I suspect that if all the scheme and ideas coming of out NHSE were scrapped, and the money was just invested in to the global sum you would:
- Have less wasted money
- Have more GPs
- Have more GP appointments
It is so simple - but just continuously ignored.
But its okay - because he is going to make it amazing with loads of apps and the interweb and all that lark.
Conservative through and through and giving up the whip to 'appear' independent. Suspect there are conservative MPs that do more crossing in private on a Friday night than this cross-bencher will ever do in politics.
So what they are saying is that if GP services are stretched we should just send patients to a&e (in hours), because that is where the extra funding has gone.
I’ll remember that next time there is a black alert.
I think there needs to be some caparison to how much better (or worse) the entire system would be if the different pots of money were just all mashed in to the global sum for GMS and PMS practices (NOT APMS - as that often includes politically driven KPIs).
A local weekend access provider pays nurses (not nurse practitioners) just under £50 an hour to sit in clinics that are half empty on a Saturday. That is not a good use of resources.
The same money pumped in to primary care, might have delivered inflation matching pay changes over the last 10 years, which in turn would lead to more GPs, fewer retirements and fewer people moving abroad. That might have had a much bigger impact on the service than changing Mrs Blogg's dressing on a Sunday rather than a Monday.
why don't we include all armed forces medicine as primary care/ General Practice care....
we can then say funding has increased by even more!
Including more stuff in GP funding, is not the same as increasing GP funding.
83% unsuccessful is a massive number. Each one represents a doctor being harmed unfairly. Probably more as I suspect many of the remaining 17% are settled to reduce the risk rather than there being true negligence.
I think there is an overall reluctance to pursue costs when a claim is unsuccessful and that needs to change.
Many claims are as a result of a patient/ family member being unhappy with an outcome despite everything being done correctly. People at the moment rarely consider that, perhaps influenced by bereavement, guilt or the effects of an illness. If there was a good chance (83%) that you would be significantly out of pocket or declared bankrupt on the back of your claim, you might be more inclined to consider how appropriate your legal action is before impacting the well being health and insurance premium of a doctor who has in fact done nothing wrong.
I also question the calculating of hours.
In my practice the most 'part time' doctor works 5 sessions, but I think they work 32 hours/ week.
The 6 session doctors work above the 37 hour threshold - but suspect they are recorded in the survey as part time.
And people who work 2 days in a GP surgery, 1 day for a university and 1 day for the CCG are probably marked as working part time based on their GP surgery time only.
I understand the 'ambition' to train GPs and psychiatrists was part of the application process to allow them to have a medical school (or more medical student places). It is however politically driven and truly awful for the process of medical education.
I, like many others changed career choice after graduating. I think it is just about possible to be clear that you want to do medicine at the age of 18, but impossible to tell the difference between different specialties you really know nothing about. For example I thought academic work was interesting and driven, but now see that it is full of politics, funding crises and bullying...
I think it is unfair to try and limit students choices at the stage of applying to a medschool - which means it is unfair to have medical school places earmarked for certain specialties.
Agree with Clare above - NHS England taking decisive action about 5 year after everyone could see it is a problem
I really interesting article. I think an important read for locums AND practices/ partners.
My one piece of advice is to treat practices fairly and expect the same in return.
- Have strict terms and conditions, but make sure you stick to your side of the bargain and perhaps be flexible for the right practice.
- If a practice treats you unfairly (and some will) just take your service elsewhere. There is not shortage of opportunities and practices who cannot treat staff fairly should be driven out of business.
It might, might help reduce some of the crazy tasks hospitals pass on to GPs.
Or at the very least makes tasks the responsibility of the patient rather than the GP.
For example if a consultant wants an annual PSA on an ongoing basis, they can now write directly to the patient and ask him or her to organise an annual PSA; rather than writing to me to somehow imply it is my responsibility.
"Since then, the doctors’ regulator has moved to improve its process, and it revealed in May this year that it had since halted seven fitness-to-practise investigations to spare doctors with mental health concerns."
100 suicides per year, and the GMC takes steps to help in just the 7 highest risk cases?
I think people are getting overly worked up about this. I am up to date on NICE, SIGN and local guidance and generally follow the principals. It looks like you will be able to indicate which guidance you generally followed and why you deviated from that guidance then they will judge if that is appropriate.
Surely that is at least the same as before. The only difference is that you will be able to elect which guidance was the starting point. For example if your local CCG guidance is much more restrictive than NICE guidance, you can say that is your starting point rather than NICE. You are then still allowed to explain why your practice differed from that - but if our practice does differ from the norm, we should be expected to justify that.
I think having the opportunity to say which guidance is the starting point is certainly a step forward.
I think most of us have seen instances where clinicians have followed one guidance, then had a complaint because the patient says we did not follow guidance from different (often slightly outdated or dodgy) set of guidance. This issue will suddenly no longer be a problem.
Knowledge is porridge is right.
We need some major changes to encourage people not to retire and encourage people to work more sessions. It seems unlikely that they will make changes in these areas just for doctors, but my suggestions would be:
- Pension cap, both the annual and lifetime allowance cause problems, encourage people to work fewer sessions and encourage people to retire early.
- At least allow a simple way of contributing whatever you want to the scheme - but to 28% of your income (rather than an all (28%) or nothing approach.
- The ridiculous tax system at 100k - just smooth it out between 50k and 150k.
- indemnity/ litigation. There is talk of a government scheme, but nobody believes it will happen until we see it.
- limits on workload, with DofH backing and legal backing for turning patients away when that limit is reached.
- And most importantly appropriate rewards. If I hear one politician say they are taking this seriously just a month after delivering a real-terms pay cut I might just explode.
The calvary is correct.
Just demand an extra £100 per session from the OOH provider.
It is ultimately them who should be paying for the indemnity increases, not the individual doctors. They should be taking in to account indemnity costs (and increases) when submitting a bid for the contract, which ultimately means that if you do not pass on the costs of increased indemnity, the money is going directly in to their profits.
I am afraid it is just about supply and demand. Any attempt to circumvent that is unfair and unjust.
If Ireland, England, or any other country wants to keep it's top talent, it needs to make sure they are rewarded appropriately. If you treat people terribly, there should be an expectation that they will leave.
Over the past 10 years, there has been a move to make QOF targets 'stricter' - I think because too many GPs were hitting them.
That was always going to lead to overtreatment related harm, and clinicians and non-clinicians who instigated those targets clearly have to have a good look in the mirror. The new system seems much more sensible, as long as the actual target figure is not too tight.
As part of all of our contracts - if you choose to register out of area patients, which we all can, then the CCG has a duty to make sure there is a home visit service available for them. I think they signed up a few surgeries (I think we might be one of them) to visit patients who fall in to that category for a fee.
The thing is I don't think the process has ever actually been tested. It is also ridiculous that they get paid the same GMS fee for looking after patients.
It's fairly simple, there are 2 options:
1 - NHS England sign any lease and are responsible for the lease, even if the GP surgery closes. There is no paying the GP partners and the partners paying the landlord etc.
2 - At the point a lease is signed, NHS England signs up to cover the cost of the lease for the entire duration of the lease. That contract is directly between the names on the lease and NHS England, meaning that if the GP surgery closes, NHS England must still pay the individuals for the lease of the building.