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Independents' Day

Gerard Bulger

  • 'Flexible' GP appraisals to restart from October

    Gerard Bulger's comment 04 Aug 2020 9:31pm

    They should make it every three years with phone call at 18 months.

  • Hancock suggests GPs can continue to do secondary care work after pandemic

    Gerard Bulger's comment 03 Aug 2020 3:07pm

    GPs to not do old primary care now anyway and believe they are not qualified despite over a decade or more at it. Many factors: GP training with an irrational fear of being sued, pressure from dermatologists who are fear of loosing private practice (as they did in Fundholding era) and nurse ticket training systems imposed on doctors. So I go to many practices and there is not even skin glue, or suture kit, no joint injections, no minor ops materials, no suction for ears, no proper eye examination kit... Won't tale bloods. Now thanks to telemedicine not even examine patients. General practice is finished.

  • NHS England set to 'redesign' GP appraisals

    Gerard Bulger's comment 10 Jul 2020 2:18pm

    The best thing they could do is make it every three years with a phone call at 18 months with appraiser. Some other tweaks but the system is not too bad, this issue is that is is FAR TOO OFTEN. Pointless annual now everyone has been re-validated. Similarly CQC has runs its course and now need only go to reported practices, and scrap performers list. We should be registered as specialists and be rid on NHS bureaucracy in registering us as GPs... that is a GMC function

  • Delay CQC inspections for at least a year to protect GP mental health, say top GPs

    Gerard Bulger's comment 19 Jun 2020 1:26pm

    Scrap CQC inspections altogether except for those with practices reported concerns. The regulations they impose are covered by GMC standards, contractual, health and safety and TORT. GPs do not need to be fussed about these standards which they have to comply with anyway, but just adds a time wasting process. Then of course CQC is tempted to invent rules and interpretations of it own to impose, to prove it needs to exist. It does not.

  • GMC asks 5,000 unlicensed GPs to return to work in coronavirus crisis

    Gerard Bulger's comment 19 Mar 2020 7:48pm

    Why not call up those of us still registered, working part time. offer us some interesting jobs. I would be happy to work in casualty been trained on ventilators. But nothing on NHS England not even to put your name down

  • GMC asks 5,000 unlicensed GPs to return to work in coronavirus crisis

    Gerard Bulger's comment 19 Mar 2020 7:47pm

    Why not call up those of us still registered, working part time... offer us some interesting jobs. I would be happy to work in casualty been trained on ventilators. But nothing on NHS England not even to put your name down

  • NHS England 'strongly recommends' suspension of GP appraisals

    Gerard Bulger's comment 19 Mar 2020 4:32pm

    While at it make appraisals every three years, with no extras, with a phone call at 18 months. Once a year is too much pointless and time consuming now everyone has been revalidated

  • GP clinical judgement leads to 20% fewer referrals than NEWS score, finds study

    Gerard Bulger's comment 28 Jan 2020 5:33pm

    These scores are designed for ill patients, say post-op, who are going off. Not for patients getting ill in the first place. It is COMPLETELY wrong for Primary Care as we are supposed to find patients before vital signs change. In fit patients signs change late, very late. My last 7 inch leaking aortic aneurysm had a Mews score of 0, which is what is required to get him in and under gas, which they did in four minutes on arrival. What I detest about these scores is the false reassurance they give. Recently I had a patient, albeit in a prison setting, with a rigid abdomen and I arranged him to be sent in; 1-2 hours was Ok, as he had been ill for three days and stable. Little did I know that this was countermanded later and he was not sent in as an emergency because MEWS was 0. MEWS 0-1 mean not ill according to ambulance and nurses. I discovered this four days later. He still rigid abdomen, now with a mass. I have a moderate tantrum, so at last he goes in. He dies four days later. Don't get me started o the risks of Pulse Oximeters in primary care.

  • Do you want to be stranded at the top of your licence?

    Gerard Bulger's comment 06 Nov 2019 9:31pm

    Microspecialisation and part time working is crushing general practice causing mutiple appointments and thus overloading the system, exhausting doctors, who respond by limiting their roles (eg the diabetic lead) making matters worse. We need to get back to being general practitioners.

  • Can the Government fail to act on GP waiting times?

    Gerard Bulger's comment 20 Aug 2019 11:43am

    Long waiting times is the professions' fault. We have all gone part time, reducing flexibility with surges in demand, and now most GPs micro-specialise, creating multiple appointments when one would have done before. Over last 20 years we moved from treating patients with problems to screening and prevention which seemed a good idea but is not working out. We created a nation of the worried well and the approach caused harm with over-diagnosis which we then have to manage with more appointments. I had 2,700 on my list with 1.25 doctors yet patients never had to wait more than three days in 2007 and emergencies on the day.

  • GPs should not prescribe antibiotics for impetigo, says NICE

    Gerard Bulger's comment 20 Aug 2019 11:30am

    I wonder if they are right.. I often wondered is antibiotics were OTT. I have never used hydrogen peroxide cream. Did not know it was a thing.

  • Stricter rules will deter GPs from working in Australia, say recruitment agencies

    Gerard Bulger's comment 30 Jul 2019 4:15pm

    MRCGP (UK) does not have all the remote stuff that RACGP and ACRRM has, the latter even more challenging and good. GPs in Australia do mote stuff, especially when remote, and all doctor training assumes you will be on your own, remote and flying doctors will not get to you because of weather for 48 hours. GPs do skin cancers, minor surgery, setting bones and more. General Practice in OZ is still General Practice, which a much wider remit. Most UK GPs seem terrified to do anything, not even suture a laceration, or joint injection. Do not panic. you can work and get there while working towards the exam. Supervision is pretty hands off, its not like being a trainee again. I suggest ACRRM exam, as a more remote orientated course. So at the start while working you cannot claim the higher "VR" fees until you have one of those exams. There are still plenty of interesting places to go. My inbox is full of pleading Oz agencies asking me back and claiming they can fix the visa. https://gerardbulger.com.au/austgp2.htm

  • If, when and how to use FeNO

    Gerard Bulger's comment 24 Jul 2019 7:58pm

    Asthma is reversible disease. It comes in attacks or is seasonal. Does FeNo still work when patient comes in seeking a repeat and their peak flow is on target. This test will only work if we catch them wheezing?

  • GP’s indemnity fees doubled to over £1k after state-backed scheme launch

    Gerard Bulger's comment 13 Jul 2019 6:51pm

    GP in English write NHS prescriptions on System 1. They are NHS funded and is in similar manner to hospital scripting as issuing medications to the patient is recorded on the system. They are not FP10s. For a decade + there have been plans to make clinics in prison standard GP practices, but so far has proved too complex (as many extra services) to set up

  • GP’s indemnity fees doubled to over £1k after state-backed scheme launch

    Gerard Bulger's comment 12 Jul 2019 11:55am

    I asked NHS Resolutions what would happen if I made a claim working at any prison, or needed help, next week. The first thing NHS Resolutions will do is look at the trail of contracts to see if Schedule 2L of the NHS Standard Contract is there (in effect APMS). If not mentioned I would not be covered, so back to MPS, having paid the double premium for “private” work cover.

    GPs do not know the wording of contracts up the chain, so we remain at risk.

    The main contract will not necessary APMS/PMS at all. But depends if somewhere in the documentation there is a Schedule 2L of the NHS Standard Contract (each a “Primary Care Contract” in effect APMS) added on to the contract. That is all that is needed.

    NHS Trusts pay a premium each year for their CNST scheme, and the premium depends on their risk and claims rate. NHS Trusts could, if they wanted, include GPs, but you can see why they would rather not. The CNSGP scheme has NHS England pay a global premium. There is no group membership or risk premiums to pay. So it may be all that is needed if for all prison providers to look at their contracts, and add if not there, Schedule 2L of the NHS Standard Contract and we are covered after all!

  • GP’s indemnity fees doubled to over £1k after state-backed scheme launch

    Gerard Bulger's comment 12 Jul 2019 11:51am

    Are there any out of hours services that do not have "Schedule L" in effect APMS contracts? They too would not be covered

  • GP’s indemnity fees doubled to over £1k after state-backed scheme launch

    Gerard Bulger's comment 12 Jul 2019 11:50am

    My MPS fees may no make sense to full time GPs. I am part-time in London prisons, and my other NHS GP work is in Scotland as two week locums, where MPS fees are cheap anyway and now comes with a separate certificate and premium.

  • This fearmongering over missed cancers will end up costing us GPs

    Gerard Bulger's comment 10 Jul 2019 9:20pm

    The must-read that explains the mess we are in
    "Over Diagnosed making people sick in the pursuit of health" by Gilbert Welch. These arguments are the real crisis in healthcare, not privatization or models of funding. The debate should be about benefit, and what is causing harm. Creating a nation of worried well is harm.

  • Welsh GP practices face six-month delay to IT switch due to safety checks

    Gerard Bulger's comment 10 Jul 2019 9:05pm

    Well Ivery liked using Microtest systems as ergonomic. Back in the Fundholding era I saved £20,000 staff costs at the Fundholder's Support Agency as it was so much faster and slicker than three other system it replaced. The clinical Evolution product lets you get instant picture of the patient on first screen which I so miss on other systems. One "flaw" is that set to allow so much local preferences and customisation which great in the end but I suspect tedious to set up.

  • Incidentaloma on the rise: how GPs are left to manage unexpected findings

    Gerard Bulger's comment 06 Jul 2019 10:18pm

    The best book that describes how this came about is
    "Overdiagnosed: Making People Sick in the pursuit of Health" by Gilbert Welch. It should be a compulsory read for all journalists spouting their human interest stories, NHS executives, health administrators and CCGs.