In message <[log in to unmask]>, Lesley Kay
<[log in to unmask]> writes
>actually, my clinical director approved my work plan, it was the assistant
>medical directors who overruled her...
>
>Chris is doing just fine in Derby...all the better for shaving his beard off
>
>Perhaps the list could help us...we've been asked to write an editorial
>about the future of shared care monitoring for DMARDs under the new contract
>(2 consultants, Chris & I, & 1 GP) - any views??
Don't know whether this helps, but I work with two hospital departments
with different views - and both expect me to prescribe!
Hospital A is very close.
No agreed shared care protocols - simply a request to prescribe and an
undertaking to monitor the patient.
Hospital B (further away)
Detailed and acceptable shared care protocols.
I have had a good deal of correspondence with the rheumatologist at
Hospital A - and we have identified a number of problems.
1. Who is responsible for ensuring that problems are detected and
addressed? The initiating hospital department or the prescribing doctor?
(From the consultant's viewpoint, this is not an issue)
2. If a patient does not attend for monitoring, or the monitored results
are unacceptable, whose responsibility is it to ensure that the
medication is altered or stopped - and to inform the *patient* (or
carer) of the change? And also to inform the prescribing doctor.. ;-<<
3. Who is liable when a medication is prescribed despite one of the
prerequisites not being met? Or outside license?
E.g. significantly raised BP and leflunomide?
It *is* necessary for the GP to know what medication a patient is
receiving, to avoid prescribing errors: does the same information need
apply for hospital issued scripts?
We decided to throw the problem (of leflunomide in this case) back to
the JPC - who decided that there was insufficient use of this to make
issuing a shared care protocol necessary!!
Just waiting for planned disaster.. ;-<<
MaryH
>
>Lesley
>
>-----Original Message-----
>From: GP-UK [mailto:[log in to unmask]]On Behalf Of Ian Trimble
>Sent: 13 April 2004 19:45
>To: [log in to unmask]
>Subject: Re: how to demoralise your workforce...
>
>
>Yes, and the Consultants' Contract is exquisite in that it is so
>*personal*. None of this formula rubbish, but all based on
>individual job plans, and determined by your (friendly) Clinical
>Director.
>
>OTOH it throws some current practice into sharp relief: e.g. a
>local consultant who takes ten weeks annual leave, and works
>only two clinical sessions per week - yet is classed as full-time!!
>
>I'm seeing your mate Chris Deighton on Friday night: I'll ask how
>he's faring now he's moved over to Derby (the Traitor!!). And no,
>he isn’t the one referred to in Para 2.
>
>
>Trims.
>
>
>> -----Original Message-----
>> From: GP-UK [mailto:[log in to unmask]] On Behalf Of Lesley Kay
>> Sent: 13 April 2004 06:32
>> To: [log in to unmask]
>> Subject: Re: how to demoralise your workforce...
>>
>>
>> just in case you are bored with the new GP contract...and if
>> you are wondering why consultants are more grumpy than usual
>> for a while.... to demoralise a workforce 1. tell the public
>> consultants are going to get a big payrise 2. make people
>> keep work diaries for a number of months so they realise how
>> many hours they are working 3. make them ask for the amount
>> of money they think they are worth 4. arbitrarily knock 10
>> hours off..but, crucially, don't tell them which 10 apart
>> from the fact these aren't clinical 5. make sure all the
>> other local trusts are paying more 6. that's it
>>
>> Lesley
>>
--
Mary Hawking
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