Category Archives: General Practitioners

The state of the Trusts’ budgetary deficits should be made public before the election… Purdah rules should not apply

Normally there would be a budgetary report on the English Welsh and Scottish Trusts before the election. Home office staff are arguing that such data is so politically sensitive that it should be kept secret until after the election. What nonsense. Hiding the truth is not a good precedent for something which should be routine. Darlington Hospital is one of many who may not be able to pay their staff. The state of the Trusts’ budgetary deficits should be made public before the election… Purdah rules should not apply to something routine and pre-planned. BBC News reports 19th May: Reality Check: Why is NHS budget data delayed by purdah? and Will NHS stats spark polling day debate? 

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All the Trusts are bust.

Ben Glaze in the Mirror reports 20th May 2017: Tories accused of ‘blocking damning figures on state of NHS finances’ – Key statistics were due to be released at the end of May but ministers are citing “purdah” rules to hold the information back until after the election

on 19th May in the Northern Echo, Graeme Hetherington reports: Darlington Memorial Hospital trust could run out of money to pay some wages unless plan to solve cash crisis is found

A HOSPITAL trust could run out of money to pay some staff wages unless it comes up with a plan to solve its dire financial predicament by next month.

Concerns over the future of Darlington Memorial Hospital have been raised after details of its financial situation were leaked to The Northern Echo.

Senior management and consultants are being told to tighten their belts as money-saving initiatives are missing their targets and an email sent to some staff has highlighted that the trust could run out of money if drastic action is not imposed.

The County Durham and Darlington NHS Foundation Trust ( CDDFT) introduced cost reduction targets (CRT) in an attempt to balance its books – but is missing its £6.9m savings target by about £1.7m.

The detailed email raises the prospect of the length of operation and appointment waiting times being extended beyond the Government target of 18 weeks, the Trust’s inability to cover staff wages and a reduction in nursing levels.

However, the CDDFT’s consultant surgeon and surgical care group director is reassuring people that patient safety is central to all discussions in the hospital and that there are no plans to reduce staffing levels.

The internal email was sent out to senior staff following a meeting of the Trust’s Financial Stability Programme, which was described as a “maul” after the stark warning was driven home by finance chiefs.

And the news comes just days after it was revealed that maternity services at the hospital could be lost as plans are being investigated to centralise care in Darlington, Durham and North Tees – albeit on a temporary basis.

Today, the full extent of the financial pressures on the hospital’s surgical departments can be revealed.

The email reads: “The three of us have to go back in four working days time with a full plan, costed and developed for a further £1.5m pounds of guaranteed CRT in addition to the already identified as an interim to meeting the full amount. So far in month one we are forecasting to be £350k (April) overspent due to not achieving CRT.

“I do not intend to just pass on this message in the same way. You all work hard and I know you are all very hard pushed for time. However, I need urgent and focused work form every one of you to help the senior triumvirate as yesterday’s is an experience I have not had before and never want to have again.

“I have been asked to ensure that all staff are fully briefed that if by June we do not have a full plan for CRT and are not completely in control of expenditure that we, CDDFT, will run out of cash to pay wages.

“Whist this has been briefed before I chose not to put it in these terms. I have been asked not to sanitise the message.”

But Mr Steve Scott, consultant surgeon and surgical care group director at County Durham & Darlington NHS Foundation Trust, has reassured people that patients’ health will not be put at risk, as the document is not a formal trust plan.

He said: “NHS organisations are working under financial pressure and we regularly review the best way to provide safe efficient patient care. It is worth noting that County Durham & Darlington NHS Foundation Trust ended 2016/17 with a surplus and ahead of our financial plan.


What and when is “purdah”?

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The Hacking reveals a collusion of anonymity for responsibility for rationing…

Update 13th May 2017: Mark Bridge May 13th in the Times: Outdated technology offers easy pickings

As readers know NHSreality says there is no NHS, but a regional system. The rationing of services, and this includes IT, is the responsibility of the Trust Boards, and commissioning groups in England. An inability to provide the requisite upgrades to computer systems is a decision made at a higher level. IT managers, paid much less than those in the private world, are rewarded by job security (never get sacked), but they have failed to use their leverage and knowledge to force the changes needed. The debate would have been puerile, if it ever happened at all. On December 8th NHSreality posted: Hackers get easy route to patient data – still on Windows XP but we have no sense of sangfroid, only sadness. The Hacking reveals a collusion of anonymity for responsibility for rationing…

“The first duty of government is to keep the nation safe”. (Amber Rudd on Radio 4 this am) The Health Services are part of this safety, but the net has been holed in so many places, and the responsibility for errors leading to potential disasters such as this is missing. NHSreality predicts that no heads will roll, and the media will fail to find a scapegoat.

The good that may arise is that computer systems may be updated. GPs in Wales were in charge of their own systems and backup until 5 years ago. The Welsh Government took over the computers, put all the data in one central server, and connected to the periphery by BT lines . ( Virtual Private Networks ) I recommended to my own practice that we had our own independent back up system which would ensure that, if the government server failed, or the lines were sabotaged, that we could perform our daily work. My recommendation was rejected but the idea needs re-visiting, even though Wales was unaffected on this occasion.

There is so much evidence for rationing, not prioritisation when it is “all or none” as in IT. Here are some articles/news from the last 24 hours:

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Laura Donelly in the Telegraph: Thousands of children and teenagers with anorexia forced to wait months for help

Chris Smyth in the Times: Hospital backlog is worst for decade – A&E units had their worst year since 2003, with one in ten patients not being seen within four hours and Patients wait longer as GP jobs lie vacant and, initially reported in the Shropshire Star: Nurses ‘forced to buy pillows for patients’

and because of the rising anger even a cancer sufferer is standing against the Minister for Health: The Deathbed Candidate. Getting nearer and nearer to “posthumous voting” isn’t it?

Paul Gallagher opines in the Independent: General election 2017: what role will the NHS play among voters? and implies Theresa May is more trusted than the others…. but this was written before the latest Hacking.

NHSreality trusts none of the parties. They are all lying. It is only going to get worse. Patients are going to wait longer. (Personnel Today) More and more, those who can afford it, will go privately.

Health Reform – Rationing for rare and complex conditions is wrong, and against the concept of a “mutual”.

The debate is puerile. There is no addressing the real issues..

NHSreality on IT systems

Hackers get easy route to patient data – still on Windows XP December 8th 2016

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Hands up – who want’s to be a GP today? Recruitment is at an all time low despite rejecting 9 out of 11 applicants for the last few decades..

We all know that the one on one confidential consultation is the bedrock of primary care. We have been taught that confidentiality is paramount, and as a profession we have honoured this. However, being a GP (or any type of Dr) means complaints and possibly litigation at some time in your career. These problems are much less if the Dr is a) female and b) British trained.

False claims against doctors are not yet commonplace, but to keep the confidentiality and the confessional nature of the GOP consultation will need audio-visual recordings in every room. The patient can undress behind a screen, but the acoustics should remain even when the video is missing.

An alternative, accepted in many hospitals and most dental practices, is to have a “chaperone” or another person (assistant) present at all times with patients. GPs could move in this direction, as could teachers. Male teachers in particular know about “false claims” against them. More and more teachers and doctors are female ….. the adverse selection processes, the timing of recruitment, and the behaviour of  students/patients/clients is excluding men.

The Yorkshire Post 11th May 2017 reported: Growing GP recruitment problem ‘staggering’ as vacancies hit new … ITV News reported 12th May 2017: ‘Staggering’ GP recruitment problem hits new high – ITV News – and the Standard followed it up with a report by Eleanor Rose: GP recruitment problem “staggering” as vacancies hit new high, research shows.   for Pulse reports 12th May: One in five practices abandon recruitment due to ‘staggering’ shortage of GPs

Almost one in five practices has had to abandon searching for a new GP as vacancy rates have hit their highest ever, a shocking Pulse survey has revealed.

Pulse’s annual practice vacanies survey was answered by 860 GPs and reveals that 12.2% of all positions are currently vacant – an increase from the 11.7% reported at the same time last year.

More worryingly, 158 said they had to give up recruiting a GP in the past 12 months after unsuccessful attempts.

The survey – the only longitudinal data available on this subject – also reveals that the average time taken to recruit a GP partner has lengthened by almost a month over the past year….

Dr Richard Vautrey, deputy chair of the BMA’s GP Committee, said: ‘The high number of positions vacant and one in five practices abandoning their search) is another sign of the recruitment crisis with many practices struggling to find GPs.

‘This is adding to the pressure of the remaining staff. Some practices are looking to recruit therapists, pharmacists and other health professionals but of course they are not a replacement for a GP. There needs to be a real step-change in recruitment initiatives to ease the pressure on GPs.’

Professor Helen Stokes-Lampard, chair of the RCGP, said: ’We know that practices across the country are finding it really difficult to recruit GPs to fill vacant posts, and the degree to which this problem has increased over the last six years is staggering. In the most severe cases, not being able to recruit has forced practices to close, and this can be a devastating experience for the patients and staff affected, and the wider NHS.’

Abi Rimmer in GP careers warns: Workload pressure would not be a defence against clinical negligence, barrister warns

Rosemary Bennett The Times May 11th 2017: False claims ‘have made teaching a lottery for men’ and False claims ‘have made teaching a lottery for men’ : ukpolitics – Reddit

What kind of person makes false rape accusations?



GP leaders to debate future of NHS, industrial action and ‘zombie GPs’. “GPs’ first priority must be their own health”..

The most important word any resilient GP needs to learn is how to say “No”. Our profession is well paid, and the argument is not about pay. The conditions of work, the restriction of choices, and the shape of the job have become so onerous that many feel like zombies. In a national incident such as a train crash the Drs need to ensure they are safe before treating the victims. They need to secure the site. They need to make decisions which perhaps amputate on site, or allow some victims pain killers only, whilst others are saved. The train crash which the UK health services are now having is similar. As Clare Gerada is correct; “we have to look after ourselves  first”.

Nick Bostock reports on GPonline 3rd May 2017: GP leaders to debate future of NHS, industrial action and ‘zombie GPs’

GP leaders at next month’s LMCs conference will discuss whether the NHS can survive chronic underfunding, whether GP contractor status has ‘reached the end of the road, and whether industrial action should be back on the table to defend the profession.

The conference in Edinburgh on 18-19 May could also discuss whether deceased GPs could be resurrected to ease the GP workforce crisis, and call for health secretary Jeremy Hunt to be sacked ‘for presiding over the worst time in the history of the NHS, missing targets, longer waiting lists and low morale’.

Pressure looks to be growing from the profession for a wide-ranging overhaul of GP funding, with LMCs set to warn that overall funding is too low, and that distribution through the Carr-Hill formula and other contract mechanisms is unfair.

Motions put forward by LMCs warn that no funding mechanism will deliver fair funding for GP practices until overall funding is increased. The GPC warned earlier this year that despite pledges to raise funding through NHS England’s GP Forward View, the profession remains underfunded by billions of pounds.

GP funding

But LMCs will question whether the existing funding formula gets the balance right between different priorities, with a motion put forward by Glasgow LMC warning that ‘careful consideration has to be given to the balance of the funding formula between deprived patients, remote and rural patients, elderly patients and those patients not in any of these groups who may face their funding being eroded’.

GP leaders will also call for a list of core GP services to be defined – a step the GPC has long opposed – in part to maintain services as new care models take shape across the NHS. The GPC has consistently argued that it is simpler to define non-core work, for example using its Urgent Prescription document to list services that practices should receive additional funding for.

The conference will also hit out at the rising cost of indemnity, warning that increased fees are driving GPs out of the profession. LMCs will argue for greater transparency from medico-legal organisations about risk criteria that can lead to sharp rises for individual GPs.

GPs will also warn that contract uplifts have not covered rising indemnity costs in full, and that direct reimbursement of costs would be a better option for practices than payments based on list size.

Locum GPs

Plans to improve communication with sessional GPs, with a proposal for a ‘national communications strategy to secure adequate communication of guidelines and patient safety communications to locums’ will also be discussed at the conference.

Broader ‘themed debates’ at the conference will discuss issues such as NHS rationing, independent contractor status, working at scale and workload.

One debate will look at whether the NHS can survive given overall underfunding, and whether co-payments for services should be considered. Another will consider whether independent contractor status has reached the end of the road and how it could be protected.

Further debates will look at whether GPs should remain within the NHS – in Northern Ireland GPs have suggested they will quit the NHS en masse if two thirds of practices hand in resignations – and whether there is ‘still a need to consider appropriate forms of action, and would this be effective or counter-productive’.

Another debate will encourage GPs to discuss whether the QOF has reached the end of its useful life – as NHS England chief executive Simon Stevens has suggested.

A motion put forward by Shropshire LMC, meanwhile, suggests ‘the urgent funding of a bioengineering program designed to immediately triple-clone all UK GPs, including the recently retired, in order to facilitate our prime minister’s glorious vision of a truly 24/7 health service’.

It adds: ‘The project should ideally extend to exploration of the resurrection of deceased general practitioners, though conference acknowledges that some health consumers might find zombie GPs unpalatable at first (assuming they even notice the difference.) However, we believe that public fears about human cloning and the walking dead could be swiftly allayed by the persuasive powers of the undisputedly veracious Mr Jeremy Hunt.’

Alex Matthews-King in Pulse 24th April reports: NHS England asks CCGs for rationing heads-up following media scrutiny

Isabella Laws on 2nd May reports Clare Gerada: GPs’ first priority must be their own health, warns former RCGP chair – GPs must put maintaining their own health above caring for patients and running their practices, former RCGP chair Dr Clare Gerada has warned.

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

NHS ‘is like a train just before a crash’ (and it is now happennin g in slow motion)

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All 4 Health Services let down the dying. International comparisons are not favourable..

The Economist has three articles in the current edition dated April 29th 2017. The theme is on how to ensure a better death, and that although death is inevitable, a bad death is not. A better death means a better life, right until the end. The irony of the UK system, whereby more care options are available in more affluent areas, is exposed. In a cradle to grave health service which is meant to be free and without reference to means this is patently unfair. In “Mending Mortality” the author says that “doctors are slowly realising that there is a better way to care for the dying”, and in “Death Wishes” a consumer survey shows that “living as long as possible is not people’s main concern”. If the service is as described by politicians, Palliative and Terminal Care should be fully funded throughout the country. 

Better Death

Mending Mortailty – Economist

Last wishes – What people most want in their final months

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NHSreality has posts on death and dying, and on Palliative and Terminal Care

A Dignified Death

Advanced directives needed. Choice in death and dying. Lord Darzi warns of “draconian rationing”. GPs need to be involved at the interface of oncology and palliative care.

Right-to-die granny, 86, starves herself to death

Wales suffering: Surgeons wait for answers on deaths before heart surgery

GP workforce crisis set to undermine palliative care, BMA warns

GPs should be encouraged to take on palliative and terminal care out of hours..

Palliative and Terminal Care should be fully funded.

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RCGP Chair’s address….

It takes 10 years to train a GP. There is no prospect of the 200 extra GP trainees needed per annum, when the total capacity is about 140 per annum now. There are schemes to attract doctors to Wales, such as £20,000 inducement for trainees, funding for moving and/or first exams taken, and other perks. However I am told that trainees will need to promise not to leave Wales for a year after completing training. (Contravening European Convention of Human Rights?) NHSreality takes issue with the college on only one issue: there is no longer an NHS. The evidence is all around the citizens of Wales, with limited access, much reduced choices, and covert post-code rationing. When the WHO reports on the 4 UK Health systems Wales will almost certainly have the worse figures for perinatal mortality, maternal mortality, life expectancy, obesity and smoking…

The solutions are all long term. They have been addressed many times, and ignored for 4 years on NHSreality. There is no reason to think this will change. Welcome to the reality of a two tier health service.

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In the latest Welsh newsletter, Rebecca Payne, the chair states:

This edition focuses on workforce, RCGP has been consistently calling for a rise in the workforce in Wales. Latest calculations show that 500 more full time equivalent GPs will be needed by the end of this assembly term in 2021 (5 years time)

Over 2000 more Full Time GPs would be needed to enter the workforce each year to make this a reality, and so we are acalling for more GP training places in Wales, as well as increases in the share of NHS funding going to General Practice, so that Wales becomes an attractive place to train and work. …..

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She has also welcomed increased funding…. but will it make any difference to you and me? Not for some years yet.

IT – the solution and a problem… Every patient deserves an examination. GPs must not be robots..

On the wall above the patient in my trainers office, in large capital letters was written “Every Patient Deserves and Examination”.

IT or Information Technology has been a great failure in the Health Services so far. There are potential benefits, and high risks.

If there are going to be too few doctors, and especially GPs they need to work smarter. New symptom checker systems could improve speed and access if used properly. What the doctor offers is a differential diagnosis, judgement in use of tests to determine the exact diagnosis, and treatment options. To achieve this he needs to Examine the Patient. If your GP never examines you he is reducing his specialist skills to those of a computer and/or robot. GPs need to retain the skills to do all appropriate examinations, including rectal and internal examinations. It could save a lot of resources if a member of each practice learned to do endoscopy and sigmoidoscopies, and another to do Ultrasound Scans. These examinations/tests would increase speed in diagnosis. Unfortunately the trend is going the other way. Male doctors in particular are not doing internals when they could help assess the possibility of ovarian/uterine causes for symptoms. They refer on, either to a colleague or a specialist and this wastes time. USS and other (CAT and MRI) investigations and out patient appointments all have waiting times…  Ray Charles has his opinion, but its not mine (Ray Charles I Don’t Need No Doctor – YouTube).

If the risks are to be addressed then the Health Services will need a team of experts, constantly trying to break in, just as the big public companies have, and insurance is another matter!

Richard and Daniel Susskind opine in the Harvard Business Review October 2016: Technology Will Replace Many Doctors, Lawyers, and Other Professionals

Mark Bridge in the Times 28th April reports: Hospitals held to ransom as state hackers step up attacks

Do you really have confidence in your records being confidential? Do Hospital Trusts have cyber insurance?

NHS data-sharing project scrapped – another opportunity missed..

Incompetents lead IT change into vast cash losses, and need to be disbanded. This is one area which should be privatised..

Increasing incompetence: Another NHS crisis looms – an inability to analyse data

Electronic Medical Records A Disappointment In The USA

Jeremy Hunt has enlisted a US professor to review the digital future of the NHS to keep it from falling into “elephant traps”

Doctors should have electronic records everywhere possible. It will reduce mistakes and litigation. GPs have been paperless for 20 years..

The Future for our Health Services

Health & Social Care Information Centre

The worried well demand more in a free service.. More information is good, it’s the perverse nature and philosophy of the health services that needs to change.

Too much technology? Its no good protesting – but it would be good to discuss exactly where spending is best directed.

Evidence basis is needed for all treatments – and confirmation by independent third party. Hospitals and pysicians collude to waste money.

How the NHS Wales wastes money on bureaucrats in non-jobs yet has lethally long waiting lists that would shame a Third World country

Ditching ineffective ways of working (Work Smarter in GP)

Symptom Checker | The one the doctors use

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