Pale Male and Stale
Thanks for this but I fear even a voice as eminent and well informed as yours will fall on deaf ears - hopefully CQC will open their eyes to the reality and inspect wrt context. Having said that, should ANYONE who doesn’t need to enter a GP surgery be allowed in - what is the risk:benefit here on a Covid let alone mental health level?
...as ever GPs are the first and last line. Patients see us first, get referred, bounced and in the end we have to deal with their issues whilst the all the other sectors (NOT just hospitals!)remain isolated as patients 'not accepted' / declined. (I'm not sure what podiatrists are doing in our area but they won't accept anything but urgent, so all that preventative podiatry will end up urgent and then they will reject as 'no capacity'!)
...err as clear as mud and as useful as a chocolate teapot....and still we are having trouble getting our own PPE!
Yes pale! Yes Male Yes stale! Yes Ca!
So 3/4 not bad. So far as I’m aware I can’t change my sex, ethnicity or age. However from now on I will try to identify as female and see if coronavirus takes notice.
This research may very well show BAME have higher risks, Bangladeshis maybe several times more (2x vs 10%) than others in this group seemingly defined by melanin content of the skin rather than any defined generic trait? (I stand to be corrected. but why the HUGE difference between a Bangladeshi and an someone of Chinese origin?!)
So what to do? The answer is clear, do what we have always done. When taking blood assume patients has HIV/Hep B, likewise with a new sexual (non-patient) partner, coughing and spluttering patient - assume the worse. So take care, use PPE, avoid touching face and wash your hands. That or get your young, white, female and non- pregnant colleague to see the patient!
Any other bright ideas??
If there is ‘blame’ it’s that economics won out over life & death and looks likely to win again with the early unlocking.
Two independent analyses have suggested that had we locked down one week earlier we would have saved 3/4 of the lives lost 25,000+ of all hues. 20:20 vision and a retrospectoscope is great if you have one but stats suggest a day here or there REALLY can make a difference - So, Boris your money or (y)our life?
Are we not supposed to follow the science rather than purely skin colour? Although there may be an increased risk with BAME (hardly a genetic subtype surely?!) I note that a large proportion of the GPs who have unfortunately died were older than the average ‘pale’ GP. Although being female and pale may be protective age certainly isn’t.
Some ethnicities are more prone to certain conditions eg diabetes and Vit D deficiency. Are these the major risk factors or skin colour? All the variables need to be taken into account before we start making rules based on melanin alone. As an old overweight male with Ca am I more or less at risk than a young Asian female?
Out of date face masks are probably as useless as in date ones - however it is the principal here that counts - a sticker saying “xx has deemed these are appropriate to use despite use by date” would have been understood and acceptable - it’s being overt rather than covert - someone thinking “....ahhh GPs - it doesn’t really matter!”
...only those GP surgeries already closed down can escape the threat of suspension!
It's grim out there/here - we spend too much time trying to make sure that we pass a CQC test that actually has no real evidence of being related to patient outcomes!
Like the author I work 2-2.5 days a week (4-5 sessions) and having done 20 years of up to 11 sessions per week I can tell the difference. I’m in the transition to retirement and winding down. If I felt the same every day I work now than I did when working FT then it wouldn’t be sustainable but it isn’t - every day there is a bigger light at the end of the tunnel - a 4-5 day w/e. The less I work the more I enjoy it and I’m sure having the variety of something else tomorrow keeps me and I’m sure those with portfolio careers going. What I see from those around me doing stuff other than GP work is that they in the main choose roles without the uncertainty of having 5 mins of duty left and 3 visits come in. That’s the issue - whether it be family time, lunch or just being there for a pm surgery - it’s OFF - dealing with uncertainty was the great strength of the old GP as we seldom had much else in our lives - work life balance has improved and not working w/e makes life a lot better despite the fact I often had only a handful of visits from Friday night to Monday morning. I lived in the area and a visit on foot or a 5 minute drive makes the choice to visit much easier than knowing a visit will take up the best part of an hour or more. Who do I blame? Everyone. Us old GPs with visit books filled by reception whilst we worked. How to turn around a ‘request’ for a visit is in my experience almost impossible and is often the cause for a complaint - “It’s my right! Are you REFUSING’ to visit?” ((Patient expectation is key - it took us years but now patients don’t expect a home visit so when they get one it’s appropriate and gratefully recieved - tell them it’s so much easier and we have all the kit in the surgery - send a taxi if needs be - yes been there done that! Often visits are requested as children need looking after - is this OUR problem? Maybe it is and if so it’s yet another job for the GP(The patients - Jeeze you pay £5 for a taxi and it saves me an hour to do other stuff for other patients - and by the way that’s less than the fag packet in your pocket. Government - it’s just too easy to push everything onto GPs and maybe home visits WERE part of that - it’s all the other 2y care work that has come our way as well as patient expectation exploding.
A local surgery has a driver and dedicated GP - I suspect this just makes more and more work - a paramedic able to triage and deal with 90% would be more efficient and probably involve more continuity of care.
There is no doubt that younger GPs see home visits as a stress and for this reason alone will drive away those we are trying to recruit and retain. Not rocket science is it?!
...when will the general public get the message? Electioneering = Lies, damn lies and statistics! Andrew Marr gave the example of the Police Cuts of 20,000 police and the new pledge of 20,000 more police. It's like taking your raincoat away in a storm and several years later saying here's a new raincoat so everything is fine now, isn't it??
The treatment of NHS GPs and Hospital consultants over the years has sapped morale and the willingness to do all those unpaid extras that we used to obligingly do as 'part of the job' - now so much has been taken away, so much added to the job and no thanks (£s would be nice too!)that our capacity to stand still let alone push on is now zero. As a past GP trainer this is hard work and this too has been made less attractive. Fully experienced GP takes time out to help train newbie inexperienced GP so there is some initial loss of availability too that doesn't seem to have been factored in. Where are all the extra trainers going to come from - were we not thinking that GP training needed to be extended further too?
Ahhh the alternative to the NHS - the grand Tory master plan and there they are not even having to face the splatter of the shit hitting the fan with focus elsewhere!
I wonder how much GP practices would improve if the anxiety and workload of a CQC inspection were lifted?
I wonder how much GPs are 'defrauded' by the NHS in not getting full payment of fees etc?
Dr Kamal Sidhu is a GP and trainer in Durham, vice chair of County Durham and Darlington LMC and chair of South Durham Health CIC.- Mmm seems to have risen to the snowy peak himself!
When I get picked out for a ‘random security check’ I think of it as ‘random’ - that some others with more melanin think that their randomness is racist is anecdotal. One surgeon, one flight does not racism make. This was a ‘safety’ issue and related to getting the plane off in its slot. Rudeness is unfortunate but happens to us all and is not an excuse for breaking the rules - no matter how ‘right’ you feel you are. It’s their rules - break them and take the consequences like the rest of us
Scary? How about this. Many years ago, single handed I did minor surgery at the end of surgery. I'd seen a lady with an 'obvious' lipoma and agreed to excise it for her. However when she arrived it seemed bigger than I had remembered and after some humming and haring I decided to refer - UNHAPPY patient! - The surgeons saw her agreed with my diagnosis and arranged day case surgery - you guessed it - spigalean hernia - I had actually seen and heard about these in medical school! Glad it wasn't me cutting through a loop of bowel!
Have faith - Haven't the government delivered on Brexit, Universal Credit and pulling out of Afghanistan and Iraq?
Some may say "Your part time flexibility is my early mornings, late evenings and working through the holidays"
I'd say "I'm off, been there done that and never got the thanks!"
Do we really want to be managed from above? Well the answer at the coal face is "No - I'll work when and where I want as a locum" - Until those taking the risk and ultimately the responsibility for premises, staff contracts, GMS Contracts etc. are rewarded MUCH better than locum or salaried jobs then the temptation will be to take the money and the flexibility.
At the end of the day we can't all have ultimate flexibility and remain 'equal' - Some are indeed more equal than others. Big Brother will take over the farm and GPs will be offered take it or leave it contracts....unless SOME GPs take back control and are rewarded for doing so, not just money.....maybe they too would like some flexibility!!
...to those who have, shall be given.
Adulting begins at sixty - twenty years a kid, 20 years pretending to be an adult, another 20 years preparing and then you’re there - Adult - only to find it’s actually like the first 20 years - fewer responsibilities and certainly less fear of mucking things up! Goodbye imposter syndrome, I’ve been there done that and if that’s not good enough for you - TOUGH !! You know you’ve arrived when you can truly laugh at yourself when the others are falling off their chair having fallen off yours and not caring you don’t know all the answers and openly use Dr Google for advice!
It's a sorry state of affairs but the best and cheapest solution is probably to do nothing. All practices MUST do GP2GP and somewhere along the way notes will be summarised (hopefully) - In time whatever is left in the Lloyd George will become less and less relevant. The alternative IS to scan everything and upload onto clinical system - not ideal but less likely to be lost than LG - The time taken to review notes and clear out 'junk' is too great - if scanned and separate pages created this exercise can again in time be edited and irrelevant guff culled.