Having been a GP partner for over 14 years I am aware of all the negatives that many of our readers will be all too familiar with.
However their are many positives too:
1. You become part of the NHS - primary care decision makers - which is key to maintaining the nationwide free access to medical care system.
The buck stops with you every day - both in clinical and commissioning decisions.
2. You see ill health and diseases evolve over many years and get a far deeper insight into your role in health care - as a friend and confidant of your most vulnerable patients.
3. You can develop closer links with the community and promote health/lifestyle to a wider populance.
4. You can develop your own niche of expertise and become a GP expert in a sub-speciality and still stay in the same clinic
5. You develop close bonds with fellow practices especially as we are moving towards federations and group practices - and you start to 'own' the care process and pathways in your locale.
So that's just a start - their are always two sides of a coin !
COPD "rescue packs" are a short course of antibiotics and oral steroids which help COPD patients with moderately severe attacks/exacerbations. For milder attacks higher dose of salbutamol via a spacer will often suffice with increased fluid intake. Self management and training is the key - and patient self management plans e.g. from BLF can be a big help.
Locally in East Kent we follow a traffic light system to distinguish mild/moderate/severe attacks.
One must remember that upto 50% of severe attacks needing admission can have pneumonia as per Hospital data we have locally.
Quality assured spirometry is a key part of both COPD and asthma management - specially for the diagnosis. After all we are making a long term condition diagnosis with all its implications - hence the stricter requirements on training/accreditation and calibration. After all we wouldn't want to be diagnosed with diabetes based on a faulty glucometer reading.
However this higher standards also require significant time for training and extra time during consultations - and the CCG's need to quickly rcognise this. If GP practices decline to do in-house spirometry and start to refer to secondary/community care we will loose a valuable asset. Lets hope this does not happen with forward planning.
It is good to see good quality research backing up what has been known for many years - continuity of care - is best for patient outcomes and is what patients value the most too.
This however is not what the policy makers in the NHS have made a priority. In their blind drive to create super-surgeries and larger hub based care in General practice they are neglecting good quality care goals - which can be best served by patients seeing their same GP; The more complex the patient with multi-morbidities the more important this model of care is.
I feel it is time policy makers took note of these findings and support practices which have made this a priority.
The shingles vaccine program from the outset has been made complex and hard to follow for both patients and immunisers. The vaccine program leads do not seem to be aware of the inertia of many members of the public to vaccinations in general and even more so in areas of socio-economic deprivation. So when patients come in interested in the vaccine they are told they are ineligible - when asked why - I say the vaccine is expensive and is being rationed out in phases !
I strongly support a universal 70-80 year program for the shingles vaccine - SIMPLES
Just saying NO to CCG allocated patients dosn't work I'm afradid. We tried saying that several times and the direct impact on patient safety and standards of care for both our existing patients and the hundreds of new patients moving onto our books. The CCG then started a process of 'forcible allocation' which the LMC confirmed they can do and once they are allocated they become the GP's responsibility ! A sad state of affairs where we have actually lost any ability to ensure safe/effective patient care. This was then followed up by a particularly intimidating CQC inspection which they refused to defer despite the turmoil from allocations - so we are now in special measures after being rated GOOD just 18 months ago.
The most common bowel condition seen by GP's is off course IBS - and I look forward to a flowchart incorporating the new faecal calprotectin test - which can be used as a screening tool for inflammatory bowel disease.