This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

Gold, incentives and meh

keitflyer

  • 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.

  • Professor Simon Gregory: ‘I want GPs to feel valued – that’s not universal yet’

    keitflyer's comment 12 Oct 2019 9:59pm

    In Denmark they were in the same mess as us a few years ago and they have turned it around and their GP jobs are filling up again with young fully trained GPs.
    How? First of all no QOF, and gentle guidelines and very little litigation, complaints etc.
    Secondly all new doctors do GP as part of their foundation programme.
    Thirdly, they still have small practices with continuity of care.

    Go figure!

  • GPs fear NHS plans for statins

    keitflyer's comment 12 Oct 2019 9:48pm

    Uspfa says ‘don’t use statins for primary prevention in over 75s ‘

    Recent massive trial results ‘ no benefit in primary prevention except in diabetes’

    So stop adding work to overloaded GPs!

  • GPs must report deaths to coroners in writing under new rules

    keitflyer's comment 11 Oct 2019 7:13pm

    What is the fee for this. Just been working in Denmark where they have an item of service contract which works very well. They would have no problem with this: it would be just a question of agreeing a reasonable rate for the work.

  • Statin the bleeding obvious

    keitflyer's comment 21 Sep 2019 9:02pm

    So we are still recommending statins in primary prevention despite lack of benefit and definite harms, and we ignore the massive weight of evidence about the benefit of regular exercise. Bonkers !

  • How much of our prescribing has a beneficial effect?

    keitflyer's comment 21 Sep 2019 8:53pm

    And how many gps are Aware that SSRIs cause seizures? Or that we should really be doing ecgs looking for long qt before prescribing many drugs, or that we should be checking acb calc to check The anticholinergic burden when prescribing unlikely drugs like furosemide and ranitidine and cetirizine.
    Prescribing should not be undertaken lightly, and we sadly do exactly that.

  • How we are promoting 'pure' self-care

    keitflyer's comment 15 Sep 2019 8:08am

    This is so important. The only way to square the circle of how to deal with an increasing workload with static resources is increase self care which is actually not that hard. Patients are checking their own bp etc, but this needs broadening. One of the main methods should be teaching people to use reliable websites not effing Google.
    This needs to be facilitated ++++++
    And yes, some form of incentive may be needed

  • The noise around statins distracts from its real problems

    keitflyer's comment 14 Sep 2019 10:44am

    cataracts, muscle weakness and falls, neuropathy, insomnia, need adding to the list too !