Category Archives: Consultants

Consultants are at the highest point of their profession – or are they? What ambitions do they have and are they able to do research easily?
How does sub-specialisation fit in with keeping ones skills as a generic doctor? If those generic skills are lost, does it matter?
Should all consultants be in teams run by tertiary centres and with opportunities to go to the centre for updating?
Are the consultants in your local hospital happy they are there? Would they have preferred to be elsewhere? And how do they see management and professional standards changing?

Don’t believe we are rationing? Do you believe in transparency and honesty? Why not use the correct word?

Just in the last few days these news items reveal the truth. Despite this the “R” word can never be acknowledged by politicians. None since Enoch Powell has embraced the truth. (Described by Richard Smith, former BMJ editor as “the best book written on the NHS”. A new look at medicine and politics: 1975 and after. Pitman Medical 1976. 2nd edition. ) 

Link to his book published by the Socialist Health Association

Why do you think we had no PET scanners until 20 years late! Why are there waiting lists longer than any other G7 country (and the results to match)? Why have the two countries that emulated the original NHS reconsidered? (NZ and Scandinavia). Why are we only appointing 1 doctor for every 10 who apply and have been encouraged to do so by their careers officers? Why are botched operations so commonplace?  Why does the NHS Ombudsman produce reports which have no notice taken? Do the politicians read these reports?

If you believe in honesty and transparency why not use the correct word? We will never win the hearts and minds of the health service staff if politicians and media and public collude in the language of denial.

Henry Bodkin in the Telegraph 14th September 2019: NHS bosses tried to “gag” father of boy whose life was ruined in botched operation

In The Guardian 30th August 2019 Dennis Campbell: ‘Crumbling’ hospitals putting lives at risk, say NHS chiefs  –  Four in five NHS trust bosses in England fear Tory squeeze on capital funding poses safety threat

Why cannot Cheshire recruit enough GPs? Pulse reported by Lea Legraien 14th September

Why do we still get fraudulent managers promoted (The Independent 19th December 2018)

Why are half of the 4 health services’ trusts using out of date radiotherapy equipment? ( Andrew Gregory in The Sunday times 15th September 2019 )

This is particularly important for Pembrokeshire and West Wales as we have a long distance over difficult roads to travel to Swansea at present. Our planned new Hospital, wherever it is, needs Radiotherapy, Radio Isotope Investigations, and STENT treatment for Coronary Heart Disease if our options are to be the same as those in more favoured areas. I reproduce the article at the bottom of this post.

Adam Shaw for the Harrow Times reports 13th September 2019: North-West London CCGs dismiss claims of “rationing” services.

Kat Hopps September 13th in the Express reports: IVF: How NHS IVF treatment is unfair postcode lottery and keeps couples childless

A disgrace and a shame on politicians: “Surge in patients raising own cash for amputations”. Rationig by waiting and by incompetence.

Pembrokeshire Oncology cancer services in crisis

There is a “need to put doctors in charge and force them to take account of patients’ views. Cancer survival rates are (just) one of the prime examples of NHS mediocrity.”

Desperate NHS needs a desperate remedy – care is already rationed

The 3 myths of the NHS…..& …No learning from other countries – no co-payments, and more scandals..

Britain ranked last (out of 20 rich countries) by a wide margin in the number of CT and MRI scanners per head of population. Australia has six times as many CT scanners per head, and spends roughly the same as Britain on healthcare overall as a share of GDP.

Why are half of the 4 health services’ trusts using out of date radiotherapy equipment? ( Andrew Gregory in The Sunday times 15th September 2019 )

Almost half of NHS trusts are using outdated radiotherapy machines that are far less effective at killing cancer cells to treat patients.

The revelation comes days after the UK came bottom of an international league for cancer survival rates in The Lancet Oncology journal.

In 2016 the NHS said it was investing £130m in upgrading radiotherapy equipment but the figures, revealed via freedom of information requests, found 46% of trusts are still using outdated linear accelerator (Linac) machines beyond their recommended 10-year lifespan.

Dr Jeanette Dickson, president of the Royal College of Radiologists, said more advanced radiotherapy techniques enable “greater precision when targeting specific tumours and have been shown to be less harmful to surrounding tissue than older types of radiotherapy, depending on the complexities of the cancer being treated”.

Rose Gray, policy manager of Cancer Research UK, said it was “deeply concerning” to hear outdated radiotherapy machines were being used.

She said: “The NHS has grappled with the question of how best to replace outdated equipment for many years, and the government has repeatedly been urged to put a long-term plan in place.

“But . . . that still hasn’t happened. These investigation findings prove the urgent need for a solution to this persistent problem.”

In total, 57 of the 272 Linac machines used this year are 10 or more years old. One of them that is still in operation has been used for 17 years.

Dr Peter Kirkbride, the former chairman of the government’s radiotherapy clinical reference group and spokesman for the Radiotherapy4Life campaign, said: “That radiotherapy has been put on a lower footing than other cancer treatments — such as chemotherapy — by successive governments is an open secret within the NHS.”

The Liberal Democrat MP Tim Farron, chairman of the all-party parliamentary group on radiotherapy, described the figures as “shocking”.

He said they proved the investment in 2016 had been a “drop in the ocean” when compared with what is required to meet soaring demand.

Saffron Cordery, deputy chief executive of NHS Providers, which represents hospitals, added: “What we do know is that for year after year, money earmarked for capital investment has been siphoned off just to keep services running.”

An NHS spokeswoman said 80 radiotherapy machines had been upgraded since 2016 and patients were benefiting from “a range of improvements” to cancer services.

Enoch Powell 4 Supply and Demand – Rationing

 

Even London and the Home Counties are feeling the squeeze… as standards and staff numbers fall re revert to the pre-NHS divide.

Just some of the pain felt in the rural shires is now feeding into London and suburbia. Standards of staffing and clinical diagnosis and speed are all falling. The blame is long term political neglect and denial from an elected elite who always felt they had access to the best – in London. No longer… it is impossible to report on all GP surgery closures as there are so many. The reality is that private services for ambulance, GP, A&E etc will follow… Bevan wanted the same high standards for the miners as the bankers – instead the standards are falling, but as before we had a health service, the bankers can afford the private option.

Owen Sheppard for MyLondon reports 7th September 2019: West London overspends by £112m!!

GP surgeries across Surrey are facing an uncertain future, with two confirmed closures and a third possibly following suit, which are set to put pressure on those nearby.

Patients say they are worried about the pressures on neighbouring services following the announcement of closures of surgeries in Staines and Guildford.

In Burpham, a petition has been launched to save the Burpham New Inn surgery which is also facing closure.

So why are surgeries closing?

The Guildford and Waverley Clinical Commissioning Group (CCG) has cited problems with leases and premises, which have led to the closures of two practices in the area.

In Staines, the Staines Thameside Medical Practice shut on Saturday (August 31) following a decision by the doctors to end their contract with the NHS to provide GP services. This was reportedly due to personal reasons.

Patients will lose the St Nicolas branch surgery in Bury Fields, Guildford, which will close at the end of October following issues with the premises and its lease.

Guildford and Waverley CCG has confirmed the surgery will close on October 24. All services will instead be provided by the main surgery at Guildford Rivers Practice in Hurst Farm, Milford.

One St Nicolas patient, who did not wish to be named, said: “I am very upset about the closure of St Nicolas Surgery, it came as a shock.

“[I believe] this was pre-planned since last year but without telling patients previously. I have not received a letter as yet about the closure.

“I think it’s been about a year that all the telephone calls to St Nicolas Surgery have been re-directed to the general practice in Milford.

“The closure of St Nicolas Surgery will put extra pressure on other GP surgeries in Guildford as patients who are ill, disabled, elderly or who don’t drive won’t be able to get to Milford.”

The CCG has said it will work with the practice to ensure that despite the changes, patients will continue to receive high quality care.

A spokesman said: “The CCG received an application from Guildford Rivers Practice that proposed the closure of its branch surgery, St Nicolas Surgery, due to issues with the premises and the lease which was proposed to have had a negative impact on the service offered to patients.

“Following a period of engagement with patients and neighbouring GP practices, the application to close the branch has now been approved by Guildford and Waverley’s Primary Care Commissioning Committee (PCCC).”

The spokesman added: “Registered patients of Guildford Rivers Practice will remain so, following the branch closure, with GPs from St Nicholas Surgery transferring to the main site and continuing to offer appointments to patients.

“Any patients who require home visits will continue to receive these in the usual way.

“The practice is committed to providing the best service for patients by operating solely from the Guildford Rivers Practice main site and the CCG will work with the practice to ensure patients continue to receive safe and high quality care moving forward.”

The news comes as patients await the decision on the future of Burpham’s New Inn surgery. A decision was set to be made on August 28 but this has been delayed.

A spokesman for Guildford and Waverley CCG said: “The PCCC has been re-arranged to ensure every option put to the CCG is fully explored, before a final decision is made.

“The committee has been rescheduled for September 13.”

In a letter to patients sent on July 31, the CCG said it was likely the New Inn Surgery in London Road would have to close later in 2019 due to problems securing a long-term home.

The letter said the surgery’s lease was expiring and no other suitable alternative sites have been found.

Patients launched a petition to save the surgery, which has been signed by 282 people to date.

Staines

Around 4,500 patients have had to re-register with another GP surgery after Staines Thameside Medical Practice closed its doors on Saturday (August 31).

Other GP surgeries in the area are accepting new patients despite some having recently had their lists capped.

Two Staines councillors are concerned about the additional pressure on those surgeries.

Councillor Jan Doerfel, Green Party member for Staines, said: “Expecting other GP practices to absorb the additional 4,500 patients is likely to result in longer waiting times for all those affected and additional travel for those that had to enrol with those practices. This is not acceptable.”

Councillor Veena Siva, Labour member for the ward, said: “Yet another GP surgery closes. Smaller practices are closing due to underfunding and insufficient GPs which means they can no longer be run safely and sustainably.”

She added: “As it stands, it is unfortunately no surprise that there was no interest from GPs to take over the surgery when in doing so all they would face is under-resourcing, enormous pressure and stress.”

NHS North West Surrey Clinical Commissioning Group (CCG) was responsible for supporting patients as they switched to a different GP service.

St David’s Family Practice Doctor Jagit Rai works at one of the surgeries receiving patients from Staines Thameside and is a governing body member at NHS North West CCG.

Doctor Rai said: “The closure of this practice does not relate to funding or staff shortages. The CCG was disappointed to receive notification from GPs at Staines Thameside of their decision to end their contract with the NHS to run the surgery.

“They made this decision due to a change in personal circumstances that could not have been predicted or planned for. The CCG asked neighbouring practices about the option to take over the running of Staines Thameside and reviewed their capacity to take on new patients.

“The surgeries decided the best way to care for Staines Thameside patients is at their practices where they can benefit from an established team and range of services.”

It’s slightly brighter news for the residents in Chiddingfold, where a new surgery is being built after the former building was destroyed by a fire.

Chiddingfold Surgery in Ridgley Road was gutted on January 7, 2019.

Plans were submitted in March to Waverley Borough Council for the complete rebuild.

The surgery has relocated to Cedar ward at Milford Hospital, where full doctor and nurse surgeries are in place. Expanded opening hours are available for patients at Dunsfold surgery.

Update : Diane Taylor in the Guardian 8th September 2019: London GPs told to restrict specialist referrals under new NHSThe New “Rationing Plan”. Plans for new cuts sent same day Boris Johnson reinforced NHS spending commitments..

The firm: does it hold the answers to teamworking and morale?

The BMJ The firm: does it hold the answers to teamworking and morale? (BMJ 2019;365:l4105 )

Rotations and shift patterns mean that junior doctors often struggle to feel part of a team. Some want to bring back the “firm” way of working. But is this feasible, and was the firm really part of a golden age for trainees, asks Abi Rimmer

In the discontinued “firm” system—a model of medical apprenticeship—groups of doctors worked together to provide patient care.

Firms generally had at least one permanent member, a consultant, who led the firm and after whom it was named. Some four of five trainees of varying seniority weren’t permanent members of this firm, but they belonged to it, and for many it was a consistent source of professional and emotional support.1 The quality of education and training that trainees received, however, varied.2

The firm’s demise came after 2005 when trainees began rotating more frequently under the Modernising Medical Careers programme. From 2009 European working time regulations shortened doctors’ working hours. Junior doctors spent less time on the wards and their involvement in teams became far more transitory.

But many doctors would like to see the firm reinstated, seeing it as an answer to today’s problems of disenfranchisement and low morale among junior staff.

The cause of all the mayhem

When the firm functioned well, says the Royal College of Physicians (RCP), it provided “a structured development process, role modelling of professional behaviour, mentoring, and a good balance of challenge and support.”2

Harold Ellis, a retired professor of surgery who qualified in 1948, describes his firm as being like a family. In a firm, Ellis tells The BMJ, there would be one or two consultants known as “the chiefs,” a senior trainee known as “the registrar,” a junior trainee known as the “house physician” or “house surgeon” who lived in the hospital, and medical students……

Re: The firm: does it hold the answers to teamworking and morale? Reply 13th June 2019

Firms would wither in this age of individualism.

Firms that thrived in past had a wise head leading it; collective responsibility was cherished and self sacrifice was applauded not derided.

In firms, good and bad decisions had ownership and learning from mistakes is encouraged without a sword hanging over the head.

But the firms of the past would not survive the current “age of individualism”. Now individual rights reign supreme without even a symbolic nod to group responsibility. Good firms place patient needs first and hence is incompatible with a clock watching culture.

Today:

Re: Consequences of losing firm: true or false ?

Having had surgical training between mid – 80s and early 90s in traditional firms led by a consultant and supported by senior registrar, registrar and house surgeons (senior and junior) and following completion of the training , worked as a consultant till date, has given me an opportunity to appreciate the gains and losses incurred under both schemes. In all honesty, both systems have their inherent advantages and disadvantages, and both are not perfect. When one speaks to trainees of current system, they favour the present system of training with shift system as this is thought to be more humane and safe in comparison to the past system which included long hours of on calls (24 hours on week days and 72 hours on the weekends) with potential risks to the patients and doctors from lack of rest and exhaustion. Lack of continuity of patients care and incomplete connection with the patients and team are the major barriers to comprehensive training in the current system. However, eight years of structured current surgical training programme (core and specialist training) with well described curriculum and objective examinations (MRCS and FRCS) on completion of stipulated training, is at par with surgical training schemes internationally, including USA and Australia, as far as I am aware. It must be acknowledged that NHS in UK is under financial constraints and its repercussion as reflected by the reduced number of staffs (doctors and nurses) has significant implications on the workload of doctors, particularly the consultants, and the quality of training. It is important to assess issues surrounding the current training scheme and address them commensurate with the rapidly advancing science and technology in medicine.

Tere is a toxic culture, and disengagement everywhere in Health and Social Care. Also in the CQC …

GP list sizes in England can be found here. 

Standards are falling in most areas because of the pressure of work both in Hospital and General Practice. Occasional well respected and popular training practices are the least under pressure. In social care standards are also falling, and one inspector (Greg Hurst reports in the Times 13th June 2019) has quit citing a toxic culture in the Care Quality Commission. He should be listened to, as there is a toxic culture, and disengagement everywhere in Health and Social Care. Of course there will always be examples of individuals who break the mould, but in general NHSreality says it as it is. The Times report is below..

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Mary MacCarthy in Pulse December 2018: Cappling GP lists would make GPs and patients safer: 

Nick Bostock in GPonline 12th December 2018 reports that since 2004, there has been a 50% increase in GP list sizes.

and earlier that year, he reported with Teni Oluwunmi  that the number of GP practices had declined by 263!!

and last year, according to the Mail by 138

Emma Bower for GPonline 5th June 2019 also suggests that Scotland needs a new target for the GP workforce. With increasingly elderly population with multiple pathologies and complexity, 15 minute appointments are also needed. (BBC News)

Anal Carcinoma needs prevention with HPV vaccine? A nurse comments on her own illness…in Healthonline

Research in the US has discovered what the drug manufacturers should have found: drugs for shrinking enlarged prostates cause delay in the diagnosis if the prostate goes malignant. Another case of Big Pharma and overtreatment.

Barry Stanley-Wilkinson gives his exit interview from the CQC. (Greg Hurst reports in the Times 13th June 2019) has quit citing a toxic culture in the Care Quality Commission.

Waiting lists are getting longer, even for cancer diagnosis and treatment. Nick MacDermott in the Sun12th June 2019 so keep up the private insurance payments as long as you can, especially if you live in Wales.

An inspector whose report highlighting failings at a scandal-hit hospital was never published resigned from the regulator, protesting that some of its staff were too close to the private company that ran the hospital.

Barry Stanley-Wilkinson also complained of a “toxic” culture at the Care Quality Commission and said many of its inspectors felt that they worked in a “bullying, hostile environment”.

Mr Stanley-Wilkinson resigned six months after he led an inspection in 2015 of Whorlton Hall, a private hospital in Co Durham for adults with learning disabilities or autism. Police arrested ten carers at the hospital last month after Panorama on the BBC broadcast footage of staff appearing to mock and intimidate patients.

The inspector reported in 2015 that some patients had accused staff of bullying and inappropriate behaviour. He said patients did not know how to protect themselves from abuse and recommended that the hospital should be given a rating of “requires improvement”.

His report was never published and a new CQC team that inspected Whorlton Hall in 2016 gave it a “good” rating. Mr Stanley-Wilkinson’s resignation email, sent to the CQC in January 2016, was published yesterday by parliament’s joint committee on human rights, which took evidence from two CQC executives. He expressed frustration that his report on Whorlton Hall had not been published “despite significant findings that compromised the safety, care and welfare of patients”.

He referred to a complaint about his report by the hospital, which was then run by the healthcare company Danshell, and pointed out that it had previously been run by Castlebeck, which ran Winterbourne View, a care home where there had been an abuse scandal in 2011. Whorlton Hall was taken over by Cygnet Health Care this year.

“I am concerned about the relationship managers have had with the service,” Mr Stanley-Wilkinson wrote. “Discussions had taken place without my involvement despite me being the inspector.”

Paul Lelliott, deputy chief executive of the CQC, said the 2015 report had had inconsistencies and lacked evidence. Ian Trenholm, its chief executive, said the CQC planned to develop a new way to monitor institutions.

Image result for falling standards cartoon

 

What is the cure for depressed doctors? Adam Kay

The BMA tries to look after the wellbeing of doctors. We all know however, that a union is far removed from an employee! Adam Kay, author of “This is going to hurt” explains his views on solutions. He asks the question, in the Sunday Times 19th May 2019, “What is the cure for depressed doctors? NHSreality agrees with his suggestions, but adds more. In addition to being treated properly, and cared for by our employers, we need meaningful exit interviews, and we need to feel that the edifice of our particular health service is founded on a financial rock, is fair and equitable, so that across the nation those paying the same taxes get access to the same quality of care for serious problems. This is NOT the case. Wales in particular, of all the UK Health Services misses out on choice, quality and waiting times. 

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In the BMA website the wellbeing of doctors is addressed.

The support services are explained clearly.

The BMA purports to support the wellbeing of doctors and medical students. it includes:

  1. Report: ‘Caring for the mental health of the medical workforce’
  2. Principles to improving the health and wellbeing of doctors and medical students
  3. Report: ‘Personal stories of doctors in training with experience of mental illness’ 

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Melting down….We are all getting what we deserve. Without honesty to ration overtly the system will only get worse.

The profession has been warning the different UK governments and Health Administrators for decades that there would not be enough trained doctors, nurses and attached staff. Now that this is actually happening, what are the thoughts of NHSreality? You get what you deserve in a first past the post short time horizon system? You get what you deserve if you don’t do exit interviews, and destroy teams? You get what you deserve if the access is so poor that citizens are pushed into private care? But even if we had trained too many doctors etc, we would still have a system with unlimited demand, limited resources, and no disincentive to make a claim (other than prescription charges, travel and parking). We need exit interviews urgently, and in West Wales the threat of Hospital closure and of poor Out of Hours coverage is so bad that many people may choose to leave the area…..

Image result for meltdown hospital cartoon

The Nuffield Trust gives some background and insight into how we have got to this point, but without referencing rationing. The trust reports the worst April on record…

The paediatricians in Wales are over-working, but this is partly because of the shortage of GPs. They find that it is easier to refer many problems than to see them again and support in the community.

The radiologists are worried that their vast workload leads to mistakes (mainly of omission).

Nick Triggle for the BBC reports: GP pressure: Numbers show first sustained drop for 50 years

Its not just patients who are charged: Trainee doctors on call at night are often charged for sleeping!

In a world market the Irish Times reports that there are plenty of opportunities in the UK, but you will have to work “HARD”.

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Perhaps Pembrokeshire will be the first area to “go private” and abandon the health service?

Do we need an Aspberger’s Teenager to tell it as it is…?

A GP in Bristol explains for Gulf News

A GP in Pembroke explains for those who don’t know that “the hours stink”.

 

The revolving door of health service managers….. mismanagement is nothiong less than neglect.

The mismanagement of the 4 health services that used to be the “National Health Service” amounts to nothing less than neglect.

We medics all know managers who move on quickly. Being fast on your feet is essential in a  service where nothing is addressed long term. Recruitment is a nightmare of under capacity, female bias, and the resultant manpower disaster means we need to recruit from overseas for decades. NHS looks abroad for thousands of nurses – Health chiefs admit failing to plan for elderly care

We jaundiced GPs and Consultants can only assume that these managers have no exit interviews, and that nobody wants to hear what they have to say any more than the professionals.

Chris Smyth reports 7th May 2019 in the Times: NHS register to stop ‘revolving door’

A professional register of NHS managers and a values test for senior leaders are being planned to stop a “revolving door” for failed bosses.

A health service scarred by bullying and stress “needs to be a better place to work”, an interim workforce plan concedes. Although the NHS acknowledges that unexpected pension tax bills are forcing doctors to retire early and work fewer shifts, plans to tackle that issue have been removed from a final version.

The NHS interim people plan makes the starkest acknowledgement yet that staff are leaving the health service because they are overworked, with increases in bullying, harassment and abuse all reported recently.

The plan promises staff that they can expect support on work-life balance, whistleblowing protection and equal opportunities. Specific details are yet to be decided but the plan pledges that more jobs should be part-time or term-time only.

The plan lays out how the management culture of the NHS had to change to “root out bullying and harassment” with an admission that all staff will have experienced a dysfunctional working environment at some point.

“It cannot be right that there are no agreed competencies for holding senior positions in the NHS or that we hold so little information about the skills, qualification or career history of our leaders,” the plan states.

“A series of reports over the last decade have all highlighted a ‘revolving door’ culture where leaders are quietly moved elsewhere in the NHS, facilitated by ‘vanilla’ references,” the plan continues. “These practices must end.”

A government-ordered review has previously recommended a set of core skills for managers. The NHS has now pledged to draw up “an explicit set of competencies, values and behaviours required in different senior leadership roles”. This could include, for example, honesty and protecting patient safety.

Ministers have previously promised a central database of directors’ qualifications. The NHS has now pledged to “develop options to create a registration scheme for NHS managers similar to those used in other healthcare professions and in finance”. It is unclear whether such registration would be compulsory. The plan concedes: “The lack of a transparent, fair and consistent process for the appraisal of senior leaders has contributed substantially to the challenges we face today.”

The plans do not address higher pension taxes for top earners, which are forcing many consultants to retire early or turn down extra shifts to avoid bills for tens of thousands of pounds.

Mistakes due to overwork are manslaughter. Not enough sickness and absenteeism? Nobody blames the management and politicians… “Wise doctors will retreat from the front line now?”

The Health Services Procurement – inefficient and risky… Centralisation and management control is needed

This mismanagement of the NHS amounts to neglect

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