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Gold, incentives and meh

David Banner

  • Coroner urges revision of mental health referral form after 15-year-old boy dies

    David Banner's comment 20 Aug 2019 3:12pm

    The GP here avoided criticism because they actually referred the patient. The constant stream of CAMHS rejecting our referrals leads to defeatism, meaning many GPs have stopped referring as it seems pointless. This is a deadly mistake, as we will stand responsible for any consequences. Keep referring, with a form or not, if you feel it is necessary, don’t be the fall guy. As these tragedies pile up the penny might drop and CAMHS will finally receive the investment it badly needs.

  • Practice set to close after GP principal resigns over 'silly' CCG meetings

    David Banner's comment 17 Aug 2019 10:30am

    The real issue here was recruitment/succession. Why on earth would a GP near the end of his career sign a long term lease with no hope of a replacement partner to take it over? Older GPs over the land are waiting out their leases, then planning to jump ship, and quite right too. If HMG don’t firm up their vague promises to take on leases, partners will continue to bail at the first opportunity.

  • Jo Churchill named as new primary care minister

    David Banner's comment 15 Aug 2019 5:52pm

    There’s a Minister for Primary Care? Really?? Never knew that.
    What a fine job they’ve done for us too!!

  • GPs should not prescribe antibiotics for impetigo, says NICE

    David Banner's comment 14 Aug 2019 5:21pm

    I’m sure that those impetigo patients subsequently admitted with “sepsis” will be perfectly satisfied that their GP failed to prescribe an antibiotic.

  • Average GP waiting times exceed two weeks for first time ever

    David Banner's comment 12 Aug 2019 1:56pm

    Given the enforced gradual evolution from many GPs with a few noctors to the exact opposite today, the public need to wise up to the future of primary care as “their” GP retires, leaves or dies, replaced (if they’re lucky) by an ANP.
    Access to a GP will be increasingly through the front line noctor, rather than direct booking of a doctor.
    Once people realise this then headlines like these will melt away. I’m afraid it’s too late to go back to the future, GPs have voted with their feet, and since our work conditions are deteriorating daily the fate of primary care is sealed.

  • GPs could prescribe medicinal cannabis under shared care arrangements, says NICE

    David Banner's comment 09 Aug 2019 2:45pm

    The article states that the only suggested indication is for nausea induced by chemotherapy. If cannabis is an effective treatment for this, then fair enough, (though bumping it to GPs seems unnecessary as these patients are being seen regularly in secondary care any way).
    At least they are standing firm against use in chronic pain. This really would smash open the floodgates as queues of patients, whether genuine or (probably) not, demand their NHS fix, and we are powerless to refuse.

  • The poverty of excess

    David Banner's comment 05 Aug 2019 11:57pm

    It’s mind boggling...........after many hundreds of millennia in which poverty equalled starvation, it flipped 180 degrees in 1 generation (in first world countries at least). The McDonaldisation of drive-through Britain has transformed the poor from cachectic to obese. But surely corpulence is preferable to malnutrition?
    I’ve always favoured traffic light taxation of food...
    Red - add 20%
    Amber - nil
    Green - deduct 20%
    All the waffling leaflets and lectures on healthy diet are no substitute for cold, hard cash, especially for those where every penny counts.

  • Avoiding a nasty pensions tax charge

    David Banner's comment 26 Jul 2019 9:25am

    It worries me how many of my GP colleagues still seem blissfully unaware of the huge AA bills coming their way. It took Hospital Consultants off guard, we’re only a year or 2 behind them.
    The disgraceful incompetence of Capita in delaying statements means that many GPs have already burnt through their “previous 3 years” allowance without even realising it, and face eye watering tax bills appearing out of the blue over the next few years.
    Even those who have opted for “scheme pays” seem unaware of the punitive interest metastasising into their pension pots.
    And we haven’t even mentioned LTA!!
    Anyone on a half decent full time income needs to act fast. Exit the scheme, do the 50:50 Hokey Cokey, take a year or 2 out of the scheme, take pension early & go part time, reduce your hours.....anything, but do it quickly.
    Financial Advisors will blithely reassure you that you are still up on the deal (if you live to be 100), but they’re not the ones staring at a £20k AA bill that just dropped on the mat.

  • Boris Johnson pledges to reduce GP waiting times in first speech as PM

    David Banner's comment 25 Jul 2019 8:54am

    Boris wants us to be optimistic and stop talking down the NHS, so here are a few positive ideas to drive down GP waiting times.
    1- 5 minute appointments (that’ll half the wait immediately)
    2- help yourself to pre-signed sick notes and penicillin scrips (just fill in the rest yourself)
    3- don’t waste time calling people in to an office, the GP can go round the waiting room with a secretary (“your problem sir? Uh-huh, mmm, yep, right...ok, 20mg Prozac for a month and see counsellor , moving on, yes madam?”)
    4- force lazy golfing GPs back to 24/7 OOH care, with surgeries 7 days a week, they’ll pack ‘em into daytime so they don’t get called at night.
    5- ban taking pension early, force GPs to work until they’re 67
    6- force all newly qualified doctors to do 2 years national service as a GP
    7- abolish partnerships immediately, make them all salaried, and put them on full time contracts
    8- reduce GP annual leave to 2 weeks a year
    9- abolish CCGs, networks and all other QUANGOs that lazy GPs use to skive off seeing patients to sit on useless committees.
    10- and if 1-9 doesn’t work, sack the useless lot of them and replace with cheap compliant noctors. You can’t complain about the time it takes to see a GP if there are no GPs, right?

  • Government consults GPs on solutions for greater flexibility in pension system

    David Banner's comment 23 Jul 2019 9:56am

    Since the blindingly obvious solution of restoring AA/LTA to their previous limits (and scrapping AA tapering) have been firmly rejected by Spreadsheet Phil (presumably because they are nice little earners for the Treasury, effect very few people, and would be spun as “tax cuts for the rich” if changed), poor old Matt Hancock has been hung out to dry (hence this rather pathetic plea for the Medical Profession to come up with a solution for him).
    The only real hope is that Boris’s new Chancellor will take off the blinkers, realise the severity of the crisis, and do the needful, otherwise the consequences (mass early retirement, no overtime, cancelled operations, unsafe hospitals, huge queues at A&E etc etc) don’t bear thinking about.......

  • GPs must diagnose and treat lyme disease on basis of rash alone, NICE says

    David Banner's comment 19 Jul 2019 10:07am

    Treat = slap on wrist from anti-antibiotic zealots

    Don’t treat = GMC witch-hunt

    Guess which option GPs will choose?

  • Beware of thin notes

    David Banner's comment 17 Jul 2019 8:07am

    A brilliantly devastating article, David.
    What starts as a typical “no nonsense/ common sense” Dr Turner blog dramatically reveals a personal tragedy that is all the more heart breaking for the matter-of-fact/ no fuss attitude of the author, concluding with a valuable lesson for all clinicians.
    Stay strong, David.

  • Government recognises NHS pension scheme discriminates on age grounds

    David Banner's comment 16 Jul 2019 8:06pm

    Presumably HMG will simply shove everyone left on the 1995/2008 schemes to the crappy 2015 version. Hey Presto, no discrimination, we’re all Donald Ducked.

  • Number of registered patients per GP rises to almost 2,100

    David Banner's comment 13 Jul 2019 11:55pm

    Re Anonymous London

    More patients, more work, more stress, more locums, more noctors, less holiday, fewer targets met, less money, partners bugger off, last man standing, bankruptcy, nervous breakdown/MI.

  • Hancock promises to fix pension tax problems by April 2020

    David Banner's comment 11 Jul 2019 10:28am

    So, a senior doctor who received a £10- £20-£30k annual allowance bill out of the blue last year is going to “hang on” whilst a health secretary (who may well be shuffled out of a job in a few weeks) promises he’ll fix it next year (with zero detail on how) despite the repeated flat refusal of the Chancellor to change anything (fearful of “tax cuts for the rich” media coverage no doubt).
    Good luck with that, Matt.

  • Almost 90% of GPs found their appraisal useful for improving patient care

    David Banner's comment 08 Jul 2019 8:35pm

    This is outrageous. Gather a group of GPs together and about the only issue they agree on is the utter uselessness of appraisal. Time for Pulse to run an identical questionnaire to see what the troops REALLY think.

  • Prescription drug addiction review must boost funding for pain services, say GPs

    David Banner's comment 06 Jul 2019 9:59am

    Great point, TER!
    The banning of co-proxamol , the demonisation of NSAIDs, the stripping away of weaker opiates to treat back pain (with no reasonable alternatives) have all contributed to the strong opiate/gabapentinoid tsunami.
    With firm advice to avoid prescribing to those at risk from deliberate overdose , co-proxamol could make a welcome (if unlikely) comeback.

  • RCGP cautiously endorses chaplains in GP practices

    David Banner's comment 06 Jul 2019 9:48am

    I don’t know how much this CCG is paying for the chaplaincy service, but presumably they feel it is value for money.
    If local provision for social counselling is poor, this could represent a cheaper in-house service, assuming they see anyone regardless of religious belief (or lack of it) and provide comfort/support without bible-bashing (unless the patient wants it).
    This could be a valuable asset in (e.g.) palliative care.
    It would be fascinating to hear from Birmingham GPs using chaplains to find out first hand if it’s working or not.

  • Prescription drug addiction review must boost funding for pain services, say GPs

    David Banner's comment 05 Jul 2019 6:01pm

    I get the sinking feeling that this report will be splashed across the news with the usual GP scapegoating, and league tables to name and shame beleaguered practices.

    Increasing Pain Clinic provision will only lead to more opiate prescribing dumped on GPs after single consultation and discharge.

    The ship has sailed for those patients already consuming/selling their gabbies and opiates, trying to wean them off is maddeningly futile.

    The real toughening up should be on new patients. Ban primary care initiation of CDs for chronic pain, if initiated in secondary care then keep on a “shared care” basis rather than discharging back to GP. That will focus the minds of our hospital colleagues, who will drown in follow up patients if they don’t drastically cut prescribing.

  • Incidentaloma on the rise: how GPs are left to manage unexpected findings

    David Banner's comment 05 Jul 2019 3:49pm

    Hypochondriac - “Why don’t you just put me through a total body scanner every year?”

    GP - “Because we might kill you trying to find the terminal illness you haven’t got”