Knowledge is Porridge
GP in North Devon, likes to surf (obviously)
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...
More money? Already promised
More staff? Already promised
Safer care? Already promised
Of course he's going to talk up technology. They are going to struggle to deliver all the promises.
Meanwhile gp at hand is making lots of noise like a dot-com start up. I bet it will fail...but something like it will succeed. In 20 years.
This guy is inspiring,
I assume an RCGP learning module will be crap (they lost me at the login page - sorry), but jumping straight to Unwin Carb on YouTube gives a real flavour of what, why and how he has achieved amazing results, saved money and given him a new joy for being a GP. We all need a bit of that!
*noting my comment above to be curmudgeonly I gritted teeth and reset my RCGP password and did the course. Despite how much I hate elearning modules, there was some great info and I even felt a tinge of enjoyment. But YouTube still wins every time.
Do we really trust cancer survival rates in countries as like for like? Seems very vulnerable to lead time bias: diagnose the same condition 6 months earlier and survival is 6 months better. Meanwhile life expectancy of a population mirrors prevailing diet, smoking and social inequalities better than access to healthcare. If NHS is good enough care at OK price, then I want to keep it ongoing...just remove the litigation lottery please.
If workforce crisis is the number 1 issue (all agreed?) then stop QOF and leave the money in Partnerships.
Reasons to be a locum or go overseas: "I dont have to worry about QOF" is very high on the list.
Sort out litigation, appraisal, CQC and referrals management too. Suddenly GP partner looks like a great job again.
Will care standards fall without the yearly tick box stuff? Of course not, especially when the focus is on the outcomes rather than metrics.
I think the benefits of continuity from same GP (in partnership with long term commitment to the practice) is the most cost effective thing we do.
Reasons to leave:
1. Litigation, compensation culture, indemnity "risk"
2. Workload, especially non patient eg appraisal, revalidation, referrals management, QOF. email overload, "effort"
3. Finance, contract, last man standing, sustainability "reward"
Reasons to stay:
1. Nice job
2. work with nice people
3. valued by patients
4. Well paid.
So shut down the litigation industry, remove the unnecessary and burdensome admin, give financial certainty and we can tick along nicely, thanks.
No need to reinvent the wheel
Lot of money going into general practice:
1. Practice fails due to retirement / premises / income
2. Other organisation offered a lot more funding to take over
3. Spends funding on locums
4. More GPs change to locum work, less partners joining
5. More pratices fail due to retirement / premises / income
Dont be a partner unless you cherry pick some easy money and have a 5y exit plan
Please just try stopping QOF.
I propose Devon to pilot this change.
The report seems to have summarised how useless it is, then decided to carry on??
Must have had a different subcommittee to produce the different sections.
The best system is turn up and wait...sitting for a while gives people some understanding of demand, urgency, resources.
It could be integrated into the app...with all diagnostic trees ending with "turn up and wait", similar to 111 but without the comment about whether or not they are breathing.
Bring on the technology! Please help us sift through the stuff and manage the workload. A computer AI can monitor online interactions and learn to collect and analyse the data. The next 10 years will be full of false dawn's, but in maybe 20 years they will be bulletproof.
Amazon was going to destroy the high street in the 90's. Now 20y later it's doing exactly that...
I think this is a reason for hope!
Thanks Sam, didnt realise you included the FY1 and FY2. Very sensible suggestion.
Also we need to push back on the fashion for "reflection", where nothing counts without some awful reflective statement. During my training I wanted to collaborate with others on building online resources for fellow trainees, but realised my efforts wouldn't count towards my ridiculous learning log which was always short of entries. Dear diary is useless for many people.
Now I have the same sinking feeling with upcoming appraisal. Although I am enjoying my partnership vacated by a chap who couldn't face another appraisal.
- Paying £10,000 indemnity is basically a "sue me" invitation.
- 4 weeks to appraisal, feel the dread rising, lots of chance to reflect on the problems of being a GP
- Referral management
- Second referral requests (they are quicker in the private treatment centre, can you refer me there too?)
- Death by guidelines. Its like following satnav down a train track.
- pension cap, retire ASAP
- attractive offers overseas.
What can be done???