CCGs do seem to under a lot of pressure as they are caught between targets set by NHSE, local demand and cutbacks in community services. You can't satisfy all of the people all of the time. However the proportion of budget that goes to GP is set too low. Does co-commissioning offer a solution here to divert funds to support GPs to cope better with workload and the positive benefits this can bring eg reduced A&E referrals etc.?
Re graduated fees for healthcare - I know of no country in Western Europe that does that. Healthcare is funded out of insurance as well as taxation in countries such as Germany, but this doesn't deprive the poorest of healthcare nor does it overtax the more wealthy. In Canada in they found that charging fees to see the doctor or for prescriptions reduced appropriate healthcare for poorer and elderly patients with chronic conditions, which led to higher hospital admission rates and healthcare cost. Efficiency and healthcare cost containment is probably best achieved through collaborative innovation through all care pathways, starting with patient at the centre.
Why not clowns? At least they can cheer everyone up and play merry mayhem with bureaucracy. I don't mean the Secretary of State kind. Too sinister and powerful, like buffon.
It's a difficult issue. I have never turned away "extra" patients but I think we have to acknowledge that there is a limit for every GP beyond which mental and emotional exhaustion and depersonalisation starts to kick in. We can't keep doing more with less. However I don't want to aim my ire at individual patients but at the system which is over-burdening and failing to support GPs. For example I would advocate closing lists, if only temporarily if tha practice cannot cope with its current workload. This will send a clear message to NHSE and local CCG that all is not well and needs addressing.
As a (relatively mild) asthmatic I can't be arsed to see my GP for an asthma review. And I'm a GP - oops! There's something about asthma that makes us sufferers deny its severity or need for review until desperate. Not the GP's fault!
Glad to be retired. I certainly won't return to a system that has become so toxic due to lack of support & funding from DH. PAs are not a replacement for GPs. CQC needs to reform radically or disappear. J Hunt needs to sit with a GP throughout a whole working week to get real.
I am not surprised by this report. I reduced my sessions after 24h retirement at age 58 and quit my practice earlier than I had originally planned. More of my colleagues are following at younger ages. The London Practitioner Health Programme is struggling to cope and the London Coaching & Mentoring Service will no longer provide coaching to any post-CCT doctor. No-one cares about GPs or other post-CCT specialists now. Outrageous!
I have no problem with considering a diagnosis of dementia and referring to my local Memory Clinic those patients (and their relatives) who have a concern about their mental function. However the drive for diagnosis must come from the sufferer and not be driven by professionals with vested interests in boosting numbers to treat. You can bet there is a powerful pharmaceutical lobby in the background. How early is early diagnosis? Frankly if I start having some mild memory dysfunction the last thing I want to hear at this early stage is that I have Alzheimer's disease which my doctors can't cure!
I agree with those who have commented aabove bout both the need for better financing of General Practice as well as reducing the bureaucratic and regulatory burden. "Golden Hellos" were effective in the past but short-lived. We need a comprehensively different approach in GP now which supports a multidisciplinary team as well as valuing the practitioner-patient relationship. An uplift of capitation payments to a minimum of £130 per pt per year (then add deprivation on top) would be a good start, linked to safe and sustainable Dr-Pt ratios to provide 100 consults (including telephone etc) per 1000 pts per week which is the current demand.
I am not a heating engineer nor a social worker. So GPs investigating patients heating situation is a bizarre idea. And let's not return to stupid top-down target-led management of GP appointments. The fact is to meet current demand for appointments (face to face or telephone) requires 100 appointments per 1000 patients per week. At best a PMS contract funds 66 appointments per 1000 pts if you allow average appt time of 10 mins. Only some APMS contracts have paid sufficiently to provide more than this. In short General Practice is grossly underfunded for what we are being asked to deliver. Neither Conservatives nor Labour have addressed this.
I agree with above comment. We are under-doctored and under-staffed. If you want to meet the demand for consultations which only goes up year on year, you need smaller list sizes per GP. And don't say the work can be delegated to other health professionals. Some tasks, yes. But until other professionals take more responsibility for pt care the problems land back at the GP's door. So, currently we need no less than 1.5 GPs for every 2000 pts. Practice income to meet this needs to be at least £130 per pt. No-one will want to enter GP until this is seriously addressed.
It is actually a lot to do with money. In order to meet current patient demand for consultations you need to provide 100 consults (face to face or telephone) per 1000 pts per week. Assuming average consult length is 10 mins of GP time this needs 1.5 GPs for every 2000 pts. The income a practice would need even if run entirely by salaried GPs comes out at approx £130 per pt per annum. In my area a PMS practice gets £85 per pt and if you add QOF etc the top income is £100 per pt. So to manage where are now needs a 30% uplift. Any other suggestion is just whistling into the wind.
Let's hope it doesn't become another DOH target!
Well, it certainly is an occupational hazard, but resilience training alone won't help. We need an NHS that is kinder and more supportive of its frontline workers and a GMC that is more sensitive about the awful stress a GMC investigation puts on doctors. 'Emotional resilience' is becoming another buzzword to throw at the problem without analysing what we mean or what we would do about it.
That's top down planning for you. Simplistic ideas from DoH translating into bureaucratic waste at the coal-face. Money & time is now thrown at giving well people chronic disease labels that only increase our workload leaving us with little time & energy to deal with those who are really sick. Health promotion is everyone's business & shd not fall mostly on GPs to sort out.
GP partnerships thrived when income was high and innovation was encouraged and properly funded i.e during the fund holding era. Now we stuck with bare capitation based income that takes no account of increased workload per patient that we experience. By contrast, as a salaried GP or locum I am paid for what I do, for the hours I work . If we continue to accept contracts in GP based purely on capitation that takes no account of workload per patient then independent contracture status will cease to be viable.
The difference between this extended access at weekends and good OOH cover with patient data sharing is the ability of patients working Mon to Fri to book ahead for something important but not urgent. I suggest that such a luxury should be properly funded, if not by the tax-payer, then by those patients who want that service, for they are the ones that can afford it. I have to pay to see my dentist. Why not my GP if it's at my convenience?
Maybe if NHS staff were less stressed and not working unhealthy shift patterns they would eat better and even find time to exercise. Then again, some won't. It's a national problem - over-eating carbohydrate rich foods and lack of exercise. We are, proportionately, now the fattest nation on the planet.
Difficult to take Jeremy Hunt or any other politician seriously when they keep fuelling patient demand for services either by extending opening hours or wanting to screen and treat more, e.g. Diagnosing dementia. Patients don't benefit, GPs get exhausted; only drug companies win!
Tattoos are definitely on the increase and among younger people mostly, it seems, as a fashion statement. What I wonder about is what will all these tattoo'd folk do when it is no longer the fashion. I predict a big future for the tattoo removal industry.
It is likely that failure to support university student health will result in health expenditure and wastage elsewhere as students turn up in A&E or walk-in centres. Slashing services in one area only results in increased expenditure elsewhere. The demand for illness care doesn't just go away. Therefore failure to support these student health GPs is simply false economy. Not only that it shows a lack of caring or compassion for the students themselves and those who would more sensitively serve their health or illness needs. Another systemic failure by NHS England.