I direct people to the numbers needed to treat website - thennt.org - and let them make their own decision. The problem is the Stalinist (collectivist rather than individual) approach to medical care that current medicine seems to demand. I think of the current approach to AF detection and treatment which is much in vogue (to the benefit of big pharma). Please don't get me wrong. There are those with AF who will benefit from anti-coagulation. But do we really involve patients in the decision making process to start it? Do we really treat people as individuals?
This is what happens when a tertiary care surgical specialist with particularly strong political affiliations (and now wearing ermine as a result) is given a remit to decide what should happen in primary care. My feelings about this are particularly strong as our practice is rural enough never to have had the benefit of a hub in the first place. But the Darzi legacy still lingers and the comments above all identify the gross inefficiencies in delivery of health care when it is fragmented in this way. I suspect that the position now would be considerably different if the money had been put where it should have been put in the first place - General Practice.
Well said Kamal. As usual the devil will be in the detail.
As always causes are multifactorial and depend on the definition of 'success'.
First, the continuous erosion of patients being required to take responsibility for their own welfare.
Second, The loss of the 'Jade Goody effect'.
Third, the overwhelming workload in GP which has to lead to prioritising what we do - and national screening programmes do not feature highly.
Fourth, and as indicated by other commentators above, professional realism about the success of the programme. Yes, if you measure success in terms of percentage of women screened, then the programme is failing. But, if you measure it in terms of mortality, then there is little to indicated that the scheme does any good at all. And then there are the downsides (unnecessary interventions, cervical incompetence etc) which are always played down in all screening programmes.
The CQC chairman said that 'the majority of services really appreciate feedback'. It's a pity this destructive and disastrous organisation doesn't take heed of its own advice in this regard. It is notoriously unreceptive of any sort of feedback.
NHSE knows this to be a lie. General Practice works to what is effectively a block contract so DNAs in GP cost the NHS nothing. The £216million makes a good headline for the Daily Mail but I know of few GPs who do not treasure their DNAs.
Ivan - I suspect that 'affective care' is a typo. But it seems most apposite here. My affect certainly needs some care on many working days.
This is absolutely typical of the woolly thinking and policy making to which we are subject. For goodness sake NHSE grow a backbone and simply blacklist all items that are readily available OTC. I really do not believe it when people say they cannot afford 32p for a pack of Paracetamol. The benefit of this also is that it encourages self-management of problems that all too readily present to primary care.
It's the 25% online booking of appointments that I don't understand (apart from MH's dogged enthusiasm for all things digital). We know that patients request Gp appointments for the most ridiculous of reasons and our receptionists are very able at filtering these out so that our time may be devoted to conditions that require our attention. This filter is automatically removed with an online booking system. So we will get the paradoxical situation where the ease of gaining an appointment actually makes it harder to see a GP in the long run.
You were lucky to get an ambulance. The last ? sepsis patient (and remember, sepsis a microbiological diagnosis, not a clinical one - the best we can do is 'suspected sepsis') I had in the surgery had a three hour wait for the ambulance to arrive. Presumably the ambulance service was mopping up all those 999 calls for ingrowing toenails.
Please read my comment on the Pulse investigation article highlighted in this column
Am I the only person in the universe who attributes the deterioration in ambulance response times to the introduction of NHS 111? This pernicious system has algorithms which seem to fail across the board. On the whole, they are so risk averse that 999 ambulances are dispatched even when the patient specifically states that this is unnecessary. More dangerously, they miss serious disease. And it is not as if NHS 111 is cheap. A recent BMJ article costed the service at £12-13 per call. Would that such resource been put into primary care.
And yet NHS 111 seems to be above criticism. When we express concerns about individual cases we are fobbed off with a corporate speak response to the effect that the algorithms directed the patient appropriately. NHS 111 does not need re-configuring, it needs to be abandoned.
Reading this article made me feel ashamed. I am so outspoken about the CQC that I am banned from the practice when we have visits rather than risk harvesting a poor report. Some people are braver than I am.
What really gets under my toenails is that all these interfering busybodies no doubt aim to practise evidence-based medicine. And yet they fly in the face of all evidence regarding their activities. There is a wealth of evidence demonstrating the negative impact that CQC inspection has on practices. The only evidence that this dire organisation can produce for the benefit of its inspections is its own. Hardly an unbiased source of data.
Is it too late all to stand together, say enough is enough and refuse to be inspected? If the GMC banned us all from practising for 2/12 the NHS would be on it's knees in days.
One is reminded of the Duke of Plaza Toro in 'The Mikado' - 'He led his soldiers from behind, he found it less exciting'
The other great stoker of demand is NHS 111 whose protocols seem unsuited to any clinical situation. Either they are so risk-averse that medical attention is deemed necessary for the most trivial of complaints or, more worryingly, barn door complaints needing urgent hospital admission are referred for GP attention in the next 24 hours. That NHS England is hoping to have 30% of GP appointments made by NHS 111 by April 2019 is extremely worrying.
I have to confess that active signposting has helped reduce doctor workload in our practice (although the receptionists are working harder than ever to achieve this). It's just a pity that NHS 111 hasn't been included in the drive to free up GP time. The direct appointments made by this service hark back to the days when every spot had to be seen by a doctor to confirm that it wasn't an MM or meningococcal septicaemia. It is vital that the plan to have NHS 111 make a third of all appointments by April 2019 is scrapped.
Be careful what you wish for Mr. Hancock. Surely the events at the Jefferies practice should be enough to make an intelligent person have second thoughts. You wish routine General Practice to implode? Here's one way to ensure that it happens. Mr. Hancock, you may regret this happening on your watch as Minister.
I find that discussing NNT and NNH with patients (after all, shared decision making is the current vogue in GP) dissuades many patients from taking meds of limited or dubious value. If you haven't time to do this in 10 minutes, get the patient to Google it for themselves before coming to a decision.
Easy. Link it to child benefit. Have the vaccine, get the benefit. Refuse the vaccine (so parental choice allowed, no benefit.
This reminds me of the eminent professor of paediatrics in the 1980s who solemnly announced in the BMJ that all children with a temperature exceeding 39C should be routinely admitted for a lumbar puncture. As we all know at the sharp end, this would reduce the hospitals to chaos in about 48 hours flat. If we are to have guidelines (?tramlines) they surely have to be developed by people who actually know what they are talking about, not by some academics in their ivory towers.