General practitioners are moving into a more central and accountable role in managing NHS resources. To achieve this they need to monitor, understand and plan the everyday services they offer. This book shows the reader how. It provides insights and practical suggestions on how demand can be met effectively and efficiently. It shows how to improve service provision and guidance is given on how to reduce the stressful working conditions of GPs, nurses and other practice staff. Illustrated with charts and graphs and tips, it provides new and relevant data in an easy to understand and accessible format. All members of the practice team, especially GPs, GP registrars and NHS managers, and those undertaking research in or about primary care, will find it essential reading.
Patient-centered, high-quality health care relies on the well-being, health, and safety of health care clinicians. However, alarmingly high rates of clinician burnout in the United States are detrimental to the quality of care being provided, harmful to individuals in the workforce, and costly. It is important to take a systemic approach to address burnout that focuses on the structure, organization, and culture of health care. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being builds upon two groundbreaking reports from the past twenty years, To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, which both called attention to the issues around patient safety and quality of care. This report explores the extent, consequences, and contributing factors of clinician burnout and provides a framework for a systems approach to clinician burnout and professional well-being, a research agenda to advance clinician well-being, and recommendations for the field.
Good Practice: What it means to put the patient first, not politics, posturing, pretentiousness, protocols or process. This is a text book for all doctors but especially GPs, Appraisers and Registrars. It is written by a 40 year plus front line NHS doctor who for most of his career worked twice to three times the current doctors’ Working Time Directive limited week. Chris Heath has been a Paediatric Lecturer in a teaching hospital, an Anaesthetist, various junior specialists and a GP for over 30 years in 3 different practices. He has been a GP Trainer and Appraiser and has seen politics and political correctness harm patients’ interests constantly over the last half of his career. From the way the NHS selects young doctors to the way they are educated and assessed, the best interests of the patient are largely ignored. This is a text book but it also contains home truths, advice, insights and original, honest guidance on being a safe, effective doctor. As well as giving an assessment of what has gone wrong with the NHS over the last 20 years, the author explains why today’s politicians, medical schools, Royal Colleges and many doctors will resist the changes essential to put the patients’ needs first again. 1 Politics, Who we are, The CQC etc 2 Administration, Training, The Consultation and Teaching 3 Basic Biology 4 Acute Medicine in General Practice 5 Alcohol 6 Allergy 7 Analgesics 8 Anticoagulants, Clotting 9 The Breast 10 Cancer and Terminal Care 11 Cardiology 12 Useful Clinical Signs, Eponymous diseases 13 Dermatology 14 Diabetes, Metabolism 15 Diet, Vitamins and Nutrition 16 Driving 17 Odd drugs 18 Ear, Nose and Throat 19 Gastroenterology 20 Geriatrics 21 Haematology 22 Hormones 23 Immunisation and Vaccines 24 Infections, Antibiotics, Microbiota 25 Legal Issues 26 Liver 27 Miscellaneous 28 Musculoskeletal, Orthopaedics, Sports, NSAIDs 29 Neurology 30 Ophthalmology 31 Paediatrics 32 Pathology 33 Pregnancy, Obstetrics and Gynaecology, Contraception 34 Psychiatry and Controlled Drugs 35 Respiratory 36 Sex and STDs 37 Sleep 38 Travel 39 Urology 40 Work References
This is a text book for all doctors but especially GPs, appraisers and registrars. It is written by a 40 year plus front line NHS doctor who for most of his career worked twice to three times the current doctors’ Working Time Directive limited week. Chris Heath has been a Paediatric Lecturer in a teaching hospital, an Anaesthetist, various junior specialists and a GP over 30 years in 3 different practices. He has been a GP Trainer and Appraiser and has seen politics and political correctness harm patients’ interests constantly over the last half of his career. From the way it selects young doctors to the way they are educated and assessed, the best interests of the patient are largely ignored. This is a text book but it also contains home truths, insights and a warts and all appraisal of how to be a good doctor as well as an unbiased assessment of what is wrong with today’s NHS. It also explains why today’s politicians, medical schools and doctors will resist the changes that are needed to put the patients’ needs first again.
In the early 1970s general practitioners were well aware that they were being asked to deal not only with physical illness in their patients but also with the stresses relating to social and emotional problems. Increasingly often they were working together with health visitors and social workers in attempting to respond more effectively to these demands. Originally published in 1972, this study describes the attachment of a social worker to a group general medical practice in London, indicating why, for all social groups, the general practice is an appropriate point at which psychosocial problems may be identified and treated. The authors describe the nature and range of patients’ problems that come to light in the consulting room; how patients present their problems to the social worker; and the kind of help the social worker is able to offer. They explore the extent to which the general practice setting provides opportunities for preventive therapy and further describe how social work in general practice can most effectively be related to existing social services in the community, particularly to the reorganised personal social services. Their findings are supported throughout by illuminating case studies. The book also discusses the integration of the social worker into the general practice team, the problems that have to be solved and the mutual enlightenment that results. This emerges as an extremely encouraging and instructive experiment, which will immediately interest social service departments and social workers, doctors and nurses, both students and those in practice. The wide spectrum of social problems encountered and dealt with by the social worker in a general practice make it a particularly stimulating account.
Anxiety about medicine becoming impersonal and mechanised permeates the NHS. In addition, the popular media is full of stories about the health service and its unhappy staff, focusing on the belief that professionals and patients are being turned into assembly-line workers and objects. This is particularly prevalent in general practice, as plans for massive policlinics are revealed and payment systems shift seemingly inexorably towards incentives and targets. The ethos of family medicine, which places so much stress on continuity of care, psychosocial understanding of illness, and the careful management of doubt, is challenged by guidelines, governance, quality frameworks, and patient satisfaction surveys. General practice is being industrialized into primary care, or so it can seem. This book explores the many dimensions of industrialization as it has occurred to others in the past, and analyses the origins of the current wave of reform in general practice. It analyses why industrialization is being pursued as a government strategy, and explores its benefits and dangers. It concludes that the medical profession has reasons for being perturbed by industrialization, but that it has advantages as well as disadvantages for the NHS and the public. Its conclusions may not please either policy makers or practitioners, but they offer ways for professionals working in the community to customise current changes in potentially beneficial ways.
"Doctors reading this book will not only be convinced of the need for medical supervison (for all doctors - even pathologists and coroners); they will also be given a handy smorgasbord of different types of medical supervision from which to choose ... There may not be many ways of rekindling the spark of compassion and loving kindness that made us want to become health professionals at the start of our careers, but Owen and Shohet have demonstrated that empathic supervision, whether this is from fellow professionals or from peers, is certainly one way of achieving this." Brian Kaplan, MD With a foreword by Iona Heath, President of the Royal College of General Practitioners. This book helps trainee and practicing doctors to develop a broader understanding of supervision. Written by doctors and other medical specialists experienced in clinical supervision it gives the reader the means to enable, structure and develop their reflective practice. It provides practical tools to engage positively with regulatory challenges, increase satisfaction at work and improve quality of care. Clinical Supervision in the Medical Profession considers the reasons for clinical supervision and how it can support doctors and even transform how they engage with challenging issues. The authors outline a range of ways that they have put clinical supervision into practice and how it has benefitted their work. Contributors Christine Dunkley, Helen Halpern, Anita Houghton, Sue Morrison, David Owen, Patricia Ridsdale, Paul Sackin, John Salinsky, Robin Shohet, Maggie Stanton, Guy Undrill and Sonya Wallbank.
The upheavals of the NHS reforms have caused a great deal of stress and uncertainty in primary care, and professional development and support for general practitioners needs to take account of this. This book offers a group supervision model which can be used to develop the core competencies needed for GPs to make the new primary care organisations work. The book analyses how primary care professionals have dealt with the various reforms of the past decade, and picks apart the paralysing culture of politeness, conflict avoidance and rivalry for power, to reveal how at the core of reform is the struggle for each GP to construct a new professional identity which integrates medicine, management and politics. It proposes ways GPs can benefit from these experiences to become equipped with the necessary competencies to be active members or dynamic leaders in the new primary care organisations. The doctor-patient relationship is no longer one-to-one, but located within a group matrix, in the same way that a GP is now required to work within a group framework. This book enables GPs to develop the essential group skills they now need, and on which the success of the healthcare reforms ultimately depends.
This edition has been revised and up-dated with relevance to the new primary care organization, NHS Direct and the increasing role of non-principles. It explores the causes of stress, with case histories and details of specific problems.
We are facing an epidemic of work stress. This study combines a critique of the scientific evidence relating to work stress, with an account of the social, historical and cultural changes that produced this phenomenon.
