'A DH spokesperson said: 'This sample survey was carried out before we launched our world-leading plan to improve conditions in general practice'
Well, since this sample survey was carried out, my last 3 remaining partners have all resigned from the practice, leaving me as the last man standing. Thanks DH - I shall look forward to your world-leading funding making a big difference. Better make it quick though.
Above all else, the UK government is determined to control wage inflation in the public sector, which is why extra funding for general practice has been so tightly rationed compared to hospital Trusts. Historically, extra funds going into practices have resulted in increased GP partner income = wage inflation. Extra funds going into hospital departments resulting in extra staff/consultants = no wage inflation.
Clearly general practice is starved of funds and desperately needs investment, but any extra funding will initially increase GPs' income before practices will invest in extra staff or services. Historically, following investment, governments have invariably frozen funding to claw back this increase.
Unfortunately, the only long term solution that would permit consistent investment in general practice by UK governments would be a salaried service.
Our practice alone saved £7000 per year by identifying 2 patients taking trimimpramine 25mg daily. The price has increased to £200 per month. Worth looking out for.
Herpetic, not hermetic :-)
I've no issue with banning co-proxamol, but it's wrong to state that these are all unnecessary, ineffective, inappropriate or unsafe treatments. Fentanyl is an ideal choice for many patients with severe pain. Lidocaine plasters are tremendously effective for some patients' pain symptoms, for example in post-hermetic neuralgia. Liothyronine is essential for a small minority of patients who don't tolerate levothyroxine. Likewise, sildenafil simply does not suit some men, when tadalafil does.
How will the guidance deal with these necessary and justified exceptions?
This is absolutely right and should be supported 100%:"they would also introduce a GP practice workload tool to measure what is happening inside primary care... the lack of this data on workload pressures had contributed to historic underfunding and was one of the reasons GP services have lost out compared to other parts of the NHS".
The analysis of data (which should be readily extractable from clinical systems) should however be extended back at least a decade to measure the extent of underfunding over this time period. If 2017 is chosen as the benchmark, the damage has already been done.
Frankly, there is absolutely NO money in the treasury's coffers, even for absolutely basic essentials such as GP premises. And if you don't believe me, go catch the HS1 and watch a new Trident misguided missile fly into the beautifully renovated Houses of Parliament next to the Garden Bridge.
Funding for general practice needs to be linked to the total number of consultations per year, which is rising at much more than 3.2% annually.
There is still a disconnection between workload and reimbursement. A 1% uplift in funding assumes a steady state. However this figure does not come close to matching the rising number of consultations per year (and associated administrative tasks). There has been a 50% increase in such workload over the last 10 years, which has been completely unremunerated.
The problem is that when the pilots have operated in isolation they have been able to attract a pool of GPs from the surrounding regions who are willing to work weekends (for a price). If EVERYWHERE is having to provide 7 day a week access, NOWHERE is going to have a sufficient pool of willing recruits - certainly not to provide traditional OOH cover as well. This will dramatically boost the costs further.
We were subjected to 14 months of investigation by NHSE following a malicious referral - the outcome being that 'there was no evidence of poor practice and numerous examples of very good practice.
Of note, the Terms of Reference for the investigation stated that the practice was expected to be 'NICE compliant'.
Assessment of NICE compliance was a major part of this process, with investigators seizing on any supposed deviation from guidance.
In one case I was criticized for treating an 82 year old nursing home resident with a chest infection with antibiotics, as guidance supposedly recommended 'watch and wait'. In fact, the patient had been admitted with pneumonia within the last year, so my action fortunately could be shown to have complied with guidance.
In another case, I was criticized for arranging blood tests for a patient with symptoms of fatigue, as NICE guidance on the management of fatigue in adults recommends waiting a month before investigation. We pointed out that NICE guidelines on the management of chronic fatigue syndrome do not apply to an 80 year woman with a history of ovarian cancer and hypothyroidism.
I could provide several more examples of over-zealous application of NICE guidelines.
The point is that compliance with NICE guidance was obviously considered mandatory, and any deviation from the guidance was evidence to be used against the practice and individual GPs.
So thank you Professor Haslam, in the real world there is a very significant hazard to all GPs from this misapplication of NICE guidance, and I would consider that in this respect at least it significantly hinders rather than helps your colleagues.
It's not inflation that cancels it out but continuously rising workload. When consultation rates are up 25% over 5 years, there has been an effective cut in funding.
This can only be considered as an increase in funding if the increase in intensity and volume of work from year to year are ignored. In reality, the baseline workload is increasing far faster than inflation.
For sure, any new funding is going to be tied into the new 'eight days a week NHS'
Electronic tagging of young doctors is the obvious solution.
With our practice of 7500 patients, 1500 have a QRisk >10%. The workload involved in initiating, following up and amending prescriptions for statins in this group will be immense. It's possible for GPs to do this work, and the evidence says that it's worthwhile, but practices would need significant additional funding to undertake this.
Plus the effect of rising Medical Defence subscriptions - rapidly approaching £10k per annum
We are users of EMIS, and requests for insurance reports are now coming through on iGPR. This system appears to extract the entire clinical record.
The fee for this is £10, with a £10 'bonus' if provided within a deadline.
I wonder, what is the value of this information to life insurance companies?
What a waste. £10 million could pay for an advertising campaign to recruit more GPs - target these for prominent positions on the back of buses, or perhaps on the tube.