I wonder has anyone asked the patients if they are happy to accept being put at increased risk or indeed feel safe being discharged at increased risk. Will it be an informed increase risk discharge and has any one assessed how likely these patients are to ring 999 at 3am when they dont feel safe and if so what is the relative saving then ?
As they say "I pay my taxes" so how do you decide which patients are forsed to take greater risk ( accept poorer care) Will higher risk patients get a discount or will others be asked to pay a premium to avoid being put at risk . This may infact be the first step on every toxic pathway.
Home visits for those that truly need them; the terminally ill, frail house bound and nursing homes are a cornerstone of general practice. To farm them out to none GPs will be a giant step forward in producing a tiered system of care, resulting in more patients being sent to A&E. GPs should jettison all the additional none GP work being piled upon them first rather than condemning those in greatest need to a second class service . we will all be old or terminally Ill one day, is this really a system we would wish to be cared for by ???
Completely agree with the above . General practice requires having a honed skill of finding needles in haystacks . In order to 1st identify the needle it helps to have seen one previously,which is what occurs during specialist rotations. E.g.In 25 yrs of practice I have seen the rash of meningococcal septicaemia 3 times thankfully all in the hospital setting.
There is also a danger that if GP training is solely in general practice a bigger schism will develop between primary and secondary care, both believing the other doesn't understand the pressure on them . Just as secondary care trainees benefit from time in primary care, future GPs benefit from appropriate placements in secondary care.
Just a suggestion , why not make being a GP more attractive and then you would be able to train and retain more ???
As far as I am aware pharmacist aren't trained to diagnose .No diagnosis = no management plan = high risk = see your Gp .
Have any pilot studies been done to see how many sore throats / coughs / rashes / insect bites initially seen by a pharmacist dont consult a GP for the same episode ?? if so would make an intetesting read . if not why are we investing £14 a consult. I would gladly see 1st presentation minor trivia for £84 / hr before the patients have been given unrealistic expectations by someone else.
The highest possible standard of care is provided by doctors. PA that cannot prescribe , cannot discharge and cannot take legal clinical responsibility are just a way of increasing numbers on paper. In reality a Dr being asked to prescribe for or discharge patients seen by PA actually need to see the patient in order their actions are defensible , so where is the point and where is the time or financial saving in that . The useful roles of PA is very limited unless they take on clinical responsibility for the entire patients care . if already evidence suggests this is high risk then why persist and why be a PA? train as a Dr and get paid more to run the same risk and provide lower risk care .
just because they go to medical school doesn't mean they will be practicing in the UK 5 yrs post graduation. So in a decade that has seen the number of elderly increas, the number of chronic illness increase and an obesity epidemic we have effectively bee training less Drs to deal with it.One would suggest suggest the horse is already half way to Australia and these poor lambs will be left shovelling rose fertiliser.
Bonza idea . I am sure young Ozzie Gps will be tempted to come . They will stay a year, travel the sites of Europe , realise just how blessed and well paid they are in Oz and return home . There is a reason why there is a flow of drs from the Uk to Oz . it is the same reason why any Gp over the age of 50 can't wait to retire .
This could increase Gp numbers and will fit well in a depersonalised conveyer belt system lacking continuity and using a salaried model .
NHS recruitment in general is becoming more unethical. it is not just the poaching of Drs from Ireland to England that should be of concern but the general wholesale poaching of health care staff for resource poor countries. Many Drs are now being brought in from Africa, from countries who struggle to provide even the very basics of health care for their populations.what then happens to those populations ?
If medicine had not been made so unpalatable we would not have the retention andrecruitment disaster we now face. we should not try to solve our problems by worsening those in countries with far less resources and who's people have a quieter voice .
Would you want to he registered at a practice with 30 000 patients ?
In resource poor countries primary health care is delivered by non-Drs. This model proposes a Gp lead rather than Gp delivered service. Clever spin as essentially it is proposing a system in which a patients chance of seeing a Dr become more and more remote.
Will it be cheaper , probably not as the general public generally want to see a Dr and if all else fails achieve this by presenting at A&E . And also generally not, as the chances of actually seeing someone who knows your history is unlikely . That is even before considering where the 120 GPs will come from , presumably not home grown . Gp does benefit from scale . small scale,for primary consultations by highly qualified Drs in practices where patients can get an appointment in a timely fashion with a Gp who can follow them up appropriately .
Patient demand now significantly outstrips GP supply and so a dilution of the system is inevitable .To spin this as a positive is deceptive .It is a shame the 35M couldn't be found years ago when it could have supported high quality healthcare instead of buying high quality veneer for a system descending to failure.
so the indemnity bodies now define ooh work, amongst other things as 111 having the ability to book appointments directly . If for his criteria remains does this mean all work will essentially become ooh for insurance purposes ?
what a common sence article. Sadly such outdated thinking has been overtaken by no win no fee Lawers and the upsurge in low risk ' cover your own bottom' practice; the worst case scenario health messages put out by main stream media creating a " better to check dr" neurotic society and the obsessional, glamorisation of being a patient in the endless TV soaps and fly on the wall documentaries.
We knew a flu epidemic was imminent but I have yet to see one public health message on peak time TV telling people en mass how to care for themselves rather than getting worn out gps to do it on an individual basis .
As the NHS sinks we need more collective, mass messaging not less ie a cohesive public health approach. cutting the public health budget just shows how little our overlords understand or highlight the fact they are sailing a completely different course.
I thought malaria prophylaxis was a private prescription? if you can afford to travel to a malaria area can afford the prophylaxis.
so approx 1 in 4 patients contacting the 111 non emergency number are deemed to have a life threatening emergency requiring immediate A&E treatment . Really ???? and then they wonder why the system is breaking .
Is it because the app doesn't have a bottom and so doesn't need to cover it that it is happy to make less referrals to GP ???
The biggest problem the NHS faces is " no one wants to be one anymore" ; be it nurses, midwives, GPS or A&E dr. Med school places now go to clearing . Not sure which bit of this Mr Hunt doesn't understand . No staff: No service . You have broken us and it irreparably. The NHS isn't about numbers it is about people.
we have gp front door streaming . costs a fortune and redirects very little . only works if highly experienced gps who are willing to manage risk stream and are able to redirect patients back to see their own gp in a timely fashion. patients come to a&e because can't get gp appointments and gp send patients to a&e as hospital has no beds for direct admissions . absurdly pointless. expensive time consuming steps added . quality added =0
The problem in a nutshell:noone wants to be one anymore. A profession of the newly qualified, in a system alien to our own will certainly increase the numbers but will do absolutely nothing to maintain standards as no one left to mentor and support them and so the trend of offloading onto A&E will continue and increase so hastening the demise of the nhs
At what point do we stop trying to increase supply, which frankly, is never going to be enough and start addressing demand . this is where the warnings need to be . massive media campaign to realign patients behaviour with frank warning if this does not occur the only recourse will be to charge for gp appointments.That,I believe would fix the problem very rapidly. similar rapid improvement would be seen with the instant scrapping of the 111 service.
And that is what it will do, address the numbers . what we need is high quality, well trained , fluent in both the English language an British culture. Not making up of the numbers which causes increase pressure through inappropriate out patient and a&e referrals .
Do they really think good quality Aussie GPS will give up their high earnings and balanced lifestyles to work in the NHS.
Madness. We have a gp crisis. We have a demand crisis . I work in one of these scenes as a streamer and a gp and now commonly here" I couldn't get a gp appointment for today so I have come here" . " I have been referred to a specialist but the appointment isn't until next month so I have come here". " My no surgery had no appointments so told me to go to the wic and the nurse has sent me up here"
It doesn't get existing inappropriate attenders out ,it Hoover's in a whole new cohort.
For doing all of this work I get paid significantly higher that the local locum rate, which is less than £80 an hour and would have a significant pay cut if they bring in the £80 cap.
Does the scheme solve anything : no as the problem is a gp staffing crisis locally + unrealistic expectations + growing waiting lists + a"better to check " mentality = unsustainable.
Getting GPS to record obs and take a quick streaming history at huge cost is pure futility and setting up as a gp in a&e just allows patients to be seen at huge cost to the nhs instead of waiting the turn in failing gp land .
Put the money into patient education gp education and funding gp land and you might get somewhere.
In my experience only a very small percentage of these patients are fully sorted and the vast majority are directed back to their own gp for review of their ongoing / chronic problem they either wanted a second opinion on; had been told there was no appt for at their own surgery or just thought the best outing on a cold and wet easter weekend was their local a&e.
Sort out the funding Staffing crisis in GP and this demand disappear. Just a thought .