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GPs hit over-65s flu vaccine target

Pulse returns to five typical GPs to see how they are dealing with the demands of the new contract

Urban GP

Dr Clare Davison

Newham, east London

Practice profile

Urban, PMS

·6 partners, 2 salaried GPs

·2.5 nurse practitioners

·5 administration staff

·10 part-time receptionists

10,500 patients

Very mixed practice population, including a range of minority

ethnic groups and people on low income

Quality points aspiration


How have the last few months been?

Steadily pressurised, relentlessly trying to do everything.

How was your quality visit?

The nursing representative helped us out. She suggested we use disposables rather then paying for sterilisation. This has worked out really well for nurses doing smears but I'm not happy with coil equipment.

Which of the quality indicators are you finding toughest?

The patient questionnaire timescale has been hard. We did it in September and have just had the report, yet we have a lot of follow-up to be done in time.

HbA1C at less then 7.4 per cent is hard to achieve. Also flu jabs for asthmatics because it's a young population who are hard

to get into the surgery.

How much is your profit going to rise?

We have been channelling Q&O money into staffing to provide more nursing hours so I think profit will be up about 10 per cent this year. Despite more valuable quality points next year I think practices will be spending a lot of money on pensions. We have also spent on bonuses because people have worked very hard.

The review of the Q&O is this year, what do you think should happen?

Exclusion criteria needs to be looked at for reasonable rates of exclusion. Rates need to be given more transparency and comparisons between practices. It is the difficult people, those who create admissions, who are being excluded and not being given high-quality care.

Commuter-belt GP

Dr Shah-naz Whitear

Hadleigh, Essex

Practice profile

Suburban, GMS

·4 whole-time equivalents

·1 salaried GP

·1.5 nurse practitioners

·2 health care assistants

11,500 patients

Relatively affluent area with high numbers of elderly and commuters

Quality points aspiration


How have the last few months been?

It's been better. We've been working hard to keep our points up and we are now looking to get more than 1,000. I think the way we work now has improved patient care as the computer flags up certain details for us to check on to help get the quality points.

What is your biggest headache?

Trying to fit everything into the consultation. We have just 10 minutes but there seems to be so much more to do. It's tough keeping up with it all.

How was your quality visit?

We were psyched up, but it went well and we didn't feel it was intrusive.

Which quality indicator are you finding toughest to meet and might you not get?

Diabetes and COPD are difficult. It's tricky to separate between asthma and COPD and I've no idea how we will make the diabetes target.

How has not doing out-of-hours changed your life?

The major difference is that previously I would work from 7am to 7pm and maybe get away by 7.30 on average ­ now I start at 8am and often get away just after 6. When you have children

that makes a massive difference.

What are you most proud of doing since the contract began?

The practice started doing GP training, which I'm proud to be involved in,

but that isn't linked with

the new contract, it was something we were

looking at anyway.

Rural GP

Dr Gordon Baird

Sandhead, Wigtownshire

Practice profile

Rural, GMS

·2 partners

·1 nurse

·3 administration staff

1,600 patients

High proportion of elderly CHD and diabetes (4 per cent of patients)

Quality points aspiration


How have the last few months been?

I'm still trying to ignore the contract and carry on as before. We have had major problems with commissioning, particularly in rural areas.

What has been your biggest headache?

Getting an agreement from the health board on premises. Having staff and patients in my house from

8-6:30 is a bugger, and we have had to turn a clinical area into waiting room.

How was your quality visit?

It hasn't happened yet. I'm not going to it and I'm not nervous about it either. People don't have the

same idea of quality as


The review of the quality framework is starting, what do you think should happen?

I don't trust the Government or the civil service to know what quality is. My practice can give access to patients the same day, but that doesn't carry any points. That is the kind of thing that is important to patients.

Do you feel you're on top of things now and is the workload starting to ease off?

I have never felt on top of things, ever since I started. With every reorganisation there are more artificial barriers to get in the way

of seeing patients. From

my point of view it is

simply a matter of getting

on with general


Dispensing GP

Dr David Bevan

Upwell, Cambridgeshire

Practice profile

Rural, dispensing, PMS

·5 whole-time equivalent GPs

·1 nurse practitioner in training

8,300 patients

Quality points aspiration


How have the last few months been?

Things have gone on a planned trajectory. We are on track to make the vast majority of aspirations.

Which quality indicator are you finding toughest to meet?

The only one we will probably miss is note summarisation. That's something we tactically decided to miss in terms of not being able to put the right capacity in the timescales involved while we have a rapidly rising list. We'll catch up but after this year.

How much is your profit going to go up?

I don't know yet, but there are changes in dispensing remuneration which could be working in a negative factor and may outweigh any gains in new contract earnings.

Is workload starting to ease off?

No, but I never thought there was anything in the new contract that allowed me to ease workload, so I'm neither upset, nor not upset. I had a very low expectation and that has been borne out.

Are you doing out-of-hours work?

We did relinquish the responsibility. I'm still doing a degree of it but am able to choose what shifts I do as opposed to being rostered which makes it slightly easier. But it feels a little like when we first started our co-op ­ it's not quite fitting like

a well-fitting glove.

Singlehanded GP

Dr Michael Smyth

Maguiresbridge, Co. Fermanagh

Practice profile Singlehanded, GMS

·1 practice nurse ·1.5 receptionists

·1 full-time practice manager/ primary care pharmacist

2,000 patients List dominated by teenagers and over-30s; rheumatic diseases most prevalent

Quality points aspiration 850

How have the last few months been?

A bit more hectic. We've been trying to get everything tidied up ready for the quality visit. We delayed because we wanted more time to prepare as we're undergoing re-accreditation for our training practice.

How much is your profit going to go up?

We're doing better than we thought on quality. Certainly for the diabetic and hypertensive patients we're more aggressive with our treatment. But prevalence is an issue we haven't worked out. The square root

formula would indicate that as a small practice we're going to lose.

Do you feel you're on top of things now and is the workload starting to ease off?

I can't see us working at this pace long-term. When the end-line comes you speed up a bit. We're doing a bit of a sprint in these last few months ­ we need to return to a marathon pace.

Are you doing out of hours? If not, how has your life changed as a result?

I've opted out personally. As of the first of January the local health board have taken over. I've committed to two sessions a month as I didn't want to become deskilled from OOH. When I'm not doing OOH I'm doing paperwork so I don't

feel I work less.

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