Prescription charges to be frozen

The Minister of State, Department of Health (Mike O'Brien) has issued a statement to the effect that prescription charges will remain at £7.20 for 2010-11. There will be no changes to the pre-payment certificate charges either. I would be keen to see an overhaul of the 'exemption' categories, as I think there is an arguement for people with long term conditions, such as asthma, who currently have to pay, to have free prescriptions. People are often discouraged from taking their medicines regularly on account of cost and this can lead to exacerbations and the need for emergency care. Not only does this impact on the patient's health but also the hospital resources, and employers because of increased sickness absence. The simplest solution would be to abolish prescription charges altogether as has been done in Wales, with continued emphasis to use the lowest-cost, most effective treatments for any given condition.

Commercialising the NHS

The British Medical Association has launched a campaign to raise public awareness about commercialising the NHS (http://www.lookafterournhs.org.uk/) . At the moment, there is a big push to involve commercial providers to bid for NHS services. This ranges from the PPI building projects (seen in many other government sectors) to treatment centres. The idea is that competition improves value for money and performance. Some concerns are that money is diverted away from the NHS to private companies. Unfortunately some of the contracts currently in place defy belief- one company I know of is paid up front to perform a given number of minor operations, regardless of whether patients are referred to them or not. At the end of the financial year, there is a big campaign to get GPs to use these centres, in order to make the payment worthwhile! I do think various elements of the NHS (as with any large bureaucracy) need a prod with a sharp stick, as all too often it is easy to sit back and adopt a reactive approach, but is the current approach really benefitting the patients and the tax payers, whom we ultimately serve?

Practice Boundaries

A consultation is underway at the moment to see if we should get rid of practice boundaries and be able to register with a GP wherever we like. I can see this being helpful to commuters and people who tend to get 'one-off' problems where continuity of care is not really an issue. My concern is that the proposals do not recognise continuity of care as a key element of general practice. I think one of the reasons for increasing A&E use and hospital admissions is that general practice is becoming more and more fragmented through part-time working, and too much choice of provider coupled with protocol-driven working, which does not allow common sense or managed risk to strike a balance. I generally encourage people moving outside the practice area to register more locally, mainly because of home visiting. If a home visit is required 20 miles away, it reduces the amount of time I have for other people living locally and takes me outside the practice area (where I normally respond to emergencies on behalf of the ambulance service).

I would be happy to expand the patient list in principle, as this will attract more services to be hosted at the practice and therefore provide more local care for people, but I would be cautious about agreeing to proposals which would require home visits miles away from the practice and have destabilising effect on continuity of care.

Further info:
http://www.theyworkforyou.com/whall/?id=2009-12-16a.268.0

http://www.bma.org.uk/images/reformgpboundaries_tcm41-193919.pdf

Have your say: http://www.gpchoice.dh.gov.uk/

Homeopathy

Should the NHS fund this? Given the current lack of evidence beyond placebo effect, I think the NHS is well within its right to withdraw funding for homoepathy, until the benefits can be proven by rigorous scientific testing. That said, we should not just pick on homeopathy; millions are wasted on poorly researched, political gestures such as walk-in centres. Currently, each North Yorkshire practice is being given its cost per patient figures, and not surprisingly, the walk in centres are by far the most expensive (Reeth was 81 out of 100 (100 is the lowest cost)). There is no evidence that they reduce demand and if anything the fragmentation of care results in increasing numbers of often unnecessary hospital referrals and cost. Unfortunately, the political will is such that backing down from rolling out such schemes, even in the face of new evidence against the proposals, is not an option. Interested to see what our followers' perceptions are!

Reeth Demographics

I thought our followers may be interested in our patient demographics. We are just preparing to send our annual statistics off to the NHS at the end of March. 13 of you are over 90 years old and there are 80 people aged 80-89 which is pretty impressive.

Evaluating your GP

Doctors will soon be regularly revalidated. The cycle of revalidation is 5 years and, much like an MOT, will make sure we are all road-worthy. The current system focusses on making sure GPs do regular educational updates, review their patient care and show how they have improved it, take part in an appraisal with a senior doctor each year and seek the views of their patients and colleagues on their performance.

Having gone through the system for a few years now, I welcome the recognition of my efforts to stay up to date across the wide range of specialities GPs cover. We spend quite a lot of time at RMC looking at patient care and trying to improve on what we do: the dispensary has a 'near miss' book similar to the system used by airline pilots in order to try and recognise error and implement changes to prevent mistakes and protect patients (most pharmacies have an estimated 1% error rate); as a practice we review all significant events, complaints and diagnoses of serious illnesses, such as cancer, to see if there is anything we can learn and improve on in the future; all members of the practice produce audits each year in their area of work, again to make sure we perform to a high a standard as possible.

Our patients can help to make this revalidation practice effective by letting us know when their care is good, when their care is not as good as they would expect, reporting when things go wrong and giving their views in national questionnaires and surveys.

A lot of the data on the practice is available through the NHS website, and in coming months, I hope to publish further information, beyond the statutory requirements to hopefully allow our patients to see the work behind the scenes.

Is alcohol the new smoking?

While numbers of smokers continue to fall, concern has focussed on the effects of harmful drinking on both health and society as a whole. Alcohol is a socially accepted drug and unfortunately we are seeing ever increasing numbers of health problems associated with harmful drinking- this is not necessarily the 'youth' binge drinking; harmful drinking can include folks who drink modest amounts each day, but cumulatively exceed their weekly limits. As well as increased risk of accidents and liver disease, alcohol also increases your risk of high blood pressure and the calories associated with it can increase your weight and put you at risk of diabetes and heart disease. Doctors are urging ministers to set a minimum price per unit of alcohol as a way of controlling harmful behaviour (this has worked in other countries without the sensible drinker seeing any significant cost in their weekly spend on alcohol). Unfortunately the drinks industry is a powerful lobbying body and prefer to demonstrate concern by sponsoring alcohol awareness campaigns (the evidence suggests that these are no benefit at all). A sobering thought is the amount spent on alcohol advertising compared to that spent on helping folks with problems.

For more info, go to: http://www.alcohollearningcentre.org.uk/Topics/Browse/AlcoholEffects/?