Category Archives: Good News

Scotland calls for a new training philosophy and paradigm for General Practice. Its the shape of the job that matters, and it will take a decade to get enough GPs for 15 minute appointments.

The supply of doctors is finite, and has to be planned a decade ahead. Not only are doctors well paid (and regarded) but they are a moveable feast: transferrable skills mean they could work in one of many dispensations. The Commonwealth countries are particularly popular..

If the UK were to train 5 times as many doctors as we needed many more as a % would go overseas. There is a net 20% loss of all graduates from Wales, mainly to the UK, and a net 40-50% (my estimate) loss of medical graduates over 5 years.. SO it we don’t want the whole to be impractically expensive we have to persuade other countries to train enough doctors as well as the UK.

It would help if fewer women (more men) as a percentage of the total were trained. It would also help if there were a move to graduate as opposed to undergraduate entry. But even these changes, without insisting on 5 years “National Service” could fail unless the shape of the job is changed. 

The fact that Scotland suggests a new paradigm emphasises the 4 different dispensations, and the lack of a “National” health service.

Adrian O’Dowd for OnMedica 6th June 2019 reports: Call for new GP recruitment target

GP leaders in Scotland are calling for new recruitment targets to be set to boost the GP workforce north of the border and a 11% slice of NHS funding.

The Royal College of General Practitioners (RCGP) Scotland has published a new report called From the Frontline *, which draws on feedback from GPs across Scotland and their thoughts and experiences within the profession.

It has also launched a new campaign called #RenewGP, which calls for 11% of the Scottish NHS budget to make Scottish general practice “fit for the future”.

It also calls for GPs to be able to have minimum 15-minute appointments with patients in order to give them better care, but warns this would only be possible with more GPs in the system.

Tackling health inequalities was also crucial, said the report authors, who wanted GPs serving areas with high socio-economic deprivation to be appropriately resourced.

Central to all of the RCGP’s desire to improve general practice was planning for the future workforce and the report and campaign argue that as the population was living longer with more long-term conditions, Scotland needed more GP capacity to build and lead community healthcare teams………

There is no sustainable ideology – so leaders find their staff disengaged and that their job is impossible..

An exodus because of poor planning and the shape of the job. Deprofessionalisation….

Unreal manpower planning. It’s too late for a decade. GP services face ‘retirement crisis’. It’s the shape of the job silly.

Checklist will help decide if it’s time to die – as the shape of the job has reduced, recruitment has declined…

2014: Severe shortage of GPs is reaching crisis-point in Derbyshire – only 37% of GP training places filled – due political rationing of Medical School places 10 years ago, and the shape of the job

It’s the shape of the GP’s job that needs to change. The pharmacist will see you now: overstretched GPs get help…The fundamental ideology of the Health Services’ provision. Funding of this type admits 30 years’ manpower planning failure

2016: Martini GPs or Dead end jobs. The option is in the hands of politicians..

It was the best job in the world – for me 1979-2012 – but now there are not enough of us to cover the country

A GP in Milford Haven exposes the Inverse Care Law as applied by successive Governments, perversely and neglectfully..

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

Women perform better at 18, so change the age at entry to med school



Whistleblowing Champions – in Scotland only (for now). Apply through NHSreality, or Holyrood.

With permission (I assume) from Peter Gregson in Scotland, I can publicise the new Whistleblowing Champion, in Scotland only for now, then apply for the job through the link below. The other 3 UK dispensations may follow suit, but you never know: after all there is no National Health Service any more, except for emergencies. Congratulations to Pete for getting this success… Now we need to measure outcomes, especially longevity in post and unemployment rates..

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This is Pete’s e-mail to me:

Here is the video of the event at Holyrood  –

It lasts 90 minutes, but I think it’s good stuff.

The PA to the Health minister Jeane Freeman has asked for the link and says he’ll send it onto Jeane. I’d be impressed if she watches it.

I will send the link to the members of the Health Committee.

One of them, Alex Cole-Hamilton (LibDem) has asked to meet Rab and I. That should happen before the end of July.

Would any of you be interested in a new job? These are paid Whistleblower Champion posts.

Finally, if you know of anybody who wants to log a whistleblowing concern with us, give them this link  We’ll make sure the new Independent National Whistleblowing Officer, Rosemary Agnew, takes note.

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NHS Scotland must tackle bullying problems ‘head-on’ – Dr Lewis Morrison for the BBC News 25th June

Third high-level resignation from NHS Highland board in as many .. NHSH vice-chairwoman Melanie Newdick .Press and Journal 16th July

Surge in calls to Scotland’s NHS whistleblowing hotline – 19th April

Holyrood: NHS Whistleblowing champions ‘can come straight to me’, says Jean Freeman October 2018

Non-executive Whistleblowing Champions – NHSScotland – Apply here

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An increase in prescription charges encourages autonomy, but only in England. It also encourages movement between different systems… In Wales we already know we are second class citizens.

The recent announcement of an increase in prescription charges is “good news” for the English, because they will have more services of a higher cost and lower volume: the very services that Aneurin Bevan wanted to be available equally to miners and bankers. Unfortunately, with 4 / 5 health services, we are going to see more differences rather than les, in life expectancy (measurable) and in many services (unmeasurable) in the future. Wales and Scotland seem unable to discuss the subject of prescription charges without the emotion involved in a regressive rather than a progressive system. The short termism of this discussion, avoiding the “hard truths” and longer term financial issues means there will be more movement between different dispensations in future… But even this may become more within England, as different commissioners reduce the choices available to their patients. In Wales these choices have been severely limited for a decade, but then we know we are second class citizens.

There are already co=payments in eyes and dental services. Why not the drugs and appliances? We have to bring reality into the Health Services, and we need to challenge and “accuse” our governments of failing us with devolution.

In the current financial year in England:

If you will have to pay for four or more prescription items in three months, or more than 14 items in 12 months, you may find it cheaper to buy a PPC. The charge for a single prescription item is £8.80 (from 1st April 2018), whereas a three month PPC will cost you £29.10 and a 12 month PPC £104.00. They are free for many groups: children, retired, disabled etc. Why not charge according to means?

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The Pharmaceutical Journal 25th Feb 2019: Prescription fees set to increase to £9 from April 2019

Money Saving Expert 21st Feb 2019: NHS prescription charge to rise to £9 Feb 2019: Fury as NHS plans to raise prescription cost to £9

The cost of a surgical bra will rise from £28.85 to £29.50. And the charge for a full bespoke wig made of human hair will increase by £6, to £282.
NHSreality May 27th 2013: Prescription Charges and philosophy
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Bullying – we have to reduce it.

There is a grand collusion in politics and public services that bullying is uncontrollable, and therefore nothing is done. Large organisations have exit interviews, but the 4 UK Health services and the Irish have the same problem. The health services are chaotic, dysfunctional and one of the worst cultures to work in – and bullying is endemic everywhere. The recent article in the Times (Not available on line) indicates a soaring number of reports, is reproduced below. This illustrates the difference between prevalence (the total amount) and incidence (What comes to our attention). It may well be good news that more bullying is reported…. How about exit interviews then? No wonder GPs, who are self employed, resist being salaried and bought into the state culture!

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The Times in Ireland 28th Feb 2018: Beat Bullying

Public representatives should respond to claims of abuse and harassment in politics by leading the way to stamp out such behaviour in any workplace

Kieran Andres in Scotland 27th December 2018: Patients ‘losing out amid culture of bullying in NHS’ and even if you want to see him: The Minister is too busy to see you! (Jan 8th 2019)

Bullying costs the NHS more than £2 BILLION a year due to harassed staff quitting, making mistakes and resigningDaily Mail26 Oct 2018

and 8th November 2018:The number of NHS staff in Hull who say they’re being bullied

Health Service Journal 16th November 2018 by Laurence Dunhill: Full details: New NHS England and Improvement structure

Health service is chaotic and dysfunctional, says NHS chief Lord Prior of Brampton

The Times reports 25th Feb 2019 (Jonathan Ames) and not on line: Bullying and harassment claims in NHS soar by 40%.

Bullying and sexual harassment allegations in the NHS have risen by nearly 40% over the past 5 years, but only a fraction of claims result in disciplinary action.

Figures released yesterday showed that there were 585 reports of bullying and harassment9n the health service (presumably England only), up from 420 in 2013-14.

It was also revealed that two hospital trusts had imposed gagging orders on employees after settling claims.

Staff shortages and other work pressures were blamed for the rising number of reports, which include various forms of harassment including racism.

The figures emerged from a freedom of information act request submitted by the Guardian. A London surgeon, who asked not to be named, told the newspaper: “There are times when I have been operating and racist comments were used – this was when I was more junior, and it happens less now i am more senior.”……

Findings show sheer scale of issue, with only a fraction of cases leading to disciplinary action

Dr Anthea Mowat, British Medical Association representative body chair, said: “This is further evidence of the scale of bullying taking place in the NHS and it is essential that solutions are put in place immediately to eradicate unacceptable behaviour.”

This was too serious for another cartoon!







Plans for state-backed indemnity scheme for GPs in Wales

This is a piece of good news for GPs in Wales, but it should be National, not regional, and the ultimate solution is a “no fault compensation” scheme as in New Zealand. The scheme may give Wales an added attraction, which along with the inducement payments may help recruit and retain GPs.  There is a net 20% loss of graduates from Wales annually, and this may help correct, but it alone is not enough. Education is the big issue for doctors and their families, and addressing this is a longer term problem. Perhaps it will be extended to Hospital specialists as well?

Adrian O’Dowd for “onmedica” reports Friday 16th October in the BMJ: Plans for state-backed indemnity scheme for GPs in Wales

he Welsh government has announced its preferred partner to deliver the new state-backed scheme to provide clinical negligence indemnity for GPs in Wales from next year.

A medical defence body, however, has criticised the move, saying this was an untested scheme with insufficient detail and could remove GPs’ ability to choose an integrated indemnity and advice product instead.

Welsh health secretary Vaughan Gething announced yesterday the NHS Wales Shared Services Partnership’s Legal and Risk Services, who currently indemnify GPs working out of hours, is the preferred partner to operate the Future Liability Scheme from April next year.

Mr Gething, speaking in Cardiff at the Primary Heath Care Conference, organised by the Primary Care Hub and 1000 Lives Improvement in Public Health Wales, said the scheme, which would be aligned to the scheme announced in England, would ensure GPs in Wales were not disadvantaged and that GP recruitment and cross border activity would not be adversely affected by different schemes operating in the two countries.

Mr Gething said: “This new scheme will provide greater stability and certainty for GPs in Wales. It will support GP practices and primary care clusters in their delivery of sustainable and accessible health care.

“The Future Liabilities Scheme will cover the activity of all contractors who provide primary medical services. This will include clinical negligence liabilities arising from the activities of GP practice staff and other medical professionals such as salaried GPs; locum GPs; practice pharmacists; practice nurses; healthcare assistants.

“I will make a final decision on the delivery of the Future Liability Scheme in Wales following further engagement with medical defence organisations.”

Medical and Dental Defence Union of Scotland (MDDUS) chief executive Chris Kenny was sceptical, saying: “We are concerned that this untested state-backed indemnity scheme will be implemented in April 2019 when so little detail has been shared with MDDUS or GPs in Wales.

“We have been pressing the UK and Welsh governments to provide comprehensive operating and funding details of the new scheme for some time now yet little has been forthcoming.”

The existing medical defence organisation (MDO) model worked well, he argued, adding: “Writing MDOs out of a claims service is a false economy – and a threat to GPs’ professional standing.

“That’s why we expect the state-backed schemes in Wales and England to preserve these principles. If government want to offer a simple claims only service, then GPs should be able to choose the integrated MDO service at no financial disbenefit.

“We believe this is a high-risk approach which fails to protect GPs’ professional reputation, removes choice and, as independent contractors, GPs should have the option to choose an integrated indemnity and advice product as compared to the state-backed scheme.”

Dr Charlotte Jones, chair of the British Medical Association’s GPC Wales, said her organisation supported the Welsh government’s choice of preferred partner.

“The proposed scheme will address one of the biggest financial pressures on GPs and will help enable all GPs, practice teams and wider cluster healthcare professionals to work more closely together taking forward the transformation of Welsh primary care.”

Dr Peter Saul, joint-chair of Royal College of GPs Wales, said: “Indemnity is a real issue for GPs, which can affect the time they can spend in practice treating patients. The college campaigned for and supported the announcement of a state-backed indemnity scheme and it’s encouraging to see steps being taken to create a sustainable solution.”

Asbestosis report: BMA – Medical indemnity for GPs in Wales

2012 (6 years ago and it’s worse now!) : Medical negligence costs rise in Wales – NHS News

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General News regarding the 4 UK Health Services in last 2 weeks.. Worse and worse…

Readers might well ask “What is the legal situation regarding rationing?” Well, as long as its called something else, prioritisation, restriction, limiting or excluding, trusts can, within certain limitations, ration health care. The risk of anarchic rationing by post code was exposed by NHSreality last week. (NHS rationing and the Law by Warwick Heale in Devon) The risk is getting higher….. and as each week draws nearer to Brexit day, UK citizens might wish to consider how they can reduce risk. Private insurance is all very well for “cold care” (Non urgent) but emergencies are unpredictable, A&E s are understaffed, and capacity is limited as well as funding. The safety net which was there when I qualified in 1974 is well and truly holed. I strived to find “good news”, and note the savings on syringes and gloves.. but this is child’s play compared to the waste elsewhere. The return of fear and the ultimate lottery in health care has arrived. The average citizen/punter will not recognise the problem until they or their next of kin are ill….. The current funding and the system for funding health overall is a political decision. The need for change is paramount, but in the Brexit limbo iceberg of today, no important changes are likely. Its going to get worse…

NHS rationing and the Law – by Warwick Heale in Devon

Gareth Iacobucci in the BMJ reports 16th September: GP exodus could force hundreds of practices to close in next five years, royal college warns

and on 2nd October David Oliver reports:  The crisis in care home supply

Mark Smith for Walesonline 22nd October reports: Welsh NHS boss quits and is moving to England to get better cancer care for her husband –  Prof Siobhan McClelland says she has lost faith in the Welsh NHS

and the Welsh Health Minister “rejects her claims” in the Mail

Michael McHugh 22nd October 2018 in the Belfast Telegraph: Cancer treatment in Northern Ireland receiving ‘sticking plaster’ approach, says campaigner – Co Down woman blasts care available to patients

and Northern Ireland health service facing resourcing crisis amid 1,800 vacancies – health chief Valerie Watts – An extra £100 million has been set aside to overhaul the system as part of the DUP’s confidence and supply agreement.

and MP’s ‘real concern’ at disparity in health service between Northern Ireland and UK

In BBC Scotland Glen Campbell reports 16th September: Health board says Brexit poses ‘very high’ risk of disruption after August : NHS Scotland works up ‘detailed’ no-deal Brexit plan

BBC News Holyrood Louise Wilson 22nd October: Statements on abuse, NHS and P1 assessments – Worse waiting lists, waiting times, cancer waits, and outcomes wompared to England.

ITV News reports something good: NHS saves £228m on syringes and disposable gloves!

and there are “not enough showers or toilets” in a Broke Trust.

Jamie Doward in the Observer Sunday 21st October: Ten NHS trusts ‘wasted £235m to hire private ambulances’ – Union anger over bill for outsourcing while service starved of cash

Dennis Campbell Sunday 21st October: NHS £20bn boost risks being spent to pay off debts, experts warn – PM urged to write off £12bn in hospital overspending or extra healthcare will be unaffordable

Martin Shipton for Walesonline 28th September: Welsh councils demand health cash is spent on schools and social care – Local authorities want the Welsh Government to give them some of the extra money that is coming to Wales as a result of NHS funding rises in England

Cathy Owen for Walesonline 18th September: Iceland is giving NHS staff free ice cream and pizza – Workers who have signed up to the supermarket’s Emergency Services Bonus Cardiff will benefit

David Williamson for Walesonline: GPs in Wales are getting a major pay hike – what the 4% deal means for staff  – Doctors are delighted but dentists are upset

Richard Youle 3oth September: Health board wants to ditch Welsh-only name because it thinks it’s putting people off working there – But it fears ending up being called Healthy McHealth Board, if it lets the public vote for a new name, following the Boaty McBoatface debacle

Mark Smith and Ruth Mozalski: Deaths of 26 babies being investigated by Cwm Taf health board

A review has found 43 maternity cases where there was an ‘adverse outcome’ since the start of 2016

Adam Hale 9th October: NHS managers ‘used names of U2 band members to cover £700,000 fraud’ – The trio allegedly helped secure payments for building work which had ‘major deficiencies’ and cost £1.4m to rectify

Strand News Service: Boy left brain damaged by ‘negligent care’ at Welsh hospital is awarded millions in compensation  – The boy, who is now eight, suffered ‘catastrophic injuries’ in the first few days of his life

Doncaster, which cannot attract doctors easily. is taking matters into it’s own hands: NHS Trust looks to Doncaster school for future staff (BBC News 19th October)

NHSreality wonders if it was a doctor who first saw the young man in Tonbridge Wells: Tunbridge Wells man died after misdiagnosis of sepsis symptoms (BBC News 18th October)

And in the Isle of Wight: Isle of Wight hospital trainee doctors ‘left alone’. – Hospital patients on the Isle of Wight suffered as a result of trainee doctors being left to make decisions they were not qualified to make, inspectors said.

BBC News 22nd October: King’s Lynn QE hospital head quits following ‘inadequate’ report

Dennis Campbell on 21st October in the Observer: NHS £20bn boost risks being spent to pay off debts, experts warn – PM urged to write off £12bn in hospital overspending or extra healthcare will be unaffordable

Are we to expect rationing by anarchy? Will we repeat the lessons of the past?

NHS rationing and the Law by Warwick Heale in Devon


New technologies and rationing by post code/region. New treatments and assessments are not available to all UK citizens.

Its good news that we can embrace new technology, and quickly, but the decision raises other issues. Mainly to do with rationing honestly… Other new technologies will follow (Hope of cure for men with aggressive prostate cancer) but whilst there are 4 different health systems, and announcements only apply to one of them, we in Wales will wonder if we can afford what England can. Only this week a friend went to London for a new prostate cancer assessment test (mpMRI) which is not available in Wales. (Sign the petition on line) ( He went Privately) Assessment and staging of Prostate Cancer is essential, and there are far more sufferers than there are with leukaemia.

Paul Kelso for Sky News reports 5th September: NHS England nets ‘game-changing’ childhood leukaemia treatment

The therapy – which has a list price of £282,000 per patient – is currently only available in Europe as part of clinical trials.

The Times also reports: Game-changing NHS treatment to save children with leukaemia

The Telegraph: NHS to fund “game changing” personalised cancer drug.

But can we afford these treatments without rationing the high volume and low cost treatments? How does such technology fit in with “personal health budgets”?

High Tech advances hit NHS funding. A proper debate wont happen however.

Interesting suggestion low cost for high volume treatments to be excluded… GPs will take no notice as their job is to put their patient “at the centre of their concern”.

World class cancer care (and Mental Health care) is possible, if we ration the high volume low cost treatments…

The cost of high tech treatments – that if these become “universal” then the low cost high volume treatments need to be paid for.

Trials of personal budgets will have long term perverse outcomes in an ageing society. Health costs are rising, and geographic variations will become greater….

Wales ‘behind’ in technology to detect prostate cancer – BBC News

Prostate Cancer breakthrough with a more accurate test (Scotland)

PET scans for prostate cancer (Birmingham)