Really bizarre. Why would it help if my practice could offer more appointments - like those above, we have no spare capacity. Why would it help when a cardiology registrar is on strike? Could I act as a cardiologist? Why would it help when a neurosurgical Senior Registrar is on strike? Could I open a head?
The man's a delusional fool. Time to go, Jeremy. You think you can break the BMA - but remember the old American song "you can't break me I'm part of the Union" etc.
Locums used? I thought GP trainees were supposed to be supernumary?
Shocking incompetence on management of the performers list, prima facie.
I feel very sad for the young doctors whose introduction to clinical general practice is marred by bureaucratic incompetence and intransigence - but will be a useful learning point for them that this is the pattern for their future careers. Computer says no.
This is not just a significant event - it is a "never event" and should join all the lost swabs on Jeremy's whiteboard in his office at Richmond House and prompt a call from him to the medical directors and people who run the performers' lists. That'll show 'em !!!!
Flying Doctor Service anyone?
regrettably the days when guidelines were for the observance of the foolish and guidance of the wise have gone. Try to tell an NHSE disciplinary panel that you were aware of a guideline but decided not to follow it for good clinical reasons. They will suspend you or send you to the Gulag.
Is it a fight still worth fighting to preserve good quality general practice? If so, I will gladly put your points of view loudly and audibly to the powers-that-be. Contact me at firstname.lastname@example.org
Nice jumping on the bandwagon in a slow news week.
They are just so Laurel and Hardy.... "that's a NICE mess you've got me into, Stan"
Our small (5000) patient practice used to look after a 61 bed EMI nursing home and took a retainer of £7000ps for non-GMS work. It took one partner a half day a week plus at least 1-2 calls a day to be "GP informed" of a temperature which had risen to 37.1deg or someone (with COPD) who had coughed.
A change of matron meant the home became very poorly run.
The retainer came nowhere near covering our extra costs and we withdrew (with lots of notice etc) once another practice agreed to take it on. (for much much more than we were offered!)
This is real work for real patients as others have said. but it is not really funded.
The long-stay geriatric wards were certainly not ideal. But dressing them up as "nursing homes" is not either (and I speak as one whose father spent the last 5 years of his life in one).
ha ha ha ha ha ha ha ha ha ha ha ha scream!!!
Remember the "high trust low bureaucracy" 2004 contract?
ha ha ha ha ha ha ha ha ha ha
[waiting to be carried away by the men in white coats....]
Dear Anonymous practice manager - why anonymous? You have reasonable views and could stand up and be counted?
Now - I agree BPA per partner would never work in 2015 as we have a practice based not a partner based contract - and rightly so as it allows a mix of partners and salaried doctors both of whom have an unique and useful contribution.
I remember talking in 2003/4 during negotiations about the "low bureaucracy high trust contract". Yes, I can hear your laughter from whoever you are wherever you are.
I agree about the uselessness of the micromanagement, the ridiculousness of persisting with a QOF whose time has run out - it was good initially and was the only way we could get an increase in resources into practices - now just a yoke round our necks of negligeable clinical worth.
I agree about the stupid multi-claims all practice managers have to struggle with to keep the cash flowing into practices and the chasing after endless enhanced services of dubious merit to earn an honest crust - and then finding money removed from stuff we have been doing and having to earn it back and still being expected to carry on doing the unfunded work (you don't have to, by the way).
I don't agree with your character assassination of Chaand Nagpaul, who is one of the most principled leaders we have ever had and is a real tiger in private negotiations. While urbane and charming, he is most definitely not a pushover. He is very much aware of his role in representing GPs but sometimes hampered by the BMA machinery, which is often anti-GP.
The FDA (Family Doctor Association) continues to fight for the ordinary frontlline GP, often behind the scenes where the most effective work is done. We know that many GPs and practices are at breaking point. We speak truth to power without fear or favour. We are the natural home of the disaffected GP and we need you all to join (1/4 of the fees you will pay the BMA!) to strengthen our hands. Together.... etc.
All these simplistic ideas are doomed in a cash-strapped health service when we are trying to provide a universal free-at-the-point-of-use 5* Waitrose/Harrods service on a Poundland budget.
We need to return to a basic practice allowance - it costs much the same to pay all our staff and cover our basic expenses (forgotten by the partner-hating trolls who blog here) whether we have one patient in a morning or 50. This needs to be enough to cover the time taken by partners and some salaried doctors doing the scripts, letters, path results, general admin.
We then need a morbidity-sensitive formula to pay for the clinical work and extra payments for the add-ons which appeal to the present or future contractor regimes - such as smoking cessation, minor surgery and who know what in future.
Over to you, GPC!!!
lots of truth in Oliver's comments. SPEUCs are being well trained - and usually understand also the limitations of their training and when to ask for further opinions. The paramedics I have encountered recently have been excellent and I would be happy to be treated by any of them.
Big however. The depth of their training cannot be as much as a GP's. There will always be the difficult situation which is outside their expertise.
Any OOH service which lacks any GP input is cruising for a bruising legally and professionally.
Great to hear of the NHS paying for training. There are many GP registrars in hock up to their necks paying for their education as undergraduates and their examinations through the RCGP. Do these paramedics/ECPs also have to pay out of their own pockets? And who bears the indemnity costs?
I already did the change in our practice - took about 20 minutes to do.
Who gets the bill for my time?!
I would like to know how much funding per patient this practice gets and how it can legally not register those patients who are inconveniently well !
What happens to the holistic care of these patients as part of a family and a community? If husband and wife wish to register, one sick, one with only 4 LTCs, how do the GPs cope with the potential duplication of effort?
An idea not without merit, but not without risk.
For as long as tertiary care ivory tower specialists try to subvert the QOF, we will have more of this nonsense.
Resignation time, Prof Keenan - and let the GPs who actually do know how to treat and look after patients set the standards. We can read clinical trials too, you know.
I have just looked at the specification for the MCQ test. I wonder how many of us established GP principals would pass this without being told we had a development need?
Has it been tried on the crusties (GPs age 50-65)?
We'd all have to quit!!!
If list-based general practices are to flourish as the Prof Roland review suggests, with continuity of care at their core, this set of proposals is deeply dangerous.
Without knowing more detail - and I may yet stand corrected - this risks the existence of practices - which do not function on just the Global Sum but which need QOF and ES income to be able to staff themselves and pay the doctors.
This approach would only have a chance of working in a fully salaried service.
Do we want this?
Local Authorities (Social Services) and secondary care trusts would love to get their hands on our revenue streams - but would have no obligation to invest in primary care and I agree that the experience of Public Health doctors has not been universally rosy.
More pronouncements to come from the Ministry of Truth, the Ministry of Love and the Ministry of Health....
Quite Orwellian, the whole thing.
And it was a sousaphone. And did you see the expression on the face of his assistant in the video clip???
But that's my pedantry....
Anonymous | 03 August 2015 9:04am I agree with the guideline tosh - why does no-one acknowledge the complexity of our job which cannot be divided into neat guidelines. My patients are inconsiderate enough to have more than one long term condition at times. I thought David Haslam would sort this out - but the silence is deafening. Prof H - are you there?!
I do NOT support COVERT recording. OVERT recording can be useful at times.
And of course when patients are kind enough to bring a list of 5 significant complaints to a 10 minute consultation, I have nearly got to the stage of just offering the full-body MRI and measuring of serum rhubarb and smegma uranium levels. One cannot be too careful these days after all. You know what they say on the internet.
Slow down folks. All our telephone calls in and out of my practice are recorded overtly - and this is a major benefit when patients claim receptionists have been ride/unhelpful/obstructive/dragons etc (we always replay the conversation and it 99% of time finds the receptionists to be on the side of the angels and the patients to have a certain unfamiliarity with the truth.
We know that, of all the pearls of wisdom we impart in a 10 minute slot, 50% are forgotten by the time the patient leaves the room and 75% by the time they leave the building. Perhaps they will gain by listening again to our thoughts.
The corollary is that our defence organisations would love a verbatim account of consultations to help with our defence in a litigious world. It would save us loads of typing of CMA (cover my a**e) things like all the negative examination findings and explanations of risk/benefit of procedure and liberate us from our keyboards to an extent.
Big brother is already watching us. Chill folks. It's all in the best possible taste.
Anonymous | Sessional/Locum GP | 29 July 2015 5:26pm
Have we a little chip on our shoulder?
My salaried doctors earn more per session than the partners in this practice receive - with no investment in the practice and no ultimate responsibility.
No, they are not exploited.
Yes, they attend all practice meetings and have a vote and their opinions are sought.
Please stop the generalisations of stupid and ignorant negativity about partners.
To supplement my reported comments above - I do a lot of telephone consulting but the default is to ask the patient to attend for examination - and my call-in rate is 37%, rather lower than my partners' as I know most of the people who call and I have access to the lifelong medical record.
With PushDoctor - that would mean that I would advise 50% or so of callers to have a physical examination.
Guess who will be asked to do this.
No, I have not applied to be one of the 7000, despite being asked.