Our Sponsors are an important foundation of our online community. Please visit their websites.
Our Associate Sponsors provide valuable support to our community and help build 'The Wall'.
Our partners help move the Wired In agenda forward.
Join our community, create your own profile page, and communicate about what matters to you.
Hi
Something interesting happened recently. I had the opportunity to attend a meeting where a number of GPs were present and the topic of shared care came up. Now I’m not fully up to speed about what shared care was about so got a matrix-esque 10 second upload by a friend of mine who was sat next to me, as to what it is all about.
Personally I think it’s a great idea. For those who don’t know, in a nutshell, it’s when local GP surgeries get involved in what they term ‘locally enhanced services and nationally enhanced services’, and take on the responsibility to provide treatment in the community to users. Generally those who have been stable for a while and transferred from their main treatment service. Or something along those lines.
I thought I was missing something here. Why are GPs getting paid extra cash on top of their ‘normal’ (usually substantial) basic salary, to treat drug users? Let me make one thing clear here from the onset, I’m not actually against GPs getting paid.
I just want some clarification, for my own sanity. about what makes drug and alcohol users so ‘special’.
If Joe Bloggs made an appointment to go see his/her GP due to the fact that they are having breathing problems because they are unfit and overweight, does the GP get a ‘special’ payment to help them? If a smoker goes to see the GP ‘cos his/her incessant (smoker’s) cough hasn’t gone away for two weeks, does the GP get an extra payment helping?
I could be wrong but I’m pretty sure that, that ‘treatment’ comes as standard!
So why do they get paid extra for doing what they would do as standard, had the person just walked in of the street? Now you could argue that they are specialists in medicine and, as doctors, are best placed to help them etc.
But are they really? Don’t we have specialist services that provide help and support for us who need it? Don’t key workers hold ‘surgeries’ at the surgeries to assist the GPs in care planning and doing all the paperwork and other stuff?
So what do GPs actually do for the extra they are earning? Now, granted that having a local place to visit instead of travelling to a drug service (for some it can be every day) can be a difficult, never mind a costly, exercise. But why do GPs get paid for the privilege? I mean they will write out the prescription would they not, as they would if dealing with Mr or Mrs Joe Bloggs from down the road? Together with instructions, times to take and dosage amounts. So hence my question once again, what makes users so ‘special’?
Surely the purpose of the PCT is to help people regardless of ‘ailment’. As I said before, I’m a bit confused with this issue and would like somebody to tell me why GPs are are getting paid this extra cash. It might be that they do a significant amount of work above and beyond their current GP remit, and hence deserve to get some extra money. Or it might not. Either way, I could do with some help with this one…
Now this is interesting. It’s one of the questions that you think you know the answer to until you think about it – and then realise you don’t.
Looking forward to finding out….
Perhaps the GPs have good union negotiators!
G.P.‘s get additional payments for many things, including smoking interventions, screening for alcohol misuse, uptake of immunisations etc etc. Drug misuse is just another one of these. No conspiracy.
Dear MGS,
No-one hitherto had mentioned conspiracy, the main concern appears to have been GP’s apparent naked greed. I think people are a little surprised that RCGP members need bribing to do what should come naturally!
Definately no conspiracy at all…i have no issues with people being paid for their work…
I suppose my query was along the lines of, what comes under standard care that the GPs administer and what then comes under ‘other’ that involves being paid additional cash…is there a criteria? if so, what is it?
What do GPs actually do to warrant this additional money, surely they dont get paid for just writing their signiture on a prescription, surely thats not all they do to get this extra cash…?
What counts as an extra depends on what is in fashion for the time being. At one stage in the mid-nineties, diabetes was all the rage, and GPs got an extra spot of cash for testing for it. Not unnaturally, a lot of tests were performed, and a lot of cases of diabetes were found, but it is not evident that eight tests for diabetes in one patient each time he turned up with the same symptoms, over a two year period helped in the diagnosis of what subsequently transpired to be tuberculosis. Now just who is it who performs the same action time after time expecting a different result?
I can only see reason for additional payments to GPs with class A addicted patients if they take responsibility for the management of all aspects of the patient’s’ health, with the clear understanding that they will be held accountable.
On had hoped that CSMTs would have been capable of this, but sadly this did not transpire. It has to be said that the chasing up of errors and omissions is a pretty thankless task.
General practitioners are mostly not direct employees of the NHS. They are contracted to provide general medical services which address a variety of basic health care. They are generally not expected to provide specialist services. The way they are paid is complex.
Where gaps exist in services or the level of service or where a higher level of care is required than can normally be provided from existing resources, an enhanced service can be commissioned. Examples of such services might include more focussed and complex treatment of multiple sclerosis or depression.
The patient gets treated in the community by someone who knows them well who has an interest in the condition and has more resources to meet the needs of the patient. This may well prevent referrals to more expensive secondary care. It represents extra work and is therefore needs to be resourced or something else given up.
In addictions, such enhanced services usually require a high level of reporting, with multiple health bases covered; many of which are normally dealt with by the specialist addiction services.
GPs might be expected to have a minumum number of sessions with patients, to offer immunisation against hepatitis A and B and to screen for blood borne viruses; to demonstrate they are working to guidelines and to report process and outcomes.
This is work which would normally be done in secondary care, now provided in primary care in some areas and requiring resources. GPs who do such work may well have done a year’s training on the RCGP Substance Misuse Management Course. Many other GPs do not feel competant to treat addiction to this level as they have not been trained.
It is true that some GPs are not interested in addiction or find the symptoms of addiction difficult to deal with. Some are uncomfortable with methadone maintenance generally. Some refuse to prescribe.
I don’t believe GPs are all greedy any more than I believe they are all tall or all born in the month of May. The hours are long, the responsibilites are enormous and they have to deal with things in the course of every day life that are truly awful.
Competing interest: I am a GP by training, now working full time in addictions.
You have raised some very interesting points here I have done a blog recently on Shared care fair Care and recovery which again raises a number of questions.I think David has made somme good points above.
Ollie.
Interesting. Without sounding rude Paps, how did you manage to attend a meeting where you were not fully up to speed? And why could you not ask these questions at the meeting you attended?, it sounds to me as though you had the right audience right in front of you.
And if I may pick up on a point raised by someone else in a previous post. You seem to be talking here about “DRUG” users. My understanding is WiredIn was developed to help drug and alcohol problems. Perhaps your personal experiences are based around drugs but it would be helpful if you could generalise the problem.
The problem is not dealing with alcohol or drug misuse on the path to recovery – that’s just a symptom of the deeper problem and something a GP (there are exceptions always) is unable to treat. In a corporate world a GP would be a “Jack of All trades and Master of none” and I use the phrase lightly and with the utmost respect.
Alcohol and Drug misuse requires specialist treatment through people who have “been there, done that and worn the stained wet t-shirt” – the path to get them there is another matter.
I can not believe the authority who pays GP’s would consider giving them the cash over and above other available local specialist services. Its another example of wasted tax payers money.
Michaela, there was more than one question – to which did you think you knew the answer until you thought about it ? ;-)
I can only talk about my own experience and what I see and hear. The first doctor I saw for help, wanted to report me to the police, my second (and current) doctor, has no idea about addiction and referred me to a service where I spent 12 months attending “lets try this approach, lets try that”, eventually I found help from outside the “NHS” umbrella. After my first 3 months there I HAD to see my doctor for a sick note for which I was given the third degree as to why I needed one.
Sorry for the long post
p.s. another acronym for my collection CSMT’s ????
