Most of the resistant organisms are nosocomial. How about the attitude of hospitals "GPs use too many antibiotics therefore we need the big-guns" toward prescribing? Then those resistant nosocomial infections end up in the community but don't actually come from it. Of course it is much easier to just blame General Practice.
I find it quite humorous that with all the "private" bashing that seems to occur everybody seems to be keen on Australia or NZ. Have you actually stopped to think that "private" is precisely what Oz and NZ have? Yes we receive some Government funding to reduce the cost of access but for the most part our primary care services are "private". There are certainly issues with Government and particularly with Ministry and their targets - usually because they are imported from the UK (along with the health bureaucrats). More recently we in NZ have adopted what is known as the "Alliance Model". Whilst many are still trying to figure out what this means and how it works, in some regions it is a collaborative effort to make things better for our communities using the resources we have available. Part charges for GP services actually IMPROVE the doctor-patient relationship by giving it a value to both the provider and the patient. All in all it is a pretty good reason to move to NZ...
The problem for Australia and New Zealand is that we don't have enough training positions to take on these young doctors and integrate them into our profession. We have to give priority to our own trainees. There is a global doctor shortage - especially with an ageing population - but Mr Hunt and the NHSE don't seem to want to acknowledge this. RIP England.
I have long argued that out-of-hours care is dependent on 3 needs: 1) the perceived need - the desire to have somebody available to attend to you should you become unwell. This person should preferably be somebody acquainted with your own health needs. The problem is that this need seldom arises and is a significant burden on your regular health provider; 2) the real need - this is the requirement to be seen in a life-or-death situation OOH - and frankly this is an emergency not a GP service and why we have emergency departments at hospitals; and 3) the need to be needed - the vain belief that somehow we stand between our patients and oblivion. The truth is that we seldom do. I hear the same heroic stories from the same people - oft repeated to justify the ongoing existence of the service. The truth is that OOH is actually about convenience and not about need. Government is simply pandering to the desire for convenience of the population to garner votes - and when it proves to be too expensive to justify its existence they will simply blame the providers. It is a global phenomenon. The problem isn't the providers, it is the public expectation and lack of consideration. Pandering to expectation only increases cost and expectation, perpetuating a cycle that is inevitably unsustainable. GG David, well played.
I best follow Godwin's Law:
"I was only following orders" was not accepted as a defence at Nuremberg and I would not expect it to be accepted by Council. Each of us needs to take full responsibility for what we do and hence if we have concerns about it then these should be voiced. This applies equally to "instructions" (because that is what they are in effect) to prescribe by hospital specialists, signing prescriptions not generated by yourself or, indeed, overseeing other providers either within or outside of your practice. If somebody has agreed to provide oversight then they should provide it and accept the responsibilities inherent in their decision. If they do not wish to do this then they simply cannot be compelled to provide it and organizations such as Council should be clear about this and provide reasonable alternatives. This applies to all those engaged in the provision of health services. Do not expect somebody else to cover your butt. And if you choose to cut corners to save money, then those who chose to cut the corners bare the responsibility. The buck has to stop somewhere - even if politicians are completely unable to accept responsibility for anything.
With respect I think you are living in cloud-cuckoo land. Continuity of care is about seeing the SAME doctor. It is about developing a relationship (the doctor-patient relationship) and consequent to that an understanding of the personal needs of the patient in terms of both their "biomedical needs" and their psychosocial context. Your method does not promote continuity, it creates fragmentation. It leads to misunderstanding and disempowerment. Frankly it is the antithesis of "patient-centred care". The doctor-patient relationship has been shown to be therapeutic in itself.
The entire issue about 7-day access is perceptual and about apparent convenience. Fundamental to this issue is that your service and the consequent doctor-patient relationship has no value. It has no value to the patient because it is free, and it has no value to you because it has become about meeting the perceived needs of the state and not the perceived needs of the patient.
7-day access will not solve any issues but it certainly will create a lot. It will require a considerable increase in the number of GPs (and they aren't there), it will create a significant increase in costs (you still need to pay staff you know), it will increase the amount of litigation - principally because of the failure of continuity of care, and it will increase the unhappiness in the profession. The next point is that there isn't even a proven need just a particular political desire to pander to the perceptions of the electorate which lack any substance.
The arguments that it will reduce the demand on secondary services and A&E have not been proven. This argument is continually repeated but the evidence that it makes a substantial and ongoing difference is lacking. You will just see the same sh*t on the weekend that you did during the week, and the people who were going to go to A&E will go there anyway. So now you have more GPs, more staff, longer hours and no improved productivity with a significant increase in cost. Your anecdotal report does not prove any point - in fact it proves the contrary to your argument: can you deliver a service for 3 quid a patient? Somehow I doubt it. From a business perspective you are cross-subsidizing on limited funds. Good luck with that.
7 day access is not about real need, it is about perceived need. It has not been shown to be necessary, but it will prove to be very expensive. Clearly you have access - as does the rest of the UK/NHS - to unlimited funds.
Dear GP Partner @23 June 11.22am
1) There is more than sufficient demand to drive the service. You do not need to create a waiting list to create demand. The demand is natural. Actually waiting lists drive down demand because patients cannot be seen when they think they need to be seen. If they are able to access affordable healthcare during the day, they are less likely to attend after-hours services or A&E. Patients, for the most part, like continuity of care too.
2) You raise the issue of affordability. Costs of care in the USA are driven by the remuneration for procedures. A 30 min extended-consult will return $70 from the insurer, a colonoscopy (also 30 min) will pay $700. What do you think happens? Procedure, procedure, procedure. This does not mean that health care is unaffordable. If a patient sees a GP 4x a year in NZ for example they will probably not spend much over $200 on GP services and prescriptions in that year - the cost of a hair-do! What is more, because the patient pays, the patient values the service provided (and expects value for the cost of the service) and the doctor values the patient (and because of competition delivers value-for-money). So everybody is happy. In NZ the State partially subsidizes the cost to reduce the patient "co-payment". This means that patients can access affordable health care with their chosen provider usually when it is convenient for them, they don't present with rubbish because it is free and they have nothing better to do (because they still have a co-payment) and the providers actually value the patients because they provide 40 - 60% of their incomes! Why you in the NHS think that your system is actually good is beyond me. Just look at all the complaints and the expectations of both the public and the profession - not to mention the media!
Anybody interested in New Zealand?
I don't know where you were working or what you were doing in Australia mark, but I can say we do "continuity of care" pretty well in the Antipodes - and from what I have read on these pages maybe even better than the NHS
NICE: Nincompoops In Control (of) Everything
Recipe for disaster here we come - and something else to blame GPs for.
QOF is about as tightly wedded to the biomedical paradigm as it is possible to be. Associating QOF with payments almost completely excluded the patient as person from care. Many of our current biomedical indicators are subject to intense debate and yet these are the things that are being used to determine "care". Despite this it has been repeatedly shown that patient-centred care (biopsychosocial model) achieves better outcomes despite a less regid adherence to the biomedical paradigm and rigid clinical targets. QOF was an attempt to control what we do without any real understanding of what it is that we do in General Practice. Clinical guidelines etc are just that: guidelines. They are an invaluable tool for assisting the provider and the patient to achieve the best outcome for the patient. QOF has failed to deliver really meaningful benefits for patients because it functions in the wrong paradigm and has diverted the real attention from the patient (as a person) to a target (which may be meaningless). I am with Mark Struthers on this: donkeys, carrots, idiots with sticks.
brilliant - but should add this:
Please do not book an appointment unless you are involved in a patient questionnaire. Any patient who is not involved in a patient questionnaire and who attempts to book an appointment will be regarded as acting aggressively and will be expelled from the practice under the aforementioned "Violent Patient" scheme
There is no "fee-for-service" component in the funding, it is population based. A DNA does not cost the system anything although it may add marginally to waiting-times. A DNA may in fact save the system money - treatments not given, referrals not sent, investigations not performed.
The problem is that the system is free to users and when something is free it has no measurable value. The patients don't really value it because it is free (and hence they resent the "over-paid" doctors) and the doctors (potentially) do not value the patients because they get paid irrespective of attendance (and may tend to value the QOF payments more - or at least the patients may see it that way). What really seems to stick in peoples craw is that somebody did not show up to see you and the implication is thus they do not value you or your service. That hurts the self-esteem.