The proposal has been recommended by David Colin-Thomé, the national clinical director for primary care, who has been charged with reviewing primary care services and whose report will be published in January. Dr Colin-Thomé says that most patients concerned about their recovery already see their GP within two weeks of surgery, rather than waiting six weeks to raise the problem with a consultant.
The inefficiency in the NHS's present arrangements, he claims, is compounded by the fact that 11.9% of patients fail to attend their routine check-up. A total of 4.2m appointments were wasted in 2005/6 at a cost of £378m. "The system needs a complete rethink," he told the Guardian. "We waste consultants' precious time and expertise if we force them to spend hours sitting in a room simply telling patients they're recovering fine ... It is like asking a Michelin-star chef to cook microwave meals all day.
"Patients don't need specialists to tell them they are fighting fit. Most will know this themselves, and those who want extra advice and reassurance would get this from their GP. We are finding that most patients who are concerned about their recovery actually contact their GP within two weeks anyway."
The Department of Health calculates the move should save £1.9bn. Government advisers hope that shifting the check-ups to more convenient locations would cut the number of missed hospital appointments. Last night the department said there might be rare instances where consultants might want to see patients after complex operations. A spokesman said: "In the vast majority of cases, routine follow ups would be done by GPs." If patients demanded appointments with a consultant, these would be at the consultant's discretion
I would agree that following each patient up routinely by a consultant at 6 weeks is probably unnecessary. I would suggest that routine follow up by GPs is also a waste of their precious time and expertise.
There is good evidence that patients with post operative complications will consult their local practice in any case and the rest with no problems are probably quite happy to be left alone. The best system would be for GP practices to provide a nurse trained in post operative care who would have direct access to urgent specialist follow up if required. This could be funded by shifting some of the money currently being paid to hospital trusts for post operative care to GP practices. I would also suggest that 6 week follow up should be optional giving the patient choice and responsibility and at the same time reducing costs
Saturday, December 30, 2006
Thursday, December 21, 2006
Cheeky Opik
Liberal Democrats are best known for winning by-elections; the Cheeky Girls are best known for the exhortation "touch my bum". How on earth did this happen? ...His family is from Estonia; hers from Romania. Mr Opik and Ms Irimia must have bonded over their mutual interest in European Union enlargement. So perhaps not such an unlikely love story after all. Only one question remains: is it too late for a cheeky Christmas duet single?"
Do we care?
Do we care?
Yorkshire Post letter 18 Dec
Dear Sir
Your editorial highlights the very real problems occuring within the NHS. The cuts will affect front line services, training and staff morale. All of these factors will affect the patient experience of healthcare in the coming years.
Having working in the NHS for many years and sampled NHS management, I make the following observations.
The has been much talk about engaging clinicians, in particular Doctors in the shaping of services. This has largely been talk. Doctors are now disengaged and disenchanted with the whole process.
PCTs have spent more energy organising and re-organising their structures than developing services.
There are more uncompleted projects than completed ones. PCT managers often lack the skills required to develop a working service. They are paralysed by Government guidance which is often unclear and changes frequently. This has resulted in indecision causing immense frustration and wasted opportunity.It is demotivating to anyone involved.
Targets whilst improving some aspects of patient care have lead to money being diverted from areas of care which are not included in targets. The targets have not been properly costed out leading to debts.
Financial management and IT development have been frankly shoddy at times.
Now to cap it all the Government has decreed that suddenly the books have to balance.It is like a bank threatening to forclose on a poorly run large business and panic has set in.The results are plain to see.
The NHS is complicated and changing it for the better will always be difficult but this Government has made a hash of it
Your editorial highlights the very real problems occuring within the NHS. The cuts will affect front line services, training and staff morale. All of these factors will affect the patient experience of healthcare in the coming years.
Having working in the NHS for many years and sampled NHS management, I make the following observations.
The has been much talk about engaging clinicians, in particular Doctors in the shaping of services. This has largely been talk. Doctors are now disengaged and disenchanted with the whole process.
PCTs have spent more energy organising and re-organising their structures than developing services.
There are more uncompleted projects than completed ones. PCT managers often lack the skills required to develop a working service. They are paralysed by Government guidance which is often unclear and changes frequently. This has resulted in indecision causing immense frustration and wasted opportunity.It is demotivating to anyone involved.
Targets whilst improving some aspects of patient care have lead to money being diverted from areas of care which are not included in targets. The targets have not been properly costed out leading to debts.
Financial management and IT development have been frankly shoddy at times.
Now to cap it all the Government has decreed that suddenly the books have to balance.It is like a bank threatening to forclose on a poorly run large business and panic has set in.The results are plain to see.
The NHS is complicated and changing it for the better will always be difficult but this Government has made a hash of it
General Practice Works by Jonathan Steele
General Practice works
“We’re off to see the Wild West show…” you know the song, “… the elephant and the kangaroo...” it goes on to exhibit the F’Kawe tribe who live on the grasslands of Africa. They are very short and the grass is very long, so you see their heads appear as they jump up and down shouting “We’re the F’Kawe”. I know how they feel. The grass is getting longer around us in General Practice. You’re not alone if you feel totally lost. It’s tempting to disappear back into the practice and wait until the grass is cut. Trouble is that no one is cutting the grass and we’re running out of energy to carry on jumping up and down. In a rush to balance the NHS books, there is a danger that General Practice will be lost forever.
A few words here cannot be truly representative nor comprehensive. I briefly attempt to draw a map of the GP journey so far in the hope that we will not be steered off course in the future.
Medicine is practised in a context of the society it serves and has always found a way of adapting to social changes. The Foundation of the RCP in 1518 is a good example as was the need for a College for General Practitioners in the 1950s.
Medicine is also practiced in a system, ours is the NHS. An understanding of the relationship between GPs and the NHS may help explain some of our current difficulties.
The National Insurance Act of 1911 allowed working men to be on the “panel” of a doctor and receive free medical care. Those doctors who listed patients under the Act were the first recognisable GPs, they established themselves in towns and villages and became the gatekeepers of referral to specialists.
GPs owe their existence to the 1948 NHS Act which extended the panel to the entire population. The NHS owes its survival to GPs who have kept the costs down by providing well trained, comprehensive and cheap health care close to home. The long term relationship between a GP and the patient is the bedrock of medical practice in the UK. GPs are independently minded, we refused to be “employed” in 1948 and we run our businesses on a self employed basis. Our entrepreneurial independence has allowed us to adapt, a look at the GP computer systems compared to those of our hospital colleagues is a good example.
95% of NHS consultations occur in General Practice, but we are much more than a mass service for trivial medical problems. The General Practitioner has a unique understanding of the patient as a person, in a family and a community. Our long term relationship provides trust where there is clinical uncertainty with the passage of time as a diagnostic tool. General Practice operates at levels beyond individual patient care. As a business it provides social capital to the community it serves. General Practitioners have always advised their local NHS on service developments and taken an interest in the direction of the NHS nationally.
General Practice works as a diverse self critical system evolving through clinical excellence and altruistic social awareness. Over the past few years the NHS has been stifled into a managed mediocrity, at the front line we are struggling to cope.
Given the freedom, we have the tools to deal with the chronic disease management of an ageing population, we have the ability to adapt to pharmacological advances, we have the experience to manage the better informed “consumer” of our care, we have the desire to improve our knowledge and practice through appraisal and revalidation. I believe that GPs can cope with the demands of our patients and of society. It is the demands of the system that distract us.
The Quality and Outcomes Framework (QOF) has impersonalised chronic disease management into a tick box process that could be “sold” to non GP providers. The current DoH consultation around urgent care does not recognise the day time urgent care role of a GP. This thinking questions the value of General Practice. Increasing managerial intrusion into clinical practice creates an impression of a lack of trust in the abilities of GPs by their PCT.
Whilst apparently trying to undermine General Practice, confusion arises as we are being asked save the NHS through Practice Based Commissioning and care closer to home, with neither time nor resources to do either. The worsening financial crisis implies that all initiatives are financially driven. The merger of PCT’s has created organisational chaos when clear policy interpretation and leadership is most needed.
NHS Direct, walk in centres and Community Matrons, are an expensive range of new models of access for basic medical care. These ventures have not cut hospital admissions nor costs. The NHS is failing to serve some of our most deprived communities; it is no coincidence that traditional General Practice no longer exists in those communities, illustrating the symbiotic relationship between the NHS and General Practice.
If we are living through a managed redefinition of comprehensive General Practice, the unintended consequence could be the destabilisation of the NHS. Amongst the current policy and organisational chaos, GPs know where we are. Through our professional values, we have to demonstrate that General Practice works.
“We’re off to see the Wild West show…” you know the song, “… the elephant and the kangaroo...” it goes on to exhibit the F’Kawe tribe who live on the grasslands of Africa. They are very short and the grass is very long, so you see their heads appear as they jump up and down shouting “We’re the F’Kawe”. I know how they feel. The grass is getting longer around us in General Practice. You’re not alone if you feel totally lost. It’s tempting to disappear back into the practice and wait until the grass is cut. Trouble is that no one is cutting the grass and we’re running out of energy to carry on jumping up and down. In a rush to balance the NHS books, there is a danger that General Practice will be lost forever.
A few words here cannot be truly representative nor comprehensive. I briefly attempt to draw a map of the GP journey so far in the hope that we will not be steered off course in the future.
Medicine is practised in a context of the society it serves and has always found a way of adapting to social changes. The Foundation of the RCP in 1518 is a good example as was the need for a College for General Practitioners in the 1950s.
Medicine is also practiced in a system, ours is the NHS. An understanding of the relationship between GPs and the NHS may help explain some of our current difficulties.
The National Insurance Act of 1911 allowed working men to be on the “panel” of a doctor and receive free medical care. Those doctors who listed patients under the Act were the first recognisable GPs, they established themselves in towns and villages and became the gatekeepers of referral to specialists.
GPs owe their existence to the 1948 NHS Act which extended the panel to the entire population. The NHS owes its survival to GPs who have kept the costs down by providing well trained, comprehensive and cheap health care close to home. The long term relationship between a GP and the patient is the bedrock of medical practice in the UK. GPs are independently minded, we refused to be “employed” in 1948 and we run our businesses on a self employed basis. Our entrepreneurial independence has allowed us to adapt, a look at the GP computer systems compared to those of our hospital colleagues is a good example.
95% of NHS consultations occur in General Practice, but we are much more than a mass service for trivial medical problems. The General Practitioner has a unique understanding of the patient as a person, in a family and a community. Our long term relationship provides trust where there is clinical uncertainty with the passage of time as a diagnostic tool. General Practice operates at levels beyond individual patient care. As a business it provides social capital to the community it serves. General Practitioners have always advised their local NHS on service developments and taken an interest in the direction of the NHS nationally.
General Practice works as a diverse self critical system evolving through clinical excellence and altruistic social awareness. Over the past few years the NHS has been stifled into a managed mediocrity, at the front line we are struggling to cope.
Given the freedom, we have the tools to deal with the chronic disease management of an ageing population, we have the ability to adapt to pharmacological advances, we have the experience to manage the better informed “consumer” of our care, we have the desire to improve our knowledge and practice through appraisal and revalidation. I believe that GPs can cope with the demands of our patients and of society. It is the demands of the system that distract us.
The Quality and Outcomes Framework (QOF) has impersonalised chronic disease management into a tick box process that could be “sold” to non GP providers. The current DoH consultation around urgent care does not recognise the day time urgent care role of a GP. This thinking questions the value of General Practice. Increasing managerial intrusion into clinical practice creates an impression of a lack of trust in the abilities of GPs by their PCT.
Whilst apparently trying to undermine General Practice, confusion arises as we are being asked save the NHS through Practice Based Commissioning and care closer to home, with neither time nor resources to do either. The worsening financial crisis implies that all initiatives are financially driven. The merger of PCT’s has created organisational chaos when clear policy interpretation and leadership is most needed.
NHS Direct, walk in centres and Community Matrons, are an expensive range of new models of access for basic medical care. These ventures have not cut hospital admissions nor costs. The NHS is failing to serve some of our most deprived communities; it is no coincidence that traditional General Practice no longer exists in those communities, illustrating the symbiotic relationship between the NHS and General Practice.
If we are living through a managed redefinition of comprehensive General Practice, the unintended consequence could be the destabilisation of the NHS. Amongst the current policy and organisational chaos, GPs know where we are. Through our professional values, we have to demonstrate that General Practice works.
Sunday, December 17, 2006
Aesthetic Nurse Prescribers
Bad Botox
A Colleague Writes
NURSE PRESCRIBERS
Currently Nurses are not permitted to write prescriptions. The MHRA are currrently "Updating their advice on this". We can expect the worst. Nurse Prescribers will be able to prescribe any medicine except DDAs. They will also be able to examine, treat and prescribe. This, coupled with the proliferation of Dentists claiming to be "Facial Aesthetic Medicine Specialists", plus the new "Assistant Medical Practitioners (Nurses)" puts all our futures in jeopardy. In fact one website of a member of this group advertises a Nurse as an "Aesthetic Medical Practitioner". I despair at the draconian regulation by the GMC and Healthcare Commission of our profession on the one hand, and the total lack of regulation of our Dental and Nursing colleagues on the other.Fascinatingly "Private Doctors" are regulated by the HCC. but not Private Dentists or Nurses. It is also interesting that Private Dentists who call themselves "Doctor" are totally exempt from HCC inspection. I believe that if they want the title, they have to put up with the regulation that comes with it. Power without responsibilty the ultimate patients nightmare. I am also afraid that the HCC is an organisation run by Nurses for Nurses and that any recommendations will be Pro-Nurse and anti-Doctor.
What do you think?
Currently Nurses are not permitted to write prescriptions. The MHRA are currrently "Updating their advice on this". We can expect the worst. Nurse Prescribers will be able to prescribe any medicine except DDAs. They will also be able to examine, treat and prescribe. This, coupled with the proliferation of Dentists claiming to be "Facial Aesthetic Medicine Specialists", plus the new "Assistant Medical Practitioners (Nurses)" puts all our futures in jeopardy. In fact one website of a member of this group advertises a Nurse as an "Aesthetic Medical Practitioner". I despair at the draconian regulation by the GMC and Healthcare Commission of our profession on the one hand, and the total lack of regulation of our Dental and Nursing colleagues on the other.Fascinatingly "Private Doctors" are regulated by the HCC. but not Private Dentists or Nurses. It is also interesting that Private Dentists who call themselves "Doctor" are totally exempt from HCC inspection. I believe that if they want the title, they have to put up with the regulation that comes with it. Power without responsibilty the ultimate patients nightmare. I am also afraid that the HCC is an organisation run by Nurses for Nurses and that any recommendations will be Pro-Nurse and anti-Doctor.
What do you think?
BAE Eurofighter
For Once Blair is Right!
Justifying the forced closure of the Serious Fraud Office’s inquiry into corruption in a Saudi arms deal to buy 72 Eurofighter jets from BAE Systems, Tony Blair spoke as an old-fashioned realist. Nations have interests; those strategic interests are paramount. [..] Pressing for political reform in Saudi Arabia is urgent. Mr Blair is not pursuing that course, but instead is acquiescing in corruption for reasons of state. It is an unprincipled decision, but worse, it is a stupid one. - Oliver Kamm in The Times
If you lived near any of the BAE sites you would realise the impact of losing this order. Who cares about some Arabs getting some freebies in the 1980s.It was a long time ago, it may not be right but it is pragmatic to let it go.
Saturday, December 16, 2006
Road Pricing
Have the "Get everybody off the roads" brigade gone mad?
Figures of £1.28 per mile have been suggested at rush hour on motorways. This is completely out of order and defies logic. People will still use their cars, the public transport system in this country will never be as good as it needs to be. The net result will be increasingly clogged A roads and empty motorways. More traffic jams and more CO2 emissions. There has to be a better way of tackling the problem.
I suggest a levy of £2 a mile for caravans and people with cloth caps driving Metros -that should fix it.
DURHAM TOLL ROAD HITS SMALL TRADERS
The first UK toll road in 100 years was introduced Durham on 1 October, 2002. Drivers are charged £2 to enter a small part of the city centre between 10am and 4pm, Monday to Saturday. The affected area runs from the entrance to the Market Place, up along the historic, narrow Saddler Street, to the Durham Cathedral peninsular. A ticket machine is linked to an automatic barrier in the carriageway, which lowers when drivers pay to leave the charging zone. The system is monitored by security cameras and drivers caught dodging the charge are liable for a fine of up to £30.
Traffic in the zone has fallen from 2,000 to 200 vehicles a day, much more than the 50% expected by planners, and there is a European feel to the old city area, with shoppers walking casually in the single-carriage roadway alongside the occasional vehicle.
According to the BBC the local council is pleased and claims that the environment has benefited, and that the roads were now safer.
"This is a model that can be used on a small scale for historic places such as Durham, or large scale for cities like London." said their spokesman.
Some small independent traders are less keen, and have complained at having to pay £2 every time they take a delivery to their shops during the charging hours. They also claim that, paradoxically, there are now less casual pedestrian visitors than when there were more cars in the zone.
Peter Jackson, chairman of the local chamber of trade, agrees that the schemes has cut down the vehicles, although he doubts the reduction is as great as the county council says. "The real problem for business is that if I want to unload from a van it costs me £2 a time. I have at least 500 deliveries a year, which means £1,000 in charges a year.
The council argues that traders are learning to alter their delivery hours and methods, and that people who live and work in the zone are also adjusting to the charges.
The City of Durham Civic Trust also supports the scheme. Its chairman Roger Cornwell said: "Pedestrians have been given a chance to reclaim the street. Having just one barrier may seem a rather low-tech solution, but it appears to be working. There is a reduction in the number of people who would drive in just to use a cash point, or to drop someone off and then come back five minutes later to pick them up."
And local resident Henry Martin Taylor said: "It is a definite improvement, with more pedestrians and less traffic. I am all for it." 21 Feb 2003
Figures of £1.28 per mile have been suggested at rush hour on motorways. This is completely out of order and defies logic. People will still use their cars, the public transport system in this country will never be as good as it needs to be. The net result will be increasingly clogged A roads and empty motorways. More traffic jams and more CO2 emissions. There has to be a better way of tackling the problem.
I suggest a levy of £2 a mile for caravans and people with cloth caps driving Metros -that should fix it.
DURHAM TOLL ROAD HITS SMALL TRADERS
The first UK toll road in 100 years was introduced Durham on 1 October, 2002. Drivers are charged £2 to enter a small part of the city centre between 10am and 4pm, Monday to Saturday. The affected area runs from the entrance to the Market Place, up along the historic, narrow Saddler Street, to the Durham Cathedral peninsular. A ticket machine is linked to an automatic barrier in the carriageway, which lowers when drivers pay to leave the charging zone. The system is monitored by security cameras and drivers caught dodging the charge are liable for a fine of up to £30.
Traffic in the zone has fallen from 2,000 to 200 vehicles a day, much more than the 50% expected by planners, and there is a European feel to the old city area, with shoppers walking casually in the single-carriage roadway alongside the occasional vehicle.
According to the BBC the local council is pleased and claims that the environment has benefited, and that the roads were now safer.
"This is a model that can be used on a small scale for historic places such as Durham, or large scale for cities like London." said their spokesman.
Some small independent traders are less keen, and have complained at having to pay £2 every time they take a delivery to their shops during the charging hours. They also claim that, paradoxically, there are now less casual pedestrian visitors than when there were more cars in the zone.
Peter Jackson, chairman of the local chamber of trade, agrees that the schemes has cut down the vehicles, although he doubts the reduction is as great as the county council says. "The real problem for business is that if I want to unload from a van it costs me £2 a time. I have at least 500 deliveries a year, which means £1,000 in charges a year.
The council argues that traders are learning to alter their delivery hours and methods, and that people who live and work in the zone are also adjusting to the charges.
The City of Durham Civic Trust also supports the scheme. Its chairman Roger Cornwell said: "Pedestrians have been given a chance to reclaim the street. Having just one barrier may seem a rather low-tech solution, but it appears to be working. There is a reduction in the number of people who would drive in just to use a cash point, or to drop someone off and then come back five minutes later to pick them up."
And local resident Henry Martin Taylor said: "It is a definite improvement, with more pedestrians and less traffic. I am all for it." 21 Feb 2003
UKIP home website
Can anybody follow the logic of this post on the UKIP website ?
If i vote but yer but no but!
TORY PPC SIGNS UP TO BETTEROFFOUTFrom BOO:"Gordon Henderson, the Conservative Party Prospective Parliamentary Candidate for Sittingbourne and Sheppey, has just become the first Conservative Party PPC to support the BETTER OFF OUT campaign (see his message below). This is very much to his credit, as we are unable to guarantee that UK Independence Party candidates will stand down against Conservative Party candidates at the next election - except in the case of those MPs who have signed up to BETTER OFF OUT.
Naturally, we will try to draw his position on British membership of the EU to the attention of the electorate in his constituency, so that voters may draw their own conclusions and vote accordingly.
It is apparent from Gordon's blog - that his support for freeing Britain from the EU runs deep, as he has written an excellent piece on there, "Time for a Referendum on Europe".Good on Gordon, but I do hope that Nigel is true to his word and that UKIP stands in this seat as Gordon is not a sitting MP, and with Labour holding a majority of just 79 and UKIP polling 926 votes last time, there is always a chance for people to abuse BOO for political opportunism.If you really want out of the EU, then you should be standing for a party that has that as a policy.And before Iain Dale starts ranting that UKIP are "helping Labour", "blocking someone who wants out of the EU" etc, remember that the Tory Party are not going to offer EU withdrawal or a referendum as part of their next manifesto and nothing is going to change that, not 10, not 20, not even 50 new anti-EU Tory MP's, so what is the point in voting for them if you passionately support EU withdrawal?If we followed Dale's logic then most Tory voters should switch to voting Labour as they offer much the same policy agenda and are clearly in the best position to deliver it.Tip: The UKIP leaflets for this seat (and others) should clearly highlight that Cameron has banned any MP who supports EU withdrawal from his front bench team, therefore showing that a vote for an EU withdrawal Tory is a wasted vote as they can never deliver their aim
Giving GPs more powers? Pulse December 15th
Your story “More power to GPs within PCTs” highlights the history of PECs to date
I spent six years on a PEC. On reflection it was largely a waste of time and money – a view shared by several other GPs who were similarly involved.
Our PEC became increasingly populated by PAMs (professions allied to medicine) , which in my view weakened it. The argument by the PCT management team being that dentists and optometrists etc were of equal importance and knowledge to GPs in managing local services. The final straw was when I sent around a spoof email suggesting clergymen be on the PEC and got two serious replies from GP colleagues.
The reality is that GPs are responsible for spending nearly all the of the PCT budget(by referral and prescription) and are in a unique position to know what is needed locally. Whatever the merits of PAMs they do not know how General Practice works and what drives and motivates referrals and prescribing.
Our PCT like many others has disengaged GPs.
Engaging them again is going to be a huge task. Most GPs are just not interested in what they view as a pointless charade.
There also needs to be a reality check over the payment for PCT work
I spent six years on a PEC. On reflection it was largely a waste of time and money – a view shared by several other GPs who were similarly involved.
Our PEC became increasingly populated by PAMs (professions allied to medicine) , which in my view weakened it. The argument by the PCT management team being that dentists and optometrists etc were of equal importance and knowledge to GPs in managing local services. The final straw was when I sent around a spoof email suggesting clergymen be on the PEC and got two serious replies from GP colleagues.
The reality is that GPs are responsible for spending nearly all the of the PCT budget(by referral and prescription) and are in a unique position to know what is needed locally. Whatever the merits of PAMs they do not know how General Practice works and what drives and motivates referrals and prescribing.
Our PCT like many others has disengaged GPs.
Engaging them again is going to be a huge task. Most GPs are just not interested in what they view as a pointless charade.
There also needs to be a reality check over the payment for PCT work
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