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Gold, incentives and meh

David Banner

  • GPs required to take pictures of lesions before skin cancer referrals

    David Banner's comment 08 Apr 2019 2:25pm

    So a fuzzy photo of a melanoma is incorrectly dismissed as a seb. keratosis. Who gets sued? The photographer for not having a better camera? Or secondary care for not seeing the patient?
    What if the 2WWait is breached because the photo would not upload? (It happens. A lot.)
    What if the photo accidentally ends up in cyberspace on Facebook accounts?
    What if the patient refuses a photo?
    Why can’t the patient be given access by secondary care to upload their own photos?
    The mind boggles.......

  • GPs the target in the fight against antimicrobial resistance

    David Banner's comment 04 Apr 2019 10:29am

    1-Increased prescribing
    2-Increased resistance
    3-Increased sepsis
    4-Manslaughter for “missing” sepsis
    5-Increased prescribing
    6-Increased resistance
    7-Increased sepsis
    8- It’s all the GPs’ fault

  • Partnership is dead, long live partnerships

    David Banner's comment 04 Apr 2019 10:17am

    Young GPs are smart cookies. Yes, they want partnerships to survive......but they don’t want to be partners themselves.
    And who can blame them? Who wouldn’t prefer a salaried/locum position (with defined workload and salary) over the financially toxic rollercoaster and bottomless workload pit of a partnership?
    Of course, this only works if idiotic older GPs are prepared to cling to the partnership mast and clean up the crappy jobs because the buck stops with them.
    The trick is to be employed by these misguided partners, not some faceless conglomerate who will expect you to dance to their tune, rather than the pathetically grateful drowning small partnership that will be ecstatic for any help you can give them.

  • Doctors not prescribing medical cannabis due to lack of knowledge

    David Banner's comment 03 Apr 2019 1:10pm

    GPs can’t prescribe these products, and the indications for specialists are extremely narrow.

    And long may this continue. We were told 20 years ago that strong opiates would only be used in extreme cases of chronic pain. Ditto 10 years ago with gabapentinoids.

    But now we are overwhelmed by a massive population hooked forever on both these drugs. Once the brakes come off medical cannabis the demand will go through the roof (many of whom will most certainly NOT have chronic pain), and our King Canute ability to limit it laughable.

  • Pariah practices have patients that 'deserve care’, says RCGP chair

    David Banner's comment 28 Mar 2019 9:19am

    This exposes the stupidity of networks. Two neighbouring practices may have diametrically opposite philosophies (e.g. visits, extras, appointment times, length of surgery, opening times, income vs staffing levels, staff pay etc), and yet they will now be forced into working together to unlock any future network income.
    If practices want to work together, fine. If they want to stand alone, fine. But a forced marriage is never a good idea.

  • GPs report increase in patients asking for medicinal cannabis and low-carb diets

    David Banner's comment 27 Mar 2019 1:11pm

    Why are these issues? Grow a spine and just say “no”, kids.

    -medical cannabis? Not allowed mate
    - low carb diet? Fine, google it, do a shopping list and nip to Aldi
    - vit D? This is Britain, we’re all low in vit D, buy supplements if you really must and book a sunny holiday.

    All done? Excellent, that was an easy consultation, next patient please!

  • The 10 plagues of Matt Hancock

    David Banner's comment 22 Mar 2019 10:18pm

    “Plague of locums “ - love it!

  • Light in the LMC conference tunnel

    David Banner's comment 22 Mar 2019 10:08pm

    No frills,
    handy for the hills,
    that’s the way you spell New Mills!
    Brooding along by the runnel,
    While she’s in Capri with her swain,
    And the light at the end of the tunnel,
    Is the light of an oncoming train.

  • GP numbers will fall 7,000 short within five years despite increasing trainees

    David Banner's comment 21 Mar 2019 9:13am

    The recruitment crisis has destroyed the traditional Primary Care model of multiple GPs working alongside a few nurses. By necessity surviving partners either squander their profits on ruinous locums, or make do and mend by employing a variety of noctors. Unsurprisingly nobody in their right mind would choose such a poisonous career path any more, whilst those trapped in partnership dream of escape to retirement, locum or salaried sanctuary.
    These promises of bread tomorrow ring hollow after Hunt’s infamously dissembling “5000 more GPs” sick joke, and even if delivered will be far too late to heal the mortal wounds inflicted on Primary Care in the last decade.

  • GPC chair: 'There is light ahead, a hope that we can rebuild general practice'

    David Banner's comment 19 Mar 2019 10:53pm

    “The light at the end of the tunnel.......
    ....... is the light of an oncoming train”

  • ‘Truly frightening’ GP workforce problems in all Northern Ireland regions

    David Banner's comment 19 Mar 2019 10:46pm

    Coming to your town soon........if it hasn’t arrived already.

  • NICE announce prescription drug dependence guidelines to cut deaths

    David Banner's comment 18 Mar 2019 1:48pm

    5 deaths a day and urgent new guidelines.... October 2021.

    Well, that’s that sorted then.

  • Statin Island

    David Banner's comment 10 Mar 2019 10:34pm

    Best Pulse article title ever!

  • Dilemma: Partner says I make too many referrals

    David Banner's comment 08 Mar 2019 8:30am

    Tell him/her that there are numerous vacancies in the area for you to choose from, and good luck trying to fill my sessions. Now, any more criticisms? No? Good, I’ll refer whenever I think it is clinically appropriate, as should you. Thanks for the feedback.

  • Patient satisfaction in GPs drops to record low levels as 'intense pressures' show

    David Banner's comment 07 Mar 2019 1:34pm

    In 5 years time a satisfaction rate of 63% will be a distant fond memory. Primary Care is in terminal decline.

  • We need support in delivering the antibiotics message

    David Banner's comment 07 Mar 2019 10:02am

    stop prosecuting GPs for “missing” sepsis.

    That patient with a nasty cough you saw on Monday who died from sepsis Thursday. Did you prescribe amoxicillin ?
    If “yes”, you did all you could, doctor.
    If “no”, it’s GMC and possible gaol time.

    The irony is that overprescribing has rendered common antibiotics useless against many bacteria, but they are a vital fig leaf defence against a vengeful, adversarial and blame/shame legal system.

  • GP-based weight loss programme leads to diabetes remission for third of patients

    David Banner's comment 06 Mar 2019 1:17pm

    It’s been known for many decades that significant weight loss, exercise and dietary change will put T2DM into remission, and trial after trial using extreme calorie control proves this. The problem is Real World experience, when any initial weight loss is rapidly reversed with a plethora of excuses and a return to former bad habits.
    If these low calorie drinks are bought by patients then fair enough as they are cost neutral (they don’t have to buy food). But if they are put on free prescription then patients will rush to demand them, fail to maintain lifestyle change and still end up on expensive medications. It would be an appalling waste of scarce resources.

  • GPs in their 30s 'being told to cut clinical hours' to avoid pension charges

    David Banner's comment 01 Mar 2019 12:40pm

    This insanity could be so easily fixed. If raising the thresholds for annual and lifetime allowances are not politically possible, then at least allow doctors to limit their amount of pensionable pay, instead of the “all or nothing” idiocy we have at present.
    But the Treasury thought they were being so clever. After the 2004 contract had (in their opinion) given GPs a far too generous pension deal, they devised these tax thresholds to claw back as much as possible, but without thinking through the consequences. Now we have doctors slashing their hours in a recruitment crisis......utter madness and (sadly) totally predictable.

  • Overdiagnosis: how ministers and the NHS are fuelling a rising epidemic

    David Banner's comment 27 Feb 2019 10:12am

    Excellent article. Another example is the push towards early prostate cancer diagnosis by well meaning, high profile, media friendly individuals, who are clearly unaware of the serious consequences of indiscriminate and discredited PSA population screening.

  • Class dismissed

    David Banner's comment 20 Feb 2019 8:01pm

    Re Decorum Est,

    Stunning use of “oleaginous”, I salute you!