Try telling a chronic cannabis user they should think about stopping. These consultations have have a similar (although admittedly less desperate and anxious ) vibe to discussion with people hooked on benzodiazepines. They just ‘know’ it’s good stuff ..you just don’t. There’s often little space for an open discussion - unless you have an hour and a half to waste in an angry evidence thin debate.
Policy is determined by a small group of managment zombies who use phrases like ‘rationalisation of their markets’. It’s not formally acknowledged or debated and agreed just pushed through by people who think they know everything and who aren’t accountable to the people they manage, self important individuals who get given sycophantic labels like ‘top GP’ by magazines like this, who sit in shady committees and make ‘important’ decisions behind closed doors without the spot light of public discussion to debate their nods and handshakes.
Ankle swelling? I just tell them all to stick their legs in the air like they just don’t care.
Let’s just scrap GPs all together and get politicians in to do our surgeries. Seriously what’s the point in going to medical school when every clinical decision you make is dictated by a bunch of twat politicians on some jerk fest committee? They dictate what you prescribe for each condition, what day and time of the week your allowed to prescribe it and what computer program your allowed to use to record the event. I don’t understand what the Dr in Dr means any more. We are simply tools of the government..with pseudo responsibility which exists simply so we can get blamed when the political decisions cause harm. F£&k medicine in the U.K. just get a job I’m MacDonalds - at least it’s honest and not a smoke and mirror puppet show ..aka UK NHS Doctoring
Wasn’t it NICE who suggested these things were prescribed in the first place? What does this say about the value of NICE guidance?
Anyone had NICE guidance used against them in a complaint?
Bollarks to NICE
“He said: ‘There’ll still be some issues at the beginning such as how local GPs will staff the resource.”
I guess they can reduce the number of weekday day time appointments and use the staff to work Sunday evenings and 9pm late shifts instead. Always better to tend to the needs of the working well than the disabled, sick and frail in a cash limited service with no staff.
This is excellent news, ensuring services are available for genuinely ill people is so yesterday. £10 million well spent!
Dear consultant , I’ve got this patient, they are a bit of a handful, I’ve got a pretty good idea what needs to be done but neither the time nor resources to do it, please help
Dear GP, thanks for your referral, indeed this one is a bit of a handful, we too have a pretty good idea what needs to be done but like you we don’t have the time nor the resources to do it, what we do have though is something called ‘referral criteria’ which means we don’t have to. I’m enclosing a leaflet I printed off NHS choices, your on your own sunshine, laters.
i.e. consultants to send photocopies of NICE guidance to GPs when they don’t have the staff to see the patients they’ve been referred.
..see enclosed NICE guidance and/or relevant chapter in Kumar and Clark.
Oh thanks, nice one
“Dr Milind Karale, EPUT executive medical director, said: ‘If a referral is not accepted by the service, the consultant is best placed to make appropriate recommendations to the GP regarding the treatment of the patient.”
Urrr no. How can somebody who hasn’t even seen the patient be ‘best placed’ to make appropriate recommendations ..regarding treatment? Really ...how so? I’m gobsmacked at the utter stupidity of this statement. Self evidently total crap. The person best placed to make recommendations is the person actually clinically responsible for their care and the person currently seeing them. Until such time as a consultant has actually seen them they are just guessing and guess what hey hold virtually no clinical responsibility if the shit his the fan. How wonderfully convenient , cheep and utterly useless
'The challenge will be to ensure that new ways to access GP care do not compromise safety, do not prioritise the needs of the well over those of the sick, and do not increase demand in non-commercial systems where increased footfall consumes resources rather than generates income.'
In a nut shell precisely the problem. This is a commercial solution being ignorantly applied in a non-commercial one. Someone needs to explain how this facilitates allocation of limited resources to those most in need. I can’t see that it does. It’s a way of making money for private providers and that’s who’s driving it ...them and dumb f*&k politicians.
DecorumEst | Salaried GP17 Aug 2018 1:10pm
I’m not really sure what your point is here. Are you suggesting exam pass rates should be lowered because none wants to do the job hence we should start employing people who are currently failing their exams? Or are you suggesting the lack of workforce is somehow something to do with institutional racism and if only this was fixed, everything would be fine and the country would be swimming with happy smiling hard working brown/black/yellow or otherwise not white GPs?
I don’t thinks the answer Is to employ people who fail their exams and I really don’t think folk don’t want to work full time because of racism. It’s because the job is too intense and the resources aren’t there to perform the job safely.
Getting into other issues and grinding your own particular favourite axe just confuses everything and encourages people to feel singled out, a special case and divides us for no good reason.
The job is shit. End of.
What we absolutely DONT need is yet another organization set up to monitor and investigate medicine. You set up a body to do one thing and soon enough it finds a reason to do something else. It expands its remit, starts charging you fees and it morphs into yet another enormous pain in the arse. That the BMA can’t see this is absolutely typical. We need fewer of these statutory bodies not more. A dedicated police unit to investigate Drs? The very idea brings out a cold sweat and sends shivers down my spine. What a completly dumb idea from a union incapable of getting anything right.
GPs are independant contractors? What utter nonsense that is. There isn’t any aspect of a GPs working life that isn’t directly micromanaged by some tosser in government. This kind of centralisation is why the communist Soviet Union died. The governments obsession with centralisation, standardisation is pathological. Squashing any chance of diversity, grass roots innovation or independence of thought. The “one shoe must fit everybody” approach will only give one result - lots of sore toes, no one walking anywhere and money wasted on plasters and podiatrist fees.
Another day another promotional piece on GP at hand. Are they sponsoring PULSE or something? Enough already about this lame bunch of wanna be ‘disruptors’. They must be jumping up and down wetting themselves in excitement every time you write an article. They’re a bunch of zeros and I’m a little fed up with the constraint drip feed about their second rate medical internet start up venture. Im currently working through an internet/app focused locum agency called Lantum. They’re like Uber but for Drs. Why don’t you write about them? Way more Dr focused than the patient centred consumerist agenda of Push Dr, the constant talk of which just feeds our growing passivity and negativity. Open your minds PULSE , there’s more going on in medical tech than these guys, some of it (like lantum) puts the control firmly back in the hands of the service provider..aka your useful but difficult to find well trained excellent but lately down trodden GP. We’re actually a vital and central resource - the tech rollercoaster ain’t always about making life easy for the consumer, it can be about making life easier for us too.
Tony you obviously work for these guys
If you cant touch the patient, can’t take their temperature, blood pressure, feel their pulse or indeed can’t even smell their breath you insult us all by suggesting this model of care is anything other than a cheap money spinner. You are fooling nobody but the punters and the politicians ..and perhaps your self.
There needs to be some fundamental reform in the law and the conduct of the GMC. Unless this follows nothing much will change..why would it?
I’m not aware of a time when the GMC was held in such low regard by the profession it charged with regulating. This is largley down to the leadership of Mr Massey. He needs to accept responsibility and go.
Midlands Doc | Locum GP13 Aug 2018 1:11pm
Spot on. Retirement is an issue because it’s fairly easily measured. There’s heaps of mid career GPs reducing their hours and finding other things to do because theyre just fed up. Then there’s the newly qualified who are going straight into Locum work and bypassing a regular job. It’s a problem that involves the entire work force, not just the people who show up in easily acessed statistics.
The answer is to fix the job, not fret over any number of mirrad consequences, early retirement being just one of them.
The question we really need answered is ‘is he BME’. We won’t know until we have some better close ups of his face and copy of his birth certificate but I’m hopeful Prof Esmail will feed back the official classification soon enough.
As a Locum what is striking when you move around and see a lot of practices is how few older GPs there actually are. They all seem to have left or are in the process of leaving. I’m 48 and I’m often the oldest Dr at just about every practice I go to. I left my job to be a locum early this year and have no intention of ever going back. There are just too many patients to see and not enough work force. I refuse to sacrifice my mental health for a society that doesn’t value me or care about my wellbeing. Talk is cheap apparently, but the reality on the ground speaks volumes. The only thing that’s cheap as far as I can see is the government and the society it represents.