er in Australia the practices get a minimum $37/£20 per patient visit for the most basic consultation, often its a lot more, and many clinics have mixed/ private billing. At a weekend we have patients pay $90/£50 to get a sick note....to do a care plan for a patient with complex needs is about $288/£160 from the government if they are being seen by other teams and need referrals etc. I think the Australian GP fees are more realistic of what we should be getting paid.....
Globeman if you want to become a cherry picker or narrowist (Oops I meant specialist) then apply to retrain. If you're not happy with your status quo either change your circumstances or change your attitude to them. Most of our dis-satisfaction comes from the inequality between general practice and narrowists. They get paid more for knowing less. If we were all paid equally per hour what would you pick?
ANPs are good, they definitely have a role with common conditions, but when it comes to the obscure diagnosis, the mental health, the polypharmacy and multi morbidity, the minor ops......the wheels com off. Can you show me a clinic that can offer the same outcomes with just ANPs? A good GP can achieve much more with much less.... specialists aren't so special..... narrow knowledge base means they often fall over as soon as they stray outside or on the verges of what they really know.... this happens more than people realise. This week a nephrologist not knowing about methotrexate, last week a cardiologist prescribing fenofibrate when he shouldn't.....a stable system needs someone with a broad knowledge base to underpin it.
Hi Globeman..... who do the ANPs come to when they can't sort it out?
Zoe Norris has more spine, integrity and more B***s than our other so called leaders...... HSL should take note....... Zoe Norris has significantly more support talking to my colleagues than HSL whom we perceive, as a small group of GPs, to be a light weight and ineffectual. Is there anyone else out there who feels Zoe would represent us better than HSL?
Dear Name and address - if you write MRCGP with the year you passed the exam in brackets is there anything they can do to stop you writing it anyway? e.g. MRCGP (2013).. you are merely indicating that you passed the exam in that year, not that you are a current member. Im not too bothered as Ive got my Australian letters to use instead anyway..... would just be nice to remind them of their loss of influence
Can anyone give me one seriously good reason to be a member of the RCGP? If anyone is reading this please ask yourself what you are achieving by paying its subscription fees? HSL is not going save General Practice.... she merely produces feeble soundbites from the sidelines whilst front line GPs are left at their own peril dealing with unsafe workloads. We need an alternate choice, not this monopoly. Use the savings for your own escape plan.
And dont forget ....over suppression in thyroid cancer worsens outcomes.... as i had to point out to our local Professor of Endocrinology.....even in advanced disease. Many patients with thyroid cancer dont actually need suppression at all, contrary to what I learned at medical school. As GPs we often pick up mistakes by our colleagues....we all have picked up on others oversights.... it doesnt mean they are bad doctors, nor that we are superior .... it simply reflects an overstretched system......lacking automated recall systems for monitoring..... what we can all agree on is that we need to the time to both keep up to date and also the time to then apply guidelines pragmatically where relevant to our patients and not to be forced to apply them were we judge it not in the patients best interests. We haven't been given the funding to put the proper systems in place and our colleagues are run ragged trying to simply hold the mess together. Today I was given advice by a well meaning nephrologist about the cancer risks of methotrexate.... I kindly wrote to him pointing out the research he was alluding to was from a paper in 2008 which had design flaws and that subsequent papers including ones from 2015 and 2017 showed that the risks were overblown and more likely related to RA itself and other factors rather than methotrexate (Lung cancer, NHL and melanoma are more common in RA). Am I a super genius ? No.... i simply work in a system where I now have the time to do my homework on the patients.......I doubt that any doctor would have missed this if given sufficient time to investigate such minutia.....but in general as a profession we dont......by and large I think most GPs do a great job under difficult circumstances, could we do better...probably..... but will the NHS ever be given the resources to do our job to the best of our abilities?... probably not.... hence why I left. We shouldn't criticise each other but recognise the failings in the system that leave us below parr and patients at risk.....this is an issue should unite us...not divide us. I dont think we can compare different doctors performances, some guys are getting absolutely slaughtered whereas some of us have found more comfortable niches with a little more breathing space... its that little extra space that allows us to do more, but if you haven't got it.... you can't do it.....I would imagine that the various contributors to this article, but with differing opinions, are all doing great work, but with very different situations.
Coal face.... come to Tasmania! Bring your colleagues with you..... its not too hot, and you get paid more the more you do....... or at least explore your options. Scotch Oakburn is great if you need a school....and it at least as good as Potora, St Kevins or anywhere else there.
Good luck! I think we all need to cough up and stick some money in the kitty
I agree with the non payment of GMC fees....
I think it would be a reasonable aim to have the majority of UK doctors contribute to the crowdfunding campaign to make a final stand on this issue, and our voices heard.... and use it to highlight the dangers in the NHS. This 'maverick' campaign which seems to have been started independently, and not by our inglorious leaders, is likely a better hope of bringing a rational debate to the table than waiting for the gong chasers to do anything......
The only good news about this case is that its the first thing Ive seen in approximately, forever, that is uniting our profession and we all concur about the absurdity of it all, and the fact we are being judged by those who clearly don't understand the conditions which we work in on a daily basis. If our respective leaders cannot capitalise on this one moment of unity, to achieve something substantial to redress the current imbalance, then our profession is dead.
is the GMC worried they might have actually overstepped the mark and misjudged the professions reaction to this? They've really opened up a lot of resentment......and anger.... towards the conditions and we now find ourselves working in and the scrutiny we face. The NHS is going to suffer because of this case.... doctors will now start pulling up the drawbridges and look to minimise their personal risks by reducing their exposure to the high pressure areas where their skills are most desperately needed e.g. Emergency medicine, General medicine, General Paediatrics etc. This is going to make the UK health care crises worse. Well done GMC! give yourself a pat in the back and collect your MBEs and OBes while the service goes from bad to worse....
Dear Ed, Can you put up the link for the crowdfunding please!
Just shows you can't trust any of our professional organisations.... the people who go into indemnity, politics, management etc all do so because they know they're safer out of day to day medicine, that and they're often just sticking their nose in the trough. Disgraceful all over.
So glad I left the country..... my nephew was thinking of applying for medicine, he's got the grades and being doing the interviews recently.... I showed him this case.... after 'reflection' he's now considering chemical engineering instead.
Dr Harrop was trying to do his best and alert people to the dangers of an overloaded system. You might not agree with his course of action.... but just look at the GMC striking off a doctor for systemic failings.... saying nothing and STFU as you recommend is not helping the situation in the NHS and it certainly won't help protect our colleagues in the future. We need to get this conversation about the NHS into the Public arena as it is operating at dangerously overstretched levels with increasing frequency, and I dont see why as a profession we should carry the can for political decisions and a resource that can't cope with the demands.
If you can't make constructive comments I would suggest that you should STFU and not Dr Harrop. Defining a safe working limit is difficult to define, like defining sexual harassment, but we all know it when we see it.
Coal face.... you say you are not allowed to close your lists? What about the remaining practices around.... I think if you stand together and state clearly to the boards that if you are 'forced' into taking on a dangerous work load, then you'll be forced into resigning..... to protect yourself as the medico-legal risks are too high as what they are asking you to do is unreasonable. If all your neighbouring practices do the same thing what can the board do? How many GPs and practices are left in the county now?
I see an overwhelming vote of positivity here from the comments! Sadly thats what JH will see these comments as, endorsement. Everyone reading this needs to leave the UK. Its only when you let the system fail will there be change, anything you can do to reduce the income of the RCGP, the GMC and the defence organisations can only be good.