Genuinely laughed at this Dr Peverley, good stuff.
We have had to take the drastic measure of only having on the day appointments, with very few pre-bookables, our DNA rate has freed up a minimum of 5 hours of appointments per month for about 6 months.
A big push on getting mobile numbers for SMS reminders has also helped, but of course the Department of Health has decided to stop funding SMS messaging - what a very smart move that is going to be.
I think this article sums up working in General Practice very well: http://www.huffingtonpost.co.uk/dr-zoe-norris/nhs-frontline-the-reality_b_6279784.html
Why was the 2004 contract offered in the first place - 1) no-one wanted to really work as a GP due to the poor conditions, something had to be done
2) Our OOH work was undervalued on purpose and it was a no brainer to relinquish it.
3) no-one thought GPs worked as hard as they did and no-one thought we could organis ourselves.
These things come round in cycles, feast and famine, feast and famine and no-one ever learns or takes heed of the warning signs early enough, even if they are well signposted warning signs.
Which part of my job am I to stop doing because of this lovely TLA (THREE LETTER ACRONYM) that I have to upload to CQRS? CCG meeting perhaps? Isn't only GPs leaving, plenty of really good practice managers leaving some of the best practices due to workload.
Discussing this with doctors dealing with falls patients and it is now clear that a fraility readcode is needed to stop patients over 75 being over prescribed medications for multiple co-morbidities when it may not be in their best interests to do so.
Reorganisation, reorganistion reorganisation. That's all we ever seem to do.
Can any new government afford to buy 10,000 GP practice buildings and pay for all the pent up sickness leave independant contractors are going to have when they become salaried?
GP contractors are the cheapest form of doctoring in the western world, with the best outcomes for overall £ spend.
Is this the start of a mass exodus?
The reason there is a recruitment crisis, is no GP I know would recommend any trainee going into GP land. Trainees will speak to GPs and quite rightly take evasive action to avoid becoming a GP having heard just how toxic an environment it actually is.
Solve the toxic environment and constant GP bashing and recruitment will look after itself, can't see it happening myself.
They are about to do the same with the fax service Hadrian, & it's a simple turn the taps off situation, no enforcement needed. The cost to government is huge but surely they can get something cheaper than the 2p a sms text message Vodafone were charging.
All this on the day that has revealed that it has been announced that: The number of patients visiting out-of-hours GP services has dropped by a third over the last seven years, according to a report by financial watchdog the National Audit Office (NAO).
No wonder we are overwhelmed.
How to square the circle of not being able to fill OOHs GP rotas, less people using OOHs and more people overwhelming in hours GP services. Is something starting to click Jeremy Hunt?
If the care plans are doddle to do, you probably aren't doing them right IMHO. I think the principal is probably fine, its the poor support and the constant change that is killing us all off.
If you truly want to make money at this, you need your phlebotomy and nursing team to take up the cudgels. No more letters booking people in, only for them to DNA. Your phlebotomy team have a captive market of people across their doors interested enough in their health to come in for a blood test, now is the time to get them interested in a Health Check too, if eligible. Make them walk to the reception to book in for the clinic, if they don't make it, they were going to DNA the appointment that phlebotomy could have booked themselves.
Then you get the results through the computer, do the risk calculations, don't do a 20 minute appointment for those with lower risks and who the Specification says you don't have to see again, send these patients a text for them to collect their results from reception.
Try this method, very useful for those looking overtime, if they can book the patients in, you can pay them the overtime, no bookings, no overtime.
Stop messing about with regard to the higher risk patients, get these into see their GP, it will have a bigger impact than the HCAs and Nurses will. Just my 2p that seems to have worked reasonable well. 20%+ of eligible patients seen two years in a row so far, next couple of years are going to be harder though.
How can anyone tell, without the calculations behind the payments. The bits of CQRS I can access doesn't show how prevalences are calculated, or any calculations. However bad QMAS was, at least you could get the figures on how the calculations were made.
We are not getting a quality premium because of accounting anomalies on specials something we as a CCG had absolutely no control over. The figures were a whisker out for a payout, but I think the CCG will have to whistle for it in the future, lots of work done and absolutely no reward, despite so much progress. The CCG goodwill account is now very empty at my practice.
They are having a laugh. Certainly wouldn't say I was in one of the happiest professions.
How can you have a contractual duty to offer online appointments when your appointments system isn't funded centrally via GPSoC. We currently have Informatica's Frontdesk and everything is a cost extra including online appointments.
While I welcome the removal of the stupidly high thresholds, which harmed patients (patients exception reported on first refusal, rather than allowing us to catch them later in the year), if we can't measure these items, we can't set up the recalls as easily and this will reduce the measurements taking place.
How does NHS ENGLAND taking £8million next year from our local area budget square with this announcement.
How does taking money out of QOF help practices either.
How does completing tenders for Public Health and soon to be Locally Enhanced Services help practices to bring care to their patients, too busy box ticking to concentrate fully on patient care.
You can't do more with less resources, no matter how it is dressed up. Continuity of care is not helped when your budget is cut and you have to do more box ticking.
Is the pressure too much, am I going potty? Surely this is already spelled out in - HYP003 (new). This requires that in those hypertensives aged <80, their last BP should be ≤ 140/90 from July each year.
Anonymous (1:49pm) The minor cut for OOH was exactly how valued the Government saw that particular service. The Government wanted to smash the Doctors Co-Operatives and open it up to a big business salaried service and they did this by undervaluing these Co-ops and introducing unnecessary bureaucracy they couldn't comply with and remain the organisation they were. The public and the rest of the NHS service are now reaping the rewards of this short-sightedness.
Just like the killing off of single-handed GPs the Government wants to kill off smaller General Practices via bureaucracy and tickbox exercises, which can really only be completed by bigger businesses. Now we all know these services will go down the route of OOHs & big business, is this really a wise decision?
Had exactly the same request to prescribe an orthopaedic boot (not on their formulary) for a long term inpatient. They all have their own budgets to think of - don't-cha know.