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CAMHS won't see you now

Labour pledges £100m to reintroduce 48-hour target to see GP

Labour leader Ed Miliband has pledged to end the ‘scandal’ of patients waiting more than a week for a GP appointment and reintroduce a right for patients to see a GP within 48 hours.

Mr Miliband announced that a Labour government would reintroduce the target scrapped in June 2010 for patients to have a guaranteed appointment at their GP surgery within 48 hours.

He also said that patients would gain a right to be seen by a GP on the same day if they need to be seen quickly and be able to book appointments more than 48 hours ahead ‘with the GP of their choice’.

The Labour leader pledged to invest an extra £100m a year in GP practices to pay for an additional 3m GP appointments every year.

He said this additional funding will come from repealing the requirements to use competition in the NHS and cutting back on what he called ‘quangos’, such as Monitor, the Trust Development Authority and Commissioning Support Units.

He said: ‘I can announce the next Labour government will put in place a new set of standards: a same-day consultation with your GP surgery with a guarantee of a GP appointment if you need it that day, a GP appointment guaranteed for all within 48 hours, and the right to book further ahead with the GP of your choice if your priority is to plan ahead or to see your preferred doctor.

‘This will be better for patients, because they have better access to their GP surgery; better for the NHS, because it will save money currently spent in A&E; and better for Britain, because it is the kind of health service we need.’

He added: ‘A quarter of the public now say they can’t get an appointment in the same week. It’s a scandal that people are waiting that long, it is not how our NHS, the pride of Britain, should work.’

He also promised to make the NHS a more integrated service. He said: ‘Our plan for the long-term of the NHS starts by making sure that physical health, mental health and social care – services which have stood apart for too long - work together. Just think of the difference it could make. If a simple grab rail is placed in someone’s hall at home, that can stop a fall that could lead to that person breaking a bone, keeping them out of hospital, saving them the pain and the suffering, and saving the NHS thousands of pounds.’

RCGP chair Dr Maureen Baker said that she welcomed the announcement of more funding for general practice.

But she added: ‘While we welcome Mr Miliband’s announcement it must not be another “sticking plaster” solution but part of a broader, long-term, shift in investment. Ultimately, general practice needs 11% of the NHS budget by 2017 in order to cut waiting times and guarantee safe care for our patients.

‘We particularly welcome Mr Milliband’s pledge to scrap the marketization of the NHS, something our members, across the country, have long said is unworkable and undermining their ability to provide joined-up patient care.

‘The college looks forward to working with politicians from all political parties to discuss how general practice can be funded to provide better and speedier access for patients, in order to take pressure off our hospitals and allow patients to be treated in their communities.’

GPC chair Dr Chaand Nagpaul said the targets were ‘misguided’ and ignored the real crisis going on in general practice.

Dr Nagpaul said: ‘I would very much want to have a discussion with the shadow health secretary Andy Burnham in particular, as I think these suggestions are misguided and are failing to address the fundamental problem which is the crisis in general practice.

‘Issues around 48-hour targets and so on are just an irrelevance. The worst thing you can do when you’ve got a system under pressure, where demand outstrips capacity, is to create such targets that are likely to result in counterproductive, perverse behaviour - this is the last thing we need.’

He added: ‘What is really important is to address the fundamental lack of investment - £100 million is 0.1% of the NHS budget, it’s a tiny sum in the totality of what general practice is expected to deliver.

‘We need to look at the workforce, manage demand and ensure GPs can deliver the most appropriate care within the constraints they have – not stoke up demand that is not achieveable, leads to perverse behaviours and often ends up denying care to those that most need it.’

Meanwhile, commenting on Labour’s plans to overhaul the NHS competition regime, NHS Clinical Commissioners co-chair Dr Steve Kell said: ‘Labour raise[s] some interesting points about competition and we know from our members the unnecessary burden and cost that it can place on the system if it is not used or understood properly.’

‘Clinical commissioners are faced with the decision to tender local services every day, and have found there are a number of practical difficulties with the current system when trying to secure the best outcome for patients. It is sometimes unclear to commissioners whether they are simply free to commission from a market, or whether they have to commission in order to make a market operate.’


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  • Ed Miliband - online

Readers' comments (86)

  • Bob Hodges

    Hahhhaaaahaaaaaaa!!!

    Hahahahahahahahahahahahahahahahahahahahahahahahahahahahahahaha!!!!!!

    PMSL!!!

    How?
    What about holidays?
    What about part timers?

    Looks like I'll be handing back the keys in May 2015 whoever wins.

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  • It would literally be "see" not "see and have a useful consultation" as there won't be time. Who has priority - those with clinical need or those who demand their "right" to see GP "of their choice" within 48 hours whether clinically necessary or not? Are we not allowed holiday/sickness any more? We can't run limitless demand general practice like that and there aren't enough GPs or funds to provide the service that the politicians keep promising "they" will deliver. As if.
    Please, will politicians just given us adequate funding then leave us alone to do the job to the best of our professional ability?

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  • National Hopeless Service

    Another political arse giving me the reason to support Una Coles resignation letter campaign.

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  • The "scandal" is the way successive governments have run down general practice so that it is now understaffed, underfunded, overworked and still taking the blame for everything

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  • WHO'S A SILLI MILLI THEN?

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  • NO OOH FOR 2 MONTHS AND WATCH THE POLITICIANS BURN.

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  • Do we have ANY politicians in this country who ARENT clueless idiots??

    It's definite then - regardless of whatever government is coming next - you'd be a certifiable LUNATIC to consider continuing working in this sad deluded country as a GP.

    What is the point?

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  • This comment has been moderated.

  • Commissioner Gordon get on the Batphone - the Joker is on the loose .

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  • Just when you think one load of politicians cannot get any more stupid.

    I'll actually have to look at UKIP purely as the others have excluded themselves on grounds of incompetence ( I'm not expecting anything from UKIP just reading what their policy on health is).

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  • Why is everyone posting as anonymous? Is their opinion to embarrassing to put a name to?

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  • And if we can't supply a 48 hr appointment - what dreadful nemesis awaits us ? A cut in funding ? We have that anyway . Fire me I would welcome it .

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  • In a short career thus far it's interesting to see this argument of access versus continuity recur over and over. It seems that there are no magic ingredients for a perfect appointment system and I am sure most practices spend a significant amount of time discussing such issues. Rather than imposing financial incentives or targets and sensationalising political statements, we should share information on what works and what doesn't. Using threads such as this could provide immense amount of knowledge and innovation. Irrespective of what politicians suggest should happen we still have some autonomy within our practices and can influence how our patients access our own services.

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  • Dr Coker - on why people post anonymously - this is an open web site and comments are accessible to everyone. GPs are judged continually on a daily basis by anyone and everyone including a fairly rabid media who wouldn't think twice about trashing the reputation of an individual GP if it suited them. Patients rate their Dr as a matter of cause...and if you step out of line it's all too easy for anyone to make a malicious complaint if they don't like you're tone. On top of that, on a personal note, as a locum your completely reliant on the good will of a whole range of people many of whom may well see the world rather differently. It very easy to google a name and any comment you've ever made will be there for anyone to use any time they want - I'm afraid anonymity is a necessity for many ...but a sad reflection on what being a doctor has become and yet another reason in my opinion to get out

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  • What works is to work hard,
    and sorry labour introduced a survey which cut gp funding , even politician do not loose pay according to a rubbish survey.
    The money works out about 1-2 pounds a pt, which is basically going to be eaten away by inflation anyway. Good luck with that.

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  • Nothing works unless you have spare capacity. You need more GPs or less demand.

    With too few GPs you need to be able to prioritise patients on the basis of need. To do this successfully you need to be backed up by the Government. I cannot see that happening, and the GMC and the courts do not take into account how overworked you are.

    The only way to protect yourself financially and medicolegally is to leave.

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  • Una Coales

    @7:22 Re UKIP, I have been instructed by a Scottish medic UKIP health advisor to say 'Anyone with any sympathies to the Labour party should be in no doubt these guys want to debase primary care and drive you to an early grave.'

    Sounds like we need more medics to infiltrate all the political parties to educate them that NHS GPs are NOT going to provide 60 million people unlimited 48 hour access appointments for £3/consultation even if they had the manpower which they don't.

    If you are a young GP, please bear in mind that the door to Australia may close in 1-2 years as Australia is filling up with former NHS GPs! You'll need letters of good standing from the RCGP and GMC.

    Else you may be stuck working as an underpaid overworked salaried GP for a private bulk provider.

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  • GP salary 75k add on employers pension costs and cost of employment and holidays
    The final cost is around 100k
    100million will fund 1000 GPs
    That's one gp per sixty thousands patients.
    That's not enough just ever increasing demand
    And wanting GPs to take more out of hospitals ect ect
    Will absorb this.
    Time for Strong proposals from our leaders
    And strong support from grass roots.
    48 hours is the usual pre election bribe ..
    We have to make sure it is payed for in full!!
    If not ... Tine for a new model of practice

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  • Ed you muppet - you've gone and alientated all us GPs as well now!.. well done

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  • Anonymous for anonymous sake!
    Not only am I fed up with being made to feel undervalued, but as pointed out by 7.54pm, continuing to give patients their God-given right to complain to get what they want, means they essentially blackmail trained and experienced professionals! Not what I trained for, nor expect in terms of behaviour?
    It's scary reading £3 per consultation ie £18 per hour! And not even taking into account all the other work that has to be done between clinics, after hours.
    Coordinated mass resignation with a clear PR campaign is the only solution.

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  • Vinci Ho

    No single party (no exception)will leave us alone. It is so sad general practice in this country has become the favourite theme park for all these politicians who know nothing other than how to earn more votes........

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  • Ed says "would gain a right to be seen by a GP on the same day if they need to be seen quickly"
    ----------------------------------
    FYI Ed all GPs have a triage system and will see patients on the same day if deemed necessary.

    Ed also says "able to book appointments more than 48 hours ahead ‘with the GP of their choice"

    Fine,book ahead but the GP of your choice may not have any free slots for a few weeks.Is the patient prepared to wait that long?

    In short this man has nothing new to say.We're going to hear all sorts of nonsense running up to the general election.The NHS will always be a political football.If we don't like it we can either head for the exits or discourage our young from becoming GPs.

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  • Una, please could you put up details of where to sign the list you've mentioned to take to the ARM etc. Having just heard Millbands 'pledge' to further decimate GP with his 48hrs pledge I have truly lost all hope of any political party to think or act sensibly with any logic about finding a solution to the current problems facing the NHS and especially primary care. You need to set a timeframe, if the BMA does not act in the way grassroots are imploring them too, then serious consideration to forming a GP union needs to be on the cards. Do not wait for them to play you, as I'm sure many of the dinosaurs (and probably some of the handpicked young bucks) within the organisation are planning to do.
    As a light aside, the closest contemporary comparison I can think to your current situation Una is Game of Thrones. It will be brutal, it will be harsh, there will be deception, there will be losses but if you remain strong and think tactically, Daenerys Targaryen Coales, you will reclaim your rightful position at Kings landing (aka Tavistock square) and Westeros (30 Euston Square) as rightful heir and ruler. So too you I say, we follow you, mother of dragons, claim your crown!!

    Disillusioned GP Partner (1yr)

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  • Just semi privatise the NHS and get it over with. It is not sustainable. Charge a fee for GP consultations and Specialist appointments.
    I previously worked as Locum GP in UK but I am now working in Australia in this system. It works fairly well.

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  • Una Coales

    http://www.avaaz.org/en/petition/British_Medical_Association_Chair_of_Council_Dr_Mark_Porter_We_call_on_the_BMA_to_ballot_GPs_on_mass_resignation_from_th/?ntBhzhb

    @00:31 I have started up a petition for a BMA ballot on mass resignation from the NHS GP contract. Either sign or email me at unacoales@aol.com.

    I was cringing as Ed Milliband was on the tv saying patients should be seen on the same day by their GPs. So it is the GP's fault that they are overworked, underfunded, risk chronic stress, an early grave and are just not working fast enough on the NHS factory assembly line? Nothing to do with the assembly line has just sped up with more parts to assemble in record time with no rest periods, 50% reduction in pay and half the manpower?

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  • Una Coales

    @00:31 the time frame is deadline May 2015, the next general election.

    If the BMA is powerless to change the course of history, ie general practice destruction and along with it the NHS too, then there is nil else to do but go private. The red flags are all there, increased factory assembly line demand, docked pay by 50%, workers leaving for Australia, smaller factories bankrupt and closing, larger factories next, etc.

    If the BMA effect change with the most powerful bargaining tool at any trade union's disposal, ie a OOHs boycott or en masse resignation, then the government will be on its knees. Surely before they take away your livelihood and force you to close your GP surgeries due to bankruptcy (but still leave you with the staff redundancy bill to payh, you would want to see payback on the government, your demanding and unrelenting boss who only beats GPs with sticks and ne'er offers you a carrot?

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  • Una Coales

    @6:08 What would you like? Guernsey option, Canadian option, Australian option or the Irish option? All sustainable semiprivate models of healthcare in which patients are safe and GPs are happy.

    Because government has been kicking the NHS football around at every general election, they argue it is political suicide to charge patients. So be it, let the NHS football deflate and everyone walk off the football pitch. Game over.

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  • The politicians are all mad the usual suspects make UKIP seem sensible.Is there a surprise coming.Most likely the death of a thousand cuts and destruction of the NHS.

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  • Let common sense prevail

    He added: ‘What is really important is to address the fundamental lack of investment - £100 million is 0.1% of the NHS budget, it’s a tiny sum in the totality of what general practice is expected to deliver.

    Exactly - It's bugger all.

    3 million extra appts per year when we are doing 1 million per day. That isn't going to reduce the waiting time!!

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  • Una Coales for minister of health I say! Just stick to the principles. How refreshing would it be to have a doctor actually being consulted on nhs policy?!

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  • STOP OOH FOR 2 MONTHS

    Thanks to Paul Dacre and the daily mail most people believe that GP's stopped doing OOH work and that is why A+E is over flowing . The politicians know that GP's do millions of consultations OOH but find it a useful political expedient to blame GP's for the lack of access at weekends . OOH work is not contracted and therefore to not take up shifts breaks no contract. OOH providers have gone out of their way to ensure we are not "employees " . This gives us a magic sword ,we can wield it without blame because no one will know who to blame . Draw the blade 3 months before the election and watch the MP's squirm .

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  • Thanks, Una.
    Made my vote in support!

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  • £100m for 3m appointments is £33 per appointment, not £3.
    I agree with the vast majority of what is said not his forum, but could this be a real attempt to invest more in general practice and the first genuine sign that someone understands?
    Don't get me wrong, I don't believe a word any of them say. The issue is where this money would come from, whether it is genuinely extra funding and what hoops we have to jump through to get it.

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  • "£100m for 3m appointments is £33 per appointment,"

    It's not this bit of the sum that is wrong.

    3 million appointments is nothing across the whole country, and the funding is probably about £10,000 per practice. This equates to under 1 session per week - ie 3 appts per day.

    How is that enough to see EVERYONE within 48h?

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  • @10.16
    Your maths is correct but the numbers input are suspect.
    Precisely which 3m appointments attract this premium( ie half way reasonable) rate? What happens with funding for all the other millions of totally unnecessary "urgent" appointments? Whoops, we're back to £3 per appointment again!

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  • Here it is!! ADVANCED ACCESS all over again.A colleague ,who agreed the mathematic futility of same amount of dr time for more patient access, explained how it worked.Make the booking process so complex and IT dependent ,that 1/3 of demanders cannot fathom it. Problem solved?? right ?

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  • Yet more futility. I am sitting at my desk laughing uncontrollably. But I am also bitterly disappointed that the invention of the "qualified gp making machine" has completely passed me by. I must have been on holiday. Yet more delusions from Ed Milliband. Quick! Someone call his local community mental health team and ask for am assessment because these delusions are going to put others at risk! WHO ON EARTH IS GOING TO SEE THESE PATIENTS IF WE ARE ALREADY SHORT OF GP'S??????? 100 million pounds is quite frankly insulting! Still they have not learnt to accept that they must hold their hands up to the general public, admit that the nhs cannot be afforded and start charging patients!!

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  • THIS is not difficult to achieve and there is money. i agree with proposals . . i see no problem with it even if they don't pay.
    gp is responsible to offer service as and when necessary. i know a and e attendances are more because some patients can't see gp's. most of them already do access within 48 hours. and now there will be financial reward. sometimes politicians are correct. this is the one..

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  • @11.35
    "THIS is not difficult to achieve and there is money. i agree with proposals . . i see no problem with it even if they don't pay. "

    Would you come and work for us please? I promise not to pay. Apparently it's easy.....

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  • even if this proposal comes in these appts are more likely going to be used up by self limiting minor illnesses.
    The GPs will have to hold back appts for these pts at the expense of older pts / pts with chronic illnesses who are likely to plan appointments ahead but they will be told to call nearer the time.
    We need at least 2 full time GPs. We have only attracted 1 locum who insists on the days he can work, demanding £75/hr, early finish and wants guaranteed leave during school holidays. As a partner I do not have the above privileges.
    I can understand the applicants side as he is newly qualified and a young father but such demands can only be made in an industry where workers are in short supply. 5 yrs ago the above would be unimaginable.

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  • Before I begin I have to say that I have witnessed the depletion of GP funding and increase in GP commitments over the years as a result of political meddling and fully support the profession in trying to restore both of these issues to a reasonable level. But, now for the unpopular bit, I believe that 48 hours is achievable and actually the really tricky bit is simply the transition. There are practices that are providing a 48 hour service so it's not impossible however they didn’t get there overnight but I am also aware of practices that tried and failed through lack of support from the PCT. It wouldn’t be easy but it would be achievable and needs funding. The problem is that what really needs to happen is for all the other issues to be addressed at the same time rather than addressing one and moving on to the next. The only way to do that would be to completely redesign primary care but what party would make such a pledge right before an election? Even if they promised to fully include the profession in the redesign of the service which might satisfy the profession it would be too risky as the electorate would be extremely wary especially after seeing what the Tories have done to the NHS having said they weren’t going to do anything!

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  • My GP practice has already done this for years. Don't see what the problem is, except (yet again!) GPs feel the need to tell us what they can't do and don't want when faced with patient need.
    For those who don't like us mere mortals presenting with crappy strep throats and the sniffles, pay a practice nurse to deal with this traffic for you, preferably a nurse prescriber, someone who does not mind the company of sick people. My practice does just that. Then pay for a Health Promotion Specialist to manage things like smoking/drinking/obese patients, someone who does not discriminate against those too stupid to look after their health without some assistance. Once again, my practice does just that.
    When you have drilled down to the genuinely sick among us (and I'm surprised that some of the folk posting on here can see patients around the coronae of their immense egos!), try listening to us or looking up from the paperwork/computer screen just long enough to make the patient feel you may be listening. MY PRACTICE DOES ALL OF THESE THINGS! What is the problem for everyone else???

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  • To Dear 12:07 NHS manager

    most practices have triage system in place for urgent appointments/home visit requests. Signing up to guaranteed appt within 48hrs with preferred GP isnt possible: let me explain as you may not be aware of the reasons:
    1. some GPs work part-time
    2. some GPs have special interests eg dermatology, mental health, COPD ,diabetes etc and hence their clinics tends to get filled in more quickly with the chronic illness pts.
    3. most pts who need appt within 48hrs have minor illnesses and they are better served by minor illness nurses: most big practices do have them saving valuable GP time to deal with more complicated pts ( in fact I at times pray to get a pt with sore throat/earache so that I catch up in my clinics).
    4. there arent enough GPs to give this demand
    5. the current supply of GP appointments will be held back to meets idiotic targets supported by politicians and NHS managers. We shouldnt just say its doable but ask the question is it right to promise preferred GP appt within 48hrs when alternatives like the minr illness nurses / practice nurses and HCAs can deal with minor ailments, review of chronic illness and HCA can do BP checks/health checks etc.
    I think I need to stop before I refer myself to crisis team

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  • Bonnie, get the chip off your shoulder and do a medical degree if the solution is so easy. Now where did I put my handbag? ( - anonymised but another lazy egotistical patient hating GP)

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  • Dear Bonnie @12.17,
    I don't mind the strep throats - but I do object to the patient that has coughed once 'you can never be too careful, can you doctor', every child that wakes with the tiniest amount of eye discharge 'school won't allow him in until he has been checked by the doctor' and all minor ailments which do not need to see any health professional let alone an emergency GP appointment. Patients have been led to expect same day, even same hour or 'when it suits them' service when there is no good medical reason or need.
    I am usually in work - physically at the surgery - for 12 hours a day and routienly leave after 8pm when the last patient has been seen by 6pm. There is so much crap to deal with which the public never sees.
    I am happy you are a patient at such a wonderful practice but unless you are a GP at the sharp end, you have no real idea about what work is involved.
    The more patients are offered by successive governments, the more demand will rise.
    How come waiting times in A+E mean the poor doctors (who work a maximum 48 hours per week) are overworked yet the GP (unlimited hours) are lazy and twiddling their thumbs?

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  • some others who use it as convience and 'you cant be too careful culture' with minor ailments; eg my son fell at school at 9am, bumped his head. At 4pm when collecting him the teachers tells me and also advised get him checked by GP. between 9am to 4pm:he has been running around, eating and drinking fine, attended classes etc.
    CAB/DWP: go to GP to get letter to support your claims for benefits: why do they give verbal advise. Do I tell my pts verbally: go to urology for your waterworks problem!

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  • This comment has been moderated.

  • Bonnie- `In your perfect surgery - It would also be interesting to know how much funding they get per patient as a whole and whether they are PMS or GMS. Most surgeries get by on £70 tops (£100 all included QoF DES NES etc) but some surgeries had top ups via PMS growth money, MPIGs of £100 per pt. Obviously if we had double the funding we could give you a first class service! You cannot compare GP surgeries that easily - there are age demographics, commuter pressures, deprivation and size of the patient population. Most single handeds with 15k patients provide a commuter service with rotating drs, a real lack of continuity of care - but thats the way we are headed. I believe the perfect model would be 3 partners for 6-7k patient - that can marry the personal touch of single handed and the government's psychosis that we are all shipmans and cannot work alone.

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  • my comment got squeezed! i was to say most single handed with <2k patients can provide 48hr appointments very easily as they have reduced demand (although proportional) but can provide a personal service. Larger multi partner group practices with 15k patients really are good for the WIC type patients but continuity is much more of a struggle...

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  • Took Early Retirement

    Vote early and vote often I say!

    I wonder if Bonnie is registered at a nice Rural, Dispensing, PMS practice with £130 per pat per year? Can we be told please?

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  • Hi all, thanks for taking the time to really hear what I was saying, rather than launch into a defensive rant.
    I understand that there are problems with the way that primary care is structured and funded, as I work for NHS England in Operations & Delivery.
    However, the rush to restructure (always remembering that the Labour Party gave us the TCS agenda, the Coalition only finished in undue haste a job started before their tenure), has left community services depleted by the acute trusts who administer them to bolster A&E and other acute functions, leaving the GPs to pick up 90% of the first contact business with less than 10% of the overall NHS budget.
    So, I DO get it. I just can't believe some of the bitter, twisted, angry stuff that passes for comment on here, when there are GPs working like the devil to provide for their patients who go unsung.
    GPs are not the only part of the NHS suffering under the vaunted restructure. Stop complaining and start making a change. You have the political power to do so, if it could be agreed as to what you need and how that should be provided.
    For those of us who are not GPs but are trying hard to make this new system work, I can say that the bellyaching is just grating.

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  • "I wonder if Bonnie is registered at a nice Rural, Dispensing, PMS practice with £130 per pat per year? Can we be told please?"
    As it happens, I am registered at just such a practice. My mother is registered with a practice nearby, in a borough which ranks 17th in England for deprivation and negative health outcomes but she can also see a GP within 48 hrs, enjoys a full OOH service and is able to take minor ailments to a practice nurse.
    So, your point was?

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