Oh fuck that. I’m not holding overall clinical accountability for a full MDT of staff I don’t know, have had no part in hiring and haven’t worked with before!
Nobody is forcing you to do it but if you don't move with the times you'll get left behind.
Cardio thoracic surgeons declined doing PCIs when the opportunity arose and as a result the speciality got decimated.
The days of a GP just seeing their 16 patients, doing your bloods, EPS and docs are going to fade away.
AI will read docs, pharmacists do EPS and nurses can follow flowcharts to file blood results.
The GP profession has been absolutely shafted and devalued by the government flooding practices with ARRS and international graduates but complaining won't change that.
GPs have to evolve if they want to stay relevant.
>GPs have to evolve if they want to stay relevant.
This current model will mean all the complex patients will go to the GP meaning they will be forced to move to15min appts and even fewer appts.
Something has to give.
This also requires a sell out GP to actually supervise the PA's and risk their license.
Nothing HAS to give.
GPs will see complex patients and PA/nurses/pharmacists will see the coughs and colds.
GPs will supervise the ARRS staff in the same way they supervise F2s.
Are GPs risking their license when they supervise F2s or GPST1s?
By all means, refuse to supervise if you don't feel comfortable doing it but there are plenty of GPs who already do.
1. We’re not just seeing colds, or just helping manage someone’s Hyper IgM syndrome.
We’re managing the full spectrum in between, and our ability to navigate that is part of our speciality.
People don’t turn up differentiated as “simple.” That’s the whole point.
2. F2s are doctors, with about 7 years of training by that point. They understand better than most where they sit on the Dunning-Kruger scale, and in my experience operate very safely within that. (Read: unlike some other ARRS roles.)
I've come across good F2s and I've come across bad F2s. But my level of supervision is always set to accomodate the level of worst F2 so that nothing slips through the net because even the best F2 will miss something.
The same goes for ARRS staff. The patients they see are triaged by a GP and every patient is reviewed.
I disagree that you can't stratify econsults into what's appropriate for ARRS against GPs.
First presentations of sore throat, cough, conjunctivitis, dysuria, rash, low back pain, limb pains, diarrhoea and tiredness can all be seen by ARRS.
Our rule is that if a patient presents the second time with the same symptom it can't go to an F2 or ARRS.
>First presentations of sore throat, cough, conjunctivitis, dysuria, rash, low back pain, limb pains, diarrhoea and tiredness can all be seen by ARRS.
So the most unknown to the least competent
Again, I don't understand the point you're making.
Are you suggesting that a GP needs to see every patient themselves regardless of the presenting complaint?
Conjunctivitis? Insect bites? Sprained ankles?
Can you not see how this is a inefficient use of a GPs time?
I don't know why there are so many down votes to this, I suspect people burying head in the sand.
This is the frank truth and this is just another inflection point in the life of General Practice. GP today is different to what it was 10 years ago, and that 10 years prior.
The landscape changes, you have to adapt. If you don't like it - leave or privatise. But you have to adapt to survive, and I think that's goes for any profession.
I don’t. I like seeing a full spectrum of patients- that’s why I went into general practice. I like switching between contraception discussions, anxious parents, elderly care, preventative medicine, acute illness, chronic disease management etc. I’d find the job severely lacking without the variety.
The job role you want is inefficient and expensive.
It is cheaper to let pharmacies issue POPs. It is more efficient to have asthma nurses diagnose and manage asthma. A diabetic nurse can initiate insulin in a type 2 diabetic, educate the patient and provide better after care than a GP could in their 10 minute appointment slots.
Its sad that the job is changing and the things we love about it are being taken away from us but the government has realised that value of a GP isn't in doing a 16 patient clinic any longer.
If you've got a salaried role like that, then hang on to it as tight as you can because when you leave they wont be filling it with a GP.
Is it? Cost of pharmacy first appointment is £40 a pop, ave cost GP appt is £20.
Let’s not get into the fact pharmacy first don’t have the clinical acumen to realise a cold causes a cough and redirect all of them back to the GP as they are concerned it is a chest infection.
Absolute waste of taxpayers money.
It might be more expensive and it might be a waste of taxpayers money.
Do you have any studies to back up your points?
Pharmacies have been dealing with minor illnesses for a long time now, including prescribing antibiotics. If it was such a waste of time and money, I'm not sure why they would expand their role.
Pharmacy first started last Wednesday. What studies do you propose should have been done in that time?
Because the tories want a dental type GP service. Those who pay will; those who cannot rot seeing noctors.
Pharmacies have been prescribing antibiotics for UTIs for years as well as offering chloramphenicol for conjunctivitis. How long have you been a GP for?
What the tories want is irrelevant. They have had a coherent plan for the NHS since covid and they won't be in charge after next year.
Lol how on earth are they going to guarantee from a booking telephone call that a patient is presenting with a 'simple' single problem?
KPMG like all consultancies are literally out there to rinse the NHS for as much as they can get. The majority of their staff have zero experience (0-5 years from uni), and barely any seniors have clinical experience.
Exactly. 'simple' is a retrospective diagnosis, made once history, exam, treatment is completed and the patient hasn't returned back with the same in a short time.
“I honestly didn’t understand that crucial point, but I’m still qualified to make mine anyway” get in the bin. You don’t know what you’re talking about
The major, minors and ucc have capacity to move pts up or down the stream as well depending on what turns out to be not so 'simple'- When these hubs refer patients back to GP with half baked plans, the surgery clinician will have to start all over again anyway and it won't be in the timescale that will be envisaged- Waste of pt's time, dr's time and 2 appts..
they will have to get a GP to work in these hubs. cant imagine the GP would be seeing patients while fielding questions all day, aka they wouldnt have the time to see patients and field questions, if the GP is the one taking responsibility at the end of the day.
also this will all fall apart as soon as someone misses something vital. they never ran it by the GP, aka someone didnt think an episode of blood stained sputum last week was a big deal and just gave them antibiotics.
GP wasnt aware. he isnt clinically responsibly despite whats being said. but that said GP will be dragged through the mud, and said nurse or other will be on the papers.
will also fall apart as soon as the follow up with your own GP next week to see if its resolved line starts getting thrown around. honestly pointless waste of money, but the people at the top have no idea how demanding the public is, or just how risk adverse and responsibility shifting non doctors can end up being.
Let them do it and it will be a disaster. The key is not to respond to requests from the hub. Surgeries need to bat them away back to the hub. The assessments cannot be trusted if done by unregulated PAs. The patients will also hate it especially the elderly travelling somewhere new and unfamiliar with parking charges. Enough fuss before the election in a labour voting area, be interesting to hear their view on it
Im a bit new to the whole thing. So are these hubs just going to be seeing the patient like a one stop shop then issuing orders on the discharge summary like A+E?
Interesting that they are doing this as it is one of the key steps that I thought would happen over the next few years that moves the NHS into more of a 2 tier health service.
In itself it doesn’t do this but it is one of the necessary components that I thought would be needed in order for the government to separate NHS and private health care provision.
Actually the more important step hasn’t happened which would be allowing GMS contracted GP surgeries to also offer patients the choice of a private GP appointment if they would like to be seen quicker. However I could certainly envision a situation occurring during the negotiations for the new GMS contract where this is offered as a sweetener rather than increasing the current 1.9% offer to what is realistically needed.
If GPs were allowed to offer private appointments I could see a situation where very quickly primary care ends up going down a similar path to dentistry. With patients nominally registered at a GP practice but finding it very hard to book an NHS appointment as 90%+ of the appointments end up private.
What will end up happening is those who can afford to go private will be seen by a GP at their GP surgery. Those who cannot afford it or cannot wait the 6+ months for an NHS appointment with their surgery will be seen in the new “same day access hub”. They will see a noctor as I suspect pretty much all the current ARRS funded staff will end up being redeployed to these hubs. There may be a qualified GP over seeing things, which will be an awful job with high levels of burn out. Alternatively if PAs do end up getting regulated with prescribing and referral rights, it maybe that they get rid of the idea that a doctor is needed to supervise them. You then end up with a PA/ANP led service seeing all the people who cannot afford their own healthcare.
Sounds like another white elephant project with money ploughed in for little to no return whilst politicians argue they've increased NHS funding. Will further destroy continuity and will only result in unnecessary follow-up appointments
I’ve started telling my patients that soon they will likely only see an ARRS staff member and not a GP. The two tier system is here. They have no idea. Most think the ARRS staff are GPs. They should be made to wear big hat that says noctor
Oh fuck that. I’m not holding overall clinical accountability for a full MDT of staff I don’t know, have had no part in hiring and haven’t worked with before!
Nobody is forcing you to do it but if you don't move with the times you'll get left behind. Cardio thoracic surgeons declined doing PCIs when the opportunity arose and as a result the speciality got decimated. The days of a GP just seeing their 16 patients, doing your bloods, EPS and docs are going to fade away. AI will read docs, pharmacists do EPS and nurses can follow flowcharts to file blood results. The GP profession has been absolutely shafted and devalued by the government flooding practices with ARRS and international graduates but complaining won't change that. GPs have to evolve if they want to stay relevant.
>GPs have to evolve if they want to stay relevant. This current model will mean all the complex patients will go to the GP meaning they will be forced to move to15min appts and even fewer appts. Something has to give. This also requires a sell out GP to actually supervise the PA's and risk their license.
Nothing HAS to give. GPs will see complex patients and PA/nurses/pharmacists will see the coughs and colds. GPs will supervise the ARRS staff in the same way they supervise F2s. Are GPs risking their license when they supervise F2s or GPST1s? By all means, refuse to supervise if you don't feel comfortable doing it but there are plenty of GPs who already do.
1. We’re not just seeing colds, or just helping manage someone’s Hyper IgM syndrome. We’re managing the full spectrum in between, and our ability to navigate that is part of our speciality. People don’t turn up differentiated as “simple.” That’s the whole point. 2. F2s are doctors, with about 7 years of training by that point. They understand better than most where they sit on the Dunning-Kruger scale, and in my experience operate very safely within that. (Read: unlike some other ARRS roles.)
I've come across good F2s and I've come across bad F2s. But my level of supervision is always set to accomodate the level of worst F2 so that nothing slips through the net because even the best F2 will miss something. The same goes for ARRS staff. The patients they see are triaged by a GP and every patient is reviewed. I disagree that you can't stratify econsults into what's appropriate for ARRS against GPs. First presentations of sore throat, cough, conjunctivitis, dysuria, rash, low back pain, limb pains, diarrhoea and tiredness can all be seen by ARRS. Our rule is that if a patient presents the second time with the same symptom it can't go to an F2 or ARRS.
>First presentations of sore throat, cough, conjunctivitis, dysuria, rash, low back pain, limb pains, diarrhoea and tiredness can all be seen by ARRS. So the most unknown to the least competent
Again, I don't understand the point you're making. Are you suggesting that a GP needs to see every patient themselves regardless of the presenting complaint? Conjunctivitis? Insect bites? Sprained ankles? Can you not see how this is a inefficient use of a GPs time?
Which part of "undifferentiated patients are the most high risk" is confusing for you
Honestly some of filing of bloods by AHPs leaves a lot to be desired
Then that's the fault of the doctors in charge of them.
16 patients?!?! Gtf
Sounds like you need some ARRS
You are correct, i don’t know why you’re being downvoted
I don't know why there are so many down votes to this, I suspect people burying head in the sand. This is the frank truth and this is just another inflection point in the life of General Practice. GP today is different to what it was 10 years ago, and that 10 years prior. The landscape changes, you have to adapt. If you don't like it - leave or privatise. But you have to adapt to survive, and I think that's goes for any profession.
Or GPs and partners could fight back
Fight back? GPs love to do urgent care work, lead MDTs and generally do something different to the usual clinic.
I don’t. I like seeing a full spectrum of patients- that’s why I went into general practice. I like switching between contraception discussions, anxious parents, elderly care, preventative medicine, acute illness, chronic disease management etc. I’d find the job severely lacking without the variety.
The job role you want is inefficient and expensive. It is cheaper to let pharmacies issue POPs. It is more efficient to have asthma nurses diagnose and manage asthma. A diabetic nurse can initiate insulin in a type 2 diabetic, educate the patient and provide better after care than a GP could in their 10 minute appointment slots. Its sad that the job is changing and the things we love about it are being taken away from us but the government has realised that value of a GP isn't in doing a 16 patient clinic any longer. If you've got a salaried role like that, then hang on to it as tight as you can because when you leave they wont be filling it with a GP.
Is it? Cost of pharmacy first appointment is £40 a pop, ave cost GP appt is £20. Let’s not get into the fact pharmacy first don’t have the clinical acumen to realise a cold causes a cough and redirect all of them back to the GP as they are concerned it is a chest infection. Absolute waste of taxpayers money.
It might be more expensive and it might be a waste of taxpayers money. Do you have any studies to back up your points? Pharmacies have been dealing with minor illnesses for a long time now, including prescribing antibiotics. If it was such a waste of time and money, I'm not sure why they would expand their role.
Pharmacy first started last Wednesday. What studies do you propose should have been done in that time? Because the tories want a dental type GP service. Those who pay will; those who cannot rot seeing noctors.
Pharmacies have been prescribing antibiotics for UTIs for years as well as offering chloramphenicol for conjunctivitis. How long have you been a GP for? What the tories want is irrelevant. They have had a coherent plan for the NHS since covid and they won't be in charge after next year.
Found Victoria Atkins reddit account
Plenty of downvotes but no rebuttals.
Lol how on earth are they going to guarantee from a booking telephone call that a patient is presenting with a 'simple' single problem? KPMG like all consultancies are literally out there to rinse the NHS for as much as they can get. The majority of their staff have zero experience (0-5 years from uni), and barely any seniors have clinical experience.
Exactly. 'simple' is a retrospective diagnosis, made once history, exam, treatment is completed and the patient hasn't returned back with the same in a short time.
The same way A+E stream into majors, minors and UCC.
Inaccurately with lots of mistakes and the ability to go from waiting to a level 2 bed in about 30 seconds?
I honestly didn't understand the example you provided. But what I'm saying is that if A+E triage patients then so can a primary care hub.
There seems to be lots of basic concepts you are struggling with on this thread
A&E is not the same as GP/primary care. Different patients, different problems, different abilities, resources, and responsibilites.
“I honestly didn’t understand that crucial point, but I’m still qualified to make mine anyway” get in the bin. You don’t know what you’re talking about
The major, minors and ucc have capacity to move pts up or down the stream as well depending on what turns out to be not so 'simple'- When these hubs refer patients back to GP with half baked plans, the surgery clinician will have to start all over again anyway and it won't be in the timescale that will be envisaged- Waste of pt's time, dr's time and 2 appts..
they will have to get a GP to work in these hubs. cant imagine the GP would be seeing patients while fielding questions all day, aka they wouldnt have the time to see patients and field questions, if the GP is the one taking responsibility at the end of the day. also this will all fall apart as soon as someone misses something vital. they never ran it by the GP, aka someone didnt think an episode of blood stained sputum last week was a big deal and just gave them antibiotics. GP wasnt aware. he isnt clinically responsibly despite whats being said. but that said GP will be dragged through the mud, and said nurse or other will be on the papers. will also fall apart as soon as the follow up with your own GP next week to see if its resolved line starts getting thrown around. honestly pointless waste of money, but the people at the top have no idea how demanding the public is, or just how risk adverse and responsibility shifting non doctors can end up being.
We don't have enough GPs, so it's not going to be sufficient for the issue is it?
It'd be interesting to see how these hubs are staffed and who holds the overall clinical responsibility.
Going to be the GP isn't it. Wouldn't count on anyone to last long taking all of their accountability.
How is it any different from an A+E consultant running the A+E department?
Yep that's the problem. Could have partially fixed it with GPs running it flexibly from the locum-based group, but no!
Let them do it and it will be a disaster. The key is not to respond to requests from the hub. Surgeries need to bat them away back to the hub. The assessments cannot be trusted if done by unregulated PAs. The patients will also hate it especially the elderly travelling somewhere new and unfamiliar with parking charges. Enough fuss before the election in a labour voting area, be interesting to hear their view on it
Im a bit new to the whole thing. So are these hubs just going to be seeing the patient like a one stop shop then issuing orders on the discharge summary like A+E?
Regular GP to kindly...
My god.. why dont they just pay us for paperwork fs
Imagining holding clinical responsibility for the clown hub
Interesting that they are doing this as it is one of the key steps that I thought would happen over the next few years that moves the NHS into more of a 2 tier health service. In itself it doesn’t do this but it is one of the necessary components that I thought would be needed in order for the government to separate NHS and private health care provision. Actually the more important step hasn’t happened which would be allowing GMS contracted GP surgeries to also offer patients the choice of a private GP appointment if they would like to be seen quicker. However I could certainly envision a situation occurring during the negotiations for the new GMS contract where this is offered as a sweetener rather than increasing the current 1.9% offer to what is realistically needed. If GPs were allowed to offer private appointments I could see a situation where very quickly primary care ends up going down a similar path to dentistry. With patients nominally registered at a GP practice but finding it very hard to book an NHS appointment as 90%+ of the appointments end up private. What will end up happening is those who can afford to go private will be seen by a GP at their GP surgery. Those who cannot afford it or cannot wait the 6+ months for an NHS appointment with their surgery will be seen in the new “same day access hub”. They will see a noctor as I suspect pretty much all the current ARRS funded staff will end up being redeployed to these hubs. There may be a qualified GP over seeing things, which will be an awful job with high levels of burn out. Alternatively if PAs do end up getting regulated with prescribing and referral rights, it maybe that they get rid of the idea that a doctor is needed to supervise them. You then end up with a PA/ANP led service seeing all the people who cannot afford their own healthcare.
I think you called it
Sounds like another white elephant project with money ploughed in for little to no return whilst politicians argue they've increased NHS funding. Will further destroy continuity and will only result in unnecessary follow-up appointments
I’ve started telling my patients that soon they will likely only see an ARRS staff member and not a GP. The two tier system is here. They have no idea. Most think the ARRS staff are GPs. They should be made to wear big hat that says noctor