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Independents' Day

Gerald Freshwater

  • Mis-sold PPE

    Gerald Freshwater's comment 04 Jul 2020 4:30pm

    Do remember that the Government made a deliberate decision not to maintain emergency stocks for a possible respiratory disease pandemic at the levels their own report advised. This was explicitly done to reduce costs, though much other major public spending continued at very high levels, particularly on 'defence' projects.
    Only four years until the next election – if D Cummings hasn't organised a Putin type putsch meanwhile.Vote more carefully in future!

  • GPs being sent 'out-of-date' face masks with 'concealed' best before dates

    Gerald Freshwater's comment 21 Mar 2020 3:16pm

    Probably the date of manufacture is not very relevant to the efficacy of this type of PPE, so long as it has been stored in suitable conditions. Obviously, it might have been better to say this up-front, instead of after complaints were made.
    More troubling, is the assertion by the CE of NHS Providers, C. Hopson, on national television, that the NHS had adequate stocks of PPE, but 'distribution had been lumpy' i.e. many people had not received any. Requiring person to work in dangerous environments without providing suitable PPE, correct fitting, and training in its use would breach the Health& Safety at Work, Act, and the period of notice for the PPE to be needed was sufficient that they ought reasonably have complied with those requirements. Hopefully, prosecutions by the HSE will ensue, but don't hold your breath. (Or do, if you have no mask!)
    If managers shared the attitude of staff facing infected patients, they would have been fetching the stuff from depots themselves, not getting lorries sent round by night two days after the complaints.
    Are we all in this together?

  • The value of general practice

    Gerald Freshwater's comment 15 Dec 2019 12:26pm

    Why not make the video? It won't take long, and the information will be useful; Dr McCartney is very committed to improving general practice, and is an experienced GP, not just an academic. Nothing to lose but twenty minutes of an evening.

  • Are there too many posh doctors?

    Gerald Freshwater's comment 08 Dec 2019 10:24am

    Yes, there are too many posh doctors. Current social trends, politically driven, will make this a continuing and increasing problem, as only the affluent will be able to afford tertiary education for their children.
    State education is being deliberately tailored to basic standards of literacy and numeracy only, with no emphasis on training in criticism, problem solving or even the least understanding of statistics and probability. One cannot start a course in medicine without a good background in these areas.
    Meanwhile, those in schools where progression to A-level is the norm can only achieve well with support from their families, not easily available when both parents have to work full time just to pay for housing and food.
    The problem of posh doctors cannot usefully be solved simply by changing entry standards, but needs to come from the earliest years of education, and a society that supports all to achieve well; our continuing obsession with extreme wealth, and deference to the powerful rich, will maintain these ancient inequalities. Start voting for fairness now!

  • I was left unsupported for 80 minutes in a life-threatening situation

    Gerald Freshwater's comment 16 Nov 2019 8:29pm

    Sometimes you just have to sit it out! All that was necessary, after your effective first aid, was to watch over a patient who was conscious and not bleeding until the scarce resource of an ambulance became available. Sometimes the the ambulance staff are dealing with ill or injured patients in an even worse condition.

    If there is a problem here, it is the result of inadequate investment in service and staff for the past twenty years. Don't blame the overstretched ambulance service, which cannot afford to employ enough qualified staff to manage calls efficiently and effectively.

  • I hear a bid of 5,000 new GPs. Do I hear 6,000?

    Gerald Freshwater's comment 28 Sep 2019 2:35pm

    Christopher Ho, there is little evidence that the country is broke, though too much of the money disappears from the UK economy to offshore accounts; other European countries manage better social welfare and pensions at the same level of GDP. And the current Government seems to think it has billions to spend on recent promises. The problem with general practice is lack of long term investment, which should have started twenty years ago, accompanied by long term planning, ditto. Cameron's promised 5,000 GPs was obviously impossible even then, and his Government did nothing to actually make it happen. Successive Governments, from before that, have made promises without ensuring they were honoured. Whilst politicians can get re-elected on the basis of failure, we shall continue to be governed by greed, not need.
    As for charging, it will be just like prescription charges; an army of accountants and clerks, exemptions, rebates, and ill feeling, with no eventual income. The Scottish Government actually saved money by abolishing them.
    Think again.

  • We should all be chucking our physician associates out of our prams

    Gerald Freshwater's comment 16 Mar 2019 10:25am

    Presumably all this is to cover up the non-arrival of Cameron's 5,000 extra GPs by next year. But why have GPs taken on the role of monitoring long term illness, and abandoned acute illness to A&E departments? Paramedics, nurse practitioners and pharmacists are getting all the interesting new stuff. Glad to have left general practice ten years ago.

  • I'm the victim of a drone attack

    Gerald Freshwater's comment 26 Jan 2019 10:20am

    Perhaps as well that you saw her in your afternoon surgery, when her presentation was markedly different from your colleague's findings; seen in the morning that might not have been apparent, and she could have been told off, not admitted?

    A;ways worth telling them to 'come back if it's not getting better'.

  • GPs demand end to 'outrageous' delayed ambulance responses to practices

    Gerald Freshwater's comment 01 Dec 2018 10:45am

    Thanks to "Cobblers" for looking up Chris Jones; I didn't do this myself. I offer no endorsement of his company, but was merely making the point that flexible approaches may be needed when the official system breaks down. I am long retired, so now am more likely to need ambulance transport for myself!

  • GPs demand end to 'outrageous' delayed ambulance responses to practices

    Gerald Freshwater's comment 27 Nov 2018 6:37pm

    Sometimes out-to-lunch solutions have to be tried; once I recruited a few able-bodied neighbours to carry a patient with a broken leg to my car, across trackless ground. I then drove her to the surgery, where we met the ambulance, back from a long hospital trip. There was no question of liability, and the patient was very grateful not to have waited to be formally stretchered over the same route, in the dark, two hours later. Of course, rural GPs have to be more flexible, but it is not solely their perquisite. Perhaps it is better to use a taxi/friend with a car instead of waiting, since earlier arrival in hospital will balance the risk of informal transport. If the main concern is avoiding liability, perhaps a job as an insurance assessor calls? Otherwise, contacting Chris Jones sounds like a useful solution.

  • What do you think of charging migrants for primary care?

    Gerald Freshwater's comment 17 Dec 2016 8:12pm

    When charging between Health Boards was introduced (20+ years ago), it required several extra staff to be employed even in our small board, just to process the claims. No cash changed hands, so we didn't need cashiers, safes, EFPOST machines, auditors, or any method of checking eligibility. You'll need all of this in every surgery! Quite apart from the inequity, general xenophobia, stupidity, etc. of this proposal, it will cost so much that there will be no gain for the NHS. It's only a political stunt for favourable publicity amongst the UKIP tendency of the Tory party. Any participation merely supports their cause.

  • GPs are the deplorables of medicine

    Gerald Freshwater's comment 10 Dec 2016 12:29pm

    The legal test of reasonable behaviour remains that of the Bolam case - would the average reasonable person (GP) have done the same. If everyone follows guidelines slavishly, that becomes 'normal'; if most people think about the individual patient, taking the guideline into account, then that is acceptable in law.

    It's up to you, the GPs still in practice, to make reasonable, thoughtful, behaviour 'normal'. Or not, if you want to treat guidelines as rules, not guidance. Glad I'm retired!

  • NHS chief executive wants 'one-stop' GP practices to do 'all of the -ologies'

    Gerald Freshwater's comment 29 Nov 2016 4:59pm

    Thirty eight years ago, I joined a practice where we did almost all of the 'ologies, including all hospital services, even some surgery. We had inpatient beds, a maternity unit, and a scattered group practice reaching across twenty miles radius. Strangely, our outcomes compared favourably with other areas, and patients could usually see the doctor of their choice within three days.
    We were well supported by consultants in the nearest DGH (200 miles away) who visited regularly, and we were unconstrained by targets, QOFs or revalidation. Complaints were very rare. Our costs were very, very low.
    Over the years, recruitment became harder as training became more formalised, and those prepared to work in flexible ways even rarer. General practice became the home of non-emergency, chronic disease management, and the excitement went out of it. The challenge now is merely to keep going under an intolerable burden of routine and trivia.
    My daughter is a paramedic advanced care practitioner, and she sees the exciting and challenging patients, without the item of service concerns, and her targets are about rapid response and favourable outcomes, not asymptomatic blood pressures and weights recorded. Of course, she doesn't get the money that GPs do.
    The writing was on the wall for general practice from the contract changes at the end of the '80s, and I was happy to change career in the early '90s. GPs have taken the downhill path for thirty years and it has now caught up in the worst way possible. For too long, the Departments of Health, and the Royal Colleges, followed a mantra of sub-specialisation and standardisation (usually to the LCD), instead of celebrating variety where it suited local needs. Recruitment and training are now at such a low ebb that it is probably unrecoverable, and Cameron's promise of 5,000 more GPs is likely to become 1,000 less. Which of our profession's leaders have stood up and said this to the voters? Who has acquiesced in the dumbing down of general practice? I am guilty; I left rather than fight. What did you do?

  • Woe betide those who dump their IT provider

    Gerald Freshwater's comment 31 May 2016 1:29pm

    Had a computer on my desk from mid-eighties; then a novelty, and handy for ICD code recording and repeat prescriptions. But I could never type fast enough to keep clinical records, and it was still the same at the last surgery I did five years ago.
    Now I'm a patient, and find myself irritated that the computer is the centre of interest, not me. It's certainly quicker to scan through the handwritten notes than the computer script in a small box on the screen.
    Too many administrators/statisticians/computer enthusiasts have defined the programming, and each has added their own pet 'wants' to the list of required records.
    I suggest that what is needed is high quality voice recognition to allow fast entry of narrative, and all the QOF and routine stuff being printed off for the patient as they arrive at reception. Thus the GP doesn't work as a poor quality clerk, and the patient speaks to the GP about their current concern only. But it will never work, because everyone is too busy typing in data to change the system.
    Glad I'm retired, just wish I didn't have any health problems needing medical attention!

  • Is continuity of care overrated?

    Gerald Freshwater's comment 03 Apr 2016 4:56pm

    Continuity of care is very important; seeing a patient repeatedly is the easiest way to notice deterioration of a patient's condition, and I have seen competent, caring doctors miss a fatal progressive illness due to six GPs conducting consecutive consultations. It doesn't have to be provided by a single handed GP, but having a usual GP easily seen, in one practice, is manageable by the GPs and beneficial to the patient. Why not take the option with the nicest, easiest workload?