Junior doctor and consultant contracts – get the latest update now.


At work blog



Cannot do right for wrong

We have been very, very naughty. The Politburo is not happy.

Our misdemeanours have been going on for years, really, but have been highlighted especially over the past six months.

We have been visiting ill and frail older patients at home, often at the urgent request of carers, family members or the district nurses; we have thought, shockingly frequently, that these older people were too unwell to cope at home; and we have, wilfully, knowingly, and with our eyes open, asked on very many occasions for urgent admission to hospital.

I appreciate that this reprehensible action will cause a sharp intake of breath in readers. It has certainly caused an epidemic of anxiety in the Politburo.

Seven months ago they counted up the number of urgent admissions of over-75s throughout Innercitysville, got a bit of a shock and set up various programmes to bring the numbers down.

Pharmacists were drafted in to review medications, with the aim of stopping a lot of nasty drugs the GPs had left patients on and were contributing to falls and renal impairment and cognitive dysfunction. This was absolutely right and proper, though actually the number of medication changes needed in our practice was 18, in the over-75 practice population of 1,139.

Specialist nurses and middle-ranking geriatricians were allocated to groups of practices to help GPs concoct preventive health and care plans for every older patient.

The idea was to be able to foresee that in the next three months Mrs Bloggs might go into acute failure or break her hip or get pneumonia, and head off these possibilities — or at least make sure they did not require urgent admission.

Podiatry, review home visits by chronic disease nurses and liaison with social care were all beefed up, and we had the requisite two monthly meetings to tell each other about them.

But when the Politburo counted again two weeks ago the urgent admission numbers were up. It was those wretched GPs again — wantonly admitting those older patients.

The Politburo worked over the holiday weekend to produce the graphs and sent them round, asking us to convene urgent practice level meetings and examine our collective consciences and come up — get this — with a plan to reduce urgent admissions, urgently.

It was notable that the highest admission rates were in our practice, which contains the 11th, 14th and 17th most deprived wards in the country and the most deprivation outside the metropolis.

I don’t feel too much like beating my breast or being sent to a re-education camp. We haven’t been that naughty.

BMA evidence

Read the BMA evidence to the Commons health select committee.

Counting the costs of social care

Read our news article, Counting the Costs of Social Care, which examined the interface and inter-dependency between health and social care.

In Parliament

Care services minister Paul Burstow has welcomed the Dilnot report but highlighted elements which were not considered including personalisation, prevention and quality of care.

He said that the government’s vision is for a social care system which invests time into wellbeing and quality of life, and has a clearer focus on outcomes.

Of the current cross-party discussion on funding reform he said that there will be necessary trade-offs stating that ‘there’s no free lunch to be had in how to implement funding reforms.’