Secure environments GP
Clinical Lead GP in a secure environment. Former Forensic Psychiatrist. All comments in a personal capacity.
I can't remember the last I initiated a pregabalin or Gabapentin prescription. Don't think ever in a prison setting. I agree most GPs aware of the issues but it's frustrating with revolving door patients/prisoners back with same meds. One for shingles 7 years ago fully resolved but kept on repeat. Naloxone does not always work when on multiple opiates and pregabalin. I've taken patients off them at much personal risk and I do appreciate this is also difficult to do in the community as well.
Be wonderful for less patients to come into prison on GABAs, often started for dubious reasons. Then we "fight" to bring them off them, quite literally sometimes. Number of threats I get and time undoing the Cocktail of prescribed meds will be helped by community GPs knowing more about the risks etc
Anyone who has worked in a prison knows how staff come close to violence or suffer violence every day. You have to be hyper-vigilant and resilient. Some prisoners are very respectful, others are far from it. Much doesn't even get to trial. Have de-escalated some situations but trying to do this when a prisoner high on MAMBA or psychotic is scary as hell (even when makeshift weapons are not being held towards you, many objects in a clinic could become weapons). In the community it can be just as bad, and you are even more in the dark knowing even less about their risk profile. Some days are awful but you go back....
Some of us have been saying this for years. This poor doctor has been desperately mistreated and let down by an intolerable system stacked against hard working doctors trying their best in toxic underfunded NHS.
Good analysis Vinci.
There will be a catch, we will pay the money somehow.
18 months of complex negotiations can change a lot.
I was sitting in front of Jeremy Hunt at the Conference. Psychological and behavioural analysis of his eye movements and expressions was telling me a different story.
I've been a GP Partner twice, and never again thank you.
Of course, for some lucky ones it works, depends where you work as so many different practices out there with different management styles and financial risks.
The uncapped workload, unsustainable demands, general lack of respect and financial pressures are just not worth it. I have a life to live and a family to be with. Instead of working 12+ hour days, I want to see my twins grow up and have physical & emotional energy left for the family after a day's work.
The prisoners come out and register with community practices, so it's a knock-on effect if they don't get the care needed in prison. A bit like secondary care work shift, you will get loads to fix because GPs are "last man standing" when others have not done the work.
And by the way, few scary moments and close calls, but never been physically assaulted. GPs are in the most part very respected by prisoners, one said "thank you for working in this place... no one cares about us". Unfortunately, that still wasn't enough to counter-balance the expletives thrown at me that particular day...
Yes, good move, good fit for job in hand.
The Professor has contributed immensely in the past but his task now is to look at supporting the younger generation. Whilst his generation have massive pension pots, partnerships/practices run by low paid salaried GPs with just as massive clinical workloads as partners then he's on the easy side of the fence!
Grassroots GP in some practices, especially the inner cities or in practices that can't recruit are so busy and stressed they can't wade out of the massive swampy tall grass. And then there's weeds too (CQC, Unrelenting NHSE....)
Offer some practical help please.
Did I misread that 8% or 80%....
It's across 16 hospital trusts as well.
A moral dilemma. The NHS follows NICE guidance for nearly everything, treats self-imposed illness in smokers etc, wastes money on management consultants but infertile couples are denied access to 3 funded cycles.
I assume CCG voting Boards may be under-represented by individuals childless by no choice who would comprehend the devastation of not having a family. Wrong postcode no family.
Only one in five GPs thinks partnership model will still exist in ten years' time
They will be the GPs left without a chair when the music stops clinging on to a the partnership model to try and avoid some massive financial loss (eg property problem) if not.
If you are swimming with Sharks eventually you have to get out......
We've been saying this for years. How many GPs have to burnout, leave the profession or get hauled before the GMC and patients get poor care before someone acts on this situation in a meaningful way?
And if you go to a Red Whale update you realise how much more you should be doing, how more perfectionist you need to be and wonder how on earth this can all be achieved in 10mins.
BREAKING NEWS: Practices will be given a share of £30m worth of funding to cover indemnity costs over the next two years - as pledged in the GP Forward View.
The big print giveth, and the fine print taketh away.
Agree that's exactly the problem Robert.
Patient care is the last thing to go, after burnt-out GPs and partners earning less than Tube drivers and plumbers. It's demoralising.
Some very welcome aspects, but unfortunately not far enough to get me to return to mainstream general practice.
Demand and workload is still at unsustainable levels and I don't see the new contract would have a palpable effect. Incrementally maybe but we're still attempting to "turn a supertanker around in choppy waters".
The left shift of work from hospitals will continue without the massive funding increase needed to support this and crucially where will all the GPs come from?
That said it's great that sickness is finally reimbursed and now there will be full payment of CQC fees.
Zishan - this question has been posed and analysed by greater minds than me. An amount that makes you confident you are offering safe care and protecting your own welfare. A partner once bragged to be that he did 90 triage calls one morning. Ask him the same question. Frankly, the GMC should start offering guidance on this too. If you make a mistake, did you follow GMC guidance, NICE and other evidenced based guidance? Try making a medico-legal defence of lack of time to complete a reasonable clinical assessment and plan... it won't wash. I know roughly the workload rate that feels safe for me, no practice has ever complained on the rare occasions I've said I need a break slot or a fixed surgery length rather than an open ended one! Locums are not always there the next day to clear up loose ends or defer referral admin from the day before.
I'm a portfolio GP, run my own business doing specialist GP work in challenging high secure environments. It pays very well, I'm lucky to have the skills and training for this, most give up due to the stress and personal risks. There is no cap on hourly rates, 3x in last 4 years asked for uplifts and always been given them. I feel like a lawyer must do, respected and suitably rewarded.
When I do Community GP work to keep my general skills up I charge £600 a day and simply say I'll work like the partners do (within safe limits) If they do crazy days like 50 triage calls 45 face to face and 3 home visits I will tell them that isn't safe then set limits. That rarely happens as most practices want you to come back! I will never be a GP partner again working 12 hour days with expected superhuman stamina and crazy financial risks.
I will never be an exploited Salaried GP. I'm too old (44) and too committed to my work and highly experienced to see my efforts (blood, sweat and tears) unduly profit partners.
Basically we are all voting with our feet trying to find a balanced life, for some only way is locum work, moving abroad, going part time, leaving the NHS. I don't think the current situation is recoverable unless an absolutely massive injection of cash into primary care and stripping away all the nonsense bureaucracy. I dream.