Reply to topic  [ 16 posts ]  Go to page 1, 2  Next
GP contract to move focus from targets to patients - Hunt 
Author Message
Legend

Joined: Sun Apr 26, 2009 12:30 pm
Posts: 45931
Location: Belfast
Reply with quote
http://www.theguardian.com/society/2013 ... nt-a-and-e

_________________
Plain English advice on everything money, purchase and service related:

http://www.moneysavingexpert.com/


Fri Nov 15, 2013 4:24 pm
Profile
What's a life?
User avatar

Joined: Thu Apr 23, 2009 8:46 pm
Posts: 10022
Reply with quote
Due to the chaos at work today, I didn't get a chance to post this. The old 2004 contract had a few positives for it:
- it recognised the work GPs did and rewarded them for it
- it gave the long withheld payrise to GPs
- it took the rapidly deteriorating out of hours service from GPs and made it the responsibility of the DoH
- it boosted morale at a time when both morale and recruitment were low enough to cause a crisis
- GPs no longer had to be partners in their practice and hence weren't forced to invest in their practice. They could move around.

Negs:
- it made guidelines and best practice into targets for more money. Except GPs were already working to best practice.
- it gave staff pension money to practices to manage.
- the Govt couldn't run the same out of hours service despite spending even more money than they ever gave to GPs for it
- private companies could bid for services normally offered by GPs so some surgeries shut down


Along with inflation payrise and recognition of work pay, it meant it looked like GPs were millionaires. The money has long since been clawed back. QoF money is going but the targets are staying so instead of a financial incentive, we're gonna be beaten with a stick to jump through the same hoops.

The "named clinician" is a load of bollocks. If I'm personally responsible for mrs jones 24/7, what am i going to be able to do about the locum GP who mismanages her during out-of-hours? I have no control over who sees her or who manages her when I'm not there. But I'm yet somehow responsible?!?

The A&E crises is a combination of a loss of hospitals, hospital beds (so patients can't be admitted and seen by relevant specialties), and loss of staff - all of which have been caused by the Govt. But they've managed to spin it so it is the fault of GPs!

The Govt wants GPs to go back to the days of "Dr Finlay". The problem is that those days are long gone. Medical conditions have advanced significAntly since then. There are more people living longer in poorer health with multiple conditions making it tricky to manage. Patients have become more demanding and rather than "not bothering the doctor" it's become "I'm the only important person, screw everyone else, I want to be seen now". Instead of a morning surgery and an afternoon/evening surgery where there was little to do in between, most are now working 11-12 hour days and a much larger proportion is not face-to-face with a patient.

The long and short of it is that the NHS is a sinking ship and the politicians have handed the ropes over to GPs who are useless to do anything about it. I've long thought about emigrating. In other countries, GPs are paid less but they do less work. Or I could move to Canada/Oz/NZ where there is comparatively less work for much more pay.

Still, the public believe the Govt have rescued the NHS and they'll vote Tory again next time, at which point the entire thing will have been fully privatised.

_________________
Image
He fights for the users.


Fri Nov 15, 2013 8:00 pm
Profile
What's a life?
User avatar

Joined: Thu Apr 23, 2009 7:26 pm
Posts: 17040
Reply with quote
cloaked_wolf wrote:
.
Still, the public believe the Govt have rescued the NHS

No they fecking well don't.


Fri Nov 15, 2013 9:49 pm
Profile
What's a life?
User avatar

Joined: Thu Apr 23, 2009 8:46 pm
Posts: 10022
Reply with quote
Has anyone noticed how they've dropped the proposed 8am-8pm 7 days a week scheme? I wonder why.

Smoke and mirrors.

_________________
Image
He fights for the users.


Fri Nov 15, 2013 9:59 pm
Profile
Legend
User avatar

Joined: Fri Apr 24, 2009 2:02 am
Posts: 29240
Location: Guantanamo Bay (thanks bobbdobbs)
Reply with quote
jonbwfc wrote:
cloaked_wolf wrote:
.
Still, the public believe the Govt have rescued the NHS

No they fecking well don't.

+1

_________________
Do concentrate, 007...

"You are gifted. Mine is bordering on seven seconds."

https://www.dropbox.com/referrals/NTg5MzczNTk

http://astore.amazon.co.uk/wwwx404couk-21


Fri Nov 15, 2013 10:08 pm
Profile
What's a life?
User avatar

Joined: Thu Apr 23, 2009 8:46 pm
Posts: 10022
Reply with quote
So reading a bit more about it, they plan to abolish boundaries so patients can register whichever service they wish. The only positive is that the patient can choose to register at any surgery they wish. The downsides:


- popular surgeries need to be able to limit list size or the service quality goes downhill.
- difficulty accessing the rest of community services eg district nurses
- increase in "dodgy" patients "doctor hopping" - something that's common amongst addicts who move on as soon as the doctor gets wise to their problems
- GPs will not have to do home visits

An example of the issue. Mr Jones lives in Birmingham but works in London every day. He can now register with the surgery close to his workplace and he sees them regularly, building up a relationship etc. One day, Mr Jones breaks his ankle and needs a home visit because the pain is getting worse despite surgery. His GP in London is under no obligation (and it would be infeasible) to go and visit him in Birmingham. Who will see him now? The Govt wants a "home visiting service" (likely nurses or advanced care practitioners rather than GPs, or the out-of-hours providers doing more work).

Mr Jones then gets diagnosed with prostate cancer and deteriorates rapidly. He no longer works and stays at home in Birmingham. Who will look after him now? His usual GPs are too far away for them to visit. They cannot coordinate care such as district nurses, macmillan nurses, palliative care etc. Mr Jones will have to register with a nearby surgery who won't know him as well.

The boundaries each GP surgery has is for a reason. It's the region in which they can adequately provide and cover services such as home visits and community services. Unless the infrastructure is present (it isn't!) this will fail.

_________________
Image
He fights for the users.


Sat Nov 16, 2013 6:24 pm
Profile
Spends far too much time on here

Joined: Fri Apr 24, 2009 9:44 pm
Posts: 4860
Reply with quote
jonbwfc wrote:
cloaked_wolf wrote:
.
Still, the public believe the Govt have rescued the NHS

No they fecking well don't.


+1 ...

_________________
Hope this helps . . . Steve ...

Nothing known travels faster than light, except bad news ...
HP Pavilion 24" AiO. Ryzen7u. 32GB/1TB M2. Windows 11 Home ...


Sat Nov 16, 2013 11:27 pm
Profile
What's a life?
User avatar

Joined: Fri Apr 24, 2009 10:21 am
Posts: 12700
Location: The Right Side of the Pennines (metaphorically & geographically)
Reply with quote
+2
I naturally prefer the Tories to Labour because of their economic policies, but even I can see they've made a right balls up of the NHS.

_________________
pcernie wrote:
'I'm going to snort this off your arse - for the benefit of government statistics, of course.'


Sun Nov 17, 2013 6:41 am
Profile WWW
What's a life?
User avatar

Joined: Thu Apr 23, 2009 8:25 pm
Posts: 10691
Location: Bramsche
Reply with quote
@cloaked_wolf and what is when he is ill? That means he would have to pretty much travel all the way to work in order to get a sick note to say he doesn't need to come to work. The couple of times i've been ill and needed to see the doctor, travelling more than the 5 minutes to our local surgery in a taxi, or with my fiancé driving, was out of the question. It is convenient to have a surgery near work, where you can make a quick appointment (although you often end up sitting around for half an hour after your appointment time) and not have to miss half a day, but when you are really ill, you need that local access.

_________________
"Do you know what this is? Hmm? No, I can see you do not. You have that vacant look in your eyes, which says hold my head to your ear, you will hear the sea!" - Londo Molari

Executive Producer No Agenda Show 246


Sun Nov 17, 2013 7:55 am
Profile ICQ
I haven't seen my friends in so long
User avatar

Joined: Thu Jun 18, 2009 5:10 pm
Posts: 5837
Reply with quote
Whatever happened to the rule of thumb we had when I was a boy?

"If it's worth seeing the doctor, it's worth a day off"

The point being that, if it's serious enough to see a doctor, it's probably serious enough that you should be taking a day off work anyway

_________________
Jim

Image


Sun Nov 17, 2013 9:05 am
Profile
Legend
User avatar

Joined: Fri Apr 24, 2009 2:02 am
Posts: 29240
Location: Guantanamo Bay (thanks bobbdobbs)
Reply with quote
l3v1ck wrote:
+2
I naturally prefer the Tories to Labour because of their economic policies, but even I can see they've made a right balls up of the NHS.

They had the same policies right up until the financial crash and even now they are only slightly different, in terms of how fast to push austerity. Don't forget that the Tories pledged to keep the same spending as new labour right upto the financial crisis.


Sent from my iPad using Tapatalk HD

_________________
Do concentrate, 007...

"You are gifted. Mine is bordering on seven seconds."

https://www.dropbox.com/referrals/NTg5MzczNTk

http://astore.amazon.co.uk/wwwx404couk-21


Sun Nov 17, 2013 10:01 am
Profile
What's a life?
User avatar

Joined: Fri Apr 24, 2009 10:21 am
Posts: 12700
Location: The Right Side of the Pennines (metaphorically & geographically)
Reply with quote
Amnesia10 wrote:
l3v1ck wrote:
+2
I naturally prefer the Tories to Labour because of their economic policies, but even I can see they've made a right balls up of the NHS.

They had the same policies right up until the financial crash and even now they are only slightly different, in terms of how fast to push austerity. Don't forget that the Tories pledged to keep the same spending as new labour right upto the financial crisis.

Yes, but then they revised spending down where as Labour would have borrow even more when we already have a massive debt. So far the Tory plan seems to be working, though not as fast as they'd claimed it would. Hardly supprising given all the Euro problems in our main are markets. To me Labour always borrowed when the ecomony was doing well to buy votes. Saddling future generations with nation debt so they could look good now. Even before all this kicked off they couldn't balance a budget to save their lives. They don't seem to understand that wealth has to be earned before it can be spent.

I think the Tories have shot themselves in the foot for the next election. All they had to do was fix the economy and people would had said they'd done well. Sure, the general public (the working ones) also gave them credit for capping house hold benifits to the average income. Now people are ignoring that and focusing on their monumental cock ups with the NHS, elected police burocrats etc. What were they thinking of when they did all that? Thankfully (from my point of view) Labour are currently so inept at being an effective opposition (Balls is lacking policies and charisma) that the Tories still have a slim chance of winning the next election. If Labour pull themselves together in time then they'll thrash the Tories at the next election. Or course the rise of UKIP will work against the Tories too as they'll take many votes away from them in swing seats.

_________________
pcernie wrote:
'I'm going to snort this off your arse - for the benefit of government statistics, of course.'


Sun Nov 17, 2013 11:52 am
Profile WWW
What's a life?
User avatar

Joined: Thu Apr 23, 2009 8:46 pm
Posts: 10022
Reply with quote
@BigD, that's kinda my point. One, he'd need to get in touch with his GP for a sick note. Now if he goes to the near surgery, he would have to temporarily register and the Birmingham GP would have bugger all idea of what's going on. Two, he only needs a sick note if he's been off work for more than seven days. Up until then, he can self-certify.

Rusty is absolutely correct. If you're unwell enough to see a doc, you probably shouldn't be in work and can be seen that day as an emergency appt. If it's routine, it can wait.

What surprises me is that some people want to be seen by a GP 24/7 to fit in wih their modern life. Yet in theory it should be far easier now to see a doctor because of other people working shifts. In the past, the majority of people worked 9-5 yet they still managed to see a doctor during working hours. Given that more people now are working shifts, arguably it should be easier to see a doc.

Things that complicate the issue: more people have more problems and it takes longer to sort out. There's also the dumping of hospital work on to primary care but without the funding. This has made things much more difficult and is part of the reason why GPs are now working longer.

_________________
Image
He fights for the users.


Sun Nov 17, 2013 1:21 pm
Profile
What's a life?
User avatar

Joined: Thu Apr 23, 2009 8:46 pm
Posts: 10022
Reply with quote
Whilst the Tories seem hellbent on destroying the NHS through privatisation, it was the Tories who came up withthe idea of the NHS. Labour then implemented it. Labour has certainly squandered money through the likes of PFIs for hospitals. The debt far outweighs the original cost, but the savings are being made by shutting down services. The plan is to have "super a&e" services. Downsides aren't just time taken to travel/be seen but the medical implications. A person could die in the time it takes for them to travel the longer distance than if they'd transported to a local hospital with a&e facilities.

_________________
Image
He fights for the users.


Sun Nov 17, 2013 1:25 pm
Profile
What's a life?
User avatar

Joined: Fri Apr 24, 2009 10:21 am
Posts: 12700
Location: The Right Side of the Pennines (metaphorically & geographically)
Reply with quote
PFI's are just a total waste of money IMO. We'd be better off just borrowing the money and building things the normal way.

_________________
pcernie wrote:
'I'm going to snort this off your arse - for the benefit of government statistics, of course.'


Sun Nov 17, 2013 1:29 pm
Profile WWW
Display posts from previous:  Sort by  
Reply to topic   [ 16 posts ]  Go to page 1, 2  Next

Who is online

Users browsing this forum: No registered users and 5 guests


You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum

Search for:
Jump to:  
Powered by phpBB® Forum Software © phpBB Group
Designed by ST Software.