Concerned-Escapee
Recent activity
Comments (6)
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Comment on: GP contract: DH proposes new funding formula
GP services are notoriously inefficient and unsatisfactory : access is difficult, out of hours service is perfunctory, many GPs son't understand the community services that are available, there is no data set material on GP consultations, complaints are regarded as a nuisance. Its a rotten apple and we almost need to start again.Any new contract that does not remedy these failures is a waste of time. But a start point would be to seek to reduce GP average pay to £80k from £105k pa, to ensure that Urban GPs are funded only to afford shared estate in polyclinics which run on a 24/7 basis, to get consultation data sets flowing so we know what they are doing/not doing in some detail, and to require all GPs to work the shift patterns that would support 24/7 access.
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Comment on: Analysed: the friends and family test
From experience in a large PCT - and this is blindingly obvious -a patient survey should meet a number of delivery criteria in order to be credible or worth while: 1.It must always be collected away from the care setting so that the patient can give an honest answer free of anxiety about repercussions.This anxiety is always there amongst patients and relatives, however unjustified it might be. Its a fact. 2.It should follow a national standard formulation 3.an arm of the NCB should perform it and report on it with league tables 4.Fundamental and specific questions should be asked based on key issues - *when you needed to urinate or defecate, did someone come to help you quickly enough *did you get your medicine (eg pain killers) on time *was the food good enough *were the nurses compassionate and concerned in their conduct to you *did you think the ward was clean *did the staff make clear what their jobs are *when you rang the bell, did someone always attend promptly *did the staff know enough about your medical history and treatment *did the standard of care for other patients around you cause you any anxiety or concern *did you think the ward was well managed 5.Elderly patients should have the option of nominating a relative to answer on their behalf. It is a damning criticism of commissioners that they have felt politically unable to run independent surveys because the output has represented a threat to local provider reputations : don't blame PCTs, blame the DH which has sat on the fence on this for decades and supported the "equal balance of power" culture . Its shaming, and part of the reason why we have frequent appalling examples of patient neglect.
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Comment on: CCG Barometer: 'Weak support' a major concern for clinical commissioners
Re Frank's comment : the layer of CSU is essential for 3 reasons . Firstly GPs, who function at the gut instinct level, do not know how to behave as responsible public servants and require the leadership of officers to pull them into line with CB expectations ; secondly CSUs are surely an effective channel for national policy and acceptable codes of behaviour and are large enough to promote a culture of compliant behaviour; thirdly, CSGs have shed much of the PCT know-how, and have to start again to learn how to commission and procure safely. I guess the whole thing is a bit like using steel buttresses to secure a badly designed building - it is inevitable once the foul deed is done.
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Comment on: Exclusive: GP practices' huge income variation revealed
The data is almost certainly flawed, but this does not detract from the fact that most GPs in England are over-remunerated. This is the Moose on the Table, the Elephant in the Room in this discussion. They work under antiquated contracts dating from a time when they were prized independent entrepreneurs who expected to be treated with provilege and be rewarded for every extra minute task. They have been protected by every Government and political party. It is ironic that this least efficient, least accountable group whose activities are riddled with conflicts of interest, has been put in charge of allocations to hospital and community providers. They should be salaried, and their earnings should be capped at Band 8D ; they should be regarded as the technicians they are. This is not going to happen, but at the very least they should be required to publish their achieved rate of return on operating costs ,and to submit full accounts annually to the NCB. They should be required to submit "consultation datasets" monthly to the NCB showing the primary diagnoses, dependency levels and disposals etc that would be expected of any business. They should be jumping through the same efficiency hoops of the rest of the NHS. The symptom of their inefficiency and gross lack of accountability is in the chronically bad levels of access in primary care - eg ring at 8.30 or 12.30 for an appointment on the day, hope your call is taken, hope there are slots before it shuts at 6.30pm or over the weekend ! What a hopeless situation.
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Comment on: ‘The Health Act is a car crash and that’s a shame’
The CCGs are not an exercise in localism or Big Society, they are an exercise in state control. Effectively nationalisation will be imposed via the Command and Control culture of the NCB. NCB officers in their various forms will require certain behaviours and decisions: like Pavlov's dogs, compliant CCGs will be periodically rewarded. Its a bit like the old prefecture system in France. This is a good thing, because there is no room in a national health service for local policy differences.
