Surely David Dalton as a CEO had a vested interest in getting the best deal for trusts, which may explain why so many other CEO's distanced themselves after the imposition. What needs to be publically declared is how much the NHS costs to run when everything is "free". There needs to be public consultation on what is affordable and what is not. I had to send an anxious father away without Meningitis B because his child was born two months before the campaign started. At £75 an injection he will struggle to afford it privately so I advised him to challenge his MP on the decisions of his government.
Why is no-one asking the question who in their right minds rejects a 13.5% pay rise??
It is insulting to claim that vocational professionals have been misled by the BMA. The problem is not the junior doctors but all the other staff technicians physio's Ot etc that are not routinely available at weekends. The reality is the country cannot afford a 7 day routine service.
Crude measurements and criteria to decide vulnerability. Decision made by people who have little understanding of the way Primary care works or is funded. Every practice is one retirement/sickness away from becoming vulnerable. The business model is not fit for 21 century General Practice.
"GPs vote to axe care home visits"
How was that distilled out of the conference to run as front page news?
Already had a patient in to check I will still be caring for their relative!!
Darker forces at work?
The reason it is an issue is the payment system. Block contract for GP services so push as much into it and pull the 'patient first' card when resisted. Payment by activity in A+E which costs the system, but, stop the flow and hospitals lose their trump card. As a A+E reg in the late 90's I stopped patients registering at A+E if their problem was not urgent. I was hauled into the managers office a week later as numbers had dropped and told their funding would be cut. I had to let them register then send them to their GP's. In those days however it was much more of a joined up service where GP's and hospitals worked together, rather than competed for funding. We need to stop using patients as a weapon to beat each part of the service and start providing the most appropriate care wherever the patient presents.
Is the tube strike still going ahead?
What impact will this have on the GP and Consultant contract negotiations on 7 day working? Currently there is Challenge fund money and the Transformation money which was meant for premises upgrades to help fund the pilots. Once 7 day working is established will it continue when the funds stop and who will be responsible?
Sadly there is the misconception that the public voted in a government on their health policy and as such believe they have a mandate based on what was in their manifesto. I doubt many people read the manifesto let alone voted because they would get 7 day access. It would be a better use of all the vanguard and PM challenge pilot money to actually ask the public what they really want and are willing to pay for. Seeing a GP at the weekend is not the same as seeing their GP.
I would love to have that trick of spending the same money several times!
It is clear to me now that there is a paucity of understanding how primary care works. Using crude counting or spend to judge the quality of care is flawed.
It is also clear that the direction of travel is into super practices with a predominantly salaried workforce.
How can the capital investment be changed to revenue before it had a chance to be spent or was it always just a sound bite?
This problem goes right back to 1948 and no-one has been brave enough to resolve it adequately. There is a wrongly held perception which I have heard from MP's that GP's are having their mortgages paid by the state. The commercial companies who want to invest in the NHS premises are struggling to engage with the Service probably because of the lessons learnt through the PFI debacle. If the Secretary of State owns everything it would suggest he would be responsible to resolve this issue, or would his Sir Humphrey advise him it would be "too brave"?
The closure of Curry houses gets more column inches than closure of GP practices! There is a shortage of cooks so two restaurants are closing every week! How long will it take to retrain as a chef?
The strength and weakness of general practice is the fixed list responsibility so are the fixed point in the health and social care system, which also encompasses education employment insurance housing and public health. The strength is the relationship and respect from the community served (not the popularist press). The weakness is the buck stops at the surgery as you can't discharge a patient and the responsibility remains. What needs to be made clear is what GP's are responsible for as there is no absolute clarity. Succession of new measures to improve workload by getting Paramedics or Pharmacists or 111 to help just seems to put more urgency on the GP to see and take the responsibility.
I love the job and am fairly strict on boundaries so don't absorb everyone else's problems, but honestly would not encourage my children to do it.
If closing the gate after the horse has bolted was a sport the UK would be world champions! There is no joined up thinking at ministerial level because of the competition between the Ministries to look better than their peers. It is also a great way to pass the blame! Not immigrations fault that health gave them EHIC cards, not health's fault for letting them in to get them that was immigration!
The solution is to commission better and stop buying poor service. Need more than one regulator to cross reference and prevent complacency but they need to be accountable and not just finger point. Health is imprecise and regulation won't prevent every mistake. We have a knee jerk reaction to close the door after the horse examples Shipman Mid Staffs etc but never learn how to implement the learning at pace and scale.
I believe British General Practice, done well, is the best job in medicine. It combines all the problem solving intricacies with long term relationships and the job satisfaction can be fantastic. I was visiting a care home and introduced myself and was kissed on both cheeks by the matron because 10 years previously I had saved her son's life by spotting his AML behind his presenting toothache. It allows me to treat patients without being concerned about my income as I am paid a capitated amount and so only see people because I need to not because they are paying me. The business model is all wrong to attract anyone into primary care. The risks are great compared to salaried in hospital. Personal indemnity rather than Crown, buying into the business where someone else controls the payment mechanisms and has an almost perverse rational for changing it to save money in another part of the system and expect GP's just to absorb it. A pension scheme where I have to pay the employer and employee contribution at a rate determined elsewhere and an increasing demand for services that are not funded. Vilification in the press for missing a cancer diagnosis when only 1/1000 consultations may be a cancer and then MP's joining the band wagon saying it is to reduce costs as we have control of all the money! If only! The independent contractor status allows for challenge and refusal to blindly follow any central dictat, or try and fulfil political promises to get a gong!
The role of the GP is so fundamental in society as the focal point of all health and social care. With the fall in students applying to medicine as a career and even fewer applying to be GP's the country will miss the corner stone of the NHS when it has withered due to neglect.
GP Partner (former Chair ESCCG)
I worked in a 24/7 clinic in Darwin Oz and a patient complained because I was the wrong GP at 4 am in the morning!! The one they wanted was known to be liberal with his prescribing of controlled substances and believed every sob story!
There is no solution because no-one has asked the right question. Patients want their family GP who they know and trust not just anyone. The politicians have not worked out how to fund that model. GP's are cost effective because they are more comfortable with risk. These pilots are nothing new and yet we persist trying it again but calling it by another name and then wondering why we get the same answers!!
Primary care has never been commissioned properly it has grown organically since 1948. The then Govt did not think they would need primary care so didn't stuff their mouths with gold like the consultants. The issue is the patients like primary care they want a fixed list with the relationship built up over years but you can't put a price on it and reward it appropriately.
25 years ago I was interviewed by Sky News and was quoted as saying my only choice was to go to Australia, so this exodus fear is not new. The influx of overseas trained doctors is because of the stranglehold the colleges have over training and the poor forward planning to know what will be needed. I was accused of misogyny in 1985 when I pointed out that 60% of my year was female and that they would be having children and working part time so we needed to train more to meet the work force plan.
It is up to the profession to provide solutions not throw the baton of blame.