IOM DHSC & MANX CARE

[360 View]

So who, or what is the Primary Care Network? Not heard anything about this before!

How much is being paid to it? And who is financially benefitting? From the November papers it seems that Dr Ellis is not only on Transformation Board and on Board of a GP practice but is also something to do with it -

Is this yet another group (presumably Drs) being paid (in addition to normal GP pay) by Manx Care to do what they should be doing as GPs anyway and how much is all this costing?? Is this new, or has this been going for a while?  

It also seems that it has been given the booster programme to run next year? What else is it doing/ being paid to do?

Yes, I do read minutes (sad, i know) as I am interested in how much this Manx Care ‘experiment’ is costing now and potentially for the future and how many individuals directly involved in Manx Care/ Transformation Group/ GPs etc are benefitting financially.

As far as staffing is concerned, how many ‘subject matter experts’ have been engaged by Manx Care in connection with ‘information governance’ (see report by the CIO)? Not seen any ads for them, so have these posts just been filled by friends, or friends of friends? What ‘expertise’ or qualifications do they have that has been verified? How much are they being paid? Or is this yet more money being pissed against the wall?

Every time there is a Board Meeting there are more maggots crawling out of the woodwork - but at least, i suppose, they are publishing minutes …

Lots of questions. FOI anyone?

[Newbie]

2 hours ago, 360 View said:

So who, or what is the Primary Care Network? Not heard anything about this before!

Plenty of information in the public domain if you look for it.

https://www.gov.im/about-the-government/departments/cabinet-office/health-and-care-transformation-projects/primary-care-at-scale/

https://www.gov.im/media/1373473/iom-primary-care-at-scale-strategy.pdf

https://www.gov.im/media/1376415/primary-care-at-scale-detailed-strategy-feb-22.pdf

2 hours ago, 360 View said:

Is this yet another group (presumably Drs) being paid (in addition to normal GP pay) by Manx Care to do what they should be doing as GPs anyway

What other groups on the island exist to facilitate collaborative working between each independent practice?

[Omobono]

Dr Allinson said in his interview on Manx radio recently  he was still keeping his hand in as a GP  does that mean he is being paid as Treasury minister  and as a GT or Locum at the same time , 

can anyone please clarify if this is the case ?

[Roger Mexico]

28 minutes ago, Omobono said:

Dr Allinson said in his interview on Manx radio recently  he was still keeping his hand in as a GP  does that mean he is being paid as Treasury minister  and as a GT or Locum at the same time , 

can anyone please clarify if this is the case ?

Yes, he'll be working as a locum (I think he gave up his partnership in Ramsey).  Doctors, like many other professionals, have to work a certain number of hours every year to maintain their accreditation and presumably he wants to do that. 

Financially it's no different from a Minister who has business interests still getting income from those and being involved in running them part-time.  In this case Allinson won't be being paid by the Government anyway as GPs technically for for their practice. 

[wrighty]

3 minutes ago, Roger Mexico said:

  Doctors, like many other professionals, have to work a certain number of hours every year to maintain their accreditation and presumably he wants to do that. 

I don’t think that’s true. We do have to undergo annual appraisal which is the basis of revalidating your GMC license to practice every 5 years, and there’s a requirement to carry out 250 hours of continuing professional development in that 5 years (eg an hour a week reading the BMJ), but there’s not a minimum number of hours you have to work as far as I’m aware. 
 

I think Alex has done some MEDS sessions since giving up his Ramsey partnership. 

[Newbie]

5 hours ago, wrighty said:

I don’t think that’s true. We do have to undergo annual appraisal which is the basis of revalidating your GMC license to practice every 5 years, and there’s a requirement to carry out 250 hours of continuing professional development in that 5 years (eg an hour a week reading the BMJ), but there’s not a minimum number of hours you have to work as far as I’m aware. 
 

I think Alex has done some MEDS sessions since giving up his Ramsey partnership. 

That is essentially correct for GPs as well. They have to work a minimum of 1 session a year to remain on the GP Performers list (a list of doctors eligible to work as GPs). However, if they work less than 40 sessions a year they have to provide additional evidence during their appraisal to show that they are still safe to continue practicing in spite of the low volume of clinical work. That is in addition to the CPD requirement of 250hours over 5 years. The reality is that if someone is working fewer sessions than that, they will be spending almost as much of their own time maintaining a licence to practice as they are actually working, so it becomes impractical.

I would also say that in General Practice at least, if their CPD consisted solely of reading the BMJ for an hour a week, it would probably be frowned upon during their annual appraisal, and consequently their might be potential problems for them with regard to revalidation. The expectation is that a doctor undertakes a range of CPD activities that are intended to address any development needs that they have previously identified. That is partly the reason that GPs attend a quarterly educational session organised locally. They were originally started to try to address the difficulties that GPs had accessing a suitable range of CPD activities as a result of being on an island.

The process may be different in Secondary Care. GPs have Dr Shipman to thank for that!

[Banker]

8 hours ago, Omobono said:

Dr Allinson said in his interview on Manx radio recently  he was still keeping his hand in as a GP  does that mean he is being paid as Treasury minister  and as a GT or Locum at the same time , 

can anyone please clarify if this is the case ?

I think he should be paid if he’s working as a locum GP & providing a valuable service, what’s the issue?

[wrighty]

54 minutes ago, Newbie said:

That is essentially correct for GPs as well. They have to work a minimum of 1 session a year to remain on the GP Performers list (a list of doctors eligible to work as GPs). However, if they work less than 40 sessions a year they have to provide additional evidence during their appraisal to show that they are still safe to continue practicing in spite of the low volume of clinical work. That is in addition to the CPD requirement of 250hours over 5 years. The reality is that if someone is working fewer sessions than that, they will be spending almost as much of their own time maintaining a licence to practice as they are actually working, so it becomes impractical.

I would also say that in General Practice at least, if their CPD consisted solely of reading the BMJ for an hour a week, it would probably be frowned upon during their annual appraisal, and consequently their might be potential problems for them with regard to revalidation. The expectation is that a doctor undertakes a range of CPD activities that are intended to address any development needs that they have previously identified. That is partly the reason that GPs attend a quarterly educational session organised locally. They were originally started to try to address the difficulties that GPs had accessing a suitable range of CPD activities as a result of being on an island.

The process may be different in Secondary Care. GPs have Dr Shipman to thank for that!

Very similar for us - not sure about the 40 sessions thing though, it’s never been an issue for me either personally or as an appraiser, since as you say that’s basically 4 hours a week and I’ve never known of anyone doing that little. 
 

My example of reading the BMJ an hour a week was slightly tongue-in-cheek, simply to illustrate that it’s not difficult to rack up 250 hours of CPD over 5 years. We too have a Personal Development Plan identified each year and should carry out CPD to deliver it, as well as general ‘keeping up to date’ by reading and attending courses and conferences. 
 

It’s a myth that Shipman was responsible for the introduction of appraisal and revalidation - it was Rodney Ledward and the Bristol heart scandal. Shipman led to changes in death certification and regs around post mortem examinations. He was a serial killer, not a dodgy doc. Just like revalidation for builders wasn’t introduced based on Fred West’s practice. 

[Hoops]

8 hours ago, Omobono said:

Dr Allinson said in his interview on Manx radio recently  he was still keeping his hand in as a GP  does that mean he is being paid as Treasury minister  and as a GT or Locum at the same time , 

can anyone please clarify if this is the case ?

As a member of the Ramsey electorate, I think that's very advisable!

[360 View]

12 hours ago, Newbie said:

Plenty of information in the public domain if you look for it.

https://www.gov.im/about-the-government/departments/cabinet-office/health-and-care-transformation-projects/primary-care-at-scale/

https://www.gov.im/media/1373473/iom-primary-care-at-scale-strategy.pdf

https://www.gov.im/media/1376415/primary-care-at-scale-detailed-strategy-feb-22.pdf

What other groups on the island exist to facilitate collaborative working between each independent practice?

Thanks for the links.

Primary care at scale I’ve heard about, and bringing together GP practices, and other providers (Physio’s and pharmacy are mentioned) under one roof is a good step forward. Why can’t this happen now  - Manx Care could put a physio a few days a week in each centre or doctors surgery. 

Manx Care could stop the individual GP practice contracts and employ GPs directly, open bigger centralised hubs, put additional services in them and have longer opening hours. People would not need to be tied to a specific practice and could, for example, go to the closest, most convenient hub - all the GPs patient data is on one system (EMIS according to the feb document), so what is the problem? 

The “Primary Care Network” is a limited company made up of some of the GP practices with other non-medical admin and managerial staff. Doesn’t seem to have a specified role either, Feb 2022 doc says terms of ref were still to be agreed! Also seems to have been kicking around since pre-covid (could NOT agree on an approach to vaccination) and still not operational yet? 

Cant find a website for it, but it’s on LinkedIn, as is the “operations manager”. It can’t operate without money, so who is paying for it? Two options - either paid for by the GPs who are members of the network from money paid to them under their contracts by Manx Care (rather than on patient care at their practice) or paid for by Manx Care/Transformation (more invisible money).

The Primary Care Network just seems to be another layer of bureaucracy or is Manx Care divesting itself of responsibility for primary care? 

Edited November 3, 2022 by 360 View
Added NOT

[Newbie]

7 hours ago, 360 View said:

Thanks for the links.

Primary care at scale I’ve heard about, and bringing together GP practices, and other providers (Physio’s and pharmacy are mentioned) under one roof is a good step forward. Why can’t this happen now  - Manx Care could put a physio a few days a week in each centre or doctors surgery. 

Manx Care could stop the individual GP practice contracts and employ GPs directly, open bigger centralised hubs, put additional services in them and have longer opening hours. People would not need to be tied to a specific practice and could, for example, go to the closest, most convenient hub - all the GPs patient data is on one system (EMIS according to the feb document), so what is the problem? 

The “Primary Care Network” is a limited company made up of some of the GP practices with other non-medical admin and managerial staff. Doesn’t seem to have a specified role either, Feb 2022 doc says terms of ref were still to be agreed! Also seems to have been kicking around since pre-covid (could NOT agree on an approach to vaccination) and still not operational yet? 

Cant find a website for it, but it’s on LinkedIn, as is the “operations manager”. It can’t operate without money, so who is paying for it? Two options - either paid for by the GPs who are members of the network from money paid to them under their contracts by Manx Care (rather than on patient care at their practice) or paid for by Manx Care/Transformation (more invisible money).

The Primary Care Network just seems to be another layer of bureaucracy or is Manx Care divesting itself of responsibility for primary care? 

Primary Care at Scale is the desired aim, and covers many aspects including Dentistry, Optometry, Community Pharmacies and General Practice. The vehicle for delivering the GP aspects of it is the Primary Care Network. You are right that the idea has been kicking around for a while, and Covid didn't do anything to help its development. I would agree that it's aims and objectives are still fairly nebulous but I suppose it is early days, and hopefully they are planning better ways of delivering certain aspects of General Practice.

You are also right that Manx Care could stop individual practice contracts, but in the past (pre Manx Care) the DHSC Primary Care Directorate always shied away from that. The current contract, amongst other things, requires GPs to see patients as many times as necessary, either at the surgery or at their home (if that is required) for a fixed sum of money each year. Historically, GP practices have managed that very well, and with their relative lack of bureaucracy have always been responsive to any changes asked of them.

 However there are real problems at the moment due to multiple factors (ageing population, ageing GP workforce, difficulty recruiting, increasing list sizes etc). It may well be that many GPs would support the idea of a salaried GP Service (rather than being independent contractors) and a move to an employment contract that specified exactly how much work they were expected to do rather than the current, effectively open ended workload. The potential downside is that history tells us that once the government (or in this case Manx Care) take over the running of a service you tend to get increased bureaucracy, increased waiting times and a less responsive service. They are worrying times and it is difficult to see an easy solution. 

[Manx Bean]

Simply..what the actual fuck!!??

https://www.manxradio.com/news/isle-of-man-news/a-fifth-of-health-letters-waiting-more-than-a-month-to-be-sent/

 

[Guest]

With modern software driven appointment booking systems and subsequent letter production how can such delays even be envisioned?  Something would appear to be needed  to be changed within the organisation.

[wrighty]

51 minutes ago, Cypman said:

With modern software driven appointment booking systems and subsequent letter production how can such delays even be envisioned?  Something would appear to be needed  to be changed within the organisation.

This article refers to clinic letters, the ones we dictate to GPs after seeing a patient, not the ones that get sent to patients telling them where to come for their appointment. 
 

The simple fact is that clinicians are doing more work (that’s generally considered to be a good thing) than the secretarial side can manage - like all areas there are vacancies and sickness absences. In orthopaedics we’ve been short of a secretary for ages now. The ones we have are overworked and will often stay late or come in at weekends to try and keep on top of things. 

[Omobono]

surely this is a complete failure of the  medical management support system ,  the other smoke and mirrors stunt  they also pull  is to give patients appointments for ay least 9 months ahead , then cancel or change them ,way before the given time 

someone told me in admin this was so they could say there was no one on that particular  waiting list   , and show the  department in a good light , there has been too much of this  going on , and its time the hospital ,and the various medical and consultants  appointments  were properly funded and open to scrutiny , the question I would like answered  is now all these waiting list initatives from the UK   are  under way  in Nobles ,  what are the locally based consultants doing , if we had capacity for extra operations before , then  we need an explanation as to what has happened to create this situation