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Gold, incentives and meh

Gerard Bulger

  • What NHS England's top GP really thinks

    Gerard Bulger's comment 01 Aug 2018 5:55pm

    What is it that the NHS has had against small practices,against the evidence, when every study shows they offer good or better quality, preferred by patients and offer better continuity of care. Of course there have been bad inner city small practices. But that problem is due to GP payments system whch pay on list size as if static. Inner cities have huge turnover of up to 30%: looking after 10,000 patients and hitting tagets is easier in static village, than inner city with a turnover, so in there looking after 12,500 but paid to 10,000

  • Commissioners provide £1m bailout to CCG after influx of Babylon patients

    Gerard Bulger's comment 13 Jun 2018 2:08pm

    Cannot be undone. But NHS needs to move to Australin type of pay systemm with fee for service, so those practices that offer telephone or skype like consults only get a different fee from face to face or those able to visit.

  • The end game was always to dismantle general practice

    Gerard Bulger's comment 06 Jun 2018 10:59pm

    It's the profession that is killing GP land. Part-time working, giving up out of hours so we no longer had the monopoly of primary care. Then we gave up being responsible for the computer systems and GPs in Scotland are now giving up being responsible for their premises. Most GPs now seem to prefer a part-time salaried service. GPs are specialising increasing the number of appointments needed, continuity of care is falling. I do not think the Government can go against the tide of what the profession seems to want. there is no plot to break General Practice, if there was the simplest thing is let the profession, now increasingly a trade, get on with its own demise.

  • GP practices set up not-for-profit company with trusts in bid to attract staff

    Gerard Bulger's comment 09 May 2018 10:45am

    Not-for-profit concept assumes that income, as in earned, is not a profit. There are all sorts of mechanisms wherby those inside can indeed profit in such organisation by way of salaries and fees. There can be subcontracts with a profit making management company, or with teams which could inculding run for profit GP practices.

    Yes, many complain of vested interest, a tactic to block all innovation in the health service. Vested interest means that you are extra interested, it is entirely beneficial concept; the only caveat being it must be open and everyone know who owns what, and who has an interest.

    Unless formed as a Community Interest Company, a not-for-profit organisation can be unwound for profit to members later, as did building societies when becoming banks.

    I worked with a trendy CIC (SecureHealth Ltd) which had heart in the right place, ambitions in the prison service. Failure to consider margins, indeed to have the discipline of that wicked profit, meant it went bankrupt with £1.4M debt and PCT had to take over running Wandworth priosn healthcare over immediately and take over the debt. SecureCare had been awarded the contract because of its saintly not for profit status; it had not won the competitive tender. Before it was given grants to tender probably outside EU rules. Finding out what really happenned is too easily blocked https://discoversociety.org/2017/08/02/on-the-frontline-challenging-secrecy-in-the-nhs-through-research/

    Apart from running a village hall, a not for profit company organisation can be a shield. They are dishonest and creepy things. Virtue signalling. Avoid them.

  • QOF may shrink to '3-4%' of GP practice income as review ‘nears completion’

    Gerard Bulger's comment 03 May 2018 11:51am

    QOF may be past is sell by date. It's not as if it has made a difference to patient outcomes, despite the alleged evidence base of the QOF ideas (such as in diabetes) which makes you wonder about the evidence base of all we have been told to do.

    I am not sure that the NHS should abandon Fee for Service, indeed it should develop some more. There are merits to parts of the Australian system which could be used here. You could pay one fee for a telephone consult, another for a Babylon/telemedicine and proper one for a face to face. Fees arranged to discourage patient churn, such as aa much higher fee for seeing a patient you have not seen for a year and lower fee if seen last week.

  • GMC review finds revalidation 'may not improve practice'

    Gerard Bulger's comment 02 May 2018 5:04pm

    Appriasals would be Ok if they were every two or three years. Once a year is pointless.

    The lastet blurb from GMC really stuffs it up for doctors who want to work overseas (that includes British overseas territories), with loss of license even if you keep up appraisals. Loss of license means loss of place on perfomers' list and getting back on that might be very costly.

    I am not sure why GMC have made subtle changes to the wording giving such a devastating effect; seeking to discourge GPs to work abroad and gain experience, or work most of the year abroad and in then UK, and also discouraging GPs in Australia New Zealand and Canada to come back. Very odd. https://gerardbulger.com.au/revalidation.html

    The new wording would also seem to prevent superspecialists such as those coming over from for a few days (say from USA)

  • GPs issue warning as London practices lose young patients to GP at Hand

    Gerard Bulger's comment 26 Apr 2018 6:47pm

    The thing is that young people, if they ever went to a GP, do not see a GP get up out of their chair and examine them. Nor understands the importance of a relationship and contact is in a consultation. But since most GPs are part time, and are glued to the computer screen, it is not surprsisng to me that younger punter takes up the lazy option of using GP at Hand. Do not even have to get out of bed to use it. Of course it will be popular, until patients are ill.

  • Why it’s time to re-think guidance on 28-day prescriptions

    Gerard Bulger's comment 24 Apr 2018 11:53am

    Agree++ At my pracitce I almost abolished the concept of a repeat preciptions, with three months supply or 6 months supply. My nurse or I would see the patients for a renewal. I am sure that saved wastage, and reduced polypharamcy, and certainly reduced risk. However we were later banned from prescribing more than 28 days at a time. I suspected the driver behind this ruling came from lobbying by pharmacists who were losing dispesning fees. I do not like the risks of repeat precriptions. It is worse as a locum glaring at the computer screeen trying to see of scipt justified, ACR/HBAC done or whatever. Terrible. Repeat dispensing has not really worked to save time and reduce risk.

  • We must tell people the truth - the Tories are deliberately wrecking the NHS

    Gerard Bulger's comment 18 Apr 2018 11:49am

    It's rubbish that there is Malign Intent by Tories grappling with the NHS, and that all other parties are goody two shoes. Any politican has to face the real problems. The NHS needs a big rethink now other models of health service around the world are surpassing the NHS. Perhaps we need a non party Royal Commission to come up with ideas and take evidence from around the word and so we have a proper debate. This is not 1948, trhe current system has done its job and now past its sell by date. What's interesing is that 20-40 years olds are signing up to GP at Hand and Babylon, and they are supposed all to by Cobynistas.

  • 200 GPs working for Babylon as 40,000 NHS patients apply

    Gerard Bulger's comment 18 Apr 2018 11:34am

    GPs gave up with relationship with patients years ago. This is the result. We went part-time, gave up being responsible for out of hours when in effect stopped being GPs for 3/5 of the week. Of course Babylon and GP at hand are disruptive, that the point as it seems it is what 18-40 years olds want from their health service. Most never knew the GP service use used to provide, hands on, take history, examine, and know the family and patient. It's over. I have to work in remote Scotland to practice as a GP in the way I know and prefer.

  • Should GPs stop prescribing gabapentinoids?

    Gerard Bulger's comment 04 Nov 2017 7:42pm

    I am looking forward to the papers that show that analgesia using opioids and gabapentinoids locks people into having chronic pain. These meds are blocking pathways (that must exist) that normally phase out the discomfort of pain with movement and time. Have you noticed that all those which chronic pain are on chronic repeat meds? Funny that.

  • Chief GP inspector admits practices have received unfair CQC ratings

    Gerard Bulger's comment 19 Oct 2017 6:00pm

    CQC is pointless, as every aspect of what it does is covered by other legislation, such as employment law, GMC, let alone tort. It definitely has different standards. I was astonished that is passed a prison healthcare service which is so dangerous, daily incidents, that some doctors refuse to work there. If it was a GP surgery it would have been correctly shamed and closed.

  • Scottish GPs to access NHS-run 'treatment rooms' for procedural tasks

    Gerard Bulger's comment 12 Oct 2017 9:11am

    Since QOF has been shown not to improve outcomes, and is a waste, this is just further jobs for the boys and further nationalisation of GP services. I do not see the point, nor do I see how you can separate chronic disease management out from diagnosis and treatment and complex care. Each patient is a day older, things happen. By splitting up GP appointments into specialty groups and QOF teams you simple create more appointments, forcing patients to attend more often, annoying them and GPs Then everyone whines that we are too busy, demanding more and more.

  • Labour's PFI review could save the NHS billions of pounds

    Gerard Bulger's comment 01 Oct 2017 11:24am

    So simplistic. Public sector debt has to shoot up without PFI and similar schemes let alone the COST to pay them out. GP cost rent was the first PFI which improved so many surgeries without adding to national debt.

    Higher public debt means higher interest rates in the end, or use Labour's favoured scheme to print money, which is so last decade as a solution. In the end it leads to inflation, as shown clearly in Hitchiker's Guide to the Galaxy, so we all pay. Printing money only worked recently because everyone else was in recession, the inflation was in capital costs as in house prices to the delight of the chattering classes.

    It wont work again.

    There is so much other waste in the NHS to deal with.

  • I'm not here just to feed your GABAergic urges

    Gerard Bulger's comment 01 Oct 2017 11:05am

    You are too pessimistic about chronic pain. It can be resolved, providing the brain's pathways to phase out unpleasant sensations are not blocked by the junk medication. The medication locks people in to permanent pain. Reduce to stop the meds, some CBT and MOVEMENT will rid most people of pain. Those with pure dependency are using these drugs for other effects, nowt to do with pain. Pain that they have to declare to be offered a script.

  • Potent analgesics destroy lives: we must stop prescribing them

    Gerard Bulger's comment 01 Oct 2017 10:49am

    It is not so much that they are addictive, its that they do not work in the long term. Have you noticed that those with chronic pain are on chronic medication? The medications locks the patients into permanent pain, and give hyperathesia. It blocks the brain from phasing out the pain, a process that must happen in normal people who have avoided such meds. If we look at MRI of people complaining of nothing, their backs look just as terrible as those in agony.

  • GPs reap significant savings as trust indemnifies out-of-hours work

    Gerard Bulger's comment 07 Jun 2017 11:16am

    A very useful precedent. I am employed by at a prison whose contract is run by an NHS Trust. They have not confirmed that we are covered by NHS indemnity, which we should be.

  • CQC closed down 14 GP practices across England in the last year

    Gerard Bulger's comment 27 May 2017 9:32am

    What upsets me is the double standards. They should have closed down most London Prison healthcare services. The standards in most local London prisons are orders of magnitude worse than any GP practice I have been to as a locum. I am not sure why CQC accepts the difficulties and excuses in prison and problems there, which are clearly not tolerated in General practice.

  • GPs warned as gabapentinoids are linked to heroin overdose deaths

    Gerard Bulger's comment 24 May 2017 11:08am

    Yes. Huge problem in prisons and I suspect they have the same paradoxical aggression effect that benzo's have. Its not just the spice in prison giving us problems but the disinhibition caused by the prescribed gapapentinoids. Back pain is not a licensed indication for these drugs, and nobody on methadone should be offered it. Too risky and its not being used for pain. The pains are hyperasthesia from heroin use.

  • Lead 'national debate' on what services NHS should cut, GPC told

    Gerard Bulger's comment 24 May 2017 11:02am

    No, what is needed is the concept of top up. As in Australia, most NHS services are free. The important stuff for the NATIONAL HEALTH, after that the more expensive contraceptives for example, some procedures you pay for or top up the NHS subsidy.
    Currently in the UK top-up is regarded as immoral by the standards of the 1940s, at that time it made sense that the limited offering of medicine should be free to all. Now patients understand choice and medicine is not absolute. That with limited evidence or poor value for the health of the nationals should be subject to top-up. No political party could every suggest this. Political suicide... but it is necessary.