Category Archives: General Practitioners

What nonsense from Mr Drakeford…. Politician afraid to acknowledge the poor manpower planning, and his responsibility to the whole population..

Politicians should make the decisions about populations and their health. Doctors, apart from public health specialists, should “put their patient at the centre of their concern”. So when the BBC publishes 3rd Feb 2020: Royal Glamorgan: First minister criticises politicians on A&E plans they are never questioning Mark Drakeford’s comment:

“It is for doctors, not politicians, to decide the future of the Royal Glamorgan Hospital’s A&E department, Labour First Minister Mark Drakeford has said”.

This downgrading and closing of hospitals is driven by staff shortages. Its the same in Haverfordwest, Blackpool, Scarborough and all the peripheral and deprived areas without a teaching hospital and tertiary care. Mr Drakeford has relatively little power over the short term supply of doctors, but he could initiate the virtual medical school, and allow far more people to train. And that gives a long term solution. Meanwhile its going to get worse.. and worse.

Some good news on new medical schools. Lets hope the politicians seize the real opportunity for virtual medical schools living in local communities

There are just not enough geese to lay enough golden eggs. The cupboard is bare. We cannot be cloned.

There is a National shortage of GPs across all the 4 health dispensations. When the Department of Health primes reporters such as Chris Smyth, in the Times 7th Feb 2020, I am surprised by his naïve acceptance, seemingly without question. The bribes will not work as there is a 10-15 year shortage…A GP might move for 20K but he will not wish to move to a deprived area, and that is where the doctors are needed. SO what sort of perverse behaviours can we think of? Changing practice repeatedly and, like Monopoly, collecting £20k whenever you become a partner? There could even be a mutually beneficial merry-go-round…. There are just not enough geese to lay enough golden eggs. The cupboard is bare. We cannot be cloned.

Image result for health merrygoround cartoon

We could make it an obligation for all new doctors to work in deprived areas at first. ( Breaking EU convention human rights?) but would that deter some from applying? There were 11 applicants for every place up to recently, so it’s worth a thought.

Just as we could move our MPs to the midlands or S Yorkshire, the change would sort out those with real commitment. How many MPs are in the house because of the opportunity in London? Moving either house will test its members. Committing doctors to deprived areas for say 2 years, would test their altruism.

Bribes belittle the profession. They encourage distorted and perverse behaviours. In the long term deprived areas are best addressed by overcapacity. There is another distortion, and that is the temptation to go abroad, and that is best addressed by cultural change, making the doctors and staff feel valued, and an honest language, And Exit Interviews: what are they? Why not obtain from GPs?

Doctors to be given £20,000 for taking over local surgeries. Chris Smyth in the Times 7th Feb 2020.

Family doctors will be given £20,000 golden hellos for taking over local surgeries as the NHS struggles to deal with a GP crisis.

Care home residents have been promised weekly visits from surgery staff as part of government efforts to boost local care and keep elderly people out of hospital.

Thousands more pharmacists, physiotherapists and dieticians will be recruited as the NHS plans to boost an “army” of support staff to 26,000.

A shortage of GPs is one of the most pressing problems facing the NHS, with numbers falling even as the government has repeatedly promised more. Recently Boris Johnson pledged to boost numbers by 6,000.

Efforts to hire more have been hampered by younger doctors’ reluctance to become full-time owners of surgeries but, in an effort to tie them in for the long term, all new GP partners will be eligible for £20,000 bonuses plus help with training.

Under a deal struck yesterday between NHS England and the British Medical Association, £1.5 billion of a £4.5 billion pot allocated for primary care will be allocated to encourage GPs to stay in the NHS.

Sir Simon Stevens, NHS chief executive, said that the agreement was a “vote of confidence” in the GP system. “This agreement funds a major increase in general practice staff — including GPs, therapists and pharmacists — so that patients can get quicker appointments with a wide range of health professionals at their local surgery,” he said.

“These extra staff will be offering expanded services, including regular health checks for people living in care homes, action to boost vaccination uptake, earlier cancer detection and better support for people with learning disabilities.”

Health checks for new mothers and consistent medication reviews are also promised under contracts that pay GPs for providing them. Doctors will be encouraged to prescribe exercise and arts groups to expand “social prescribing”.

Richard Vautrey, of the BMA’s GP committee, said: “The significant investment in and focus on recruitment and retention, including payments to incentivise doctors to take up partnership roles and work in under-doctored areas, is a vote of confidence in the partnership model and a much-needed first step if we are to reverse the trend of falling GP numbers.

“An expanded healthcare team working in GP practices as well as increasingly closely with community colleagues across groups of practices, will mean patients have access to a wider range of staff, allowing GPs to see those who need them most more quickly.”

Matt Hancock, the health secretary, said: “This new contract is the first step to delivering our manifesto commitment to make it easier to get a GP appointment when you need it by delivering 50 million more appointments a year in general practice.”

2019: To paraphrase Spike Milligan: “I told you the Health Services were all ill”.

2019: A GP in Milford Haven exposes the Inverse Care Law as applied by successive Governments, perversely and neglectfully..

2017: The decline of General Practice.. Bribes may be too late…

2017: The flock of geese that laid golden eggs has been culled. It takes years to rebuild, and the fox is at the door.

2016: The public will only miss what they had – when its gone. GP indemnity fees spiral out of control with 25% rise last year..

2015: 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.

A new and very different type of NHS in England (BMJ 2011)

May 2011: BBC Panorama Report By Undercover Investigator

2012: Nuffield Trust Report on Rationing

2012 The Health and Social Care Bill 100 Voices on NHS Reforms

2013: Burnout forces almost 10% of GPs to take time off work as pressure on occupational health services grows

2013: Mid Staffs – Who, if Anyone, Will Be Accountable?

2013: The Demographic Time Bomb

NHS 111 is a disgrace… How to get rid of it?

I have personal experience of the inefficiency and risks attached to incorrect advice from NHS 111. One of my relatives was ill after a delivery, with fever and I wanted to ring 999. I was stopped by the relative who demanded I ring NHS111. The advice for a post partum sepsis was to ring her GP, and was not to attend hospital. There are too few full time GPs to run a proper out of hours service…. There are so many part timers that any form of continuity of care, particularly when we are terminally ill, has virtually disappeared. Experimental technology is being used in reality. There is a real need to bring experienced diagnosticians closer to the initial presentation, whether it is by phone, in GP or in A&E (or whatever it is named). How do we get rid of NHS 111?

Image result for nhs111 cartoon

So it is no surprise to read about the problems reported by Jon Ungoed-Thomas and Jack Taylor in the Sunday Times 5th Jan 2020: Toddlers died after NHS 111 helpline said they were not in danger – The urgent medical care service faces calls for an independent investigation after a number of child fatalities

The NHS 111 helpline for urgent medical care is facing calls for an investigation after poor decision-making was linked to more than 20 deaths.

Experts say that inexperienced call handlers and the software used to highlight life-threatening emergencies may not always be safe for young children. At least five have died in potentially avoidable incidents.

Professor Carrie MacEwen, chairwoman of the Academy of Medical Royal Colleges, said: “These distressing reports suggest that existing processes did not safeguard the needs of the children in these instances.”

Since 2014 coroners have written 15 reports involving NHS 111 to try to prevent further deaths. There have been five other cases where inquests heard of missed chances to save lives by NHS 111 staff; two other cases are continuing and one was subject to an NHS England investigation.

The latest coroner’s report issued to prevent further deaths was published in November. It concerned Myla Deviren, 2, from Peterborough, who died from an intestinal blockage in August 2015….

,,,Researchers examined 2,191 patient safety incidents involving children receiving NHS care between January 1, 2005 and December 1, 2013. The majority of the 659 incidents involving diagnosis, assessment and referrals — including 10 child deaths — occurred during calls to NHS 111.

The report stated: “The safety of software used to triage children over the telephone is unclear, particularly its sensitivity to detect signs of serious illness in children.”

The NHS Pathways triage system, used by NHS 111 and in about half of ambulance services, is one focus of the inquest into the death of Shante Turay-Thomas, 18, from north London, who suffered a suspected allergic reaction.

Leigh Day, the legal firm representing Shante’s family, said she was assigned an ambulance with a response time of two hours (category 3), but a 999 call to the London ambulance service with suspected anaphylaxis would trigger an ambulance with a target response time of seven minutes (category 1).

NHS 111 is operated by various providers, and NHS Digital supports the NHS Pathways triaging software. The 24-hour service is free to use.

Professor Jonathan Benger, acting interim chief medical officer at NHS Digital, said: “NHS Pathways supports the remote assessment of more than 17m calls each year and is a safe and robust system.”

NHS Digital said that since 2016 there had been changes to improve identification of patients at risk of critical illness; where a clinical safety issue is raised, an assessment is made within 24 hours.

NHS England said serious safety incidents involving NHS 111 were “thankfully rare” and more than half of callers received advice from qualified clinicians.

Professor Martin Marshall, chairman of the Royal College of General Practitioners, said: “Patients need to be reassured that valuable lessons have been learnt if we are to maintain public trust and confidence in NHS triage systems.”

Dr Chaand Nagpaul, chairman of the British Medical Association (BMA) council, said: “There is clearly much more to do be done to ensure there is adequate assessment, expertise and support on hand for those who contact the service.”

Image result for nhs111 cartoon

Rationing over Christmas. Just part of the routine now… in a toxic culture of denial.

Over Christmas we hate to hear about the hard truths of peoples lives. Dying alone is not something I look forward to, and I suspect I will not know the medical person who comes to see me in the last days. Continuity of care has disappeared, and in its place is part time working of both nurses and doctors. These professionals have not necessarily been trained to deal with the variety of conditions which the ageing community and General Practice demands of them, Many miss out on Paediatrics or Gynaecology or Dermatology as well. Most miss out on orthopaedics… The “hard truths” which Mr Stevens wishes to discuss (since 2014!), facing politicians and their electorate about health, are present all the year round. And its too toxic a subject for all politicians..

Image result for toxic culture health cartoon

So it is no surprise that diagnoses are late, especially for conditions with rather unspecific symptoms such as early leukaemia ( Susan Oneill in the Times 27th December: A quarter of cancer patients go to GP three times before a diagnosis ). Doctors are taught to use time as a diagnostic tool, and if all patients had all possible tests on presentation the service would surely implode. Sepsis on the other hand is severe and should be recognised by every doctor.. It is still “causing more deaths than expected” in Wigan.

Dennis Campbell reports 10th December in the Guardian: Thousands die waiting for Hospital Beds – study.

Shaun Lantern in the Independent 27th December reports that the nursing profession don’t think Boris Johnson’s NHS plan is deliverable.

Laura Donnelly in the Telegraph: Hip Rationing

The Daily Mail reports that the Scots are to get three rounds of IVF compared to the one offered by most English Trusts.

Andrew Proctor for the Dermatologists reports on the rationing of emollients (which are almost all very cheap)

It features National Eczema Society’s Chief Executive Andrew Proctor discussing the important issue of emollient rationing for people with eczema.

Denial for 5 years. On 4th June 2014 Mr Stevens asked for an honest debate…

The politics of health.. The Lemmings of the left leave a vacuum where Mr Stevens’ debate will not happen… Are we all lemmings as far as our health system is concerned?

The Election Horror Show, and denial… The political spin doctors are leading us into a health-less “black hole”. The Health services are too toxic for honesty…

NHS Rationing & Finances | A King’s Fund Report‎ March 2017. Understand the NHS financial pressures. How are they affecting patient care?

toxic work environment cartoon

 

A curse on all their houses. Banal debates omit the really important questions. Entertainment has come before long term politics and unity..

For anyone who has watches the banal ITV debate (Boris v Jeremy)  and BBC question time leaders special I can only sympathise with the shallow nature of the questions, and the replies. They have omitted the really important questions. Entertainment has come before long term politics and unity. What a pity for those who gave their time to watch this display of denial. A curse on all their houses. They have all conspired to put patients and doctors lives at risk….

Here are some of the questions that NHSreality would like to have asked:

Brexit.

Do you feel that the Union of Great Britain and N Ireland is more or less likely to survive if we leave the EU?

Do you feel that continuing peace is more or less likely to continue if we leave the EU?

Do you feel that varied opportunities for work, particularly for younger people, are more or less likely if we leave the EU?

Do you believe the reports of the Economist, Governor of the Bank of England, World Bank, EU economists, all UK economists (bar one) and most politicians before the first referendum, when they indicate that prosperity and influence will diminish after leaving the EU?

Proportional Representation.

Please can you give your parties’ arguments against PR? Do these still apply?

If Proportional Representation is good enough for the devolved dispensations, why is it not good enough for the UK?

What form of PR would you advocate if we changed our system?

Do you think the vote should be extended to all those over 16, as in Scotland?

Identity

Since we have a virtual identity system with face recognition and other methods connected to central databases, and since we have a problem with identifying those eligible for state benefits, including health, would you support ID cards?

Could these ID cards lead to means related co-payments or taxes?

Tax

Would you support Land Rental Tax?

Do you think it could be at a level that allowed replacement of Estate Duty, Stamp Tax and reduction of Council Tax?

Health.

Do you feel that the 4 health services are sustainable under their present rules? Do you think that the pace of technological advance is faster than any government’s ability to pay? Given the demographics how would you change the rules?

If social care is means tested, then why not medical care? Or would you advocate the Scottish model of social care for England?

Is health care rationed covertly, so that nobody knows what is unavailable to them until they are denied it?

As far as health is concerned, has devolution worked in Wales and N Ireland?

Bearing in mind the excess of able applicants, for decades: Why are there so few doctors and nurses to meet the nations’ needs? Do you think this has anything to do with our political system and FPTP time horizons?

Usually when trying to fill the bath you put the plug in rather than turn the taps on more. We are now training more doctors, nurses and allied professionals than ever before. What are you going to do to change the culture  in the health service to stop the loss of the workforce soon after these individuals  qualify .

Bearing in mind that most purchases of equipment for the 4 health services are in dollars, and the costs have gone up 20% since the referendum, and this without trade barriers, do you believe leaving the EU will make our health as a nation better?

Education.

Bearing in mind job applications and competition for places at university, and interviews: Do you feel that all education is divisive? Is it more important to aim for excellence, or to reduce inequalities, when there is competition for resources and people? Do parents have the right to choose how to educate their children, and whether to spend their money on private tuition, sports activities, music etc?

Spin doctors – what the economist thinks about the conservatives health manifesto promises.

Northern Ireland health collapses. It would be kinder to bring in co-payments than to let more suffer.

Cloud cuckoo land….. The poor will remain slaves in a GIG economy.

Disgraceful leadership, and a longstanding culture of fear. Successive PMs of all colours are to blame. Spending money on bribing the electorate will bring only short term gains..

What the GP did best: used time as a diagnostic tool. The “failiing fiasco” of health care in the UK.

 

In the BMJs subsidiary magazine “Doctor” on 16th November the headline article is “On the cusp of collapse”. Overcrowding and Underfunding have left patients and doctors at risk……

New Registrations: More non-UK graduates than home grown clinicians…. in 2018

After failing to provide the 5000 extra GPs promised 4 years ago, the numbers have actually fallen by 1600, and of those remaining a far larger proportion are part time. The complete failure of forward planning is due to rationing of med school places, and the First Past the Post electoral system. It will happen again, and repeatedly. If the conservatives win an outright victory the money will dry up quickly. If Labour wins they wont be able to borrow, and they will have to print more money. Both outcomes are likely to lead to a fall in the value of the pound. We still have 11 applicants for every place. Increasing the numbers by a small % is not enough…. We now need locality based virtual training for medicine. It can be run by the local medical scghool, and exams and assessments can be centralised, but the training should be local, and graduate based. Traditional medical schools just dont have the capacity. …

Doctors‘ early retirement triples in a decade BMJ 21st June 2019

Rowena Mason reports in the Guardian 8th November 2019: Boris Johnson promises preferential immigration for NHS staff

The GP recruitment farce – Mr Hunt never said the 5000 would come from the UK!

PM proposes half-price visas and quick decisions for doctors and nurses as part of points-based system

Jonathan Paige reports in the Times 8th November 2019: Hospitals told to pay doctors cash over fears of winter crisis

Andrew Gregory in the Times 9th November 2019 reports: Will Tory promises help to clear your GP’s waiting room? 500 more GPs in training per annum promised……

The Conservatives today promised to create an extra 50m more GP appointments a year if they win the election.

In this early stage of the campaign, the NHS has dominated the agenda….

Adrian O’Dowd reports in the BMJ: More non-UK graduates than home grown clinicians joined medical register in past year (BMJ 2019;367:l6203 )

Where are the UK’s doctors from?

new registrations as an image

Of the 251 319 doctors on the UK medical register in 2019:

  • 164 525 trained in the UK (65.5% of the total, and a 2.2% rise from the number in 2018)

  • 22 280 trained in European Economic Area countries (8.8%, and a 2.2% rise from 2018)

  • 64 514 trained outside the EEA (25.6%, and an 8.3% rise from 2018)

There was an especially large increase in the number of medical graduates from Africa and the Middle East, but most non-EEA joiners still come from South Asia.

The trend of increasing numbers of doctors joining from Central and Eastern Europe and the Baltic countries continued in 2019. The number joining from northwest Europe remained the same in 2019, after a prolonged period of steady decline. Southern European doctors have joined in slightly greater numbers in 2019, a contrast to decreases since 2014.

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..

Medical Schools: your chances – applications-to-acceptance ratio was 11.2.

Some good news on new medical schools. Lets hope the politicians sieze the real opportunity for virtual medical schools living in local communities

 

Health Services might be designed wrongly: In praise of dissenters.. Currently there is little ability to speak out, “without fear of sanction”.

The Different health services in the UK are not open to the suggestion that they might be designed wrongly. They are failing more quickly than anyone imagined (other than those in the profession, and NHSreality). An interview with Helen Stokes-Lampard (RCGP chair) In “You and Yours” on Radio 4 17th October 2019 tells it straight: its going to take at least 12 years to remedy the failure in forward and manpower planning. (The interview is at the end of the recording) The culture of fear means that opportunities to learn constructively are being lost, educational standard are falling, and engagement with the politics of health is minimal. One route to honesty is the exit interview, and these collated together could give messages that lead to the changes needed. Meanwhile……  “Winter is coming”. We will all be hearing how they will listen (See Jill Patterson in Walesonline below), but NHSreality can tell you that even if they hear, they don’t have the human resources to act. 

In Bartleby in The Economist 12th October 2019 “In praise of dissenters – It pays companies to encourage a variety of opinions “

The ability to speak up within an organisation, without fear of sanction, is known as “psychological safety” and was described by Amy Edmondson of the Harvard Business School in a book on the issue. Mr Syed cites a study of teams at Google, which found that self-reported psychological safety was by far the most important factor behind successful teamwork at the technology giant. ….“In praise of dissenters

As many practices disintegrate, I give a link to a local practice in the news.

Eleanor Philpotts in Pulse 12th October 2019 reports on Ferryside practice.: Practice set to close after 3 years without a GP

In Walesonline Sandra Hembury on 14th October reports: The GP surgery that hasn’t had a GP for over 3 years..

A doctors’ surgery hasn’t had a GP working there for three years and is now being threatened with closure.

The Mariners Surgery in Ferryside has only had nurse sessions since 2016, because there were no GPs available to operate from it.

Now plans have been unveiled to close the surgery and relocate services to other practices, forcing patients to have to travel for miles to receive treatment.

A public drop-in session is being held to consult with patients at the Three Rivers Hotel in Ferryside between 2pm and 7pm tomorrow (Tuesday, October 15).

But there are fears those less mobile patients will struggle to get to the next nearest surgeries in the Meddygfa Minafon practice – in Kidwelly or Trimsaran.

Cllr Mair Stephens is ward councillor for St Ishmael and deputy leader of Carmarthenshire County Council.

She said the Carmarthen Road practice had been there for a number of years.

“There’s traditionally been a dispensing surgery, which is exactly what we do need,” she said.

“The majority of people who live in the area are older, and the surgery has been on the decline in recent years, but it still has such things as foot clinics and heart clinics.

“They are now going to close it, which is out of all proportion.”

She said the nearest surgery in the group was Minafon in Kidwelly, which was about four miles away. But it was difficult to get to if patients needed public transport. The nearest bus route to the Kidwelly surgery dropped passengers off at least 10 minutes away from the practice, which wasn’t suitable for the less mobile, she added.

She suggested the practice could set up a bus route taking passengers without suitable transport from the Ferryside surgery to Kidwelly.

Cllr Stephens added: “This is about moving services from their locality.

“What older people want to do is to see a GP. They don’t necessarily want to see a nurse.

“Once they have seen the doctor they are quite happy to meet a nurse or practitioner. That’s where the whole system seems to be falling down.”

She felt the consultation was not being spread out enough to the wider community, including nearby Llandyfaelog.

A petition has been set up to maintain the surgery in Ferryside.

Started by Ute Eden, it says: “We feel very strongly that it is essential to maintain a surgery in Ferryside.

“We need a doctor, a nurse and a dispensary to provide the vital services required by a village where most residents are over the age of 50.

“It is an integral part of Calon y Fferi Community Centre, which is very accessible.”

The petition, which has been signed by 44 people, said it would be a backward step to oblige all residents to leave the village for treatment.

Jill Paterson, director of primary care at Hywel Dda University Health Board, said: “As a health board we are committed to listening to and engaging with local populations around our proposals to relocate our primary care services from Mariners Surgery to neighbouring surgeries.

“We would therefore like to invite residents to come along and get involved in the conversation.

“Following a review of how services are used by patients at the surgery, it is becoming clear that these services are limited and not fully utilised and could be relocated to Minafon and Trimsaran Surgeries.”