Knowledge is Porridge
GP in North Devon, likes to surf (obviously)
Seems like the retrospective audit will find 75% of hospital deaths could have been anticipated, with 50% being cared at home instead. All the gift of hindsight of course. So the anticipatory care is excitedly dumped on GPs, but the real world prospective outcomes are rarely as planned, many patients and family bewildered by the intrusive requests to plan their death which is then signed and pinned to the fridge door to confirm their expected demise.
District nurses in panic, patient dying at home with syringe driver, but doesnt want a DNR form. What if she dies? They would HAVE to do CPR...
Of course they wouldn't, but procedures and pathways for end of life care are a risky business. Is the reSPECT the thin edge of the LCP wedge? (Yes) Will it make our country a better place to die? (No)
Reasons why I will shorten my GP career:
* Referral management
* Indemnity / litigation (partially fixed!)
* Workload / staffing
I think fixing appraisal is the most important as it would cost nothing. Referral management could be brought back into PCN's so at least we could ration our own referrals with peer support rather than being shafted by every rejection. The CQC seems to be getting more reasonable with time (and they are starved of funding and left firefighting).
None of this would encourage a new GP to be a partner?
How can the RCGP support appraisal?
What planet are they on?
I really just dont get it.
We have been worried that the new pharmacists, paramedics, physicians assistants will be roped into some new open ended project, as yet unclear and with limitless demand.
This shows we are simply trying to reduce GP workload and make our jobs sustainable.
Lets get appraisal sorted, which is a huge cause of burnout from my perspective and then GP really will be attractive.
I briefly worked with prof Gregory a few years ago, gets my vote by a mile...
i've no problem where pharmacist, nurse or practice manager becomes a partner and shares the work, reward and risk, but where local practices have been "saved" or taken over in my patch, very generous uplift for "transition" has been payed.
This may be a good time to threaten to close (and push for better funding).
Of course this creates more inbalances in GP funding, on top of a system which leaves everyone with some grievance about how they are paid.
Some valid concerns, but ignores many positives:
- Indemnity paid is good.
- Networks have reason to think about collaborate patient record systems which could be very helpful and reduce data churn.
- Extended hours not a problem if blended into improved access rota which is shared in our patch and well paid.
- Promise of front-line help by new clinicians (giving us hope that we can survive despite dwindling GP numbers).
Now we just need to address appraisal, revalidation, CQC, referrals management, home visits, GMC.
All of these are more possible with good GP networks to support and represent us.
Could the extended hours DES be fulfilled by employing an additional HCA and nurse during improved access appointments?
Or what about simply agreeing as network to not deliver extended hours?
Not sure this is worth getting knickers in a twist.
In 5 years your Apple watch type device could monitor temperature, pulse, saturations, BP, maybe even glucose levels.
Could be 3 years, could be 10, but this technology could be amazing? May help us more than our new paramedics and physios...
Would be very interesting to try stopping appraisal / revalidation in an area and carefully reviewing the cost, workforce and performance implications for perhaps 5 years.
I would propose the South West for this...
I expect would be cheaper, support recruitment and retention, have no harmful affects on patient safety or trust in the profession.
Thanks for the heads up!
How many other payments are not being properly claimed up and down the land?
Looks great. Just worried its coming too late.
Is there enough to make people invest their career to GP partnership?
If they sorted out tax/pension mess, make appraisal optional for GP with over 20y experience, then we could have a bright spell ahead?
We are doing improved access through our GP network, shared rota of practices. Working well. Partners are volunteering as paid well. Locums are missing out on attractive work by not being partners. This is good for partnerships in my patch, which in turn is good for the long term future of GP care. Who'd have thought more money helps!!
We are doing IA appointments across practices in my patch on a rota. They are well paid, patients really appreciate evening or weekend access with their regular doctor, staff are OK with it. We have regular meetings with other practices and developing joined work.
I never thought that people attending A and E was a measure of poor GP provision, so I wouldn't expect a better GP service to make those numbers fall.
I think its working well here so far (2 months in...)
But a £1-£2 fee may be enough (carrier bag use down by huge amount)
Are we ready for the surge of well tanned and remunerated GPs from Oz?
"ensure that changes to the clinical record are understood and agreed by the person with heart failure"
Should we set them a written exam, MCQ or perhaps require a reflective piece, shared on an eportfolio?
We all know the biggest issue is the retirements. Why are you leaving?
Could it be
* Falling pay
* Increasing workload
* Pensions cap
* Rising indemnity and litigation
* Referrals management
* Appraisal / revalidation
* Working at scale, which often means major upheaval to an already strained organisation.
* Get out quick, last man standing.
Practices are staying afloat by getting paramedics, pharmacists, nurses doing more, but in a falling market nobody wants a partnership. (If house prices are falling, rent don't buy).
If I was health secretary I would block all litigation against NHS, perhaps some no fault compensation scheme. I would make appraisal optional aged over 55, and every 2 years below 55.
I would stop pensions cap for GPs, to encourage people to continue working.
I reckon that might help?
Having made the econsult "platform" he may really believe in it, but he should not then organise NHS funding to force econsult on us, with money going in his pocket. Very dodgy.
Unfortunately NHS England will not want a fresh perspective, but will want "on message" input.
Maybe someone from babylon will have an NHS England sabbatical to promote apps in general practice...