RCGP members have overwhelmingly backed moves for the Health and Social Care Bill to be scrapped, with more than 98% of respondents to a new poll calling on the College to seek the withdrawal of the bill alongside other royal colleges.
More than 98% of 2,600 respondents said they either strongly supported (66%) or supported (32%) asking for the health bill to be withdrawn as part of a joint approach with other medical colleges.
Read more at Pulse.
Future Forum chair Professor Steve Field has launched a stinging attack on the quality of general practice in the UK, claiming the NHS has ‘lost the plot’ on primary care provision.
In a debate at the NHS Alliance conference in Manchester, the former RCGP chair said there was too much variation in primary care and that levels of access were unacceptable in some parts of the country.
Professor Field said it was time to consider new innovative models for primary care.
Read more at Pulse.
People should be signed off for long-term sickness by an independent assessment service and not GPs, a government-backed review says.
The review also suggests tax breaks for firms which employ people who suffer from long-term conditions.
It is estimated the changes would send 20% of those off sick back to work.
A Department for Work and Pensions spokesman said: “The government is committed to supporting more people with health conditions to work.”
Around 300,000 people a year are absent from work due to long-term sickness.
Read more at BBC Health.
If PCTs and Clinical Commissioning Groups with financial and professional incentives inhibit referrals to specialists and this iron grip is set to tighten.
If standards of primary care were beyond reproach and consistent there would be a strong case for this illiberal model of healthcare. A King’s Fund report in 2011 punctured this optimistic balloon and confirmed what specialists have long appreciated: there is enormous variation in knowledge and skills and diagnostic delays which produce, for example, cancer outcomes inferior to those of our European neighbours in spite of excellent, well resourced oncology services.
The variation of referral rate in one study of 51 practices for suspected cancer symptoms was from 0.72 to 25 for every 1,000 patients.
The government’s proposals to abolish SHAs and PCTs will place a heavy burden on GPs to make good clinical and financial decisions and is a high risk strategy. Their burden would be lightened if patients were given real freedom and choice to consult specialists without GP referral.
The advantages would include:
- appropriate investigation, early diagnosis and optimal treatment;
- specialists work in teams and compare their practice with local, national and international standards. It makes secondary care far more even in terms of performance than primary care.
- patients being confident that they will receive the best available care.
The disadvantages might include:
- specialists could be overwhelmed by minor conditions (though this could be addressed through the ratio of specialists to generalists);
- patients might consult the wrong specialists. The pre-Berlin Wall collapse style diktat banning consultant to consultant referrals must be overturned so that patients can be smoothly passed on. Specialists in their first comprehensive assessment of a patient often find problems fully justifying the opinion of their colleagues.
- the direct access model might be more expensive in the short term but early effective treatment of cancer and musculoskeletal conditions could save money in the medium and long term and may return patients to work sooner.
- loss of single, coordinating GPs with good knowledge of their patients. I think this traditional strength of primary care has long since disappeared. Patients see the GP with the next available appointment.
At this time of healthcare reform, we should consider abolishing the out-dated, restrictive practices typical of mid-twentieth century trade unionism and allow our patients real choice.
Asylum seekers and undocumented migrants must retain access to NHS primary care.
These are the views of Dr Paquita de Zulueta, who calls on colleagues to “overcome bureaucratic barriers and register patients irrespective of their residential status”.
She describes some of the vulnerable people she sees as a GP for a health advocacy programme in London. “They are like Dante’s lost souls wafting in limbo, neither in heaven nor hell, but in a cold and lifeless purgatory, a place the world refuses to acknowledge.”
“Many of them have not sought medical help for several years despite serious medical problems, some brought on by the lives they lead or the trauma they have experienced,” she adds.
She recalls some harrowing stories - a woman brought to the UK and forced into sexual slavery; a teenager with severe post-traumatic stress disorder at risk of harming himself or others; women giving birth at home without any clinical supervision.
“These people are all in clinical need yet have been unable to access primary healthcare in the United Kingdom,” she writes. “Despite pleas to my colleagues to take them on…they still turn them away.”
The BMA says there is no requirement for doctors to determine someone’s immigration status in order to access health services, and the GMC guidance requires that doctors do not discriminate unfairly but provide care and treatment to meet the clinical needs of all patients.
She acknowledges the bureaucratic barriers to providing care, but argues that “these impositions carry no valid legal or ethical authority”.
And she warns, in this week’s BMJ, that government plans to expand its existing restrictions on free secondary care to primary care “does not augur well for the vulnerable and dispossessed in need of humane clinical care - particularly as compassion seems to be a dwindling resource in modern medicine”.
Read the full article.
GPs are facing growing complaints over the ‘unfair removal’ of patients from practice lists, with terminally ill patients among those affected, according to a damning report by the Health Service Ombudsman.
Complaints about patients being wiped by GP lists accounted for more than one in five (21%) of complaints about GPs investigated by the ombudsman in 2010/11, up 6% from the previous year.
In her highly critical report, Ann Abraham, blasted the NHS for failing to deal appropriately with basic complaints and warned some GPs are breaching NHS contracts and BMA guidance by removing patients from practice lists “without fair warning or proper explanation”.
Read more in Pulse.
One of my patients (let’s call her Beryl) complained to me this week that she had been denied bariatric surgery. She had been unable to lose the percentage of body weight required to demonstrate an ability to adhere to the stringent dietary restrictions patients have to live with following a gastric bypass. She was therefore deemed ‘unsuitable’ by the PCT despite her BMI of approaching 60.
One of the founding principles of the NHS is that services should be free at the point of access, and that the secretary of state for health is responsible for ensuring the delivery of all ‘reasonable’ services. In practice, the only services which the NHS has not generally delivered have been cosmetic surgery, some infertility services, complementary therapies and the long-term nursing care of the elderly. The distressing consequences of the latter for many, who mistakenly believed that the NHS would care for them in their hour of need, are well known to us all.
Currently Beryl can appeal against the PCT’s decision - and if she can demonstrate that they haven’t followed NICE guidance, she has a good chance of winning. She might even choose to take her appeal to the secretary of state for health. It might also be reassuring for Beryl to know that under the present system staff at the PCT aren’t personally quids-in as a direct result of their refusal. Surgery has almost certainly been refused because A. it’s unlikely to be successful because she can’t stick to a diet, and B. the PCT hasn’t got money to throw away on pointless procedures.
What Beryl, and many like her, don’t realise is that under the proposed Health and Social Care Bill things will be very different. As we have seen from the behaviour of a Yorkshire GP practice (who have jumped the gun, admittedly, but probably only by a few months), commissioning consortia will be given the power to decide which procedures are available on the NHS and which are not.
They can do this without any public discussion, and it’s not obvious who to appeal to. The Haxby GPs have also ably demonstrated to the most sceptical observer the potential for massive conflict of interest. The practice wrote to patients informing them that their procedures were no longer available on the NHS, and offering them a choice of four private providers, one of which just happens to be owned by the very same Haxby group. Under the proposed new rules, as an additional bonus, any money not spent on patients from their NHS-budget can be divvied up amongst the group. Denying NHS treatment to patients therefore becomes fantastically profitable.
Why hasn’t there been an outcry about this? Possibly because not many of us have read the 700 pages of the Bill sufficiently carefully, or perhaps, with typical British pragmatism, we are just hoping that things won’t turn out as badly as expected. Let’s hope we’re right.
GPs at a health centre in York have written to patients saying the NHS will no longer fund minor operations and instead offering to carry out the procedures for a fee, an unprecedented step in the health service.
In a letter obtained by the website nhsmanagers.net, patients are advised that for a number of minor surgical procedures, such as ingrowing toenails, mole removal and chopping out warts and cysts, they would have to go private.
It says: “We are holding your details on a list of patients who require a minor surgical procedure that is no longer paid for by the NHS.”
The letter identifies four “local service providers who offer the procedure privately”, including HBG Ltd, which it admits is “a company that is wholly owned by the practice”. The price list of treatments range from £56 to remove a skin tag to £243 for lipomas.
Read more at The Guardian.
I don’t go to see my GP very often; in fact, when I rang up for an appointment last week, I discovered he didn’t work there any more. So I made an appointment with the partner that my wife sees, and very competent she was too.
But it really was a salutary experience, being on the receiving end for once. As I sat in the waiting room, I noticed that the patients who came in after me made a beeline for something on the far side of a pillar before checking in at the reception desk. I got up and wandered around to see what the attraction was, and guess what? It was an alcohol gel dispenser, and it was only then that I saw the notices requesting patients to use it.
WTF? The patients aren’t going to be examining each other or, presumably, performing procedures on the doctor, so who is being protected from what here? If it’s a question of stopping patients infecting each other, then it would surely make more sense to dispense surgical masks to anyone with a cough. I couldn’t help noticing the smug and slightly self-important expressions on the faces of those patients who did use the gel. They really felt involved, bless them - they were having their Holby City moment. Mind you, I suppose that anything that makes patients feel they have some responsibility for their own health and that of others can’t be entirely a bad thing.
Even so…sodding alcohol gel?
The other thing brought home to me by my surgery visit was the reality of the ten minute appointment slot. I was five minutes late being called in, and I had heard a chap check in at reception with an appointment time ten minutes after mine, so I knew the pressure was on. Now I hadn’t ‘been to the doctor’s’ for about 20 years, so I had a lot of stuff to tell my new GP about, but she showed no sign of being rushed, and I managed to air all three of my problems*, generating a flurry of computer-generated blood tests and scan requests and a couple of referrals. She even examined me and let me have a quick go on the peak flow meter - amazing. This only confirmed what I already knew - that I couldn’t do a GP’s job to save my life.
It also illustrated the difference that computerised records and ordering of tests has made in general practice - pity that we are lagging so far behind in hospital practice. When I scan an inpatient and need to write in the notes, it can take as long to find the most recent page in the disorganised pile of paper that constitutes the inpatient record as it did to perform the examination.
Then I went back today to pick up a prescription and the surgery was closed for lunch. Closed for bloody lunch - can you believe it? All that good work undone (well, not all of it, but jeez…closed for lunch!).
* mind your own business
The BMA’s GP committee has defended the notional rent scheme for GPs as a necessary tool to provide the government with enough practices and patients with the best care after a national newspaper investigation.
In a letter for publication to the Daily Telegraph, GPC chairman Dr Laurence Buckman responded to accusations from the newspaper that the scheme was ‘secretive’ and allowed GPs to ‘pocket windfalls running into millions of pounds from their surgeries’.
The article published on Monday in the Daily Telegraph, in collaboration with the Bureau of Investigative Journalism, claimed doctors ‘are permitted to buy buildings for their surgeries which are then ‘rented’ back to the DoH, often for far more than the mortgage repayments’.
In his letter Dr Buckman said that the scheme is not ‘secret’ and without it the government would not have been able to afford enough GP surgeries.
“No government could afford to buy all the buildings it would need to house the 44,000 GPs who work for it,” Dr Buckman wrote.
Dr Buckman said that buying a premises was not without its risks for GPs.
Read more at GP.
