The British journal of general practice : the journal of the Royal College of General Practitioners
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I am increasingly bemused by the narrowing and blinkered view of training to becoming a GP. Rosenthal and Chana1 comment 'many trainees still spend part of this time in posts that offer traditional hospital-based experience that may not reflect the context of new community based service models'. Cautiously I would like to add the comment 'so what?' We do want 'well rounded' GPs, people open to new ideas, and who are open to 'lifelong learning.' Many who qualified at a similar time to me will have done hospital jobs as 'part of the team.' Six months at the end of which we were hopefully competent but also confident. ⋯ This also seems to becoming more difficult and not encouraged generally while trying to achieve CCT. That great idea of learner-led education, particularly for trainees, seems to have gone out of the window. I suppose I am saying, can we be a bit more generic in our training years, widen our horizons again, and use First5 to help settle doctors into the rewarding job we do?
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There are often many interpretations of patient-centred care. The plethora of information at a patients disposal coupled with current financial strictures, highlights the importance of the concept of patient-centred care and its place in providing evidence based medicine that is cost-effective. Many PCTs and hospitals have and continue to place increasing restrictions in various aspects of health care; screening tests, for example, cervical smear, pathological and radiological investigations, not to mention the proliferation of referral management schemes. ⋯ Now, one could argue that this is whatdoctors should always have been doing. One benefit of the current restrictions is to return doctors to their professional roots and to encourage evaluation of the scope of care with patients. In both these scenarios doctors would be required to address the perennial issue of needs versus wants and their own professionalism.
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The bad news is that the BJGP published under such a negative and provocative title without balanced debate, in contrast to the recent BMJ head-to-head debate 'Has child protection become a form of madness'.1,2 One interesting comparison made in that debate is that Sweden and Finland spend 50% more of their gross domestic product on children and families than we do in the UK, we spend 200% more than they do on social problems. In my view these figures help us understand societal attitudes that have knock-on effects through all services for children and families including general practice. The current UK GP contract is certainly not child and family friendly and it is unlikely that current NHS changes will improve matters. ⋯ Those specific to general practice are on pages 60-63 of Working Together to Safeguard Children 2012.5GP colleagues in Cornwall show appreciation of the importance of safeguarding, but many feel there is too much guidance and insufficient resources. The majority of the practices value the RCGP/NSPCC Toolkit for Safeguarding Adults and Young People, that being written for GPs by GPs helps practices establish policies and procedures on safeguarding which work.6 I commend the RCGP for grasping the safeguarding nettle, collaborating with the NSPCC to produce this toolkit, and including safeguarding as one of the ten priorities of the RCGP Child Health Strategy for 2012-15.7 Can the BJGP help the College bring this strategy forward? Up to 25% of our patients are children. They are the future of the UK.
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Early detection and management of dementia in primary care are difficult problems for practitioners. England's National Dementia Strategy 2009 seeks to improve these areas but there is limited evidence on how to achieve this most effectively. ⋯ The quality of the studies varied considerably. Educational interventions are effective when learners are able to set their own educational agenda. Although modifying the service pathway and using case management can assist in several aspects of dementia care, these would require the provision of extra resources, and their value is yet to be tested in different health systems.
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The ease with which patients can make primary care appointments in the UK has been subject to a pay for performance scheme since 2004. A separate scheme, extended hours - the provision of extra appointments outside normal office hours -was introduced in 2008. ⋯ Demand for additional opening in primary care is only influenced by Saturday appointments. Satisfaction with opening hours responds to increased capacity, but is not linked to a specific time period.