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Gold, incentives and meh

Secure environments GP

  • Devon GPs' 'don't come to us' leaflet didn't go far enough - so I wrote my own

    Secure environments GP 's comment 04 Dec 2014 2:01pm

    NHS England Area Team are meeting with the practice today, so I gather, so we shall see what happens next.

  • Devon GPs' 'don't come to us' leaflet didn't go far enough - so I wrote my own

    Secure environments GP 's comment 04 Dec 2014 12:43pm

    Meant: Why "shouldn't" we be permitted to educate patients and this includes guiding our patients to self-refer to certain selected services?

  • Devon GPs' 'don't come to us' leaflet didn't go far enough - so I wrote my own

    Secure environments GP 's comment 04 Dec 2014 12:40pm

    Fabulous..Too much is expected of GPs, who I feel sometimes are expected to do all those roles you mention (well perhaps not exorcisms).

    There needs to be boundaries set. A practice attempting to set sensible boundaries, guide patients to use more appropriate NHS resources is correct and proper. In fact important for delivery of safe and effective services for those who "need" them.

    Why should we be permitted to educate patients and this includes guiding our patients to self-refer to certain selected services?

    I currently work a 12- or 13- hour day, amounting to 40 or 50 patient contacts, visits, as well as letters, prescriptions and so on. I work until the job is done. I try and set limits, but frequently when I do so patients get disgruntled if I ask them to rebook for the 4th and 5th problem.

    General practice is being "broken" by underfunding, by overworking NHS staff, bullying by the Press, unreasonable expectations by the public, by clinician burnout, early retirement and emigration. What is to replace it?

    £73 per year per patient can no longer fund comprehensive care for a year, all you can eat, unlimited appointments etc. The model must change.
    ( As an aside, it costs me £430 a year to insure my dog, then there is a 20% copayment because he is is old ! )

    So some exhausted Clinicians have been pushed past their limits of human endurance and are dis-engaging whilst the Govt and NHSE over-regulate, impose change and yet more re-organisation.

    It is to be applauded when a practice takes an overview of local services and its own capacity and takes steps in overcoming organisational barriers to good medical practice.

    They are responding to patient Unmet need which of course is an inevitable consequence of a unprecedented funding squeeze for years.

    They are responding to risks of "getting it wrong" for individual care by understanding about the environments from which complaints arise.

    They should be assisted and supported by NHS England to help them overcome the challenges they face when difficult choices must be made about practice funding priorities.

    It is so sad that this needs pointing out so bluntly; that overloading GPs is unsustainable. Failing to attend to the needs of one group of patients (doctors) does nothing to benefit the wider population.

  • 'I cannot sit back and watch an attack on our profession'

    Secure environments GP 's comment 29 Nov 2014 10:55am

    Totally the right stand to make and action to take including permitting this article. Well done. More brave GPs needed.

    I dare not comment anymore than this out of specific fears.

  • Practices to offer routine Saturday appointments in £810m a year bid to reshape general practice

    Secure environments GP 's comment 27 Nov 2014 8:25pm

    Now I feel like I want to comment. I could see where this was heading right at my first post and it has "played out" as expected...

    In my view General Practice needs stability, getting well and "consolidating wellness" before yet more change. If it works don't break it, and it was working up until about 4 years ago. GP is being "broken" by underfunding, by overworking NHS staff, bullying by the Press, by inevitable burnout, early retirement and emigration. What is to replace it? We are being manipulated on a grand scale. If WE do not have a plan for the future, it will be forced upon us. Look what Theresa May said to the Police:

    "If you do not change of your own accord, we will impose change on you."

    So exhausted Clinicians are dis-engaging whilst they impose change.

    I think the personalised criticism of Clare is unfair. At least Clare is engaging, trying to nudge the steaming ship a little. She "happens" to works in London, so what, I have no doubt she genuinely does best for her patients and salaried staff. The most she could be accussed of is being a pragmatist and a realist who is therefore not being adequately understood or listened to.

    It is sad and unfortunate that this "super-federated model" is a step towards privatisation. Do we take a steer within it? Or keep jumping off?

    £73 handed over to a "corner-shop practice" can no longer fund comprehensive care for a year, all you can eat, unlimited appointments, Saturday mornings etc. The model will change. Private Providers may loss-lead for a while then their shareholders will see the long-term gains. They will have more clout than the BMA & GPC to ask for more money from the Govt. After giving them £9billion of NHS contracts first (see link) they will give them a bit more within the "financial envelope" as we sink further freeing it up for them. United Health Care (Simon Stevens buddies) will have difficulty running to budget as we are finding, the tax-payers flow of money stops. Then the public will pays through co-payments, private health insurances and the like. Main-streamed. NHS no more. We've already gone.

    http://www.theguardian.com/society/2014/nov/19/private-firms-nhs-contracts-circle-healthcare-bupa-virgin-care-care-uk

    At least Clare is trying whilst the target is moving.

    Recover, Consolidate first. Buy us some time. Perhaps, the Voters will have more say at the May Election this time around. Pulse comments are representative opinion, not just of a vocal few, up and down the land the conversations are similar without the "pulse moderation".

  • Practices to offer routine Saturday appointments in £810m a year bid to reshape general practice

    Secure environments GP 's comment 27 Nov 2014 10:44am

    No comment....(again)

  • Hunt: 'I took my children to A&E rather than wait for a GP'

    Secure environments GP 's comment 26 Nov 2014 10:20pm

    Hunt: "Freddie Starr ate my hamster"

    Hunt: 'I took my children to A&E rather than wait for a GP'

    Do I believe either of these headlines ?
    Are they likely to be true?

    This is probity test for his Revalidation... sorry Re-election...

  • Hunt: 'I took my children to A&E rather than wait for a GP'

    Secure environments GP 's comment 26 Nov 2014 2:09pm

    What I also don't understand, as Mr Hunt said he ""didn't want to wait" for a GP (so whatever it was routine not urgent). However, it is extremely unlikely he would wait 4 hours for an OOH GPs appt or a Walk-in-centre appt.

    Backfired on him, this has somewhat...

  • Hunt: 'I took my children to A&E rather than wait for a GP'

    Secure environments GP 's comment 26 Nov 2014 1:02pm

    He never fails to come out with utter rubbish of political opportunism or complete lack of understanding of the health service.

    Secretary of State for health attending A&E inappropriately is a waste of public funds.
    It costs the NHS £110 for every A&E attendance, whereas for £73 you can attend my practice for comprehensive care for a year, all you eat, unlimted data plan (sorry access to a GP free at the point of abuse).

    Has he really not heard about Out-of-hours GPs? Mr Hunt, my full time 12-13 hour days are enough Monday to Friday. If you "want" or force me to work weekends doing routine work at my practice I will clear off quicksmart to Australia (already thinking about it).

    If I had been the SHO / Registrar in A&E seeing him, the conversation would have gone something like this:

    Clearly, viral infection in a child.
    "Mr Hunt, Is this an ACCIDENT (said slowly) or AN EMERGENCY (said if in slower)?"
    A&E does NOT mean "ANYTHING & EVERTHING"

    Have you attended the OOH service or rang 111 before pitching up here, waiting 4 hours and doing a patient survey whilst you waited?

    If the Secretary of State for Overseas development decided to steal from the petty cash or misappropriate money from a Charity meant for Third World Countries, we might be calling for his resignation....

  • CQC's risk assessment of GP practices will 'demoralise an already shattered profession', says Burnham

    Secure environments GP 's comment 18 Nov 2014 7:00pm

    Good catch from Pulse Team, saw you nail him Joe as he came out the room, but it was an easy political opportunity for him.

    CQC lady's talk was called:
    "CQC inspections: Driving standards through ratings" - she was late starting as she lost her PowerPoint slides. No USB data.... I gave her a Band 1 before I even heard her speak.

    And she went out saying this.....
    "I never like ending on special measures" I kid you not!!

    Meanwhile in Leicester, The Press are cold-calling practices. LLR LMC just released this statement which might help if your a Band 1-2 and get press calls.

    "We have learnt today that the Leicester Mercury is going to publish a list of surgeries and their ratings from the CQC IM Data"

    We are concerned that there will be unnecessary worry for patients and carers caused by the premature publishing of data from an untested monitoring tool. We fully expect that practices labelled as ‘potential high risk’ will have this confounded by good and satisfactory inspections in most cases.
    The Intelligent Monitoring data is not without its inaccuracies and this is something that the CQC recognises and accepts. The CQC also accepts that the IM data provides nothing more than a snapshot insight into the practice and in for some of its measures is outdated by 18 months or so. It is important to stress that the risk score is no way reflective of the care being provided by the practice but rather a simplistic means for CQC to identify and generate its practice visit schedule. There may be very good a reason why a practice is deemed an outlier and this is not reflected in the risk score that is generated. Is it surprising that a University practice has lower than the national average of end of life care plans? It is important to be clear; this is not a judgement on the practice or the care that it is providing and it important that patients or any other body do not misconstrue it as such.
    The Local Medical Committee is working closely with the CQC, NHS England, the Clinical Commissioning Groups and the practices we represent to improve practices facilities and services.

    The LMC looks forward to supporting the CQC as it develops and improves its monitoring tool to ensure that in future there will be a fair and balanced view of primary care in the area.

  • Doctors 'to be scapegoated' under GMC fitness to practise plans, says Gerada

    Secure environments GP 's comment 10 Nov 2014 2:32pm

    Reading this article and the comments just leads to ask more questions....

    Just what is the threshold number of mistakes we are "allowed" to make in 7,000 patient contacts per year as a full time inner city GP for example? (I'm a rural GP by the way). Just what is our individual responsibility and threshold to raise concerns when there are increasing barriers to good medical practice not of our making? If Jeremy Hunt was a Medical Director Doctor I suspect we should have reported him to the GMC a long while ago.

    10.07 insightfully and perfectly stated.

    And from 10.34 - As you say "Unfortunately we need to factor in we are heading towards a very defensive approach to all parts of our practice"

    It becomes almost impossible to maintain this defensive approach under current pressures of under capacity of clinicians, and for example if we are to hit targets, refer less, follow a deluge of protocols and guidance missives, diagnose dementia for £55 etc

    Dr Margaret McCartney states quite rightly "GPs cannot safely see 40 or 50 patients a day, with two or three problems each, and not slip up. If the GMC can’t recognise this, we need a regulator that can." I know that needed saying but what difference will it make?

    In my opinion the GMC are coming at this from the wrong end. How about taking action on the grounds of:
    1. Overcoming organisational barriers to good medical practice.
    2. Patient Unmet need becoming an inevitable consequence if unprecedented funding squeeze for years.
    3. More understanding about the environments from which complaints arise.
    4. A need to ensure that doctors have tailored support to help them overcome the challenges they face when difficult choices must be made about practice funding priorities.
    5. An acknowledgement of genuine mitigating factors when things go wrong. (Mental health problems are triggered by work induced causes "in the main", financial pressures, currently some GPs can hardly take much drawings, It is just a bit distracting when you can't pay your mortgage etc)

    Can someone (anyone) be able to find out what the delay is in release of the GMC report in deaths of doctors under investigation?

    Under Article 2 of the European Convention on Human Rights, public bodies must account for their actions if they were either involved in a death or there is a question over whether they could have done something to prevent it from happening.

    We are far from being treated equally under the law. Quite the reverse. Neither the BMA, GPC, RCGP or Indemnity organisations have made any progress in relieving doctors from the multiple jeopardy we experience. Doctors are being held to an ideal that is unobtainable.

    There are risks of excessive working hours by GPs on patient safety. There are many cases where the GMC should not blame the sick doctor but the failing NHS instead please.

    There is evidence base to improving doctors lives not keep us in a state of constant pillory. See Warwick Uni research:

    http://po.st/NmX1VN

    Professor Oswald said: “Companies like Google have invested more in employee support and employee satisfaction has risen as a result. For Google, it rose by 37%, they know what they are talking about. Under scientifically controlled conditions, making workers happier really pays off.”

    Dr Sgroi added: “The driving force seems to be that happier workers use the time they have more effectively, increasing the pace at which they can work without sacrificing quality.” (+ patient safety )

    Dr Proto said the research had implications for employers and promotion policies.

    He said: “We have shown that happier subjects are more productive, the same pattern appears in four different experiments. This research will provide some guidance for management in all kinds of organizations, they should strive to make their workplaces emotionally healthy for their workforce.”

  • Mr Hunt meets his named GP

    Secure environments GP 's comment 08 Nov 2014 5:11pm

    I've been laughing for days after reading this! Also forwarded the transcript to every GP in my contact list. Priceless.

  • Boosting practice funding will worsen salaried GP recruitment, claims NHS England

    Secure environments GP 's comment 07 Nov 2014 3:46pm

    I am ready and willing to sign.

  • Boosting practice funding will worsen salaried GP recruitment, claims NHS England

    Secure environments GP 's comment 07 Nov 2014 11:45am

    No surprises, more divide and conquer. When are they going to realise the 1% funds small businesses trying to deliver safe and high quality care for NHS patients (=voters for the Govt)?

    Expenses have skyrocketed and years of cuts are the reality. Low morale and burnout, practices at risk of closure, some GPs cannot make ends meet with practice finances (& their own personal finances) and have heard some partners not having drawings for months.

  • In full: NHS England and DH on why GPs should be given a 1% funding uplift

    Secure environments GP 's comment 07 Nov 2014 11:11am

    No surprises, more divide and conquer. When are they going to realise the 1% funds small businesses trying to deliver safe and high quality care for the NHS patients (=voters)?

    Expenses have skyrocketed and years of cuts are the reality. Low morale and burnout, practices at risk of closure, some GPs cannot make ends meet with practice finances (& their own personal finances) and have heard some partners not having drawings for months.
    What is this nonsense that GPs are personally going to get a 1% pay rise? Pigs are flying around Westminster and The Daily Mail Offices....

  • How we offer patients access to their records

    Secure environments GP 's comment 06 Nov 2014 8:04pm

    My hands are up ... I was a convert initially and the practice I worked at back then started using this system from 2007 until I left in 2013. I heard many of your talks at various conferences, dazzled , I was a groupie. I still respect all this work, effort and the aims intended. I write this carefully.

    This is now the worse possible time to have enormous amounts of work foisted upon on us. Mark my words "this will be a disaster right now, will tip us over the edge" (if we're not there already ) and The Daily Mail will have a field day. I was full of energy, the vigours of youth so I found time driving this forwards past all the hurdles back then. There is no slack in the system to roll this out nationally right now. It may well triple our Indemnity insurance in an instance as we will be unearthing all manner of incorrect until proven otherwise, misunderstood or irrelevant info. They will be test cases for damages to feelings, practice managers will drown in this work; direct complaint emails to the gmc about recording info a patient told us not to and such like. Use your imagination.

    I spent an hour a day checking notes for 3rd party data or other harmful info. Frankly in some cases I felt I was not helping a patient for them to, for example check their CXR showing a "shadow" at 2am.

    Even showing only coded info in the summary most complaints and queries came as follows eg:

    "I had my hysterectomy in 1963 not 1971"
    "I've made an appt doc because you said I was "born by Caesarian section", I was a normal birth but I did "deliver by c-section" 3 years ago"
    "My basophils and eosinophils counts is zero, do I have leukaemia?"
    Email from patient: "all my operations are coded as done in 1897" reply "yes it's a known technical fault unfixed for the last 3 yrs, thanks for pointing that out"
    "I've made an appt to see you as my father/mum/boyfriend was looking over my shoulder when I was checking my notes. They saw I'd had 3x TOPs and Chlamydia when I was 15. I'm in deep trouble now...."
    "My ESR is 45 and you marked it as normal "
    "I don't understand it, can I have a translation ...also Into Polish/ Arabic (any language) etc

    Not to mention those who will be harassed by significant others to reveal their easily accessible medical information on an iPad in the living room. There are serious risks to vulnerable adults here.

    In a small pond this was and is a laudable experiment. Problem will become a very serious one in April 2015...it will not scale up. I want it to but it won't. Dave.

  • Trainees 'shun partnerships' in favour of locum work or emigration

    Secure environments GP 's comment 06 Nov 2014 6:19pm

    Politicians have very short memories and they obviously fail to recall that the reasons us GPs negotiated a new contract in 2003 was because THERE WAS A CRISIS IN RECRUITMENT.

    I think they will find that was a windy day compared to the storm that is coming....

  • Trainees 'shun partnerships' in favour of locum work or emigration

    Secure environments GP 's comment 06 Nov 2014 1:59pm

    Australia calling GPs - at 2am - here is tempting email I got only this morning =

    Good morning Doctor Barrett,

    Please do let me know if you have any queries on GP locum or permanent work in Australia.
    We have some excellent opportunities for MRCGP General Practitioners to come across and enjoy Australia’s outdoor lifestyle while working in a world class medical system (which isn’t too far removed from the one you know), and to earn well at the same time.
    Please do let me know if you would like to find out more.
    Sincerely,
    Dave Bell

    Speaks volumes doesn't it...

  • Trainees 'shun partnerships' in favour of locum work or emigration

    Secure environments GP 's comment 06 Nov 2014 12:53pm

    I am a Partner half the week, portfolio GP, Locum the other half - edging my bets !

    I don't at all think my situation is unique, but have worked at 50+ places across all of the Midlands (WiC's, OOH, Hospitals) in 18 months between leaving and joining another partnership, now settled again. It has given me some insights that I hadn't quite expected.

    It has been very sad seeing practices lack of capacity even when all GPs are at work, let alone those where doctors are off sick, burnout, practices where GPs have just emigrated (one where a GP had died).

    Sad to see patient's complain about their practice and the service they get, about having to see "just the locum" because it takes 3 weeks before they can see their usual doctor, some so upset that their GP has retired early, reduced their sessions etc

    To see it and live it, being able to lend an ear to Practice Managers and GPs, I have come away rather concerned frankly and frustrated seeing good caring doctors pushed passed their limit.

    I suppose I look to leaders - GPC, RCGP not seeming to have the disposition for the grandstand myself. Desperate times and we must all find a way to contribute, at least to improve our lot in each locality, groups of us meet and talk, make useful step forwards. Get out of our "Silo-mentality" working 12 hours a day in our practice Prisons.

    People like Dr Clare Gerada are few and far between with this same agenda of giving the opportunity to engage more GPs and wider practice teams.

  • GP practice facing closure rescued by £100k bailout from NHS England

    Secure environments GP 's comment 31 Oct 2014 11:16am

    Is it any wonder we cannot attract GPs let alone Partners? No hospital manager, Consultant risks any more than his job, in GP land the partners risk everythng including their family home, personal bankruptcy etc