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A faulty production line


  • To engage or not to engage…?

    keitflyer's comment 01 Feb 2020 3:13pm

    Dear Dr Kanani

    I have been a GP for a long time and I have seen most of my contemporaries retire early because of the constant stream of extra work and reorganisations, which Together with QOF and the CQC and the GMC has damaged morale and reduced job satisfaction. This has led to a vicious cycle of doctor shortage causing an even bigger workload and unhappy patients who are can’t get appointments or are fobbed off with nurses. Poor continuity has lead to increased referrals, overprescribing and morbidity. The situation has been worsened by large numbers of doctors being taken out of front line care to run CCGs appraisal, CQC work and now PCNs.
    To reverse this will take years, and to start with you should study other nearby countries which have kept up gp morale and good standards of care. Most of them have stayed with the model of small practices with good continuity. Other important factors are easy to use IT which does not bombard GPs with pop ups, a stable payment system, light touch regulation, and good communication with and access to specialist care with no dumping of work.
    So far the PCN idea has completely ignored all of this and I and my colleagues are filled with dismay at proposals which will take even more doctors out of frontline care and will add extra work burdens. If we start doing anything new we will stop doing part of what we are doing now. I am currently working abroad and unless things change I am not keen to come back to work in the uk.

  • DH plans for pharmacists and paramedics to retrain as doctors in three years

    keitflyer's comment 31 Jan 2020 4:56pm

    You couldn’t make it up. We are training 7500 doctors per year, which is plenty, and actually quite hard work for the NHS.
    The problem is a failure to retain experienced doctors especially GPs, and artificial unnecessary restrictions that stop other doctors working in primary care.
    Recruiting more doctors from the bottom drawer is not going to help
    Come on bma RCGP gmc etc do your job for a change and prevent this

  • How GPs are left without fair pay for local enhanced services

    keitflyer's comment 09 Jan 2020 1:31pm

    Bring back the red book! All was fair and equal

  • GP acquitted of ‘assault’ after serving 15 months in prison

    keitflyer's comment 08 Jan 2020 5:06pm

    I expect the Gmc will immediately restore him and issue a sincere apology and recompense his financial loss, and the confidence of the medical profession will be restored.

  • LMC issues urgent call to GPs on 'viability' of practices following network proposals

    keitflyer's comment 08 Jan 2020 5:00pm

    What are the bma playing at? Doctors unions in Denmark and New Zealand where I have worked have robustly refused to be pushed around and have kept high quality general practice afloat. In England we have been s**t on and the bma and the RCGP twits have been useless, even helping the process.

  • The RCGP must adopt a neutral position on the assisted dying debate

    keitflyer's comment 14 Dec 2019 4:41pm

    I have had several patients who have begged me for help to end their miserable suffering and in whom massive opiate doses have been useless.
    When I talk to Dutch people who have had relatives assisted to die, who all say what a great thing it was and what a good ending, I feel sick at all the suffering my patients have needlessly been put through. All because of an intolerant and dishonest and unkind religious minority who insist on imposing their outdated beliefs on the rest of us.
    Grow up RCGP!

  • Banned by bureaucracy from practising in the UK

    keitflyer's comment 07 Dec 2019 8:45pm

    Try applying to work in denmark. I did anD they were so helpful and they need GPs. The same person answered my emails and was available on the phone and it was sorted in a couple of weeks. And it’s easy to get to the uk and the health service is more Oz standard. The uk is going down the drain, gmc CQC QOF you name it it’s a nightmare

  • Are there too many posh doctors?

    keitflyer's comment 05 Dec 2019 8:02am

    What would William Osler had said about this ? (Hint - look it up and no he didn’t agree)

  • Highest number of appointments ever as GP numbers continue to fall

    keitflyer's comment 28 Nov 2019 9:19pm

    It may be too late but surely time for CQC QOF CCGS PCNS, Revalidation, etc. to be abolished, and seniority restored. On top of a critical situation this loss of experienced GPs is a disaster. The quality of primary care is appalling now and bound to get worse, with noctors missing serious diagnoses, overprescribing and over investigation and punters being refused appointments.

    And If registrars count as Part of the workforce why don’t practices have to pay them?

  • PDA issues urgent warning to GP-based pharmacists after serious incidents

    keitflyer's comment 22 Nov 2019 11:49am

    Let’s not be too hard on them. There are a few pharmacists maybe 1 in 10 who are aware of their limitations and total lack of training in patient care.
    They have been pushed into these Noctor jobs by the idiots in charge of the system and the results are as predicted.
    Stop it now and get all the doctors on CCG’s and PCNs and CQC, and deaneries etc etc back on the front line.

  • ‘We want the CQC to be seen as a critical friend’

    keitflyer's comment 02 Nov 2019 3:10pm

    As a gp for many years i can see, and surely few would disagree, that the overall quality of GP care has nosedived in the last 10 years. Continuity has fallen off a cliff, dangerous polypharmacy goes unchecked and patients cannot get to see doctors even for urgent medical problems. GPs struggle with outof date slow IT which cannot cope with the clinical software and slows further when managers download useless add ons for example to help save pence of the prescribing budget. Patients are often seen by incompetent noctors who do not even realise how ignorant they are and fail to learn from their mistakes. We have a surfeit of managers and initiatives but nothing effective has been done to tackle dumping from hospitals.
    Any GP with any sense will follow her example and get one of these pointless desk jobs, get home on time, and never get sued.
    Or move abroad where they have for some reason not followed our lead with QOF,CQC, CCG's, etc. etc.

  • Climate change in the consultation room

    keitflyer's comment 26 Oct 2019 11:37am

    Dr Chand is right. GPs have enormous credibility with our patients. If we set an example and ride bikes and have eco friendly transport it really makes a difference .

    And for gods sake stop prescribing Metered dose inhalers each of which is equivalent to driving 180 miles!

  • A third of GPs have reduced their hours over the past year, says GMC

    keitflyer's comment 25 Oct 2019 4:57pm

    They have turned it around in Denmark. GP is now v popular for young doctors. How have they done it? It is not pay which after tax is poor.
    They have very light touch regulation, v little litigation, no qof, very easy referrals that all use the same online form, paperless prescribing, small practices with good continuity, and yes 'hygge' which we have lost big time. We can follow their example - first step abolish the gmc and qof and the tickbox culture. Then make all new doctors do GP as part of foundation and make that the shop window.
    It can be done.

  • MDU admits 'dwindling funds' to cover GPs' future claims

    keitflyer's comment 24 Oct 2019 6:36pm

    Remember the Mdu is no longer a mutual,having sold out with large payouts to the board years ago. The risk is now borne by a large insurance company. As we retire we no longer have to maintain payments, so there will almost inevitably be a deficit which the company will suffer.

  • ​GMC referrals to medical tribunal service up by 40%

    keitflyer's comment 24 Oct 2019 6:32pm

    So around 20% of gps are subject to fitness to practise enquiries per year with about 5% ie a quarter proceeding to full investigation and around 1% or a quarter of those going to the MPTS.

    And GPs are retiring in droves.

    Surely even the GMC can work out that there might be a connection?
    So what do they do? Increase the number of investigations. !
    Who is next for the guillotine?

  • MDU admits 'dwindling funds' to cover GPs' future claims

    keitflyer's comment 23 Oct 2019 1:17pm

    What nonsense. I paid a 'reduced' sub for 1 year but after that found that the sub had risen back to the previous level and no explanation was offered.
    I suspect the real problem is that they were in deficit going back for a while, and the government takeover leaves them exposed with no clothes as gps head for the exit and retire.

  • NICE revises antidepressant guidance to warn of 'severe' withdrawal symptoms

    keitflyer's comment 17 Oct 2019 4:45pm

    Of course ssris have bad withdrawal symptoms, as is obvious from the fact that patients by and large dont successfully stop them. We now have around 10% of the adult population taking them, in most cases after their gp dishes out a prescription when patients present with adjustment disorder for which they dont actually work. Patients are rarely warned about the severe side effects and the difficulty coming off them. See anything by David Healy or Peter Goetsche on this subject. We should be ashamed of ourselves in my opinion.

  • Practice set to close after three years without a GP

    keitflyer's comment 16 Oct 2019 1:32pm

    Forcing emis practices to change it systems in wales has led to a lot of premature retirement and poor morale.

    ?an own goal or do they actually want GP to be taken over by noctors ?

  • How to spot zebras - motor neurone disease

    keitflyer's comment 14 Oct 2019 4:48am

    Urgent referral to a neurologist? On which planet/ country?

  • PCNs are a chance to redefine general practice and feel empowered about the future

    keitflyer's comment 12 Oct 2019 10:07pm

    Maybe there are some good PCNs out there just as apparently there are some good CCGS.
    But our PCN meetings have taken lots of doctors away from patients and done nothing apart from spend time and energy arguing about voting power and whether the minutes of the last meeting were accurate etc etc.
    If using pharmacists and counsellors really is the cavalry that can save general practice why could practices not just be allocated funding to employ them directly rather than use this laborious and arcane PCN mechanism.
    How the BMA has fallen for this bullxxxx I can hardly believe.