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Independents' Day


  • Locums out of work: 'I never thought as a GP I would struggle to find work'

    DrDoTooMuch's comment 22 May 2020 11:25am

    I'm a partner in a large practice and - other than maternity locums which we are currently using as normal - we don't employ locums as we can cover each other when off. Also we have developed good working-from-home capacity for those GPs who are self-isolating.
    Our workload is not less than it was previously.
    But I have spoken to a few colleagues at other practices where they employed lots of locums for work-life balance. They have stopped them all as they fear that the practice will lose money as a result of covid and therefore they are not prepared to risk over-spending on locums. They are doing more sessions themselves - and on-line/telephone consultations are (by and large) less onerous than face to face.
    I find it hard to sympathise too much with locums in all honesty. I've had to downsize my house (from a standard 4 bed semi to a standard 3 bed one) due to falling profits in recent years. Other than GPs who locum as the only way to manage childcare everyone else appears to be doing it for more money with less responsibility - and that comes with risks.

  • NHS England director apologises for handling of shielded patient lists

    DrDoTooMuch's comment 20 Apr 2020 7:23pm

    And the amount of emotional blackmail being given to the staff "I'll sue you if I get covid" etc - from people who don't actually want to properly shield but want the perks of getting shopping delivered for free.

  • GPs 'not expected' to see Covid-19 patients booked in by CCAS face to face

    DrDoTooMuch's comment 17 Apr 2020 3:40pm

    John Cahill, there is no point in the CCAS except where it directs patients to self care. Even though you personally are probably excellent, I am not going to put myself or my colleagues at risk unless I have confirmed that it's an appropriate level of risk. I cannot rely on someone else to make that decision for me.

  • GPs fielding phone calls after 13,000 'shielding' letters sent to wrong address

    DrDoTooMuch's comment 16 Apr 2020 3:27pm

    Several of ours were sent to dead people. Not all of them had died recently. Nothing is shocking about NHSE's incompetence except their own surprise.

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

    DrDoTooMuch's comment 22 Oct 2019 12:43pm

    MDU's fault here.
    All GPs should have moved to MPS/MDDUS as it was clear they had a risky strategy.

  • Welcome to Planet Advanced Nurse Practitioner

    DrDoTooMuch's comment 01 Jul 2019 10:11am

    I normally agree with pretty much everything you write Dr C but in this case I disagree. I find the ANPs much less likely to prescribe unnecessary medications than the doctors (often jaded and close to retirement) who work in the OOH settings. They are more protocol driven it is true - but I find this results in their being far more happy to advise otc medications or nothing at all.

  • Losing continuity may mean fewer Xmas gifts – but it will be worth it

    DrDoTooMuch's comment 19 Nov 2018 5:56pm

    I'm with Zoe on this one. I've been a partner for 18 years (ever since qualifying as a GP) and I have witnessed the erosion of personal lists and continuity. There are things I miss about them - not just the wine but the easy consultations where the patient doesn't need to be seen but just fancies a chat - but I have also seen the downsides.
    I have inherited hundreds of patients from retired colleagues, who never saw another doctor (and how often I am told how much they LOVED Dr J or Dr R) and, no wonder, when they were given massive doses of inappropriate benzos every week or bizarre untested concoctions of drugs because "well Dr J knew me, you see, and she knew this is what I liked".
    I have seen patients walk through my door and virtually diagnosed cancer on the spot where they've been seeing the same doctor every month for a year and he's not spotted it because familiarity can breed blindness if not contempt. Conversely, I had a lady who I saw very frequently for years - when she went to see a colleague her gastric carcinoma was diagnosed - could I have picked that up sooner if she didn't prefer to spend her 10 minutes discussing her grandchildren and how good I was at listening to her woes? I don't know. I fear so.
    I liked many things about continuity of care but I think it can make one a lazier doctor.
    Quite apart from any of our feelings on this matter (and we know that patients prefer continuity of care - or so they say), there is a clear direction of travel from the government that what they want is increased access (and they say that's what patients want). You can't have both. Same number of GPs, stretched over more hours, more hubs, more centres = less continuity.
    I regularly ask the patients what they want - more ability to see me or more ability to see someone with their 14 minute history of a sore throat? Their answer is inevitably both so it's clear that the pathway to increased access is set for the future.

  • GPs may have failed to receive thousands of discharge summaries from a trust

    DrDoTooMuch's comment 11 Sep 2018 10:13am

    DrDr is right. This should not affect patients because no further referrals/need for tests etc should have been dumped on GPs in the first place.

  • Jeremy Hunt to strip GMC of right to appeal own fitness-to-practise tribunal

    DrDoTooMuch's comment 11 Jun 2018 11:28am

    I wonder how we become medical examiners? Asking for a friend...

  • No f___ing appointments, but we can offer you an e-consultation

    DrDoTooMuch's comment 29 May 2018 4:03pm

    "NHS England doesn’t seem to have grasped the simple fact that increasing heath access stimulates, rather than reduces, demand.."

    This. Over and over again we try to explain this.

  • GP prescribing crackdown after review finds 600 excess deaths a year

    DrDoTooMuch's comment 27 Feb 2018 8:42am

    I haven't read all the comments. But our practice has changed hugely over the 17 years I have been a partner. I used to sign scripts, almost without looking. Now I am completely defensive. I look in every set of notes; I decline to prescribe more than 14 days if they have not got up to date bloods (and then decrease numbers from there). I refuse to sign CDs unless there is a clear plan in the notes for reducing / managing demand. I stop drugs if the patients refuse monitoring. It takes longer but we have outsourced other things to make up for it. We employ ECPs/ANPs to see the worried well; we employ other people to look at our letters and weed out the ones that don't require a response.
    Prescribing is the one area that I don't want to be up in front of a coroner. I feel I can defend anything if I have seen a patient, even if I turn out to have made a wrong judgement (in the wake of Dr B-G this may turn out to be incorrect but it's how I feel currently) but I cannot defend signing a prescription for salbutamol every 2 weeks and never checking that their asthma is under control (or an ACE- and never checking their U and Es).

  • 'Indemnity fees are killing our profession' - sign this letter to Jeremy Hunt

    DrDoTooMuch's comment 01 Sep 2017 12:23pm

    Pippa Vincent, London

  • Collect feedback following every GP-patient interaction, says GMC report

    DrDoTooMuch's comment 13 Jan 2017 1:11pm

    F**k off GMC, suggest All GPs Everywhere.

  • Collect feedback following every GP-patient interaction, says GMC report

    DrDoTooMuch's comment 13 Jan 2017 1:09pm

    Positive patient feedback is often linked to worse medical practice. (eg unnecessary prescribing etc). That's not even mentioned in the report.

  • GPs asked to come into hospital to discharge patients and take on care

    DrDoTooMuch's comment 12 Jan 2017 12:36pm

    Obi wins the internet today.... (11.33am)

  • GPs asked to come into hospital to discharge patients and take on care

    DrDoTooMuch's comment 12 Jan 2017 10:49am

    Ha ha ha ha ha!
    Now where are the local RCGP reps who will run to their rescue? Must deal with those patient ICEs after all...

  • Hunt promises to release GP time to 'support urgent care services'

    DrDoTooMuch's comment 10 Jan 2017 2:52pm

    Completely and utterly ridiculous. I couldn't give a s*** about QOF really; I'm working flat out just seeing patients and dealing with paperwork. Delaying QOF by 1/12 is going to lead to precisely no more time for anything...

  • GPs to have indemnity costs covered for out-of-hours shifts through winter

    DrDoTooMuch's comment 09 Dec 2015 12:20pm

    6 sessions as a partner plus occ OOH - over £10,500 quoted by my original MDO, £5,000 by another (whom I have obviously moved to). Costs are ridiculous and all indemnity should be covered by the NHS...

  • Practice hands contract back after four partners are forced to resign

    DrDoTooMuch's comment 16 Sep 2014 11:51am

    Comments like that last one are so out of date. Where are you living and working? We have been trying to recruit new partners for the past 3+ years. We have managed to recruit one (because she's not the main earner in her family) but have interviewed several others who take one look at our accounts and ask why they should take a pay cut by moving from a salaried position to a partnership? We have given up now and have employed 4 new salaried doctors. All of them cost us very very slightly less than we earn ourselves (and I mean very very slightly) and do significantly less work in terms of paperwork and income generation (without which we couldn't afford to run the practice at all). Everyone I meet at conferences looks at me as though I'm mad when I ask why no one wants partnerships - most people under 35 don't even seem to want a salaried post and seem happy to locum because they can earn so much more. It's a fallacy to say that it's all the fault of greedy partners - and it's a dangerous fallacy because people out there believe it and then can blame GPs for the ridiculous situation rather than the government/NHS England and everyone else who is bent on destroying general practice.

  • Women doctors are ‘tremendous burden’ says female Tory MP

    DrDoTooMuch's comment 18 Jun 2013 10:25am

    I don't know any GPs who work every day any more. Male or female, the job is too demanding to do 5 days a week. I work the same number of sessions as my male colleagues - the only difference being that I'm working the rest of the week too, trying to do the best by my children.