I agree with all the ideas expressed
I just find it nonsense that for years locally in Derby the coroner insisted that SRN s needed to go on a course and be certified so that they can verify death
I tried years ago to talk sensibly to a senior person in BUPA homes who would have none of it
At least I’m future we can presumably insist that a nurse can verify death or tell us there is no respiration no heart sounds and fixed dilated pupils so we can verify remotely
However, in residential homes or in the community if no HCP it is our job to go to verify ensuring we visit Or carry any urgent medical assessment first
Glad to be an OOH locum
Much less stress
Much less responsibility
Much less remuneration variability
More medicine less admin
It’s not a game of numbers
Mr Hancock rather access to appropriate
Common sense needs applying here
Nurses and nurse practitioners should not need to go on a course to be judged competent to verify death
Expected deaths in residential homes can be managed with a phone call to a HCP
For too long coroners have over reached on this
However for a death at home with no HCP present it can be very supportive of relatives for a HCP to visit and support and empathise at this sad time
Although death is familiar to us it is a huge and sad emotional experience for relatives meriting support
£60k is better than nothing and realistically nothing can compensate for the death of a loved one
Time to make GPs an entirely salaried service
Some one else’s problem if the right PPE is not
Billions of overspend written off in secondary care
GP just lose income in difficult circumstances and go bankrupt if they get overwhelmed
The partnership model is dead unless we run a truly private independent primary care system
However I guess the dentists wish they were salaried not private now ?
As a semi retired GP who worked for nearly 35 years in a very deprived practice and now work half time OOH I think total triage is a good idea. However, we tried this some years ago and it fell flat on its face as the volume of calls was too great.
More resources are needed to achieve total triage on an ongoing basis but would give fair access in relation to priority of clinical need
I can’t see the government being prepared to fund it post pandemic
Meanwhile I assume all GPs and especially partners are working very hard in these unusual times
At least this government has at last “got it” and realise the value of the NHS
Perhaps the US may “get it” except for President Trump
Basically if we are to avoid crashing secondary care many patients need assessing f2f
A and E, 111 and OOH primary care can not achieve this alone
We need hot clinics, hot visiting facilities, and seeing patients who have a cough / URTI but may or may not have Covid19 the bottom line being use/ availability of appropriate PPE
Perhaps we should remember that many people are suffering huge financial and personal losses including colleagues
It is clearly a great public service and indeed an honour for GPs to open on the two bank holidays which should be embraced willingly
Needs to be funded adequately as more exposure and risk
Will the low grade and drawn out review of clinicians by the NMC and GMC possibly be dealt with in a prompt and humane manner closing spurious and dubious complaints and alleged whistle blowing but suspiciously malicious colleague referrals or are they going to bumble on with the major stress to clinicians
I know of a colleague who is more fearful of the NMC than Corona virus as he has a protracted investigation by the NMC which has gone on over a year without any interim restrictions on his practice
Not sure how the GMC compares but I suggest all these should be dealt with and concluded promptly !!!
Hard to see how things can improve without more GPs
The number of consultants seems to increase steadily but not GPs
This imbalance must change or the only way is (melt)down
After 42 years of practice I still enjoy seeing and often helping patients with hopefully kindness, patience and skill
The problem in primary care is that it is potentially unlimited work causing stress and tension and being unfair to patients and clinicians
The best way forward in my view is for all GPs to be salaried and to work to the BMA contract with 20 minute appointments
Gate keeping by way of charges are necessary let the managers and NHSE promote this idea
If you have to be paid 20k to agree to being a GP partner that says it all !??
Maybe the government needs to pay GPs more for the time being instead of less - (either by grinding down pay, making GPs work longer hours, increasing stress with CQC meetings of limited value etc, removing money from pensions by increasing contributions and capping them etc)
The removal of seniority pay is a clear trigger for senior GPs to leave as they are not rewarded for their experience.
The laws of economics would work to tide the country over until enough doctors are trained.
Flexible working, salaried well paid service, support, paid training and less ‘extended hours’ would all help.
I think GPs rather like marathon runners hit ‘ the wall’ and become worn out and dejected but this could be reversed
All is not lost, just the political will to act
A sad situation caused by lack of the 5 Ps by governments
I am ashamed to be British
An excellent summary
Now about 111?
Thank the Good Lord Boris J did not take up medicine !
An excellent evidence based article ( or maybe not)
The Carr Hill formula and greater numbers of establishment / medico politically involved GPs in leafy suburbs ensure funding for practices in deprived areas is grossly inadequate and remains so !!
After 34.5 years working in the second most deprived area of a city I remain frustrated by this unethical situation
I now work as a half time Locum OOH
Doctors would flock to and work hard for and with deprived populations but the pay is less, workload more, recruitment stymied by cash and all this is hard to cope with
Please let’s have genuine fairer funding and more support staff and allied clinicians poorer areas
Let’s deal with this equitably and honestly
The rules quite simply need changing
Is this a surprise to politicians?
You reap what you sow