Knowledge is Porridge
GP in North Devon, likes to surf (obviously)
I absolutely fear the spread of this virus. Especially for all frontline staff. But my patients are taking this very seriously and self isolating in large numbers and amazing community organising and staff flexibility.
I think the tide could be turning already (reflected in numbers in 2 weeks time).
We have a few weeks to ignore all the usual crap and just focus on what we trained for. This is a chance for retired GPs to work for the common good, and I welcome / salute all those who bravely put their hands up. Their assistance - perhaps remotely by phone / video, could be amazing. Thank you all.
Perhaps some might stick around if government takes another look at why they all left in the first place?
Not MORE overloaded guff from 111. They need to use something to filter out the useless information they send us, or to highlight the useful bits.
While we are recognising and removing the barriers to good care (cqc, qof, appraisal, revalidation) can't we use this moment to try life without 111 data overload?
Any views/experience here on eConsult.
Looks terrible to me but CCG keeps pushing...
Thanks for the helpful insight Clare and sorry to see some frankly bizarre comments.
Am I missing something. Is it the lifetime limit people are still unhappy with? Looks like good news to me...I want some positive news before my dose of covid19 comes!
Wow, so simple and so sensible. Count me in.
OK, I have been quite keen so far, but just been reading the frankly incomprehendable Comprehensive Geriatric Assessment (CGA): multidimensional holistic assessment of an older person.
Oh dear. Its over 2h per patient of scores and guidelines, within scores and guidelines ad infinitum, inception style.
The patient will end up with big red "this is your life" folder with little really helpful output.
There is still a great opportunity to build experienced teams with continuity of care supporting our most frail and elderly, but not if all we do is "comprehensive assessements".
Is this why our mental health teams write 10 page detailed assessments but see very few people?
Do we want to try and deliver a Rolls Royce service with Reliant robin funding? Hmmmph.
I have read the document and to me it looks fantastic. It's no free lunch and strings are attached but 100% reimbursement for additional roles was the only way to get us out of the draft proposal mess. I didn't expect NHSE had the balls to back down, and therefore game over for everything PCN.
Cheer up everyone, this time its good news. Go and read it!
I think some OK ideas in terms of future care, just not the workforce to deliver, or contract mechanism to pay for it.
No way forwards...NHSE can't just back down, BMA can't carry the profession. I haven't thrown in the towel as "only a draft", but feels like PCNs need an end of life care plan.
I think the network DES would be viable with a few months delay AND 90% paid for extra staff, not 70%.
Would we be able to get behind that?
The problem now is we have seen the PCN destination.
The gloomy partners are now the wize and sage. They said it was a trap!
The enthusiasts are now the betrayed romantics, with PCN directors resigning as matter of honour.
The spec will be scrapped of course, too late.
Who can argue with an overworked GP in and overworked practice who says no thanks?
It takes just one partner to force a practice to leave a PCN.
It then takes just one practice leaving a PCN to close the PCN down.
How many PCNs will survive this consultation?
The lights are on, the music has stopped. The party is over.
Link to draft network specifications...
I think networks have the option to decouple home visits from usual GP: perhaps 1 GP and 2 paramedic could supply visits, care home support, intermediate care. Usual GP could choose to still attend end of life care.
No public relations disaster required.
Meanwhile fix appraisal, pensions, referral management, LES, DES, CQC, QOF.
If we were refusing something, I would have thought referral management services would be top of the list?
This has been a good year with indemnity.
Next sort out the terrible terrible appraisal system, such a demoralising waste of time.
It is the biggest discredit to the RCGP that they support it, infact they designed it. The eportfolio was awful as a trainee.
Never mind the bigger workload struggles and funding. These are not under your control, but appraisal and eportfolio could be fixed and might get you some grassroots support.
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.