I think a general education of the public of the success rate and possible complications of resuscitation would be useful. I think people tend to believe it’s always successful. I don’t think an arbitrary age is appropriate as there is such diversity in how fit people are at 70 and even 80. It never ceases to amaze me when I ask people about their wishes how polarised views are so I think it is important to ask. I also think certainly hospital medics tend to do fewer other treatments if the form is signed - there is often a bit of a shrug and a ‘ they’ve got a purple form’ attitude and I think that is wrong. Personally I think maybe an opt in form for anyone in a nursing or residential home might be a start and certainly no one on a palliative care register should have one.
Home visits should be reserved for those who are truly house bound or dying. I would define this as needing the assistance of more than one person to get into a car. These people need care though and I wonder if now we are heading towards super surgeries one designated GP with interest in elderly and palliative care could look after everyone in this category thus providing the continuity of care that is so essential to this group. I think GPs DNS and palliative care nurses are best placed for this. Paramedics - I’m not sure yet - their skill seems very dependant on the jobs they have previously done and I am not sure that a paramedic qualification does equip you with the required skill set. In a resource stretched setting visits due to lack of transport need to be a thing of the past although perhaps ccg’s could look into some sort of subsidised transport to surgeries for patients..
Spot on. It's ridiculously short and I certainly didn't feel prepared. I have just gone back into A and E after 15 years in general practice - it's been a great way to improve my knowledge on all sorts of things.
Good comments although I don't think Steve was patronising ...
I already work in the ED as a GP. I am fully integrated so I advise on GP type presentations and will set up a mini surgery in minors when demand is high. I also work in resus (initially terrifying!) deal with minor injuries, see majors patients and sometimes review patients on our ED ward admitted by the night team. I do 4 sessions of this and 3 of Gp as a locum locally. I love the job! It has given me some great skills to take back to general practice and helped out the ED. The new model is quite prescriptive with how they want the new service to run with GPs being on site but totally separate from the ED. They have also stipulated that we should not have access to diagnostics. This follows the L and D model. The problem is one model does not necessarily suit all hospitals. The first thing that strikes me with what is proposed is that they will have difficulty with recruitment - why would GPS want to work in this model when they could earn a lot more in the ooh service down the road? I do the job because I enjoy being part of the team. I was fed up with the grind of seeing hundreds of patients isolated in a room on my own - I am in awe of anyone who can do that full time! You may think that this job has taken me away from GP - it has not . Nothing would persuade me to do 9/10 sessions salaried or locum Gp work and I am not really interested in running a business so partnership does t appeal either. I enjoy the fact that I have instant access to investigations and that I see a different cohort of patients - definitely sicker and more likely to have significant underlying pathology. So bring on ED GPS! But let's think carefully how it is done.
Quite happy to do my bit to provide around the clock emergency care for the general public every day of the year. It's not great missing out on friends and family at weekends, on public holidays and doing late shifts gets harder as you get older but I do this because I believe I signed up for this when I took up a place at medical school. BUT am I prepared to miss even more of my family and friends for the sake of convenience so general public don't have to take time off work? NO NO NO! Can you have a routine filling on a Sunday afternoon? Have your car serviced? Have a new bathroom plumbed in? Ah - No! I suspect a lot of doctors if forced to do this would simply, like me , hang up their stethoscope at that point. In addition to this there is a whopping list of things that we should spend valuable NHS funds on before we try to do something that is simply unnecessary i.e. Improve social care. Private doctors?? Well I think people need to be encouraged to start paying for more of the 'softer' health issues i.e. ' I don't want my period to interfere with my holiday to the Caribbean ' - neither would I but it's time to start self funding for these sorts of things.
Introduce direct access to dermatology, ent, Physio, podiatry, counselling, ophthalmology. Patients can already self refer for gum, family planning and minor injuries/ ED we need to send some of the work load back to secondary care in return for accepting more of the chronic disease management.
It wouldn't be for me but good on you Kieran. It is high time we made private general practice more accessible to patients who are quite happy to pay for more 'social' consultations but currently have no idea where to go so overload the already stretched NHS with them