Caroline steel
@DrCarolineMWF
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GP mum wife cranky
England, United Kingdom
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All of this! This is why patient’s are asked to repeat their history as well. Because we don’t just want the words. We need the tone, the micro expressions as you say them, the bits you falter over or repeat. It all matters. Someone else’s history isn’t the same.
“Let PAs take a simple history, examine & then discuss with a GP”
Short 🧵 to explain why this wouldn’t work…
GPs are highly trained diagnosticians. With no immediate investigations to hand, the diagnostic skill we use IS history taking & examination.
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I think the last straw may have been when we were basically told all our years of rotating and training and exams and nights and missed weddings and missed Christmas and missed parents’ evenings and discretionary effort were absolutely unnecessary and brought in PAs w better t&c
‘Reduced effort’ may have contributed to 10% productivity drop, says NHSE
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I don’t consent to you using my fees for this legal defence against my union to protect my profession. I know you don’t care - I didn’t consent to you buying yourselves maccas shares and private healthcare with them either. But it feels important to say
Today we have responded to the BMA, strongly rejecting the basis on which they have proposed to bring legal proceedings.
You can read our statement on our website -
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The issue is who decides it’s a lower level task? So much of my GP training was about hidden agendas and patients trying us out with an easy thing to see if they trusted us with the bigger scarier things and now that’s all thrown out the window because we’ve taskified medicine
GPs really failing to get what the tweet said
Nobody is saying they’re the same - what they are saying is that on lower level tasks, which is what they are intended for, PAs perform just as well as GPs
The whole point is GPs are more trained so shouldn’t do PA level tasks
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We really need to take a leaf from the AHPs book and start calling ourselves doctors, senior doctors, specialist senior doctors and highly specialist senior doctors.
First day
@UHMBT
and we’re already being called “trainee doctors”. Some attending the induction today are senior registrars 1 or 2 years away from becoming consultants.
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My husband and I fell for that chestnut. He’s now a consultant in an office with seven other consultants and two secretaries for 20 of them. I’m a GP with ever reducing practice income at risk of losing my house. I’m glad the next generation of doctors aren’t as gullible as us
Think it’s ok to pay doctors less than physician associates because doctors have ‘earning potential?’.
I’ve got news for you. Physician associates have the same earning potential, but it requires some more exams and investment (medical school).
Exactly how it does for doctors
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Wrong. Very little private GP work.
What do you mean full time? Full time GP is 5 12 hour days. So 60h a week. You’re right. Most of us aren’t doing that. I tried. It left me thinking about driving into traffic so I reduced my hours. And now work full time hours for anyone else
@DrCarolineMWF
90% of GPs work part-time. Either they can afford to work part-time or they are moonlighting in the private sector they claim to despise. Source: NHS England
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In what world can you possibly be reg level when you can’t prescribe???
Quite apart from the rest of the false equivalence, what senior doctors are signing off on this utter nonsense?
@wesstreeting
please fix this. It is dangerous
Oh here is also the list of jobs I was given by the reg level PAs when I was busy on call holding the bleep. So they can go to theatre/clinics ASAP.
I had seen none of these patients. And I had to prescribe all these. Not from a consultant or a doctor but a PA.
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Did you write this in your own office with a computer that works and no one else is trying to use? Would you have written it as quickly if you had to find a free computer that worked and the first four didn’t. Which scenario might make you more productive do you think?
The new government's efforts to settling pay disputes with junior doctors and GPs must not ONLY be about achieving a better relationship with the profession. It needs to ensure its gets more productivity out of doctors as part of any pay deal
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If GPs moving to work to safe working standards that have been in existence since at least 2016 is going to grind the entire NHS to a halt then the entire NHS has been helping itself to unpaid work for years. The golden goose has been slaughtered by a thousand cuts
Is it OK for GPs to take industrial action for the first time in 60 years?
They are voting on reducing the number of daily patients, despite warnings that it could bring the NHS to a 'standstill'.
What do you think?
@MarinaPurkiss
|
@Ommasalma
|
@theJeremyVine
|
#JeremyVine
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Anyone can do your job, but you have to do a decade of training and a bunch of exams.
#itsaGPthing
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Have you spoken to any doctors recently? We feel quite denigrated shamed and bullied by being held to impossible standards while those with nowhere near similar training are ushered in under our indemnity and risk. Whilst also being paid less than them for years after graduating
I entered the debate on physician associates and anaesthetist associates in good faith after a PA wrote to me saying that the profession felt denigrated, shamed and bullied by a campaign of intimidation. I now know what they mean.
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The toxic workplace culture is most toxic to doctors. Imagine doing five years undergrad and then another five to ten postgrad. Rigorous exams. ARCP. Brutal rotation and nights. To be told someone with two years postgrad could do your job but please indemnify them
The same hereditary peer who is so accountable for his professionalism that he lost his WhatsApp messages and in the PA debate in
@UKHouseofLords
allowed his fellow peers to believe that the legislation he was proposing dealt with PA scope, supervision and regulation
Toxic
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I’m sure the GMC would see it as an IT blunder if a doctor did something they knew was illegal, right?
🔴 NEW: IT blunder allowed PAs at Calderdale and Huddersfield to "illegally" prescribe drugs inc opiates and sedatives
PAs prescribed oxycodone, codeine, lorazepam, diazepam and midazolam, despite being "instructed they are not legally able to prescribe”
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What are they thinking is going to happen when the current senior doctors retire or die and the doctors and PAs coming up have either insufficient experience because they’ve been ward monkeys or insufficient training because they never went to medical school????
Hi
@drcolinm
When the
@gmcuk
and
@NHSEngland
came out to say PAs shouldn't be replacing doctors, I must have missed the part where they qualified that it as "senior" doctors
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There are places where PAs are rejecting the 2 week wait cancer referrals of GPs. We have entered an era of the taskification of medicine so it can be done by tick box algorithms and soon AI.
@DrCarolineMWF
Lets make sure that cancer patients get seen by this lot and not an oncologist to make it fair.
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This is the most extraordinary thing I’ve ever seen. Standards? We don’t need no stinking standards. What is the
@gmc
actually for at this point? The entire medical establishment appears to have been captured bought and paid for while no one was looking
Dear UK public,
Yesterday, hot on the heels of widespread concern among doctors at the govt’s project of replacing NHS doctors with doctor substitutes,
@gmcuk
released a blog about its future intentions.
It left doctors like me reeling.
Here's why 🧵
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I firmly expect to be given enough money to do so then.
Because I’m still out of pocket from the last time you lied about a 6% pay rise for my employees
NHS England has said it ‘firmly’ expects GP partners to award practice nurses and other practice staff a full 6% pay rise.
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If this is actually the future of GP shouldn’t
@rcgp
be training GP Registrars in how to lead a team of people with 5-10w training in GP and huge unknown unknowns. Not continuing with ICE and comm skills? How to appoint the best lawyer for your GMC appearance for example
Is the error that this was (embarrassingly) posted on the
@RCGP
website?
Or is the error that staff with only 2 years training are doing the work of doctors with minimal supervision, and the RCGP isn't up in arms?
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It’s complicit I’m afraid. They were against regulating PAs until Charlie Massey was installed as head stooge. And now they are an arm of government
@DrEilidhMaria
If they are unqualified are they actually practice medicine? I thought only Physicians/Drs could do that in the sense of the meaning. The GMC have either been asleep, incompetent or complicit. As the regulator it is there job to make medicine is safe it seems it may not be.
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Get rid of ARRS in GP and let GPs employ who is available and useful to them
Stop and reverse privatisation by companies with shareholders
CQC either scrapped or pared back to a central decided realistic standard not the hobby horse of lead investigator
Singapore General Hospital has a programme called Get Rid Of Stupid Stuff.
I want to hear from NHS staff about the stupid stuff that wastes your time, patients’ time, and taxpayers’ pounds.
Let me know how you think we can deliver a better NHS here 👇
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Nurses are not dependent practitioners. They are nurses with their own regulation. This is guidance to the supervisors, who are doctors. Our trade union and professional association is the bma. Not the colleges. What’s changed is the BMA is listening to its members
@BMA_James_Steen
I mean they have every right to get angry when you over step your remit.
Imagine if this was done about nurses scope of practice and remit without any consultation with the nurses union.
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I’m old enough to have trained in that old system. Our morning surgery ran from 0900-1100. Then pm surgery ran from 1600-1800 with a tea break halfway through. This morning I have spoken to over 50 people and am just now home on my half day at 1630. I would love to go back
@i_iratus
The doctors are demanding pay linked to old practices where their predecessors worked longer hours. Its a disgrace that patients aren't seen the same day, if it's not possible then the waiting times will get longer & longer. Save the wages paid to people arranging appointments
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In a way you have to admire their cheek. To try and sell those dodgy stats to an audience that included the person who wrote the literal book on how to read data in medicine. The hubris of it
My snapshot analysis of “shit they’ve fucked it” pales in comparison to Prof Greenhalgh who articulates the critical analysis much better than me.
I’d suggest listening to the expert…
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It does raise the question of what PAs are being taught about themselves and about medicine that any of them are prepared to put themselves in these positions though. I wouldn’t have agreed to do any paeds alone after med school, because I knew there was a lot I didn’t know
We really can't blame the PA involved, but we should blame the employers.
PA training in paediatrics can be as little as some e-learning & a 2-3 week placement.
There is no paeds in the PANE (national exam).
PAs should not be seeing babies & children, it is far too high risk.
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Pharmacists are great. They are pharmacists. They are not doctors any more than doctors are pharmacists. I would like to see them rewarded as pharmacists instead of having to do things like pharmacy first. That’s all.
So looks like
#medtwitter
are now turning on pharmacists… I get how shit it is to be a doctor right now, but I don’t think any group is having a whole bunch of fun. But maybe, just maybe, it’s better if we don’t turn on each other and actually, oh I dunno, support each other?
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The fact that none of the options presented for this first phase of action for GPs is a contract breach shows how much free work the NHS has been getting out of GPs, as our numbers shrink and our workloads rise. We are working way beyond what is safe currently. It has to stop
Actually - GPs NOT capping patient numbers will have a catastrophic effect on patient care
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You’ve had five years to bed them in. During which time doctors are leaving and patients are less satisfied. Think it’s fair to say the pilot has not been a roaring success and cut your losses
I heard some frustrations in responses to my thread three weeks ago around the continued ringfencing of ARRS money. We want to protect the new ARRS staff and the new capacity they bring as they bed into their roles, ensuring there is appropriate funding to pay for them. 16/x
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Personally I think we’d benefit more from more physios being physios than the first contact model we have now where a proportion of patients didn’t need a physio they needed a doctor, and some need imaging or prescribing that….needs a doctor.
@Jo_McGinn
@DrNeenaJha
@DrCarolineMWF
@rcgp
I guess that I don't see it as being undermined, I've benefitted a lot from their presence and it's made me a better clinician.
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Maybe if the royal colleges had pulled their fingers out on this a couple of decades ago we wouldn’t be in this Wild West situation in the first place. Where doctors are having to do rigorous training and exams to ‘supervise’ and indemnify PAs doing what they think they can do
I don’t feel
@RCPhysicians
or Sarah Clarke have any right in writing what they have written
They should have called out their own failings and commended the BMA in helping them and giving them something to work from.
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That’s nice. I left the rcgp because it didn’t represent me at all and now it really needs to rebrand itself the RCGPA. The incongruity between the exams to cct as a gp and support for PAs seeing undifferentiated patients is huge
@mmamas1973
@DrAsifQasim
@Parody_RCGP
@rvautrey
is the president and
@KamilaRCGP
is the chair of the
@RCGP
As a GP, I for one find them to be representing me well
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The rcgp are heavily implicated. BMA have written the only scope of practice for PAs or the doctors supervising them.
@carryonkeith
@damo_war
Why is this news being suppressed? Why is not all over national TV and Radio, like the Post Office scandal?
Why are the BMA and RCGP so quiet? Outrageous.
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A chunk of the global sum was hived off and is only given back to reimburse salaries for roles we mostly didn’t want. The pot that was left to pay for things like GPs is smaller in real terms thanks to inflation, and has had to pay inc energy costs, minimum wage rises etc etc
@goldstone_tony
@ClareGerada
Tony, how can there have been 5,000 GP vacancies and now GP unemployment? Were we misled about the number of posts practices were actually willing/able to fund? Or has real terms practice funding imploded so that conditions now are different to when
@ClareGerada
posted her tweet?
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How have we managed to forget so comprehensively that doctors are people?
A junior doctor has been offered a training rotation that involves a job 70 miles away. They have 2 kids under 10 and spouse is about to have treatment for stage IV cancer. Apparently, they have to accept the job or leave specialty training? Who should they speak to about this?
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I know! It’s awful. We need money to pay for GPs. In practices. There are plenty of GPs. NHSE will only reimburse us money for ‘additional’ roles. We don’t need any more of those. We need GPs. Patients need GPs.
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And this is why newly qualified GPs are largely not keen on partnership even where it can be offered. It used to be hard work well rewarded. Now it’s all risk and slog and your house on the line when the money finally completely runs out.
@DrSteveTaylor
@DrSelvarajah
@doctor_katie
No extra funding? Tough. You have to do it. Someone off sick? Tough. Get on with it. We are *the* most cost effective part running at £0 deficit. Imagine if we had just a little help.
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Looks great. Not at all like a reversal of all the microbial stewardship work of the last at least twenty years
We then announced the launch of Pharmacy First on Wednesday - a major step change in treating common conditions faster.
You can now get treatment for seven conditions at most pharmacies without a GP prescription.
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Who do you think practices would employ if the ARRS money was put into core funding (which has massively reduced at the same time as costs - that can’t be paid from ARRRS -have risen). If you think it would continue to be everyone but a GP, you have to wonder why DHSC don’t do it
General practice in danger of turning on additional roles, when problem is not additional roles but lack of funding
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This is what they’ve done in GP too. Defunded the actual GP contract so most practices aren’t financially viable without signing up to the PCN DES (which only funds non-doctors) then used the fact that 99% if practices are signed up to PCN DES as proof everyone thinks it’s great
@DrEilidhMaria
@james_bedford
B/c as he described in the previous thread "funding only for PA".
So the choice he was given was PA or no-one.
This is exactly the sort of perverted incentive & pressure that is ruining the NHS.
Funding only for govt approved projects, not for sensible on the ground solutions.
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NHSE have had 5 1/2 years of trying out their micromanagement of GP.
The verdict?
Patient satisfaction - worse
GP numbers - worse
Outcomes - worse
Retention of newly qualified GPs - worse
How much monger before we accept the model is just worse???
GPs in ARRS.
I believe petition referenced called for allowing ‘ARRS funding’ to be used by ‘GP practices’ to employ GPs & nurses & not explicitly asking for addition of GPs to ARRS scheme?
Increased investment for more GP roles is essential, GPs in practices is what’s needed.
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Or you could argue that is the literal point of all the training. To be there when the zebra turns up. With sufficient experience to have developed the spidey-sense that this one isn’t like the others
@Jo_McGinn
@medicalmodelbri
@MHG1910
@iDrSunny
@Parody_RCGP
@NavinaEvans
Or you could argue it’s a waste of my time seeing a shoulder pain that a physio is better at dealing with? Yes the shoulder pain could be a lung ca but normally a spade is just a spade
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There may not be a framework. But I haven’t had a patient seen by a psychiatrist in probably fifteen years. It’s all nurse consultants, social workers, OTs and pharmacists. Or more often ‘the MDT’ usually rejecting any referral and suggesting we call the 2h a week medication line
@DrCarolineMWF
There's also no framework (as far as I can see) where the work that a 'junior' psychiatrist would do is done by a non-doctor, much less one endorsed by the College. So a bit more centrally protected I suppose.
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All this. And the ‘taskification’ involved in getting competencies signed off as individual aliquots of doctoring.
@Dr_Done_
I strongly believe that what allowed PA idea to really take hold is a product of the medical education lobby and what they have done with UK training programs.
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Getting rid of all the tiny pots of money to be chased in GP. Putting all the money into one pot instead of making us chase pennies under buses with things like ARRS. Stop promising access like it’s completely unrelated to capacity. Honesty about replacing doctors in NHS
@Dr__Sarmy
What one thing apart from money (theoretical question) do doctors think would improve the NHS?
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You don’t think maybe something about working conditions, like say, rotating every 4m and turning up to your shift to discover there’s only one of you when there should be three, and your senior support has less training than you, might, possibly, be contributing to the burnout?
And what have we, as the system, done to prevent that?
I’ve been flagging this, I kid you not, since 2010 to CEOs of trusts and deaneries
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Presumably he’s refusing to sit down with the flood defences until they stop all this nonsense about floods. Same as when he was health secretary
Has anybody seen this man? Asking for a flooded country.
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You’ve got that the wrong way round. Fully 50% of my workload this week wouldn’t have been needed if hospital waiting lists were where they were pre-coalition government, or hospitals were fulfilling their contract properly. Which would have freed me up to see more of the GP pts
@OurSacredGrove
@soundabuse
No.
It's shocking & places pressures on hospitals when patients become more seriously ill through lack of primary care & have to be admitted - always assuming a bed is available.
The non availability of GP care causes pressure on hospitals.
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How do you hold the cognitive dissonance of doctors need years of training and rigorous exams to see undifferentiated patients, and the emphasis on comm skills, and unknown unknowns and PUNs and DENs with championing a set of HCPs who are unregulated and might have done 5w in GP?
Drs deserve answers, not platitudes
@RCGP
.
& patients, which incl Drs, deserve their care to be of as high a standard as possible…not of a “anyone is better than no one” standard.
There clearly isn’t “enough work for everyone” & the only ppl you’re being kind to are PAs.
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The answer to the question ‘why can’t you see a GP’ is because there aren’t enough of them and the government would rather play around with ‘additional roles’ that aren’t additional because you can’t be additional to GPs that don’t exist.
Fixed it for you
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Agree with all of this. The issue is that all of these people were sold to us as additional to GPs (it’s even the A in ARRS) but they are being forced into a space replacing GPs, which they can’t safely do. It’s not evolution so much as extinction threat
1/6 I know I’m on thin ice here. And i have COI with
@peakhealthcoach
. BUT I worry this sort of rhetoric is undermining us as GPs embracing evolving needs of our populations. Yes GPs are great at quick decision making, risk taking, diagnosis, prescribing. We are less good…
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@MichelePaduano
During the pandemic we were given a box of masks to share between three practices. Told to keep patients safe by doing remote consults as much as possible. Then berated in a letter by the same people for not seeing enough face to face. We are traumatised and now being blamed
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The other problem? They’re not GPs
The Conservatives are today promising to expand the Pharmacy First scheme, enabling pharmacists to expand the number of treatments they offer before someone has to see a GP. All part of reducing GP waiting times.
The problem? As we reported in January, eight pharmacies are
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I’ve been a GP for 20 years and this myth has been studied and debunked repeatedly over that time. A&E attendance largely driven by proximity and deprivation
I’d like to see the evidence that GP patients end up in A&E. This is a myth. A&E attendances have remained fairly static over the last years except for a small increase. Why don’t politicians keep perpetuating these ideas. One thing he is right about though is that there is a GP
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Exactly. Are there really no GPs to ask?? I can think of a few if
@wesstreeting
needs some names
Suggest any independent investigation into NHS performance prioritise evaluating the cost-effectiveness of "Darzi" diagnosis and treatment centres, and the wisdom of accepting policy advice for primary care from a tertiary care surgeon with an interest in care delivery by robots
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I’ve not seen the medical profession so united either. Even GPs who are famously difficult to get to agree on anything
Tearing itself apart?
I’m not sure I’ve ever seen the medical profession so unified (albeit in my brief career)
Maybe I’m in an echo chamber, but the vast majority both IRL and online are pissed off and angry about exactly the same things.
The minority being some leaders…
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It all sounded so impossibly unlikely. Replace ten years of training (5 undergrad and 5 post) exams and portfolios and feedback to become GPs. With some grads who’d done two years conversion. Who would have thought
@rcgp
@gmc
@rcp
would allow it?
We were naive as a profession
People were sleeping . It’s all here in black and white
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Health and wellbeing coaches were what we were given in GPland instead of actually enough GPs or a functioning specialist weight management service. Lovely people. Not sure I’d employ them if I could employ a nurse or GP with that money instead
A PA is not a specialist. Pharmacists = pharmacy💊, mental health practitioners = CPN, psychologists etc, paramedics = specialists in pre-hospital care, not sure what a social prescriber is? Health and wellbeing coaches, not seen many of them in the NHS.
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Thank you. I resigned from the rcgp because I felt entirely unrepresented and couldn’t see that changing. This is the first hint of possibility that might change.
A huge, sincere thank you to everyone who responded to my informal survey of
@rcgp
members - the results were taken seriously!
And a huge thank you to the incredible
@VictoriaTzB
for her leadership and courage in bringing this paper to Council ❤️
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How about let GPs be GPs and stop the constant derisory suggestion that we’ve wasted our time with all the training and exams because literally anyone can do it (they can’t). It’s demoralising. Of course people choose to go somewhere their hard work and talent is recognised
🩺 Non-GP staff in surgeries are meant to free up GPs' time & ease workloads
🤔 But with this policy showing cracks, what more is needed to stem the exodus of GPs?
👇 Read our article by
@hippomanc
&
@SMS_Spooner
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Most of us want them regulated. Just not by the organisation set up specifically so patients could know they were seeing and actual qualified doctor. (Just like all the other HCPs are). And also maybe by a regulator that also regulated them, which
@gmc
have said they won’t do
Why would the move to regulate PAs in itself increase the numbers of doctors wanting to leave.
Are we saying they'd stay if PAs remained unregulated?????.
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It is shocking. It is because there aren’t enough GPs. The government accepted years ago we needed another 6000. Instead we have 2200 fewer. A quart into a pint pot will not go. Please direct your ire at the people refusing to fund GPs (only not-doctors have been allowed for yrs)
In a GP waiting room; patients asking for appointments & r told all GPs booked until next month. That’s fine they say, an early Dec appointment would suit. No, says the receptionist, Dec bookings r not open yet. Come back end of next week. Am I alone in thinking this shocking?
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This is the same ICBs that ensure trusts are sticking their contractual requirements is it? If they did GPs wouldn’t be quite so overburdened in the first place!
ICBs should make sure that GP practices are continuing to meet contractual requirements during collective action, NHS England has said.
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Imagine if there was funding to employ all the GPs we are already training. Or the job wasn’t burning so many people out. Or the funding had come even close to inflation for the past five years
We currently train 4,000 GPs a year, on a 3 year training programme
Imagine if we bumped that up to 5/6,000
We’d soon be able to offer thousands more appointments, and wouldn’t have to keep such a tight triage model at 8am on the dot.
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I’m so sorry. I get it. Mine was pondering how early/late I could edge into a roundabout to be hurt enough to not have to go to work, but not to be seriously hurt. I don’t feel like that now. And I am back at work as a gp. I’m still terrified of feeling like that again
@Dr_J_M_Dickson
I sought help when I bought the rope
I’m no longer a GP
But I absolutely loved my job and my patients
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You mean you don’t enjoy making your clinic run late while you try to find someone on the hospital to accept an admission before giving up and sending them to a and e once you’re a further three patients behind, just for a laugh and a change of pace?
Dear NHS management
Do those emails where you say "we are still on OPEL4, please can GPs be mindful about sending people on to hospital" actually work?
I can be mindful but I'm still sending my sick patient to hospital. I leave it to you guys to improve things there
Much love
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And this, my GP friends, is why we should all be looking very carefully at ‘shared’ care and declining to share it. And to be clear. I mean all ‘shared’ care
Yes, bcos GICs do *not* prescribe
They recommend a treatment plan
They then rely on GPs to prescribe and arrange blood work
This is the MoC
If GPs then refuse shared care agreements because "it's unpaid work" then they're *choosing* to not support their trans patients
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I think I’d rather have the funding go back into core wheee it was stolen from and lose the micromanagement of PCNs entirely. Nothing to stop those it’s working for continuing to work that way. Just not seen any value add and plenty of extra unnecessary work locally from PCN DES
The current funding mechanism for general practice actively discriminates against practices and PCNs employing GPs and practice nurses. This has to stop.
Allow ARRS funding to be used for practice nurses and GPs
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The difference to morale alone has been tangible. People who usually just plod along are furious. What goodwill there was is evaporating.
We were told we couldn’t have more money because of the 5 year deal. It turns out it’s because of ideological opposition to our existence
GP contract changes will make a ‘tiny difference’
Nope it’s a massive difference
It is a massive negative difference
Practices will have to make redundancies & some will hand back contracts
Well done for standing up to Govt for GPs👏🏼
@amandadoylegp
@AmandaPritchard
@NHSEngland
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They’re welcome to compete with everyone else for GEM. Doesn’t the PA course come with a bursary of some sort anyway? Doctors rotational training clearly needs fixing and policies that will actually widen participation (like bursaries) need sorting
Sorry but that's a hard NO. If a PA wants to become a doctor, they can apply to go to medical school - undergraduate or GEM. There is not other option.
Replacing one shortcut with another solves nothing. You can't avoid the nitty-gritty.
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Anyone can do your job, except this bit because that’s too tricky for us in the big shiny building, so you do it for us
#itsaGPthing
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This is the NHS people promise. How much did this shiny piece of gaslighting cost from the people who are defunding Practitioner Health despite a doctor killing themselves every 3 weeks and a nurse every week?
@NHSEngland
safe and healthy? Voice that counts?
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No. And we don’t employ them any more in our practice but others in our PCN do and it’s really really hard to resist when you’re not even sure you can keep the lights on and all anyone seems to care about is access to any appointment
GPs-in-daytime-practice, whose team includes PAs funded by ARSS: would you choose to employ PAs if you had to pay for them? If yes, presumably you’ve had a good experience: how would you use them if you were paying for them?
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Same way GPs do everything. On a shoestring while people tell us how to do our jobs and how lazy we are
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If we funded and resourced primary care properly we could have long appointments and deal with lots of things. Single issue appointments are a reaction to overwhelm. The primary care equivalent of treating patients in corridors in hospital because there’s no space/time
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GPs in Norfolk and actually just England generally too. Unless you want to have all the responsibility for the patient data and none of the control over it.
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The more I think about it the more I think this started with the disempowering of consultants. If rotational training makes running a department so impossible, where were the consultant voices saying so?
I note you’ve disabled replies.
FYs are similarly fully engaged, caring, arguably better trained, and equally able to “learn skills quickly”.
If you want to see the system improve, then support us to put an end to rotational training. Stop pulling up the ladder behind you.
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You’re the data protector for medical records but we’re just going to go ahead and insist you do unsafe things with the data, like making test results available to patients before a clinician can contact them. You’ll still be responsible though.
#itsaGPthing
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I know! We really need funds to employ GPs. And space for them to see patients in. But funds to employ them is the main thing. Would love to offer more appointments and have that wait time be what it used to be. But for the past six years the only money has been for anyone else
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In writing the one for mine this weekend. We’ve reached impossible even for GPs now. Who are already the most efficient part of the system, with zero deficit. We’ve been rewarded with further cuts. We can’t, to quote the statement, work any harder
An outstanding practice doing “everything right” according to its local ICB.
I’d encourage more practices to use
@docmike79
’s statement as a basis to speak truth to their PPGs…
@BMA_GP
@RebuildGP
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We haven’t commissioned this service properly - just fill in the gaps with zero resource and take all the clinical and Medico-Legal risk for us
#itsaGPthing
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To everyone just starting in GPland today good luck! Remember it’s a completely different type of medicine to most of what you’ve learned and experienced so far. Make the most of the opportunity for longitudinal relationships with your patients.
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And private medical. Because nothing says believing in what you��re doing like opting out of it entirely.
But yeah. Wouldn’t be enough for me to be the outward face of the degradation of my profession either.
For £220,000 a year I still wouldn't be the shill for the GMC.
Cause I have to look people in the eye.
I also want to have a good nights sleep.
We are all different....and that's me.
Who would have thought that a toxic anon account would take the high road against the GMC?
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Same as the emails that say ‘the hospital is very busy. Please think carefully before you send any patients in’ like it’s usually just something we do for the lolz
“Mass emails that demand clinicians to discharge older patients without proper assessment are not only disrespectful but also undermine the clinicians' role.”
This has driven me potty over the years. Did they think we weren’t trying, before their email?
It’s multifactorial.
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Of course it’s absolutely not the fault of the people who set the system up by removing part of the funding for GP surgeries and offering it back as reimbursement of salaries for roles no one asked for and reward only quantity of appointments with no thought to quality.
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Stop thinking everyone but GPs knows how to run GP best
Stop recruitment of PAs and AAs
Slash mandatory training to actually useful stuff done on an actually useful timescale
Scrap revalidation
Treat doctors and nurses like valued employees and people- so much goodwill gone
Singapore General Hospital has a programme called Get Rid Of Stupid Stuff.
I want to hear from NHS staff about the stupid stuff that wastes your time, patients’ time, and taxpayers’ pounds.
Let me know how you think we can deliver a better NHS here 👇
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The problem is absolutely not the bread and butter bits of GP that are being farmed out to literally anyone who fancies a go. The problem is systematic defunding and an ideological opposition to independent expert generalist doctors advocating for their patients
As the pharmacy first scheme comes into play, it has got me thinking about what kind of general practice we are creating. I am worried, very worried. 😔
🧵
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It means even though we have taken your pay, your mess, your team, your study leave, your study budget, your right to know where you will be working, your white coat, your guarantee of employment, your psychological safety at work, and your ability to take pride in what you do -
"It is our reduction of everything to a transactional nature that deprofessionalises us" - Could someone explain the reasoning of this statement to me? I genuinely don't get it
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Not sure that’s actually access now is it?
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The registrars I’ve spoken to have no frame of reference for a properly funded and resourced and working NHS. Most of them can’t understand why we haven’t pushed to go private already
Conversation this evening with an excellent NHS Salaried GP
“I am thinking of working Privately”
So it begins the final thread has been broken
Well done NHSE/Govt/RCGP you are all responsible for the end of NHS General Practice
@AmandaPritchard
@KamilaRCGP
@VictoriaAtkins
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Can we have a royal college of GPs of Edinburgh? Asking for a friend
To be fair they did bend over backwards to welcome PAs?
I reckon the Scottish RCP might take us? They seem like the ballers in this whole debacle.
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I worked all through med school because I had to to eat. Unless this is coming with a truly generous bursary (lol) it’s only accessible to anyone who has cash reserves or family with deep pockets.
That’ll be bloody intense for 18 year olds, and with no time to have a job how is it going to increase participation and access? I think I’d have gone the other way and modularised courses, and the failure rate/those who need to repeat a year will need monitoring very carefully.
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But declining patient satisfaction and doctor satisfaction shows that it’s not fit for purpose. And did anyone really ever think of GP as a one off consultation? I went into GP for cradle to grave continuity of care
We need to stop thinking of GP as a one off 10 minute consultation with a clinician
GP has changed
Primary care is about care over time through your life with a range of professionals who provide continuity through teamwork and information sharing
This is Modern Primary Care
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We’re just going to set up this property services company that will raise its already astronomical service charge as often and as much as it can even if it makes your practice unviable because you haven’t had an inflationary uplift for years
#itsaGPthing
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Better yet. Put it all into core and stop making people doing the work jump through hoops to get the funds to do their job so someone who isn’t doing the job can feel like they’re doing something
Petition-
The Additional Roles Reimbursement Scheme (ARRS) has made available £1.4bn/yr to GP practices to employ people in 17 new roles.
GP practices should to be able to use this money to pay for Practice Nurses & GPs who are currently excluded & needed
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We’re going to go out of our way to conflate primary care and general practice as much as possible so we can obfuscate as much as possible
#itsaGPthing
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Of course it is. If ARRS was really an improvement it would have been freely choosable instead of forced on us
@pulsetoday
Don’t you think it’s actually because if GPs were part of the scheme, they would be employed preferentially?
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I doubt they were told the project was to dedoctor the NHS and produce a two tier system ripe for privatisation. Which isn’t to say pennies shouldn’t have dropped considerably sooner. Like, say, when the organisation that tells people who the doctors are was pushed as regulator
Many of the original proponents of the PA/AA experiment are now waking up to the damage they have caused to patient care and the medical profession. I think they never really contemplated the long term effects. They opened Pandora's Box and we are now stuck with a mess to clear.
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And we have colluded with this idea. That because it’s usually a vital URTI or a tonsillitis there’s no thought going on about any of the other myriad possibilities. And that means someone with far less training and experience can do it. Simple is a retrospective diagnosis.
The skill of UK general practice is making it look effortless
That's also why GPs are not valued or respected
GPs make it look so easy that everybody (including hospital doctor colleagues) thinks that anyone could do the job of a GP...
That's why non-doctors are replacing GPs
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Did you speak to any patients about how they feel about being treated by PAs?
I entered the debate on physician associates and anaesthetist associates in good faith after a PA wrote to me saying that the profession felt denigrated, shamed and bullied by a campaign of intimidation. I now know what they mean.
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My son was one. He decided against it. He said ‘I hardly ever see dad’ and ‘you’re always working’. I love my job. Can’t say I was unhappy that my kids don’t want to follow me into it
Very interesting poll
@UniversitiesUK
3/4 young people interested NHS career *BUT*👇
"vast majority are being put off embarking on healthcare careers because of perceptions of low pay (90%), poor work/life balance (82%), stress of the job (79%), and long working hours (75%)"
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