Unfortunately, this was written in the original LES documentation, buried within the detail. The Impact and Investment Fund specs are even more onerous (reducing A&E attendance). It was 100 pages of dirge to wade through, but I can see why GPs who read it in its entirety were much more cautious about signing up. Get out now - it's way too much additional work for hardly any extra funding. The aptly named ARRS scheme for additional roles was the sweetener that got everyone's hopes up. It was a Trojan horse.
It's my final day ever as a GP tomorrow, and I am sad but relieved to be leaving, aged 44. The Daily Mail comments certainly help to assuage any guilt I might be feeling about leaving.
We should've noticed that the acronym for the PCN DES' Additional Roles Reimbursement Scheme is ARRS.
I have met four GPs in the last month who are under 45 and are working their notice as partners. I met another salaried GP, late forties, this weekend who is currently carrying their failing-to-practice and has just collapsed in a heap with the stress of 12-15 hour non-stop days. It's not looking good if you keep refilling the bucket which is full of holes.
Excellent article Shaba. Top of Licence working pre-disposes GPs to burnout. Seeing 40+ patients/day with a DOB before 1930 in the 10 minute tyranny is unsafe and unsustainable. There needs to be acknowledgement that you have a cognitive load beyond which the decision density is excessive i.e. we need an occasional infected toenail or pill check. If not, then we need longer with these complex patients. Having worked in practices where there are several ANPs doing an excellent job, a 16 patient surgery for a GP is exhausting.
I took on GP training because I wanted to be a GP, but also because I wanted to pay off my student debts earlier than my hospital colleagues, as well as settling into a permanent job sooner. 5 years is excessive, unless we go back to the olden days of pick n mix 6/12 jobs where you could try out different specialties before committing.
The genie won't be forced back into the bottle now. Higher earning GPs and Consultants have had a taste of freedom and are claiming back their lives without losing any money. These changes still amount to a cap, beyond which there lies maths and complexity. It's easier to say no to more work, and sign up to a day or two a week where Medicine doesn't encroach. Medics are notoriously bad at self-care, but this pension trap has resulted in enforced leisure and a new culture of work-life balance. I would rather go out for a walk in the hills than have a 3 hour meeting with my IFA about how to mitigate for the extra tax on that extra clinical session.
Wait until the pension trap bites - GPs will not make the same mistake next year - and reduce their sessions further.
Population health is so different from advising the patient in front of you. Most GPs vastly overestimate the risk-lowering impact of statins etc.
David explains so well what's missing at the heart of the job that I'd worked so hard to get, and then I abandoned. The panopticon of potential threats, as well as the very real ones, increase inexorably. The 4Cs, REMIC and Gigantism are absolutely at the core of the destruction of General Practice. And here we are, blowing in the wind, the remaining tumbleweeds of primary care.
Another option is not to assume that you can't have an impact on demand. Complete a search for your high intensity users (frequent attenders) and have a look at the top 20-100 and how many consultations they have per year. This group need a different service and you need to look at each person individually. Their problems are unlikely to be medical. Social Prescribers may well be able to have an impact on the frequency of their attendance. A similar approach in Blackpool reduced ED attendance by 93%, with about 70% of the highest frequency attenders able to change their behaviour with the support of other services. Many people are lonely, in debt, living in poverty. GPs are not best placed to fix them, otherwise they would've done that by now. https://www.england.nhs.uk/rightcare/workstreams/high-intensity-user-programme/
Please consider net profit rather than gross income when signing up to this new Network DES. The 7 new national service specs, plus the Investment and Impact Fund conditions, will need huge amounts of extra work. And check clause 7.8 about the Balancing Mechanism to reduce GP partner earnings.
Clause 7.8 describes the new Balancing Mechanism whereby GPs earning too much will be penalised the following year by cuts to their global sum. A marvellous way to improve recruitment and retention.
@d in vadar NHS GP health does help people who are less severely unwell and in fact about 75% of patients are much lower level mental ill-health i.e. anxiety, depression, burnout, physical illness impacting on ability to work, stress relating to life events/GMC complaint etc.
Like treating bleeding oesophageal varices with a mop.
NHS GP Health already exists and has been very busy since it started in 2017. It's being rolled out for all doctors soon.
NHSE/'The Centre' fails to recognise how its culture of blame and fear is at odds with its alleged desire to create psychological safety within the NHS.
Myriad reasons are behind why these very resilient individuals are now breaking. It will take many systemic changes to mend things.
We need to look at places and practices where GPs aren't breaking, and ask why it's working.
What are thriving practices doing well? There are some around - what's their recipe?
Is core general practice a loss leader now? It's clear that the value we're adding as GPs isn't widely understood - how do we measure what we're doing and get paid for it?
No good deed goes unpunished in the NHS. I hope the arm-twisting was accompanied by a significant premium to attract clinicians to the service.
Matt Handapp and his digital cock - you have surpassed all previous genius with this Dr C. I am still giggling. But then, it is my lunchtime...
How about 2020 GPs by the year 5000.
If it doesn't cover GMC hearings, what does it cover? And if you found yourself charged with manslaughter, like Hadiza Bawa-Garba, you wouldn't be covered either. I think I'll stick with the day job, ta.