And I don't think I'm semi -competent for being concerned that men with prostate cancer might skip through the net of GP monitoring - it has happened with tragic results
IDGAF yes obviously in an ideal world everyone would read the notes and go into the letters and read that the urologist wanted a referral back when the PSA increased to 3 having previously been 1.5 but in 100 blood results the is a chance this will be missed and filed as normal. It's just another opportunity for something to go wrong - you can mitigate the risk but it's not 'easy' or quick which is what is suggested.
David Banner the problem is that a lot of PSA levels will be rising but are within the normal range so when a GP is filing 150 blood results the PSA is just filed as normal as it's not 'abnormal' but for that Patient it is abnormal. You need a proper system to be monitoring it which can be done but don't dismiss it as 'easy work' that's risky.
I don't actually agree with you this time Copperfield, PSA monitoring can be a disaster and is much better kept with urology. PSA results come in with hundreds of others and they may be within the normal range so filed as normal but actually are creeping up within the normal range, significant to a urologist but missed by the GP practice amongst everything else. With a few hundred of these this is a significant amount of work and needs a really robust system so it's not a trivial thing as you suggest.
I think it's great you've highlighted the need for better postnatal care for women but I think there are more fundamental problems with maternity care that a GP appt at 6 weeks isn't going to fix. Many women are suffering from PTSD after labour due to their horrendous experiences in hospital - while it is good to pick this up it would be better to prevent it happening with better staffing, support, access to analgesia etc and better postnatal support in hospital. If there are perineal problems will it be guaranteed we can quickly refer back to an obstetrician/gynae physio otherwise there isn't much point in identifying a problem. My other issue is the NCT - I personally detest this organisation, I think they are part of the natural childbirth agenda that has dominated midwifery and maternity care leading to deliberate inadequate analgesia provision, demonisation of cesarean section and other interventions leading to the disasters at Morecambe Bay etc and to a massive group of women feeling like they have failed as they didn't manage to have a natural birth when this is completely out of their control. I think this is why postnatal care is so scanty, it's like 'well if she'd just tried harder she wouldn't have had a 60hr labour forceps and an episiotomy so on you go....'
Marie Louise this is nothing to do with the 6-8 week check for babies, that is standard GP care. The article is about the postnatal check for mum which isn't contractual or standardized. They are talking about introducing a postnatal check for mother's into the GP contract in lieu of actually improving maternity services.
The reason this is being discussed is so actual obstetric/midwifery services don't have to do anything about their own p**s poor postnatal care - instead of looking at the real failings in intrapartum and postnatal care shown by increasing rates of postnatal depression, PTSD, poor breastfeeding support for those that want it etc they are shoving a token 10 minute appt onto GPs which will achieve nothing for mums but will allow the government to say 'something has been done' as we all know using GP time is the best solution as it is essentially free.
Why is mirtazepine added into the mix with gabapentinoids/benzos/opiates?? I thought it actually was an antidepressant which had the best evidence of effectiveness in that recent review?? Can someone who was critical of it enilghten me?!
They wont even let English GPs do a flipping smear test without hours of training and updates - it's a bit of a jump from that to c sections! It's clearly ridiculous and has probably come from a committee of non medical busybodies devoted to saving the hospital who don't understand anything about medical training 'well 40 yrs ago GPs delivered babies why not now?'
Isn't being over 85 linked with cognitive decline and death???
Is the tide turning against the ‘medical expert witness’?? Anyone who is sitting in judgement against another GP should PROVE that they are seeing at least 18 patients per session for the same the number of sessions the GP they are screwing over, sorry giving evidence against does. So if the gp on ‘trial’ does 9 sessions only current 9 session GPs can be a witness - if you do a few sessions here and there and make the rest up with appraisals and ‘being an expert’ then jog on, you have no right to judge your colleagues.
I think it’s a bit unfair to moan about the ‘male, pale and stale’ GPs who have been the majority working 9-10 sessions, running out of hours and generally keeping general practice going at the expense of their health and their family in many cases. I’m a female doctor and I don’t want to work full time - due to family and also I just couldn’t do it, I’ve always been grateful to my male colleagues who were willing to work full time. And they have always been men. If I wanted to work full time I could but I don’t want to and I think general practice is pretty good at giving us a choice.
I think this is a great idea just to raise awareness more than any practical use - bombard hospital consultants with ‘GP is on black alert’ emails daily and they might think twice about the reflex ‘get the GP to do it’ mentality.....
DNA’s are a godsend, the worst are the ones who arrive 5-6 mins late for your first appointment! This seems like a lot of hassle to solve a tiny problem...
Why do so many people need to be seen with flu? Is there a high rate of complications with this strain - surely most fit adults just need to stay in bed and away from gp receptions?
Right but if you’re on a zero hours minimum wage job and cannot take work with anyone else without losing your contract then I bet it feels a bit less dreamy and a bit more exploitative.
This poor poor woman - didn’t the investigation find 80 odd systems errors? They were understaffed with doctors and nurses and she was hung out to dry for this, the jury weren’t even allowed to know about the systems errors as they had been ‘fixed’. So true all of us could have been in this position at one time or another - who reported her to the police in the first place???
What are these consultations over Skype etc going to be about? What can you deal with over the phone that is a first presentation, actually needs medical advice and doesn’t need face to face assessment. Colds and sore throats? Don’t need any assessment, maybe a rash might work. Even contraception you need a BP most of the time. I can understand using phone calls to follow up or maybe titrating meds’ for known patients etc but what is the actual point of this service??? It seems like a massive amount of money to spend on doctors for people who don’t need doctors
Not sure this article really helps anyone - the patient can moan at the CCGs or their MP, the gp is not a punchbag for others decisions and I wouldn’t tolerate it.
On the vasectomy issue - what a stupid thing to limit access to, it won’t save any money as you’ll still have to pay for contraception for the couple - so as above 1 vasectomy £150 forever = only 6 yrs nexplanon = 1-2 yrs of the contraceptive pill. Plus all the hormonal side effects that come with female contraception. Then if the couple have an unwanted pregnancy from this denied vasectomy the costs will skyrocket. Is this actually a thing that CCGs are denying vasectomies? Are they run by idiots?
Well that's spectacularly unhelpful advice. Why don't they develop a decent test and get back to us??