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GPs go forth


  • Over 300 GPs urge police to investigate Dominic Cummings

    tom's comment 26 May 2020 12:06pm

    I suspect the chief has done little else but think about Mr Cummings for the past few weeks,and made a value judgement,between keeping his head down, and suicide.
    Listening to the press conference yesterday,clearly the hidden agenda,or message is the extraordinary extent which Dominic Cummings manages,controls and runs Boris.Why are we also paying for a cabinet and civil service ?
    It was always peculiar that D Raab was so cool when Boris was on CCU,who was running the country,well now we know.
    As Boris points out the public have been confused by the endless repetitive" STAY AT HOME" message, from Hancock, and the holy trinity of medical experts.
    Note none of the experts acknowledge this failure, or has offered resignation.
    The question is now.Will Cummings sack Hancock, for so misleading the public.
    You cannot have it both ways,either Cummings, or Hancock is right.
    One must go
    GP survival need to be realistic,go for Hancock,Cummings is untouchable,as he explained yesterday,he is the government.

  • RCGP outlines details of new trainee assessment replacing the CSA

    tom's comment 21 May 2020 10:24am

    Indeed John,and I am sure we both knew a few,as I recollect they were great well liked happy guys.

    In the late 70's you could go straight into practice from house jobs,no training or exams.

    If you did this,you could leave after six months,and pursue any career in the knoledge you were a recognised GP and could go back to practice any time.

    What happened to them,did they face catastrophic career failure for lack of physical psychological social,or did they have long happy profitable careers for nearly half a century

    The college,an institution,within an institution,holding a permanent monopoly,is immune from scrutiny by the taxpayer.One suspects they regard accountability as beneath them

  • RCGP outlines details of new trainee assessment replacing the CSA

    tom's comment 20 May 2020 11:02am

    We certainly live in interesting times

    Presumably,this could be marked by Alexa,if so,one imagines she could also produce the consultation,using two different voices.

    Certainly local trainers should be able to vet any recordings prior to submission,raising the question as to who has failed and their motives for doing so.

    As JG Munro points out things used to be somewhat different,though
    there is a paucity of evidence they were worse.

    Where is the evidence that scores in these assessments correlate with;

    actually being a GP 10 yrs later

    not having a nervous breakdown

    not killing people

    not being struck off

    Amazingly,should a serious error arise,the college holds no liability,despite being the validating body.

    The NHS is one of the worst kind of institutions in that it begets institutions,and the RCGP is one of it's worst creations

  • GPs wishing to return to NHS for pandemic caught up in red tape for weeks

    tom's comment 22 Apr 2020 1:17pm

    True unto a point Yorkshire,you have to have a valid GMC number,but at present, we returnees are not being charged.

    Thank you Pulse, and all comments,I was beginning to worry it was just me.Dr Death,an excellent, and sobering point.

    We have to deal with five agencies

    1 GMC

    2 Covid Hub Wales

    3 Performers list.

    4 DBS check,Capita

    5 Health Authority.

    Personally I am failing

    It would be useful to know,what precisely the powers that be wish to use us for,whether there will be any induction, or training,and whether there is any proposal for supervision, or support.

    I would like to help,but would prefer not to kill anyone,certainly in the first week.

  • Coroner warning over patient death after 16-month wait from 'urgent GP referral'

    tom's comment 18 Dec 2019 12:20pm


  • Coroner warning over patient death after 16-month wait from 'urgent GP referral'

    tom's comment 18 Dec 2019 10:58am

    Horrendous problem that has not changed one iota in 40 years.

    Except the glorious halcyon,sunlit, balmy days of fundholding,when it was unheard of.

    The LMC are of course utterly ineffectual,I am not even sure why it was worth typing that.

    No educational meeting or institution has ever addressed this,and most senior academics refuse to accept it exists.They prefer endless specialist speakers on hypertension, and to drown in models of the consultation.

    Educational supervisors sit in meetings listening to specialists who refuse to acknowledge this problem and never say a word.

    Any attempt to raise it ,they block with sycophantic drivel.

    Worst of all the coroners focus narrowly on the patient who has died.

    We need a global medical accidents investigation bureau, to replace GMC,CQC,etc

    A bureau to investigate and highlight system,not individual failures

    This would be a good place to start

  • High-profile GPs lose seats in Conservative landslide

    tom's comment 14 Dec 2019 7:08am

    The conservatives set out to win.

    Labour set out to present a reformed view of a utopian society.

    To go back to the first lesson we teach students and registrars,study the exam,not the subject matter.

    Boris is now firmly focused on the 2025 election,Labour on the 1905 election.

    However he is a hostage to fortune,the most important developments preset,and beyond his control.

    He will shortly be at his most vulnerable.

    Labour plan to use this opportunity for a period of reflection.The fundamental political skill,the ability to swiftly counterattack,is beyond them.

    In politics,as in general practice,if you need to reflect,you are probably in the wrong business.

  • Could reforms to GP incentives help boost vaccination take-up?

    tom's comment 06 Dec 2019 6:04pm

    Oh Peter Higgins !

    Be very careful,introducing reason,rationale and sanity into the argument can be awfully dangerous,no medical institution will condone this.

    The case for immunisation has been made,it is beyond disputation.

    At this point,all the doctors,nurses,medical establishment,professors,and colleges become irrelevant,they don't like it,but they are. It is their inability to acknowledge this that is at the heart of the problem.

    This is now a job for someone who specialises in persuading people to do things they start out not wanting to do.

    An advertising man,a salesman,a manipulator, a mentalist,whatever you want to call him,someone who gets people to do things,they would not otherwise do.

    It is a different role with a different background, and skill set.

    It is a real thing.

    It is beyond the wit of the NHS hierarchy to recognise.

  • GPs vote for home visits to be removed from contract

    tom's comment 25 Nov 2019 11:44am

    Thinking of Oz;

    "I had no idea when I trained to do this job"

    Really; as possibly your most sympathetic reader, Really !

    No idea

    Five years at medical school,house jobs,three years vocational training,endless medical and lay articles,books,films and memoirs,and yet no idea.

    Perchance,the GMC/College fantasy process you endured,was not actually training.

    Perhaps,if we commenced some actual training,we might get somewhere.

  • GPs should not refer patients based on genetic tests alone, says RCGP

    tom's comment 08 Nov 2019 5:18pm

    So dear college

    Have you considered the possibility of reporting the purveyors of these tests to trading standards?

    Have you considered approaching Watchdog.

    Have you approached any statutory body,with your allegations that the public is being sold tests which do not have a value

    For once,if only once,stand up and be counted

  • GPs should not refer patients based on genetic tests alone, says RCGP

    tom's comment 08 Nov 2019 4:48pm


    Nonsense from the college,as per usual.

    A statement by whoever has taken over from the MDU,whoever and wherever they are, might hold water ,but not the RCGP.

    A statement by the GMC, who are as usual,silent,would be interesting,but not the RCGP

    The Health authorities,could issue a ban,based on this advice,but have not yet.

    As we have seen on the news,Mr Hancock,could issue a fantasy policy,which the BMA could be relied upon to swallow.

    However,when the patient comes to harm,and the litigation begins, we all know how much support all these organisations will give

    Rule number one, don't get left holding the patient

  • NICE opens consultation on guidelines recommending x-rays for diagnosing lung cancer

    tom's comment 01 Nov 2019 7:25am

    Personally,I just do not like NICE,in fact I like very little Tony Blair did.

    The guidelines are so long you need a summary.

    They are for everyone,clearly there should be two sets,one for specialists and one for GP's, with clear boundaries.

    They tend to look back from the diagnosis,where the specialist starts and extrapolate to what the GP should have done.

    They make no allowance for actual resources available.

    A recent urgent CT request locally was indeed performed urgently,however the department did not consider it appropriate to report urgently,as that had not been specifically requested.

    NICE tend to ignore the big questions.

    Having performed whatever test,a week later the patient will still be a breathless smoker.How often should we x ray,every three ? six ? nine ? months,the clinical scenario is not going away.

  • NHS Wales terminates IT contract with Microtest over ongoing delays

    tom's comment 28 Oct 2019 3:38pm

    Cheers Cedric

    Entirely agree

    However I suspect the actual functional use of the system in a consultation is of absolutely no interest whatsoever to those mismanaging this mess. The thought has probably not occurred to them.In fact it would be hard to think of any management change where there is any evidence whatsoever that the actual frontline implications were considered.

    There is simply no mechanism by which that could occur.

  • The consequences of an underfunded mental health system

    tom's comment 27 Oct 2019 7:24am

    I think 9.03 sums it up very well.

    Unfortunately this is an area of medicine that does not really progress technically,the process is little changed in 100 years.

    There are no tests,scans,bloods or measures.

    Professors of psychiatry can teach,but never having done it,and never intending to do it,the guidance is somewhat suspect.

    We can obtain the referral criteria,as published,which appear to be generally wacky and disassociated from reality.We can let the family have these.We can send a truthful referral anyway in anticipation of rejection.

    However we cannot be sure there is any sure way of preventing any suicide

  • Outgoing RCGP chair to head new social prescribing academy

    tom's comment 23 Oct 2019 2:25pm

    OK all valid points however;

    This could be good,and having a nominal GP at the top could be useful,best not to denigrate too quickly.

    Ideally,medical institutions,including the one she is leaving,would lobby to head the patients off at the pass.

    A campaign to persuade the patients to directly access all these resources,before consulting a GP.Patients should be advised to try these first,then see a GP if it is not helping.

    The GP does not have any magic way of knowing if this is going to help,the only way forward is to try it and see.

  • Primary prevention statins benefit 'may be marginal’ for healthy patients, says study

    tom's comment 21 Oct 2019 5:49pm

    So how many GP's stop statins at the five year mark, after which we are practising evidence hoped for,supposed or fantasy medicine.

    So statins are effective,are they,quite how effective would that be then,doctors tend to use the term NNT,what level of NNT are you claiming.

    A statin lowers your 10% risk to 9.9 %.

    As to side effects,read J Le Fanu,especially the line about a GP not allowing his patient to stop the statin

    A statin holiday is surely one of the most basic clinical tests.

    The college has been insufficiently vocal and critical on this issue,a trend which appears to be continuing

  • RCGP warns GPs against interpreting genetic tests from commercial companies

    tom's comment 18 Oct 2019 8:22am

    Life is certainly getting complicated

    The question is what happens if a GP refuses to interpret these tests,would the judge agree it was outside his expertise,or would he say the GP still had a duty of care.Would a judge insist a GP undertake an activity beyond his abilities.

    Clearly of course we consult Google to see the MDU advice on this.

    But they no longer cover us.

    We are covered by NHS crown indemnity departments.

    So what do they say.

    Well according to Google they have said nothing !

    So the blind leading the blind, until a judge decides to punish a sample GP for the whole sorry mess

  • Four in 10 GPs in favour of charging patients for appointments

    tom's comment 10 Oct 2019 4:32pm

    So what we need now is some objective meaningful validated data.

    Certainly at the meetings I attend,the Irish GP's are on average 100% happier and more professionally satisfied than their British counterparts,clearly that are always also the noisiest table,and the one everyone else wants to join.

    It would be interesting to know how many of those who oppose this proposal also support staying in the EU where this occurs,e.g. France.

    A trip to France,to meet some French GP's,is I think called for,all in the name of professional research

    I feel a booze cruise coming on