This isn't just a simple financial kick in the teeth, it's a complete dereliction of duty and a rubbishing of all the considerable, detailed, and longstanding IT expertise available on primary care. Bear in mind if you will that of all the areas of medicine, primary care is by far the best in its use of IT - in come cases by about 15 years. So where was the consultation with the leading representatives of primary care, and primary care informaticians? Was there any at all? With the BMA, with the User Groups, with the PHCSUG, with the Faculty of Clinical Informatics, with the CCIO and CIO networks?
Utterly daft to require a wet signature. The more that the prescribing process is fragmented, the less patients will use it and the more prone to error and manipulation it will become. Remember KISS - "Keep It Simple, Stupid". The more complex the prescribing system, the more that is likely to go wrong, get forgotten, or get bypassed.
The real measure of expertise in any given subject isn't whether you can do the procedure properly, but whether you can reliably extricate yourself and your patient from every one of the standard potential snags and pitfalls that may befall you. If you can't deal with the standard complications, you shouldn't even be attempting the procedure on your own.
Remember Einstein's dictum: not everything that can be measured matters; and not everything that matters can be measured.
Why does everyone run around in circles here? It's not rocket science.
The basic question is: how can government stabilise payments to GPs so that it is appropriately profitable for them to continue to provide services to patients who aren't suitable for telemedicine solutions?
In essence it simply means a decent re-tweak of the Carr-Hill formula. My suggestion would be reduce the remuneration somewhat for patients who are being seen via telemedicine, because they are likely to be far less demanding on time, and increase the remuneration hugely for those who are still seen face to face. This would be fair and just all round, allowing the benefits of new technology to take place, suitably rewarding those who do the telemedicine while also appropriately remunerating those toil away seeing the much more intensively demanding clinical situations that remain.
This will be fine... until the first legal cases for misdiagnosis, harm and even death come in. Will Matt Hancock be prepared to shoulder the responsibility then, I wonder? (And maybe the answer with be a sold 'Yes', so I'm not making allegations.) But he needs to realise that his statements need to be seen as accountable.
Yes, agreed - good description, clear guidance.
What a ridiculous situation! Mistakes and mishaps are so often about 'things that slipped through the net despite everyone being careful'. If we aren't supposed to be specific, then how can we learn, or teach others so that they don't fall into the same trap inadvertently?
Dr Tea is unfortunately absolutely correct - and it will of course increase the pressure on the GP to perform the action, not reduce it.
We will continue to have this problem until and unless each doctor is given the absolute right in law to sue for exemplary damages any patient making a false, inappropriate or malicious accusation against them.
This is why for some time I have urged everyone to talk about 'guidelines' (which are intended to be more fuzzy and therefore can more easily be appropriately ignored) and 'protocols' which have to be obeyed.
The PHSO doesn't seem yet to have twigged that a profession is by definition an occupation that cannot be defined by rigid protocols or guidelines, nor can it be assessed by simple targets: any attempt to do either of these merely acts to destroy that profession and so its workers become mere functionaries. Perhaps that's the idea?
However, medicine is currently impossible to reduce to simple guidelines and rules (and in any case, guidelines and rules are NOT what AI is about). In AI even the creators of the robots often don't know how/why the robot is working as it does. I can see the argument that managers and politicians are trying to replace GPs with robots -- I just know that this isn't going to happen in medicine in a global way (i.e. as opposed to a very specialised function) any time soon.
This strikes me as being like President Kennedy's speech announcing the plans to send a man to the moon... though in this case, not by the end of the following decade, but by next Tuesday.
Writing a GP IT application is a HUGE task; to get it right for many different healthcare settings in such a way that it will work seamlessly in all of them is almost impossibly complicated; and to agree that it will need to be done by summer next year (or at least have the basics in place) is ridiculous to the point of stupidity, because who knows what software glitches will be left lying around in the rush to meet the new deadline?
Yes, by all means have targets - but above all they must be reasonable. Reworking the whole of GPSoC in under a year doesn't strike me as anywhere near a reasonable timescale. Remember, we've already spent over a generation getting GP IT to its current position; suddenly including a huge step-change isn't likely to safely create the improvements its proponents hope for. Indeed, it may well turn out to be like another project from the sixties - Chairman Mao's 'great leap forward' - which was supposed to be a leap forward overnight, but instead took the Chinese people back ten years and killed millions of them.
Progress in complex medical IT will never come about by introducing rushed objectives: instead, we still need objectives and standards, applied firmly and decisively... but introduced slowly and carefully, with constant assessment and re-assessment, and certainly not in a rushed manner.
OK, shall we get one thing clear? If we have a viable model, then it shouldn't need 'incentives' to make it work. The very existence of 'incentives' (anywhere)is an admission that the basic model itself isn't fully working or even workable.
"Dr Madan has suggested that GPs should be ‘pleased’ when small practices close, as there are ‘too many’ of them struggling to meet patient demand."
So why not join them all into one big (struggling) practice, then it doesn't look as though the problem is all that widespread? :-(
Amalgamation is not necessarily the answer to every problem. If you have ten separate doctors each with not enough time to service the demand and they amalgamate, they don't suddenly create new slots: the new practice will have to service ten times each doctor's original list size. There may be a few savings and efficiencies, but against this has to be all the time spent liaising with the other doctors about the work and running of the practice.
Not a helpful comment, overall. What about those areas where expansion or combination is impossible - i.e. rural and semi-rural ones? Where the GPs delight in knowing all the patients; where the patients delight in always being seen by someone who know them (or perhaps, always by the same doctor).
Remember also - our notes are only the tip of the iceberg of our knowledge about the patient: all the rest of the un-noted (but personally remembered) knowledge is there and being utilised in the small practices, providing the best possible quantity and quality of continuity of care.
Or doesn't that matter, suddenly?
A statement about this from the BMA from a Data Protection point of view would be welcome.
And the Achilles' heel of all this is that if the patient decides to make a complaint to the CCG, as like as not the doctor will be hauled in for criticism: ditto the GMC; and ditto the ombudsman (to say nothing of the media).
Yet we cannot be expected to show discipline and strength (including toeing the party line over, say, prescriptions) if those managing us always cave in and assume that the doctor is always wrong. Indeed, the patient wins even if the professional(technically) wins, because with a bit of luck (according to the patient) responding to the allegation of unprofessional behavior will cause you so many sleepless nights, and waste so much of your precious time that that of itself with be punishment enough as far as the really unpleasant patient is concerned (and will also tend to make you never want to do it again).
Yes, there are some GPs and staff at fault out there and I don't want to sound as though I am standing up for them inappropriately -- but we need a complaints situation which is truly even-handed, whereby if the doctor is deemed to be not guilty of the subject of a formal complaint, then ALL the costs of the hearing (including the doctors legal fees) have to be paid by the patient, AND there is a 'victim surcharge' that they also have to pay.
The bottom line is this: complaints cannot ever be one-sided, but at the moment the boot is far too far on the side of the over-demanding patient.
Another example of where management of the NHS thoroughly gets in the way of service delivery. There need to be clear, nationally-defined levels of competence, which will therefore *always* have to be taken into account by those who devise targets.
When will NHS managers get round to understanding that these organisational aspects *have* to be created holistically, taking into account the time needed to acquire the expertise, its cost, the benefits it will give, etc etc? Currently there is far too much of the 'Oh yes, we'll need to impose standards...' without anyone appearing to think about the wider implications. This is not what good healthcare management is about.
And how will this integrate with the ability of receptionists to manage the few remaining slots that day so that the truly important cases take priority over the minor stuff?
If it won't, all I can see here is a faster route to chaos.
Yes, there is a role for on-line appointments, but no, there is no role for an app through which ALL appointments have to be made, which I suspect may be the next part of The Plan.
And I agree with all the above comments: on-line appointments are already widely available, so what's the fuss? And do they empower those not on the internet? Clearly not.
It would be nice to feel that our lords and masters have at least a basic understanding of the more subtle aspects of medical life they are trying to control but sadly, this present announcement doesn't fill me with confidence.