CCG's have to be aware that as a membership organisation recall of the board is indeed possible.
Primary care general practice has been the golden goose in terms of delivering outputs with an efficiency far greater than any other providor for a given financial input.
This efficiency is the reason for the " shift to community" in national policy.
The learning lesson from the Wirral expereince is that the capacity to cross subsidise is long bled out of the GP primary care system- practices are going to the wall financially, having extended individuals working inputs to "beyond sustainable" in the core job.
if this scheme is desirable it needs to be appropriately costed, have a sustainable and sufficiently long contract to allow recruitment of additional workforce which meets the extra costs with "new" money.
A 12 hour working day with the additional 4 hours of "take home paperwork" is a 16 hour day 7 days a week.
This was achieved in a few state models of provision historically, ( I G Faben's Monowitz model).
I would not personally consider the model desirable for the United Kingdom.
Yes these practices major on health promotion to a young inteligent group and are the foreseeable front line casualty of a shift to elderly chronic disease management admission avoidance policy.
However the lesson for us all is fail to support our colleagues existance and the rules will change to wipe us out at some point.
Neglecting the health of this group of mainly young " instant consumerism" patients will drive up unscheduled attendances Walk in Centres and AED- all of which will cost the taxpayer more than adequately resourcing the full variety of general practice primary care.
we are conflating two seperate items and putting the usual NHS management "anti GP Spin" on them.
Firstly- prescribing quality
- pharmacy support, decision support software and so forth- all of which optimise the GP's own professional practice and choices and I recommend strongly.
Secondly- "pass thorough" medicines costs.
With the strategy being for "out of hospital care" more secondary care prescribing and dispensing is moving to primary care.
I have been unable to find any evidence of hospital pharmacy budget and staff admin costs being added on to the "pass through" primary care budget increase.
We have been given a "financial cap" and wifully had extra costs put into it.
The third and inevitable consequence will be to lambast the profession for failure when the impossible task is impossible.
Astro-pu and all other tools weight against a historical "GP only prescribing" model. The increased unremunerated secondary care costs practices are now scripting will ensure we all fail, the only difference is how long you can hang on.
Call on your CCG to delibver a costed rationale for your presctibing budget clearly demonstrating the additionality for the pass through costs.
"Water flows downhill"- the scheme will have to be alert to the possibility of becoming a "home visit on demand" service and growing a throughput of patients that would not have attended AED previously but will use the service if it gets "no questions asked" home visits.
These are selected motions for debate not yet policy.
The topics are all sentiments that I have seen expressed in the discussion threads at Pulse.
LMC conference agenda does identify the crushing workload , recruitment and retention crisis.
The Pulse item lists the most contentious (and therefore newsworthy) items.
I think NHS Medical Practice and our profession is approaching a
" stand together united or all fall" point.
Its not a good start if we cannot agree it is benefical to have a debate on the differences and resolve our variances by a democratic process.
I sympathise with Dr Vautrey, the GPC clearly get no credit for the " might have been much worse" that they averted in the in camera negotiations.
However to the " street GP" an unsustainable workload, a continuing micromanagement by NHS England, falling residual income, rising expenses and the general perception the state is wiflully bankrupting small independant providors to permit a " privatisation of the NHS" -( effectively evicting the "sitting tennants" in a very profitable bit of real estate it owns for sale)- does not make for much joy.
May we please be pleasanter with our colleagues of all persuasions GPC/ NHS Management Physicians unless we have definitive evidence they are wilfully selling the profession down the road?
My own opinion of Dr Vautrey is he is a no nonsense yorkshire man with integrity and bloody mindedness in eaqul measure and I don't doubt it would have been very much worse without the GPC efforts.
You cannot move a democratic government with fixed ideas short of civil war and revolution, and I don't have the time to do the CPD on battlefield injuries currently.
I "love" anonymous 12;32 comment.
It is so reminiscent of world war 2 line management on the Burma railway construction.
"this (starving prisioner) cannot lift as much as this (well nourished soldier) so clearly does not deserve feeding for the lesser work"
I was told the above with real names by a former POW Royal Marine in 1975.
Does it only take 1 or 2 generations for the corruptive effects of power to reduce people to promulgating unjust comparisons and apparently sincerely believing they are " fair comment"?
It should not surprise me- the only other command system that published acceptable policies, then took its senior management into closed rooms to brief on the actual" implementation and interpretation of the publication" I am currently aware of was the Third Reich.
Not a paradigm I would wish to follow or be associated with in any way Mr Hunt, but each to his own.
Anonymous 5:27- copying for which a statutory fee is payableData Protection Act- and can be performed by a non-clinical member of the practice team- lets call that a service delivery advantage then.
Anonymous 11:57 is correct this is a simple fact that the public do not "value" GP's and object to payment for non nhs professional services.
Is the subliminal public meme on the NHS the same as the public hold on comercial " reciprocity /gifting" marketing strategies;- " it is free so it must be rubbish?"
My local specialist MH trust has between 20 and 40 people a year on its high risk CPN/Community supervision commit suicide.
This is well intentioned from the ivory tower , however the majority of people with frequent presentation are resistant to or in denial as to the psychological aspects of their presentations.
They are also competnet to refuse psychological interventions- QV.
Give me an effective intervention before calling for screening.
This is worrying.
The LMC is a statutory body with a duty regarding the number and quality of performers of Medical services in its locality.Similar commitees for Dentist, OPharmacy and Optical Services.
In this new NHS where co-working with all interested parties, CQC local authority, healthwatch and so on is the norm, the removal of discipline specific commitee representation is unjust.
A practioner has a right to be judged by the standards of peers in their own discipline.
This genericisation of assessment of professional standards is unfair and not in patients interests.
1) Move your practice further away from a Walk in centre immediately- its the biggest driverin the stats.
2) Gp's contracted/funded to provide assessment on clinical need within 48 hours.
public choose to go to service comissioned "on demand and finished within 4 hours"
3) This is about capacity provision to an engineered "need" of instant access.
The government are slowly waking up to the fact that when they have introduced the plurality of primary care provision the "cost per contact" of all new systems is higher than the " cost per contact" in old fashioned GP Primary Care.
The Government either do not have the wit ,
do and also have the mendacity to appreciate that its the costs of the "instant" access that makes the other providors dearer.
If they are wed to instant access , instant access to GP's needs an investment in premises and staffing and cost per contact will rise.
Move the work but not the monies and this is a mendacious engineered "constructive termination" of GP providors.
So the NHS under the ex M+S chief adopts "fashion Manufacturing Policies" and imports overseas workers as the amount they can earn at uk rates makes them a wealthy person in their home country economy?
Not old enough to remember it ,despite being born but the NHS History is clear- we are officially back in the mid 1960's- " Brain Drain" " overseas Doctor recruitment"-
So my Prediction?
The cycle runs elect a labour government,
80% Higher rate income tax,
some rehash of " fair days work for a fair days wage" industrial action by medical staff (cf1969),
a renamed Independent pay review award body to prevent the need to strike in future.
Oh sorry- we have that since the last cylce its supposed to be a fair wage system now , however the politicians feel they can renage on it for nearly every public sector employee.
-Note Sole exception.
The new independant one for MP's
" its independant must be paid in full fair remuneration for responsibilities"
I hope the public are slowly coming to realise that MP's deliberately kept the official salary low but the expenses huge and unchecked ,to keep restraint on public sector " but your MP only get 58k per anum".
Clare Curtis-Thompson 250,00k per anum full package- where are you now?
This type of request is expressly prohibited- dig out " reducing GP paperwork "
and I quote from the introduction;-
"This is a fine balance to maintain,"
"as it could be argued that any approach to a GP about one of their patients is a clinical enquiry almost by definition. Unfortunately, over time citizens, businesses and public sector bodies have placed increased certification and verification demands on GPs. The culture that has evolved is one in which GPs are approached almost as a matter of course because they are seen as an accessible, cost-effective and reputable source of information. This has created an imbalance where inappropriate paperwork (i.e. requests for certificates and verification unrelated directly to the clinical treatment of a patient) is diverting and distracting GPs from providing a high quality and responsive service to those in need of treatment.
There now exists a culture and mistaken belief that GPs are a legitimate source of all patient-related information and should be consulted first in all cases. This must be remedied if the potential to reduce paperwork offered by the actions set out in this report is to be optimised. "
And for organisations and citizens chapter 5 states
"Public sector organisations, including Government Departments
• Do not automatically seek information from a GP. Find out what relevant information the person or other government departments and agencies already possess, such as entitlement to certain benefits. Contact the Cabinet Office Public Sector Team (see back of this report for details) if data sharing appears to be a problem.
• Consider the use of self-certification. Where there are barriers to this, consider self-certification with follow-ups for further information as and when circumstances demand. But follow-ups should be the exception rather than the rule.
• Ask yourself whether a GP is the only, or indeed most appropriate, person to provide the information you are seeking. Use other professionals or persons that are likely to be in regular contact with the person or better placed give you precisely what you want.
• Consider the use of occupational health specialists if necessary – they are trained to advise on the effects that a medical condition will have on a person's ability to undertake particular tasks.
• If you feel that information from a GP is essential, then ensure that you request factual clinical information only, not opinions about the effects of a condition.
• Do not contact your GP for non-medical reasons. Time that a GP spends counter-signing documents such as passport and driving licence applications could be spent treating patients and reducing your waiting times.
• Consider alternative sources of advice. For example, your pharmacist or NHS (111).
• If you are unsure whether you should contact your GP, speak to one of the practice staff first.
• If you are asked who should be approached to provide medical information about you,consider whether your GP is always the best answer. Could someone else – for example, a consultant, health visitor or nurse – provide more accurate and up to date information "
I do not think there is a single GP who is not in support of the initiative , but many like I want assuance of a joined up service co-ordination.
This improved detection brings next years patient presentation into this years financial budget -which NHS England is so assiduosly performance managing practices on.What easement for this forseeable surge is made?
Many clinicians note the small but real "extensive negative investigation" group that appear highly suggestable to these campaigns.
How does our Tsar recommend we adress this area?
What advance notice is given to our hospital colleagues of the phasing of these campaigns for organsation of consultant leave so the capacioty to meet the throughput is present at and shortly after the campaigns so we do not end up with worried 2 week wait patients on day 15 and punative financial sanction on the hositals for waiting time breaches?
Sorry to be "joined up system thinking" , but obviously DOH is so many years ahead of me in comissioning experience that someone can answer these querys?...................
Will this include the
"cost per whole time performer profit ratio" of the contracts such as APMS served by large private sector organisations, as a level playing field comparator?
As it always would.
Our patients and their representatives have a clear duty to follow the cabint office policy document in regard to approaches to GP's:-
It is still the Governmental policy until recinded and it means that legal aid approval would not be given. The case was always doomed to failure as the onus is on the individual to look elsewhere for restitution without involving their GP.
From your posts on pulse I am certain it was!
Accept my congratulations that the system did not trip you up,
CQC threatens to send 'OFSTED-style' letters to patients in poor practices as Field unveils findings from first 1,000 inspections
"I was most concerned about the practice that did not have GP available at any point in the working day- how is that a medical Practice if GP was not sat drinking coffee?"
"No doors on consulting rooms? odd but watch your hospital Dr taking a history behind the "soundproof" curtain and fit one!"
"Have we DNA tested the maggots to ensure they where not an escaped clinical clone?"
Yes we can exercise our famous sardonic sense of black humour, and yes I do believe as quoted, many of the lesser failings are from chronic underinvestment in the sector.
However there is some indisputably poor practice described, sensationally magnified and thrown back to put of business I grant you, but indisputably poor nonetheless.
What do we do about it?
I am sorry that nursing colleagues are experiencing disruption with the closure of NHS direct, I hope the NHS 111 service will be able to accommodate staff in a new organisation.
Please read the leaked Deloittes report into the 111 Procurement , especially the behaviour of the management of NHSDirect in the organisations bid to run 111 Services out for procurement earlier this year.
I share your frustrations about political interference, I remember them being expressed by hospitals and GP's at NHS Direct launch.
Please do not view this as "getting at Nurses" it is not.
It is a plea for us to be alert to the need to regulate our own spheres of Independant practice, and be moderate and objective in our feedback to other professions.
The issue for your profession now is welcome to the criticism that GP's received when NHSD launched with the publicity Nurses replaced GP's as provider of advice, as Nurses are replaced with call handlers.
The issue for my medical colleagues is be moderate in their actions in CCG commissioning roles, life is indeed good when you are"the next new thing" in the NHS,.
However when political whims short attention span tires of the novelty and moves on it is a long time in a cold corner for most people's lifetime career, and your warmth may have to come from those you have recently stood on in a desire to be at the top.
The key points of this article are in my view:-
1)the tacit admission that additional funding is needed in general practice to adress fundamental NHS failings across the entire system.
2)The accceptance that "traditional General Practice/General Practice Out of Hours" model; is the most cost effective vector to deliver the NHS service.
3) It would appear that the NHS management meme is so "anti GP" that there has been a large amount of B.B.B.* in the proposal to achieve the necessary funding.
4) That if increasing the funding of a sector fixes the whole NHS system, it was Strategic managers of the system, not performers in the sector now given the resource to deliver, who where to blame for the initial failure.
Now a realistic outcome assessment criteria.
- will NHS leeds fall over with winter pressures at a higher level of population demand than previously?
if yes its a success.
* BBB= Buzzword Bingo B*llsh*t