Well said Dr Devarakonda (10.58am). A wise programme to start to give us back our professionalism which will raise some headroom to treat patients and not spend our entire lives looking for the QOF prompts on the computer.
QOF worked initially - our care of diabetics and hypertensives improved dramatically - but it has now become a box ticking exercise with targets subject to interference from the DoH/NHSE.
The QOF money really needs to be moved lock stock and barrel into the global sum equivalent.
I entirely agree on the basic practice allowance. There must be recognition of the extra responsibilities born by partners both clinically and organisationally.
We also need real funding for premises improvements backed by recurring revenue funding - £1 of revenue funding creates at least £10 of investment in capital.
Love @9.58 and @10.56 comments.
Clearly there is a veracity gap when patients tell A&E that we have no appointments/have refused to see them/they want to see a doctor in pyjamas or whatever. Would patients feel that they had a better deal if we all wore pyjamas (scrubs) instead of neat business dress?
i regret that Bruce Keogh still thinks that we are sitting around idly waiting for the pleasure of a patient turning up.
What measures will he put in place to commission enough GP services to cope with demand - or more imaginatively, what will he do with publicity and public health to reduce demand??????
Oh dear, 1.48pm, you do have a bee in your bonnet about part time working and the partnership model - and I quote "Please put and end to GP Partnership model. Make it compulsory for all GPs to work 9 clinical sessions a week which are spread over a 7 day period."
What gain do you anticipate from banning part time working? More GPs? Dream on.
What you would do is wreck the last chances of retaining senior GPs who cannot face a 9-10 session week but do still have a lot to offer to their patients. Force them into full time working and they would resign. This is not a totalitarian state in which professional people can be forced labour.
Moving on, many useful comments, such as Crown Indemnity, abolition of CQC etc in this string. But stopping the invidious erosion of income and piecemeal addition of unfunded work is the urgent necessity. And for those who favour abolition of the partnership model - would you rather have some freedoms as a partner or be employed by NHS England or a Foundation Trust? (Note to salaried doctors who resent this comment - there are many partnerships vacant around the country for good quality GPs. The opportunities are there)
Thank you anon salaried 11.43am - get in touch with me at FDA Office in Heywood - firstname.lastname@example.org finds me.
The Family Doctor Association, among others, has been steadily campaigning with NHS England to introduce Crown Indemnity for GPs. It is bizarre that our hospital colleagues are covered by this and yet, although the majority of our work is purely for the NHS, we are not.
This would be a major positive step in the enhancement of retention and recruitment.
We are already seeing poorer risk doctors being totally refused cover by the big three and having to go into the commercial market where rates are prohibitive - £30k is a starting point for worse cover. Residual MDU/MPS/MDDUS subs for the private aspects of our work such as medical examinations and certificates/reports which even the most NHS-only GP will do should be eminently affordable.
Come on, NHS E - this would be a brilliant positive thing to do for general practice and would be a terrific morale boost - we may even start to believe that you care about GPs!!!
Excuse me, Ms Sturgeon....
....health is a devolved power. You can do this in Scotland just now if you want.....
....I know some Scottish GPs who would be delighted to have extra resources for their patients....
Oops forgot. This is the political bidding war and nothing to do reality.
lah, lah lah, lah
More muddled pre-election politics.
I used to work for DHSS or whatever it was called doing Attendance and Mobility allowance examinations and later Disabity Living Allowance examinations.
There is a different skill set to routine GP - although easily acquired by a GP - and you are responsible to the commissioning authority and not to the patient when you are doing this - on several occaions I had to recommend a patient see their GP as a result of my examination.
I could not do these ethically on patients registered with me.
Next policy please......
The first comment in this string is an interesting perspective and, if anything, optimistic.
There is now a presumption of guilt on all actions of GPs from referral to diagnosis to prescribing to consulting rates to hours of availability.
Despite my fairly reasonable work ethic I am starting to find some aspects of the job just un-do-able if I wish to preserve some vestige of a work-life balance and be able to smile for the last patient of the day as much as for the first.
It is not the patients' fault that we are feeling put-upon.
Retention of experienced GPs seems unvalued by the present payment structure - seniority pay is a recognition of the value of wisdon about patient management which is gained from years of experience and not from doing an MRCGP examination.
Resourcing of practices needs addressing - I have taken a 25% pay cut in the last 3 years - this doesn't make me feel like pressing on as now....
So what are the positive things that we can do to make GP better and make it fun to work here again? I really would appreciate positive suggestions - not moans (you can do that on the Pulse blog) to email@example.com
Paul Cundy (for those who don't know him, a serious GP IT expert) is right as ever.
So is Sanjeev Juneja - this is unfunded work and we are not obliged to do it. If a majority of your CCG's practices disagree with the central edict they should call a meeting and overturn it. Most of us too busy doing the day job though...
GPs are ideally placed to.........
Oh no. Another election idea.
What would Mr Clegg like us to stop doing to allow us to play with Skippy? I think there are enough technophobe GPs who could not readily integrate this into a consultation and who would retire/emigrate/break down etc to stop this really working across the piece. Also patients could see us munching doughnuts and slurping coffee in what was the telephone consultation slot... Aaaarrrrgh!
The only consolation is that Mr Clegg is up for a job interview in May and may not get the job he has been doing for the last 5 years.
At least we have some security of tenure (and higher popularity ratings...)
going back to the comments by salaried GPs - there is room in general practice both for partners and salaried GPs. Clare Gerada is strongly advocating a salaried-only service while being a partner in a mega-practice business. I do not agree with her model of practice.
My practice has two partners and two salaried doctors. The salaried colleagues earn more per session than the partners (supply and demand market economics) yet have no personal financial investment in the practice and no ultimate responsibility as doctor-of-last-resort. They join in partnership and practice meetings and their views are valued.
There are many partnership vacancies in this town where I work and almost no applications.
If the salaried doctors who continually complain in these columns want to be partners, may I suggest they relocate to lovely Swindon, which has a good medical community and is a great place to live?
Well, we had "advanced access" under the previous government - 48 hour guarantee etc etc.
Is there any evidence it worked?
My patients hated it as they could not forward-book appointments and we abandoned it.
I suppose evidence-based policy is kind of unlikely. But is there any evidence of this political posturing winning votes? I think equally unlikely.
So stop it.
nice one Nigel.
There is an insidious pressure on younger doctors to avoid general practice, which after 30+ years I still believe to be the most interesting and satisfying speciality in medicine (give or take paperwork, over-regulation and political pressures).
Until medical schools start promoting the only general physicians for all ages (the geriatricians do a good job for the over 65s), we may be on a loser.
It makes a mockery of all the over-promising of the political parties for more doctors. Or was that a "pledge"?.......
when is screening not screening?
When it is a political imperative and not evidence based.
Can you imagine the furore - and the sky falling in on a practice - if a group of GPs decided to spend their time and effort on screening for a disease where there is a moderately subjective diagnosis, limited therapeutic options, high cost of screening and even higher cost of management WITHOUT LOOKING AT THE EVIDENCE FROM PREVIOUS SCREENING?
Only the government can get away with such unscientific practice - and they wonder why GPs get demoralised at being forced to do such unevidenced work at the expense of good care for patients - for which there is ever-decreasing time as we are all so busy doing the government's bidding.
It is one of the paradoxes of current NHS GP work that we pay our executioners. The bandings were unscientific and even relied on retired QOF indicators - which clearly we make less effort to achieve - and on QOF which is and remains voluntary.
Unscientifically, therefore, I rate the CQC as BAND 1 on its risk to the livelihoods and emotional health of GPs and their staff.
But I may withdraw that rating in due course....
Just bizarre that this out-of-control quango can raise its fees irrespective of affordability and ability to pay to fund its self-serving and high handed holier-than-thou "tough" inspection regime.
Anyone who was wise enough to attend the Pulse Live show in London last week may have been struck by the totally OTT trade stand of the CQC, with beautiful colour-coded purple perspex counter and large touchscreen (about 42") and a couple of imbedded iPads.
I asked them the cost of the stand and they "didn't know" - so I have asked them to let me know. When they aske dme why, I said that I, with my colleagues, were paying for it. Quite a contrast to the modest Family Doctor Association stand opposite - but then you choose to be a member of the FDA and it only costs you £100 a year - but you have no choice about the CQC.
Then an FOI request if they don't come clean.
In the interests of transparency, you know...
So tempting to wax "lyrical" about this, but there may be a copyright problem.
I though pharmacists normally queried directly to the GP if they were concerned about a script. This does prima facie appear to be a significant over-reaction.
We really have got to the "one in, one out" stage in what we can cope with in practice.
In isolation, no doubt this looks like a good idea.
In practice, there is no slack for us to be levered into doing this unless there is a suggestion of what we could stop doing. Agree with the first comment that this is primarily a public health issue but of course, "GPs are ideally placed to,,,,,," (those that remain, at least)
agree with anon 4.32.
If the DDRB have not had any feedback, listen up and look at the responses on this blog.
My response? The 2004 contract was in response to a crisis in general practice and delivered a substantial pay rise, mostly (contrary to GPC preference but to satisfy the Labour government of the day who would only pay extra for "quality") through QOF.
Since then, the pay has been systematically eroded. Result? A Crisis in general practice - but a bigger crisis than in 2002-4 due to all the other pressures which have been well rehearsed in colleagues' comments above.
Solution? The government needs, in the vernacular, to "get a pair" and give us back seniority and MPIG (guaranteed "in perpetuity"!!!) and stop being afraid of paying GPs properly for an incredibly complex job. Stop relying on our goodwill as we like treating our patients (it has gone, largely) and remember that, if all the GPs in an area resigned their NHS contracts and offered their services privately to patients, they would survive well, the government would have to allow patients to receive NHS prescriptions and would have to reimburse patients their costs.
What about it, folks?