Does anyone else think this is a complete waste of time and money. Getting every network together to discuss anything is going to take out huge chunks of clinical time and no one will do it for free. people keep telling me they will spend all the money on new staff and resources - it will all get spent on meeting and lawyers and accountants trying to run several thousand new companies - what a waste.
we did this 2 winters ago. really annoys me this is presented as a new idea. we got our local practices paid to do this as part of a winter pressures scheme. there was evidence it helped - the biggest problem was although the GPs did earlier visits - the ambulance service were still taking 4-6 hours to get the pt into hospital ruining the whole point of them being seen earlier in the day!
i dont disagree but really only the first paragraph of this adds any new info. what has the bma done to help? found us cheaper insurance? helped us find more doctors? helped us in any way?? advertising in the bmj gets more and more expensive.. what does the money get spent on?
do you have a link?
headlines... i suspect the headline is clickbate. are you really giving up GPing because of the indemnity fees or because its not the job you thought it was and its getting worse on all accounts (i dont disagree). i suspect the headline should be - person finds being a GP not to his liking so looks to retrain else where so he has a better life.
the point im trying to make is i think its far too easy to blame one thing. if they suddenly gave us free indemnity would we all be happy campers? i dont think so. ok reducing indemnity fees might be part of the solution but its not just that..
its all too easy to reduce complex issues around why GPing is crap to if only they paid the indemnity.
perhaps thats how our leaders think it will be solved.. i doubt it and it gives the polictians a easy way out. they give us cheaper indemnity then say well we gave you what you wanted why are you still complaining.. or worse they give that but only against another tick box.
rising demands, rising expectations and poor workforce planning are the problems. im not even sure right now there are any solutions.
lets face it pay me double or triple time and i might do a shift. our local ooh - despite sometimes being described as like working in Beirut - pays crap. they have endless meetings about why arent the local gps supporting them... well after a 10-14 hour day the last thing i want to do is take a cut in pay and do a shift. yes indemnity is an issue but just recognize its crap work and needs to pay to attract.
Frankly im all for this as long as they dont try and use me as the safety net like the pharmacist does for almost everything..."pharmacist said i needed to be seen straight away"
Get rid of the dross that fills my time and let me concentrate on medicine. instant access to trained on line counselors 24/7 should be a high priorty. i had 5 pts in a row cry at me the other day.. yes GPs need to recognize low level mental health and psycho social issues but these were just people with reactive issues to life events who cant cope and who dont need a GP.
there is some evidence that if done correctly - which includes finding time and funding - this can be seen as a very positive quality exercise by the referring doctors especially if its done retrospectively in a peer supported way with careful attention paid to how the feedback is given by whom and about what. what you dont do is obsess about guidance, have non gps giving the feedback - do it in a negative critical way. of course anything nhs e implements will be done badly and for the wrong reasons... so im against it.. but there is some merit...
1. ive been very impressed with the quality and dedication of the GP registrars we have had over the last few years. despite the "old" me saying they dont work as hard as i did as a junior doc in their hospital jobs... perhaps teaching is better than on the job training! so im not convinced we need to extend GP training.
2.newly qualified GPs and consultants arent the same. a consultant is way more experienced. the problem is a year 1 GP despite being good isnt as experienced as a good senior GP.
not that im a member of the college or support much of what it does but the myth that MRCGP is the same as a consultant isnt true. in most hospital specialties Membership of College is a qualification you get along the way - there are exist exams and CCST assessments.
my opinion is MRCGP should be something people do in training to partly proove to themselves they are generalists and to proove they have the basic skills to operate as a "basic" GP. there then should be a fellowship exam to be taken 3-5 years later that is considered the same as a consultant post.
the current lets give an F to our mates on production of 3 letters from friends so they can have a nice meal and access to the college wine cellar is rubbish.
the question is what to do with existing GPs who dont want to sit exit/exams. well a combination of appraisal and assessment on the job - that isnt hundreds of pages of documentation is probably the way to go.
agree with the comments about make sure they do a deal on your lease.. however 1. why would i sign a mcp contract?? 2. if they dont give me back the pts who are they going to give them too? we are 12 docs with 15K pts. if they dont give us the 15K pts - whose going to look after them? none of the local practices will - they are all going under. they are going to say to our pts. because your gps think the new system is crap - and its not working we;ve decided to not give you a GP?
might be the greatest job in the world as an acedemic and well paid RCGP chair.. but those of us who have just finished morning surgery at 242pm with pm surgery starting at 3pm arent so happy.. perhaps if the RCGP chair recognised that... id be keener to be a member
we employ a practice pharmacist under the recent scheme. she is great - but while the aim of the scheme was to get them doing clinical work. the insurance company want a fortune for her to see routine hypertensives. this is crazy. we have spoken to a new insurance comppany who are keen to get into the primary care market but everyone is scared off by the st pauls fiasco
re: unscepted... im not so sure.. a state system will be either trying to minimize state damage or cost - will it really be looking after my interests. most consultants i know have mdu/other cover too. i dont want to be hung out to dry. weve locaaly also spoken to a new company who reckon they can save us a fortune by working in a different way - small excess - lots of peer learning events - etc. id rather my cover was 100% funded that state controlled.
agree with policenthieves - i just don't see this as a they want to privatise the nhs thing - where is the evidence of that - most of the big players avoid primary care - or state they only want to provide back office. none of the big super practices have sold out - you would think they would be the first. the reality is GPs run a tight ship and any savings you might make on cheaper salaried docs - and I'm not convinced thats actually the case - are offset by the increased management costs. its years of incompetence - and political inability to discuss rationing. also there are a lot of pressure groups particularly pharma and in secondary care - who see it in their interests to drive demand.
Lets face it - the feminisation of medicine has been a disaster. previously boffin types would work ridiculous hours with little thought of their own family/home life and be emotionally detached from the crying patients so that they could carry on regardless. Once the "female" side came in - touchy feeling circle sitting sandal wearing - everyone goes part time or drops out - needs a day to reflect on each consultation then write it in their e-porfolio. the profession looses its status - its earning potential..
can anyone point to any of these crazy schemes that actually make a difference over and above just doing a annual review on pts on meds. its all tick box - fill in a form - what are the exclusion criteria lets beat GPs up because their pts are difficult. Stop doing process. locally our pain consultant has been doing a lot of talks on why not to use opiods on chronic pain patients and heart sinks - the rate of prescribing is down no silly boxes no mandatory call recall systems.
MAcdonalds medicine has a great idea - instead of super practices - how about a new membership organisation that offers indemnity and training purchased at bulk.
the reality is the RCGP is run by power crazed self publicity seeking individuals who have no concept of the real world - they spend to much time wining and dining at members expense in london. in my 17 years of GPing in the north of england ive yet to see any useful thing they have done or any meaningful engagement with my practice or locality. bring back the JCTGP. My view is they made general practice unattractive to a whole generation of doctors and have actively harmed the profession by not embracing things like special interests and staff grade equivalent type posts. only now when with the top 10 high impact changes are people talking about skill mix and signposting.
Does this really help? You say no - you get a complaint that takes - 10x as long to deal with. and no one supports you - especially the two faced Medicines Management teams
one of our local practices called in the local hospital - asking them to run the practice and put all the GPs on consultant contracts. The hospital after a lot of deliberation - decided it couldn't afford to runt he practice for the GMS income.. and are waiting for it to go under so the CCG/NHSE give them a bung....