Just your average GP
Has this guidance just cut off our arms right before we go into battle. This would cut our team by half. Are we to send home half our staff for 12 weeks. I’m looking for clarification from the local health board. What are other GPs doing.
Hi curious, I didn’t work in Australia as a GP but I did spend 4 months there. A&E was better staffed but I’ll admit I don’t have a good insight into the GP workings for there. Where I was it was generally copay and it didn’t seem to deter folk from what I could see but I was staying in a nicer part of Melbourne.
I’ve worked in healthcare settings as a gp where it has been both free and also where it costs. New Zealand was one and had a charge similar to 15 pound to see your GP. It was free for children under 12, reduced cost for those between age 12-18 and also those for lower incomes. We had a set government allocation where we could also give 4 free appointments that year to any individual. This would usually be a new diabetic or new hypertension with the goal to investigate and get these conditions under control thereafter diabetes patients had a free twice yearly reviews and similarly with a few other conditions. People often self triaged to the pharmacy or our in house physiotherapist.
Home visits cost more about 35 pound. I covered a very large geographic area and to put things in context outside of the weekly visit to the nursing home I did 6 home visits in 6 months, I can often do that in a day over here as people do not value this service appropriately. Any delays in healthcare over there that I saw came more from the secondary care side of things e.g. 18 months for a knee replacement 8 weeks for a ct scan. New Zealand has a longer life expectancy than the UK and this despite very skewed figures within the Maori population which has been a challenging area to improve healthcare outcomes on.
I also had 15 minute appointments with patients. I saw 2/3rds of the normal here and had very few phone calls compared to here. I’m originally Irish and think the charge of 50 euro over in Ireland for about half the population is counter productive and almost definitely changes the relationship. But I did not find that the case in New Zealand with a similar charge of 15 pound. In fact I found it the opposite patients often engaged better with lifestyle advice when given more time to explain it etc. They would often choose this path also as medication was 5 dollars (2.50) for each item for a 3 month supply, so if something was free and could achieve better or similar outcomes e.g back exercises for back pain, weight loss for urinary stress incontinance they would often be more encouraged to take that route.
To date I have found it the best system I have worked in and I looked after a slightly bigger and very much geographically spread out population. I could easily work 5 days there but over here the intensity after 3 days one is pretty broken (and we even covered OOH’s there but with nurses doing the visits and us being available via phone, I would come in for the occasional difficult case). It was not all perfect as people due to the government accident insurance system would falsify there history to have a free appointment stating something was an accident when it wasn’t but this was pretty rare overall. We have one of the lowest doctor to patient ratio’s in the oecd I.e 2.8 per 1000 people compared to the average of 3.5 per 1000. We really do need an economic solution to this as it is breaking general practice. If supply of GPs can be markedly increased than okay. However, we were promised 5000 GPs extra in England 5 years ago and we are actually down 1000 FTE compared to then when the original pledge was made. So realistically I do not see this forthcoming. The waits and queues will likely get longer.
The only way to reduce them is to use allied health professionals however even finding people to hire for this has been difficult and lots leave as the find the undifferentiated presentations of general practice very challenging and boxing people into just see the mental health nurse leaves out the holistic approach e.g maybe their depression is secondary to their poorly treated copd and fatigue and by not addressing both at the one consult we are doing a disservice to our patients. Just my 2 bits
I hate that any of this gets reported as a rise. It really just matched inflation so we are just standing still and the increased pension charges are a pay cut but hard to explain that to the average man on the street.
This is pretty disgraceful. But not surprising - one less carrot and one more stick.
You're definitely not alone in your thinking Johnathon. I'm moving form a salaried health board setup with ANPs, Specialist physios and MHN's. Fewer GPs means more oncalls, patients always triaged, so most things you see are complex, more admin as other practitioners do less of it. You end up missing the little bright moments in the day when you see a smiling kid with a rash etc. Pharmacist though have been a great addition as definitely help with the admin burden. Nurses etc all have a role and are valuable but I've had times being the only GP for 9600 patients and whilst its nice having the support of the other professionals the numbers don't quite match up. So I'm afraid it's off to practice in a more run of the mill setup where the numbers are a bit more favourable. It was educational though to see it, I won't rule out the new models of care but definitely doesn't stack up to a well run partnership in my opinion.
Having worked in NZ a co pay system along with some capitation is the only real way to manage workload. Along with provision for those with chronic conditions e.g 4-6 free visits per year etc. If they bring this in you might find a lot of the issues of recruitment and retention improve, health budgets become easier to manage etc. I'm pretty sure for example that weekly visits of some of our patients has not improved health outcomes and is probably a poor use of resource.
The audit was actually quite a good read, definitely open to subjective bias but I liked the breakdown for each of the specialties and what common themes/improvements could be made.Pretty soft data but a report I think if folk read any jobbing physician might take something away from it.