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Gold, incentives and meh

David Banner

  • The many disappointments behind this appointment

    David Banner's comment 06 Nov 2019 1:16pm

    “These are not appointments. These are disappointments”
    Quote of the year!

  • GP leaders call for afternoon home visits to be passed onto ambulance services

    David Banner's comment 06 Nov 2019 1:08pm

    HMG will never scrap GP visits from our contract. Why would they, it’s fabulous value for (no) money.
    Fortunately we have final say on visits, not the patient.
    Ruthless triaging, dragging into surgery, diverting to another service.....other than palliative care and possibly care homes (at our discretion) visits can be pruned back, mainly by having the spine (and medical defence cover) to say “no”.
    Take back control.
    And as others have said, if an early evening visit cannot wait until the next day, then by definition it needs to go to A&E. It mysteriously becomes less urgent when you tell them that.

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

    David Banner's comment 02 Nov 2019 11:35am

    The bitter irony here is that experienced older GPs and Practice Managers wasted months of precious clinical time pointlessly box ticking to pass a CQC inspection, then decided to throw in the towel rather than drag themselves through the whole Sisyphean task again.
    This has been a major contributor to the exodus of senior GPs, leading to inevitable falling standards on subsequent CQC inspections.
    Drastic reform/simplification of the inspection system is urgently needed or CQC will continue to have a diametrically opposite effect on standards.

  • Over seven in 10 doctors face ‘superdoctor syndrome’

    David Banner's comment 01 Nov 2019 1:52pm

    It may not be healthy, but the unwritten rule of partnerships is “thou shalt not go off sick”.
    None of us wants to be the one to dump on the other partners, who are left with double workload if we don’t show up.
    By struggling in when dying from terminal man flu you set a high bar to the others, who won’t dare go off with their URTIs. Equally, if one partner starts to take a few sickies , you suddenly don’t feel so bad about taking a duvet day yourself.
    Within reason this stoicism is a strength of partnerships, not a weakness. But once we’ve all been swept away and replaced by salaried docs, I suspect there will be a sharp rise in sick leave.

  • Anti-inflammatories can help curb symptoms of depression, study finds

    David Banner's comment 29 Oct 2019 8:09am

    Was the placebo fluoxetine?

    Should make for some interesting consultations.
    “Well Mr Bloggs, you are clearly depressed. I suggest you buy some aspirin from Asda. Just don’t take them all at once....”

  • BMA: Government pensions plans are 'worthless' and won't stop GP retirements

    David Banner's comment 24 Oct 2019 11:00am

    Hammond flatly and repeatedly refused scrapping the taper and restoring AA and LTA to previous levels, despite the fact that it’s a blindingly obvious and rapid solution to a deepening crisis. Will Javid have the foresight to avoid a Winter of NHS chaos that could scupper his party’s election chances? I wouldn’t bet on it.

  • Teenager dies after GP mental health referral is rejected

    David Banner's comment 22 Oct 2019 4:48pm

    It has been stated many times by Pulse readers that children will have to die before the scandal that is CAMHS policy of rejecting most GP referrals (to reach their access targets) is exposed and condemned. There is zero pleasure in being proved so brutally right.

    But what really sticks in the craw is CAMHS “Crisis? What crisis?” stance. Instead of highlighting their chronic underfunding to deal with a huge increase in referrals (encouraged by decades of “increasing awareness” campaigns aimed at improving GP detection), CAMHS repeatedly claim they have everything under control, other than the annoyance of having to reject and divert 80% of “inappropriate” GP referrals. Hitting targets has superseded the proper assessment of suicidal children.

    If CAMHS can’t come clean about their rank inability to deal with workload, then those at the top need to be removed from their posts, and quickly.

  • NHS trusts ask GP practices to identify overseas patients when referring

    David Banner's comment 22 Oct 2019 11:24am

    The article makes it clear that this is a voluntary request, not a compulsion. As Primary Care is free for all who attend, our only duty is to the patient in front of us. If a decision is made to refer, then it is Secondary Care’s responsibility to check if fees are required.

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

    David Banner's comment 17 Oct 2019 9:31pm

    Re DeadEndDr,

    Totally agree. We find huge numbers of patients who have stopped taking SSRIs contrary to advice without a jot of trouble. They rock up a year later depressed again looking for more. Compliance has always been poor with these drugs.
    The tiny vocal minority who bitterly complain of withdrawal issues are the usual suspects, often heartsinks who have side effects from paracetamol, pollute social media with their medical mishap nightmares, and should never have received an SSRI in the first place (though they’re often prescribed in desperation 30 minutes into a 10 minute consultation)

  • GPs may have to assess mental health and mental capacity free of charge

    David Banner's comment 16 Oct 2019 1:12pm

    General Practitioner
    The clue’s in the name.
    We’re generalists, not specialists.
    We’re not Psychiatrists.
    We will pass this work for which we are not qualified nor trained to those who are.

  • Lower GP practice ratings due to workforce and demand issues, says CQC

    David Banner's comment 15 Oct 2019 1:11pm

    So....
    -CQC downgrades a surgery because they cannot recruit.
    -New low grade guarantees that no GP will touch this surgery with a barge pole.
    -Partners scarper.
    -CQC closes down surgery.
    -Patients have no GP, and Last Man Standing goes bankrupt.
    Cheers CQC, a job well done.

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

    David Banner's comment 15 Oct 2019 0:19am

    Kudos to Krishna for having the sphericals to write such a hopelessly optimistic piece, knowing full well the volley of venomous abuse he would receive in reply.
    But seriously, you’re kidding, right? PCNs are yet another unwelcome and unnecessary layer of beaurocracy that will crash and burn like all their useless predecessors (Federations? You’re SO 2017!) whilst sucking the life out of GPs who realise that this herding of drowning practices into a Network lifeboat is doomed to fail due to the absence of a bigger boat to come to our rescue.

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

    David Banner's comment 10 Oct 2019 11:07pm

    5p for a plastic bag

    A nominal charge would significantly reduce use whilst not impeding the poor.

  • Decrease in GP income 'contributing to recruitment problems', finds study

    David Banner's comment 09 Oct 2019 1:15pm

    Oops, money talks, BS walks.....sorry!!

  • Decrease in GP income 'contributing to recruitment problems', finds study

    David Banner's comment 09 Oct 2019 1:12pm

    When doctors like us warned people 5 years ago that HMG had an agenda of dismantling the GP partnership model, we were dismissed as alarmist cynical cranks.
    But now, with old partners fleeing into retirement and young GPs not touching toxic partnerships with a barge pole, the final piece of damning evidence is laid bare.
    Money walks, BS talks. Who in their right mind would take on a partnership with falling income, increasing workload/regulation/paperwork/CQC etc etc?
    And now the remaining bewildered partners (trapped in Last Man Standing Hell) are being herded into Networks so they can beg for crumbs of funding just to stay afloat.
    If HMG wanted to kill partnerships, then it should have said so and announced a Plan B.
    But slowly starving us into submission (whilst having the nerve to repeatedly state support for partnerships) is cruel and chaotic, unfair on patients, deeply deceptive, and above all cowardly.

  • GPs requesting ambulance will have to provide a score for level of emergency

    David Banner's comment 28 Sep 2019 6:35pm

    GP - “I suspect you might have appendicitis and need to attend A&E”

    Punter - “(groans) Blimey doc, how do I get there in this state?”

    GP - “Crawl home and call an ambulance”

    Punter - (gasping) WTF?!?!?

    GP - “Trust me, you’ll be dead from peritonitis if you stick around here all night”

  • CCG delays surgery in obese patients in move that 'risks opioid dependency'

    David Banner's comment 26 Sep 2019 12:14pm

    Dropping the BMI threshold to 30 is clearly a cynical move to slash waiting lists. Given that roughly 50% of these patients have a BMI over 30, then Hey Presto!.........half the waiting time, target achieved, box ticked. CAMHS blazed the trail in rejecting referrals to meet targets, now it’s all the rage in secondary care.

  • Labour pledges to abolish prescription charges

    David Banner's comment 24 Sep 2019 9:44am

    Given that 80% of scrips are not paid for any way, plus the inequity of Scotland/Wales/NI already enjoying freebies, it’s not such a fanciful suggestion.

    But the knock on effect of increased demand for OTC drugs on prescription could be ruinous, and the income lost from the 20% of paid for English scrips has to be recovered somehow.

    Given the unfair current situation (free for some, £9 per item for others, £10 per month if on 2 or more repeats) we should look at narrowing the gap between payers and non payers. After the success of 5p for a plastic bag, nominal charging (eg 10p per item up to a maximum of 30p per month for those who don’t currently pay) may drive down demand as a bonus, whilst the cost for those who do currently pay could be slashed.

  • Government's flagship named GP scheme 'is not effective'

    David Banner's comment 24 Sep 2019 9:03am

    For the Named GP scheme to work you need stable thriving full time partnerships with partners spending their whole career working in the same practice .....you know, like the good ol’ days when everyone had “their” GP.
    But If you spend a decade running partnerships into the ground, leaving unstable practices staffed by part time salaried/Locum GPs (who quite rightly disappear every year or 2 when they are worked into the ground) then sticking a name on a record is the useless gimmick we all knew it would be.

  • Labour pledges to train 5,000 new GPs a year

    David Banner's comment 23 Sep 2019 10:17am

    What is this political obsession with the number 5000? Never 4000 nor 6000, always 5000. Is it just a neat round number, or did it please a focus group? Or perhaps Hunt, Hancock and Ashworth suffer from a Messiah Complex regarding the NHS and are channeling “The Feeding of the 5000” with 2 loaves and 5 fishes (which would at least explain their ludicrous promises of inflated outcomes from pitifully inadequate resources).