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Gold, incentives and meh

Why stop at stopping home visits?

Copperfield

Well that showed me, didn’t it? Despite me pouring scorn on the logic of pitching to dump acute home visits, the LMC conference went and voted in favour.

True, it’ll only come to fruition if the GPC can negotiate some kind of deal with the Government, and that’s an ‘if’ that can be seen from space, plus, of course, any agreement will come with industrial-sized ropes attached.

And the PR damage has already been done with the predictable ‘lazy GP headlines’ and a sarcy mock-astonished relative on a home visit yesterday smirking: ‘I thought you’d stopped doing these’.

Not yet. But when/if we do, it’ll be the thin end of a very welcome wedge.

Because it’s the first tangible acknowledgement that we can no longer cope with the two full-time jobs we cram into one: consultant in primary care (multimorbidity, chronic disease, subacute illness, cancer-spotting etc etc) and acute care specialist (all the day duty crud).

The entirely logical extension of this will be to point out, in a couple of years, when the seismic shock of the acute visit pull-out has settled, that we can’t realistically cope with the ambulant ’acutes’, either: in other words, rerun the acute visit logic for acute attendances, emphasising quantity rather than time per consultation.

The thin end of a very welcome wedge

A reasonable compromise from that position would be a commitment to provide a limited number of urgent slots per 1,000 patients, as we currently do for direct NHS 111 bookings, with any overflow being directed to an acute illness hub organised by, oooooh, let’s think, the same people commissioned to provide the acute visiting service, maybe?

And to avoid sacrificing too many routine slots for urgents, the latter would be mandated as an agreed proportion of overall available daily appointments – thereby defining our daily appointment provision, aka an appointment ceiling.

And voila, we have, at last, put a lid on appointments per day. Remember the BMA trying to do that in 2016, with its ‘urgent prescription for general practice’?

Cleverly anticipating the current unfillable prescription debacle, this has been delayed/forgotten about for three years, but now we seem to have managed to reverse engineer one of its main USPs.

True, it’ll make for a more tedious job. But better to die of boredom than burnout.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield or follow him on Twitter @doccopperfield

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Readers' comments (4)

  • You could house the acute services in buildings known as “centres” and advise people they can “walk in” with their urgent problems too. If we can just think of a catchy label....

    The endless circle continues. All change again 5 years. Tickets please.

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  • We try to provide enough on the day availability but as the f2f numbers hit twenty (or look like they will) we set a cap for extras. Twenty was set as the absolute maximum by the BMA

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  • time to start a serious conversation about how general practice can be replaced. If Pulse want to make me an offer to write an article...

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  • 12 visit requests today. 9 of them in a Nursing Home.
    Fix this and my job is infinitely better tomorrow not some vague time in the future

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