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Alan Shortt

Alan Shortt

General Medical Practitioner WA

  • GPs’ diagnostic skills could be obsolete within 20 years, says Hunt

    Alan Shortt's comment 08 Oct 2015 5:00pm

    Well yes good appropriately used technology will of course improve outcomes for patients and healthcare providers both and I like the balanced comments of Lorna Gold, the NZ doctor and especially the poster who referenced FindZebra

    But this particular vision is deffo misguided - blood-borne biomarkers do not in isolation make diagnoses they are more likely to create more "noise"

    Some things stand the test of time until replaced (or indeed enhanced) by something better.

    Skilled history taking and examination is something doctors and other clinicians can still do well (by skilled I don't necessarily mean difficult - we all learnt that stuff we just need to remember apply and reclaim that) and save lives, prevent and reduce morbidity and like save money.

    imho I think doctors should reexamine and reclaim what it means to be a professional Dr (yes using decision support aids etc)
    That's in the domain of "real" physical disease never mind the psychosocial undifferentiated areas that good doctors should also be skilled in

    wrt to current biomarkers I for one think for for example prostate screening satisfies Wilsons Criteria despite ongoing outdated arguments against that

  • GPs escape to the country to promote rural GP training

    Alan Shortt's comment 23 Jul 2015 6:32am

    both the yaes and the naes are entitled to their opinions but some of the yeas seem to be adopting a high moral highwater towards those with their own other experiences. the negativity may be less about the fact that other and younger GPs remain optimistic about the future but more an understandable scepticism about amateur hour happy clappy spoonful of sugar helps the medicine go down social media marketing campaings

  • Polypill for secondary CVD prevention 'likely to be cost-effective'

    Alan Shortt's comment 28 May 2015 12:28pm

    @ Vince Ho
    yes very complex economic arguments
    one thing I don't understand is why the polypill would be dearer - it should surely be cheap as chips to make?

  • Polypill for secondary CVD prevention 'likely to be cost-effective'

    Alan Shortt's comment 28 May 2015 12:16pm

    I used to be sceptical about the polypill approach to polypharmacy - drug A will reduce your mortality by 25% drugs B & C ditto - put them all together & add in drug D your mortality will be reduced by 100%
    (Ok thats a simplification but not too far removed from what seems to have been sold at times)
    I now think its a neat idea and am surprised it still hasn't yet taken off
    Quite a few patients don't take their meds - unless forced to by well meaning carers. The meds, the Webster packs are hidden away in a cupboard under the sink or wherever (over here they end up on the dump) but they are still dutifully collected / accepted by someone. The scripts get cashed but the meds don't get taken. I think we could save the NHS and the national debt if we addressed that - never mind, God forbid, Grandma Grumps one day decides to comply and actually swallows her escalated pharmamentorium.

    I do agree with Dr Steven Martin. Best evidenced based current therapy tailored to motivated ahem health-literate patients' individual clinical circumstances is the Gold Standard ...but a decent polypill might be a reasonable option for many others?

  • Andy Burnham launches Labour leadership campaign

    Alan Shortt's comment 14 May 2015 4:02pm

    It's flabbergasting there are no charismatic coherent voter-friendly leaders from within any of the middle ground mainstream parties. never mind it's (obvs) already too late and the next 5 years are going to be very difficult for ordinary working people (including GPs) and their families
    Might I suggest Owen Jones

  • What will the next five years hold for GPs?

    Alan Shortt's comment 14 May 2015 3:37pm

    apologies no opportunity to edit on this site

  • What will the next five years hold for GPs?

    Alan Shortt's comment 14 May 2015 3:35pm

    "If a Government says it can't pay GPs....it is because they DON'T WANT to pay GPs enough. Nothing to do with budget deficits or surpluses."

    I agree with that but would add NHS specialists, nurses, ahps, teachers, social workers, dinner ladies, traffic wardens, da police, armed forces, civil servants, bus-drivers, school-leavers etc

    I'm not sure Monetary Theory and Economics illuminates or proves one thing or another but I think I agree - in particular Austerity is a Lie - but opinions are like aerosols - everyone's got one - except perhaps for the increasing tranche of neo-poor destined to become Orwell's even smellier proletarians on the road to wigan pier

    I'm not sure Monetary Theory and Economics illuminates or proves one thing or another but I think I agree - in particular Austerity is a Lie - but opinions are like aerosols - everyone's got one - except perhaps for the increasing tranche of neo-poor destined to become Orwell's even smellier proletarians on the road to wigan pier

  • Single-handed GP to sue NHS England for closing his surgery

    Alan Shortt's comment 14 May 2015 2:59pm

    Anonymous GP Partner 3:11pm is referencing common law and business mores but does includes the term "unfortunately".
    Bankruptcy is no small thing whatever the reasons.
    I do wish Dr Wasu well but "unfortunately" he's on a hiding to nothing and would be well advised to stop his legal proceedings
    (which is not to say I think there shouldn't / couldn't be legal challenges to the destruction of the NHS, i'ts staff and it's patients' access to services etc)

  • GPs should be sued for ‘late’ dementia diagnoses, says professor

    Alan Shortt's comment 30 Apr 2015 3:25pm

    I remain puzzled why the Ambulance Chasers don't turn their attentions to the statutory obligations of the state, the NHS constitution, promises made and not delivered etc
    So yes Prof June I acknowledge your ill-informed contribution and call to arms for recourse to legal redress for the poor dispossessed and disenfranchised (if thats what you actually mean) but maybe shine your light on the real culprits ?

  • Is life as a GP better abroad?

    Alan Shortt's comment 30 Apr 2015 2:44pm

    I think the baseline comparator should be the total value of "the package" comparing say a self-employed plumber vs say a GP Partner, locum or salaried GP

  • Is life as a GP better abroad?

    Alan Shortt's comment 30 Apr 2015 2:32pm

    20 - 30 minute appointments = 20 patients per day, genuine joined up multidisciplinary health & social care (ok this doesn't always work), opportunity to work alongside visiting specialists form relationships and have face-to-face discussions about said same patients

  • Is life as a GP better abroad?

    Alan Shortt's comment 30 Apr 2015 12:21pm

    $AUS 300k + 9% superannuation paid + salary sacrifice worth another $17K, 4 weeks holiday + 12 Rostered Days Off, 2 weeks study leave, ability to accumulate Time Off In Lieu = approx another day per month, 8 hrs working day 830-430 M-F including 1 hr paid lunch break
    House + Car + some related utilities plus accommodation allowance $1100 per month, Remote Area Allowance this year $27K increasing up to $50K if i stay "remote" another 2 years -- Long Service Leave of 12 weeks if i stayed with my employer another 4 years
    Ability to offset expenses vs tax more in line with a self-employed worker than say a UK salaried GP
    Assistance getting over here approx value $5000k

  • Why I'm glad to be back in the UK

    Alan Shortt's comment 22 Apr 2015 12:06pm

    @ J Smith
    I've retained my Membership for the same reason - essentially to be able to get a "letter of Good Standing" if needs be but realistically a letter of Good Standing from the RACGP should be equally "valid" ?

    Having tried (and apparently failed) to do my best to maintain the ability to return to work in the UK (temporarily or permanently) relatively easily and noting your 8 years absence I might suggest you're likely to find the process a struggle in any case for the foreseeable future despite/because of the new returners scheme
    I fear I may have to just sit things out until there is genuine recognition of equivalence of experience and a genuinely streamlined process that can be done overseas.

    I can elaborate on my own particular use case scenario what I did and what were the stumbling blocks but perhaps should wait till the final outcome of my recent IRS scheme application

  • Practices to be given £8,000 annual grant to take on GP returners

    Alan Shortt's comment 27 Mar 2015 3:34pm

    ....Declaration of interest
    Having reviewed the document I think I'm probably "safe" under the new scheme.
    I'm not simply grinding my own axe here, venting my spleen, nor feeling hard done to
    but this issue does illustrate & resonate with my zeitgeist
    I believe medicine & healthcare might still yet be a noble career. (Career vs underpaid wage-slave knave in an age of dubious Austerity )
    I understand governments, their media & their bureaucrats might disagree (especially if they've ever been a patient)

  • Practices to be given £8,000 annual grant to take on GP returners

    Alan Shortt's comment 27 Mar 2015 2:58pm

    yes - its insane
    the new scheme purports to streamline the process for returners and address historic and geographic variances. But the devil is in the detail and having looked at it more closely there is no detail
    NHSE have a job to do & in my own personal experience they and my LAT have been very helpful.

    The BMA & RCGP are (somewhat quietly) trumping this as a step in the right direction but it seems to be the same old same old ivory towered / politicos make it up on the back of an envelope then overcomplicate it ad nauseam to (i really dunno) protect their self interests? propagate a self-serving industry of nothingness whilst at the same time thinking it's OK for highly experienced practitioners to work for nothing

  • Practices to be given £8,000 annual grant to take on GP returners

    Alan Shortt's comment 26 Mar 2015 4:56pm

    Somewhat unfortunate timing for me personally.

    I've retained my LTP, Performers List status, had two Appraisals and been Revalidated whist away, but the now formal two year cut-off seems likely to trump all that.

    I have twice attempted to line up some UK GP work with visits to the UK but on both occasions the stumbling block has been my indemnity organisation who twice took so long to approve my reapplication that it came too late to be of any use (despite a clean record with them over 22 years etc).
    I had decided for my 3rd attempt the most pragmatic solution (only practical solution) was to sign up for a full years indemnity (c 5K I'd thought not 10k for 1 session / week averaged i.e. 52 sessions) and accept that as a necessary evil if I wanted to retain the option to continue to be able to work in the UK a) at all and b) at short notice.
    So i was about to grudgingly return the direct debit er like today!

    why bother?
    • because England is home - I’m not yet ready to give up on it completely - I have friends and family
    • this includes elderly parents

    So good points:
    a uniform single system that can be negotiated by the applicant offshore with (they state) the ability to examine individual circumstances and fine tune the requirements and (they state) a much improved turnaround time

    Bad points: covered already by the contributors above - “surely they must be joking?”
    • patronising, arrogant, jingoistic. Sorry if that’s not quite the right word - maybe LittleBritainistic? - yeah the RCGP, BMA and other High Priests have previous form on that .
    • “Edumentalistic” deffo
    • £575 a week aka £15 per hour may be obviously technically better than nothing but is not a step in the right direction. It’s both a gross insult to potential returners (House Officers too) and a huge practical barrier to potential overseas returners

    @ anonymous 8.24 26/3/14 - I am still willing to swallow the bitter pill of say £10k ($20K Aus) per year to remain “dually registered” but I couldn’t afford £20k and upwards costs should I have to undergo some sort of reintegration scheme.
    I came here with the sad expectation this was likely to be a long term gig not a short hop. Economic migration is for the young.

    I’m a bit dissapointed I haven’t got rich enough to retire yet in my 3 years down under but am probably almost finally matching the £140K I earned in my last 3 years as a UK GP Principle and doing much better than the £80k I then earned as a salaried GP.

    To whit: your bad as it is hell hole is a self-imposed cage - you still have choices. (er I’m still looking at Canada) - but would really like to be able to spend maybe 3 months a year like Jessica suggests in inner city Glasgow, the Scottish highlands or wherever but would need (not greedily desire) house car indemnity etc to make the numbers stack

    When will the penny drop with the NHS, RCGP, BMA, deaneries whoever that shortages of professional skilled labour are generally addressed in the wider world by making the positions attractive - including ahem remuneration, terms and conditions, working environments, being made to feel respected and valued and often most importantly for say medics all of the above plus being able to perform their trade well.

    Here in WA, a Professor from Boston had to turn down a $200K+ position because that wouldn’t allow him to live in a half decent suburb of Perth. My last UK job - OOH in Liverpool England the drivers and were good-naturedly “taking the mick” with a newly qualified locally trained GP who had just bought the only house he could afford in an area of Liverpool they said they wouldn’t go into without a police escort.

  • Are NICE guidelines becoming a ‘laughing stock’?

    Alan Shortt's comment 06 Mar 2015 2:40pm

    @ Dylan Summers

    I wouldn't suggest "No Experts" - I want my practice to be informed by experts - maybe they are choosing the wrong experts!

  • Are NICE guidelines becoming a ‘laughing stock’?

    Alan Shortt's comment 06 Mar 2015 2:33pm

    @ Anonymous 8.07pm

    because as Dr Gordon suggests "Guidelines" can so easily become tramlines

    as I think Dr Summerton suggests the NICE guidance wasn't that good in the first place and is indeed getting worse

    Unlike you, Sir Michael Rawlins (the clue is in the Sir) won't have to defend his clinical decisions and deviations from "Best Practice" (aka NICE guidance)

    so one can invoke the fact that EBM was supposed to include up to date evidence, clinical judgement, and patient specifics but as I think Dr Ho is suggesting - good luck!

  • Nuclear option: Rise in practices seeking to close or merge

    Alan Shortt's comment 06 Mar 2015 2:01pm

    agree with both of you

    as Richard Butler once wrote "the first in the line is the last to remember her name"

    I might shed a genuine tear or two.

    UK GP and UK NHS was for all its faults inefficiencies and variances somewhat cost effective

    In the new world order of austerity Primary Care Physicians and all other health care providers will ultimately be employed by Serco, G4S or (in the medium term) CCG conglomerates run by colleagues looking after their own self-interests whilst selling the "Profession" and patients down the river.

    Nevermind their own children might wish to pursue a career in Healthcare/Medicine.... er to be an underpaid and undervalued worker bee drone vs said "Professsional".
    Nevermind we all become patients in the end

    I'm still genuinely puzzled how/why various RCGP & BMA campaigns tried / still try to posit "putting patients first" versus "Healthcare workers are highly skilled and committed and should be remunerated as such"

    The BMA does not hesitate to comment on a wide range of difficult political international problems - world poverty, global warming WMDs domestic violence etc

    Why are they not shouting loud and clear the need for ""Austerity" in the public sector is a lie designed to send all but the very rich (and clinging to the wreckage opportunists) back to the workhouse

  • Doctors need resilience training like soldiers in Afghanistan, GMC head says

    Alan Shortt's comment 28 Jan 2015 2:14pm

    @ Una Coles
    I agree with almost every comment on these 16 pages but to reply to your point - I remain surprised how clinical supervision / debriefing is a de facto expectation / mandatory professional regulatory requirement for say psychotherapists (maybe even Barristers) but not for GPs addressing similar problems in a much shorter time on a daily basis.
    imho (and I think you've argued something similar) the basic fault is the de-professionalism & de-valuing of medicine, medical practitioners (and indeed other Health Care Workers) which is becoming something of a global issue not one just confined to the UK
    regards