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Independents' Day

Vineet Joshi

  • Become a partner? Not if I can help it

    Vineet Joshi's comment 16 Aug 2014 0:37am

    Being a partner bestows ownership/accountability/camaraderie in my business. We're in it together. Obviously it's important we get on which we do. I don't mind getting blitzed, the sense of mild hysteria that comes from a day of sponging peoples problems but the true satisfaction and meaning gained from seeing and managing my dear patient the day before his death and the talk with his partner about his beloved classic bus he used to have parked in his drive. Forever Locums won't have that. Forever Locums will be empty inside, like robots. In fact they are basically ANP's armed in the art of medically qualified deferral. Making a long term difference is what counts. It 's what makes that Friday night pint taste all the sweeter, and for most of us partners and long term salaried GP's, gives us strength to do it over and over again. For the right price.;)

  • Half of GPs call for contract renegotiation

    Vineet Joshi's comment 14 Jul 2014 8:15pm

    That's a legendary post gp reg 2.19! I would like to change the minor surgery aspect, consultants will snip a tag for 200 quid and we in our Samaritan role will snip those bad boys at a cost to ourselves.
    See it in perspective guys- my other half is a vet working >50 hrs/week (and overtime regularly for no extra) let's just say it's approx a third of my drawings.
    We need a militant leader of our trade union to re-negotiate the contract and if no ball is being played- do a teacher act.

  • You name and shame, I’ll open the floodgates

    Vineet Joshi's comment 03 Jul 2014 7:16pm

    I'm with David on this one. Watch the CT scanners, MRI, endoscopy suites fill with ME patients. But then we'll be blamed for our new crusade on avoiding missing cancer diagnoses! These bughead politicians should keep their mouths shut about things they haven't got a scooby-doo about.

  • Extending GP access will reduce missed appointments, says health minister

    Vineet Joshi's comment 03 Jul 2014 7:02pm

    I would work 1 in 4 Saturdays if I could finish consulting during the week at 5 or so on 2/4 of my days (=spread my work not add to it)

  • GPs to be 'named and shamed' after missing cancer diagnoses

    Vineet Joshi's comment 01 Jul 2014 6:08pm

    Haha what an idiot hunt is! He needs a hundred eggs thrown at him.
    I agree there are some poor performers out there who repeatedly miss diagnoses or delay. If it makes an average hard working GP cringe to hear the negligent case the GMC should deal with the poor GP. If we can back ourselves up with appropriate note keeping, and logical approach, I won't be changing my practice.

  • Almost 40% of GP training places unfilled in some areas of UK

    Vineet Joshi's comment 13 Jun 2014 6:25pm

    What about all the specialist trainees who get "juiced" out of the ST bottleneck? They'll come our way most likely. We need a model where GP's can enter sub-specialist training to vary our weeks/develop skills and make some extra dough. Pure GP day in,week in,month in,year in and decade in coupled with current climate can lead to the sad stories we have read further up this column.

  • RCGP hits back at GP 'four-hour lunch' claims

    Vineet Joshi's comment 11 Jun 2014 10:23am

    Dear 10.13 you have obviously got a story to tell now I'll tell you mine. I cover 1800 patients on my list, we have fully booked lists through the day, 18 in morning, 15 in pm with 8 phone consultations pre-bookable. Usually these have already gone by the time the day has started. Unlike hospitals we have direct access staffed by receptionists and it seems some practices are better than others. In your case it's indefensible not answering the phone as in an emergency they would do the same.
    Patients also need to be aware to use our service appropriately. Having medical advice on the end of the phone which is accredited, qualified and licensed is something the public take for granted and therefore the system is abused which leads to the needy few losing out. The principle of whoever shouts loudest will get heard seems to overshadow our commitment to the unheard vulnerable few.
    We as GP's are being squeezed now and without the support of some of our patients who understand and appreciate the difficulties we are under, I'm sure a few more of us will crash and burn.
    Finally I'm not sure why some of us take any notice of the daily mail's views on us. Do politicians care about the bashing they get? Do lawyers, dentists, insurance brokers really give a monkeys? They just carry on. I think some of us should stop being so sensitive and get on with working hard. If patients don't like our service they are free to move on, if they appreciate our service they will stay. Simples.

  • GPs' independent status may change under Labour, says Burnham

    Vineet Joshi's comment 09 Jun 2014 10:34pm

    Yep hicks was the Trojan, ripley's rock, when all the xenomorphs we're running riot and a few marines got spooked this nucleus of individuals stayed together and ultimately the humans won with the aid of an android.
    This parallel could be applied to general practice, the politicians are the xenos, the GP's are the marines but are you going to be Hudson or hicks my friend? Ripley could be any one of una coales or Maureen baker.
    These ramblings have a distinct point my anonymous friend- GP is not a wasteland yet- there are a select few who ultimately will take our profession forward, who won't take any crap, who are respected enough by their patients to carry them with them through these times of upheavel. I choose not to fold and I think u should do the same comrade

  • GPs' independent status may change under Labour, says Burnham

    Vineet Joshi's comment 08 Jun 2014 11:59pm

    1:45pm- what do you dislike the most about work?
    I think you need some CBT my ally.
    Best regards
    Fellow young GP

  • One more request and I will pop

    Vineet Joshi's comment 08 Jun 2014 1:52pm

    pop in or they might pop off. then you may be pop-corn. very annoying scenario. we need to use other staff for these kinds of visits - triagers - extended scope paramedics/ANP's - it's not rocket science - lying/standing BP/consider antihypertensives being the cause and do a home risk assessment/pop off some bloods - get someone else to pop out in a proportion of cases.

  • GPs face tighter prescribing rules on tramadol and temazepam

    Vineet Joshi's comment 08 Jun 2014 11:09am

    pregabalin is very expensive we can't prescribe that here without feeling dirty inside, ive given 1 patient it in 3 years (pain clinic recommendation)
    tramadol can be hard to avoid in the backpains in whom the 30/500's arent working well. the long term trams should move to morphine if theyre going to be on long term opiates otherwise tough - back to your para/cod. change the temazes to zop/amitrypt (unless theyre in their 80's and been on it since 1988)- if theyre not happy with that then again- tough

  • GPs' independent status may change under Labour, says Burnham

    Vineet Joshi's comment 06 Jun 2014 8:22pm

    Don't think GP's will stand for a significant paycut. It will undermine them, reduce morale yet more and lead to less coming into the profession/less doctors for more patients - health armageddon. It will be the politicians who are blamed ultimately for this "ice age" but i imagine the thaw will set in and there'll be a "golden-hello!" back with red carpets/nice bunting and cakes to get us back to where we were before. Few extra may have perished unnecessarily though and that makes it more serious so Mr Burnham if you're reading this DON'T BE A MUPPET

  • GP sees 84 patients in one day

    Vineet Joshi's comment 06 Jun 2014 3:22pm

    84 patients (840min) is that face to faces because thats 14 hrs of consulting in a row - that cant be right! How much of that is minor illness? I would guess a lot. Once you federate you can train up a pot of mobile minor illness practitioners to do it for you. You cant carry on like that without combusting into charred carrion.
    Bob - how do you surpass the 80mark ? Why don't your ANP's deal with the staple and leave the more complex/challenging cases to you?
    There's ways around this - educating patients - if anyone interested my colleague has helped make this leaflet for parents who bring their children in whenever they have a cough;

  • GPs should be paid per 1,000 consultations, says Gerada

    Vineet Joshi's comment 28 May 2014 10:40pm

    A payment by appointment number system will lead to more follow up appt's/strategic callback systems to keep the appointment rate up to maximise income. A new patient appt waiting time criteria will need to be implemented to less than a week to ensure clog-up does not occur with the same old patients coming in for a renumerated chat.

  • Gerada urges LMCs to oppose GP charges

    Vineet Joshi's comment 19 May 2014 10:53pm

    There are a lot of unlucky people out there with complex medical problems developed through no fault of their own. Do we really want to charge these individuals who are simply carrying on with the life cards they've been dealt? It's hard to pick out the real "targets" for appt payments without looking discriminatory (obese/smokers/drinkers/personality disorders/freeloaders/drug seekers/the lonely. See what I mean?!

  • It is time for the BMA to ballot GPs on mass resignation

    Vineet Joshi's comment 11 May 2014 1:32am

    That's a heartening post 10.50! I suppose it depends where you are- but a large proportion of patients could pay a fee to be seen. If they truly can't (are on benefits) then they can be seen for free. If they smoke or are obese they could give up 20 cigarettes worth or a visit to Mcdonalds that week to check in on their problem with their friendly realistic GP. A lot of the stuff I saw on my on call morning on Friday was utter rubbish- if they had to pay a fiver for that they may have decided to see how things went rather than "check before the weekend". They would have seen that actually things got better so positively reinforcing self-care for future illnesses. I appreciate there will be those who will stay away who are truly disadvantaged and this is the difficult group. The "I pay my taxes" or the " I fought in the war" group also - we can't just expect to get everything we want at the drop of a hat- this is not a fantasy movie. The social care system is struggling/hospitals are bursting and we end up scurrying around trying to keep a hundred plates spinning all at once! The British public need to sort themselves out. Look after your parents. They brought you into this world and you wipe your hands with them when they become dependant and expect the state and their "named GP/care coordinator" to rush out and quell their suffering/loneliness because you are too busy.
    The private companies won't have a chance at taking our patients - it costs too much they'll only be involved if they can make their defined profits- we 're just aiming to cover our increased costs and deficits imposed by the government and a select proportion of the public!
    GP partner year 2

  • Five steps to starting the unplanned admissions DES

    Vineet Joshi's comment 07 May 2014 10:55pm

    Half the patients on the list won't be able to meaningfully add to their care plan due to cognitive disturbance/general frailty. The major difficulty will be upkeep of the register from an eagle-eyed individual who can flag up when the numbers are low giving enough time to draw up new plans. I have already found a few patients flagged up in our 2% from the risk profiling software (acg) who I can't understand why they're on it- they've not had recent admissions. We're waiting on a care plan template which we can hopefully auto-populate with relevant info from a summary consultation. Once this is done, it's the monthly reviews of A&E from the 2% and N homes + the upkeep/monitoring which will be the onerous problems to overcome. EMIS prompts when their record is loaded, phone number to call on the standard letter for the 2%, and weekly auto reports counting the codes for active case management will help this process. The what-to-do (key action points) is relatively easy- in the letter we can include a patient leaflet which can be written up focussing on the time-critical illnesses for 999, and everything else the practice/111.

  • One in seven GPs will refuse to take on unplanned admissions DES

    Vineet Joshi's comment 22 Apr 2014 8:33pm

    Does anyone have any good ideas at how we should get the funds in different ways? Ways to improve primary care services, patient care and keep GP's content? Increasing the funding from 7-11% would be great but what would we use the money for? Employing more doctors would be good but I thought there weren't enough anyway? Training up ANP's and ENP's to take the minor illness load of us would be useful but a significant investment of "our money" to improve things in the longer term.
    I'm a new partner so missed out on the short lived "Bronze Age" between 2004 and recently. I don't mind working hard and therefore I like to see the positives in what's trying to be achieved. I get to cover my medical indemnity fees for drawing up advanced care plans for my vulnerable patients (30 in total approx). Some of them are not necessarily required which will offset the ones which are complicated and necessary. We'll share the A+E reviews on a monthly basis (I'll sit with my laptop in front of MOTD and look for themes on my watch). Any poor play by OOH or Nursing home staff who call an ambulance unnecessarily will be flagged up and the NH will be educated and the patients care plan amended to CALL US OR OOH rather than 999, who may have copies of our ACP's so more likely not to knee jerk to A+E. 111 should have a dedicated number like we have to for the vulnerable 2% and nursing home patients where an OOH clinician with access to our kindly drafted ACP can decide on blue lighting or visiting the patient. It won't prevent unavoidable A+E attendances but may prevent avoidable ones in this way. Anyway I'll do my bit, shave a few edges here and there but ultimately improve our records for the complicated, vulnerable few, have more EOL discussions, get more SW assessments and involve NOK in the chats so they are aware of what I'm doing for my 30 odd. And pay my subs at the same time! Hopefully

  • In one ear and out the other

    Vineet Joshi's comment 14 Apr 2014 0:52am

    She's blatantly got fibromyalgia/cfs.
    Tx- wildlife photography whilst wearing two left slippers. Works every time. They leave straight away.

  • Dr Maureen Baker: 'We agree that further action is necessary'

    Vineet Joshi's comment 13 Apr 2014 0:38am

    Trainees are being failed for not following a "blueprint" consultation. The most important thing is safety, risk assessment and follow up. After qualifying, the sheer workload will force any new GP to modify this blueprint into a workable format. You can teach a dummy to ask about ICE. Failing medically safe trainees for saying something the examiner feels as inappropriate or marked down for missing a "cryptic colloquial clue" from a scouser simulated patient is wrong. The patient will come out with it in real life if it's that important, or choose another GP! Stop the charades and get to the real point- stop weak csa fails to finance the RCGP.