Huge problem as traded in prisons. There attempts there to phase them out is undermined by outside doctors not appreciating the problem and dish them out.
But there is a role for them. When I first went to Australia there were not available for pain at all. As a result there is an epidemic of prescribed opiate dependency.
I just wonder for the angry, personality disordered chronic pain sufferer who has had opioid and other dependencies, these drugs may act as a mood stabiliser and help in many ways. I have no evidence for that. They may not have the paradoxical aggression that benzos give, and clearly benzos drugs must be avoided above all else. Benzos, in making people feel invulnerable, cause crime.
At the moment there is no encouragement for NHS GPs to see patients. A good day for a UK GP is a quiet day. In Australia that is a disaster, if no patients then no income at all. So NHS has to consider element of Fee for Service or the private sector will fill that space...adding further encouragement for GPs NOT be rid of waiting lists. Indeed all UK private practice depends on NHS waiting lists, which was why Fundholding was abolished. The hospital consultants could not tolerate loss of private income so lobbied accordingly.
Time and Time again the NHS rewards failure. Those of us who invested heavily in computers paid to do so were punished and never thanked or rewarded as those who delayed did where in the end given them. The poorer practices who did not have basic equipment were again given them in the end, when we had paid for our scanners, spirometers, ECG machines, minor Op kit. Various schemes to help the "failing" practices just dilute the funds available to those who do the work and prepared to invest. This should stop, rewarding failure encourages it.
Until any patient can be seen that day in their practice, this problem will get worse. What is not understood that GPs will not need to work much harder to achieve this. Offering one or two more slots a day, and being flexible when there is flu or pre-holiday inspection syndrome about. Patients should be able to book months in advance. All it is needed it to clear the waiting list, that will be a bit of work, then prevent it arising again. The demand is NOT infinite. There are only that many patients on our lists. Make sure there are 5.5x list size slots available over the year.
Appraisal is good. Cannot scrap that, but it should be every three years. Once a year is pointless and far too often.
We gave up being resposible for out of hours damaged that profession and ruined our reputation. We gave up a monopoly on patient care. Turned us from professional to a trade, along with part time working. We are wide open to attack.
I ran a small grouping. OK and some economies and it protected small practices. These HUGE practices are quite different. They must draw the attention of the Competition and Markets Authority, since they impose a monopoly in an area.
I ran a small grouping. OK and some economies and protected small practices. But these HUGE large area practices are quite different. It must draw the attention of the Competition and Markets Authority, since it imposes a monopoly in an area. The success of General Practice as against hospitals has been because GPs were in slight competition and self employed so kept our costs down. This will be lost down the track. This will be a disaster for patient with nowhere else to go.
There is little wrong with the appraisal format. It just comes round far too often. Every three years would be OK and revalidation after 6 years. You could do a very short simple annual progress report (to help avoid last minute panic) to satisfy those who think it should be every year.
Why should NICE reflect current clinical practice? That is not what it is for. NICE looks at the evidence. Current clinical practice might not be right.
I have always thought that the suppression of sulphonylureas was overblown, sponsored by the makers of the newer drugs.
As it happens I found the GMC more pragmatic than the RCGP and GP-training COGPED. This institutions inspired much of the current burdensome apparatus. The thing wrong is that appraisals come round too often. Should be every three years, not annual.
The last guidelines were bad... no guidance at all, full of statements such as clinicians may consider this or that.
I did my own on call for 7 years and never had to pay such a premium. It's the profession's fault for giving up being responsible for out of hours that caused this split and extra costs.
The most successful part of the NHS has been general practice. Since NHS inception it was privatised or rather never nationalised. Hopefully any government would refuse to do such a thing and directly employ more doctors.
Working in Australia is just different. A change is always good. Both NHS and Australian systems have pros and cons. Astonishing thing is that whole layer of bureaucracy does not exist in Australia. No PCTs or commissioning groups. Those jobs do need need doing at all.
My experience overseas is on
You do not have to lose your position on the performers' list and will not need retraining on return if gone for more than two years. The main thing is to keep up with NHS appraisals.
How to do this is here
When I took MRCGP decades ago I felt that I had to toe a certain political line, and certainly follow an ethical stance that had been adopted and assumed as normal by its leaders. I learnt to tell another story.
Later I found that Fellowship By Assessment was designed by Fellows in large partnerships for such doctors alone. Anyone else was beyond the pale. That process is a little better now, but The College has had a similar malign influence of appraisal and revalidation. The processes the College imposes assumes that you are working in a trendy left of centre partnership, and if you are not doing so, you should be. Revalidation and appraisal for portfolio doctors is made extra difficult as a matter of College policy.
They do not know what they are doing, so convinced they are that they alone carry the tablets of medical commandments and good practice down the mountain.
It may be differing ethical views of the world is a cause of the failure rate.
Dr Gerard Bulger FRCGP FRACGP CCFP
NHS reforms and real cut in red tape costs were doomed to fail as soon as the government announced it and "culled" quangos. Instead of abolishing many, including PCTs they announced that the functions were being transferred to other organisations. The functions DO NOT NEED DOING AT ALL. There is no such this as PCT or Commissioning organisations in Australia, or anything like it. Its lovely.
Dr Kingston needs to get out and about and see Canada, Australia and NZ to understand he is quite wrong.