-----Original Message-----
From: Dr I Cox <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 26 August 1998 21:21
Subject: monitoring in practice
>We have just had a letter about patient taking salazopyrine and other 2nd
>line anti-rheumatic drugs, asking us to:
>1. take blood monthly
>2. monitor changes and trends in results
>3. fill in co-operation card
>4. ask patient to remember to bring card to clinic each time.
>
>
>My partners had all initialled the letter (suggesting acceptance) but I was
>feeling particularly stroppy. I found that we have 30 patients on these and
>similar drugs from different departments. If you estimate, as most sensible
>professions would, that it would take 10 minutes to do this for each
patient
>safely, it equates to half a day a month at least. No new money-just a
>request from a consultant ( and a friend,, I believe who is having similar
>troubles in his clinic).
>
>Any comments from people out there?
>Am I being paranoid?
>Do I need another holiday?.....( only back 3 days!)
>
>Ian Cox
Ian,
This is definitely non-core work by the GMSC's definition, but we have
failed miserably to get anywhere with payments from Glos Health. Section 36
monies might have been a possibility, but we only got the same old story
"There's no money available". You ought to refuse to do this extra work,
but if our LMC's experience is anything to go by, when it comes to the
crunch GPs will just get on and do the monitoring, and will not be willing
to bounce patients back to the hospital clinic. We thought we were on safe
ground and would have almost unanimous backing for tough negotiating on
proper payment for anticoagulant monitoring, but when the LMC ballotted all
Gloucestershire practices ( twice, because we thought we had got the wording
wrong and didn't believe the result!) we were amazed that the vast majority
would not withdraw service from existing patients, or even refuse to take
on new patients bounced out from the secondary care sector for monitoring.
The LMC therefore had no mandate to negotiate effectively. It is just not
possible to negotiate from a position of weakness, as I have repeatedly
learnt to my cost. I suppose you have to be a masochist to be a GP these
days, and the word Lemmings springs to mind! In spite of Simon Fradd's
attempt yet again to block it, a motion was passed at LMC Conference
demanding national rather than local negotiation for non-core work. That was
always the only sensible way forward as far as I was
concerned.(Gloucestershire had given up trying to persuade the profession on
this one after our similar motions had been rejected at previous
Conferences. It's a great shame the profession didn't wake up earlier, as
PCGs have probably now displaced any effective national moves on non-core
work!). However you should write to Liz Housden at GPC and ask for the
negotiators to get working on it as per Conference decision!!! I am copying
this to her. ( Liz Housden , secretary to GPC E-Mail
[log in to unmask] )
While we are at it, what about Gloucestershire ( and SW Region's) other
failed campaign to get separate in-hours and out-of hours contracts? We will
never be properly paid for out of hours work until it happens. Any mileage
in us continuing the campaign? We had given up on that one this year as
well! All thoughts gratefully received. (Has anyone sighted that hidden army
waiting to poach the "lucrative bits" of our contract if we give up 24hour
responsibility? I've got spies everywhere I can think of, but no reported
sightings yet!)
I have, however, been a bit alarmed by a more extreme view which seems to
be gaining rapidly in popularity, and was first pointed out to me by two
Welsh GPC members :- that we should not deal with any acute/emergency care
either "out of hours" or "in hours". That work should be dealt with entirely
by the ambulance service and A&E departments directly, leaving GPs to get on
with daytime routine surgery-based primary care only. This is apparently the
norm for primary care physicians in many other countries. I don't personally
like that idea, but feedback would be very welcome. I mentioned it at an LMC
/ Ambulance liaison meeting in Gloucester today. I thought the chief
ambulance officer would be horrified at the potential workload. Instead he
said he thought it might make a lot of sense! ( Could be an ulterior motive,
but I think it was a considered response) If there is significant support
for this, I will pursue it further. ( It is easier to reach one's
destination when sailing with the tide!)
Regards,
Peter Fellows.
(GPC rep. SW Region, Chairman Glos. LMC.)
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