[log in to unmask],Net wrote at 11:05 on 21/03/98
about "The bottom line":
-----------------------------
Ahmad is right, (below) but our hospital colleagues have managed
under these conditions since 1948.
I think to level the playing field they should be required to remove
their waiting lists, and provide appointments no later than the next
clinic if a patient is declared to be urgent (by themselves or their
GP)
or we should be expected to develop a waiting list of one year with
a time to appointment of 8 weeks for routine matters.
<consumed by own wit, ROTFL>
Seriously, not that the first proposal above is not, of course -
Ethics
---------
there are some ethical problems to be thought through, and although
HAs have plenty of legitimate concerns with regard to the financial
and administrative organisation of PCGs, the implementation of
monitoring of outcomes, and the supporting at service ctees and in
public of GPs who decline toprovide a treatment known to be of no or
negative benefit -
It is up to the profession to sort out the ethics here.
I don't think it is impossible, perhaps not even difficult given the
apparent success of those working in the hospitals in doing so, but
we need to see more discussion of how we work together in these
circumstances and less of how bad it is that we are to be forced to
make the changes many of us have called and yearned for since 1990.
Money vs medicine
---------------------------
The main suggestion I have is that we learn, rapidly, to distinguish
between advising a paitent on the best course of treatment or
management - our role as a doctor and _not_ to be compromised, and
telling them that the NHS will not provide it, or won't provide it
as soon as we would like, and _who_ is in charge of setting the
taxes and NHS funding.
I have learnt to do this, and it works. (a degree of unreticence is
required - perhaps i could take a degree _in_ unreticence by now<g>)
Truth and Vision
-----------------------
(it is a subclass of those useful tools, honesty and openness, and
hence much more appropriate to the current government than the
previous one)
I believe that more clearly and simply defining the manner in which
we are paid will aid us in that, and I believe that arrangements
that allow a PCG to pay its doctors uniformly/according to work and
off the top of the budget rather than from whatever is left over
would be an advance over what we have at present.
An Overdue and Massive Reform
----------------------------------------------
The reform of the payment structures in GP has been left for too
long, and will be a massive inconvenience to us as we move into the
new age.
Salaried GP Service?
------------------------------
Salaried? I am not sure, but I no longer feel so fussed about it.
The Bottom Line
-----------------------
I want to hear less about the minutiae of problems caused by changes
to how we used to do things, and more of how we should do things.
I want to hear my colleagues exploring and stating, in public, what
the requirements are for them to deliver good care, from healthy
doctors and other primary caredroids, under various circumstances
they envisage.
A Starter ad absurdum
---------------------------------
To deliver good care to the population following a mass resignation
and dismantlement of NHS general practice I require that the minimum
wage, and negative income tax provisions are such that all citizens,
residents and travellers have sufficient funds available to them
immediately to pay my entirely reasonable fees.
For thos suffering care in the community, who cannot be expected to
handle their own money, I require a social worker tasked to them,
available 24 hours per day, to authorise and pay in advance
treatment when needed.
Now, you may like that model, but i think it is more expensive and
less effective than what we have or what we are about to build.
Could we have a few other requirements for doing things the way one
wants?
==========================================
Ahmad's Message Quoted
--------------------------------------
>Point 1:
>
>I have invested a great deal in my Practice.
>
>Time, effort, sweat, blood, tears, and, most importantly, agreat
>deal of money. My money.
>
>I am not prepared to have all that jeopardised by the 1000 and one
other
>groups who will determine things for me on the alledged PCG Boards
>UNLESS:
>
>They put their money where their mouths are.
>
>Point 2:
>
>Since I, as a Principal GP, carry the can for all clinical decisions,
>I am not prepared to work in a group whose members do not have that
>responsibility and may find it easier or convenient to impose things
>that would put me at risk.
>
>In other words:
>
>Nurses, , Practice Managers, Social Workers, CHC, HA bod, uncle Tom
>etc and whever else is going to make decisions for me *must* pay due
>regard to those issues.
>
>Without that assurance, I reserve the right to do what I see fit to
>protect my profissional integrity and my investment.
>
>Ahmad
>
>-----------------------------------------------------------------------
------
>Dr Ahmad Risk
>http://www.cybermedic.org
>Chairman British Healthcare Internet Association <http://www.bhia.org>
>Director Internet Healthcare Coalition - USA <http://www.ihc.net>
>
>Home: +44 1273 724866/748198
>Work: +44(1737)240022 Fax: +44 1737 244660
>
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--- OffRoad 1.9r registered to Adrian Midgley
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