There are many reasons why GPs are jaded at present, but we do ourselves no favours with knee-jerk, uninformed negativity. Physician Associates (as they are now called are NOT the same as Nurse Practitioners. If you are interested to find out what PAs are and how they could help us google 'Physician Assistants' and read Prof Jim Parle's 2012 paper. Our legal colleagues have been emplying Paralegals for decades and they do an excellent job!
I have great respect for colleagues' nervousness regarding duties superimposed on their already-full working day. However, this shows we are missing the point. The majority of modern GPs have taken 10-11 yrs to train, and earn over £100K pa. What should a professional at this level be spending their time on? Typing (how many hours a day do you use up doing this)? Making banal decisions about repeat prescription? Diagnosing viral pharyngitis? Wading through hundreds of normal lab results? Filling in ridiculous forms (eGPRs, DWP, approval of 'homely remedies', 'fit for tandem parachute jump' etc, etc.)
No, such highly-trained, highly-paid clinicians should be making high-level clinical decisions, ONLY. We should be part of large teams with appropriate skill-mix. Less highly trained/paid professionals should be doing all the above. A model that we might look to would be the modern solicitors' partnership. Every decision/action is devolved to an appropriately trained/paid team member.
I'm sorry, dear colleagues, but what we need is an IMAGINATIVE REVOLUTION in the way we work.
I understand the world less and less. In relation to this controversy I heard a commentator on the radio announce that a committee was looking into 'whether the MRCGP exam is discriminatory'. In 1980 there would have outrage if the answer was 'No'. In 2013, it would seem, there will be outrage if the answer is 'Yes'.
Health minister blames GPs for failing to offer patients choice - and claims 'many doctors take any excuse to keep appointments as short as possible'
Dear Earl Howe
Would you like to spend a day with me at my practice?
What good sense! The 'independent contractor' model is an illusion anyway, that works against GPs. Are we truly able to negotiate our terms of service? Are we truly able to compete as independent businesses? Who presently MUST accept the blame for the current level of overwork, leading to DANGEROUS standards of care in many areas? - PARTNERS. If something goes horribly wrong due to overwork the accusation is simple: 'Doctor, you should have employed enough people to make your organisation safe.' The fact that to do so, would probably mean zero income for partners in the present model, will never be a defence.
In answer to those who wonder about the details of a universally salaried primary care system - look at the Defence Medical Services which, I think, still works pretty well.
The key to improving OOH primary care is NOT 'continuity-of-care' but 'continuity-of-information'. Every GP knows the value of the 30 secs we spend scanning our computer screens before collecting the next patient from the waiting room/pressing the 'Send' button. Most important our last note entry reminds us to ask about the holiday in Tenerife that makes the patient feel we care (which we do). Why oh why has the GP establishment at every level blocked the universal sharing of medical records? Are we really so worried about confidentiality or did we regard this issue as a side skirmish that we could 'win'? I fear, on this matter, we are reaping what we have sown. The solution: Volte face - we must throw our support behind 'continuity-of-information' with all urgency.
The concept of triage was a military one and relates to the need of an overwhelmed health service to prioritise cases - as inevitably occurs during battles.
However the central concept of triage was that it MUST be performed by the most senior, most experienced military surgeon available. Only he/she would have the necessary skills to make the quick decisions required. (Average call length for 111 interactions now 18 mins - what in god's name do they talk about?) Thus, NHS 111 breaks the first rule of triage, that's why it doesn't work.
GP contract set to change as Hunt hands responsibility for out-of-hours care back to general practice
Time to hand responsibility for general practice back to Jeremy Hunt! In other words, we all simply resign from our partnerships. After all, our salaried doctors are now earning more than we are. In the shambles that remains there'll be lots of salaried work and salaried staff have the right to say no.