As socrates says, this all seems to be entirely missing the point - delayed, cancelled, re-appointed, then letter sent to wrong address or after the date of the appointment, so patient misses appointment and needs re-referral, is all an entirely normal pattern for referrals at the moment. I have a patient who missed an appointment in August for reasons that I completely believe are down to the hospital and not to him; re-booked appointment is in March, despite my letters to explain and try to expedite. I made an urgent referral to the Mental Health Team a couple of weeks ago, patient has heard nothing, so I ask staff to chase up; message comes back yesterday to say there are no urgent appointments, so referral has been downgraded to routine. No advice to or discussion with me about this. If she dies by suicide, will it be my fault?
This is so sad, and so unreasonable - and so not understanding of how locum GPs work.
There are days when I do absolutely nothing connected to being a doctor. And there are days when I am at work seeing patients as a locum. And there are days when I do CPD, arrange work, write invoices, and more.
Just over the last couple of days that I have been "off", I have emailed the Appraisals Team about issues with my last appraisal, spoken with a PM about a complaint, and done this month's invoices and pension forms. Would none of these count as "ancillary" activities? Or would the date stamps on my emails help? I don't know, but think this should be clarified. Maybe we all need to email someone about work every day of the year, just so we're covered?
What a lovely, balanced article, Shaba. I think the title sums up the issue - there are lots of patients and politicians who think they value home visits, but not enough to pay (directly or via taxation) what they actually cost. And the under-valuing is probably what causes a lot of GP frustration about visits: patients expect us to visit when they manage to get, albeit with some effort, to the hairdresser. I think some patients do have the attitude of "well, you're the one with the car" - I actually had someone ask me to collect a prescription for them for exactly this reason last week.
Home visiting is a service that does have a value, and a future, for patients and doctors, I think; but it needs to be better funded, clinically safer, and more responsibly and efficiently used. Which is why I was happy to see this issue on the agenda last week (as a member of the Conference Agenda Committee) and spoke in favour of the motion. However, if General Practice continues to feel the financial squeeze, we continue to dash out to visits with a 2 page print out whilst inhaling lunch, and patients continue to request visits because their walking isn't so good and they haven't got the cash to hand for a taxi - then I'm not so sure about it having a future.
What is this “NHS database” from which pharmacies will access medication information? If this means “the spine”, what about those who have not consented to records upload to this?
Jaimie, you are correct that workload "dump" from secondary care continues. Appointments for sick notes that apparently secondary care said had to be done by the GP or could only do for 2 weeks, requests from super-specialists to refer to another super-specialist within the same specialty, and weeks to months of waits for clinic letters continue. And on top of this are all the appointments along the lines of "my hospital appointment isn't for 5 months and I can't possibly wait till then" - the irony of the effect of this on access to GP appointments doesn't seem immediately apparent to many. This latter type of appointment is a daily occurrence (at least).
Many of these issues are down to resourcing. Some are down to ignorance of the correct processes. Overall, the workload in primary care due to work not being done in secondary care but that should be done there appears to be increasing.
“At the moment, the highest earning members of the NHS Pension Scheme pay at least 14.5% in contributions...” And locums. Locums who work one day a year pay at this rate. I await the “consultation” on annualisation...
From ongoing experience of Capita’s management of pensions - this doesn’t feel like news.
'We are also working closely with CCGs and industry groups to help educate locums and GPs on the correct processes, to reduce the number of unallocated payments made.' - Really? I have seen no evidence of this. The fact that they don’t even seem to understand that locums ARE GPs (a mistake repeated earlier in the article by Pulse), says it all about their approach.
Helpful article. Explaining the difference between a screening and a symptomatic FIT is going to be a communication challenge; I have lost count of the number of patients who have answered "how are your bowels?" with "they're fine because I have just done that screening sample test and it was ok".
I think the introductory vignette neatly illustrates the difference between primary care and secondary care doctors: presented with a patient with a relatively short history of loose stool very clearly associated with the initiation of metformin, I don't think I would immediately reach for any tests at all. If there were no red flags in the history, I would suggest reducing the dose and reviewing in about a month, with a view to slower titration - or investigation if symptoms continued / worsened / new features developed. Which is why GPs are relatively cost effective!
I feel like I must be missing something as this sounds rather like reinventing the wheel to me. I'm not saying this always happens, but asthma and COPD patients should already have this treatment to hand and know how to use it. Adding further prescriptions sounds like adding further confusion to me - "When do I use the "emergency pack" and when do I use my "normal" blue inhaler, doctor?" And I can just see some patients saying the "emergency pack" works better because it is packaged as "special"! Further, surely this pack would incur 2 prescription charges; I can't see many people who pay shelling out if they already have other equivalent prescriptions.
This article leaves me wanting to know more - what did they do, what did they say to patients, what other services were provided, in the apparently amazing pilot in Bury? But I am mostly cynical - the issues behind this "problem" are often really not for general practice, or even the NHS, to solve - education, housing, social care, employment... It shouldn't be for us to be "training" to deal with all these complex background issues.
It sounds like this will apply to all NHS Pension Scheme members but Pulse have headlined it to be about GPs rather than all doctors / NHS staff to get our attention.
But this doesn't change my view that this is disgraceful - another potential "innocence tax". At least you might get Legal Aid if you had no pension income... although one might envisage the twisted system denying you Legal Aid because your income is too great, then subsequently withdrawing this income...
To say that the “BMA previously had no formal policy on expenses” just isn’t true. There may well not be a formal policy on expenses for spouses, but I have had various involvements with the BMA over 15 years, and have always claimed expenses in line with clear organisation policy. I also recollect that there is wording in the expenses guidance for the Annual Representative Meeting that says that attendees cannot claim hotel double occupancy expenses for a partner who is not a member of the Representative Body.
I’m not saying not to call out the BMA if questionable things have been going on, Pulse, but the quote I use above overblows the situation and weakens the criticism.
Pension problems taking up inordinate amounts of GP time due to Capita incompetence are not really news these days... even when their website says that they have had some technical issues but these have not affected pension forms, they are emailing me saying that they have not received my... pension forms.
I have been saying for months that I am less than positive about this; it seems obvious that funding it properly would cost too much for our paymasters. I am pretty stunned at all the GPs who have ridden off on the unicorn offered by the MDU.
Such a good point - we don’t think about the heartlifters enough. My only criticism of this piece would be that it spent 3/4 of its length describing causes of heartsink, which I am sure many GPs will identify with to the point of rising irritation on reading... More of a counterbalance of stories of heartlift would have been balm for the worn GP.
So, here are some types of patients who cheer me:
The 7 year old who delights in a sticker for being a good boy and high fives you on the way out.
The older lady who thanks you and says she came to see you as her “granddaughter said you were lovely, and she was right!”
The person who doesn’t just not mind your late running, but says you are worth waiting for.
And those with whom you have genuine top banter.
I look forward to my heart being lifted at work tomorrow!
I think "noctor" is definitely a conceptualisation rather than a way of referring to a colleague! Not a word I would use, but describes an idea I do think - perfectly described by the comment in the piece about "... practices utilising ANPs as a kind of cut-price salaried GP, seeing unfiltered patients without appropriate supervision."
I work as a locum, so almost by definition in practices that are struggling a bit to a lot, and I regularly see nurse practitioners working in ways that leave me feeling that I would be terrified if I were the GP nominally supervising them. My experience is of nurse practitioners who look to be under pressure to cope beyond what is appropriate for them, with over-investigating and over-prescribing common. Patients end up seeing me after 3-4 appointments with the nurse practitioner, when, unsurprisingly to me, the prescription hasn't worked, and the panoply of tests, that I wouldn't have requested, are slightly squiffy. I then have to start again, which doesn't seem great use of resources.
Don't get me wrong, in a well supported and well staffed practice, nurse practitioners seem to find their niche, and really add to the service - but this is too often not the case, and this isn't fair on them or patients, or good use of precious NHS resources.
Quite aside from the need to make the "basics" work properly first, and the effect on how doctors communicate - what about the effect on how patients communicate? How would this system be explained to them? I can't begin to imagine how some patients might try to manipulate this - and equally how some patients might withhold information as they perceived "big brother" was listening. Lots of things to consider before any implementation methinks.
Looks like there have been a few slip-ups with setting this up; I indicated I was a locum, but still got a lot of questions about "your practice" that I had to click "don't know" to. At the end there is a question about reading Pulse in print, and even if you say you don't read in print, you have to say where you get your print copy in the next question. Further, as a locum, I indicated the CCG I am currently mostly working in, but this is not the CCG I was working in at the time of the winter pressures last year.
Northwestdoc - it's all in your T&C; mine explicitly state that the employer contribution isn't included.
There are some useful things to think about if you are new to locum work in this article, but some of what is presented as firm advice is actually opinion e.g. "Payment terms are usually 30 days." Says who? Mine aren't!
It is also highly questionable to suggest discussing locum fees on social media, as this might be considered to be forming a cartel. I'm surprised Pulse has published this advice.
The recent “technical fault” DID affect pensions; I have had to resubmit locum pension forms. They even get it wrong about what they have got wrong!