We only want to import well qualified and experienced doctors.
Fine if they are coming from developed countries but surely unethical if we are poaching the best doctors from under developed countries, hence the entirely justifiable aspiration to train more home-grown doctors.
Where on Earth does party politics come into this???
Send the first 10 illegible letters back to the hospital , with a note that the next 10 will go to the GMC.
Maybe that will make the idle idiots that wrote them take more care when they hand on care to a colleague .
Copperfield stand?I hope he is already saddling his charger to be the White Knight who leaps the Pond to smite The Donald and duff up The Hilary and lead Civilisation to the Sunlit Uplands.......or maybe he also has ten extras to see first.
If we raise the level of the debate from that of the Infants Playground we still need to address the dilemma of what the public has been told the NHS can do, and reality.
You can quote statisticians till the cows come home but the Man in the Pub wants an assurance that if his Nan has a stroke on Sunday,she gets the treatment that she would if it happened on Monday.No idea,Khailash ,when the NHS was "the envy of the world" but it ain't now.The public deserves to be treated with maturity and told what the NHS is realistically capable of.
EMIS can beastly be configured to print the cost of the drug on the right hand side.Might provoke some interesting conversations with patients who are effectively being taxed twice for NHS services.Before I retired, I was happy to offer patients the choice of scripts.
Obesity is a life-style choice.When I became a GP in 1981,obesity was uncommon.
Now that it is becoming almost universal when we will consider a tax not on sugar but on BMI.Why should those with a normal BMI have to subsidise the folly of the obsese?
In a service funded by tax payers, GPs certainly do not have a divine right to refer,nor do patients have a right to demand one.
Peer group review of referrals, either at Practice or CCG level, can be a valuable learning experience.None of us should be arrogant enough to presume that our way is always the right way.
Quite so.This should be a mutually supportive exercise rather than name and shame outliers, but frankly, if you are prescribing,say,five times more antibiotics than Practices with comparable demographics, you need to be able to justify this.
Prescribing should be for patients' needs not their wants, and exercises like this can support GPs in modifying their clinical practice.
Q.Do we want our referred patients to be treated in a safe,timely and effective way?
Q.Given that private providers meeting the above criteria can only charge the same tariff as NHS Trusts, is our duty of care to our patients or to a political shibboleth ?
"factually wrong to say the NHS is inefficient"??
Do you reside in a galaxy far,far away?
One of my jobs as a CCG GP Exec was to chair the weekly Quality Improvement Committee, an oxymoron if ever there was one.This dispiriting experience would review the Significant Events from Secondary Care and how they had failed to learn from them.
Given your presence on another planet if not galaxy you clearly will have failed to notice the daily toll of missing/late clinic letters,failure of discharge summaries to be presented in a timely manner, "lost to follow up", "please arrange the following tests...because we cannot be bothered to".If the NHS is not inefficient, why is PULSE reporting the actions to try and stop Secondary Care dumping on us?
At many levels, the NHS is a grossly inefficient and (see the Keogh Report)often seriously harming to patients.
The politicians did not cause the problems at Mid Staffs or Barrow in Furness, but I agree that if our clinicians had the courage to lead we might be able to salvage something from the mess.
.....except that no-one is dying in the streets of Dublin,Dortmund or Dieppe simply because they have to pay a few euros to see a GP.
Why are we so arrogant that we believe that our dysfunctional, shabby, inefficient "world class "NHS is the only model for health care?
"denationalise"....but you are a private contractor to the NHS!You have yet to be nationalised! Ditto chemists,opticians, dentists etc.
Until we start charging patients for consultations this inappropriate demand will continue.Patients are not dying in the streets of Dublin or Dortmund simply because they have to pay a few euros to see a doctor.
A blunt instrument perhaps, but squandering scarce funds on tree hugging cannot be justified.
Well done Dr Spence for having the courage to state what we all know to be true,and shame on the infantile scatological comments from colleagues that brook no opinion but their own.
Viewing General Practice with 34 years hindsight I can chart the rise in unsustainable and inappropriate demand, the biggest spike perhaps being our medicalising of unhappiness.
We may get a warm smug glow from being nice to patients, but fostering dependence helps no-one.
The pot of money, be it in St Helens or St Elsewheres is limited and will remain so.
Demand is currently unlimited.
The sky is darkening with chickens coming home to roost. Politicians and the public will have to realise that the free for all of "free at the point of delivery" is not sustainable.
Hard choices will have to be made (and not by GPs).Should we really be proposing to spend money on drugs to counter diseases caught by unsafe sex?Should we be funding arthroplasties for those with BMIs in the 40s?The list goes no, but politicians vacillate and the unrealistic expectations of the public are not corrected.
Any nationalised industry such as the NHS is bound to be plagued by the sort of "group think" drivel that Tony describes.
When will we have the courage to concede we got the paradigm wrong, and the 1949 model does not work in 2016?
If we don't, we will be condemned to attend courses on "Maritime deckchair arranging in sub polar regions".
Reassuring re your neuro anatomy, but may I adjust it by making your head swell a little (with pride) ,not that I would want to make any other part of your anatomy swell.As a veteran of 34 years 10 session weeks, your column sustained me through many a dark hour.
Incidentally, were you required to do a Two Cycle audit of your hole punching for your Annual Hole Punching Appraisal?
The fact that NHS England has to spell out what should be normal professional conduct tells you all you need to know about the shambolic dysfunctional mess that is the NHS.
Perhaps if the JDs spent more time on writing timely and accurate hand overs of care(aka Discharge summaries) rather than whingeing about their spoilt Saturday afternoons, fewer patients might be harmed.
Given that there is a per capita fee per patient ,the tax payer is surely entitled to expect that patient numbers are as accurate as possible .
The principle is therefore sound; the practicalities of funding
The workload may require further elucidation.
Not comic but very serious .If we are to turn back the tide of ever increasing demand, patients must be told(yes,told) to take responsibility for their minor ailments .The rest of the world must think we are mad to offer free access to a highly qualified clinician simply because patients can't be bothered to pay for a few tablets.
We can have a coughs and sniffles service,or a highly focussed system to detect and treat serious pathology, and if anyone suggests we should see every short-lived headache in case we miss meningitis .......welcome to Burnout City.