There are three types of patients. Those who make appointments and keep them, those who make appointments and don't keep them, and those who don't make appointments at all. Most of the trouble comes from the first group.
Within the past four years I reduced my referrals and prescribing to just a third of what they were! Also admissions by the same amount!
I did this by cutting my weekly sessions down from six to just two. Where do I claim my reward?
Third world health service; first world expectations.
Judged and punished as if working in ideal conditions, when the actual situation is anything but.
When you do CPR the first question you ask is, “Am I safe?”
When you turn up for work, you need to ask, “Are these conditions safe to work in?”
Anyone employed by the practice should walk out if they feel at risk of being blamed and punished for the consequences of excessive workload, and inadequate support.
As for partners, I’m afraid you put yourself at risk by continuing to hold a contract which makes you responsible for doing the impossible.
If they don’t make a stand, they shouldn’t be surprised if the workload gets worse and worse. Work at a safe pace. After five hours per session, the outstanding work should be handed back to their employer on the grounds that it isn’t indemnified, not to mention paid. If they feel they have to carry on, to avoid harm to patients, then charge them punitive overtime rates. Maybe something will be done about it then.
Regretting being so economical with my referral rate to date, as there’s no leverage to cut it further. Tempted to avoid the same mistake with scrips and admissions, which might be coming next.
I wonder how much trouble she would have been in had she simply walked out, once she realised she was doing the work of three doctors, a double shift without food or a break, with a broken computer system, no adequate support and no induction? Would she have been as culpable for the events that ensued? I suspect not. A lesson for us all.
When appraisal first started my senior partner retired, and then my remaining partner became seriously ill, and very sadly died. This left me, previously part-time and with four children including a young baby, single-handedly looking after 4000 patients.
It seemed the only way to escape this insane situation was either to get struck off, go to prison, or fail my appraisal. Deciding that the last option was the best one, I did no preparation for my appraisal, and had the worst attitude you can imagine. However, I still passed the bloody thing!
After an extremely difficult six months, a new partner joined. However, since then, I refuse to worry too much about appraisals. They don’t want you to fail!
What about, “I’m sorry but I have reached the safe maximum for number of patient contacts/hours worked this session, so I am unable to help you today. I suggest you complain to your MP”?
Legally a session is no more than five hours, including all admin, etc. Otherwise we’re not properly indemnified, and this is dishonest as well as foolish. After five hours, we are into another session and should be paid and indemnified accordingly (if salaried).
If it’s impossible to cater for demand within the indemnified hours, excess patients should be turned away, with emergencies sent to A&E. Anyone who regularly works more than five hours per session is shoring up an unsustainable, unsafe system and not doing themselves, or their colleagues, any favours.
6 am? For goodness sake. How can someone with a family, dogs, household to run, breakfast to prepare, children to get off to school... be at work ready to start seeing patients at that ridiculous time of the morning? Utter madness!
For those who are struggling to understand what ‘Sustainability and Transformation Plans’ actually are, I have interpreted them into plain English as follows:
Encourage working at scale
CLOSE SMALL PRACTICES, DESPITE THE FACT THAT THEY ARE POPULAR WITH PATIENTS AND REDUCE ADMISSIONS.
7 day opening
STRETCH ALREADY OVERLOADED WEEKDAY SERVICES
More care at home
DUMP MORE HOSPITAL WORK ONTO GPS, INCLUDING VERY ILL, COMPLEX PATIENTS
Enhanced multi-professional primary care teams
NON-DOCTORS TO DO GP WORK, AND GENERAL PRACTITIONERS TO DO SPECIALIST WORK. NEVER MIND THE MASSIVE MEDICO-LEGAL IMPLICATIONS OF THIS
Reconfigure acute hospital services to ensure efficient and cost effective
CLOSE ALL BUT THE BIGGEST HOSPITALS, MAKE PATIENTS TRAVEL FURTHER, SEND PATIENTS HOME SOONER
Encourage behaviour change eg. childhood obesity
TRY THE SAME STRATEGIES WHICH HAVE ALREADY FAILED. FOR EXAMPLE THE ‘FIVE A DAY’ INITIATIVE HAS FAILED TO REDUCE RATES OF CANCER, AND OBESITY HAS IN FACT INCREASED SUBSTANTIALLY SINCE IT STARTED.
Integrate mental and physical health care
MANAGE MENTAL HEALTH PATIENTS IN PRIMARY CARE WITHOUT ADMITTING THEM, WITH THE HELP OF ‘THERAPISTS’ RATHER THAN PSYCHIATRISTS
Integrated health and social care
MAKE GPS RESPONSIBLE FOR SOCIAL CARE AND MAKE IT ALL COME OUT OF THE SAME INADEQUATE BUDGET
Reduce system costs and pressure from unmitigated growth in demand
FAIL TO MEET INCREASING DEMAND
Efficiency saving to lead to break-even position by 2020/21
Dedicated support for the most complex 0.5% and those near the end of their life.
ENSURE THAT DNACPR FORMS ARE SIGNED AND LET THESE PATIENTS DIE RATHER THAN ADMITTING THEM.
“Many practices are reporting having to work fifteen hour days to cope with the demand and associated administration.”
I trust these practices are also paying their defence organisation for 3 sessions to cover this time, as one session is defined as up to 5 hours of work, inclusive all admin. Any more than this isn’t indemnified, and is therefore illegal.
We really are our own worst enemy if we are prepared to work these hours. Why are we doing this? It’s utterly ridiculous.
A stand needs to be made. Excessive work must be turned away. If this is impossible without the risk of being sued for negligence, then it is impossible to be a partner, and the practice should be closed.
The situation is impossible! We should stop being so bloody stupid!
Thank you Copperfield for cheering me up - we have just paid over £500 to have our equipment calibrated/checked, including £26. to check a couch (!!??) and £23 to calibrate a mercury sphyg (which if you think about it, is about as logical as calibrating a ruler). What a rip-off.
I have personally controlled my debilitating fibromyalgia symptoms by cutting out dietary oxalate (found in tea, potatoes, many fruit/veg, etc) - as recommended for those with kidney stones. It has helped quite a few patients too. Might be worth a try.