Tony | GP Partner/Principal18 Apr 2018 4:21pm
It’s completely irrelevant who’s paying the indemnity fees, it makes no difference to the risk you carry and doesn’t make consulting without possibility of examination any safer. I’m sure you’ve consulted by phone, so have I and just about everybody else. 95% of the time you do so with their full medical record in front of you, quite possibly personal knowledge of the person you are speaking to and if not you are triaging and have the real option of getting them down to the surgery to see them in person. Babylon is patently not the same thing all.
I think what’s being lost in the whole discussion about this issue, amongst the convenience, and the distruptive tech, and the working from home and the money that people will make , is the stark fact the the entirety of the risk associated with the new model of care lies solely with the Dr. Yes people like the convenience, of cause they do. The cost is a risky consultation model, the punters don’t care because you are the one to blame if it goes tits up. Not them.
policenthieves | GP Partner/Principal18 Apr 2018 1:22pm
The safety issue is nothing to do with consumer assessment. This is about the Doctor. It isn’t safe to practice as a Dr...and on what basis do you asume ‘consumers aren’t so stupid at assessing safety as you might like to think’ ...where do you get this from? Quite a large number of the average patient population are exactly that - pretty clueless. That’s exactly why they need to see a Dr , they don’t know what to do and they need your advice. If you are the one dispensing that advice, you are liable for any errors that occur and you can’t even lay a hand on the patent, the stupid one is in this scenario is actually the Dr.
I don’t believe this is safe. Show me the evidence that someone has proven this model of care to be an appropriate, safe and effective way of delivering primary care. How can it be right that a wholesale reorganisation of primary care has been introduced without proper analysis? How can it be that we have a massive oversupply of medical regulatory bodies and none of them has bothered to analyse and state what they think of this model? It’s like we are passive recipients of something that is just happening. Work for them if you like but you are practicing crap medicine and I will shed no tears when I read about the inevitable wave of medical negligence claims coming your way. You see the Drs working for these people hold all the risk. Ponder on that .. it’s the individual Drs working for these people who will shoulder all the blame when mistakes happen. If you think otherwise you are a total fool. Take their money but you are personally responsible for the consequences ...no one else. Mugs. But there are plenty of them...200 at least.
I feel for you and know exactly what you mean as I have experienced exactly the same scenario and felt exactly the same. To be honest it was these kind of encounters that played a large part in my decision to move away from practicing as a GP. I’m not quite there yet and still need to pay my mortgage but I’m getting there. Perhaps there is something wrong with me, perhaps I need to grow a thicker skin, but perhaps, just perhaps, there are other things I could be spending my time and creativity doing - like being a Dr in a country where my skills would be put to better use. Or doing something entirely different. There is something about the self entitled, unthinking, demanding attitude of an increasingly vocal minority of people, that seems to grow month after month, that does make you wonder - you only have one life, you need to spend your energy wisely. Is working as a GP in the U.K. really the best thing to be doing? It’s an individual decision - for me it became clear a while ago. Something else is where it’s at.
More appraisal, more regulation. There are too many bodies looking to set things up in order to justify their existence. We are being regulated out of existence. So if you’re a GPwER you will have to do TWO appraisals every year?? Or collect TWICE as much evidence? Why add yet another level of bureaucracy? The only effect this will have is to reduce the numbers of GPs with special interest / extended role accreditation. And all to feed the ego of the RCGP. To all self important administrators out there...shut up already!
Wikipedia - wilful blindness:
Willful blindness is a term used in law to describe a situation in which a person seeks to avoid civil or criminal liability for a wrongful act by intentionally keeping oneself unaware of facts that would render liability.
Although the term was originally—and still is—used in legal contexts, the phrase "willful ignorance" has come to mean any situation in which people intentionally turn their attention away from an ethical problem that is believed to be important by those using the phrase (for instance, because the problem is too disturbing for people to want it dominating their thoughts, or from the knowledge that solving the problem would require extensive effort).
NICE guidance is used as a template for ‘normal acceptable practice’ by a whole range of non medical folk including lawyers. You can very well get sued for not following guidelines if anything subsequently goes wrong. NICE doesn’t produce ‘guidelines’ - in reality that’s a shameful lie. They spray poison from their chalice onto the surfs below and demonstrate ‘wilful blindness’ to the unintended consequences of their work.
Disturbing. The ever expanding tentacles of government. Car registration, council tax records, HMRC, the voting register and now your GP record. All part of a centralised government data base. Call me paranoid if you like, but the U.K. is one of the most CCTVd countries on the planet. Not long before CCTV facial recognition will be pretty much standard and you won’t be able to step out your front door with out the government knowing who you are, where you are and where your going. The only thing that keeps them in check is our fragile ballot box. As the years roll by I for one have less and less faith in this blunt instrument as a tool for keeping it all in check. We rely on what we are told to make our votes and yet we only know what the media feeds us. Do you think we have a free and open media where all views are freely expressed? Judging by the frequency of ‘moderation’ on the fairly innocuous comments in this fairly middle of the road publication, multiply that across the media in the U.K. in general sadly I think not.
Who is this guy...seriously who is he and why is he leading the GMC?
Yeah right, so what’s exactly is the problem with just advising someone verbally what to go and buy? That’s what we are already doing every day. Why do we need to waste even more money on an oficalized piece of paper? Isn’t this just encouraging people to attend for prescriptions for things they could just have gone and bought themselves? I can see why people making money selling OTC meds might think this is a wonderful idea. Basicallly an NHS certified direct recommendation for a commercial product. This wouldnt saving anyone any mone. Quite obviously pants.
Too many contradictory guidelines - isn’t that actually the real problem here?
In an era where guidelines are increasingly used as a legal tool with which to extract compensation, the lawyers are certainly spoiled for choice in the field of asthma.
Prediction - this will be an absolute bloody disaster. It will be under funded and rely disproportionately on flawed IT.
‘Customer’ facing responsibility will remain with the GP but there will be some faceless beurocracy contactable only by via an online form that will be actually producing the certificates. Computer glitches/teething problems and ‘lessons to be learned’ will all follow.
The undertakers better invest in a few more fridges, there will be long backlogs waiting for their cremation papers
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(Forget freedom of speech - in todays UK you don’t say anything controversial - the lawyers are watching)
Thank f* I’m a Locum
...perhaps they should fund a one off motivational interviewing study day, might cost them a couple of hundred quid. Might that not be a more efficient way of spending our money?
I wonder who’s idea this was, how much are they being paid? What do they actually do? Maybe they could scrap that particular role, and save themselves the considerable amount they are no doubt paying this self-justifier (along with all the cash they’d be wasting on this GP consultation micromanagement scheme). I bet that would help balance the prescribing budget immediately.
Our healthcare system is funded out of taxation and organised by our government. Increasingly it’s treated as if it is just another government department, with all its employees, and the data it collects, government property to be fed into any other arm of the state that’s convenient. Regardless of the ins and outs of this particular issue, it’s a good example of the problems inherent in things like centralised medical notes, the NHS spine and any other of the number of government initiatives to centralise information and exert control for vague reasons of ‘efficiency’ and ‘for everyone’s benefit’ . The more involved any state becomes in its individual citizens lives the more individual freedom is eroded. Immigration officials have no business demanding information about people from Drs unless there is an immediate significant risk to someone. There will always be officials who overstep the mark, give someone a job as a government official wherever you are in the world and some of them will misuse their power. The UK is not different. As a good an argument for small government as many.
Yup they get the service they deserve. You ain’t got not respect for me, well I ain’t got no respect for you neither. In the me-me-me world where everyone expects everything with zero effort and no personal responsibility everyone looses. Tough shit. Good stuff is earned, it’s not a right.
oncehadavocation | Hospital Doctor10 Apr 2018 10:40am
It’s not numbers of hours worked, it’s the intensity of the work
I can jog for hour after hour but don’t ask me to sprint all day and expect me to be ok.