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Gold, incentives and meh

LateralThink

  • GMC to advise doctors to leave ‘factual details’ out of appraisal reflections

    LateralThink's comment 10 Sep 2018 10:55am

    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?

  • It’s all English to you!

    LateralThink's comment 08 Sep 2018 10:22am

    Dr Tea is unfortunately absolutely correct - and it will of course increase the pressure on the GP to perform the action, not reduce it.

  • Top GP issues mental health warning as 400 doctors die by suicide

    LateralThink's comment 03 Sep 2018 10:49am

    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.

  • GPs defending patient complaints to be asked which guidelines they followed

    LateralThink's comment 31 Aug 2018 11:48am

    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.

  • GPs could be forced to switch IT systems under new NHS Digital contract

    LateralThink's comment 16 Aug 2018 8:53pm

    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.

  • Government 'serious' about retaining GP partnership model, says review lead

    LateralThink's comment 07 Aug 2018 10:25am

    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.

  • NHS England primary care director 'sorry' for comments about small practices

    LateralThink's comment 03 Aug 2018 10:50am

    "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.

  • GPs should be ‘pleased’ when small practices close, suggests NHS's top GP

    LateralThink's comment 01 Aug 2018 3:21pm

    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?

  • GP practices 'asked to trace patients who have come into contact with measles'

    LateralThink's comment 18 Jul 2018 10:04am

    A statement about this from the BMA from a Data Protection point of view would be welcome.

  • We have to stop making excuses for abusive patients

    LateralThink's comment 14 Jul 2018 2:55pm

    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.

  • New spirometry training requirement ‘not covered under GMS’, says GPC

    LateralThink's comment 06 Jul 2018 10:30am

    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.

  • Patients to book GP appointments through new app by end of 2018

    LateralThink's comment 02 Jul 2018 11:13am

    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.

  • UK doctors set to ‘oppose Brexit’ following BMA vote

    LateralThink's comment 28 Jun 2018 11:32am

    #NotInMyName.

  • Lord Darzi: All GP partners should be offered salaried NHS employment

    LateralThink's comment 19 Jun 2018 10:06am

    'Offer all partners salaried GP employment.'
    Great idea! But hang on...
    What happens to the costs of/buying out of:
    premises (including branch premises)
    existing staff (especially the responsibility for severance payments)
    ongoing contractual requirements in leased buildings and PFI buildings
    existing ongoing contracts (telephones, IT, vehicles, equipment)
    .. and how does this fit in with private work done at these establishments, or buildings which are privately owned which are sub-let to other healthcare professionals?
    What about those who still work from premises in or still attached to their own residence?

  • GPs told to print off their own forms and leaflets after Capita stock issues

    LateralThink's comment 04 Jun 2018 8:04pm

    Why is it that with so many managers to the square inch in the NHS, there is no-one with the ability/foresight/guts to say to Capita's executives that this is a major breach of contract for which exemplary damages will be sought (as well as full reimbursement of all expenses of time and money expended by practices.)
    Why not? WHY NOT? This is what makes NHS management into a laughing stock.
    If you don't have watertight, enforceable contracts, then what is the point of contracting at all?

  • Journal publishes study into Pulse readers' comments on GP news

    LateralThink's comment 25 Apr 2018 11:06am

    An absolutely useless survey from which to try to generalise. It breaks the fundamental rule of statistics: ensure your sample population is representative of the population you are trying to study.
    Yes, it's probably a well-analysed report of what this very self-selecting group of people have said (and WITHIN THESE CONSTRAINT is likely to be accurate and valuable), but under no circumstances can it be extrapolated to the GP population as a whole.

  • I’ve learned the hard way to live without patient ‘satisfaction’

    LateralThink's comment 18 Apr 2018 7:54am

    As a profession we will never get things like this under control until we have the absolute right in law to complain back without Fear of reprisals. Just imagine - at a time when it is getting harder to find a GP - if you were able to say to her that this is an abuse of the system - no one coming in with a list is EVER an emergency - and to be complained about as well is simply not acceptable - and that any repetition will lead to her being thrown off the practice list... This would sort it out once and for all.

  • GMC to review effect of poor mental health in 'wider doctor population'

    LateralThink's comment 28 Mar 2018 12:59pm

    I see a potentially HUGE problem here. If the GMC 'investigate' (but then feel they have to 'shop' all doctors that declare themselves to be stressed/ noticing they are making mistakes /experiencing suicidal ideation) they simply won't be getting the data they need for their investigation, because no practising doctor will admit to any of these symptoms or problems for fear that they will be inviting their controlling body to strike them off.

    Any investigation like this has to have a cast-iron, legally sound promise attached that under NO circumstances will the GMC use this data for any purpose other than surveying doctors' mental health. Either that, or it has to be totally anonymous -- but even so, it's all too easy to let slip details about oneself that would allow a shrewd investigator to find out who the declaring doctor was.)

    And if they don't attach this promise, then they might as well say goodbye to the survey because without a shadow of doubt it will not reflect the real state of play in clinicians' mental states.

    The GMC will undoubtedly respond by saying that they have an overall duty to deal with any situation which is potentially dangerous to patients, and if this situation arose, then they would have to break their word and investigate. Well then, before even starting their survey, they GMC need to weigh up the relative risks of (1) breaking their promise and identifying a few doctors who might be teetering on the edge of possibly doing something that will make them a risk to a few patients (2)not breaking their word and as a result being able to identify and start to deal with the much bigger problem of discovering the breadth of doctor stress and learning how to prevent damage to patients from it in the future -- and I suspect this cohort of patients potentially at risk from their doctors will be much bigger than than the cohort identified/ damage prevented in No 1.

  • Why not just rebadge 111 as 666

    LateralThink's comment 26 Mar 2018 12:25pm

    I LOVE the idea of 111 having to book into a triage slot, but:

    1. Can we trust 111 not to take the attitude of 'we are the triage service so we shouldn't be booking a triage, we should be sending them to see the clinician face to face'?

    2. Can we trust 111 to choose the triage slot rather than 'squeezing them in to see the ECG/minor illness /immunisations nurse'?

  • Babylon's GP at Hand app signs up new patient 'every two minutes'

    LateralThink's comment 14 Mar 2018 11:13am

    Perhaps we need to think about having regulations that say once you have registered with Babylon, you will not be allowed to return to your previous practice -- in other words, Babylon has to be prepared to provide all GMS services to all their patients or be held to be contravening their NHS contract.
    Now if they can service all their NHS patients in this way, then fine -- and the allegations of cherry-picking will go away. But if they can't, why are they being allowed to take on such patients?
    The real problem however will come when this scenario comes mandated by circumstances: when the original practices have had their more profitable patients removed, leaving them too few resources to cope with the less profitable remainder: then that original practice folds, and now there is no-one to look after the more complex patients.

    This is all highly predictable: we need the regulations amending to prevent cherry-picking as otherwise nemesis will inevitably follow.