The Mcdonaldisation of UK youth is destroying the NHS. We need a tax cut on healthy foods and a tax hike on unhealthy ones.
An excellent and informative article, but regarding the “Unfounded safety concerns” around HRT, GPs really are stuck between a rock and a hard place. We are duty bound to discuss these risks (no matter how inflated they may be) with patients, and usually lose them once the dreaded “breast cancer risk” topic arises. Unfortunately GPs face a GMC grilling if they fail to record this discussion with a patient who is subsequently diagnosed with breast cancer, whether it was associated with their HRT or not.
(I think Kailasch and Ivans’ debate on this subject is first class, both very persuasive and thoughtful without resorting to insults and hyperbole - bravo to both!)
Most GPs have their own spin on statin prescribing guidelines. Like many others I tend to say....
Sec Prev - statins for (nearly) all
Prim Prev -
-under 10% no,
- over 20% yes,
-10-20% discuss pros & cons then let patient decide.
So if CAP is diagnosed OOH (with no local 24 hr pharmacy open) do we send them all to A&E?
Flexibility may reduce your AA bill, but it means a smaller pension and 40% income tax on the money not put into the scheme. Problem solved? Unlikely.
The obvious answer was to scrap the AA taper, and restore AA and LTA to their former values. The treasury would hardly notice the difference as doctors would increase their hours again, increasing the tax grab.
But fears of the media spinning this as “tax cuts for the rich” has scuppered this obvious, common sense solution.
Presumably GPs will still check PSAs in symptomatic patients then refer to urology who can perform this new test to reduce unnecessary biopsies and speed up diagnosis of the more aggressive cancers. Can’t see a down side, looks very promising.
GPs have been press-ganged into prescribing fluoxetine to under 18s due to the non-existence of CAMHS appointments.
The patients and their parents don’t just conveniently disappear, they keep on attending demanding you do something for the depressed patient.
Waiting out their 18th birthday doesn’t always work, so in the end we have to reluctantly crack open the SSRIs, and even with all out dire warnings of increased suicidal risk they keep coming back for more.
So once again we are the whipping boys for a failing and unfit for purpose CAMHS. Cheers, NICE.
Solicitors are already all over this like a cheap suit. Soon, patients (who badgered us for years to obtain ever more powerful analgesia) will be queuing up at their nearest “No Win, No Fee” outlet to blame ‘n’ claim their way to a few grand whilst trashing our reputations in the media. (“My prescription drugs hell”/ “My GP never bothered to review me” Panorama special coming to a TV near you soon).
So now we have to drag them all in to non-existent appointments to document that they refuse any withdrawal attempt just to cover our massively exposed behinds. The benzo claims were merely an hors d’oeuvre, the coming codeine main course will be a bean feast.
So, whilst we can’t convince patients who do need (usually prescription charge exempt) high dose statins to comply (take a bow, Daily Mail), patients who don’t need them can purchase at a premium price with no provision for any follow up.
Yep, makes perfect sense to me too.
Re Mandy Dingle
You’re analysis is spot on. In 2004 practices replaced partners with salaried doctors for financial gain, so cannot complain now that partnerships have become toxic.
But this wasn’t my point. Young GPs in this survey indicate they still are interested in partnerships, yet repeated adverts receive zero applicants. So clearly they’re not THAT interested.
My assumption is that younger GPs are smart enough to realise that partnerships are an elephant trap of unlimited workload and liability, so won’t touch them with a barge pole, but are hoping that future reform may make them attractive again. Sadly, that day will never come so partnerships are on the road to inevitable extinction.
Relax. Even those women not put off by previous scares can’t find HRT at any chemist due to supply issues.
But seriously, it does annoy me that GPs are criticised for putting women off HRT when we are legally obliged to lay out the various risk/benefits and document them. It’s not our fault if patients run a mile when breast cancer risks are discussed. The GMC would have a field day if we didn’t.
“How can I help seeing what’s in front of my eyes? 2 and 2 are 4”
“Sometimes, Winston. Sometimes they are 5. Sometimes they are 3. Sometimes they are all of them at once. You must try harder. It is not easy to become sane.”
Advertise for a partner 10-15 years ago? Loads of applicants
Advertise for a partner 5-10 years ago? A few applicants
Advertise for a partner last 5 years? No applicants
Actions speak louder than words.
....less than half a day PER WEEK per practice, sorry
Yes, they are fantastic IF they are trained to the right level, but very expensive for struggling GP partners, who often employ a pharmacist simply because they cannot recruit a doctor. And the “70% discount “ provision through PCNs is a joke, amounts to less than half a day per practice in many areas.
Damn, looking back I think we must have had a bogus CQC official. She stole our time and robbed us of our dignity, ( whilst asking lots of meaningless questions about irrelevant trivialities). Call the cops!
Stop prosecuting us for “missing” sepsis, then we can talk. In the mean time they should focus on the gallons of antibiotics pumped into farmyard animals and EU countries were you can buy them OTC before shooting down GPs for giving Little Johnny amoxil for his earache. Perspective please.
Prof Marshall has only been in his post 5 minutes, let’s give him a chance to match his fine words with actions. But if this IS yet more RCGP empty rhetoric he will soon be found out.
(Re Stelvio - just how do you keep the codeine craving crowd away? Your surgery must be like Rorke’s Drift! Seriously, any handy hints would be welcomed...)
Talk about door locking/bolted horse! First they batter us with WHO guidelines lambasting GPs for withholding strong opiates in the late 20th century, then push the strongest opiates and gabapentinoids on to willing patients via Pain Clinics, and finally (when the true horror of this catastrophic short term thinking unfolds) start lambasting the hapless GPs AGAIN for reckless/feckless prescribing!
As anyone who has ever embarked upon the thankless futile task of withdrawing an unwilling codeine/tramadol/pregabalin “addict” will testify, this is a useless Sisyphean task. Within weeks Dr B has put them back on the same stuff.
A whole new approach is needed....
- ban initiation of CDs for chronic pain in Primary Care
- If Secondary Care initiate CDs, they must keep patients on their books (under a Shared Care scheme) until they have withdrawn.
- stop A&E and surgeons recklessly discharging people with bottles of Oramorph!
- and for the huge number poor wretches already hopelessly hooked on the stuff, properly funded structured withdrawal clinics in the community (yeah, I know, flying pigs and all that)
But if (as we all suspect) the recommendations simply amount to GP bashing and blaming (with lots of league tables to name and shame the worst offenders splashed across the local rag) then this slow moving disaster will continue ad nauseum.
The Child Avoidance Mental Health Service pioneered the modern phenomenon of referral dodging. Their unflinching devotion to diverting, rejecting and ignoring GP referrals was a genius move now being duplicated across a grateful Secondary Care. Kick out 80% of your referrals and Hey Presto! All targets met and boxes ticked on a shoestring budget with minimal staffing.
It’s a shame this latest tragedy hasn’t hit the headlines harder. It seems many more children will have to commit suicide before any substantial improvement.