I agree - and when it happens, I will be retiring. And I dare say a fair number more will as well. Or emigrating etc.
OOH is something one does as a choice. if the choice is that you are being put at risk and poorly paid, I would d never blame doctors for not doing it. We set up Co-ops years ago because it was becoming unworkable. We have to be careful it is not just dumped back onto us though through the PCNs.
'There probably are enough GPs in Scotland, but they have either taken early retirement or are working as little as they can get away with. A situation for which the BMA shares some of the blame.'
Not sure what the BMA has to do with this and if GPs do not wish to work overnight and they are not being enticed to do so by better rates of pay, that surely is not surprising. This has become a market economy and if OOH want to get GPs to work for them, they need to make the job sufficiently attractive, both financially and in respect to workload.
'In 1975, our 3 GP practice in Sussex had a combined list size of 7,500 patients - 24 hrs coverage, including out-of-hours calls and visits, was the norm on a 1:3 schedule, as was the Saturday morning surgery - a round of home visits was the norm Monday to Friday. Sunday was on a call-out basis.
The practice had 2 receptionists and 1 bookkeeper.
None of us were burnt out or 'demoralised.
What happened? You tell me.'
The demand went up. When I started in 1988, the number of consults per patient a year was about 3. It is now about 8. The advent of mobile phones has made Primary care instantly accessible so the work is far more. When I was a houseman, I did a 1:2 rota with 1:1 whenever my colleague was on holiday - so 2 weeks in a row. No-one would suggest that my job then was harder than juniors now doing their shift work as I was covering only my wards and was massively protected by the night staff nurses so did get to sleep. Comparing now and then is comparing chalk and cheese.
I understand the GP but these patients should not be going to A&E. By all means ring 111 but the majority should be advised self care with the vulnerable being directed to Primary Care.
58yo, 10 sessions. We have experimented recently with various ideas - one doctor who does the majority of the visits - usually 8 but depends on how many others in to pick up some of the rest - also depends a bit on who is visiting doctor. We have just appointed a paramedic who has taken on this role but we will be protecting him from calls which would not be suitable. We triage calls from those who are not coded as housebound and we have a fairly strict cut off of 11.30 after which they are triaged by the two doctors running the acute service that sees the on day demand.
I still do my own palliative care patients as much as I can and they are able to call or message me whenever. We also do weekly visits to 5 care homes which reduces the numbers of visits substantially.
I think removing the visiting would continue to erode the bond between the public and Primary Care. We need to be strict about visiting - the days of visiting children with chickenpox is long gone - but to remove it completely means we should probably pack up shop and live in the hospital.
This would appear to be consultants only so not relevant to most readers here. It allows consultants to be paid for overtime without it adversely affecting their pension contributions and tax allowances when they enter the taper of allowances at a certain income.
Home visits when appropriate are in my view an important part of Primary Care. I have two so far down for today, and both totally appropriate with one for a rapidly developing ca lung and the other in a younger man who is tetraplegic due to a spinal abscess and just out of hospital. I still strive for a degree of continuity of care and handing these patients across to the ambulance service would seem unlikely to be very helpful.
To be honest, I didn't know there were 10, 30 and 40mg versions. Only ever seen 20 and 60mg capsules. I note the huge cost of the 10mg version as well.Don't think this will require much work at all for my practice at least!
Quite right - wonderful job. When you are allowed to do it and not have to sit through team building and suffer CQC visits.The seeing the patients bit is great - I still do 10 clinical sessions and cover my palliative care OOH. That is the rewarding bit. Unfortunately so much now is politics. I am however pretty Jurassic!
I think the NHS England comment about part time working is outrageous. Many salaried GPs and indeed partners make a life decision about the hours they work and implying that they should work more, which would likely lead to a mass exodus, is ridiculous.
Surely this is the Doctor First model - rather than additional phone calls. We have avoided this as it would appear to make every day and on call day. We do however run an Acute Service which involves triage by phone and seeing run by two doctors each day in a dedicated area. This makes the rest of the surgery more relaxed and the acute service is only one day - some GPs actually like doing it - I am ambivalent but it makes the rest of the week better and the patients like it.
Interestingly, the vet put my basset hound on a slightly bigger dose for his back and he too improved markedly. Again short course!
From personal experience, for sciatica, which was causing me to have to crawl to bathroom, 24 hrs gabapentin allowed me to carry on working. On for 2 weeks and then stopped as really slows the brain down, but was completely fantastic for pain. Anecdotal I know, but short courses would possibly seem the way forward.
Interestingly, we are being incentivised to move away from Emis!
But you will just get the same people. Cronyism and nepotism is alive and well in Westminster. Unlike teaching and medicine, no formal qualifications are needed so to equate with them seems bizarre. I suggested some time ago that the obvious pay scale for an MP would be directly related to the median salary of the UK, so that success in making the country richer would be rewarded. I see little to change my opinion.
Only Labour and Conservative promises actually have any hope of actually being in a position where they can be tested. The other parties can promise anything they like since they are at no risk of having to deliver them. And as the Labour party have returned to the plan of squeezing till the pips squeak, they are unlikely to get in and even if they did, they would then see that they would face a failing economy due to their policies. We need a sensible opposition party but it looks like we will be getting 5 more years of what we already have but worse. The only light at the end of the tunnel would seem to be that Mr Hunt will be no longer Health Secretary - please let it be Sarah Wollaston, though I doubt it will be.
Sympathise with you - have the same - Kneeling chair good for consulting - back actually feels better at end of surgery. You can also use bottom step to sit on when dealing with kids so you are on same level which can be useful. Not so good on knees at end of day though. Found gabapentin simply brilliant for sciatica though - stopped me being off though made me very stupid so only took for 2 weeks. The vet put our dog on it after this but is basset hound so tricky to say if it made him any more stupid.
Completely agree - if this is what they want us to do, that is fine - however it is clearly not going to happen in the lead up to an election!!
DoH - Ministry of Truth
NHSE- Ministry of Plenty
CQC/GMC- Ministry of Love