Has the compensation/litigation culture, actively encouraged by previous governments, actually led to a safer service to patients? I am all for patients who have been harmed by negligent practice being appropriately apologised to and if necessary compensated. But this trend towards a US-like negligence culture was always going to end in tears, for patients, clinicians and the tax-payer alike.
Is this not the CCG operating as a provider?
Is this not the CCG operating as a provider?
There are risks and opportunities with any change. GPs can work with other providers and commissioners to decide their future - including a good work life balance. However they need to be pro-active and have a seat at the negotiating table otherwise yes anyone and everyone will try to sort out your problems.
Whilst I appreciate that the CQC has done good work in uncovering issues in some practices, 100 million would have been very useful in developing general practice in terms of staffing, premises, supporting new models of care etc. We need to decide what our priorities are and perhaps support CCGs to be able to undertake some of the CQCs functions in terms of assessing quality in practices?
This argument is fundamentally flawed. For NHS111 to take and triage all GP calls it would have to be huge and employ 1000s of clinicians. The computer algorithms are risk averse due to in the main the process being undertaken by lay advisors. This, together with a DOS that is totally dependant on correct information being uploaded and those services also taking referrals, means ultimately the system becomes too complex to work reliably and efficiently. Rather than centralise, the best option is to localise, so that human beings with local expertise and knowledge can triage and navigate effectively. So it is too big and making it bigger and more centralised will just exacerbate the proble. I am not against computer aided decision making nor NHS111 as a concept, but needs better implementation.
I would have loved to do chronic disease managent rather than retire completely, but not an option currently in England. In part the small practice/independant contractor model limits our ability to offer this option.
Unfortunately GPs complain of the current dire work life situation, but then reject even considering possible solutions. We are our own worst enemies!
Good article and some sensible ideas to resolve. Interesting that David Cameron has come out against spurious no win no fee claims against soldiers! Both the Government and the lawyers are to blame gor this - it is easy money if most claims are settled out of court. To improve safety and cost effectiveness we must move to a no blame system.
How do we get around individual choice and the election process?
It would be interesting to know at 5 years how many doctors who trained in the UK are still working in the UK.
Shame that GPs are always quick to criticise those trying something new and hark back to the halcyon days when all was "wonderful". The NHS (and country/government) are in a financial mess so I cannot see the billions of pounds we need coming our way any time soon. I remember doing a 1:1 on call when I was single handed, rushing out to deliver babies during a surgery, having no easy checking system for drug interactions, having to pull down the Oxford textbook of medicine to work out a diagnosis etc etc. Time moves on and so should we.
If we wish more care to happen in a community setting, then the resources have to follow. Isn't that the simple answer?
We need a model that combines the control and influence of a partnership with the improved working conditions of being salaried. It is not an either or argument but we need something new or risk General Practice falling over and the government imposing a solution. Superpractices and federated practices are already happening despite the paucity of ideas and guidance from the GPC.
I think this suggests that the quest for profits can get in the way of patient care.
Agree with anonymous above, also there are other possibilities - mergers, partnering with other organisations etc. Giving the contract back was always going to result in either tender or list dispersal - these are the only options NHSE have.
Re a salaried option, it depends on what the offer is. £120k per year, no management stress, personal lists, supported training, integrated teams etc etc? Whilst independent contractor status has served the profession well for many years, the crisis in popularity and recruitment in General Practice, the unremitting workload etc means we must start looking at options that will improve work life balance and stop GPs retiring in their droves.
I agree with the previous comment that we need to understand whay other professions are contributing to their pensions and then how their pensions are then paid. If everything is then fair and the same. I think our position is weaker. The reality is our incomes are being rebased to a lower level and we are going to have to live with this. GPs need to work together in collaborative organisations so that we can improve our work life balance and yet earn a reasonable income. Given the increase in our employer contributions it may well be time to be salaried. At least then the open ended nature of our current contract could be removed or moderated. Superannuation is taken from gross income so effectively that is what is being reduced - ie our tax bill will be reduced thus partially compensating us for the loss. It is clear the government is tightening the screws on us - we need to plan our way through this rather than just moan - though I appreciate that helps - a bit!
Maybe some of these people should actually see patients to see the effect that their advice can have on patients. This, on the back of GPPAQ and pregabalin/gabapentin etc starts to make a mockery of the advice they are giving.
I think that the Pathways designer has tried to get the software right in terms of the resulting disposition (though risk averse of course given it is lay triage) . However the resulting report to GPs has not been thought through. As a previous responder says, NHSD took years to get their reports to be anything like understandable so suspect the same with Pathways.