Bristol based and a GP for 31 years. I served for 8 years on my local LMC. I was Professional Executive Chairman of South Gloucestershire PCT for 6 years and national clinical advisor to the Modernisation Agency for 2 years. I am on the Council of the South West Clinical Senate and the Council of the NAPC. Since 2007 I have Chaired GP Care, an innovative GP Provider Company (www.gpcare.org.uk). My passion is for strengthening primary care quality and scope to deliver more for its patients.
Couldn't agree more. I've got a very busy year most of which I love. I have boundless energy for things I believe in and no energy at all for things I hate.
And I hate the box-ticking waste of time that appraisal represents. It adds no value and serves no useful purpose. I don't need it to convince myself to stay updated and reflective. If I ever feel that's in jeopardy I'll hang up my stethoscope - I don't need appraisal to persuade me (& it wouldn't identify it anyway). Total waste of medical resource.
This article is such a misrepresentation of what STPs are trying to do. If we think the old system of PbR worked sucking all the money into the hospital sector that's disappointing.
The issues that still exists is how to get true integration including general practice. Most areas are struggling with that but, if we can get this right, with proper investment in IT too, there should be better VFM and concurrently better integrated services. It's the boldest, most hopeful bit of policy I've seen coming through in 15 years - that's not to say it won't get sabotaged by organisational or professional self-interest though
Well said! One acute Trust I recently visited had 5 CRs & 4 MRIs. How many of these investigations really add value? And which obfuscate and add irrelevant complexity? To say nothing of upping the anxiety of the patient & useless cost to the taxpayer
To 10.11. Assura had run medical services & pharmacy but pulled out of both and retracted just into primary care buildings company as they were losing money. I don't see them wanting to run medical services any time soon - when you can make a 78% return on the property portfolio!
We need to know if the research was sponsored by the manufacturer of the vaccine. How independent is it?
There appears to be little no doubt though that changes in sexual practice have led to an increase in oral HPV related cancer in males and females.
Everyone knows Clare's conflict of interest and I don't believe she's speaking out to encourage a salaried profession.
When GPs no longer wanted to do OOH because it was too onerous and didn't fit into family & practice life an alternative had to be put in place - it wasn't better but it had to be done.
Most GPs go into general practice as they like doing medicine in the community - not to run businesses. As the business risks keep increasing (which they'll continue to do) less people are attracted into partnership. So Clare is just reflecting that an alternative has to be put into place - it might not be better but it has to be done (at least in metropolitan areas).
If we take Clare's remarks as her reflection on what the future holds (and I agree with her predictions by the way), then it's beholden on her and all of us who believe in the NHS as a concept to try to forge a new way forward which is as good as it can be.
What is the best model for GPs that work with their vocational commitment to patients, is sustainable, professionally and financially rewarding and affordable to the country? Come up with the answer to that question and we might have recreated something good for the way medicine in the community could work.
Deeply depressing. Huge upheaval when all that was needed was to 'de-bureaucratise' PCT Executives and allow the clinical leadership its head. It's not only the financial cost that's wasted, it's the enormous expenditure of person-hours recreating structures and recruiting to them and the opportunity-cost there's been in not getting on with the commissioning job of improving services for patients.
I'm all for retiring QOF indicators that have no clinical value but ACR is not one of them. It's a good discriminator of the amount of damage to the endothelium and basement membrane in the kidney and associated with vascular damage elsewhere (like the eye). It therefore gives a much earlier warning of incipient diabetic nephropathy than eGFR alone (which starts to fall much later) and focus the mind on interventions that relieve the strain on the kidney (like tight BP control). QOF used as a political tool does harm - but used well clinically has been a good support in identifying who really needs our concentrated input. ACR is a useful marker that shouldn't be abandoned.
This is another proxy indicator of the increase in workload there has been within primary care. Most of the drugs listed as going up most (atorvastatin, anti-diabetes drugs and antidepressants would have been prescribed by GPs not hospital specialists.
As a recipient of part of the PMCF money, I want to see how supportive I can be to General Practice. That increased access and 7-day availability is a given, we must try to do it in a way that doesn't break the back of General Practice - it's already 'at risk of implosion' (RCGP words).
So it remains to be seen how creative we can be to put in solutions that reduce, not increase, the pressure on GPs and Practices. Although expectations of this investment are already too optimistic nationally, we should firmly grasp every opportunity to improve things for patients and GPs.
Well done South Worcestershire! Having personally spent some time supporting you to get off the starting blocks, it's great to see that you are going to be delivering the sort of joined up integrated care that needs to be in place close to people's home. This CCG's strategy of placing such contracts in this way is pragmatic and sensible. Best wishes.
This is a well thought through and helpful article.
This is a welcome change. For such an effective medication and such a common condition, it's good to see that the NHS is willing to loosen prescribing constraints.
If drugs for other conditions were half as effective as sildenafil has been shown to be, the NHS would welcome their inclusion.
I've always found it difficult to tell many impecunious men that we've got a very good drug that works, but that just a few tablets, to restore a perfectly natural bodily function, are going to cost them £50 or thereabouts.
Pfiser have made a mint on Viagra, but it's good to see that now, off patent, the remit is changing to be more inclusive. That's got to be right.
Let's not be duped though, it's the process indicators that have been removed. The end point targets are still in place. To achieve those targets, it stands to reason that the process of checking the parameter still needs to be being done.
Your can't show you've achieve good BP control unless you've measured the BP! So the recording of the parameter will not drop.
All that has happened is that is that the totality of the payment per outcome has dropped, though the amount of work in general practice to achieve it has not. It is moving the profession towards an outcome driven contract but the work reduction in primary care will be negligible. All fine provided the lost QOF money goes back in full into global sums.
It's clear that QOF is a blunt instrument (e.g. tight HbA1c targets are correct for 30 year olds, but are probably damaging in 80 year olds) and needs amending / reducing but regulation of primary care is not going to go away.
What is needed, and what Somerset Local Area Team is trying to do, is give some space for GPs to think much more laterally about what structurally is needed to support primary care for a broader future role.
So unless other areas are prepared to think about this its probably unlikely their LATs will just 'let them off' QOF.
Well done Somerset LAT. These are not contractual changes (QOF is, after all, voluntary) but a very brave, sensible and insightful solution to the fact that, if NHSE want practice transformation, then GPs need time off the treadmill of unremitting pressure to have the headspace to address the objectives and process.
For better or worse this inititiative has been forecast for years. GP Care is a GP Provider Co set up by local GPs in part to bid for and win contracts like these so that they are then subcontracted back to practices. The objective is that patients continue to receive a service properly integrated with primary care and GPs continue to get the income that supports their service delivery. If you're likely to be struggling with this in your area please speak to us at email@example.com. I can't promise we can help you but we would seriously see if we could.
Hope: That the current / forthcoming climate enables us to release a little of our fierce independence allowing collaboration & rationalisation between practices
Fear: That our workload & historic perceptions won't give us the headspace to realise our future is stronger together, which risks being damaging to us and our patients in the longer term
The clinical workforce crisis [doctors and community nurses]; the drive for keeping the frail elderly in the community and away from A&E and hospital generally; the requirement for 7/7 working; and the changes in competition law over DES/LES should focus GPs on collaboration. There's every opportunity that sharing backoffice functions and other resources can create efficiencies and take the pressure off inidividual practice management teams whilst supporting the transfer of work [with accompanying resource] to the community.
Jonathan's right. When I took on a PEC Chair role at the inception of PCTs I got myself onto a management course / learning set with a mix of clinicians and managers of every flavour. It was invaluable to me as it helped me see health from their perspectives too. Combined with some basic management skills training (effective meeting management, negotiating & influencing skills, etc) we could see competent & sensitive clinical leaders. It grieves me to see CCGs revisiting so much of the learning we did years ago in PCT-land.