'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?
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?
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.
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.
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.
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'?
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.
To the Editor: thank you for acknowledging that you were the originator of the 'Pale, male and stale' headline -- but you haven't actually apologised for using it (in fact you've made light of it by reminding us that it's been used on other occasions), and as you have insulted me through using it, perhaps you would care to apologise profusely now, both to me and the the thousands of GPs who, through no fault of their own, were born pale and male. Whether we are also stale is a different matter, but certainly not one casually to attach to the other two epithets.
Technically, the High Court is right in that the Medical Practitioner Tribunal Service technically has no option but to take at face value the original court's decision.
However, it seems to me that justice has neither been done, nor seen to be done, and the collateral ramifications and damage will be immense.
May I suggest that the appropriate, moral, humane and ethical thing to do now is for the GMC to strike Dr Bawa-Garba off the medical register for, say, four months, then let her apply for readmission (and accept her).
At the same time the GMC needs to take a long hard look at the responsibility an individual clinician faces when system errors are involved, and alter its own regulations so that system failures and pressure of work are ALWAYS taken into account when judging the actions of individual clinicians.
The greater pity, of course, is that the hospital management won't support you. They should be there, (sadly) cheering for you, telling the world that this is the real situation, of the difficulties that it brings you, and that while they may not have any ability to change matters in terms of the resources available to them, you and they are definitely on the same side and pulling in the same direction of trying to help the patients with all the resources they between you yo have available.
So where are they? And what are they doing?
I do agree with those who think revalidation ought to be better targeted, and the amount of intrusive questioning /data collection minimised.
Therefore, may I suggest that the requirement to write down 'reflection' ought to be dispensed with for all of us who can show we are Myers-Briggs Introverts. To us, reflection is as automatic as breathing, and about as impossible to stop. Therefore we shouldn't need to prove that we do it.
Such a move would save us AGES.
Why don't we instead train NHS managers to do root cause analyses on why GP numbers are falling; and why GPs are so overloaded - particularly through work that should be done by hospitals but instead just gets dumped on GPs; or else the supportive stuff they are supposed to be doing - letters sent out on time, patients not discharged too early -- hasn't been done, yet the hospitals themselves are never sanctioned. A little bit of training for the NHS higher management wouldn't go amiss, methinks.
But please remember that not everyone behaved like this! I know you never said that they did but I think we all need to be to be clear that the disreputable behaviour you describe was perpetrated by only a small subsection of the profession.
This totally ignores the value of the receptionist who knows the local patients and can quickly make valuable judgements about the validity of the request and thus avoid using up appointments on trivia. Yet another example of non-GPs sticking their noses in where all they will do is make things worse.
One of the difficulties relates to the use of paracetamol in low-grade but prolonged arthritis. Being able to buy only 32 tablets at any one time, and therefore having to go every few days to the chemist may be possible in the big cities, but in the country it's a nightmare, especially if the nearest chemist is four miles away and you need the medication for three months.
The other problem is severity. How do you ascertain the severity of pain? At the beginning of my career as a GP I felt that most arthritic pain was minor. Then I had a frozen shoulder/ rotator cuff injury and was on at least one occasion left nearly in tears by the continuous nature of the pain over months. That's quite a different scenario from a short time of the same intensity of pain: it's the unremitting, unrelenting nature of it that makes it a whole new ballgame (especially when you can only buy the tablets in small quantities), so the cost in petrol and time of getting adequate supplies is a considerable overhead.
The bottom line is that prescribing of paracetamol for chronic or long-time pain needs to be treated separately from acute pain.
Clearly designed by someone with little knowledge of general practice in the more rural areas. My former practice was a semi-rural one, and it could take a full hour to get there, do the medicine, and get back. So if I do a single visit early in the day, and then get called again to that same village, I will have taken 2 hrs out of my day instead of the 1 hr 15mins it would have taken to do both visits together, in the afternoon.
Is the entire health service run by people who live within metropolitan areas, I wonder?
re Copernicus.....Or to quote Lord Denning from the end of the last century: “Be you ever so high, the law is above you”.
It seems to have escaped the notice of a lot of people, but the £350 for the NHS' could only become available AFTER we have formally left, and cease paying into the EU coffers. That can't happen until March 2019 at least, and if we also choose to pay a 'divorce bill' it will be a long time before the financial benefits of Brexit become available.
Why is it that NHS England - which should be the absolute leader in the NHS - has apparently such a weak understanding of the relevant law? It smacks remarkably of the blind leading the sighted.
Usual NHS practice -- any complex, timeconsuming or difficult requirements - delegate it to those on the front line.