring any more. Those who "meet criteria" find their way in themselves.
As GPs what should we do about it?- tell patients how it is.
So you wish to be referred a specialist service that can diagnose, advise on treatment, care etc? Eh... you see, in reality, you will fail to answer phone within one beep and will be triaged green/silver/whatever and discharged. At best you will be seen by a social worker or a psychology graduate, who will have no idea about questions in my referral. Consider saying that you want to kill yourself, or somebody else, this might get you further. Sorry, but we are all in it together. Next!
we need a minister of health app