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A faulty production line

Craig Melrose

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

    Craig Melrose's comment 27 Jun 2018 11:17pm

    Salaried would be my preference every day of every week of every year, Anyone here saying that it wouldn't work hard because they wouldn't commit to working hard because they are not a partner is wrong. I have been in salaried roles and in partnership, my commitment to doing the right thing doesn't alter. What does change is the knowledge that I will get paid a fair wage for a fair days work, I will get the opportunity to work in a role that is defined and allows me to focus on what is important and I am not going to come home to worry about the staff, the lease, the contractual obligations.. etc....
    Young GP's don't want to be partners, they recognise that buying in to the opportunity to be legally bound to a contract that opens you and your family to financial ruin in return for the opportunity to merely earn the same wage as a salaried GP who doesn't have the same risk is a nonsense. Hang on to your partnerships and bury your heads in the sand if you like but when you pull your heads out and look around, don't be surprised to find you are the last partner standing on a contract that makes you liable for providing the service, employing the staff and servicing the loans and the lease with no one vaguely willing to take your place. why???
    The GPC have negotiated us into this position, it is right to say that this is a resourcing issue and that if partnership and the GMS contract were resourced better we would be in a different position but that is not where we are. They have incrimentaly negotiated a contract that is undeliverable as the workload is unsustainable. There would be no way that a similar expectation could be placed on a salaried worker, it would be illegal. There is also no escaping that there is no way that the NHS is going to invest in a contractual model that is impossible to manage and has proven an barrier to integration and modernisation. The only way to secure investment in Primary Care in the future is to accept radical change, become salaried consultant generalists, leading teams in the community that deliver complex integrated care to our populations.
    Look at the opportunities, don't cling on to the wreckage!

  • Pressures force GP practices to halt routine appointment bookings

    Craig Melrose's comment 30 May 2018 9:27pm

    Cant believe NHS E response is to dismiss the survey as being unrepresentative, if they think that it does not reflect reality, they are dangerously disconnected from the service they are responsible for commissioning and incredibly incompetent. If they do know that the survey is right and are trying to deny it, then they are deceitful and incredibly incompetent!Either way lots of fiddling whist Rome burns.... As for extended access evenings and weekends, who will be doing the sessions....... the same depleted workforce that cant manage to fully staff the daytime service, that is not going to solve anything.

  • BMA warns of patient impact amid another spate of GP practice closures

    Craig Melrose's comment 06 Apr 2018 10:38pm

    This is absolutely a slow motion crash, working at scale is probably the answer, lip service is paid but no tangible support for those who put themselves on the line financially, reputationally and professionally by merging and trying to build an innovative workforce that tries to meet the needs of patients with fewer GP;s as we cant get any. then CQC comes along with no concept of how much there is to merging practices whilst running a live service and without any additional financial or managerial support and tells you you are not doing it well enough. the fact there would be no service at all if you hadn't tried merging is missed and all involved feel gutted and like there is no point any more. patients will suffer through this feckless and inept system's neglect of a profession willing to work like no other and there will be no getting it back when its gone.....

  • GPs have ‘chosen’ 10-minute consultations, claims NHS England lead

    Craig Melrose's comment 25 Jan 2018 8:41pm

    Having worked in NHS management roles it is safe to say a telephone call is never less than 30 mins in the diary, most meetings are over an hour and will be followed by further meetings to follow up on the issues raised in the previous one. This does allow adequate time to deal with things and resolve them, we need to be realistic about how long things take. Clinical consultation length cant be the hours in the day divided by the open ended number of people wanting to speak to you if we expect the consultations to be effective. Lengthening the consultations may reduce the consultation rate and improve quality! We are not working in a factory on a production line with predictable work, trying to pretend we are is unhelpful.

  • ​GPs have almost twice the safe number of patient contacts a day

    Craig Melrose's comment 25 Jan 2018 8:26pm

    Jeremy Hunt rants on about wanting the safest health service in the world whilst ignoring the day in day out crisis of demand exceeding supply in every aspect of the NHS. I never imagined how many patients i would be seeing a day now when I qualified as a GP in 1999. decisions made at such a pace involve risk to patients and risk to the doctor, its a crisis every day and I don't think I want to do it much longer but if I dont and our colleagues think the same, who will?

  • Triple whammy forces 17,000-patient practice to hand back contract

    Craig Melrose's comment 13 Dec 2017 10:54pm

    pulse may like to do an FOI to see what rate is being paid for the APMS contract. it will be higher than before, then ask the question as to why the same deal couldn't have been offered to the incumbent partners.

  • Hospital in mass takeover of GP practices will soon have 70k patient list

    Craig Melrose's comment 23 Jun 2017 9:29pm

    GPC have negotiated us such a poor contract that our independent practices are no longer viable in a market where we have unlimited work and very limited supply of skilled workers. the best option for GP's as individuals is to become salaried so that you can ensure your income and loose your liabilities. imagine coming to work where someone is responsible for ensuring your workload is manageable and being sure that you will get paid a certain salary each year. mmm wonder what to do???
    larger organisations will be more successful at negotiating a viable contract for GP and if it actually costs them more to deliver services than they are given, YOU don't earn less, the trust accrues a deficit and the government miraculously pays it off. come on guys what are you waiting for!

  • GP shortages down to practices 'not delivering', says new health minister

    Craig Melrose's comment 23 Jun 2017 9:11pm

    Old adage says "keep your mouth shut and let people think you are an idiot rather than opening it and confirming you are an idiot". the ill informed naivety of her comments betrays her complete ignorance. Perhaps ask Jezza how the recruitment of 5000 more GP's is going, perhaps ask GP's how despite advertising for months on end with no applicants for GP jobs, perhaps try asking GP's who have employed other clinicians at their own expense and trained them only to still pick up all of the work they cant do and the bill for them being there, before saying we are not trying hard enough because after another 12 hour day with lunch whilst driving to visits it doesn't go down well.
    Tory mismanagement of public services through their choice to impose austerity rather than have an honest conversation with the public about what the services they promise will actually cost is a facade to exploit all of us who work in them to protect the wealthiest in society from paying their fair share of the true cost of living in our wonderful civilised country.

  • GPs, it is time to face the elephant in the room

    Craig Melrose's comment 22 Feb 2017 0:00am

    I agree with Des, the advantages of working at scale outweigh the perils of trying to cling on to small and unstable "corner shops". Continuity and quality of care come from having good operating models that ensure patients can access their preferred clinician, that the notes and care plans are clear and accessible so that when an urgent issue dictates, patients can access a primary care clinician who has access to all of that information rather than being told that there is no one available and therefore left to go to A+E or OOH. Scale allows us to work differently and develop more productive MDT working with community colleagues, with other clinicians who are also able to see patients on the front line (Nurse Practitioners, Chronic disease nurses, physiotherapists, mental health workers, pharmacists). Small units cant employ alternative clinicians or integrate effectively to change their model of working, larger single units can. We can free ourselves to be more effective as the consultant physicians in the community that we already are.
    The current contractual arrangements we have create high risks, small partnerships where care is dependent on 2-3-4 individuals, where patients' care is dependent on those individuals being fit, able, willing to continue, maintain their investment, recruit their replacements creates a massive risk to the partners' health and finances and to the population they serve, we are seeing practices fold, partners can go bankrupt, populations loose their primary care, bad for everyone.
    It is true that the lack of funding is partly to blame but Des is right in saying that higher pay would not in its self fix the problem as unless we work in a different way we will simply be paid more to endure the misery we have now so will opt to shorten the duration of the pain and do fewer days. We need both reform in the way we work and more adequate funding to solve the problems.
    Larger units do have a stronger voice. Put simply if a practice that cares for 40000 patients is threatening to fail there is no way that commissioners can ignore it and rely on being able to disperse the list. That voice is also much stronger in other commissioning forums, Primary Care has had such a small input to the STP's, this is in large part due to our desperate small units not having a single voice. Commissioners are clearly anxious about investing in primary care as they worry that any investment will disappear as profit and not lead to a tangible change in outcomes, they are also hamstrung by having to hold multiple different negotiations with multiple small providers. This leads to Primary Care being overlooked and investment passing us by in favour of secondary care where the conversation is often much easier, their pressures far easier to see due to their size and the relationships between commissioner and provider, far simpler.
    If you want what you have always got, stay small and pray the GPC can do something that they have been unable to do for the last 20 years and negotiate a GMS (General Medical Slavery) contract which works, fat chance, probably lots of tinkering round the edges as we have seen this year without addressing the open ended workload, decreasing reward, increasing risk and imminent collapse of the workforce.
    There is no option but to change. We have just merged and crated a 36000 patient practice, it's not been easy and there is a lot to do to make it work properly but we can see a future together that we could not see as 3 separate practices.