It had been snowing heavily ,I went to work in slippers .Morning surgery went well ,patients tthought I was sensible “changing my boots into slippers”.Had to visit a 90 yr old lady.I apologised for turning up in slippers.She was very understanding “ that’s alright dear when you get to our age,these things happen .I was 55 at the time .
1)discuss with GMC and MDU and ask in writing from both what their advice is in this situation- if you are being forced to practice unsafe medicine /lower your standard of care because of lack of appropriate resources -In my view what you are being asked to do also goes against the Hippocratic Oath -in the first instance "do no harm" and in this situation the significant danger for any patient is that they feel they are going to receive an appropriate standard of care. they wont -and it isn't their fault/or the professionals if you don't have the resources-.Iam in the twilight of my professional career having been qualified for nearly 42yrs .I can remember back when the doctors in our PCG advised the PCT, at times,what we would and wouldn't do -because sometimes we were asked /told to do things that we thought were wrong -and given very little time in which to do them -I think there were about 40 gp's in our PCG -and when we all agreed not to do them the PCT backed down - for me it was and I suspect is the same in this situation -DO the right things for the right reason - discuss amongst yourselves ,agree a decision with LMC support and stick to that decision unless new information/resources become available .I have always felt that the profession via the colleges/BMA/LMC's /and local practices,at times should be advising the government what they can and cannot do professionally including safely and not always be accepting of what we are told to do. I genuinely feel for everyone in this situation -the state of the nhs is currently the worst I have experienced in my career and until there is COMPLETE honesty from all those involved in the nhs and the department of health - we will continue in a downward spiral
Lets apply this to all MP's ,all civil servants and everyone who works in the nhs -otherwise it sounds like discrimination
This philosophy is frightening - and the MDU need to be involved - To ask GP's to provide "clinical leadership " is fraught with a multitude of interpretations -as is the comment "complex cases "-and is a complex case decided before the pt is seen or retrospectively ,or retrospectively when something goes wrong ?When I see a patient I may not be taking a history or examining them all the time ,but I am aware of how they are behaving/how children are relating to their parents etc -all the time. You lose that if you "cover other people "and just write a script that someone else isn't qualified to write .The only safe cover is where you see that patient as though they were a new consultation for you .Are all the various professionals going to have the same indemnity cover ?The time that it could get really nasty is in a court of law if these points aren't addressed now.
My first day as a student someone had carved on the desk in front of me 2 lines
"Do not adjust your mind
There is a fault in reality "
My 40yrs working in the NHS have proved those words to be right on a regular basis
It gets more worrying- so far removed from reality and what would make a positive difference
MR Hunt, the Department of Health civil servants,and everyone who works in the NHS if they seriously wanted to make the NHS safer,should all read Matthew Syed's book "Black Box Thinking " and stop going down the route of closed loop thinking and cognitive dissonance,-The comparison between how the aviation industry address problems/errors and how the NHS and its management/clinicians do is stark
It isnt difficult - treat patients appropriately whatever anyone says,refer appropriately -and let hospitals make the decision whether they are seen or not .Once you stop doing what is clinically right by your patient then you are in trouble . you can always add in the letter that should the hospital fail to treat the patient appropriately the hospital /clinician in the hospital takes full medico legal responsibility for that decision
What worries me is that these people run the country -you couldnt make up the garbage that comes out of the Department of Health/NHS England -If they actually took time to reflect on how they are behaving and understood what they were saying and doing they would be incredibly embarrassed .Im not sure they have the intellect to appreciate this .
to consultant 9.59 -My first day at med school in 1969(which makes me very old ) someone had carved on my desk - "do not adjust your mind ,there is a fault in reality" - that person was a true visionary
Afternoon John (John Elder 11.43) -sorry to say you you couldnt get a job as a government adviser on anything - you have too much common sense and ability Regards John