I agree with Trefor ,Mr Hunt is ensuring the NHS is giving GP's a good death by working us to death.
The only thing is I cannot acuse him of discrimination, he is clearly ensuring the NHS (body corporate) has a good death by his actions and speeches.
And this is recorded incidents only.
I regret that there are a few individuals locally that seem to be regularly moved on from surgerys for antisocial behaviour that the police , though assiting in removal do not log or report as they are well aware the CPS will not pursue ASBO's.
I suspect the Northwest is not alone inthis given the agenda to reduce recorded crime figures.
The issue seems to be an understandable but misguided reluctance to use an ASBO to exclude from health premises.
The arguement is the perpetrator has "a human right to healthcare"- but what is forgotten is the individuals reponsibility to be moderate and approriate in their behaviour whilst accessing this right.
A "right to life" requires a responsibility not to kill others and this key feature of any "right" must have a counterbalanceing responsibility seems to be absent from the debate.
I suspect that the practical application of ASBO would not be denial of access, as happens with retail premises, but the knowledge that whilst on the health premises and technically "in breach" of their ASBO any incident that caused the staff to ring the police would result in escalation and possible fine or imprisonment.
Bad behaviour on health premises is rising because they are the only places courts do not ban the perpetrator from and there is no regular application of effective social or legal sanction to curtail the behaviour.
It is not existence of "the punishment" that deters, it is the individuals assessment of the probability the punishment will be applied to them a mixture of "chance of getting caught." and subsequent conviction.
"NHS ZERO TOLERANCE" is toothless as the operation in practice does not result in any adverse consequence to the perpetrator.
And there was I thinking the regulatory system was sensible and the GMC regulated the person and the CQC the premises and organisation...............................
I had one patient elevate potassium on ace in nearly 8000 initiations since 1995. Lab costs phlebotomy time result viewing time just a little over 9 pound a go 72,000 per life saved- except the index case came back earlier telling me he felt "bloody awful" so my experience was a check on symptoms methodology would have delivered the same outcome for 4,500 - (there being more who came back c/o issues than had raised potassium ;for those awake enough to query the figure - used private lab reference costs local NHS " Can't tell you exactly it's a block contract")
Although I have sympathy with anonymous 5:29 , the issue is well documented that your obligations as a Doctor extend into all areas of your life and at all times. See GMC guidance on Doctors as Managers and the historical record on Doctors receiving sanction for action "in private life" such as consorting with prostitutes, convictions for minor public disorder abroad, and I predict within a few years stating an opinion in an electronic forum claiming medical qualification without identification.
Ok so you can take "witty" of the list.
I do despair of NHS management - How long has it taken the penny to drop of the clear causal realtionships:-
that if you denigrate GP's in any way you undermine Public trust in the GP,
if you undermine trust the public loose confidence in the GP Service,
if they loose confidence in the service they attend AED for Health needs;
Oh Wait answer my own question with the next step,
If the public attend AED for routine health matters in increaseing numbers it COST MUCH MORE MONEY!
So the answer is HMG and NHS Mangement cannot afford FINANCIALLY to denigrate general practice, rather than they truely desire to change their opinion.
My future vison of the likely changes to be announced - a primary care facility without medical staff but all perfomers badged as "consultant " or "specialist", so we can expect a return to normal " bash the medic"
Goodlooking, mega intelligent; highly motivated- you can see why the public should hate us.
Gerbo Huisman is absolutely correct
- the advance completion "authorises" an non medic to start a therapy- or put in correct GMC terms "Delegates the Doctors professional autonomy to another for administration of therapy."
someone else does it but you "carry the can" at inquest if they made an error.
Ask yourself the GMC question:-
"what steps had I taken to be assured that ALL individual who MAY initiate the pathway where personally suitably qualified to make a decision on initiation?"
If you cannot answer this in a way you would be happy to relate at the new Medical Tribunal Hearing you should not delegate this task.
I have seem reems of proof local staff are trained in the operation of the equipment and technical skills but none that the the average community nurse has any formal diagnositic training to be able to correctly identify the need to start the pathway.
The comments conflate two issues, firstly what is appropriate nutritional products for the state to provide?and secondly in the light of this study and the pressures on GP , is a prescription an adequate let alone the best way of meeting the delivery?
I do not actually hold a view on the first , but I am utterly convinced a voucher system for pharmacy uptake issued by state registered dietician is the only sensible way to issue an appropriate diet for those nutritional products the state has adjudicated are "therapeutic"
Stop the minimum/maximum appointment debate. There should be a fixed number contacts per thousand patients for the specification and you deliver no more or no less without appropriate "per contact" financial addition or deductions.
The Governments attraction to "NHS 24/7" is fuelled solely by "unlimited volume for fixed price" contracts and a "something more for nothing" mentality.
It is this injustice that is killing Primary Care and Accident and Emergency services.
Until the treasurey have a " cost per consultation for closure of care need" financial perspective they will never appreciate the value or worth of frontline NHS primary care and will denigrate it.
I am old enough to remember a senior politicians speech to LMC conference, to the best of my memory at the time of discussion of the possible implementation of "the NEW GP Contract with Opt out"
"in reality there are no circumstances in which we would return the Out of hours commitment to General Practice; it would be a damning inditement of comprehensive failure of the NHS reforms"
They got one long term prognosis right then.
Shaba Nabi is entirely correct, an audit of people offered my surgeries " we will see you today if its urgent" revealed that the public want instant access.
The fundamental dichotomy of GP service is the commissioners want "value for money" with a full working day of health promotion and chronic disease management plus unlimited I scheduled "instant access" from the same GP.
the name is not Dr Who , GPs cannot be two places at the same time.
A workforce expansion and perhaps federated working to staff an unscheduled medically led primary care rapid response team on a rota basis like the hospital acute medical and surgical take system might help.
It is important to remember people die after contacts with any health provider in an unforeseen/ unpredictable manner. Given the known marked risk aversion and onward referral levels of 111 I would be surprised and concerned if analysis showed these where above the "twist of fate" we all risk every day. Note the qualification of "analysis" and ask me what I found surprising and concerning later.
The "health check" concept is appealing but a bit like an mot it picks a position in time, carries little future predictive worth and is highly observer dependant.
I am reminded of the child star of the 1950's jungle book who did not become a major hollywood star owing to an untimely heart attack- 24 hours after a much publiscised health check with "the best American Cardiologist" who pronounced him on camera to be " the fittest person I have ever seen".
Evidenced based interventions only- health checks as seen by the public follow the salt proposal, "if a little tastes good, a lot tastes better" - exactly what we have found in our own meals then?
There is a very good reason why GP's are exempted from european working time directive. I would draw colleagues attention to an excellent letter to a national newspaper from Dr Peter Holden, assuming they have the decency to publish it.
As I know Peter reads Pulse he may even see fit to pass it on in the forums.
I am sad to hear the solution to my woes is to develop a portfolio career away from core GP clinical , drop a full time commitment and OOH work .
Is "Family Practice" dead in the UK?
The direction of travel is clear . Mr Hunt is trailing the return of 24 hour responsibility to GP's and refining his "formal launch strategy" from the screams that go up from his testers.
The "New Contract" does include the provision for HMG to do this after a period of notice,and let us not forget did not let some GP's opt out at implementation " where no viable alternative exists" .
I would like to remind that when the old wise heads questioned the sincerity of the then government, and advised it was impossible to manage the OOH pressure with the allocation in the proposed contract the ministerial reply was:-
" this is manageble and sustainable from the planned resource : Any future return of 24 hour reponsibility would be a sign of abject failure of the political management of the NHS."
One down one to go perhaps?
This really is gutter politics blame game. His superficiality is amazing.
We had a old 24 hour responsibility with a mondya to friday work week, regular Saturday morning and at all other times "emergency on call" contract where people did not expect to be seen with a runny nose at 3-00am without getting a lecture.
Mr Hunt has been advocating " The NHS seamless service routine provision 24/7.
Unsurprisingly if you triple the routine provision hours you increase the pass through activity numbers.
Is he fool enough to belive that the NHS has every had 100% market penetration of service at any point?
could he be stupid enough to believe "increaseing the shop counter was going to reduce the depth of queing in front of it " instead of the predictable reality it will increase volume by allowing more people who where not getting health issues adressed previously to have them addressed?
"They Paved Paradise and put up a parking lot" is required listening.
Yes HMG is happy for GP's to volunteer to take back OOH, it overlooks the derisory value they placed on the commitment at the new contract negotiaions and yes , unless we want to be bashed in the " Red Tops" we have to do it for less than the private sector currently do.
The plus point is that is more than was on offer at new contract, the minus point is it is still substantially less than the continuity of care is worth and the ultimate "deal breaker", a volume of expectation that will have you dead if you try to do the old GP 1:1 or bankrupt if you try to resurect a cooperative.
Whilst I would not disagree with the vast majority of the sentiment of Dr Reynolds piece I must differ on one level.
The 111 debacle in my area does not have substantial comissioniner "learning lessions" .
What it has is a provider failure to deliver a correctly specified number of contacts by the winner of a procurement that passed all assurances and testing at al levels including central government, and then did not deliver the promises.
The only lesson this comissioner can learn is that this providor cannot be relied upon.
Do not get me wrong there are worrying system reflection points, but not comissioner learning ones.
As this was " an exemplar NHS procurement" in my area to "train the new GP comissioner in the NHS procurment methodology" is the historical NHS methodology fit for purpose?
I suspect yes which leaves the unpalatable questions, some I can answer.
The specification volume correct?,- true in my area;
the procurement process robust? ,- true in my area
Where the delivery assurances reliable- In my are I had better stick to unreliable- the "f " word needs a more detailed investigation to uncover.
I await the Deloites report with interest if it ever leaves Whitehall.
The main reason more people go to AEd is the rising social disconnect and the attitude of
" Of Course its an emergency;Its happening to me!"
I greatly appreciated my last call from AEd berating me for the fact my patient was choosing to go to AED with sore throat "because "you won't give them antibiotics".
I am sorry but I can maintain my standards of approprate practice.
If idiots with vrial sore throats want to go to AED- and presumably wish (and perhaps get given) Ab inappropiately- then it is not my clinical issue as a GP.
"As a Comissione"r we need a national
" Poorly performing patient program" we can refer them to for attitudinal readjustment, not a poorly perfoming GP issue.
How can I have confidence in a Minister who cannot perform the most basic root cause anlysis?