Every patient who gets directed to GP inappropriately should then result in a penalty payment.
I would generally agree that the indicators are good apart from:
The first and second one - do they really need to have hard deadlines of 6 months and 18 months. In reality it just means a load of extra coding work for practices where the patient has had their vaccination late appropriately, i.e. due to illness.
Particularly a problem for the first indicator.
And the shingles vaccination indicator must have an autopay option if there is difficulty getting hold of the vaccination from PHE. (In fact all indicators must be paid in full if their respective vaccinations become unavailable.
I don't doubt the value of the information - but question why they ask someone so expensive (a GP) and scarce (6000 short) to do it.
Requesting an extra test - lets say a FIT test will probably take a GP 8 minutes, by the time they do the paperwork, call the patient check the results file them and ask someone else to send it on to the hospital. + 15 mins of admin time.
8 mins GP time is 15 pounds and 15 mins of admin time is £3 - so 18 in total.
It could be done by some with far fewer qualifications and skill - lets say a colorectal care-coordinator. It might take them twice as long - 30 mins but that would still only cost £6.
The problem is it might get complicated if they had to do that for ALL referrals and they keep changing. And each surgery does not have enough colorectal referrals to make that role cost effecitve. If only there was a place where all the colorectal referrals could be managed in one place, without bouncing stuff on to expensive professionals?
It really would be easy for a colorectal administrator to check and send out requests for tests. Then pass the results to the consultant with the referral. So much efficiency gained by only dealing with one speciality and enough workload to mean several people doing the job and able to cross cover each other.
It is almost the definition of efficiency savings.
We already have software which tells us the risk of someone dying if they get covid. It is only as reliable as the data inserted but seems fairly accurate.
It really is not that hard to run it centrally.
I think it is an excellent idea and look forward to nhs England commissioning the service.
ADoc - has it correct. Most locums would have prepared for something like this. Not specifically a pandemic - but they must realise that illness could scupper them for a while. And they are very vulnerable to sudden changes in the way government treats practices (like we all are).
The majority should have enough savings to weather the storm - and the underlying problem of there not being enough GPs is not going to change soon. Things will return to normality in 6 months or less.
The only thing I would like to correct is that partners are not happy. The majority of them are happy. Every partner has the option of switching to locum work at the drop of a hat and chooses not to.As a group doctors like a good moan.... about EVERYTHING, but if you naive enough to think that means everyone is unhappy then you are wrong.
As a partner I have more varied work, shorter hours and more money then I would as a locum. I also enjoy the relationships with patients and the community. I probably take more holiday too - as I would find it difficult to take holiday as a locum. (in normal times). I would not swap jobs with a locum now or 12 months ago.
Many think that there is a link between early lockdown and the reduced spread of the virus. But that is often confounding with the supply of PPE for healthcare prodessionals. That might just be the most important step, because in a country where most people are staying at home, transmission via the health workforce is really significant.
Germany South Korea and other low transmission countries had a good system of PPE.
USA UK Italy and Spain had major shortages of PPE.
I might be the only one - but I think that doing the CSA exam was better and easier than the old style recorded submissions. My understanding is that people spend a huge amount of time doing non-educational things like making sure the video was framed correctly, making sure each skill was demonstrated and excluding all the videos which had errors.
I would change completely. Invest in surgeries so that ALL trainees have rooms where every consultation is recorded. Then stooges book in to regular clinics without the knowledge of the trainee, sometime in the last 6 months of their placement. Perhaps the only clue being that they are a new patient or TR.
The following day a call is made to the surgery to save that recording - and it is sent to assessed by a panel - perhaps sent electronically to 4 random examiners, unknown to each other. Four examiners is more expensive than one and actors need travel time. But examiner time is saved by making the assessments possible to do at home without the delays of an exam sitting.
Most importantly it allows examiner variability to be assessed. It improves the efficiency of examiner time. It removes the stress of exam day and therefore gives a more realistic opinion of the trainee in a regular clinic.
There is a separate issue being:
- If the coroner insists that death needs to be verified - who's job is it to do it.
I am pretty sure it does not meet my interpretation of the GMS contract.
I am not fully up to speed on the ambulance contract - but I would imagine that it includes being called out to manage medical emergencies - and being dead is not time dependent so not an emergency.
So what would happen if everyone just refused to do it? Would they really just leave dead bodies in the houses forever? (technically not dead as they had not been verified)
I really would not mind if I thought it was at all effective.
Those that think they are at risk will already be isolating properly - regardless of their underlying risk.
Those who don't think they are at risk will not have their mind changed by this system.
Most people only want to be on the shielded list because it is easier to get supermarket delivery. When those same people are told they need to continue isolating despite the rest of the country being allowed to relax isolation they will just ignore the advice.
And just to top the whole hing off - the system for choosing patients is ridiculous. Why does a 22 year old asthmatic with a few courses of prednisolone being dispensed by a quick to prescribe GP need shielding, but a 75 year old with ischemic heart disease and moderately poorly controlled diabetes not need shielding?
I suggest everyone takes their contract - subtly change the term 'hot hubs' for 'hot tubs' sign it and return.
Then when they demand you put yourselves in the way of a bullet, everyone gets a day trip to the spa - and nobody has broken the contract.
Honestly, they won't notice.
In all seriousness the supply of GPs in that region is so poor that the DofH can't really hold it against you for any length of time. hand in your notice if you need to, come and work in my practice in England for a bit - and return when the pandemic has finished and they are desperately short of GPs.
I totally hate this guidance about choosing individually. It is a total sell out for those less knowledgable skilled and confident. I think I could calculate my own position easily, at what stage would I be willing to say no.
But can we expect others to do the same. What about a junior nurse? What about a porter or cleaner? Are they really going to be in a position to judge risk themselves they need someone to take the decision for them.
Not sure how it works in every area- but has been running for a while and:
- The slots are untimed and for repeat Triage by us, rather than booked to attend surgery.
- That allows the GP surgery to avoid seeing a patient unnecessarily and if they need to be seen book them in the safest possible way.
- We have had 30 slots a day for the last 2 weeks and in total they have used none. We don't even have the slots assigned to a clinician and treat they will be moved on to a list to call back just like any other phone call.
So for us - so far it really has not been as bad or dramatic as it sounds. That could change though.
I just want to know how this story ends:
Mr Smith gets a letter to say he is high risk.
Dr Obi reviews the notes decides he is not high risk and calls him, tells him that he is not high risk.
Mr Smith gets covid and dies - because he is low risk, not no risk.
Mrs Smith is very cross with Dr Obi - because they knew Mr Smith was high risk, the letter said he was high risk, and Mr Smith only went out because that crap Dr Obi said it was fine to do so.
I don't live/ work in Dorset, but if I did I think I would be preparing an email with a title of:
'Get your own doctors/ nurses'
In preparation for when the CCG/ NHS England or the other local health bodies inevitably ask for clinicians to redeploy.
Those in charge are going to need a lot of goodwill from clinicians. They should not be burning it away at the drop of a hat.
As per No - I think GPs want something more concrete:
It should be:
"Practices will get the higher amount of the ir current QOF achievement or their 2018/2019 achievement".
The problem is that GPs and in fact the entire health care workforce has such little trust in Whitehall, we feel that that they will just use it as an opportunity to save a few pennies.
LastManStanding - I'm worried that you might be giving them ideas. By this time next week we will all have been sent a 2 minute ventilation training video - and be expected to turn our waiting rooms in to mini-ITUs.
Protected for 20/21 only? really?
Need some urgent clarity on this as at the moment it seems that we should absolutely 100% be making sure all QOF for this year is done, because it will be worth double/ counted for next year as well!
I don't mean to be rude/ unfair and I am sure some of the recently retired doctors are excellent. But everyone will assume they are deficient/ not up to date when something goes wrong. Some will also indeed by out of date.
Stuff goes wrong all the time. All of us know that. And when something goes wrong, patients (understandably), lawyers and now the courts and GMC cannot be trusted to decide if it is reckless incompetence in keeping with manslaughter or understandable systemwide error.
I don't know why anyone would return to help with that particular Sword of Damocles hanging over their head. As we all know nobody will help by reenforcing that horses hair to protect you.
Then of course there is the much sharper sword which involves just dying of Coronavirus.
Does that mean we have to close for a fortnight for a deep clean after every hospital admission?
We probably admit a patient meeting that criteria every third day in our large practice. Particularly if you include children.