I've been trying to look at our data from different angles to see where the 'missed' or under treated pathology is:
1) We consistently (normally) have 50 new cancer diagnoses per quarter. I estimate we're about 33% below usual for April and May 2020 compared with previous years.
2) There appears to be an upswing in admission with acute cardiac issues: Fluid over load tipping people into symptomatic CCF (hot weather not helping), and delayed chest pain presentations.
3) Diabetic control is getting better in some as they use lockdown to exercise improve their diets. A great proportion are being LESS active and piling on the carbs I think - the tsunami of awful HbA1cs is hitting us as we open up our chronic disease monitoring.
4) Self isolating has REALLY reduced respiratory consultations of all types. People are also avoiding catching simple URTIs which is nice. Children are presenting significantly less often, except for atopy as hayfever is quite bad this year.
Instead of chasing blood pressures, look at cleaning registers and tidy up coding to get prevalences more reflective of the try burden of workload out there.
Consultation charges need not apply to those initiated by practices for follow up of identifed condition and chronic disease monitoring.
The charges could be for patient initiated appointments.
I could personally fill by week many times over with meaningful work derived from database seraches without even turning on the phones or opening the door......because chronic disease are not being optimally managed as you say Ivan.
We at the Gloucestershire LMC have repeated submitted motions to conferences about a nominal access charge. Hoever, during debate these motions are shouted down by the usual suspects who seems to have a religious regards for things being free at the point of access, even where this demonstably inflicts intolerable pressures on their colleagues around the country.
However, there is no other equivalent country on Earth where primary care is absolutely free and unlimited in theory, and there are also no European countries (America is different obviously) were people without money are denied care.
I reckon £3 is enough. If its too high, then certain people will act like they've just bought themselves a spa experience day.£3 is a roughly 10% contribution to the cost of provision in recgonition of the value of the resource being accessed.
One of the devices I sometimes use when deciding on a 2 weeke wait referral is to say to the patient 'if more than 2-3% people we refer under this system are shown to have cancer, then it means that we're not referring enough people'.
Most people are reassurred by numbers when they are in their favour (particularly men I find).
Whereas if you are a single practice PCN, it is a no-brainer and very much helps to sustain yhr independent contractor model.
Its a curate's egg alright.
Precicely the point I was making.
I'm not convinced of the efficacy of smoking cessation services myself. I've never had a patient act surprised at me being the first person to ever tell them that smoking is bad for their health.
However, nothing says 'BIN THE FAGS' like a dodgy FEV1 and a diagnosis of COPD.......all in black and white on a graph.
Intervention at diagnosis with support (as with T2DM) is the the most likely thing to effect significant behavioural change.
Yeah, lets be civil about colleagues (thay we've never met) shall we?
I doubt whether many of the contributors to these discussions have spent much time as part of LMCs.
It would seem quite obvious that this practice has been put under addtional pressure by a housing development that was approved without ANY reference to health service infrastructure.
Neither practices, LMCs or CCGs (or health boards in Wales) have any statutory influence over hosue development (no even to enforce section 106 provisions). It's got NOTHING to do with 'weak' LMCs or BMA.
I think the practice is doing EXACTLY the right thing, as this is sadly the only mechanism by which it exert influence. Well played.
What kind of business in the private sector has to regard new customers not as an opportunity, but as a THREAT? This is the most obvious manifestation of the unsustainable nature of the business model under the current funding envelope. The lack of staff to recruit is a secondary consequence of this and has been YEARS in the making.
It aleady HAS mad a difference and proved useful......... so we're going to adopt in Gloucestershire as part of a regional effort.
Just because you can't imagine how, it doesn't mean it hasn't.
It doesn't have to have 'evidence' - it's a good opportunity to start/renew a longitudinal relationship with a patient (and their baby) from a 'customer service' point of view (we ARE businesses whether you like or not and complaints cost you a lot of time/money and are less likely to come from happy patients):
1) Explain how to access care in a an appropriate manner i.e. We see babies on triage come what may - reassure Mum.
2) Feeding concerns - expalin about the colic the baby is about to start getting if they haven't already and explainhow to manage it. Might prevent calls/aggro in the next few weeks. NO IT ISN'T CMPA!! Stop reading Mumsnet!!
3) Gestational diabetes? That has a HUGE improtance for ongoing maternal heath and chronic/metabolic disease (prevention IS possible with lower carb lifestyles etc).
4) Post natal depression is NOT always picked up by 6 weeks by any stretch of the imagination.
Use your imagination.....
So the average GP appointment is otherwise invariably taken up by someone that actually needs to see a doctor?
On which planet is this?
In planet UK NHS, the average GP appointment is booked by someone who wasn't sure whether or not they needed to see a GP, so they booked a GP appointment to talk about it. The other 10% are booked by people who want to know whne the hospital are going to seend their appointment through.
Post natal checks are really valuable when used correctly and with a little imagination. A significant number of ladies will book an appointment in the post-natal period for various reasons anyway, those appointments can be preempted.
'No proven value' is technically called 'General Practice' if you're going to be pedantic. How do you 'prove' the value of a maternal post natal check anyway.
Its stands to reason its a good thing, not least if it gives the opportunity to explain to a new first time mum how to access GP services if they have concerns (i.e. PLEASE don't call 111 if we're open) about their baby. A lot of people don't have much support and are vulnerable. Remeving some unwarranted anxieties about accessing health services before they happen is a good thing.
We have sick not slots for people to request on the day they're due. No time wasting appointments ot phone calls.....med 3s no questions asked.
If the country is STUPID enough to expect me to Police this nonsense for free, more fool them.
However, come in and start shouting at the receptionist for a sick line for 'depression and anxiety' backdated a month because you forgot to ask.......you will NOT find the process so smooth.
Will the data show what proportion of ED attendances have been sent there by 111?
This is the '3rd tap' approach to filling the bath, typical of 'modern' UK governments.
Most sane rational people would buy a PLUG instead.
Its cheaper and quicker to not actively drive experienced GPs out of the workforce at the earliest practical opportunity.
An extra 6000 GP registrars will take 6000 sessions per week of experienced GP time OUT of the workforce to do training. That's the equivalent of 1000 more 6-session GPs doing nothing but training other GPs.
This is called 'Turning the taps up to 11 whilst leaving the plug out'.
Whereas if you have a 30,000 patient practice and you can be your own 'hub' and there's no data sharing shennanigans and the additional appointments are valuable extra capacity (including for QoF/Chronic Disease management). We also don't struggle to staff the hours either because we have 25 doctors and those that opt in start later in the day, and do one or 2 per month. Because we're seeing our own patients, the DNA is only 5% (still double our standard DNA rate though). Saturdays are paid as over time......and I'd rather see my own patients than work in OOH for less.
However, I fully accept that what suits us is not a universal salve and that any attempts to force this model (that we have adopted for our own reasons) on others will fail utterly.
I want a Unicorn Tikka Masala with magic mushroom pillau rice...but I can't have one.
Hence the probable outcome this year thet the GPC will not agree a contract that they can put to the profession either way. If, for example NHS England turned up to present an unfinished power point presentation full of random nuggets plucked out of the air, in the mistaken belif they can create an eagle by stapling togther whichever oven ready birds they have to hand.
You CAN'T negotiaite with disorganised, unprepared, unprofessional people who fundamentally do not understand the nature of General Practice. If a private secotr organisation had published the PCN DES and also failed to present a working document for contract negs, all within 3 months.......imaging the P45s flying about the place....