Is there an echo in here?Despite the BBC being momentarily distracted by the (not entirely unpredictable) results of the banking system's combination of greed and fraud, that has been euphemistically described as 'exuberance', normal service has been predictably resumed today - GP Bashing!
Apparently, the Public Accounts Committee has declared that our 'productivity' has fallen despite a 'massive increase in pay'. How the fuck do you measure the productivity of an activity that 'produces' the infinitely subjective and unquantifiable concept of 'health'? Could this be yet another example of their obsession with measuring the immeasurable and trying to value the priceless?
Has life expectancy got worse? Are chronic diseases like asthma and diabetes now not better and less expensively managed than they were (thanks entirely to General Practices)?
The report even states:
"The cross-party group of MPs also said GP consultations had become longer as nurses had taken on extra responsibilities including asthma and diabetes reviews. This also meant family doctors were offering a wider range of services - in recent years they have started taking on care traditionally done in hospitals, such as minor surgery."
...completely scuppering the premise of the headline!
Neither does it address the fact that GPs were both overworked AND underpaid in the past, and some redress was long overdue. The toll that was being extracted on a stressed and ageing workforce's health, family life and finances was totally unsustainable, and the Primary Care system (the only world class bit of the NHS) was in real danger of collapse. 5 years down the line, the miracle of workforce planning means that a much greater proportion of GPs are approaching retirement or are actually women with families, many of whom won't do 'extra hours' at any price, and why the fuck should they? If you're ill enough to a see a GP, you've got 10 hours per day to get yourself organised and down the surgery.
Having said that, there are some GPs who are taking the piss and pocketing the money and not employing more partners or other doctors, and their patients are struggling to get appropriate access during the existing hours, but why spread those hours around? The minority are causing the rest of us a BBC sized pain in the arse.
So where are we now? I earn less than the supposed average, and work longer hours than those quoted in that report. My patients are healthier despite being older and more of them can appropriately manage self-limiting trivial illness without coming to see me because of the time I've invested addressing their 'ideas, concern and expectations'. I offer fewer, but longer appointments and actively look to stop people getting ill in the first place. Importantly, fewer of my punters have to go to the (expensive, inefficient and MRSA ridden) hospital now because I sort them out in my surgery.
I still earn less than a 'Banker's Bonus', less than my dentist (who works fewer hours than me) and less than my MP once 'expenses' are taken into account (they've sneakily taken mine into account in their report). I rarely eat my lunch in peace, play golf once a year and see my kids awake twice a week.
If you pay peanuts, you will get monkeys.
If productivity for MPs can be measured by standing aroung talking bollocks for a whole thirty-odd weeks per year, or by the amount of meaningless bullshit paper reports produced by committees, then we can be prodigiously proud of ours.........
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Having said that, there are some GPs who are taking the piss and pocketing the money and not employing more partners or other doctors, and their patients are struggling to get appropriate access during the existing hours
Indeed. (My GPs are not, it did take them ages and ages to appoint a new partner when one left but they appointed at least two temporary doctors plus some locums -- in addition of course to the Registrar -- the meanwhile.) But though the doctors you attack are indeed (I take it) a minority, they do cause serious unrest and something needs to be done about them...
also
Are chronic diseases like asthma and diabetes now not better and less expensively managed than they were (thanks entirely to General Practices)?
yes but look, GPs are paid extra to do this kind of thing, we do need to ask why it wasn't done so well before they were
If you're ill enough to a see a GP, you've got 10 hours per day to get yourself organised and down the surgery.
ah, the old 'ill enough to see a GP' thing again. So, when someone is well enough to go to work (has say the symptoms of cystitis, or finds a lump in their breast) they aren't 'ill enough to see a GP'?
yes but look, GPs are paid extra to do this kind of thing, we do need to ask why it wasn't done so well before they were
Exactly! So the money has been earned becasue productivity has risen if you measure it - unless you are a dodgy MP fucktard. It wasn't done before because GPs were up all night one night in three/four and couldn't do five 12 hour days per week as well as do all this work that we weren't paid to do. The extra money that we've 'earned' has also helped to pay for extra staff.
So, when someone is well enough to go to work (has say the symptoms of cystitis, or finds a lump in their breast) they aren't 'ill enough to see a GP'?
Those are examples where people ARE NOT well enough to work, and any surgery worth it's salt will sort those things out on the day - without fail. My surgery would.
Time off work to see a doctor at your discretion is your employer's responisibity. I'd love to see an employer try to deny this right.
QOF has made us tidy up our chronic disease management- and shows that GPs are in part motivated by finance. I know we should be altruistic and professional etc, but we are also human and venial at times.
Anything we earned extra under new contract has been clawed back by the vengeful and venial new Labour Department of Health. They talk about our pay rise which we got once but fail to report that we have had no increase for 4 years (but we have paid out rises to practice staff, and increased running costs, and increasing medical indemnity premiums)
My take home pay has dropped significantly, and the tax man has given me a significant refund this year. The truth is GP pay is being cut back by deliberate government actions.
Exactly!
:)
It wasn't done before because GPs were up all night one night in three/four
not in my experience (they hired deputising services); but I accept that many GPs were.
Those are examples where people ARE NOT well enough to work,
wrong.
any surgery worth it's salt will sort those things out on the day
my GPs' surgery would now; before the Tony-Blair-within-48-hours thing they might not have been able to. (I've seen GPs about breast lumps rather a large number of times... really there was no reason for it to be same-day and there'd have been rather a lot of days off work.) There are surgeries now that give only 'emergency' appointments within 48 hours (see patients' discussion boards), 'triage' by receptionist. Cystitis, well I do actually tend to agree, and my previous GPs saw me fairly quickly the only time it happened; but my taking time off work to see them was not well received albeit I didn't have to take a whole day off (I didn't have to ring at 8.30 am to get a same day appointment, carry on ringing, etc.). And that takes me to
Time off work to see a doctor at your discretion is your employer's responisibity. I'd love to see an employer try to deny this right.
They do, though. They harass people for being off work, and threaten them, even when contracts specifically allow for e.g. hospital visits and for a set amount of sick leave, and even try to get people who have clear diagnoses and 'clean' sick leave records (i.e. each one, not that frequent anyway, properly certificated -- horrible word... -- and for conditions that were not, e.g., 'cough' or 'flu'). I do think given that, some doctors could try to be a bit more flexible. (But I emphasise that I am talking about conditions/symptoms that I don't see as making someone too ill to work.) And I think if they don't then walk-in clinics will make headway.
That reminds me. My GPs have a 'GP service under threat' poster in the waiting room. I thought there was no such threat in Wales (albeit almost all the parties seem to support nurse-led WICs as a response to the really rather hard pressed Welsh NHS)?
QOF has made us tidy up our chronic disease management- and shows that GPs are in part motivated by finance.
that was what I had in mind, yes!
Actually QoF achieved two things:
1. It funded extra nurse/doctor time for chronic disease management.
2. It funded the clerical/management time to DOCUMENT that the work was getting done.
We spent our entire QoF budget on (1) and (2) above. There was virtually no 'profit' above the basic hourly rates.
Much of this work was already being done because we were professionals who wanted to do the best for patients.
Now the problem is that the target data collection gets in the way of things that are not being measured - like empathy and holistic care.
It's a load of bollocks.
Oh, and GP income is falling fast.
"Neither does it address the fact that GPs were both overworked AND underpaid in the past, and some redress was long overdue."
Says whom? Dr Rant, GP? Well, ain't that a surprise.
I thought that you chaps were all so dedicated to your patients that you were happy to work for shitty wages?
Or maybe you feel that having a shitty socialised health service is fine for the patients, but that GPs should be paid as the market determines?
Wow! A hypocritical doctor -- who'd have thunk it?
DK
DK,
I'd be delighted to look after patients for shitty wages. That's what I went into medical school to do.
What I won't do is be blocked from looking after patients, take the flack for shitty services I have no control over, get given every shitty job that no-one else wants to do (including spending hours on the phone organising fucking taxis which I AM STILL NOT GETTING PAID FOR, FUCKERS!), getting threatened and abused by a minority of patients with impunity, getting bashed in the press constantly, and being driven to work my fucking arse off not for patients but to fuck patients over to make a profit for shareholders.
For that I need fucking paying.
Jayann
presumably when you see the GP with your Breast Lump and you are referred, you will be expecting the consultant Surgeon to see you at your convenience outside normal hours and also organise a special operating list complete with anaesthetist, scrub nurse, assistant, ODAs, histology labs for the frozen section, haematology and Biochem labs for your Blood chemistry pre op to be also organised around your work schedule.
Beware you don't get squashed, Pigs don't actually fly very well when they get airborne.
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