AIBU to think this needs to be more widely know? Re NHS/GPs/funding

[PacificDogwood]

I am reposting this from 'In the News' because I feel brave this morning I would like more opinions/comments on this:

"RCGP chairman Prof Clare Gerada, said: ‘The NHS is changing, general practice is changing, patients are living longer with long term and multiple conditions, and health inequalities are growing, so we must step up and meet the challenges ahead.

‘This vision outlines ways in which to provide easier access to a more flexible and integrated system of primary care that will benefit our patients immensely. It maps out a way for patients to receive the best possible care in and out of hours from the start to the end of their lives.

‘As GPs change, so must the role of patients and so it is important to promote healthy lifestyles, increase health literacy and encourage self-care as we move forward with limited resources and increasing demand for services.’

She added: ‘Most importantly, none of this vision will become reality if we do not receive fairer investment for general practice. If GPs, who do 90% of NHS work for 9% of the budget, are not properly funded then much of this new vision will not be achievable. {my highlight}

‘Innovation and reform are vital but must be underpinned by investment. The Government must recognise that general practice is the most cost effective way of providing care and act accordingly, by urgently reversing the real terms decline in the amount of money that general practice receives.’"
(from here )

And yes, I have a vested interest - as a professional and as a patient.

From my perspective, I work twice as hard for less money under worse conditions and with less options for my patients angry, many of which have higher expectations at least partially because politicians pander to the electorate rather than spelling out that a finite pot of money + ageing population + more expensive medicine = more cuts at times of economic hardship.

nhap.org
These people are your friends. I totally agree, the nhs is one of britains greatest achievements we should protect it at all costs. They are cutting budgets then saying 'it's not working' so it can ultimately be privatised.

Primary care has a lower proportion of the NHS budget because of the nature of the work; treating via what are effectively OP appointments is always going to cost less per episode compared to say a hip replacement operation.

I think if GPs want more funding then they have to put their house in order first to relieve some of the pressure on acute and thus enable the release of funding. Out of hours services and access to appointments are shockingly bad, putting pressure back onto the acute sector. OP you mention a finite pot of money but CG's statement suggests increasing funding in primary care- where is this going to come from other than the acute sector? GPs did extremely well out of the new contract a few years ago so complaints about pay are unfounded.

I should add, I will defend the NHS to my last, and I have huge respect for CG, I think she was thrust into a difficult and unexpected position back in May 2010 and acted brilliantly in the best interests of GPs, patients and the NHS in general. I just think we need to be practical when looking at funding streams, be realistic about what we can expect and work within that.

Cheby, I have not (not in my OP and not in RL) complained about pay - that is a whole other conversation. Don't put words in my mouth.
The Contract cost the government much more money than anticipated because GPs fulfilled it better than anticipated. It was 'sold' to GPs as 'a way to control workload', even in 2004. I can still remember my hollow laugh and am somewhat chuffed that I did not vote for it .

More and more workload is put from Secondary Care in to Primary Care: early discharges (post op and frail elderly), near patient testing of 2nd line meds, increasingly complex problems 'managed' in the community.

My gripe is that this 'managing' typically involves these things being simply transferred in to the community with little in the way of forward planning wrt of work force, resources, time and space.

Of course Primary Care is always going to need less money than hospital care, but the proportions are massively out of sync currently.

I was a hospital dr for many years, I am married to one and I have been a pt in several - I have a grasp of what goes on in Secondary Care.
A lot of hospital drs and many, many 'service users' aka patients do not have the fainted notion what GPs do IME.

As a whole, 'working more for less money' is a neoliberal mantra they call 'Spare Capacity', particularly in the Public Sector, so no surprises there with this administration.

You didn't mention pay in your OP, but it needs saying now before the usual flood of messages from those indoctrinated by the Daily Wail detract from the content of your post: GP pay is NOT high for the job, is dropping, and will continue to drop. GPs don't earn half what much of the general public think they do.

It's all community services IMO that need to be funded properly. The issues you highlight are exactly the same for community nursing teams - increasingly frail elderly patients with multiple long-term conditions needing complex nursing and social care in the community to keep then out of hospital; or discharged with no equipment, insufficient social care and no discussion with primary care services. And as always, there is a special problem at the weekend, when all routine services shut down (including not being able to access a GP who actually knows the patient), coupled with lack of urgent social care and zero therapy services to assess and advise on urgent equipment, all if which could keep people out of hospital and reduce stress on hospital admissions.

I think damnautocorrect is damn right.

I think anyone who looks at the demographics and costings agrees with you, but no politician is prepared to shut hospitals to free up the money for primary care (because it's political suicide).

Good grief, I am not looking to shut hospitals

I tripped across GC's quote posted above as I sat at work at 8pm on a Friday night (as I usually do) and thought is was interesting and reflected what I experienced.
That, and a number of threads on here describing patient/HCP contact gone horribly wrong (for a variety of reasons and I am not referring to any particular situation and I am NOT up for rehashing other threads ) which than unleashes a degree of vitriol that I find quite hard to stomach tbh.

iliketea, our community nurses are a huge and vitally important part of the team. We value them highly. Some patients seem to see their services as a 'right': "Can the nurse come at 3pm to take my blood because I am at the Bingo before then" or statements to that effect are common and often said without guile or malice because people have no inkling of how tight things are time/resource/workforce-wise.

I don't know what the answer is but ongoing GP bashing in the medja is politically driven IMO, it's dangerous and it does not reflect the wider reality.

And yy for the 'system' to continue functioning at all massive funding for community services are required: physios, OTs, carers, community clinics etc etc.
And joined up thinking would be required, no narrow-minded 'this is MY budget' short-termism.
I can but dream….

It is interesting that this does not start a bunfight whereas all sorts of personal experiences inspire all sorts of replies from every side of various fences

The 'bigger picture' is much more boring that good or bad individual experiences even though the multiple of anecdote does not data make…

And also, I get the distinct impression that every poster on this thread works for the NHS

GPS get shafted because they keep accepting it. You don't seem to realise the massive power you hold as a group to change things. You won't stand together, there's too much in fighting and disagreement and misplaced loyalty to an NHS/government that is trying to ruin your whole way of working. Without GP cooperation the entire NHS would collapse in less than 48 hours. You have the power to make a huge difference.

I am a psychiatrist. Our way of working has been completely eroded by government and health board interventions. I no longer even have the power to admit someone to my own ward without the agreement of the crisis nurse, FFS! It's too late for us to claw back any sort of say in things, the Mental Health Measure appears to be the final nail in the coffin for psych services. I wish GP would learn from our mistakes. Stop rolling over, and stand up for your service while you still have one worth standing up for.

I agree that the plural of anecdote is not data, but if you put members of staff from primary care services together from different areas, they all say the same thing and share similar experiences - that's got to count for something.

Creampie, move to Scotland - things are much better in mental health up here.

Are you arguing for investment in primary care from central Government budgets, rather than trying to shift the spend from secondary care? That's a whole different (but equally politically difficult) bun fight?

YAB very U to think that your first post widens my knowledge of anything

Apologies Pacific I didn't mean to put words in your mouth, but I thought "I work twice as hard for less money under worse conditions" was a complaint about pay.

I agree there is a move to push care from secondary to primary settings (driven by the idea that its better and cheaper for patients to be treated at home,
I'm not convinced on the latter) but at the same time workload in secondary care is also increasing due to the same things that out pressure on primary care; ageing population, obesity crisis etc, as well as the constant pressure to provide new drugs and specialist treatment the minute they come on the market. That coupled with the final stages of 'The Nicholson Challenge' meaning that huge savings have to be made each year against a back drop of increasing cost and demand, results in a very difficult position for acute trusts as well.

So I'm not convinced that funding between the sectors is out of sync. I think it's just incredibly difficult for everyone.

Oh, I know that hospital services are just as stretched and overstretched.

I am angry at politicians making blithe comments about 'rights' (access, for instance, to name something that was just recently in the press) and setting targets without a. mentioning any obligations that go with that and b. making provisions to enable the service to be bigger.

I am in Scotland which I am v grateful for because the privatisation of the NHS is nowhere near as advanced here as in England.

We had had an unsustainable rise in our list size (think 15%) or so in the last 3 years in surgery premises which were too small when I joined 15 years ago. Plans for a new building have been on the go for 5 years!
We are hot-desking, every single nook and cranny as somebody doing something from 8 til 8 and we can still not meet demand.

AND then to be moaned at by the politicos (who I am quite sure make more than I do and I am NOT complaining about my income even though I was frothing at the mouth a couple of years ago when according to the popular press GPs were making a cool 250k annually ) and at times by Joe Public, is frankly galling and demoralising.

A whole cohort of experienced drs in their late 50s are leaving, frustrated by the above, angry that their pensions have been robbed (not as much as mine or those younger than me) and fed up.
There are not enough GPs being trained because it is not an attractive lifestyle choice and has a bad reputation as even medical students have little understanding that we our specialty is being generalists. Locally training posts cannot be filled. We cannot get locums for love nor money (even if we did have somewhere to put them… ).

It frustrates me on here that many posters are happy to pile in on a thread in which somebody describes shoddy treatment by a HCP and I am not defending at all when somebody is not treated as they should be (usually, as ever, it's all about communication), but the bigger picture just does not get looked at by many in the general public.

And I agree, we medics are terrible at standing up for ourselves and our patients, v apolitical; always have been.

I was not going to rant, but now I did and feel better for it, so thank you for reading