About time we need to provide evidence of the exhausting and lengthy days we all do
It’s now 18:45 and I’ve been at my desk since 7:45am and not finished yet
Predictable and will be recognised in other areas-the GP innovators are those who step up to lead and see the opportunities to make money but they are also often (not always) the ‘wide boys’ who do not have the trust of their peers
Eventually the vaccum will be filled by trusted leaders with sound governance but this takes time
Youve identified all the risk and barriers to younger GPs taking up partnerships but I don’t feel optimistic about finding solutions
Certainly not soon enough to help the majority of us left
I simply can’t continue to work 12 hour days even though I only do 2 full clinical days a week (and 3 days doing other work thank goodness)
It isn’t safe and it isn’t an acceptable situation for doctors or patients
I do wish him well with his negations however. Answers can’t come soon enough
It is true that more GPs are being churned out but remember they are more than likely to 1. Be Female-so not replacing like for like WTE as wont work FT 2. Be young males who again don’t want to work FT and end up like us doing 12 hour days 3. Be offered ‘first five’ Carew schemes whereby they work 1/2 a week at most doing GP and 1/ a week in leadership roles 4. Become a locum 5. Just sod off
Like is not replacing like
The alternative workforce of ANPs, paramedics, clinical pharmacists are good but need supervision and governance which takes time from the GP partner and using them puts extra strain on secondary care as they are more risk adverse
At the same time:
Patients are increasingly demanding and less likely to look to their lifestyle to improve their health and just want a quick fix
The elderly baby boomers want to ‘live forever’
Meanwhile rough sleepers have little or no healthcare
There is growing demand and gross inequality
The leaders of our system need to have an honest conversation with the public about what is affordable and let us do our job seeing patients who genuinely need us
I'm a rare breed who has done the management job (doing 1 day a week as a GP) and gone over to 'the dark side' and come back again-I'm now a partner again although still keep my management role going-and you know what? Now I get it, I really get it-we can't continue like this. I've just returned from the same conference to find out another of our partners has resigned (going in March), one going on maternity leave and a further space we can't recruit to in a practice of 17.5K 7 day access?-we cannot even manage 5 day access!!
Some of it can be time well spent if it enables a more holistic assessment and a better health and/or social care outcome but this time needs to be resourced
Maybe the thrice spent better care fund could be utilised?
This is the future-a colleague tells me that when the same thing happened in the consultant's contracts, his wife took her work activity log along to her medical director and came out on the same pay for 3/4 the time worked. She was being paid for 3/4 time but doing full time. So at least her time was rebalanced. However she's now back to 13 sessions a week.My advice:start recording a log of what you do and hours worked to present as evidence when ours contracts are changed.
Well said Steve. The challenge is to convince our members in CCGs that this is a change for them to shape their future and address the increasing demands of elderly/LTC/reduced acute beds and workforce issues. GPs at the grassroots are understandably sceptical and see GPs in CCG positions as an enemy-actually we are trying to help!
A message to Mr. Hunt.. As the incoming chair of Stafford CCG the story is much more complex. Please accept my invitation to meet with us and get the GP side.
Taking back the responsibility means just that..not actually doing the OOH yourself. There will be restrictions on hours worked over a week by a doctor anyway as any commissioner of OOH should already know. the NHS has to get a grip of the crisis in A&E and their root cause analysis (RCA) takes them to the dropping of OOH by GPs, which is a fair assessment. No one looked forward and calculated the risks around allowing GPs to surrender their 24 hr responsibility. The GPs were at the time delighted to give up 6K or whatever it was at the time, knowing they were worth far more but accepting the offer. Could a =n OOH be provider for 6K a GP? Of course not! And further more the knock on effect of reduced continuity of care and increased NEL admissions wasn't factored in either-hence crisis in acute care. Also, and I'm not sure if I dare say this, the quality of holistic E of L care in the community meant that there was probably more TLC around very frail elderly and people being more likely to die earlier-this change has resulted in additional frail elderly blocking acute beds and increased nursing home need when the alternative was a comfortable death at home with a loving family around you.
By GPs taking back responsibility of OOH they might be able to reverse some of the medicalisation of old age
As GPs are essentially self employed they have a duty to provide their own occupational health support. However the ATs have a responsibility to ensure GPs are fit to practice and that should include a health report as well as a knowledge based report. Any trends in ill health should be triangulated and would feed into a wider source of information. Registrars and sessional/salaried doctors should be assessed annually independent of revalidation and responsibility of their occupational health should be the practice that employs them. I fear too many GPs and doctors in general are working when they are too stressed and probably just keep going. We sign dozens of people of a week with stress-where do all the doctors go?
As a GP I'm able to see the LMCs point of view
This work isn't resourced. However as a holistic practitioner this isn't morally right
I once wrote a letter of support for a patient with COPD who was getting nocturnal exacerbations because his council turned the heating off overnight and he couldn't adjust it. This ended up costing more in terms of 999 calls and non elective admissions. Did I charge him for the letter? No I didn't. Did it make a difference? Yes it did. The housing association let him turn his thermostat up overnight, he stopped going into hospital and he enjoys good health with an excellent community respiratory team support. What I did as a doctor was part of my job. I went into medicine to make the odd small difference and not to play the "jobs worth" card.
The system in wrong and the poor patients are caught in the middle
I agree with the comments that patients should get what the choose. Even where primary care is of excellent quality the access is poor. Have any of you tried to get an appt or sat waiting for ages to see a GP? Probably not because we treat ourselves or ring up a colleague (I know we shouldn't but we do). Primary care as we know it is dying and we have to face it. We'll all be salaried in 5-10 years. The result will be a standardised service with good access but risk adverse practitioners and layers of appraisal and policies and procedures. It was a done deal after the 24 hr care was relinquished but that was unsustainable.
well done. The trust have a huge wealth of resource with your experience and you can help develop the correct and appropriate services that GPs need for their patients
agree totally with your blog Tony
I've always said you can be a crap doctor but if the patients love you, you can get away with murder..
remember Shipman?-he would have probably passed the friends and family test as he was actually a very popular doctor!
I agree with Bryan. It's the worried well and these are usually the middle class educated A small charge might be the answer but who has the balls for that ?
I am relieved Dr Dixon has been misquoted as I was about to "give up and go home" if one of CCG's most influential leaders was prepared to "deprofessionalise" us and practically say we should pay for the privilege of working! Get your quotes right Pulse-however it has provoked a lot of comments!
Just read this out to a group of GP colleagues sitting in a CCG meeting that is due to end after 9pm and that's after our day jobs!! Made us laugh though
I always thought the vets did a better job than us- antibiotics and steroid shot for everything and anything when they see my dog- is that what we've come to?