All the new models of care are predicated on having a GP holding the reins as the default when the rest of the system can't cope. All the pump priming money in Vanguards etc allow for back fill and then everyone else is just expected to copy the results with none of the added resources and vilified when they fail. The MCP models that are being touted as the saviour of the NHS from the US models have an expectation that the patients have some responsibility to maintain their health or they don't get the care. The insurance model refuse pre-existing conditions and patients have to pay up front. The biggest cause of personal bankruptcy and austerity in the US is medical bills! How many patients in the UK would ever get insurance because of their multiple co-morbidities. The NHS treats on needs irrespective of the causes yet we are sleep walking into the managed care organisations!
This is the tip of the iceberg! Once one practice goes under the extra stress on the surrounding practices to absorb and re-register patients will lead to more early retirements. With so few GP's willing to join partnerships the future looks bleak. NHSE needs to step up and come up with a lasting solution not more plasters on a fatal haemorrhage!
I declare an interest as I have four cousins with severe learning difficulties from birth. In 2001 I was asked by the then East Surrey PCG/PCT to help devise a health check for patients with learning disabilities. Along with Jill Rasmussen and Chris Botten we set about determining what was the best way to treat anyone with LD. I was personally fed up with being asked to 'try' a new antipsychotic to see what it would do. The GP's cradle to grave responsibility is to all patients irrespective of their status and to refer to specialists when needed. The carers of my patients knew them best and could tell me what the issues were without needing a chemical cosh! It was usually dental or constipation and relatively easy to sort as I was known to the patient unlike the random specialist who saw a different behaviour and had a drug to calm it. I watched one who flew over the Cuckoo's nest and vowed I would not treat people that way! We set up a LES which is still going and was rolled out across Surrey. There was training if need be or patients could transfer to those practices with an interest. There are ways of caring without chemicals and so long as it is adequately resourced everyone can be happy!
STP's are an oxymoron! How can you have sustainability and transformation in a negative sum game? There have to be losers to transform or the status quo is maintained. Costs go up but funding is flat and negative from the social care side so something must give. Clever accounting won't be able to hide the massive overspends planned. Trusts are already in debt and so are CCG's and the councils will not be keen to bail either out even though they are part of the problem and solution. Devo Manc will be the first big test of the new STP's and I predict there will be a health tax added to the council tax to help fund the shortfall as no-one will be brave enough to cut anything! Though today they are suggesting reducing from three hospitals to one!
Well said Nigel! Our STP is Chaired by the CEO of the local trust appointed he says by NHSE CEO, so if that is not putting the rabbit in charge of the carrots... !! No conflict of interest there then? Where are the Health and Wellbeing Boards on this why are there new boards crossing over existing boundaries and who is accountable? Is this the last throws of a terminal, publicly funded, health service before being cast to global corporations to pick over the corpse and revive it as a private service??
As a patient myself with a cholesterol of 7.7 but a Q-risk less than 10% but a terrible family history my cardiologist is recommending I take a statin but my GP colleagues don't. Whose advice would you take?? Do I wait for the first (and possibly last!) MI or do I start preventative measures now?
Like a deck of cards what is the tipping point? Once practices start struggling to recruit it makes them less attractive compounding the problem. We have a practice that has given back their contract and no-one is coming forward to take over so 5000 patients have no GP and a quick bus trip to A+E. Why do we continue to prove Einstein's theory of insanity by doing the same things expecting different outcomes. I have been a GP since 1994 and the job has changed so dramatically. I still think it is the hardest job in medicine to do well and the easiest to do badly. It can be so rewarding and positively challenging but the ever growing delusional entitlement disorder of society is sucking the enjoyment out. The lack of respect from the paymasters and the punitive contract changes to make the hamster wheel go faster will end up destroying the backbone of the NHS and we will have a US style system where good practices will only offer a private service and everyone else ends up in A+E. Sad that the powers that be ignored the rot under the waterline for so long!
Wake up people!! it is no longer about spin or targets it is about quality. What we have designed is a system based on systems not patients or as I like to call them people your mum or dad or child or relative We need to stop worrying about targets and to start challenging quality. Need to read and listen to Atul Gwande and read Clayton Christensen The innovators prescription. The answers are there just wake up to why and how we can get a first class service by using checklists and challenge why we continue making the same mistakes? ###Darwin said it was not the survival of the fittest but the ones most committed to change!!!Life is not linear and is finite how and where is determined by our maker My goal is to be shot by a jealous husband at 96!!Need to get away from the targets and understand why the problems exist and the determinants to improve the well being of the population without bankrupting the country.
It's not whether you win or lose its how you place the blame!
The NHS can only be denationalised if the unions are broken and Jeremy Hunt has repeatedly said that he cannot let the trade union of the BMA prevent him from fulfilling his mandate for a 7 day working NHS.
Once the junior doctors are discredited the consultants are next then Unite then Unison and the TUC.
This is all about the Transatlantic Trade and Investment Partnership and Brexit. Softening up the NHS for competition.
Quote from Wikipedia "British unions such as Unite and the TUC have opposed TTIP on the grounds that it would undermine the National Health Service and allows for the further privatisation of public services. A Unite spokesperson described TTIP as "about deregulation and a race to the bottom on standards. Unison has fought and won on bringing services back into the public sector. ... We cannot allow TTIP to threaten those successes."
Former Foreign Secretary David Owen said that TTIP would have a significant negative impact on the UK's National Health Service because the Service would be subject to increased competition under the TTIP regime"
Interim managers can get more than £1000 per day plus expenses and no-one bats an eye. The question needs answering why are they unfilled? Once that is resolved then determine how to incentivise anyone to take on the job. Throwing money used to work but not anymore, lifestyle and mental health is more important.
Sadly Steven Hopkins is right, Jeremy Hunt wrote his plan was to denationalise the NHS and by driving a wedge by saying he can't let a trade union prevent him achieving his mandate pledge of seven day working. The LMC conference this week will be interesting to see how far we GP's will go.
I thought we had a National contract how could such massive variation be accepted by LMC's and the GPC? I understand there are practices that do more LCS's but the basic contract should be the same?
As GP's we should have more training to be able to deal with these problems. What is needed is someone to take ultimate charge of the issue and ensure the services work. At the moment there seems to me to be a vacuum of responsibility. The schools say it is health, health says it is CAMHS and CAHMS say it is social services. The unfortunate child languishes untreated whilst the agencies dither. Prevention by education early on in schools and building pastoral care so children have some inkling to know where to access help. Mental health issues are still so stigmatised by adults it is no wonder children suffer!
AS I said yesterday this is the softening up before the Transatlantic trade and investment partnership is signed and then it will be a free for all. Obama is over to ensure we don't Brexit and scupper the deal.
I wonder what role the Transatlantic Trade and Investment Partnership has on this announcement? Softening the NHS up for de-Nationalisation?? The promised money has to come out of the acute sector as it is not new money and the Devolution that is happening will only speed the process up as the central funds dry up and the costs of health and social care rise councils will be looking outside for alternative providers.
I would agree with Robin Jackson about funding for CRP testing. When I suggested it all the usual excuses are churned out of "we don't have the budget" "that's someone else's responsibility" "don't have time" etc etc. In the 21st Century we should be using every tool available to help determine if antibiotics are needed with near patient testing. As a medical student 30years ago I did my GP placement in a rural practice where the GP did his own gram staining as the local lab was so far away. There needs to be joined up thinking about how to tackle this problem and stop passing the buck and the blame.
It is all about de-Nationalising the NHS by driving a wedge between the public and the medical profession then blaming the profession when it falls over. GP's on the whole are all self employed small businesses and so have to take into account the effect any action has on all their staff as well as their own finances. JD only lose a day or two's pay by striking. Withdrawing from providing unfunded non-core contract work and returning it to whence it came would be a start.
What a mess we have slept walked in to!! The academic GP's encourage openness, reflection and recording to aid learning and now it is being used by lawyers. What are the RCGP lawyers advising now??? The witch hunt after Shipman has destroyed the profession as everyone is guilty till proved otherwise and if it was not recorded it didn't happen. Damned if you do damned if you don't. As a trainer it is impossible to sign up a trainee unless it can be demonstrated they are improving and learning from their mistakes or educational needs. If those deficiencies can now be used in court who is going to record them?? The RCGP and GMC must advise us. My Registrar has just gone pale and asked should he review all his records?
Just need to read the Health chapter in the book Direct Democracy published in 2005 to understand the drivers for the Machiavellian approach now being taken. You can't make an omelette without breaking eggs and you can't privatise health without first killing the monolithic beast of the state run NHS. It's not whether you win or lose it is how to place the blame! The blame will be left squarely at the door of the BMA and RCGP for allowing the collapse of the NHS as will be spun by the Government. There has been resistance to change which is ideologically determined but not logical given the rapidly changing world. Dr Google is taking over with Amazon delivering your treatments. Tweaking at the edges with promised rescue packages are undinal songs luring SS NHS on to the rocks!
The special LMC conference in January concluded with a plan to canvass the profession to sign undated resignations from the NHS, what has happened to that? The feeling was so strong that the profession is in crisis, the low uptake of training places and the spin put on it confirms that yet there is such inertia!
Gongs more important??