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Independents' Day

David Banner

David Banner

  • NHS England set to 'redesign' GP appraisals

    David Banner's comment 11 Jul 2020 5:24pm

    When appraisal first appeared roughly 20 years ago it was sufficient to hand in a load of attendance certificates without any “reflection” nonsense.

    Now they’ve scrapped the certificates but left in the redundant reflecting. For a week before appraisal you have to wrack your brain to trot out some drivel about a lecture you barely remember attending, sure in the knowledge that nobody on planet Earth will ever read it, but the box must be ticked.

    It’s tempting not to attend any lectures, all you need are the meeting dates, then invent some waffly BS reflections. Cynicism is the only reasonable response to this annual, pointless painful charade.

  • There isn't a one size fits all approach to weight management

    David Banner's comment 09 Jul 2020 11:01am

    The article correctly points out that without massive investment into a dedicated obesity service (including psychologists, dieticians and obesity surgeons working in co-ordinated clinics) then the whole new QOF initiative is a total waste of box-ticking time.

    Well, since the country is being bankrupted by a pandemic, there is precisely zero chance of this happening.

    And classifying a lifestyle issue like obesity as a “disease“ is stupid and dangerous. Suddenly the patient is dissolved of all personal responsibility, whilst the GP is expected to sort it out with no meaningful resources to call upon.

    And a word to those dreaming up any new service......make it self-referral if you want it to succeed. Firstly it will reduce DNA rates, and secondly GPs will draw the line at filling in hundreds of long complex forms....ain’t gonna happen any more.

  • GPs should refer a quarter of all patients for weight management, suggests NICE

    David Banner's comment 07 Jul 2020 1:47pm

    David Jenkins is spot on. Treat this fat-uous nonsense with the respect it deserves. Dictate swift referral to Wt Mgmt (or if no service advice Wt Watchers) tick the QOF box and collect the points. Referral rejected or complex form required? Sorry, not my problem any more. Wt Mgmt hopelessly overrun with GP referrals? Same again, you reap what you sow, not my problem, it wasn’t my bright idea to destroy an already overburdened service.
    Sometimes cynicism is the only sane response to idiocy.

  • How GPs have used the independent model to adapt in the pandemic

    David Banner's comment 07 Jul 2020 1:22pm

    P McT et al are correct. This is a honeymoon period that will end once the leaves are falling from the trees.
    - remote consulting is a medicolegal elephant trap.
    - huge swathes of the population are hoarding problems that they have not brought forward because they think we are closed, too busy, or our surgeries are riddled with virus.
    - Autumn’s viruses coupled with a second wave will swamp our services
    - sussed patients are loving email/phone consults as they receive same day satisfaction. They won’t be easily repelled when the honeymoon is over.
    - secondary care remains a basket case, there will a flood of angry punters demanding we chase/change unanswered referrals for at least a year.
    - consulting with PPE, social distancing etc takes far longer than the usual in/out traditional model, slowing us down to a crawl.
    - CQC are back, QOF has not been suspended next year, and the appraisal holiday will soon end. These time devouring useless chores will be back with a vengeance.
    - the net result is that by the end of the year we will be wrestling with F2F, phone calls and emails whilst managing a huge backlog of delayed admin, with patients who work through a scroll of accumulated ills, with a no effective secondary care to send them to, whilst CQC kicks you in the nuts for running out of undelivered PPE, and ominous brown envelopes from GMC flop on to your desk regarding the late Mrs Bloggs that you gave antibiotics to over the phone.


  • Debate: Do practices have a duty to support locums during the pandemic?

    David Banner's comment 05 Jul 2020 10:10am

    “We mustn’t fight each other! Surely we should be united against the common enemy!”
    “The Judean People’s Front!!!”
    “No, no! The Romans!”
    “Oh, yeah, yeah”

    The Romans must be laughing at us now.

  • Working Life: Working in trans health

    David Banner's comment 04 Jul 2020 11:04am

    Re This was d

    I agree. What consenting adults choose to do to with their bodies is one thing, but subjecting children under 18 to powerful puberty blockers, hormones or even potentially mutilating surgery is deeply disturbing. These kids need compassionate support and counselling to guide them through these incredibly difficult years until they are adults and can make their own choices.
    As more of these children decide to detransition in adult life, I can see them turning on their parents/doctors and saying “What the hell where you thinking? I was a CHILD! You were supposed to protect me!”, then sue the Tavistock into extinction.

  • GPs asked to buddy up with PCN practices to cover for isolating staff

    David Banner's comment 14 Jun 2020 4:10pm

    If we are all strictly following 2metre social distancing and wearing masks, why would the whole practice workforce be forced to stay off for 2 weeks just because one contracted Covid? We cannot possibly return to normal with this approach. Minimising risk is not the same as eliminating risk.

  • Should remote consulting remain the default option post-Covid 19?

    David Banner's comment 12 Jun 2020 0:51am

    - Every time a new service is introduced, it attracts new customers. Walk-in centres, OOH services, 111........we’re always told they will take the pressure off GPs/A&E, but quickly they too become flooded whilst we don’t notice the difference.
    - Heartsinks are loving the current situation. They can ring several times per week and receive same day satisfaction. But post Covid they won’t just disappear quietly.
    - E-consults are already swamping our inboxes. How quickly should we reply? What if they are overlooked?
    - telephone is a medicolegal elephant trap. Plus the dog barking/ TV noise/ sound dropping out etc. And don’t get me started on the time wasted waiting for answer machine followed 5 minutes later by a demand that you ring back immediately “cos I was on the loo”.
    - post Covid, people will still expect to “see their doctor”, probably in larger numbers, each with long lists of symptoms they’ve been holding back. Add these to the telephone calls, video consults and mushrooming E-consults, how can we possibly cope, other than ludicrously long waits for each?
    - increasing access only stokes more and more demand, and requires more troops in the trenches. But there aren’t any more. We are sadly creating several rods for our own backs.

  • DHSC working on ‘better’ risk algorithm for shielded patients

    David Banner's comment 06 Jun 2020 11:55am

    “Shield everyone who needs a flu jab.
    Oh, hang on, that’s too many, only shield this narrow group.
    Ah, too few, add this lot in.
    Hmmm, now let people text in if they like, then you can add them in, or not, whatever.
    Oh, we forgot about these.....
    And a few more....
    Sorted? Right, we’re scrapping shielding!
    BUT, every shielded person needs a named GP.
    But actually, the lists were probably wrong any way, so now we don’t need shielding we’re gifting you a new algorithm so you can identify those who need to shield in the future. Well, not the future, we mean now, but not shield as much as before.
    All clear? Simples!”

  • BMA 'in discussions' around QOF payments for this year

    David Banner's comment 05 Jun 2020 1:37pm

    If the economic forecasters are even remotely right with their catastrophic predictions regarding recession/ depression Post Covid, then QOF will be an easy money saver for HMG. Can’t make the targets? Oh dear, what a pity, never mind, ah well, you knew the rules of the game, no QOF money for you. A pay rise? Come back in 10 years, we’ll have a look then.

  • Can we talk about death?

    David Banner's comment 04 Jun 2020 9:42am

    Copernicus makes a great point about baby boomers/BBs (and all of the generations that followed). Pre BB, there was an acceptance of the inevitability of death. Life expectancy was less, young men were routinely slaughtered in wars, humble bacteria frequently killed children, childbirth was positively dangerous, and people reaching their “3 score and 10” were grateful for a long life and ready to meet the their Maker.

    Well not any more. People seem to have a sense of immortality, “70 is the new 40”, and an unrealistic expectation of life-preserving treatment irrespective of the cost. Death is definitely taboo, because it won’t happen until I’m well past 100 and gone ga-ga.

    As Shaba suggests, one positive aspect of Covid has been a reckoning on the inevitability of death. The over 65s suddenly have to confront the possibility of a sudden demise, with no possibility of a (probably futile) ventilator.

    Will this realisation will remain post Covid? I doubt it. If you think the BBs are entitled and self obsessed, just wait until the Millenials hit 60! You ain’t seen nothing yet.

  • Most GPs practising 'outside comfort zone' during Covid-19 pandemic

    David Banner's comment 04 Jun 2020 9:06am

    There is a huge minefield of rejected referrals both to secondary care and radiology etc waiting to explode over my he next few years. And don’t expect any medicolegal leniency. If the hospital can prove they rejected your referral, then it all falls back on the hapless GP, no matter how chaotic the situation was at the time.

    As for the huge reduction in F2F consultations, I have heard umpteen colleagues optimistically declaring this a positive game changer that will revolutionise our working methods. Well, just wait a couple of years and see what a dim view the GMC takes of your telephone/video only diagnoses when they go south. Remember when we criticised colleagues working for Babylon’s telephone service and predicted their medicolegal downfall ? Well that elephant trap awaits us all post COVID.

  • My strangled cry against the hero worship

    David Banner's comment 01 Jun 2020 8:29pm

    He got an ice pick that made his ears burn.

  • Shielding patients told they can go outside in 'out of the blue' announcement

    David Banner's comment 01 Jun 2020 8:23pm

    Shielding lists done? Updated? Added a few more last week? And more the week before? Good, phew, that was time consuming but undoubtedly worth it......

    GOTCHA!! Now rip ‘em up, we’re not shielding any more.

    BUT, now every (ex) shielded patient needs a named GP!!

    What’s that you say? Incompetent? Making it up as they’re going along? Couldn’t run a what in a brewery?? Well stop moaning and start writing those protocols (that nobody will ever read ) for our CQC inspection. There’s a national crisis going on, don’t you know???

  • All shielded patients should have named clinical lead, says NHS England

    David Banner's comment 01 Jun 2020 8:13pm

    Ha Ha!! Sometimes you’ve just got to laugh. But if you give the keys to clowns, don’t complain when they crash your car.

  • Locum GPs forced to claim benefits as work dries up

    David Banner's comment 29 May 2020 9:47am

    Though the comments on this article have been fascinating and highly entertaining, I can’t help thinking that the Partner vs Locum spat is akin to 2 badgers fighting in a sack carried by a farmer who intends to drown both of them in the nearest pond.

  • GP bureaucracy must not return after pandemic, says RCGP chair

    David Banner's comment 26 May 2020 6:40pm

    It’s a nice thought, but the cold hard reality is that when the regulators and bean counters come off furlough they’ll be back in their droves, dreaming up new tortures to add to the old. Too many vested interests, sadly.

    Anyone actually listening to GPs would already know that pointless annual appraisal and Stasi-style CQC inspections were hounding good honest hard working GPs into early retirement.

    These callous vultures nonchalantly watched as primary care collapsed and never flinched. Why would they let a humble virus spoil their party?

  • Over 300 GPs urge police to investigate Dominic Cummings

    David Banner's comment 26 May 2020 12:46pm

    No fan of DC nor his paymaster puppet, but this is over the top. Who can honestly say that they haven’t breached “lockdown law” at least once over the past 2 months, especially with family emergencies? Most GPs I know could not cast the first stone.

  • Can us GPs do more to help during this pandemic?

    David Banner's comment 23 May 2020 9:36am

    Intriguing article....reading between the lines, the author appears to be miffed at the current paucity of Locum sessions, and so urges practices to encourage reluctant patients to return to surgeries, therefore presumably requiring his/her services again.

    I shouldn’t worry too much. Workload will inevitably soar after the recent dip, and practices will be desperate for locums, especially when partners start taking long delayed annual leave.

    But really you should practice what you preach. There are copious salaried/partnership vacancies the length and breadth of this country, so take up a more permanent post and lead by example, rather than lecturing us from the sidelines.

  • Locum GPs forced to claim benefits as work dries up

    David Banner's comment 21 May 2020 3:20pm

    I am eternally grateful to our fantastic regular locums who have kept us afloat in some rough seas recently.

    And I don’t blame them for turning down our repeated offers of salaried/partnership posts.

    They have all accepted with good grace that we currently don’t need them.

    The offers of a permanent post remain on the table, but all have politely refused, despite their current difficulties. Again, I totally respect this.

    Hopefully they will still be available when we need them again. If not, c’est la vie. But we have treated each other with respect during both feast and famine, and see our relationship as symbiotic, not parasitic. Maybe that’s why they prefer to work for us, not elsewhere.

    Yes, they are expensive, probably too expensive (but that’s market forces for you), but as medical professionals and colleagues I have rhe utmost respect for them.