-----Original Message-----
From: Donovan Ross <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 02 April 1998 23:35
Subject: Re: Primary Care Groups
>>1) Those who truly believe PCGs are a good thing.
>
>I am a fairly pragmatic sort and, although I agree with parts of your
>argument I think that the PCG is a useful practical concept.
Which parts do you agree with and do they not make the concept impractical?
> Primary care does need communication accross the proffessional boundries
and
>could benefit from a re-negociation/reassessment of its position with
>secondary care, especially on a local basis. I believe that a future
>front line team will be a very fluid mix of skills that moves onto a
>problem that it is alerted to.
The big problem I have with this scenario is that the GPs are the only
professionals on the group whose personal income is threatened by an
overspend by the whole body. I had a meeting with my local service
development manager today and was told that the PCG could decide to ring
fence the cash-limited GMS funds to remove the threat of virement to
overspent areas. If this were possible, and we couldn't find the reference
today, then wouldn't everyone choose to do this and then ....... er
......... where else does the money come from?
> Ihe majority of "illness" problems will remain efficiently handled at
practice level and would become
>"expwnsive" if handled in any other way - that is why a GP is effective.
Is the GP likely to be as effective if precious clinical or, perish the
thought, relaxation time is to be spent on committees or perhaps dealing
with disgruntled patient groups whose perceived beneficial treatments have
been prohibited as unaffordable by the PCG .
>However, data gathering for planning of care needs to be co-ordinated
>and is a part of the "evidence based" movement of the moment. Its
>weakness is its need for evidence! Only high levels of diagnostic skill
>in contact with social dis-ease provide the raw material.
What percentage of GPs' patient contacts can be managed using EBHC? I
suspect that good evidence only exists for a relatively few major disease
areas but these make up a small part of our workload as we are usually the
first port of call for every form of social "dis-ease". Someone recently
called into question the benefits of counselling yet in brief, informal
sessions this is what we spend a lot of our time doing. Are we to say
"Sorry, there's no evidence that me sitting here listening to you is of any
benefit and anyway I've got to be at a PCG meeting in ten minutes"
>Wandering into irrelevence
Me too, also wandering off the point.
Main objections:
No choice
Rationing in disguise
GPs will be scapegoats for limited supply to unlimited demand
GPs enlisting out of fear rather than enthusiasm for concept (Unsure without
a ballot)
Enforced financial partnerships
Those on committee unlikely to have representative views of majority (Unsure
without a ballot)
Still at least one vote for group (1) then?
Dr Peter Wilson
GP, Broadstairs, Kent. <http://www.albionrd.demon.co.uk>
Medical Manager - EKDOC <http://www.ekdoc.com>
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