Accurate, factual and utterly damning of NHSE. Chapeau.
Spot on - too many GPs who need to get back in the clinical game or sod off and let those who want to see patients do so.
It's time for CCGs to pay for ads on the sides of buses. I suggest:
'NHS: expect less.' or 'There's no money and your care will get worse.'
Once again: is it GMS? No? Then not primary care's responsibility and the Dorset CCG, who supposedly are 'GP-led' need to think about who they work for.
Show me where it's GMS and I'll 'upskill.'
Bravo. That is all.
Sorry, but the first vanguards will be made to work by throwing money at them in order to be able to declare them a success. Just like QOF, at first. Or the first WICs. Or, if we stray onto education, the first academies.
Give it a year or two and the funding for the 30,000 patient practice will ahve been reduced, staff sick leave will start rising, things won't be so rosy there either and the aim of destroying traditional GP will be a step closer to being achieved.
'The second guiding principle ("Every test result received by a GP practice for a patient should be reviewed and where necessary acted on by a responsible clinician even if this clinician did not order the test.") sounds like a sensible safety net. However, how is the GP to know whether or not the result of a test they did not order has been acted on by the requestor? Equally, how can the requestor of any test know that the GP is competent to act on the results of a test that they might not be familiar with'
I agree completely. This green-lights work-dumping by 2' care.
Indeed - I would like to do some OOH work, as I used to enjoy it. However, indemnity rises are now of such magnitude that OOH is financially viable only if one doe s alot of it, to the exclsuion of daytime GP, rather than a shift every couple of weeks as used to be the norm.
Good man. Bravo.
'The problem is - standard medical thinking assumes patients go running to the doctor for any little sniffle. '
Anon - you read Pulse. You are probably better-educated than 95% of the UK population (I'm guessing you're a GP or associated professional). You probably pay for your scripts and probably work, so time is a priority.
None of these factors apply to many of our more frequent presenters - the elderly, the young parents, the unemployed and the never-been-employed - they have lots of time, little education, few coping skills and not a great deal of money. The GP is therefore the 'can't be too safe' default, with the possibility of getting OTC drugs for free also.
Sorry, not my job. My signature is a statement of the facts as I see them and I have no knowledge of a pt's income nor how they spend it, therefore no signature.
Anonymous - I'm no dinosaur (GP qualified relatively recently) but believe that prescribing without notes or ability to examine is likely to lead to harm - as, funnily enough, do the MDOs, hence their higher indemnity fees for OOH work.
Anonymous GP partner: could not agree more. £45/hr minus significant indemnity costs (a plea to my current provider: please don't indemnify anyone for this work, as my premiums are already bad enough) is work for the truly desperate and lacking in self-respect. No previous notes and no examination possible - what could go wrong?
I disagree with you more or less completely: if people are aware that there are no consequences for bad behaviour a minority will behave badly. If they know that there will be consequences for verbal or physical abuse (be it off-listing, being moved onto a violent patients scheme or being arrested), they will be less likely to do it.
I have long been puzzled by the fact that it pays more to be sick than unemployed - can anyone enlighten me as to how one's expenses go up when off work for anxiety as opposed to off work but looking for a job?
Four observations from my perspective as a f/t locum:
1. I am clinically independent, something I cannot say of all those in salaried roles (like Farah, in a salaried role I experienced pressure from partners to prescribe poorly or give Med3s inappropriately in order to avert complaints); as a locum, I am quite content to not work again for a practice that does not accept this and work more for those that do.
2. As a locum who works regularly for a few practices, I have a degree of continuity.
3. When locumming, it is not unusual to see more patients in a day than partners and yet to still leave for home earlier, and happier.
4. If the GP partners of 2004 had not cashed-in by employing salaried underlings en masse, the current generation of GPs may be inclined to feel a little more solidarity and possibly even aspire to partnership in due course - a model, incidentally, which I think provides excellent patient care and value for the taxpayer. As it is, that generation of partners are now either comfortably retired or paying the price of chasing the short-term cash.
'LMCs are impotent and at a local level lick boots of NHSE trying to stay in good books.'
That depends upon the LMC - some are actively pushing back as much unfunded work as possible due to the sheer bloody-mindedness and willingness to say 'no' of their members.