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GPS FACE IMMEDIATE CAP ON CHILD FLU VACCINE ORDERS

From the FMS Global News Desk of Jeanne Hambleton PULSE TODAY                        September  15 2014 | By Caroline Price

 

GP practices will only be able to order a maximum of 50 doses of nasal flu vaccine next week to start routine immunisations in children, public health officials have warned.

Public Health England (PHE) said it will be temporarily capping orders of the new Fluenz Tetra vaccine at 50 doses – or five packs – per practice per week, when central ordering of the vaccine opens next Wednesday, 24 September.

PHE said in its latest vaccine update the cap was needed to make sure the vaccine could be distributed equitably across the country. The update also reminded practices the vaccine has a limited shelf life and said they should only order what they need for a week or two in advance.

The update states: ‘To ensure that vaccine is distributed equitably across the NHS in England for the children’s part of national flu programme, an initial restriction on the number of doses of Fluenz Tetra that can be ordered by each practice per week will be implemented from the start of ordering on Wednesday 24 September.

‘The controls will allow practices to order 50 doses per week (five packs) initially. We will be monitoring the situation on a daily basis and as soon as we are in receipt of sufficient quantities of vaccine we will lift the restriction.’

GPs are this year taking on seasonal flu immunisation of four-year-olds, as well as two- and three-year-olds as they did last year when the routine flu vaccination programme children was first introduced.

However, as all the vaccine stocks will expire by the end of January, PHE is again urging GPs to get as many children immunised before Christmas as possible – which GPC warned could leave practices struggling to fit them in.

A PHE spokesperson told Pulse the restriction was the result of a ‘gradual supply’ of vaccine from the manufacturer, as well as the shorter shelf-life of live-attenuated vaccines.

The spokesperson said: ‘The temporary order restriction is concerned with the gradual supply of the vaccine and the shorter shelf life of the flu nasal spray vaccine Fluenz Tetra which means that it has been agreed with the manufacturer that deliveries will be staggered to ensure that there is sufficient in-date vaccine for patients who present later in the season.’

PHE added there is no restriction on the nasal flu vaccine Fluarix Tetra.

The spokesperson said: ‘There is not an order cap in place for Fluarix Tetra but it should only be ordered for eligible children aged from three years who are contraindicated for Fluenz Tetra. It should not be used for children for whom Fluenz Tetra is suitable and flu vaccine ordered via ImmForm should not be used for patients over the age of 18.’

 

GPS TOLD TO CARRY OUT CHILD FLU VACCINATION PROGRAMME IN THREE-MONTH WINDOW

From the FMS Global News Desk of Jeanne Hambleton PULSE TODAY    9 May 2014               By Caroline Price, Alex Matthews-King

 

Public health chiefs have told GPs they must vaccinate children aged between 2-4 years within a three-month window this winter because the chosen vaccines will expire midway through the flu season.

Experts from Public Health England (PHE) said in guidance for this year’s flu immunisation programme that it was ‘highly likely’ central stocks of the chosen Fluenz vaccines will have expired by the end of January, despite the vaccination programme expanding to include all 2-4 year olds this year.

The guidance also told GPs they must focus their efforts on improving uptake of the flu vaccine in patients with liver or neurological diseases.

GP leaders said that increased numbers of patients could be left unimmunised as a result of the short time-frame for immunising children.

The update stated: ‘Vaccine has been ordered to cover the period over which historically the flu vaccine has been administered, extending from September to mid-December.’

‘It is highly likely that all the Fluenz Tetra® supplied centrally will have expired before the end of January 2015. In the light of this it will be important to ensure that efforts are made to vaccinate children before the Christmas holidays.’

Last year, stocks of the vaccine had a similar expiry date, and some practices said they were struggling to vaccinate two- and three-year olds as a result.

Dr Richard Vautrey, a member of the GPC negotiating team and a GP in Leeds, told Pulse that patients could be left unimmunised and GPs could see their QOF achievement hit by failure to provide adequate stocks of vaccine.

Dr Vautrey said: ‘There is an increasing problem, as more patients fall into the cohort for immunisation with Fluenz, it means that increasing numbers of patients will be left unimmunised unless practices use their own supplies of the alternative vaccine for those patients.’

He added: ‘This year, it has been extended to 2-4 year olds. So it is a bigger group and it is bound to have a much bigger impact because it then impacts on QOF targets for immunisations as well. So it is important that the vaccine is available throughout the flu season.’

‘We were told that with the extension of the scheme, to include a greater number of patients, they would ensure there was a considerable supply right through the immunisation program, right through to the end of March. It is a manufacturing issue, and that’s simply not good enough.’

The public health update also urged GPs to concentrate their vaccination programmes on patients with liver or neurological diseases.

Average uptake of the flu vaccine in the under-65s clinical risk groups has been stuck at about 50% for the past three years. But it is even lower in patients with chronic liver disease, in whom uptake was around 43% last flu season, while coverage in those with neurological disease was 49% last year, despite them being among the most at risk of dying from the complications of flu.

A spokesperson for PHE told Pulse: ‘For a number of years now around only half of patients in at-risk groups have been vaccinated and increasing uptake in these groups is important because of the increased risk of serious illness should people in these groups catch flu. 

‘However, we know that establishing the true uptake rate is hard because of difficulties in determining the denominator and therefore this year we decided to take a different approach which is to ask that particular attention is focused on those in at risk groups who are most at risk of death from flu but who have the lowest uptake rates amongst the at risk groups (that is those with chronic liver and neurological disease, including those with learning disabilities).’ 

PHE declined to comment on what additional resources or support GPs could get to help boost uptake in these groups, but said it wanted to see coverage upped to that of other clinical risk groups.

The spokesperson added: ‘We would expect vaccine uptake in those with chronic liver and neurological disease (including learning disabilities) to reach levels closer to those being achieved for other at risk groups who have a higher level of uptake.’

 

TWO-THIRDS OF YOUNG CHILDREN NOT VACCINATED AGAINST FLU YET

From the FMS Global News Desk of Jeanne Hambleton PULSE TODAY         2 December 2013 | By Caroline Price

 

Two-thirds of young children have yet to be vaccinated against flu, as practices battle to immunise two and three- year olds before central stocks of vaccine expire in January.

The most recent weekly figures showed 34.1% of two-year-olds and 30.6% of three-year-olds had received influenza vaccine by 24 November.

The data show uptake has gone up around 10% since the end of October, when the monthly breakdown showed 22% and 20% of two- and three-year-olds overall had been vaccinated.

But LMCs said practices face an uphill battle to immunise children before central supplies run out after the 16 January – with some batches expiring in mid-December.

It comes as Public Health England revealed that a ‘small number’ of GP practices had yet to order any nasal vaccine at all and that NHS England would be in touch with them to make sure they have not ‘overlooked’ the scheme.

Public health chiefs advised GP practices last month that they should make their own arrangements with the manufacturer of the nasal vaccine if they need additional doses after then.

Public Health England said the uptake with the new programme was ‘encouraging, given the extra workload this has generated for primary care’.

It added: ‘It is interesting to note that a small number of GP surgeries have yet to order any Fluenz vaccine. For some, this is because they have opted out of offering childhood immunisations, but for the others NHS England will be in contact to make sure they have not overlooked the fluvaccination programme for healthy two- and three- year olds.’

But LMC leaders expressed concerns about a lack of a national campaign to help GPs keep parents aware of the campaign – and how low uptake could impact on practices using up vaccine stocks that they are currently ordering in centrally from Public Health England.

Dr Paul Roblin, chair of Berkshire, Buckhingamshire  and Oxfordshire LMCs, told Pulse: ‘I sent an email to practices about two weeks ago pointing out there was concern in the Thames Valley about low uptake – and that all the national vaccine stock will be out of shelf-life after Christmas.

‘But practices are inundated and the last thing they can do is chase parents who do not want the vaccine.’

Dr Roblin added: ‘It is a worry that as vaccines expire, there could be a whole load of wasted stock. But I would expect the central procurement team to have sorted that out in advance – to have a financial arrangement if stock was not used.

‘If parents do not want it and there has not been a national campaign then Public Health England and politicians should take responsibility for not making it clear what the recommendations were for parents of two- and three-year-olds.’

For clinical at-risk groups, the latest weekly figures are up slightly on last year with over 67% of people aged 65 and over, 44% of those under 65 in an at-risk group and 34% of pregnant women having been vaccinated – compared with 65%, 41% and 32% of each groups around the same time last year.

 

GP-LED FLU VACCINATION OF CHILDREN TO BE EXTENDED TO ALL FOUR-YEAR-OLDS FROM SEPTEMBER

From the FMS Global News Desk of Jeanne Hambleton PULSE TODAY        21 February 2014 | By Caroline Price

 

GPs will be expected to vaccinate all four-year-olds as well as two- and three-year-old children against flu from September, Public Health England has confirmed.

The public health body said the national childhood flu vaccination programme in children and adolescents aged two to 17 – which began to be rolled out last year – will now be extended through GP practices to four-year-olds nationally, as well as through pilot programmes in schools to children aged 11 to 13 years.

A PHE spokesperson confirmed to Pulse GPs would be expected to deliver the flu vaccines to four-year olds.

The spokesperson said: ‘Yes, [the] plan is for vaccination for four-year-olds to be delivered by GPs’.

It comes as GP leaders had already criticised the workload associated with this season’s campaign, which spanned only two- and three-year olds.

The GP-led campaign was hailed a success by public health chiefs, after around 40% of children were vaccinated by the end of January, but GP leaders said GPs shouldered too much of the responsibility for informing parents and ensuring adequate uptake.

PHE advised GPs the live-attenuated flu vaccine – Fluenz – used would again be provided centrally and practices will need to take into account the additional four-year-old cohort when ordering stocks.

In a new vaccine update communication to GPs, Public Health England wrote: ‘The flu vaccine ordering season for the winter 2014/15 is already upon us, so we are using this month’s issue to update readers on who will be eligible for the flu vaccine later in the year when the vaccination programme starts.

‘Next winter sees the addition of two more age groups of children to those introduced in winter 2013/14. These are planned for eligible four-year-olds, and in several pilot programmes around the country to 11- to 13-year-olds.

‘GP practices should note that flu vaccine will be provided centrally for all children in the extended programme, and those of all ages in clinical risk groups, up to and including those aged 17 years.’

Anonymous comment from a GP reader

Whilst agreeing that Flu vaccination in these age groups is a good thing it is yet one more job to be added to an incredibly busy time of year. This year I decided enough was enough. It was underfunded and distracted from my primary purpose. I will not be doing it this year either. Nor the shingles vaccine.

Whether you do it is up to you but please then do not complain that you have not enough time to see your ill patients and you have not time to have lunch or even take a break.

Time management is key here. NHS England and HMG really do not give a monkeys and will keep piling this stuff on us until we say no or crack.

Make your choice.

GPs do their best but they are not supermen .. we only think they are. J.

 

LMC FORCES DELAY IN PHARMACY FLU VACCINATION PLANS

From the FMS Global News Desk of Jeanne Hambleton PULSE TODAY       22 August 2014 | By Caroline Price

Exclusive: GP leaders have forced NHS England in one area to halt plans to co-opt pharmacies into delivering flu jabs, amid concerns it would put practices at serious financial risk without helping to improve uptake in at-risk groups.

LMC leaders in Shropshire and Staffordshire said they have managed to get the plans – announced earlier this month – put on hold, after objecting over the short notice for GPs who had already ordered in vaccine stocks for their at-risk populations.

GPC leaders have criticised NHS England’s continued push for pharmacy-led schemes across the country, which they said had not increased flu vaccine uptake and were potentially depriving GPs of income at the same time as adding to their workload.

NHS England Shropshire and Staffordshire area team sent out a letter to local pharmacy groups in the first week of August, offering them service level agreements to provide the flu vaccinations to patients aged 65 years and over; those aged from 18 years to under 65 years in clinical risk groups and pregnant women aged 18 years and over.

Dr David Dickson, secretary of South Staffordshire LMC, told Pulse that GP leaders in the area – which also covers Shropshire and North Staffordshire LMCs – immediately raised their concerns with the area team. They have now been informed by NHS England that the plans are on hold while the area team formulates a proper plan.

Dr Dickson said: ‘They have put it on hold for the moment. They have not given sufficient notice for this, practices have already placed their orders for vaccine and they are at financial risk if they are not taken up. It is too late in the year to change those orders – and some practices do not have return of sale arrangements.’

‘We also do not think there is evidence it will improve the uptake and are worried pharmacy colleagues do not have the same recording and reporting duties – they are not going to target the hard-to-reach groups.’

A spokesperson for NHS England Shropshire and Staffordshire said discussions about the scheme were ‘ongoing’ and it would likely be in place ‘by the end of the year’.

But Dr Dickson said the Government should instead adopt more vigorous publicity campaigns to encourage uptake in difficult to reach at-risk groups – such as young working men, housebound people and people with impaired mobility  – as well as better strategies to help inform pregnant women about the benefits of vaccination.

He said: ‘There are key things like that they need to address before handing all the easy ones over to pharmacies.’

Pharmacy-led flu vaccination programmes have been implemented in several areas in recent years, and NHS England is continuing to encourage CCGs to commission them to help boost vaccine uptake in at-risk groups, which is falling well below the national target of 75%, as part of its ‘winter pressures’ strategy to prevent avoidable hospital admissions.

The NHS England Shropshire and Staffordshire area team spokeperson said: ‘We are committed to ensuring that people who are most at risk have easy access to the flu vaccination.

‘NHS England in Shropshire and Staffordshire proposed a scheme earlier this year to allow pharmacies to administer flu vaccinations to adults in the “at risk” groups. We are continuing to have on-going discussions with GP practices, Local Medical Committees (LMCs) and Local Pharmacy Committees (LPCs) and anticipate the scheme will be available by the end of this year.’

But GPC Wales chair Dr Charlotte Jones, who is also co-lead for the GPC on immunisations, said initiatives to get pharmacies to deliver flu vaccines to at-risk groups in Wales had not helped to reach more patients in vulnerable groups.

Dr Jones said: ‘Whilst we do not disagree with any initiative to increase flu vaccine uptake, our experience has been it is those patients who would have always had their flu jabs done in the GP surgery that are being captured by the pharmacies – and they are not actually reaching those who have not been getting it, so it is not meeting that need.

‘We are concerned it is removing this work from GPs who deliver the vast bulk of the programme, and end up chasing the harder to reach patients.’

Dr Richard Vautrey, GPC deputy chair and also co-lead on immunisation, said experience elsewhere in the country had similarly demonstrated that pharmacy-based schemes were causing disruption for practices but not helping to boost uptake.

He said: ‘All it does is add complexity and confusion to the process rather than producing any greater benefits in terms of numbers of vaccinated.’

He added that the GPC wanted to reinstate national publicity campaigns to promote flu vaccinations, despite Department of Health claims they were ineffective.

‘The more the Department of Health and Public Health England can promote vaccination the better there is no loss and only gain to be made if it is more widely promoted whether through direct publicity or articles in the media.’

A spokesperson for the Pharmaceutical Services Negotiating Committee (PSNC) told Pulse ‘there is evidence for the positive impact that pharmacies can have on [flu vaccine] delivery rates’.

The PSNC spokesperson added: ‘There is also evidence that patients strongly welcome the additional choice that alternative providers allow them.’

 

For even  More  Medical Trouble  with lost patients and  GPs’ cut backs, please log into fmsglobalnews.wordpress.com

Back tomorrow I hope. Jeanne

 

 

 

MEDICAL MAYHEM

PATIENTS LAUNCH CAMPAIGN TO STOP NORTH EAST PRACTICE CLOSURE

From The FMS Global News Desk of Jeanne Hambleton                                                                        Pulse Today 26 August 2014 | By Christina Kenny

 

A group of patients and residents in Hartlepool has launched patients and residents in Hartlepool patients and residents in Hartlepool, claiming that NHS managers’ arguments for closing the practice are ‘unadulterated rubbish’.

The Fens Residents’ Association have distributed posters in the town’s shopping parade and in a popular local pub calling for residents to take action against the proposed closure of the Fens Medical Practice.

The posters read: ‘The NHS has done enough damage to our town already by stripping Hartlepool Hospital of essential services. Enough is enough, this time they have to be stopped.’

The news comes as Pulse has launched a campaign to Stop Practice Closures after revealing that more than 100 practices across the UK had either closed or were actively considering closing as a result of funding cuts and a recruitment crisis.

The Fens Medical Practice has a list of nearly 3,000 patients and opened in 2009 as part of a national initiative aimed at improving access and choice of GP services for local communities.

The practice’s APMS contract comes to an end on 31 March 2015 and residents fear that the surgery will be merged with a nearby practice on Wynyard Road (which is also under review) and the Fens premises closed.

The NHS England local area team for Durham, Darlington & Tees say that there are five other primary care providers within a two-mile radius that have ‘limited capacity’ to accept new patients. They argue that the practice’s current premises, a converted dentist practice, is neither accessible nor visible due to its position behind a row of shops and a stairwell.

However, the Fens Residents’ Association described the area team’s assessment as ‘unadulterated rubbish’, arguing that the premises are ‘superbly accessible’ with free parking and access to public transport. They suggest instead that additional signage should be provided at nearby roads and pathways.

NHS England’s local area team have opened a survey to get residents’ views, which closes on 29 September. In a statement put out alongside the survey, NHS England said: ‘The information that we have reviewed to date suggests that we need to consider setting up a new contract for a provider within the local area from 1 April 2015 to replace Fens Medical Practice and Intrahealth Wynyard Road.

‘It costs more to provide services to a smaller number of registered patients, and the type of contract that this GP practice operates under often costs more per patient than other local GP service contracts for the same or a very similar level of service. This does not represent the value for money that we aim to achieve.

‘Should a new contract be introduced, it may be with the existing provider or a new provider. We would not expect the change in contract to significantly alter the current GP services that are offered.’

The Fens Medical Practice and Wynyard Road practices are two of nine across Teeside and Hartlepool that NHS England has announced could close when their APMS contracts expire in late 2014 or early 2015.

An APMS practice at a nearby retirement village has also recently been threatened with closure as it has not reached the level of patients needed to fulfil its contract. The Hartfields Medical Centre is situated on-site at the Hartfields Retirement Village, but many of its 2,000 patients come from the surrounding area.

A spokesman from the Joseph Rowntree Housing Trust, who run the retirement village, said that closing the practice would have a ‘detrimental effect’ on residents, the vast majority of whom are registered with the practice.

They said: ‘The trust does not want to see Hartfields lose the GP surgery located here. Hartfields is an innovative model of how we can provide quality care and support for the future, linked to essentials services like the on-site GP surgery. Closure could mean our residents lose some of their independence, and it could also result in residents requesting more home visits from GPs, which may have higher financial costs for the NHS.

‘Joseph Rowntree Housing Trust is formulating a formal response to the consultation being conducted by the Durham, Darlington and Tees area team of NHS England.’

 

SCORES OF PRACTICES TEETERING ON THE BRINK OF CLOSURE

Practices across the country face imminent closure, but the NHS seems happy for them to go to the wall. The time is right to fight back, argues Jaimie Kaffash

From The FMS Global News Desk of Jeanne Hambleton                                             PULSE TODAY 15 August 2014 3:18pm By Jaimie Kaffash

Practices across the country face imminent closure, but the NHS seems happy for them to go to the wall. The time is right to fight back, argues Jaimie Kaffash

General practice is heading towards a precipice. Scores of GPs across the country are facing such hardship that they may be forced to shut their practice doors altogether.

LMC leaders have told Pulse they are aware of more than 100 practices that have either closed or face imminent closure – and this is likely to be the tip of the iceberg.

Local GP leaders say they have ‘not seen anything like it’ and warn of a ‘domino effect’ on surrounding practices if closures cannot be avoided.

‘I think mergers are the only way to keep practices in the hands of the profession’ said Dr Robert Morley, West Midlands

Some practices say they have ‘exhausted all other options’ and have no choice but to close, while others are preparing to merge with others in order to continue providing services.

Either way, the grim reality is that, before the year is out, the profession could face an unprecedented mass closure of practices across the UK, unless the NHS steps in with emergency help.

The warning signs were there several months ago. Former GPC negotiator Dr Peter Holden warned in April that there was ‘a year to save general practice’ predicting the profession would see practices going bust within months.

Since January at least 13 have closed, many of which were single-handed practices that had been unable to find anyone to take over their lists. And there are many more that are very close to dropping over the edge.

Pulse asked 47 LMC leaders from across the UK whether they had been contacted by practices that were considering closing. More than half (24) said practices in their area were considering closing, identifying a total of 96 practices.

Dr Mark Sanford-Wood, chair of Devon LMC, says the situation in his area is unprecedented: ‘We have on our radar at least half a dozen practices that we are very concerned about. It is highly likely a good number will end up closing by the end of the year.

‘I’ve been involved with the LMC for 20 years and I’ve never seen this before. For this to start happening now is significant.’

It could get even worse as trainees shun partnerships, Dr Sanford-Wood suggests: ‘I see a lot of bright, young, highly talented GPs. They see a workforce that is chained to the wheel, and they do not want in.’

Join the fight to protect your patients

Scores of practices across the country face closure and many more are likely to follow unless better support is given to GPs. If these closures go ahead it will be a disaster for patients struggling to find a new GP – and for all the remaining neighbouring practices who will be left to mop up the mess. Pulse is launching a campaign to raise awareness of the growing crisis in general practice and to help practices fight for the support they need.

As part of the campaign, Pulse will:

• Lobby ministers to ensure practices facing closure are given emergency support to help them restructure and protect their patients;
• Begin an e-petition calling for a parliamentary debate on the threat of practice closures across the UK; http://epetitions.direct.gov.uk/petitions/67648
• Bring GP leaders together to discuss ideas on how the morale of general practice can be improved and GPs can be funded more sustainably to prevent more practices going to the wall;
• And create resources for practices to share ideas and campaign locally for better support so that practices and patient services are protected.

We are calling on GPs to:

• Let us know if you are struggling. From your stories we can build up a picture of what is happening across the UK. Email us in confidence at feedback@pulsetoday.co.uk;
• Sign our e-petition calling for a parliamentary debate on practice closures here;
  • http://epetitions.direct.gov.uk/petitions/67648

Out of options

London has the highest number of practices in danger – with up to 30 practices contacting their LMC regarding closure. In Wales at least 14 practices are preparing to close, while Wessex, Northamptonshire and Devon each have six practices on the brink.

One GP partner, who wished to remain anonymous, says her high-achieving practice has run out of options following struggles with recruitment.

She says:  ‘Despite all efforts to recruit or merge over a two-year period, there is currently one faint hope left. If this goes the way of all past hopes then closure beckons in the next few months.’

She adds that this is not because the practice has failed in any way: ‘This is because of the starvation and withdrawal of primary care funding and resources in the face of the relentless increase in unfunded and underfunded workload.’

Dr Charlotte Jones, chair of the Welsh GPC, says four practices in her area have given notice that they will give up their contract to health boards, while there are ‘more than 10… examples of surgeries that are struggling and for whom the next steps may be that they have to close’.

She adds: ‘Sometimes practices are reluctant to voice concerns; some keep on working over and above what is safe.’

‘I have spoken to about six practices who are considering resigning their contract. It is a mix of practices and areas – it is a universal problem’ – Dr Nigel Watson, Wessex

Dr Beth McCarron-Nash, a GPC negotiator and a GP in Cornwall, says there are a clutch of familiar problems that lie behind the closures. She says: ‘I am hearing about more and more practices considering their options.

‘It’s a perfect storm of problems: the contract imposition from 2013, funding swings as a result of MPIG redistribution and difficulty recruiting. That, alongside spiralling workload and increasing demand… is having a catastrophic effect and practices are struggling to cope.’

If significant numbers of practices hit the wall, the level of destruction to the NHS would be unprecedented, with the likelihood of a ‘domino effect’ on nearby practices, GPs say.

Dr Chris Hewitt, chief executive Leicester, Leicestershire and Rutland LMC, says two practices in his region ‘have decided that if their financial situation gets any worse they will formally ask NHS England to take over their contracts’.

But the region is already under strain from branch surgeries closing. He adds: ‘In the past six months, 10 surgeries (out of 152 practices) have been tasked with dealing with a sizeable influx of patients as lists are disbursed as a result of surgeries or branch surgeries closing.

‘The very real threat of practice closures due to retirements or loss of financial viability will start a chain reaction, which impacts on surrounding practices that are only just coping with the demand from their current patient list.’

NHS England unconcerned

But managers seem to be taking a relaxed response. A spokesperson from NHS England tells Pulse that it did not have any intelligence centrally regarding practice closures, as this was a matter for area teams working with CCGs and LMCs.

She says: ‘Practices close – and open – all the time and it should not be assumed that this is a problem or a reduction of service; it needs to be seen in the context of local provision.’

In Wales, on the other hand, the Government is working with the RCGP, the GPC, health boards and deaneries to try to ease recruitment problems.

In Scotland, the Government is directly tackling the problems for dispensing practices with new regulations brought in from last month.

But in England, on the various issues of recruitment, MPIG withdrawal and PMS reviews, local leaders are receiving patchy help from area teams.

‘There are only three health boards where practices are not closing. It is due to an inability to recruit partners – and remaining partners cannot cope’ – Dr Charlotte Jones, Wales

Dr Robert Morley, chair of the GPC contracts and regulations subcommittee and executive secretary of Birmingham LMCs, whose area has already seen two practices close this year, says the only way for many practices to survive will be to merge with others.

He says: ‘The only way to safeguard the profession and safeguard these practices is for partners to merge. [It’s] the only way forward to keep these practices in the hands of the profession, but also, from a business perspective, to try and work within a business model that allows general practice to continue.’

Other practices have used their relationship with patients to campaign for better support. The Jubilee Practice in Tower Hamlets, east London, has been at the centre of a major campaign in the borough to prevent practices going under.

The ‘Save Our Surgeries’ campaign has already seen marches organised with neighbouring practices, articles in The Guardian, a meeting with health minister Earl Howe and co-ordinated actions with MPs – all with little help from BMA or RCGP. They have managed to win some guarantee of emergency payments from NHS England to protect them from the withdrawal of MPIG, but are continuing their campaign for more sustainable funding in the future.

‘There are several practices that are in trouble and threatened with closure, because of dispensing being withdrawn’ – Dr Alan McDevitt, Scotland

Dr Naomi Beer, a partner at the practice, says: ‘We are having to do the co-ordinating for ourselves – working to get the message across to practices, developing tools for practices to do up to a seven-year forecast on income, pushing for co-ordinated action by local MPs and councillors to press for meetings, raising questions in Parliament and delivering a petition to Downing Street.

‘These ideas all come from us and we have little communication from the BMA or GPC except during an event such as the marches we organised in Tower Hamlets.’

It may be that galvanising local patients in this way can help practices fight back against the threat of closure, and that is why Pulse is launching a campaign to help practices do just this.

For many practices, this could be the last resort.

• Additional reporting by Christina Kenny

 

DR NAOMI BEER: ‘WE CANNOT LET PRACTICES BE FORCED TO CLOSE’

From The FMS Global News Desk of Jeanne Hambleton                                  PULSE TODAY 22 August 2014

Dr Naomi Beer’s anger at Government policy on struggling GP practices saw her lead a campaign forcing a crucial concession from NHS England. But, as she tells Sofia Lind, the battle to prevent closures goes on.

CV….Age: 51

Family: Four children of ages ranging from 16 to 24, the youngest aspiring to be a doctor herself

Education: Trained at Guy’s Hospital and did her general practice vocational training scheme at the Royal London Hospital and at Jubilee Street Practice.

Career: 1992 – present: GP at Jubilee Street Practice, including being a GP tutor. Elected to Tower Hamlets LMC, effective this month

Career high: Leading the east London Save Our Surgeries campaign alongside Jubilee Street practice manager Virginia Patania to secure funding for 22 GP practices at risk of closure because of MPIG funding withdrawal. The campaign has won the support of local patients, MPs and Tower Hamlets Council as well as the RCGP and BMA

Other interests: Frequent attender at the National Theatre, enjoys the ‘rare treat’ of reading a book and is an active member at the local church, where music is ‘another passion’

In the space of just a few months, east London GP Dr Naomi Beer has gone from being a low-profile, hard-working GP partner to spearheading the fight against the destabilisation of general practice in England.

In that time, Dr Beer’s impassioned campaigning has succeeded where official GP representatives have failed since the announcement almost two years that the minimum practice income guarantee (MPIG) would be withdrawn over seven years, in winning support for practices faced with funding cuts.

By mobilising patients onto the streets of the London borough of Tower Hamlets and leading a rally to 10 Downing Street, the Save Our Surgeries campaign has challenged the portrayal of GPs as overpaid profiteers. And it has prompted the Government to take real action, with NHS England last month offering a two-year reprieve to those practices most heavily affected by the seven-year phase-out of the MPIG.

With her dignified and determined approach, Dr Beer has become the human face behind that success – helping the public to understand the plight of practices and how it will eventually affect their ability to see a doctor when they need one.

Concession

While the concession is not exactly what Dr Beer was fighting for – her campaign specifically calls for a long-term funding solution and not a ‘sticking plaster’ – this represents an undeniable victory for GPs and patients in Tower Hamlets.

Dr Beer particularly believes it sends a message to those disheartened GPs  who argued when Pulse launched its Stop Practice Closures campaign last month that ‘we should let practices close’ to make the Government learn the hard way how their policies affect their voters.

‘GPs have been backed against the wall and are angry at the position we have all been put in and the way we have been treated. I can understand some people saying, out of desperation, that isn’t it better that some practices fail,’ she says.

‘But I would argue so strongly against that because the practices that initially are going to be affected are serving very vulnerable populations.

‘If you let those practices go you cannot replace the level of care that we are giving and that means that you are condemning a whole group of the population to having a lesser standard of care than they are receiving at the moment. I think that is totally irresponsible and we cannot let it happen.’

With admirable calm, Dr Beer explains how she and her practice manager had to move quickly when they discovered in March – three weeks before she was due to sign her new contract – that the practice would be forced to close within a year on its current level of funding.

They secured a meeting with the NHS England local area team, at which the stark truth emerged that the area team could do nothing at all to help.

‘It was very clear that there was no money and no support because we had already done everything they considered relevant to support ourselves.

‘We are a practice that is already working in a network and that has already trimmed down a lot of our staff to create a good skill-mix and reduce the cost of having a lot of GPs. We have invested heavily in our staff to have a physician’s assistant, a healthcare assistant and highly trained nurses. So we have done pretty much everything we could have done to ensure efficiency.’

Drastic action

Faced with two options of either closing or drastically reducing staff, the practice went with a third – to make as much noise as it could.

After approaching local Labour MP, Jim Fitzpatrick, Dr Beer was amazed when he was able to organise a meeting with health minister Earl Howe and NHS England.

Dr Beer recalls: ‘We presented our very detailed position papers, and Earl Howe was very sympathetic. He said: “Clearly you are an excellent practice, clearly you are delivering a high quality of care. No, I am not sending you back to make more efficiencies because I can see that there aren’t any to be made. I am committed to finding a solution for you”.’

NHS England had originally promised to support practices as it phased in changes to the MPIG, but Pulse later learned that area teams had failed to offer any extra funding to those affected by the swingeing cuts. Dr Beer said a representative from NHS England visited the practice but was only interested in what made their surgery unique.

She says: ‘We felt that this was potentially a rather divisive manoeuvre but we agreed to describe what our practice did, and we let other practices in our area know what was going on.’

That was the last the practice heard from NHS England until last month’s announcement of the two-year reprieve. Despite the U-turn, however, Dr Beer is clear that the fight is not over.

High on her agenda, she says, is to ensure the Government sorts out the Carr-Hill formula, which decides weighting of GP funding based on demographics.

‘Equity is a meaningless word when you are talking just about age and numbers of patients, because that is clearly not the whole picture. Healthcare needs surely depend on how sick your population is. If you’re only basing it on age, and especially patients over 75, and our patients are dying 15 years younger than that, it is very clear that we will be massively disadvantaged.

‘None of this formula actually makes sense.’

Foot-dragging

While the Government began working on the Carr-Hill formula to take account of deprivation back in 2007 and announced a fresh review in 2012, nothing has yet happened to change it and the latest review group had yet to commence its work in earnest on Pulse’s last check.

‘This evidence has been around for some time but, for whatever reason, nothing has changed as yet,’ says Dr Beer. ‘Frankly the Government has shown no interest in areas of deprivation because they have allowed this to happen. They have done nothing until we pushed them, absolutely nothing.’

So with one win under her belt, Dr Beer is determined to pursue her battle. Asked if she wishes to add any other messages, she fixes her gaze earnestly and says: ‘I would like to encourage people that it is possible.’

PLEASE Sign our e-petition calling for a parliamentary debate on practice closures here –    http://epetitions.direct.gov.uk/petitions/67648

WELL DONE DR. BEER. KEEP UP THE GOOD WORK.   Back tomorrow. Jeanne

 

 

 

 

 

 

 

GPs FACE DELAY IN PHARMACY FLU VACCINATION PLANS

LMC forces delay in pharmacy flu vaccination plans

From FMS Global News Desk of Jeanne Hambleton                                                                       PULSE 22 August 2014 | By Caroline Price

 

Exclusive: GP leaders have forced NHS England in one area to halt plans to co-opt pharmacies into delivering flu jabs, amid concerns it would put practices at serious financial risk without helping to improve uptake in at-risk groups.

LMC leaders in Shropshire and Staffordshire said they have managed to get the plans – announced earlier this month – put on hold, after objecting over the short notice for GPs who had already ordered in vaccine stocks for their at-risk populations.

GPC leaders have criticised NHS England’s continued push for pharmacy-led schemes across the country, which they said had not increased flu vaccine uptake and were potentially depriving GPs of income at the same time as adding to their workload.

NHS England Shropshire and Staffordshire area team sent out a letter to local pharmacy groups in the first week of August, offering them service level agreements to provide the flu vaccinations to patients aged 65 years and over; those aged from 18 years to under 65 years in clinical risk groups and pregnant women aged 18 years and over.

Dr David Dickson, secretary of South Staffordshire LMC, told Pulse that GP leaders in the area – which also covers Shropshire and North Staffordshire LMCs – immediately raised their concerns with the area team. They have now been informed by NHS England that the plans are on hold while the area team formulates a proper plan.

Dr Dickson said: ‘They have put it on hold for the moment. They have not given sufficient notice for this, practices have already placed their orders for vaccine and they are at financial risk if they are not taken up. It is too late in the year to change those orders – and some practices do not have return of sale arrangements.’

‘We also do not think there is evidence it will improve the uptake and are worried pharmacy colleagues do not have the same recording and reporting duties – they are not going to target the hard-to-reach groups.’

A spokesperson for NHS England Shropshire and Staffordshire said discussions about the scheme were ‘ongoing’ and it would likely be in place ‘by the end of the year’.

But Dr Dickson said the Government should instead adopt more vigorous publicity campaigns to encourage uptake in difficult to reach at-risk groups – such as young working men, housebound people and people with impaired mobility  – as well as better strategies to help inform pregnant women about the benefits of vaccination.

He said: ‘There are key things like that they need to address before handing all the easy ones over to pharmacies.’

Pharmacy-led flu vaccination programmes have been implemented in several areas in recent years, and NHS England is continuing to encourage CCGs to commission them to help boost vaccine uptake in at-risk groups, which is falling well below the national target of 75%, as part of its ‘winter pressures’ strategy to prevent avoidable hospital admissions.

The NHS England Shropshire and Staffordshire area team spokeperson said: ‘We are committed to ensuring that people who are most at risk have easy access to the flu vaccination.

‘NHS England in Shropshire and Staffordshire proposed a scheme earlier this year to allow pharmacies to administer flu vaccinations to adults in the “at risk” groups. We are continuing to have on-going discussions with GP practices, Local Medical Committees (LMCs) and Local Pharmacy Committees (LPCs) and anticipate the scheme will be available by the end of this year.’

But GPC Wales chair Dr Charlotte Jones, who is also co-lead for the GPC on immunisations, said initiatives to get pharmacies to deliver flu vaccines to at-risk groups in Wales had not helped to reach more patients in vulnerable groups.

Dr Jones said: ‘Whilst we do not disagree with any initiative to increase flu vaccine uptake, our experience has been it is those patients who would have always had their flu jabs done in the GP surgery that are being captured by the pharmacies – and they are not actually reaching those who have not been getting it, so it is not meeting that need.

‘We are concerned it is removing this work from GPs who deliver the vast bulk of the programme, and end up chasing the harder to reach patients.’

Dr Richard Vautrey, GPC deputy chair and also co-lead on immunisation, said experience elsewhere in the country had similarly demonstrated that pharmacy-based schemes were causing disruption for practices but not helping to boost uptake.

He said: ‘All it does is add complexity and confusion to the process rather than producing any greater benefits in terms of numbers of vaccinated.’

He added that the GPC wanted to reinstate national publicity campaigns to promote flu vaccinations, despite Department of Health claims they were ineffective.

‘The more the Department of Health and Public Health England can promote vaccination the better there is no loss and only gain to be made if it is more widely promoted whether through direct publicity or articles in the media.’

A spokesperson for the Pharmaceutical Services Negotiating Committee (PSNC) told Pulse ‘there is evidence for the positive impact that pharmacies can have on [flu vaccine] delivery rates’.

The PSNC spokesperson added: ‘There is also evidence that patients strongly welcome the additional choice that alternative providers allow them.’

Note: This story was amended at 11:51 on 22 August 2014 to incorporate NHS England Shropshire and Staffordshire area team’s comments

 

FLU ANTIVIRAL ALERT ‘SHOULD BE SENT OUT EARLIER TO GPS’

From the FMS Global News Desk of Jeanne Hambleton                                                                       PULSE 8 August 2014 | By Caroline Price

 

Peak flu activity had already been reached in two areas of England when the national alert went out for GPs to start using antivirals in at-risk groups, according to regional surveillance data for the 2012/13 flu season.

The data also showed levels of circulating flu were high in some areas up to two weeks before the Department of Health sent out its national advice to start using antivirals.

Currently the DH times the antiviral alert based on national surveillance information, such as acute respiratory outbreaks in the community and rates of GP-reported influenza-like illness consultations and linked respiratory swab results co-ordinated by the RCGP.

Researchers from Public Health England looked at how the timing compared with more detailed regional data that has begun being collected since the 2009 swine flu pandemic, including the Respiratory DataMart System (RDMS) that provides weekly virological data mainly from secondary care.

These data showed influenza B activity peaked in East Midlands and North West England in Week 51 of the flu season, the week the DH sent out the national alert to prescribe antivirals. Prior to this, pre-epidemic thresholds of influenza B activity had already been reached in three other areas in weeks 48 or 49.

The researchers said: ‘For two regions, peak RDMS activity had already been reached in the week community antiviral prescription commenced, suggesting this did not occur early enough for some regions.’

They concluded: ‘Any early signals at a subnational level should feed into the decision to improve the timeliness of reporting of the start of significant influenza activity and increase awareness in the community.’

GPS TOLD TO CARRY OUT CHILD FLU VACCINATION PROGRAMME IN THREE-MONTH WINDOW

From the FMS Global News Desk of Jeanne Hambleton                                   PULSE 9 May 2014 | By Caroline Price, Alex Matthews-King

 

Public health chiefs have told GPs they must vaccinate children aged between 2-4 years within a three-month window this winter because the chosen vaccines will expire midway through the flu season.

Experts from Public Health England (PHE) said in guidance for this year’s flu immunisation programme that it was ‘highly likely’ central stocks of the chosen Fluenz vaccines will have expired by the end of January, despite the vaccination programme expanding to include all 2-4 year olds this year.

The guidance also told GPs they must focus their efforts on improving uptake of the flu vaccine in patients with liver or neurological diseases.

GP leaders said that increased numbers of patients could be left unimmunised as a result of the short time-frame for immunising children.

The update stated: ‘Vaccine has been ordered to cover the period over which historically the flu vaccine has been administered, extending from September to mid-December.’

‘It is highly likely that all the Fluenz Tetra® supplied centrally will have expired before the end of January 2015. In the light of this it will be important to ensure that efforts are made to vaccinate children before the Christmas holidays.’

Last year, stocks of the vaccine had a similar expiry date, and some practices said they were struggling to vaccinate two- and three-year olds as a result.

Dr Richard Vautrey, a member of the GPC negotiating team and a GP in Leeds, told Pulse that patients could be left unimmunised and GPs could see their QOF achievement hit by failure to provide adequate stocks of vaccine.

Dr Vautrey said: ‘There is an increasing problem, as more patients fall into the cohort for immunisation with Fluenz, it means that increasing numbers of patients will be left unimmunised unless practices use their own supplies of the alternative vaccine for those patients.’

He added: ‘This year, it has been extended to 2-4 year olds. So it is a bigger group and it is bound to have a much bigger impact because it then impacts on QOF targets for immunisations as well. So it is important that the vaccine is available throughout the flu season.’

‘We were told that with the extension of the scheme, to include a greater number of patients, they would ensure there was a considerable supply right through the immunisation program, right through to the end of March. It is a manufacturing issue, and that is simply not good enough.’

The public health update also urged GPs to concentrate their vaccination programmes on patients with liver or neurological diseases.

Average uptake of the flu vaccine in the under-65s clinical risk groups has been stuck at about 50% for the past three years. But it is even lower in patients with chronic liver disease, in whom uptake was around 43% last flu season, while coverage in those with neurological disease was 49% last year, despite them being among the most at risk of dying from the complications of flu.

A spokesperson for PHE told Pulse: ‘For a number of years now around only half of patients in at-risk groups have been vaccinated and increasing uptake in these groups is important because of the increased risk of serious illness should people in these groups catch flu. 

‘However, we know that establishing the true uptake rate is hard because of difficulties in determining the denominator and therefore this year we decided to take a different approach which is to ask that particular attention is focused on those in at risk groups who are most at risk of death from flu but who have the lowest uptake rates amongst the at risk groups (that is those with chronic liver and neurological disease, including those with learning disabilities).’ 

PHE declined to comment on what additional resources or support GPs could get to help boost uptake in these groups, but said it wanted to see coverage upped to that of other clinical risk groups.

The spokesperson added: ‘We would expect vaccine uptake in those with chronic liver and neurological disease (including learning disabilities) to reach levels closer to those being achieved for other at risk groups who have a higher level of uptake.’

 

GP-LED FLU VACCINATION OF CHILDREN TO BE EXTENDED TO ALL FOUR-YEAR-OLDS FROM SEPTEMBER

From the FMS Global News Desk of Jeanne Hambleton                                   PULSE 21 February 2014 | By Caroline Price

 

GPs will be expected to vaccinate all four-year-olds as well as two- and three-year-old children against flu from September, Public Health England has confirmed.

The public health body said the national childhood flu vaccination programme in children and adolescents aged two to 17 – which began to be rolled out last year – will now be extended through GP practices to four-year-olds nationally, as well as through pilot programmes in schools to children aged 11 to 13 years.

A PHE spokesperson confirmed to Pulse GPs would be expected to deliver the flu vaccines to four-year olds.

The spokesperson said: ‘Yes, [the] plan is for vaccination for four-year-olds to be delivered by GPs’.

It comes as GP leaders had already criticised the workload associated with this season’s campaign, which spanned only two- and three-year olds.

The GP-led campaign was hailed a success by public health chiefs, after around 40% of children were vaccinated by the end of January, but GP leaders said GPs shouldered too much of the responsibility for informing parents and ensuring adequate uptake.

PHE advised GPs the live-attenuated flu vaccine – Fluenz – used would again be provided centrally and practices will need to take into account the additional four-year-old cohort when ordering stocks.

In a new vaccine update communication to GPs, Public Health England wrote: ‘The flu vaccine ordering season for the winter 2014/15 is already upon us, so we are using this month’s issue to update readers on who will be eligible for the flu vaccine later in the year when the vaccination programme starts.

‘Next winter sees the addition of two more age groups of children to those introduced in winter 2013/14. These are planned for eligible four-year-olds, and in several pilot programmes around the country to 11- to 13-year-olds.

‘GP practices should note that flu vaccine will be provided centrally for all children in the extended programme, and those of all ages in clinical risk groups, up to and including those aged 17 years.’

 

My comments

I seem to be eligible as fibromite  as I have a compromised immune system. Last year our surgery  had i the “flu jab session”  working like clockwork.  We were given an appointment at maybe  10.05am The next would be 10.10pm and within that five minutes the staff would ‘jab’  quite  number of patients. We queued patiently and  all  went in with sleeves rolled up, chatting to other patients about the weather and the winter.  It was almost a reunion as you saw some of your friends.  I believe we should leave it with the GPs. They know what they are doing and who they can help.  All I can say it paid dividends for me each winter and I got through the cold months quite well.  Painful it certain was not.

As my other main  WordPress blog,  FMSGlobalNews.wordpress.com,  seems to have been stuck on August 14th page, I am  asking folks to look at the Archives to see I am  still posting daily.  It is soul destroying that I cannot find anyone to email to ask them to sort out this glitch.  Today I  sent stories about  very old metal,  the Tibetans who live at high altitudes and something else – fibro fog….sorry.

Sorry our blog is a bit longer today but I felt the information was important to those of us who have elderly relatives and young children in the family.  The Flu Jab is really life saving.  Back tomorrow. Jeanne

 

 

 

 

 

 

38 DEGREES BECOMES LATEST TO LAUNCH CAMPAIGN AGAINST GP PRACTICE CLOSURES

From the FMS Global News Desk of Jeanne Hambleton                        Pulse Today 18 August 2014 | By David Brill

 

 

Lobby group 38 Degrees has launched a petition for health secretary Jeremy Hunt to ‘stop closing GP surgeries’.

The petition, launched last week, has already generated over 70,000 signatures. Titled: ‘Jeremy Hunt, don’t close our GP surgeries’, the petition calls on the health secretary not to go ahead with his ‘plans to strip away millions of pounds from some GPs’, saying it could ‘hit some of the poorest communities in the country’.

The calls are the latest in a string of calls to protect general practice from Government spending cuts, boosting the leverage of Pulse’s campaign for the Government to step in to provide emergency funding to a growing list of over 100 practices at risk of having to close.

The 38 Degrees petition saw several patients adding heartfelt messages in support of their local GPs, including one commenter who said: ‘Our local GPs are stretched to the limit and services are suffering now. Taking away this funding will sound the death knell for many surgeries and will be another nail in the coffin of a health service that was once the envy of the world,” one wrote.

A 38 Degrees spokesperson said: ‘We’ll definitely be handing in the petition to Jeremy Hunt and [are also] considering what other action we can take together to ensure that our vital GP services are protected.’

It comes as Save Our Surgeries campaign, led by a group of east London GP practices, delivered 20,000 signatures to 10 Downing Street earlier this month, calling for funding for practices destabilised by the withdrawal of the minimum practice income guarantee (MPIG).

The BMA and RCGP are also currently running major campaigns calling for sustainable funding for general practice.

 

My comments

To support the 38 Degrees GP closures campaign get in touch with

https://secure.38degrees.org.uk/page/s/jeremy-hunt-don-t-close-our-gp-surgeries#petition

For more background on the fight to save GP surgeries view fmsglobalnews.wordpress.com but look on the right at August 2014 Archives as system is not working correctly. New news is all in archives sadly and no one bothers to fix it.

Back soon Jeanne

 

 

Why being “my GP” to a patient will secure the future for Doctors

From the Fibromyalgia News Desk of Jeanne Hambleton

By THE JOBBING DOCTOR

 March 10  2009

        

In the first of his new weekly blogs for pulsetoday, The Jobbing Doctor recalls how his last patient of the week exemplified what general practice is about and demonstrated why it will survive despite the Government’s efforts to destroy it.

My last patient of the week (6.30 on a Friday evening) was a young lady who is making her way in the world. She is now nearly 21, and is moving onwards and upwards in her career.

She is working in a large utility group, and has started to apply for managerial jobs. Nothing strange in that, I’m sure you’ll agree. Except that, apart from her mum and nan, I have been the one constant feature of her life. I remember when her mum was in labour, and I attended to her on the local GP unit (and may well have stitched up the episiotomy), looked after all her childhood illnesses, saw her in junior, then senior school, then she became a teenager.

 

Ah, teenagers. They know everything and have the attitude to say so. I remember her rebellions and her behaviour issues.

 

 

Then, as she started to grow into an adult, it was me who put her on the pill and gave her sexual health advice. Then she left home, and set up home with her boyfriend, but made sure we was close to mum and in Jobbing Doctor’s practice area.

 

This is one of the stories that many GPs up and down the country could tell, and is the bedrock of the way in which healthcare is delivered in this country. It has worked pretty well until now, although we are beginning to see the cracks in this system as more and more roles are done by non-doctors, and Government values convenience over continuity, and puts all the resources in that direction.

I was reminded of the time when I was a young dad, and would pick up my two daughters from primary school, as we had a new baby. There were little knots of mothers standing around the playground, and as I was a bloke, I didn’t fit in with any particular group, so I drifted from group to group.

 

They were all talking about the things they had in common, and what they had in common were the experiences of pregnancy, birth, early childhood illnesses, immunisations etc. I heard them referring to colleagues saying ‘Dr Smith came to see me’ or ‘I was examined by Dr Brown’ – I knew Drs. Smith and Brown (but the mums didn’t know me as I live just outside my practice area).

Two things then struck me. Firstly, there would be an identical playground 3 miles away where they would be talking about me! Secondly, whenever they referred to the hospital experience, they would talk about the nurse, the consultant, the midwife, the paediatrician; but whenever they talked about their GPs it was always my doctor, my surgery.

So there you have it. The difference between general practice and hospital medicine is down to the personal possessive pronoun, first person singular versus the definite article. ‘My’ not ‘the’.

Unfortunately, the Government just don’t understand this. Generally, the patients do understand this. This is why General Practice will survive.

The Jobbing Doctor is a jobbing general practitioner in a deprived urban area of England. I tend to write about what I see and experience in primary care – the highs (and there are many of them), the lows (some of them as well), and many other things in between.

There is a long history of doctors who write. Whilst I would never put myself in the same league as almost all of them, there seems to be a compulsion to write down our experiences, as we are often the chronicler of the common man. Writing a blog is really a form of this.

 

The difference between general practice and hospital medicine is down to the personal possessive pronoun, first person singular versus the definite article.  ‘My’ not ‘the’.

 

MY GP & CUSTOMER SERVICE

If only this man was my doctor? I am signed in to a practice with oodles of GPs and when I want to see my  doctor I have to run the gauntlet. By that I mean it is not enough to be feeling so ill you want to see a doctor, but you are faced with telephone calls on an 0844 – not even the receptionist knows how much a minute the calls are.

 

So you start at 8.30 am precisely ringing the surgery in the hope you might see ‘your’ doctor that day.  How could you book yesterday or the day before when you did not feel ill? At 8.30 am precisely I dial the 0844 number and I am advised by a recorded voice that the surgery is receiving a high volume of calls – what? At 8.31 am and 30 seconds. So I wait and  wait and even wait until suddenly I hear a voice with a number.  Does that mean I am 11th in the queue. The minutes tick on – 5 minutes – shall I hang up, will I feel better later – no I will hang on.  I watch the minutes pass on the BBC television newscast screen.

 

A different message – press 2 for appointments. I am suddenly talking to a real voice and I am so excited I forgot to look and see how long it took.  I ask to make an appointment – but my doctor is not in today. Who can I see please? The registrar or a locum. I choose the registrar. Ooophs sorry that appointment has just been taken. Well I will go for the locum.  I had the distinct impression that was the last appointment available unless you play the waiting game – sit in the surgery and hope the doctors are not running late and you might be lucky. I once sat there ‘forever’ when the duty doctor I was seeing was called out to an emergency…..   It was also chaotic when two GPs were off sick – can you imagine the fun they had juggling the appointments. Boy am I glad I was well that day.

 

What kind of system are surgeries running?  Is there a criteria – rules laid down? It appears you cannot make an appointment for tomorrow – the next day my doctor is off -and so it goes on.

 

The alternative is to be ill by appointment. If you can book an appointment for Thursday week, then it seems that is the day to be ill. I certainly am not interested in polyclinics with   people untrained in fibromyalgia  and saying “Fibro what?” Give me the old bedside manner, a doctor who remembers you have got fibromyalgia as well as cares and understands. I think they call that plain old  customer service.

 

 Dear Jobbing Doctor will you be mine? You might even be the one to  prescribe some co-proxamol for me, if you knew me well.

 

What I also find hard to bear is the cost of hanging on line from 8.30 am precisely using a mobile telephone to book an urgent appointment (as you have no alternative  telephone at home and the  telephone boxes are in pieces). I have been told this cost one person £12 on the mobile.  You could say  that person  was sick – sick to the back teeth with it all.

 

Now the Government is pushing up the prescription and dentistry charges while much of the British Isles enjoy free prescriptions.  The hospital car park charges will be going up next.  Who can afford to be ill  – is it the credit crunch do you think?

 

Having said all that I can remember when we had a very angry receptionist – she was so unpleasant patients called her the Rottweiler.  I am glad that has changed. At least we now see a smiling face when we are feeling proper poorly even if we did have to wait until Michelmas to see a doctor. JH.

 

On the subject of doctors and surgeries John Robson,  editor of PulseToday.co.uk,  wrote on March 11th 2009,

 
The practice-based structure of UK general practice is ‘unsustainable’. That’s the verdict of the BMA and RCGP, which have begun radical moves to overhaul the GP business model. including a move to large umbrella organisations running several surgeries. The far-reaching policy paper from the two organisations also envisages the end of the distinction between partners and salaried GPs and proposes new ‘primary care director’ roles. 

 

The report comes as NHS managers admit GPs face a battle with Darzi centres for their practice nurses. Also, following SHA reports under World Class Commissioning which showed even even trailblazers were failing to meet Government targets, PCTs are set to ramp up their drive to attract private providers.

 

To help you get to grips with the changing landscape, we’ve got aspecial report on maximising your practice profits, with advice on boosting income, bidding for contracts and assessing the profitability of enhanced services. 

 

Much talk this week about patients being able to rate practices online. Well, the host site for this, NHS Choices, is riddled with errors, with half of listings not showing if practices are offering extended hours or having wrong opening hours.

 

Follow PulseToday on Twitter  – me too.

 

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