Change and the GP
The thing that sparked off this was the National Health & Hospitals Reform Commission Report. This is one of the many reports and changes that have been proposed and been coming on the scene for the last 2 years—on top of changes for health care plans. I would like to try and work through the changes and why I am upset about it all (actually profoundly depressed). Then to work out what should be my own individual response. It is important that I do this because I still have some time left in working as a GP Locum and I have to get things right.
What these plans have done is to put on top of a patient management system a whole lot of extra administration that does not achieve anything except get a physio at a cheaper rate for the patient. (reverse referral) If we do not use them for our other long term CDM patients then we deprive ourselves of income.
We all had a sense of purpose as GP’s and that is to assess, diagnose and manage a patient’s problems. In order to survive we have to be crystal clear and focussed with this..
I have to sort out things and use a USB stick to transfer data e.g. Mental Health Plans. I do not expect any follow up but these things will be requested. So in doing this I can get the referrals done and also continue to manage the patient as I have always done. The reason is that in changing over to other different ways of conducting a General practice they all collapse in the end – usually due to financial reasons. So it is best to stick to the old ways and graft these other systems onto what I do.
In this way I will not become demoralised or disillusioned. The next generation of doctors will attempt to go along with it all and seemingly make progress but they will collapse because of financial constraints. They will join bigger units to financially survive and not care too much about Chronic Disease Management. They will be good and focus on a professional job, much like a hospital doctor does now… Targets will come and go. Bundled health care will come and go. Others in the management will have to work it all out. These doctors will not!! Doctors will consult in the least aggressive manner and not work too hard. Making $$ will be a main factor.
For me I will seek episodic practice and rural work. As regards these care Plans etc, unless the practice has a mechanism in place I will not attempt to manage patients in a long term sense.
So I need to develop diagnostic programs like Tiredness etc so I can manage people and then troll back through chronic management plans.
In order for this to work a practice would need a database program that says in effect that today you as a doctor need to check BP check lipids manage obesity what is Hb1ac? As a separate consultation. Need to monitor if patient has gone to ophthalmologist, podiatrist.
If none of this happens and a care plan in place then pick on 1 thing and note that you have requested it. Put this at the end of the normal consultation Or say that I notice that there a lot of different things wrong and that we need to sort them out at a future consult (which will be made but not kept)
