Takes time to write up
Less likelihood of clinical errors
Continuity of care is clinically effective and cost effective. In a 10 minute consultation time is saved by asking how did you get on with that treatment rather than the patient having to give their history again, irrespective of how good the notes are, which also takes time.
There is likelihood of clinical errors, or misunderstandings, and as a result , less potential for complaints. If things do go wrong they are more likely to be forgiving, and more likely to accept that shit happens. Trust is built up over time and should never be taken for granted.
It does not necessarily have to Dr A every time. Dr B, or possibly Dr C will be quite acceptable. It is when it isDr X, Y or Z that patients lose confidence, investigations are repeated and bucks get passed, increasing costs. It certainly does not have to be a return to a 24/7/365 contract. Patients understand they cannot see their own GP out of hours ( and that includes a 7 day service).
If we were then to get rid of CQC, appraisals, revalidation, micromanagement and revamp totally the GMC, then full time working would be manageable and even enjoyable. Tough, but still manageable .
It is naive to think than when a serious clinical incident occurs, there will be any publicity at all.
GP at Hand is an excellent service for the great majority of patients. In fact , it is excellent for everyone except those who are ill.
That is one appointment for each GP per year !
26% of consultations are avoidable. 60- 80% do not need face to face consultations.
It is easy to look at things retrospectively and make these statements. Unfortunately,you cannot tell in advance which are the 26%. I can say with 100% accuracy what last weekend`s football scores were, but it does not help with predicting this weekend!
I am over 65 and have frequent falls. I suppose that puts me “at risk.” Perhaps I should stop playing football!
Excellent article. The danger is that too many will not get past stage 3 in the future. Good practice does not really start until stage 4
We produced Premier League performance on non league budget, playing with 10 players ( sometimes 9), every week for 34 years.
(I was Norman Hunter)
Weston Super Mare
I'm an older person. I fall quite often but have absolutely no intention of stopping playing football.
The trouble is that the cases you mention cannot be measured and are , therefore, deemed to be of no value by NHSE, DH, GMC and CQC. They are clearly , of great value to the patients, but they don't count in the eyes of NHSE etc. I mean, you're not even following a protocol, so the CQC won't be impressed.,
Yea, we know all that. What are you going to do about it? If nothing changes , you`ve got to resign !
Just because a colleague suffers with depression does not mean he or she is not fit to practice. It does not necessarily mean that they are a danger to patients. I think you have to have very good grounds for thinking they are a danger before referring them to the GMC , knowing how unsympathetic they are. If you were to make that situation worse, and heaven forbid, the colleague was to injure himself or commit suicide then the defence of "only doing my duty" may be acceptable in law . I am not a natural GMC referrer ( my only contact with them is to pay my subscription ever year) but if a colleague reported a depressed GP, without very good evidence that he was a danger to patients, I may be tempted to make an exception, on the basis that was causing undue stress to an already depressed patient.
Look. I think we should recognise that our secondary care colleagues still do a good job. Years ago if you referred a patient with say abdominal pain or anaemia or anything you wish to think of , they would come back with a diagnosis and a management plan and be followed up before being passed back to us for ongoing care. They were the experts and we were the all rounders.
Now patients are passed back to us, having had a number of tests which have not revealed a diagnosis , but the patient is still suffering from the original symptoms with which they presented. Our secondary care colleagues are often now technicians rather than physicians, and we are now the experts! We should , however, still value the support they give us!
I think patients do value what we do, perhaps too much, as the weight of responsibility is sometimes too heavy. We should not be afraid of informing ignorant members of the public, mainly politicians and the media, of the reality of medical practice in the UK, and what incredible value we are, before it is lost. It is probably too late.
Cameron - you admit lack of investment in general practice. So what are you going to do about it?
Incidentally, in 2004 we gave up £ 6000 to give up OOH. There are 6000 OOH hours in a year. So we were responsible for a 24/7/365 service for £1/ hr! That's what I call a disastrous contract!
Ivan- as you say it comes at a price. What do we do if the government are not to pay that price? We can see that they don't want to pay the junior doctors an enhanced rate for working unsociable hours, but that is what our staff will expect, as , indeed, we will. Where lies the default if a slot can't be filled or someone goes off sick at short notice? With the partners who may have already worked a 60 hr week? Even if, in the very unlikely event of it being funded properly, can we trust the government to maintain that level of funding? Or are so many practices going to be involved in this that it is like an OOH cooperative in which case it would be better to fund an OOH provider to offer routine appointments ?
Rachel and the partners are as one on this issue. Sarcastic remarks about her value to the practice are unhelpful. As it happens, she is the best of the ANPs and we won't lose her!
The main issue is that if PAs, ANPs, paramedics and others are brought in to primary care, and riskier ways of practice (telemedicine , Skype, etc) increase then clinical risk increases, but partners cannot bear the full cost as it will , no doubt, increase year on year, at the same time as having a pay cut for 8 successive years, with more cuts to come.
WE HAVE TO RECOGNIZE WHO THE ENEMY ARE AND STICK TOGETHER
It doesn't help to take a pot shot at one another, an d yeah, I know I'm taking a pot shot at you.
You can only spend the same pound once. My view as a citizen ( I think I still am a citizen, although as a GP I often feel I am subject to a Soviet style bureaucracy, and , as such, not entitled to have an individual view), is that the highest priority in any health system should be given to the patients with the highest clinical need- cancer, heart disease, mental health, diabetes or whatever.
What I would like to see is the discussion between the businessman who is reluctant to take time off work to consult his GP, explaining to the cancer patient, that it is very important that he can consult his GP, although it may be for a relatively minor matter, at a time of his convenience, and hence that priority in funding should be given to him, and people like him, rather than to the cancer patient, who may as a consequence die.
As GPs we deal with mental health pretty effectively.The overwhelming majority of mental health cases are managed by GPs. Contrary to what many in the tabloid press and government believe we do not resort to pills at the drop of a hat. Thankfully most patients do get better, and many others are treated reasonably successfully in that they are able to manage their lives, and contribute to society and see that contribution that they make which helps. Virtually all anxiety, moderate and even severe depression ,social phobia, obsessive sand even stable ( and sometimes not so stable psychotics) are managed by GPS.
However psychiatry is a unique speciality. If we we have a patient with a cardiac problem in whom we want an opinion better than which we offer ,then we refer to a cardiologist. It is the same in all specialities except in psychiatry they are nearly always seen by someone with less expertise than ourselves. It is virtually impossible to get a patient to see a psychiatrist unless they are psychotic. Mental health nurses are good but they are not as good as GPs