[log in to unmask],Net wrote at 22:31 on 27/09/98 
about "RE: Pharmacy registration":
-----------------------------
>I agree about the private area, but less embarrassing all round to have
>access to records than to ask and depend on the patients memory and
>willingness to tell.
Our civil servants are very keen to avoid embarassment.
The BMA view is that if the patient is unwilling to tell, then, 
appallingly stupid and misguided as this might seem, we do not have 
the right to circumvent this by passing their records on to somebody 
who wishes (or needs) to know.  Almost always.
However, you might feel that approaching it from the other angle - 
rather than asking "are you taking nitrates" saying " taking 
nitrates with this medicine is dangerous, a list of nitrates is 
available here, if you show the label of a medicine to the barcode 
scanner on you home video the surgery/pharmacy/NHS Direct computer 
will say whether it is a nitrate or not"
                   is a Good Idea.  Clear patient Rights and 
Responsibilities, and they carry the Risk.


>Dare to think about change. What is wrong with a system of surgeries
open
>all hours, salaried doctors working shifts, with higher rates of pay
for
>working late, bank holidays etc?

1.  It depends upon good records.  Current records are shit.  (I am 
paraphrasing the National Audit Office reoprt on medical records 
here)

2.  It is distinctly more expensive, or able to achieve less for the 
money the citizens make available.

3.  It loses what the President of the Royal College of GPs, and I, 
currently practicing 2 miles appart, both think is important and of 
considerable value to the patient, the personal continuing attention 
of an individual doctor.  (With to be sure partners/assistants, team 
members and so on and a recognition that sometimes it is more useful 
to have any doctor now than the right doctor tomorrow.)

(1) may be partly fixed by the new strategy and by developments 
within the profession, including clinical governance at the PCG/Firm 
level, and the OoH Co-ops.
(2) - if the £27 per contact with NHS Direct was channelled through 
General Practice and OoH coops it would make a difference, perhaps - 
but the only way it could be so channelled would be by going through 
the Firms.  (my opinion)
(3) he would say that, and I would say that, wouldn't we.  For 
anyone who doesn't know I am a single-hander.  
When Tesco opened 24 * 7 * 52 did the amount of groceries bought by 
the population increase?  I see no reason to think so, so as the 
costs of Tesco increase, the cost of groceries increases.
There are exceptions to this economic rule, that if you are selling 
something which is limited in its provision by the size of the 
counter or the car park or NHS rationing, then an increase in hours 
may allow you to deliver more of it, but I am not convinced they 
apply to general practice.

But it is more convenient for companies to have staff only going to 
the doctor out of working hours?
Not M&S view, and although they have slipped a bit they still think 
looking after their staff is a  good investment...
Is it bette for someone with a health worry to carry n working, 
badly, and then go to a doctor at 0700 or 2200, or is it better for 
them to go away from work, sort it out, and come back unworried?
This last of course is another area where the NHS is failing people 
appallingly badly at present - but not in GP - where if we need an 
investigation in order to reassure somebody or select their proper 
treatment, they get to wait for ludicrous periods before it happens. 
 In the meantime they are accident prone, worried/frightened and very 
probably consuming more healthcare resources by enquiring again.

But hospitals already have duty docs at all hours.
QED

--- OffRoad 1.9r registered to Adrian Midgley


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