I did not vote in the survey, but I would be willing to count myself in the "13%". Some of my fellow professionals therefore believe I must be a drug abuser, an "ass licker,prostitute,traitor or parasite". Someone, hiding behind the skirts of anonymity, presumes I must have "significant mental health issues". I sincerely hope this individual does not have to treat patients who genuinely suffer from mental health issues.
We may be entering the terminal phase of a concept that worked in 1949 but is totally unsustainable for the disease and demographics if the 21st century.What we need at this time is incisive debate about positive alternatives, not infantile invective.
My post actually states that we(as in GPs) prefer EBM, but having been heavily involved in a CCG trying to redesign services, I can assure you that the man(and woman) in the pub does not.
My local Trust runs an isolated maternity unit heavily criticised for an excess in perinatal and maternal deaths .The RCOG says it is not safe,but Mr & Mrs Local demand to have their babies there.Result: Trust to spend millions on new unit(which they will be unable to staff) and which will remain unsafe because the number of births per year is so low.
Until politicians have the courage to cater to the public's needs and not its wants, the man in the pub will trump EBM every time(apologies for using the T word).
Lies,dammed lies and statistics.Arcane navel gazing by academics is irrelevant (much as we would like decisions to be based on evidence ). The NHS is a public service and we are public servants. The man in the pub, whose taxes pay our salaries understands a simple concept :"If my Nan has a stroke on Sunday morning, I want her to get exactly the same care as she would do if she had the stroke on Monday "
The corollary (I'm sorry, Man-in-the-Pub, but we are clever people and will tell you what is good for you")is the sort of patronising attitude I thought we had consigned to history.
So if I claim a Capitation fee/taxpayers money for a patient with no verifiable identity or address, the Government is not going to sue me???
Nailed it @1.07. RCGP is an evidence -free zone.The money I save by not being a Member pays for my travel insurance ,which covers the payment I would have to make if I needed to see a GP in Dublin or Dortmund or Darkest Peru.
Actually it is not an evil Tory or indeed SNP plot. I am sure they would love to have a solution, and more money is not it.
The public has been assured for years that it is their right to have open-ended and free access to health care no matter how minor or inappropriate their ailment is.
Until the politicians have the courage to disabuse them of this, the unsustainable demand will rise inexorably.
We have a fact (number of Practices falling) but rather than a vacuous "evil Tory plot"knee jerk reaction, we then need an explanation of the background to that fact.
If it represents the closure of small non-viable "cottage industry" Practices, and the emergence of merged and more sustainable ones, then patients must be the beneficiaries.
We need jewels in a crown configured for the 21st century, not the 1940s.
Be careful what you wish for!Yes, the current workload is unsustainable and overwhelmingly inappropriate, but over the last 35 years I have seen huge chunks of "traditional" Family Doctor (in the days before PC made that pejorative)work taken away:ending on call duties(good),intrapartum obstetrics (probably wise),antenatal care (a sad loss).If we are now going to hand off the snotty noses to the pharmacist(vg)but also the care of the elderly at home, we are salami slicing ourselves into a valuable but high intensity role of complex problem solving of difficult patients.A valid use of our skills, but you may miss the light relief of :" just my Pill check,Doctor".
@1210:Its a "no-brainer".Trusts already have the HR and Finance structures which makes it cheap and easy for them to absorb Practices, and gain a guaranteed income.
I cannot blame Practices in distress for seeking this lifebelt, but in terms of transforming Primary Care from what it is to what it could be, it represents a cul-de-sac.
Hospital Trusts know little about General Practice and care less.
Unless GP Federations can seize the day, articulate their vision and lobby for funding, General Practice as we know it is doomed, and will implode quicker than anyone might think.
Strongly support Mayur.These announcements are but a step in the right direction but are essential to turn a 1940s cottage industry into an integrated Primary Care system delivered from 21st century purpose-built premises.
Cynicism is the easy route for idle apologists.The Government is in a deep,deep hole; an ideal time to smite them with your positive vision for the future.If you have not got one,stop whingeing, and book your ticket to NZ/Aus.
A move in the right direction to sustain integrated Primary Care in collegiate groups with 21st century premises instead of "cottage industry" small Practices in leaky Edwardian semis, but no solutions to ever-rising demand from patients.If the bath is overflowing, turn off the tap not design a better plug-hole.
Until politicians wean the public of their addiction to universal free health care we are whistling in the wind.
We must have support from government, the media and society at large to run a system that addresses patients' needs and not their wants.
When I was a GP Exec member of a CCG, this sort of arrant nonsense was the bane of my life, but NHSE has given us the ammunition for CCGs to fire at Trusts. Regrettably the problem rests not only with the managers but with our clinical colleagues, junior and senior, many of whom failed to see the imperative of communication in managing the safe handing over of their patient to a third party(us) on discharge.They seem happy to dump work on us, then demand our sympathy because they would rather not work on Saturday afternoons.
Until politicians of all persuasions have the moral courage to unite and tell patients that unfettered access to "free at the point of demand" healthcare is no longer sustainable, we will go from bad to very much worse.
Essex is just one example of where the graphs of rising demand and falling capacity have intersected:the "NHS" as a paradigm has failed.
Is this column a forum for informed debate or infantile invective?
Not seen the new tool,but benchmarking for eg antibiotics has been available for years.
As a former CCG Exec member with responsibility for Medicines Management I can assure readers that such tools are useful in identifying significant outliers.It is then possible to determine whether this prescribing pattern is appropriate (eg high prevalence of COPD)or not.
We must prescribe for patients' needs, not their wants.Education of patients may be a challenge, but the corollary (submitting to whatever they want) is a certain recipe for ever increasing workload, and a generation doomed by multi-resistant bacteria.
Where does one even begin with this???
Perhaps with the supreme arrogance of the statement that the payment reflects the funding available (and crucially, not the work involved).
As a CCG GP Exec some years ago, we were sold 111 as a "signposting service" for patients wanting Blue Badges or stair rails.When this morphed into an algorithm-driven emergency service, we predicted it would be the dysfuntional shambles it became.We were told to wind our necks in.The rest is history.
If the bath is overflowing, don't invent a better plughole (and certainly don't throw yet more money at it to make a gold-plated plughole).The answer is to turn off the tap.
We all realise that the NHS is not sustainable as a system with completely unrestricted and un-costed access. "Free at the point of delivery" will be the epitaph on the gravestone of this once noble concept.
We are now in a "death spiral" of rising demand and falling numbers of GPs. Unfortunately we are stuck in the paradigm of the public addicted to their "rights" and oblivious to their responsibilities.
Despite the "evil Tory plot" placard wavers, I very much doubt this government has the courage to carry out reforms, and we will just "muddle through" with this shambolic apologia for a health service.
"Evil Tory plot:not all patients need to be seen by a GP".
Its not a plot,its a statement of the blindingly obvious!If the cardie view is that we need to see three just to make sure that the two who don't need to see us genuinely don't need to see us, then you are simply feeding the beast.
General Practice is overwhelmed by inappropriate demand.Unless this is robustly challenged, Primary Care will collapse, and probably sooner than we think.
Contrary to the vacuous drivel of @10:07, CCGs are not run by "failed doctors".In my experience,as a GP CCG Exec, they are run by dedicated senior GPs who want to use their experience to seize the opportunity given to GPs to transform local health care on behalf of their patients.I worked with a fantastic team of GP colleagues and NHS managers.
This work attracts some GPs but not others,and I acknowledge that few may be interested in reforming the £500,000 spend in my CCG on sip feeds, but look at it another way: I am sure you could all tell me better ways to use that £500,000.
Reducing the type of procedures funded? Given that the NHS is a broken system and failed paradigm, it is inevitable that we cannot fund everything.If you have sore knees and a BMI of 50, the answer is not surgery, but a padlock on the fridge.
The inevitable consequence of "free at the point of delivery" is abuse of the system.Whilst charging for appointments is a blunt instrument, desperate times may need desperate measures.
People are not dropping dead in the streets of Dublin for want of a few euros to see their GP.
Like Dr A, I retired from 34 years full time NHS GP work 2 years ago,but am still doing clinical GP work.
There is a chilling thread running through many of the above posts: "If you disagree with us, you must be silenced".
What Dr A and I can bring to the debate is the long view.The fascination of General Practice is being able to take a longitudinal view of health and society's response to it.For instance, in 1981 when I started, Type 2 diabetes was an uncommon disease, treated by hospitals, ditto hypertension.We have also witnessed the attempts of Governments of all shades to adapt the 1949 paradigm of a National Health Service to those changes in society.Unfortunately we now seem to have reached the stage where evolution can no longer accomodate the rising elderly demographic, rising expectations from the public, and the consequences of inappropriate life-style choices,principally obesity.
If a centrally funded health service is to survive, we now need revolution not evolution.A new paradigm is required, and there are plenty of hybrid models in Europe to consider.
In the interim, however self-righteous the JDs feel, theirs is an ill-conceived politically motivated dispute.Dr Annesley's analysis is accurate.
Junior doctors: lions lead by donkeys