Category Archives: General Practitioners

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.”

The best and worst places to have your hip operation (In England. No global comparisons)

All hail the honesty of the Health Services Journal. Unfortunately they are not allowed to advocate rationing and freedom of speech is limited. But the stories they expose and the issues they address are relevant to  us all. There are many problems, which include poor staff hygiene, poor hospital cleaning, inadequate training, and above all, the failure to separate cold orthopaedics from “dirty” hospital cases where infected wounds and guts are operated on in the same building. The old fashioned DGH has served its time for hips and knees. But why are there no comparable figures for the Scottish, Welsh and Irish Hospitals? Because there is no “National” health service, I as a taxpaying citizen in Wales cannot find out how my service performs compared to England. Indeed, I would like to know comparisons with other countries, and with the private sector. Only with such data can patients be properly advised, and of course they also need to be “led” ask the right questions! Rationing by lack of choice, restriction to a local DGH, and long waiting lists, can only lead to more infections and complications (increased obesity and heart attacks from immobility). Should your GP air these issues when you choose to be referred? Of course he should even if it means telling the truth about your local services.

In the Times Monday 14th October a short report ( not in the on line edition) reads:

Repeat Offenders

The hospitals with the worst records for having to repeat knee and hip surgery on patients are revealed in a report in the Health Services Journal. The sick/ Six NHS hospitals are Southampton General, Milton Keynes, Chichester, Wansbeck, (Northumbria), Weston General, Somerset, and Ormskirk DGH Lancashire. Overweight patients, high infection levels and shortcomings in supervising trainees are blamed for poor performance.

In the Telegraph they report: “Revealed: the best and the worst places to have your hip operation”.

As it gets worse, YOU are going to have to wait longer and longer – or pay up. A “grim reality”..

The evidence basis of all practice(s) needs to be challenged – continuously. There are perverse Incentives in private systems, but why do the UK health services still overtreat?

NHS rationing: hip-replacement patients needlessly suffering in pain on operation waiting lists

Orthopaedic waiting lists: time for more, and equal access to, non-urgent centres

South Wales NHS: Plan to centralise services on five sites

 

Ambulances use unproven scoring system to ration their service…

As a recent sufferer from sepsis, and having had much pain as a result, and from a hand operation (for which I am most grateful) I am interested in this new form of rationing. Since ambulances are “free” and since many calls are for relatively trivial issues, triage has to occur. However, when a GP rings, rather like when a doctor appears in A&E, lights should alert the telephonist that this needs to be taken seriously. A&E, and Emergency, and Urgent Care centres, have sepsis warnings all over their walls…  It made little difference to my care..

The ambulance service regards being in a GP practice as a place of safety, with medical care to hand, although GPs are being systematically deskilled in emergency care. This reduces their “points” score and the perverse action of the GP whose surgery has been “arrested” by this, is to send the patient outside and ask them to ring the ambulance!

Yes, the ambulance service is underfunded, especially if it remains free for all. The Air Ambulance is a charity, and like many others it too has to prioritise its service. Waiting times for ambulance calls are generally getting worse, and it wont be long before private contractors compete. But in West Wales it would be very expensive as the journey to a competent hospital is 1.25 hours at Swansea, or 2 hours to Cardiff.

Hiba Mohamadi reports for Pulse 27th September 2019: GPs requesting ambulance will have to provide a score for level of emergency.

In the BMJ Elizabeth Mahase reports: GPs warn against use of scoring system.  BMJ 2019;367:l5814

…..The system is based on six physiological measures: respiratory rate, temperature, oxygen saturation, systolic blood pressure, pulse rate, and level of consciousness. Despite not being validated for primary care, NHS England has “encouraged” its use. Last year its was made mandatory in ambulance trusts. NHS England said the score should be used “for all pre-hospital patients who are ill or at risk of deteriorating” and to “support colleagues to identify deterioration early and prioritise resources in times of surge.”…..

Dr Rachel Marsden RCGP Clinical Support Fellow for Sepsis, is on the RGP website: The updated National Early Warning Score and its use with suspected Sepsis

Image result for ambulance cartoon

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..

NHS needs 5,000 trainee doctors a year

The NHS’s lack of GPs is so acute that ministers must boost the number of medics who train to be family doctors to a record 5,000 a year, the head of the profession is demanding.

The unprecedented rise in the number of GP trainees is needed urgently because the workforce has shrunk so sharply and waiting times for appointments have become so long, said Prof Helen Stokes-Lampard.

The chair of the Royal College of GPs urged the government to increase the number of trainees in England from 3,500 to 5,000 as soon as possible to relieve the strain on surgeries and burnout that are pushing so many to quit.

Boris Johnson will not be able to fulfil his pledge to shorten waiting times to see a GP or a longstanding promise to expand the workforce by 5,000 doctors unless his government ensures that over half of all medical graduates become family doctors, she warned.

Growing numbers of GPs are giving up as a result of a relentless rise in the demand for patient care and the impact of punitive changes to doctors’ pensions. The NHS lost 576 full-time equivalent GPs last year – one in 50 of the total – according to latest official workforce figures published last week. In June it had 28,257 full-time, fully qualified GPs, compared with 28,833 a year earlier.

“GPs and our teams are facing intense resource and workforce pressures and it is causing a growing crisis in our patients’ access to general practice services, which the prime minister pledged to address when he took up office,” Stokes-Lampard said.

“We need to think big, and based on current workforce trends the college estimates that we need to start training at least 5,000 GPs every year to meet the government’s overall target to expand the GP workforce by 5,000 full-time GPs.”

Johnson recently declared “it cannot be right that people are waiting so long to see their GP”. He has promised to improve access but not given any details so far.

Many patients have to wait more than two weeks to see a GP, according to the most recent evidence.

In a letter to Rishi Sonak, the chief secretary to the Treasury, Stokes-Lampard said the rise in the number of GP trainees would need separate funding to the £4.5bn extra that is due to go into primary and community care by 2023-24.

It costs the government an estimated £150,000 to fund a GP during what is usually three years of training, on top of the £250,000 cost of undergraduate medical training.

Although the number of full-time GPs in post is falling, the number of medical graduates entering GP training is at an all-time high. It has risen from 2,671 in 2014 to 3,473 last year, which was the first time the target of 3,250 had been exceeded.

Nigel Edwards, the chief executive of the Nuffield Trust thinktank, said more GPs would mean fewer graduates becoming hospital doctors.

“I completely agree that more GPs are needed. The current shortfall has seen patients’ experience of waits get worse year after year, and created a vicious cycle as overwork makes doctors retire early.

“But we do need to remember there are only so many medical graduates coming through, so realistically we would need to cut back on trainees going into hospital, which may not be easy. And more GPs coming in won’t solve this problem alone if burnout keeps pushing them away again.”

A Department of Health and Social Care spokesperson said: “We have seen a record number of GP trainees enter training and we expect that trend to continue this year. We have also created an additional 1,500 undergraduate medical school places and opened five brand new medical schools so that more doctors are beginning careers in the NHS.

“The NHS People Plan – published later this year by NHS England – will set out our plans for securing the staff we need for the future, including for primary care.”

GPs told to stop closing for half-days . Corporate bullying and breaking contracts unilaterally will not “gag” self employed GPs.

The contract between an independent GP as a self employed practitioner, and the state is a written one negotiated by the BMA. Some practices are large enough for there to be no half day closures, but some are not. This “instruction” is illegal, and should be ignored and challenged in court. (By the BMA). However, there is a problem with single handed practices, usually either in distant rural locations, or in city centres. GPs, mainly female appointments since 2000, are NOT an emergency service any longer, and their contract states this. Many GPs work part time to accommodate family commitments. The idea of the instruction is to free up appointments; I know of no GP who is not exceeding his contractual commitment, but it is very possible that corporate bullying of this nature will mean they start working to rule. It is not the professions fault that there are too few bodies at the coal face. Even today, when Medical Schools are trying to train more, there are 10 applicants for every place. Why not appoint on criteria rather than competitively…. Overcapacity might result in rather more appointments but it will take a decade. It is the perverse incentive to save money and plan for only the next four years, rather than empower good manpower planning, which has led to this situation. Government has been in denial of it’s own part in the mess that is General Practice today for at least 6 years… The corporate culture of Hospital bullying will not work in General Practice.

Exclusive: Doctors are ordered to stop halfday closing at surgeries …
Daily Mail19 Aug 2019

Anviksha Patel reports in Pulse 0n 19th August: GPs told to stop closing for half-days or risk losing £40k in funding

GP practices have been warned to stop closing for half-days or risk losing £40,000 in funding, according to new plans by NHS England.

The plans to withhold funding come as figures show over 700 practices in England regularly close for part of the working week, according to findings from the Daily Mail…..

….Figures show in 2018/19, 722 practices were shut for part of the week, 197 of which initially did not declare they were closed for a half-day. Additionally, 38 practices reported their total opening hours amounted to fewer than 45 hours per week, lower than the contracted 52.5 hours per week.

The BMA has said instead for ‘threatening’ GPs by reducing their funding, NHS England must address the GP recruitment and retention crisis as a solution to ‘lasting improvement to patient care.’

BMA GP committee chair Dr Richard Vautrey said: ‘It is disingenuous for NHS England to be so categorical in claiming they know exactly how many more appointments would be available if practices changed their opening arrangements….

Richard Ault in Stoke on Trent live 23rd August reports “North \Staffordshire GPs ordered to end half-day closing.

Orders issued to GPs to end the practice of half-day closing have been slammed as ‘political nit-picking’ by a leading North Staffordshire doctor.

NHS England says more than a quarter of a million GP appointments will be available when surgeries end the practice of shutting midway through the day…

In future, as part of the NHS Long Term plan, practices will have to seek permission from local health authorities to shut during working hours or risk losing funding worth more than £40,000 per business……

Image result for corporate bully cartoon

Pulse 29th September 2017: Extended GP opening has ‘no immediate correlation’ to A&E … –

Sofia Lind in Pulse 27th October 2013: Longer opening hours needed