Category Archives: General Practitioners

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.

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To paraphrase Spike Milligan: “I told you the Health Services were all ill”.

NHSreality as well as Spike told you it was going to get worse. Is it not ironic that in a country where we have depended on nurses, carers and doctors from overseas (usually less developed countries than ourselves) that we are now threatening not to allow them in, and especially not from Europe and the EEC, which means we may well get staff from less culturally affiliated countries, OR we have to export our elderly, OR we have to look after them with robotics! Personal continuity of care has died in the 4 health services, but many of us, if we can afford it, will pay for it.

In the last few weeks the shortage of GPs and poor access to the health care system applicable in your Post Code has become more evident. Rich areas like Horsham cannot attract GPs, partly because the price of property is so high, and poorer areas of the country cannot attract GPs because of the poor housing and schooling problems. Gainsborough surgery closed suddenly… (Connor Creaghan 29th May 2019 in the Lincolnshire Post)

Don’t believe it when the government says they are learning from their mistakes. They still have no “honest language” and they have no exit interviews. These are their main mistakes….

The whole idea of a mutualised health service is to care for those with the bad luck to have a serious illness or a physical / mental handicap. The latter do not often vote, and numbers don’t influence an election so they have been left behind, to the benefit of voters. Our Minister of health seems more concerned with innovation and Big Pharma than she is in boosting numbers of staff!

In a world market (English speaking) Nurses and Doctors have skills and are people who can move. The best way to keep them is to look after them, and to train a surplus.

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Meanwhile clinical acumen and skills, and organisational issues are in decline. Public health has been underinvested and now people are starting to suffer.

The cost of care is so great that we may end up exporting our elderly….

Nursing crisis extends all the time… Surgery, ICU, intensive care and now oncology and cancer care…

29th May 2019 BBC News: ‘Lessons learned’ over £24m Altrincham health hub failings

Sarah Page in the West Sussex county times 22nd Jan 2019: Shortage of GPs in Mid Sussex

and Martin Bagot on the Mirror 31st May reports that there are over half a million people who have had to change their GP.and Desperation recruitment from abroad (Philippines, India, Ireland and Australia are targets, but Bangladesh and Pakistan may be the reality)

BBC News 21st May: ‘Broken’ care system for most vulnerable

on 21st May ITV reported that there were not enough nurses and doctors to meet demand  and the implication of their report is that there won’t be in the foreseeable future.

The Government is in denial and Nicola Blackwood in a speech to the ABPI opined: “We are going to have one of the most exciting health innovation systems in the world.” It certainly will be different for those who fall foul of it…

Thank Goodness one health Trust has agreed to actually pay nursing trainees! Cornwall’s Megan Ford on 14th May in The Nursing Times.

The Yorkshire Post: Scandal of the growing wait for a GP appointment. (YP 11th May 2019)

Meka Beresford and Ollie Cole in Human Rights News report 21st March 2019: NHS staff shortages could double without radical action.

Nick Triggle admits through the BBC news 21st March that there is “No chance of training enough staff”.

BBC News 29th May: Glan Clwyd Hospital told to improve orthopaedic care by coroner

BBC News 31st May 2019: Llwynhendy TB outbreak: Family ‘disgusted’ after death

And Matthew Parris in 2018 asked “How does anyone know how to navigate the maze of our second-rate NHS: ( You can download the whole article below)

The Maze of the NHS – Matthew Parris

Just cry at the bribery, and the Death of the Goose that used to lay the golden eggs that used to make the Health Service(s) so efficient, and the envy of the world.

Say goodbye to continuity of care.

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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…..

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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”.

 

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

It is no surprise to us GPs in Pembrokeshire that we are the area with easily the most lack of coverage of Out-of-Hours care by GPs. The Times reported this as “Struggling out-of-hours care leaves patients without a GP” (Chris Smyth on May 3rd) . It will be interesting to see the outcome measures for West Wales over the next 5 years, in life expectancy, emergency admissions and satisfaction. Perhaps this unpopular area will be the first to “go private”?

Paul Gallagher in the “I” 3rd May 2019 reports: GP shortages leaving out-of-hours services with no doctors

Pulse investigation reveals number of urgent care shifts in which a GP was not present rose from 57 in 2017 to 146 last year.

Chronic shortages of doctors meant at least six UK regions ran out-of-hours (OOH) services with no GP on shift last year, an investigation has revealed.

The total number of urgent care shifts in which a GP was not present rose from 57 in 2017 to 146 last year, according to data supplied to Pulse magazine by 79 clinical commissioning groups (CCGs) and health boards in response to Freedom of Information requests.

GPs said the national staffing shortage was to blame, while warning the potential safety risks now associated with stretched OOH services meant GPs were often no longer willing to work for them.

NHS commissioners said they were using other healthcare professionals, such as advanced nurse practitioners and paramedics, to help fill staffing gaps.

In Wales, Hywel Dda University Health Board’s out-of-hours service reported the highest number of occasions without a family doctor on shift last year. The region, which covers 384,000 patients, had no GP cover 125 times last year – almost triple the 42 times it operated without a GP in 2017.

In England, two CCGs reported struggling to fill out-of-hours shifts in 2018: Tower Hamlets in east London, serving 331,000 patients, experienced the problem three times in 2018, and North East Lincolnshire, which covers 169,000 patients, had two instances last year.

Worsening in Scotland

In Scotland, one health board – NHS Borders, which has a population of 115,020 – responded with figures showing the problem is worsening. It had only two occasions of no GP cover in 2017, a figure that rose to eight last year.

Meanwhile, the number of serious incidents recorded by out-of-hours providers has risen by more than a quarter in the space of a year, according to Pulse’s findings. Data provided by 109 CCGs and health boards across the UK to FOI requests show 108 serious incidents were reported across 44 CCGs and health boards in 2018, against 84 serious incidents in 2017.

Dr Simon Abrams, a Liverpool GP and chair of Urgent Health UK, which represents out-of-hours providers, said: “We’re in a national recruitment crisis. If you’ve got a day job there’s a lot of pressure that makes being available to do out-of-hours even less likely than it used to be.”

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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The four GP dispensations / jurisdictions. Nothing “national” about GP contracts.

There is nothing “national” about the GP contracts around the UK. The only way to ensure adequate supply is to train enough. NHSreality believes we should aim at overcapacity to ensure both supply and financial control. The contracts seem to endorse “private practice” but at the same time stop GP premises being used at all for private activity. Will this include Insurance and DVLA medicals? We are all in the UK (just) and pay the same taxes, and yet we have dofferential, hidden, randomised post code rationing.

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The BMA in England has produced “A five-year framework for GP contract reform to implement The NHS Long Term Plan” but this does not apply to Scotland N Ireland and Wales, and indeed, it has not been agreed by NHS England in it’s entirety. Despite the lack of recruitment, loss and early retirement of GPs, the whole edifice is falling like a pack of cards.

Pulse commented on the headlines in January observing that this was the most significant reform since 2004. The comments on line are “looks like the exodus will continue” and “150K lloks like a lot but after tax and pension it’s a much more modest sum.” Another is “Well if you are close to the !%)K limit …. what will happen is GPs will simply stop doing NHS work”.

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In Northern Ireland the HSC (Health and Social Care) Board rules.

In Wales the GPone website from the Welsh Government supplies their details. In Wales agreement has not been reached on the litigation funding arrangements, which at present may be top-sliced obligatorily, and causing resentment. In Wales we even cerebrate a reduction in the degree of bankruptcy…   and the poorest standards in Bowel Cancer screening, results, and Waiting times.

The Scottish Government contract and website is different again

NHS England contract 2019 which all the headlines are about. They ignore the other 3 dispensations. The Medical Indemnity scheme is funded separately in England, and will not be top-sliced as threatened in Wales.

“A new state backed indemnity scheme will start from April 2019 for all general practice staff including out-of-hours.” (NHS England)

See the source image

See the source image