I'm glad the Royal College of Physicians is of the opinion PAs won't be used to replace GPs. The problem is the RCP doesn't set the government adgenda, the Government does that bit, and they have a strong track record of ignoring the opinions of Royal Colleges. If there simply aren't any GPs because the Government doesn't think they are worth training and/or paying for who else are they going to employ? ..and how long before the rules are 'tweaked' so they receive 'clinical supervision' from any other 'appropriate clinician'. I'm not down on the idea of Physicians Assistant at all just deeply cynical of the direction this is taking us and the potential for Government dumbing down for short term financial savings. If something is cheep and someone can make the argument for organising primary care without the need for expensive, irritating, challenging Drs do you really think a government will say anything other than 'yes please!' ...regardless of the fact it'll probably increase hospital work load/referral rates/medical indemnity costs/over treatment. Is what they are doing to the NHS at the moment driven by sensible clinical reasoning? .. why would this issue be any different.
Sounds like they aren't allowed to increase the overall rate of pay which kind of says it all. No change in rate of pay for 11 years and yet indemnity rates are currently going up at around 12% a year (and that's for non OOH work - I don't know the figure for OOHs rates because I can't afford to pay them). It might sound lame but I haven't done a single out of hours shift since I became a GP 12 years ago. I've looked into it but I'd be taking a significant pay cut for doing work which is significantly more risky. I don't intend to subsidise a government which is already ripping me off in my day job. The solution is obvious but the government doesn't want to fund out of hours care - they seem to prefer ignoring the problem and/or blaming the ever reducing work force. Paying a 'bonus' can't be anything but a good idea made by desperate people but it isn't a solution, probably isn't enough and I agree would piss me off if I was one of the good folk already doing OOHs. I'm just glad I'm not working in Northern Ireland I really feel for you guys.
This isn't caused by ignorant GPs who need more training. This is the result of near hysterical levels of societal worry about 'mental health issues' in the young. It's almost as if someone is pouring money into advertising mental health problems as todays 'must have' problem. Self harm is rocketing ..why? partly because it's almost being actively pushed as an idea. The result is parents bringing in mildly depressed moody adolescents demanding 'something is done' all on the back of the latest thing they saw on TV. You are almost forced to refer and ..suprise surprise ..nothing much is done (cause there's not much needed ) but this is interpreted as 'a crisis in mental health support' Much of this is medicalising normality and/or actively encouraging maladaptive behaviour in impressionable young people. Don't blame GPs..this is a societal issue and not driven by poor training in general practice. We increasingly simply reflect what people demand. And the latest thing is child mental health ..it's currently a top government priority ...everyone is obsessing about it.. I find it all a little sick to honest..but then I think Facebook is sick too ..maybe I need a referral to child mental health myself ? I'll scratch my arms and go see my GP tomorrow
Theres nothing modern, new, now or fresh about 'working at scale' it's just an overused cliche...Stalin was very keen on centralised working at scale, it's known as Stalinism and is generally agree to have been a complete failure. Fetishising anything that's cynically been dressed up as 'new' is limp beyond belief. enormous all powerful individual crushing corporations aren't sexy and they aren't new...they are as old as the hills and steam roll you unless you conform ..I'm really sorry but this analysis is riddled with superficial 'copy and paste' cliched crap - lifted straight from someone else's stereotyped view of a past that never existed. Sorry to be harsh but this kind of thing gets my goat. Use your brain,come up with something original and stop regurgitating other people's sound bites.
I think maybe it's because the longer term agenda is to replace GPs with cheap easily controlled physician associates ...employed by serious folk like NHS trusts or super massive mega practices. It'll all dove tail nicely with secondary care treatment pathways and help keep the silly crap out of A&E. The narrative is that the world of primary care is a pretty simple place, not requiring much training, just more 'drones on the ground' ..it can call be sorted and controlled centrally by protocol. GPs are an unnecessary extravagance not in keeping with what's needed for the '21st Century'. How on earth this squares with the other narrative currently going round - namely primary care is set to become more and more complex as more and more hospital care is dumped there - I've no idea.
I think this is an example of cognitive dissonance - the simultaneous existence of two contradictory view points in the same individual. But then the NHS isn't an individual hey ..if it was it'd obviously be bonkers
GPs should ...all bleedin resign, en mass
you kick a dog long enough it dies. we shouldn't all be hanging round waiting for this inevitable event to occur.
we need to give the finger and leave
The market decides pay..not a department of worthiness.
Do bankers get paid offensive rates because they are good and worthy people? Not at all. If something is difficult to get hold of and people want it it's valuable...try to go against this and you'll end up without ...but evidently feeling deeply miffed and entitled all the same
'..continuing to grow and innovate within the system'
This is where all the physician assistants are going to be working ..wouldnt be such a bad idea .. cheeper too. No doubt they'll get subsidised with crown indemnity. Cushty.
Medical Defense fees ..crown indemnity
The government dumps work on GPs and we carry all the risk ..no come back on the government because we're responsible if anything goes wrong...and it is, and we are all paying for it directly now out of our own pockets in our rocketing indemnity fees.
This carries on and soon it won't make any financial sense going to work ..forget all the other shit...unchecked this issue alone will kill general practice dead in just the next few years.
I work part time and it's isn't because I'm 'millennial' cause I'm not. It's because if I worked full time it'd be a matter of months before I was struck off for screwing up or punching someone. This is the comment of someone who gets their 'information' secondhand without real understanding. An essential quality if you want any kind of role mismanaging the NHS.
Yes you are completely right but....
obviously the position to take on this one hey
Oh the irony
I guess if you accept a contract you are actually obliged to carry it out. We need to grow some balls and start saying no. We're in the mess that we are because we have continually agreed to pretty much anything that's been imposed ..all we do is say 'yes...' and then moan about what we've agreed to do. No wonder half wits like this woman get totally confused..why do we think contracts don't apply to us like everybody else. The error lies entirely with us for agreeing to a set up which completely shaft us..how weak and utterly stupid is that? Why do we continually comply? Greed of a few? Trapped and no way out? I don't know ..the consequence is the lack of fellow idiots prepared to be GPs..those left behind continuously saying 'yes' are either trapped or stupid ..which kind are you ?
This is a good example of something we should be say 'no because..' to rather than 'yes but...'
An artificial construct designed by, and for the benefit of, the administration, rather than those who are actually tasked with doing the work. We weren't asking for a frailty monitoring system...why has this been forced upon us? Unnessessary box ticking for bean counters.
This is exactly what's needed.
It's a 'consultation' is it? My arse.
..or perhaps the folk posting congratulations to NICE for giving them guidance on issues they obviously are already expert in genuinely believe that they are the only Drs who knew. Might I suggest we would be better educating the public rather than patronising the medical profession.
I make the above point not because I disagree with the guidance. I agree with what they are saying complete. I think we all already know there is an issue with the over use of antibiotics. What is the point of NICE exactly...to spend our precious health budget restating the blindingly obvious? Surely there are better ways to be spending our money than churning out endless guidelines on issues that are already well known. Perhaps someone should launch another 'appropriate antibiotic prescribing' campaign instead. Or a patient education campaign to stop folk booking appointments asking for antibiotics for this issue. If the NICE budget is so vast it can produce guidelines such as this you have to ask yourself ..why? My day to day working life has been completely hobbled by lack of funding - and here they are working away producing this kind of clap trap. We don't need another set of mindless 'rules' from this bloated guideline factory. There are more useful things they could be attending to than this. That too I'd suggest, along with this guideline, is fairly obvious.
I'd like to third the motion to stop publishing this mans picture. Seeing it makes me depressed. Can't you use the NHS symbol or something instead? Seriously.