All for one ?
I welcome 5000 to deal with Capita and bills and pensions and former staff payments and complete madness, never mind networks and CQC and revalidation and complaints and burnout.
Come in to my parlour.
The sad part is all those aspiring GPs have no real clue as to the Tory penance initiated by Hunt that awaits them. Poor sods.
Prof Stephenson said that doctors need resilience training because Medicine is like soldiers going to war in Afghanistan.
But soldiers get tours and then rest and peace from war for some time and in times of peace for long periods. In GP land it is constant and unremitting. It is running flat out everyday. There is hardly time to rest because work spills into weekends in paperwork and reading.
Should Medicine be like going to war ? And I don't want to go to war everyday.
Jaimie All of this is pointless. We GPs accept a list based Contract. Consultations have almost trebled in 20 years. So, effectively a 1700 list was 3400 in 2000, is 10000 now.
If LMC/ BMA conferences keep voting to keep the status quo, we can hardly blame the DOH or anyone else.
If, on the other hand, we vote to provide a service based on appointments, it will soon be clear there are not enough appointments or GPs.
But, year on year we keep list sizes. If consultation per patient rise every year, it is hardly the fault of someone else.
I do understand that the major newspapers think we get paid millions for playing golf, so that is unlikely to change.
Perhaps it will take a complete collapse of medical care for the BMA to act.
Though, having done hundreds of 80 hour sleepless weekends and weeks of 1:1 cover in the past, I am not holding my breath.
When the RCGP chair states 12 hour days and 100 contacts as a problem, but no solutions, we are in difficulty.
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Lewis Carroll [ Charles Dodgson ] was a mathematician and very unlikely to be involved in this Alice's adventures with the GMC
I have seen one in 45 years
I fear it is not GPs [ again] who are uniquely placed as they are part of the system and depressed themselves.
It is the Union, the BMA, that needs to define work safety and hours. It can prevent the sort of Dr Bawa Garba situation.
If we vote for list size rather than activity payments, then workload is entirely our problem.
I cannot understand the mathematical logic when consultation/ contact rates have trebled in 15 years per patient.
We are the authors of our own misfortune.
And you want to be a partner. And this is what the GPC and RCGP are talking about as a turning point / light at the end of the tunnel.
Turn back if you can and run away from the oncoming missile
The timeline of poor Jack Adcock shows he was getting much better under Dr BG's care.
That is why he was transferred to a general ward by someone else.
Who authorized the transfer and why is this person not in court to explain the decision?
My contention would be that had Jack not been transferred from Dr BG's direct care, he would got have got his ACEI [ she had not written it up], and would not have suffered the catastrophic hypotension.
He would have continued to improve and gone home.
It was BECAUSE he left Dr BG's care that he died and not the other way around.
In any case, my opinion is this case belongs to the realms of lunacy.
Poor Jack was UNRESPONSIVE AT ADMISSION. pH near 7. in 2 hours, his pH was 7.24.
He had IMPROVED and was so WELL AT 7 PM, he was transferred from CAU to a general ward.
Yet, Dr BG is condemned as GNM for negligently disregarding decline and deterioration, when Jack actually IMPROVED remarkably UNDER HER CARE. He declined AFTER he left her care.
How the expert witness can express this opinion is beyond my logic, irrespective of all other circumstances.
In fact, I believe had Jack remained under Dr BG's care, he would not have got the ACEI, as she did not write it up and he would have got better and gone home.
I believe it is because he was TRANSFERRED from her care that he died!!!
How can a doctor be left to cover 3/4 other doctors ? How can a junior doctor be expected to cover for a senior doctor's absence ? How can they be expected to function in a normal manner in such abnormal circumstances ?
For example, Dr BG was condemned for not looking at an XR earlier.
But, she was not sitting on her hands watching TV. She was doing lumbar punctures and attending to multiple children in multiple sites she SHOULD NOT have been covering.
It is a shame on the British system and justice that a doctor is expected to do the impossible and be in multiple places at the same time.
The reward in the UK for covering 4 other doctors and doing 4 times your workload is not a Thank you, but Gross Negligence Manslaughter.
Both the BMA and GMC should define safe working, but they do not.
The GMC is quick to condemn. Why does it not define safe parameters of work?
I blame the BMA for not looking after its workforce.
Does the employer [ the Trust ] not have a duty of care to its employee, Dr BG ?
What is going on in the UK ?
Dr BG is not free. She is wrongly convicted of manslaughter. She was convicted for :
IGNORING DECLINE BEFORE TRANSFER TO A GENERAL WARD.
BUT POOR JACK DID NOT DECLINE. HE GOT BETTER. THAT WAS WHY HE WAS TRANSFERRED. BECAUSE HE IMPROVED. YET DR BG AND SR AMARO ARE CONVICTED FOR NEGLECT.
JACK WAS BETTER WHEN HE LEFT DR BG'S CARE.HE WAS BOUNCING ABOUT. HOW IS THIS NEGLECT?
This is the worst case of injustice I have come across. We cannot blame the mother. She asked the ward staff. But should she have not have known, should she not have been told that ACEI are not given in dehydration when it was started? My sympathies are with the family.
BUT, it was not Dr BG's fault that she was covering 4 other doctors. And when/ why does a junior doctor carry the can because a Consultant deems it more important to give a lecture.
In any case, he did not worry about the bloods, did he ?
TO CAP IT ALL THE PATHOLOGIST COULD NOT TELL IF IT WAS SEPSIS OR THE ACEI IN COURT. IT WAS ' BEYOND HIS EXPERISE'
Yet, Dr BG is convicted for missing septic shock when the pathologist could not differentiate.
This case is utterly horrible and a stain on British justice.
Vinci I enjoy your columns but you must have voice dictation.
By the way, this is the ' penance' imposed by Mr Hunt. You must remember he and his cronies in DM think we get paid for playing golf.
So it is better to be paid per item. That way everyone knows what we get paid for doing everything we do.
Shaba this has been brought up at BMA ARM a few times. Initially, my proposal did not make the agenda. When it did, it never got to debate. When it did get to debate it got voted down.
So really, there is no point blaming the Govt., DOH etc.
We can change the Contract. The fact that GPs are leaving is a sure sign the current Contract is rubbish.
We are our own masters to a degree. So, if we accept a capitation fee for increasing workload that is our problem.
The net result is that profit per patient has fallen 25% and take home pay today per consult is 50% of 2004.
The DOH looks after public money and they are very happy at how foolish we are.
Maybe this issue will make the ARM in Belfast this year and we will vote Yes.
The NHS is a bully. It abuses its staff, especially doctors.
Who looks after the doctors welfare. BMA.
So over to you. Do they?
Easy. Define safety in hours, contacts and consultations. Patient:Hospital beds:doctor ratios.
Time to do it BMA. Otherwise this abuse will continue. Because Medicine is such a noble vocation in itself, there will be doctors in spite of the BMA, not because if the BMA.
So sorry Lucy I was not making fun of you at all. Quite the contrary, I agree with what you say entirely.
But, the wider public view us in the way portrayed by DM and Mr Hunt [ remember his penance statement?] as fat cats. That view is widespread because we do not define what we do and how much we do it for.
If we doctors cannot/ will not define safe working there is no chance the NHS will.
I agree with you. What I would like is a definition of safety such that doctors like Richie never ever feel overwhelmed.
Prof Stephenson said we need resilience like soldiers in Afghanistan.
Surely, the practice of Medicine and General practice should not be war.
So, who should define safe working such that this tragedy of Richie is not constantly repeated ?
This is Hunt's stated penance. He wanted 5000 more to undergo his penance. I am glad there is 7000 less for his belief that we earn half a million for frequenting undulating fairways.
An unlimited Contract that abuses its Contractors deserves to fail.It is natural justice that unremitting and undeserved penance finally gets rid of those sinners deserving of penance. At least, the DM would have achieved its goal of getting rid of all those lazy GPs.
Lucy, you are seen as earning 500000 for playing golf.
So, if we are truly Independent Contractors WE [ the GPC, RCGP ] need to define safe working. No point blaming the NHS.
Unless we define workloads, what we do and what we get paid for,[ currently take home pay of 3 pounds per consultation] we will always been seen as whingeing.
Let us for clarity for both sides define what we do. This unremitting, undefined and limitless Contract leaves us wide open to complaint of not doing 'enough' even if we are working 14 hour days.
My issue is this, the fault is in ourselves that we are underlings.
But LMCs / BMA conferences without number have declined to define workloads. I know I have been there.