Monthly Archives: April 2016

The BMA’s heatmap for General Practitioners leaving or retiring… Mr Hunt should read and take note..

What’s happening in your area: The BMA’s heatmap for General Practitioners leaving or retiring… Mr Hunt should read and take note..

Prescription for general practice

These heatmaps help illustrate the impact on general practice in England, Scotland and Wales.

Make sure you use the dropdown menu and search to find out what’s happening in your area.


  • Choose an option from the Survey Question dropdown
  • Type in the name of your area in the Constituency field
  • The arrow displayed will show the impact in your area
  • Change the dropdown option to see more results

Use the heatmap

Trainee’s portfolio ‘used as evidence against them’ in legal case

The real man smiles in trouble, gathers strength from distress, and grows brave by reflection. Thomas Paine
Article from Pulse magazine once again the opportunity to learn from mistakes will be lost in order to satisfy the thirst for cash for claims bonanza that is going on in the UK. Good luck retaining doctors with this  sort of thing  going on …. We will become the dumping ground for the worlds worst practitioners , man can only learn through experience. LINK TO FULL ARTICLE BELOW

“If you want a vision of the future, imagine a boot stamping on a human face – forever.”  Could be a quote from any tory politician …. but alas not their actions speak far louder than words …


Trainee’s portfolio ‘used as evidence against them’ in legal case
|15 April 2016 |By Alex Matthews-King

GPs must provide ‘honest explanation’ to patients if something goes wrong, says GMC
03 Nov 2014
A trainee’s ‘written reflections’ on an incident in their training development portfolio was used against them in a legal case, which GP leaders have said illustrates the medico-legal ‘minefield’ that GPs are having to operate in.

Health Education England bosses in London and the South East have warned that a recent legal challenge saw a trainee release their reflections – a vital part of a trainee’s portfolio – which ‘was subsequently used against the trainee in court’.

But in a letter to postgraduate deans and training supervisors, HEE said trainees should continue to make particular note of cases where ‘things do not go well’.

It highlights that for trainees the reflection process is exactly the same as for GP appraisal, and that these should avoid patient-identifiable information and focus on the positive lessons learned.

RCGP’s guide to revalidationGP leaders warned that GPs need to take all precautions to not incriminate themselves

The letter from HEE, which was shared by doctor and medical educator Dan Furmedge on Twitter, said: ‘Recently, a trainee released a written reflection to a legal agency, when requested, which was subsequently used as evidence against the trainee in court. This has resulted in questions about whether trainees should still provide reflection about incidents in their portfolios.

fewer women should be allowed to train as doctors because men are ‘better value for money’… The answer is graduate entry to medical school.

Graduate entry to medical school will solve the gender bias, but if the government does not wish to address this, then they need to train far more doctors, and allow for the 20% net loss from Wales and the rural areas. Ambitious and successful graduates often choose to work in cities.

Caroline Mortimer in the Independent reports 7th April 2016:  Academic says fewer women should be allowed to train as doctors because men are ‘better value for money’

‘Young men will give a full career of medical service and provide society with much better value for the money spent on medical training’

Female junior doctors have reacted with fury to a letter by a retired LSE academic which suggested fewer women should be “allowed” to become doctors.

In a letter to the Times, Emeritus reader in economics at LSE, Dr Roger Alford, questioned the wisdom of employing women as doctors because they are “likely in due course to move to part-time appointments”.

Responding to an editorial by the newspaper which called for the Government to allow universities to train more doctors, he wrote: “I understand that there is now a very high proportion of women students in our medical schools, and that many women doctors are likely in due course to move to part-time appointments.

“Given that the role of medical schools must be to deliver the full-time frontline doctors that we need, surely the number of young women allowed to begin training should be considerably limited to allow in more young men who will give a full career of medical service and provide society with much better value for the money spent on medical training.”

Which party will embrace any form of deserts based rationing?

With obesity, alcohol, smoking and general unfitness, many of the population obviously need sticks as well as carrots to control their behaviour. Tax alone is evidently not sufficient…. but neither is witchcraft.. Deserts based rationed should be part of the eventual pragmatic rationing package…Unhealthiness cartoons, Unhealthiness cartoon, funny, Unhealthiness picture, Unhealthiness pictures, Unhealthiness image, Unhealthiness images, Unhealthiness illustration, Unhealthiness illustrations

Katie Gibbons in the Times 29th April 2016 reports: Hospitals admit 300,000 obese women in one year

Hospital admissions for obesity have increased tenfold in the past decade and are at a record level, it has emerged. Three quarters of patients are women.

In 2014-15 there were 440,288 admissions to hospital in which obesity was the main or secondary factor. This is the highest figure on record and more than ten times higher than in 2004-05, when 40,741 were recorded.

Health campaigners warn that obesity will “break the NHS” unless the government takes decisive action to tackle unhealthy habits….

Gabriella Swerling reported 29th December 2015 in The Times: Thousands of obese people rescued from their own homes 

Almost 2,000 obese people have had to be rescued by firefighters and paramedics in the past three years after they became stuck in their homes, The Times can reveal.

The so-called bariatric rescues involved more than 5,000 fire and rescue workers using animal harnesses, crowbars, electric saws, shovels, chimney rods, aerial ladder platforms and lifting and hydraulic equipment.

In some cases the equipment was used to take out windows and help undertakers to remove bodies.

Health experts said last night that the figures exposed “the hidden problem” of the obesity crisis. They raised concerns that lives were being put in danger elsewhere because crews were being diverted from their normal duties.

From January 2013 to May this year, 5,565 firefighters attended 1,866 incidents, Freedom of Information data showed. The number of rescues is likely to be higher because not every service provided firefighter figures or gave information in the same timeframe.

Matt Wrack, general secretary of the Fire Brigades Union, which represents firefighters, said that services generally responded with a crew of four or five people per incident because “we are talking about lifting people in quite difficult situations or positions”.

In January a report from McKinsey, the consultancy group, said that obesity costs Britain £10 billion a year, and medical experts are worried that the problem shows no sign of diminishing. Tam Fry, the spokesman for the National Obesity Forum, said that the NHS had no option but to call on the fire service for heavy-duty work because “the obese are getting obeser”.

Mr Fry said he was “deeply worried that in time a tragic fire and even loss of life will result from crews being diverted from their normal duties”. Paul Hancock, president of the Chief Fire Officers Association, said that crews were responding to increasing numbers of bariatric rescues.

According to the Times data, London had the most bariatric rescues, at 180, followed by south Wales with 106 and Scotland with 95. Almost 530 firefighters were called to 58 incidents in Cleveland.

The cost of dispatching a fire engine is about £400 and Mr Wrack said that these incidents were occurring while funding was “being slashed to pieces”. Since 2010 the government has cut its funding to the service by almost a third, resulting in the loss of nearly 7,000 firefighters.


A bad day for the Health Services in the UK? Majority of doctors believe none of the political parties have the right prescription for the NHS. Do we really need a “none of the above” party?

A difference In philosophy. Sticks as well as carrots? To fine and regress in order to be pragmatic?

The NHS is not safe in any party’s hands. The real swindle lies in the pretence that the NHS model works.. it is fundamentally flawed..

Health professionals call for NHS Wales ‘vision’ by prospective parties. If you don’t have a choice in Wales, you can buy or game that choice….

The duty of candour should extend to politicians. They should all embrace exit interviews by an independent body and overt rationing. Pretending we can continue as we are will lead to increasing inequality. If you don’t have a choice in Wales, you can buy or game that choice…. There is no short term solution, only a long term solution addressing recruitment, and honesty. The BMA response to the WG Green paper says it all.

Owain Clarke for BBC Wales 29th April reports: Health professionals call for NHS Wales ‘vision’

None of the main political parties in Wales are offering a long term vision for the NHS, according to professional bodies representing frontline staff.

Hospital doctors, surgeons, GPs and nurses told BBC Wales they are also concerned about a lack of detail in party manifestos.

All contained useful ideas among pledges but there was need to tackle ever increasing demands, they said.

Meanwhile, an open letter to parties calls for waiting times to be tackled.

BBC Wales spoke to six professional organisations representing tens of thousands of NHS staff.

Four of them also offered to examine each main party manifesto in detail for us.

The full responses can be found here:

Specifically, there are concerns none of the parties have set out a vision of how the NHS needs to change in the next five or 10 years to deal with growing pressures from an aging population, with more complex needs.

Nor, they have argued, is there a clear indication about much money would be needed to deliver the changes.

Meanwhile, the Royal College of Surgeons (RCS) – which represents most surgeons working in Wales, wants all parties to focus on reducing waiting lists.

In an open letter to all the political party leaders published on Friday, the College said it is concerned that 430,000 people are waiting for treatment in Wales and that both the 26 and 36 week waiting list targets are being missed.

The letter was also signed by the leaders of the Royal College of Nursing, Royal College of Physicians and Royal College of GPs in Wales.

Tim Havard, director of professional affairs for the RCS in Wales, said it is “broadly encouraged” that many of the parties are pledging to tackle long waits.

Yet he said it will be a tough challenge to address.

“I’d be wary of any political party that say they have simple solutions to this,” said Mr Havard, a hospital consultant.

“I think it’s going to involve hard and difficult decisions. What we want to see would be the new administration engaging with doctors and nurses to come up with a sensible plan.”

He said “quick fixes” had brought improvements in cardiac waiting times for example but had also been followed with investment in cardiac units for the medium and long term.

“We need that sort of initiative and push taken more generally through scheduled care,” he added.

Dr Alan Rees, vice president of the Royal College of Physicians in Wales which represent hospital doctors, said: “There’s an element of mum and apple pie about this.

“All the parties want an efficient comprehensive, health care system in Wales. How you deliver that is dependent on resources and the budget and you need to provide details about how you deliver these plans.”

He is opposed to large-scale structural changes but said the NHS had to think beyond the traditional model of GPs and hospitals.

“GPs should be working at the front door of hospitals and hospital consultants should be going out into the community – so we’ve got to be innovative, be more efficient,” he added.

The British Medical Association – which represents 8,000 doctors in Wales – welcomed commitments for more staff and to improve quality and safety in the NHS.

Yet it suggested the manifestos lack big, radical ideas.

‘Not fit for purpose’

Dr Phil Banfield, BMA chairman in Wales, said the Welsh NHS was at a “complete crunch point”.

He added: “Either there needs to be an injection of cash or there has to be a radical rethink about how we’re going to provide services into the future.

“What’s missing is that vision. Starting with the patient – working what their health needs are and challenging health boards and politicians to provide that.

“The NHS is a massively complicated and cumbersome organisation – in some ways it’s not fit for purpose. And we’re trying to fit the patient to that organisation. That seems to be completely the wrong way round.”

All the medical bodies agreed that whoever forms the new Welsh Government needs to listen to the views of patients and frontline staff in developing new health policies.

They also appealed for the political parties to work together to address some of the big challenges that inevitably lie ahead.

The Welsh Green (nearly white) paper on Health – and the BMA Wales response. The candour of honest language and overt rationing, & exit interviews to lever cultural change..

Line break

The Royal College of Nursing in Wales (RCN) – which represents 25,000 nurses – is also opposed to any large scale NHS reorganisation but welcomed proposals to train and recruit more nurses.

However, it said more details are needed about how to achieve that.

“We need a vision about what the NHS is going to look like in five to 10 years,” said director Tina Donnelly.

“We haven’t got that yet. Nobody can tell us.

“It’s one thing to say lets have an increase in medical staff. But we know there are recruitment problems across the UK. And we know when we sometimes recruit staff into Wales sometimes they don’t want to stay.”

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The Royal College of Paediatrics and Child Health – which represents around 600 children’s doctors in Wales – argued some of the more deep-rooted problems will take longer to address.

Dr Mair Parry, officer for Wales, said: “It’s not just something you can put out an advert and get hundreds of nurses applying.

“There are no quick fixes to this. But the problem with long term fixes is it’s going to take more than one term of government.”

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The Royal College of General Practitioners also argues “piecemeal” changes will not be sufficient to address the “crisis” they claim facing family doctors.

It wants 400 extra GPs to be recruited and a big increase in the proportion of the health budget spent on primary care.

“I’m desperately concerned,” said Dr Rebecca Payne, Wales chair.

“We need vision, we need to see transformation, we need things delivered differently, we need to make the most of apps and telemedicine and all the ways we can work in the modern world and still keep the best of general practice – that personal relationship with a GP you known and trust.”

Line break

“You cannot oppose something you did not know was going on”…. PRIVATISATION derided

Dr Gill, a GP in Kent goes on to talk about contracted and salaried GPs and the demise of “continuity of care”.. The following film focusses on an American model alternative when there is no reason for this to be the model for the 4/5 different UK systems. The weakness in both the article and the video is denial of the need to ration overtly…. The honest debate asked for by Mr Stevens has not yet begun…. but watch the video, and do not stay gagged..

On borrowed time – The demise of General Practice Dr Bob Gill GP Welling, Kent February 2015


National Health Service privatisation plan has utilised many reliable techniques including concealment, divide and rule, and playing the long game. The Thatcher plan produced by the Adams Smith Institute in 1988 has been enacted by consecutive governments with only a few being aware. Failure by mainstream media and representative bodies to inform and educate the public and professionals has been an essential ingredient. How else could you disguise the gross betrayal of the public interest being conducted without raising significant public resistance? You can not oppose something that you didn’t know was going on.

The NHS sell off – a video on the privatisation of our Health Services.

A tsunami of structural change; the NHS has been abolished; increasing restrictions and exclusions; obsession with performance targets; the system is rotten; management and not doctors calling the shots; Tony Blair embraced Thatcher’s internal market; increasing Americanisation; PFI is derided (not allowed any more, and not ever in Wales); choice is a distraction when there is undercapacity, but it does help people aspire; we are losing something very special indeed…We ALL need to speak out.

Terrifyingly, according to the World Health Organisation definition the UK no longer has a NHS

David Oliver: The best health system – we are world class for equity, but not for outcomes

Amazing how England has been able to kid themselves there is an NHS – until now. Manchester’s health devolution: taking the national out of the NHS?

Liberal beliefs need to be modified pragmatically to create a sustainable health service – especially in Wales