Nicola is right!! (the Aust Minister of Health must be right)

Nicola is right!!
Her assessment that others can do the job that GP’s do and just as well as the GP is correct.  Sacrilege I know but when you look at what the average suburban GP does each day it is not really that difficult.  When the difficulty level rises then referrals are necessary.
For such a GP the average day is episodic care for people who have aches and pains, feelings of unwellness – all of whom need blood tests, x-rays and ultrasounds all of which will be negative.  Then there are the “check-ups”   BP’s, lipids arthritis etc. Not very complex skill level here needed.  Repeat pill scripts and cervical smears are usually the lot of the female practitioners.  Asthma now needs complex investigations while stable diabetes means more of the same. If changes then off to the diabetic specialist.
PLUS  the forms to complete ranging from Workcover, drivers licence and Centrelink. This is the average day.
There are no emergencies to worry about in the metropolitan area as much we try and fool ourselves to maintain some relevance.  The reality is that serious problems go by ambulance to the A+E dept.  Nursing home visits (if done) are also not complex as the nursing staff do most of the work.
In short if you dare to take on palliative care or manage some cardiac problem then you quick smart get reprimanded by the specialists in those areas.  This is the same for any problem you might have identified.  E.g. prolactinemia or PCOS …off to the specialists.
Why then have we become so dumbed down??
It is a combination of the need for short consults in order to make a decent  living and run a practice – plus the medico-legal implications of mal-management (especially in the metro area)  So we go on saying that only we as GP’s can do it.  Slowly but surely our diagnostic skill levels drop (we do not need them).  We just need a good network of specialists to whom we can refer/. 
We go through the charade of CDM + TCM plans because they generate money, but we know that in order to make a difference follow-up is needed but it can never be properly done.  So on we go as metropolitan GP’s.
As you can see Nicola is right .  it does need a highly trained person to do the job of a metro GP.
This is precisely why you will not get GP’s into rural areas where the skills required are enormous. But no more than used to be demanded of metro GP’s in past times.  We still cling to these outmoded images. Why shift to the country when we can make a living in the metro area without a lot of stress and the deprivations of country life.
All of this is very sad and depressing but this is the way that the govt and social pressures have shaped us.  Most of us keep seeing patients because we like that type of contact and this is why we get upset when Nicola wants us to tackle CDM by a coordinated team approach which means more paperwork and less patient contact.  If we want to be true medical professionals then we should do rural medicine or become a specialist.  This is probably the reason why there is a rise in GP sub-specialisation.
Change is coming. The tidal wave of chronic disease management is here.
So in summary
Until the govt educates the patients about their part in health management we will just keep on being metro GP’s without any high expectations of patient management but avoiding being responsible for the actions of other health professionals around us. It is time to move on when we wake up in the morning and believe what I have just written and believe that what we do will not make the slightest difference to any patient.

Are Care plans for patients worth it???

Care Plans
Recent discussions have confirmed what I have already written.  I did not mention that another negative is the duplication in entering information in the Plans and the Team Care plans..
I explored the reasons for not wanting to set them up and although I did not specifically mention it, one of the major negatives is the total artificiality of the whole exercise  You go through the exercise of creating a plan and then explaining it.  The patients even sign to say they agree.  But they just see it as a thing the doctor has to do.
They rarely reappear and trying to track for plan adherence is a nightmare.  So the question has to be asked if any plan helps to improve patient care over what is done now without any plans.
The patient appears and you look for what is the chronic disease or diseases they have and then see if they need any follow-up.  Then you arrange it.  It seems to work well but is dependant on the patient coming to see the doctor.  There is no pre-emptive care and this is what care Plans attempt to do.  The whole idea is to construct a planned management approach which should optimise care of any chronic disease.
Follow up could be still done by a receptionist who would do it the same as the ideal followup that should be done for test results / referrals / x-rays .  it would work.  You could say that the patient has been referred for podiatrist.  Have they gone (is there a letter) if not follow it up.  But very labour intensive 
A Professor Georgeff has evolved web based system.  But again it has to be done by staff.  The question is whether or not you are paying a wage just to see if patients look after themselves. Is it worth it??  At the moment no because we are paid for sickness and not patient wellness.  Plans and adherence will be looked at in another light if we are paid on wellness results.  Sounds good but then we focus on adherence and not the patient.