"...this will allow GPs to 'demonstrate an open culture'..."
The people who need to develop an open culture aren't the GPs but senior NHS managers. (Some hope!)
I suspect this is a somewhat biased sound-bite headline. The Daily Telegraph headline on the same news item is 'Brexit could mean £5billion for the NHS, study shows', though they clearly report that this would depend on the state of the economy,and of course that Brexit could pose a series of risks to the NHS.
So how truthful is your own headline and story?
I wouldn't mind so much if CQC and similar took a standards-based approach, as long as it was uniformly rolled out across the NHS. But it seems to me that draconian standards are applied to front-line staff, whereas hardly anyone seems to do anything to address those guilty of poor-quality leadership.
One law for the front-line workers, and another for those in charge, perhaps? That's what it feels like - unless I've missed something.
Why is this situation always one-sided - 'The CQC wants to check this, that, the other...'? Why is no-one asking the obvious question, 'Is the CQC actually fit for purpose?' Does it know how to interpret and use statistics; are its investigations spotting the real problems, or simply turning up spurious things that it can prove but whose existence/absence doesn't really have any bearing on the quality of healthcare delivered to the patients by that organisation? (For example, the real question isn't 'Do you have a written protocol for dealing with requests for the morning after pill' but 'do you put this protocol into practice every time someone presents with this request?')
Is there any evidence to suggest that the CQC is doing the job it's paid to do in a way that delivers real results, is cost-effective and minimally intrusive?
I wonder how long it will be before super-large practices like this fall foul of anti-monopoly legislation?
Isn't this EXACTLY what NHS managers should be doing - taking the initiative, fighting clinicians' battles for them -- so that we don't have to waste our time doing it ourselves? There is no better example of why the NHS is in the mess it's in than this dreadful situation. 'We've created all these rules... but we won't police them.'
It's not just the insurance cover that will be a problem for these GPs - it will be the personal liability which renders each of these GPs liable to be complained about to the hospital managers or the GMC for saying 'go away', with all the worry and time then taken up responding to individuals who complain and to disciplinary proceedings.
Perhaps we ought to insist at the start of this project that 50% of the time of these GPs is immediately top-sliced for dealing with complaints. That might just demonstrate to Hammond, Hunt et al what the real world is actually like.
The problem with asking inappropriate attenders to take a hike is the hours and hours that you'll have to spend answering complaints that you were neglecting your duties; that they were much more ill than you made out (because you didn't examine them thoroughly enough to find out); that you were professionally negligent; or that you were simply rude. Then the hospital will feel obliged to investigate; and so will the GMC; and your defence subscription will then go up.... far easier to give in and see the patient.
The bottom line is very simple: if politicians/managers want us to be 'firm' over refusing treatment and reducing inappropriate demand, they have to be similarly firm in backing us up, and refusing to allow us to be blamed, pilloried or referred to a hearing -- never mind named and shamed in the press.
In the absence of this, forget any question of doctors turning patients away from A&E: it just won't happen.
I am genuinely sorry that the motivation for this exercise seems to be purely financial. What about the ethics of it? What about creating a joined-up set of standards for everyone in the health service? What about including a regulator for NHS managers? (That really would be ground-breaking.) What about ending double/treble/quadruple jeopardy?
Please remember everyone, if you do do these reports for free and make a mistake, (or even if you don't but the patient accuses you of doing so) it is YOU who will be in court/ facing the GMC / in the newspapers. Our pay is in part to recompense us for the risks we take, and the time it takes us away from other things to do this work.
The honourable way for this situation to be fully resolved is for the government to pay us a fee for completing documentation such as this. Then no-one gets disadvantaged.
It is quite wrong that the taxpayers of the UK have to fork out for the care of those coming from abroad, particularly when it is acknowledged on all sides that there is simply not enough money to support the existing NHS. OK, so this amount is a relatively small proportion of the total NHS budget, but it equates to millions of pounds - and if you don't want it for your area, then I will happily agree to receive it on behalf of my own CCG or local hospital. It would fund a lot of clinics and operations for those in the UK who are currently going without the healthcare they have been promised at the time when they need it.
Whether GPs should have anything to do with collecting this money is an entirely different question.
And what happened to the principle of Choice in all this? Or is Choice something that the politicians support when it's convenient, but want to remove when people won't do what they want? Or in other words, are they discriminating against people who actually do want to choose in their own way?
The country needs to decided which of two roles GPs provide: EITHER they are there to support each individual patient, OR they are there to provide objective assessment/ certification of the patients needs. Clearly, the same person cannot perform both roles simultaneously.
I have said for many years that general practice is the hardest job in medicine to do well and the easiest to do badly.
I find it fascinating that we are all told to offer 'Choice'... but when the patients tell us, repeatedly, that they like small practices, suddenly the concept of 'choice' is nowhere to be seen.
But shotguns are an important tool for the farmer. It's not just about sport.
'I am a name, not a number!!' That aside, it's all too easy to mis-transcribe numbers, with all sorts of unpleasant IG consequences if you get it wrong by transposing even a single digit. By comparison, it's much easier to pick up a potential error in a name.
I find it weird that so many people want to ban it because 'it can cause problems if you take too much of it, and with alcohol'. So why should those responsible, clear-minded patients with arthritic pain who don't take it in excess, and don't use it with alcohol, have to stop using it - especially as for some people it seems to be the only thing that will stop their pain?
And now for some more unintended consequences....
1. If we have full 7/7/ services, then once non-retail industry realises this, without exception, they will be saying to their workers 'You may NOT have time off to see the doctor in working hours. Go at the weekend.'
2.Weekend surgeries will increasingly fill up with patients who are in work, so they will get busy, on both days, to cater for the 'in-work demand'.
3.GPs will have to have time off, so the only alternative will be during the week, so less routine work will be done then.
4. This is very family-unfriendly and will reduce the willingness of doctors with families to commit to general practice.
5. The net result will be a shift from weekday working to weekend working; a reduction in availability of GPs during the week; and a huge reduction in GP numbers overall.
The shift from weekday working to full-time weekend working under the pressure of demand from patients in full-time, non-shift work is the one that intrigues me the most, because it hasn't yet been thought through properly - though non-retail businesses will certainly love it!
The reason why the word 'scorecard' is so divisive is that it represents a response to some of the most appalling statistical practices that have been inflicted upon hard-working practices in the past.
I am fully in favour of scorecards (as I suspect we all are) but ONLY if what is being measured is based on accurate data, fairly and properly analysed and fairly and properly presented.
However, historically, the NHS has played fast and loose with statistics - not comparing like with like; creating scorecards using incorrect or unverified data; creating rankings where like isn't being compared with like; using data for different purposes than for which they were collected (eg using QOF points - really just for payment - to create practice rankings); and making spurious assumptions about whether a set of data (say, crude referral rates) is a true proxy for 'the good doctor' (it isn't). Perhaps the worst of all is where practices are scored using criteria that they aren't fully in charge of - especially where patients are expressing a choice - such as 'the percentage of new mothers who breast-feed', or those who choose not to have their children vaccinated.
We desperately need high-quality, reliable, objective measurements of practice and personal abilities within the NHS. The problem is that they are extremely hard to come by. Any botched attempt to create them therefore merely adds to the level of suspicion in the minds of practices and clinicians.