I understand that some Irish history had a political intersection with British history that might be…challenging, but YDTM has always managed that sensitively, and I bet you can do it.

Oh, I have heard *every* episode and am eager for more!!

@gregjenner.bsky.social

Could I request some Irish history for You’re Dead to Me, please?

Brian Boru
Strongbow
St Patrick
The Famine
The Easter Rising

I really don’t mind what you do, but barring Grainne O’Malley, it feels…like a blank space currently.

Don’t need to be. There is specific care navigation training, and practices, federations and PCNs share training and resources.

Ok…
But our vaccination clinics functioned this year because we were able to use medical students and our teenage children to check patients in, paid on a casual basis.
Would a centrally operated GP service be as agile and adaptive?
No.
Partners get a profit share: not a fixed income.

In case you were wondering where primary care is at, there is currently training for a course on “A framework for managing the sudden and unexpected death of a colleague in the primary care setting” on my timeline.

We insist patients speak to a GP before getting blood tests: you can’t just see our nurse for “routine blood tests”.

Patients don’t always appreciate that it’s an essential safety measure.

A random abnormal result with no history or examination is very difficult to manage safely, so we avoid it.

When patient won’t tell our receptionists what the problem is, and insist on speaking to a GP, it can be very frustrating for everyone to then say “you should have gone to ED or a pharmacy hours ago when you first called”, but it happens.

Care navigation is key, and admin team are trained.

There is a list of “do not pass go: ED”, another list of “have you gone to a pharmacy: they can probably sort this”, a list of “our pharmacist/nurse can deal with that” and finally, “you need to speak to a GP”.

My practice pharmacists do our hypertension and asthma reviews and deal with most medication queries, probably better than I would.
No undifferentiated illnesses.

PAs have no role in General Practice seeing undifferentiated patients : as per RCGP. I would personally never employ one.
Either a nurse or HCA or a GP instead. PAs don’t bring skills I need at a cost I would pay.

The choices are uplifting GMS (which is based on 2 visits per year) to reflect reality, or fee per visit.

It’s interesting you think it’s boomers who visit most.
It’s kids and people aged 50-70.

The old folk got that way by avoiding us.

Everything says partnership is the most productive, cost effective model possible: it’s not shady:
GP Partnerships have UNLIMITED liability. It’s in our interests to make things work.

Income is limited by government monopsony contracts which aren’t really negotiated , we have very few options.

I work in a Trust owned building: rent is I/O.

No pharmacy (and dispensing practices are rare).

If partners own building, notional rent is paid…which may or may not cover mortgage and maintenance.

£40basic GMS which covers one appointment, with £20 per appointment thereafter.

A single payment to cover bottomless appointments/tests/referrals is not sustainable with an ageing population with multiple co-morbidities.

Telephony, texting, IT, postage, office supplies, cleaning, confidential waste, utilities, medical equipment and consumables: that all has to be paid for too.

And the “ideal” list size per full time GP is somewhere between 1500-1800.
So for a list size of 7690 you *ideally* want 4-5 full time GP.
Plus practice manager, admin team (at least 4 full time) and practice nurses.
That £600k has to stretch quite far…

At least 150 10min appointments a day, including nurse appointments, probably.
And that’s just appointments: not admin (results, referrals, letters, prescriptions, reports), which takes about the same amount of time again for GPs.
And remember the safe limit is supposed to be 25appointments/day/GP

It’s not sustainable.
Contracts are being handed back.
There has been a 20% real terms cut in funding.
Primary care in the UK is offering millions more appointments per year now than pre-pandemic: that’s a huge improvement in access and productivity, and it’s invisible.

The average patient sees a GP 6 times a year, and no GP works 10sessions a week, because that would mean >100hrs once the admin time (results, letters, reports) is taken into account.

Your numbers are…not based in reality.

No, I’m saying that a hybrid model will be a last resort to increase practice funding to keep the lights on, unless something changes, not that it’s what we’re doing now, or what I want to do.

Does £70 sound ridiculous? Yes. Because it is.
Most GPs just want a sensible number instead.

It’s not the partnership model, it’s the level of funding.

Without care, GP is going to end up like dentistry, a two tier hybrid private/NHS service with fee per activity, unless funding increases to sustainable levels.

Not keen. I like being my own boss.

This model has been proposed, but it would cost billions…because partners do so much invisible unpaid work.

I’ll be on my laptop today and tomorrow.
Wouldn’t for a salary.

And now National insurance costs (because we can’t get SME exemption because we’re “public bodies”, but ALSO can’t get Health exemption because we’re “private businesses”) we’re looking at >£20k additional costs per year.
We can’t raise our prices, reduce our services or advertise for more customers

Northern Ireland GP currently has 5.4% of Health budget…

0% increase in funding for 4th year running.

Global sum allocation formula We remind GP practices how funding for GMS practices is calculated, and what is taken into account.

That’s the Global sum (GMS) payment.
We get some extra payments for certain things (vaccines, monitoring specific medicines, chronic disease reviews etc), but for the average person without chronic illness, it’s Carr-Hill applied to GMS. www.bma.org.uk/advice-and-s...

Everyone likes to complain about GPs
No one knows how we are funded.
How can you complain you aren’t getting value for money when you don’t know what is being paid?

Your *insurance* for a pet cat is probably double what your go gets paid for unlimited appointments, blood tests, prescriptions, referrals

Do you know my practice gets paid £70 per patient, per year.
I will get paid £70 if you have 0 appointments or 26 appointments.
If you attend the nurse (who I employ) 0 or 10 times.

Pollling in the Irish #GE24 is now open!

Make sure to check your polling station, and bring some ID with you!

There are a lot of dangerous candidates on the ballot, so after you #VoteLeftTransferLeft, consider continuing preferences to parties that are not actually fascist.