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GPs buried under trusts' workload dump

John Cosgrove

  • 'Indemnity fees are killing our profession' - sign this letter to Jeremy Hunt

    John Cosgrove's comment 04 Sep 2017 3:38pm

    Salaried GP, Atherstone, and RCGP Council member

  • The gratitude journal of Dr Heather Ryan, aged 29 and 3/4

    John Cosgrove's comment 27 Sep 2016 10:31am

    You make your point powerfully and entertainingly as ever, Heather!

    To be clear, these packs were handed out to Council members only for their feedback last week. It has since been confirmed to me that it is intended only to use them as part of wellbeing courses, exactly as you suggest in your penultimate paragraph.

  • Hospitals will have to take responsibility for patients after discharge

    John Cosgrove's comment 17 Mar 2016 8:06pm

    Thank you for this clarification, Andrew, and for supporting the revised wording of Standard 5. As I have remarked on the news story on this site today and in my tweets to you, I remain concerned that this document may be used to achieve an effect opposite to that which you intend.

    The second guiding principle ("Every test result received by a GP practice for a patient should be reviewed and where necessary acted on by a responsible clinician even if this clinician did not order the test.") sounds like a sensible safety net. However, how is the GP to know whether or not the result of a test they did not order has been acted on by the requestor? Equally, how can the requestor of any test know that the GP is competent to act on the results of a test that they might not be familiar with?

    Similarly, Standard 7 ("Appropriate systems and safety net arrangements should be in place in primary and secondary care to ensure any follow-up diagnostic tests required after discharge are performed and the results are appropriately fed-back to patients.") opens up potentially unsafe ambiguity about the responsibility of post-discharge tests, especially if discharge summaries are delayed. I am sure every GP has received a discharge summary advising blood tests to be carried out BEFORE the discharge summary actually reaches the GP!

    GPs should not be the default safety net for everything. Requestors of tests should retain responsibility for arranging them and actioning the results and should ensure that they maintain reasonable safety nets.

    GPs are not community house officers. If a hospital doctor has made the decision that a test, prescription or referral is required, they should arrange that. If, on the other hand, they believe that the opinion of a GP (who is well placed to know what can be arranged in the community) would be helpful, they should advise the patient to consult their GP on a routine basis after the discharge summary or clinic letter has been received by the GP.

    I fear this guidance actually INCREASES the risk that post-discharge tests will not be arranged or acted upon by introducing ambiguity in responsibility. BMA guidance in this area is much clearer tinyurl.com/dutytestprescribe and should stand.

    For ease of reference, I have also published these remarks on my blog at http://www.drcosgrove.net/2016/03/nhs-england-test-standards-increase-risk.html.

  • GPs fear new hospital discharge guidance will lead to workload dump

    John Cosgrove's comment 17 Mar 2016 5:49pm

    I am most relieved to see this clarification of Standard 5. Maureen Baker, NHS England and others are to be congratulated for their work to achieve such a rapid revision.

    I remain concerned about elements of this document, however.

    The second guiding principle ("Every test result received by a GP practice for a patient should be reviewed and where necessary acted on by a responsible clinician even if this clinician did not order the test.") sounds like a sensible safety net. However, how is the GP to know whether or not the result of a test they did not order has been acted on by the requestor? Equally, how can the requestor of any test know that the GP is competent to act on the results of a test that they might not be familiar with?-

    Similarly, Standard 7 ("Appropriate systems and safety net arrangements should be in place in primary and secondary care to ensure any follow-up diagnostic tests required after discharge are performed and the results are appropriately fed-back to patients.") opens up potentially unsafe ambiguity about the responsibility of post-discharge tests, especially if discharge summaries are delayed. I am sure every GP has received a discharge summary advising blood tests to be carried out BEFORE the discharge summary actually reaches the GP!

    GPs should not be the default safety net for everything. Requestors of tests should retain responsibility for arranging them and actioning the results and should ensure that they maintain reasonable safety nets.

    GPs are not community house officers. If a hospital doctor has made the decision that a test, prescription or referral is required, they should arrange that. If, on the other hand, they believe that the opinion of a GP (who is well placed to know what can be arranged in the community) would be helpful, they should advise the patient to consult their GP on a routine basis after the discharge summary or clinic letter has been received by the GP.

    I fear this guidance actually INCREASES the risk that post-discharge tests will not be arranged or acted upon by introducing ambiguity in responsibility. BMA guidance in this area is much clearer http://tinyurl.com/dutytestprescribe and should stand.

  • Is it time for all GPs to resign from the NHS?

    John Cosgrove's comment 08 Oct 2015 7:06pm

    I would like to clarify that whether general practice's share of the NHS budget has risen or fallen over the last year is open to debate by wiser minds than mine.

  • GP indemnity fees 'up by one quarter' in just one year, says FDA

    John Cosgrove's comment 02 Sep 2015 10:18pm

    Indemnity costs must be reimbursed. GPs absorb risk for the benefit of the tax payer. The cost must be borne by the beneficiary.

  • GPs to be required to demonstrate 'emotional resilience' at end of training

    John Cosgrove's comment 03 Jul 2015 9:04pm

    What utter tosh. What is required is not resilience training but a less hostile regulatory, contractual and media context. The GMC should lead by example. Rather than seeking to grow its empire and out-do other regulators by adding to our training and revalidation burden, it should fulfil one of it's core functions, supporting doctors. Otherwise, patients, far from being protected, will be put at risk of harm from a burnt out profession.

  • Orthopaedic groups apologise after claiming that ‘GPs not doing their job properly'

    John Cosgrove's comment 01 Jul 2015 11:00pm

    Full marks to the formidable Michelle Sinclair for eliciting this u-turn.

    However, I do not read it as an apology. I am more insulted by this back-handed apology than the original statement.

    "The aim highlight the gaps in the MSK general knowledge!"

    GPs have excellent MSK knowledge appropriate to their role as generalists. I am quite sure all GP colleagues would, however, be open to learning more. That learning is likely to be more effectIve when now preceded by insults and when our learning needs are properly considered.

    What we need is support from all sides to RAISE public confidence in our clinical abilities, reduce expectations for tests and quick fixes, improve diagnostic support from radiologists who may feel requests are not optimal, improve availability of treatment options other than surgery (physio) and support from orthopaedic surgeons to have the courage to be honest to those patients unlikely to benefit from surgery, regardless of any MRI report.

    It''s not rocket science.

  • 'It is vital that urgent action is taken on this issue'

    John Cosgrove's comment 19 Jun 2015 9:36am

    John Cosgrove,
    Birmingham

  • ‘We’re here to protect the public’

    John Cosgrove's comment 26 Apr 2015 10:44pm

    How will emotional resilience training pay the mortgage?

  • Increase in number of GP consultations has been 'modest', think-tank claims

    John Cosgrove's comment 04 Mar 2015 9:34am

    The "fact or fiction" headline is inappropriately provocative from a charity whose purpose is to provide evidence. The report sensibly acknowledges that there may well much work undertaken by GPs which they have not accounted for.

    I cannot see that telephone (and Skype/email, Mr Lamb!) consultations have been accounted for, and it would be difficult to do so.

    We also know that the number of prescriptions are spiralling. In my experience, the GP work involved in monitoring these can be phenomenal.

    It is also important to remember that if non-GP staff are undertaking work, this will place a burden on whichever GP is supervising them.

    I hope Nuffield Trust's next evaluation is reported more responsibly.

  • Sponsorship doesn't make a conference better - or cheaper

    John Cosgrove's comment 15 Oct 2014 6:26pm

    You must tell the secret to getting good wifi at conferences, Martin!

  • Add your name to Pulse’s letter to NHS England over GP workload

    John Cosgrove's comment 27 Jun 2014 9:17pm

    Dr John Cosgrove
    Midlands Medical Partnership
    Birmingham

  • Turning people into patients

    John Cosgrove's comment 06 Feb 2014 10:11pm

    Very well said, Martin. This campaign is exactly the opposite of what we desparately need. Yes, we need to encourage many to present not hide worrying symptoms. However, scaring the "normally well" can only increase competition for appointments and restrict access for those whom Medicine could help.