Been waiting for unpleasant comments like 11:48am. Anonymity to add to the unpleasantness, too.
I don’t think using out of date over up to date doctors is good for patients.
I don’t think doctors working for free is good for the profession (the Government may think otherwise...)
I don’t think the CCAS shambles is good for anyone.
I don’t think asking for sympathy is helpful - or reasonable, in my opinion.
I do think we should all be angry that medical skills are being under-utilised in a pandemic - and we should reflect on the myriad reasons the locum workforce is needed in “normal” times.
A point: CCAS work is not minimum wage. If this isn’t a typo, it is a rather daft comment.
A comment: as an out of work locum, I sympathise with much of the above BUT I certainly don’t expect sympathy. I would suggest that the prudent locum would have some savings to cover a potential gap in work, for whatever reason.
I would hope, however, that the anger and frustration of locums at NHS administration and prioritisation is widely shared. The onboarding for CCAS is a shambles, and I hear that the contact tracing service (which I have also just applied to) is similarly blighted. And the fanfare about the return of retired doctors feels a political points scoring insult.
HELLO 111, I’M OVER HERE! Fully qualified, up to date locum GP who is available, and wouldn’t mind a spot of work. Oh, sorry, I did say work, the kind that one gets paid for, not volunteering... Ah. Is this why you have essentially ignored my application and subsequent emails?
This is not really hot news... 7 weeks since I applied, and nothing but holding responses from NHS England. Not really surprising now I know Capita are involved...
I was going to ask if NHS England operate on this planet, but actually, are they even in the same universe as the rest of us? As has been noted, patients wait hours for a call back from 111, then they ask GPs to contact them in 30 mins, so they know they haven’t been “forgotten”? Sounds like offloading of risk to me, and if the risk is so high that a 999-level response time is needed, then maybe general practice isn’t the right place for this risk?
Also, maybe using all the GPs who have applied to work in the CCAS might help, rather than leaving dozens (at least) of us stuck in admin hell? Just a thought.
OR - use some of the 100s+ GP locums who are currently idle to cover trainers and examiners to crack on with the examinations in a socially distant way?
Not just GPs wishing to return; I know of a surgeon wishing to return who is also mired in red tape, and I am one of many current locums similarly mired.
I actually wonder if returning retirees are being prioritised over locums as they don’t really want to have to pay for this work; I would respectfully suggest that returning retirees ask if the locum workforce has been exhausted before taking any work. We are, obviously, up to date medically, and I know some colleagues are very concerned about their finances.
I'm a locum. Contacted NHSE 2 weeks ago - not even had an acknowledgement - and their form doesn't ask what your contractual status is, so I can't conclude that they are ignoring me as a known locum.
I think The cavalry isn't coming is spot on as to why they're not targeting locums, though. It seems that, just maybe, the NHS isn't going to get "whatever it takes", as our great leaders promised.
I do tend to conclude, however, that NHSE have woefully limited administrative capacity and competence.
I am sick of banging on about this, and am glad I have a financial cushion (and refunds from cancelled holidays!) to keep me going whilst I spend the next couple of months doing jigsaw puzzles and reading novels. Hopefully NHSE's lack of ability to use available and highly trained human resource will be noted in the great big wash-up after this is all over. But I won't hold my breath.
Letters. Hmmm. Not the most reliable means of communication at the moment. The postal service is overwhelmed. May be why patients haven’t had these letters yet.
I haven’t had Boris’s letter yet...
I guess the ultimate answer is that Governments are elected to make these decisions - for the population as a whole, rather than for individuals, though, which it seems to me is where the tensions highlighted in this article lie. I tend to agree with Twesige Mugisa's analysis of where we are at the moment.
However, it occurs to me that there are a number of reasons for "net" hope with regard to the current pandemic.
I have heard it suggested in several places that many more people have unexpectedly NOT died of air pollution-related causes in China over the last 2-3 months than have died of Covid.
Further, will the amount of flying the world does ever return to the previous level? Partly due to changing habits, partly because airlines go bust and their services just disappear. Reducing the impact of climate change will save lives.
I understand that seasonal flu deaths are also recently relatively down, which may possibly be connected to improvements in hygiene, and these may also reduce morbidity and mortality from other infectious diseases and food poisoning going forwards.
There may also be future mental health support from better neighbourhood and community engagement.
Will there be fewer RTAs as people aren't travelling to work - or anywhere else? Will there be a long term health benefit from daily exercise becoming a habit?
Individual harm and death, of course, is much easier to "see" that all those who may not be harmed or die. This issues will be important and interesting to watch - probably over a number of years.
How? Simple question, no answer as far as I can see. I’m not retired - but a licensed doctor who was all ready for her now deferred revalidation in a couple of months. I usually locum. Have had work cancelled, and there don’t seem to be any adverts or requests for work locally. I have a phone line, internet connection - and skills. But where is the secure remote access to a clinical system that would be needed for me to work for 111? Where is the system for recruitment and induction?
And, btw, I don’t think there should be any question of “volunteering” here. The NHS is meant to be getting “whatever it needs”, and this must include those who are continuing to deliver the non-covid parts of the service with essentially no resources for back up.
Exactly, Mark Howson. Opening the hotel room door after the virus is already replicating.
1 in 4 are up to date? That's more than I might have guessed...
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.