This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

A faulty production line

Dr. Matt

  • Pharmacist to dispense high-dose statins without GP prescription under NHS plans

    Dr. Matt's comment 04 Sep 2019 5:57pm

    @ Kath Morrison, we already know the benefits of statins in terms of reducing mortality.

    They obviously make a bigger difference to higher risk patients or in secondary prevention.

    The benefit for lower risk patients is small but from a population point of view it is still beneficial.

    Monitoring is needed in terms of LFTs, the risk however in terms of liver adverse effects is very small.

    My worry with this scheme is whether Community Pharmacists will actually do this work. We’re endlessly told Community Pharmacists will start taking some of the workload from General Practice however I find out workload is just forever increasing. I’m sure Community Pharmacists are already busy to take this on.

    My other worry with this is whether we’ll find out if the patient is taking a statin, particularly important if we’re prescribing something like a macrolide where there is a significant interaction.

  • Coroner calls for changes to NHS 111 following death of young adult

    Dr. Matt's comment 12 Aug 2019 11:38am

    I’m not sure why everyone here thinks this is about money.

    Inflation adjusted the NHS is spending ten times as much as it did when it created.

    Out of hours GP spending went up by 600%-700% within a couple of years between 2003/04 until 2005/06 and has been sustained since.

    Has this meant better care for patients?

    NHS spending continues to rise year on year, other areas of spending are squeezed and is healthcare improving?

  • Record A&E attendances and worst-ever referral waiting times, official data shows

    Dr. Matt's comment 09 Aug 2019 0:50am

    The NHS budget (inflation adjusted) has increased by 10 fold since its creation and yet we’re in a crisis year on year.

    The only solution is to think radically.

    Change however is totally unacceptable to the electorate and (most) doctors alike.

  • Why I'll leave RCGP if Julia Hartley-Brewer speaks at conference

    Dr. Matt's comment 23 May 2019 7:08pm

    I have noticed that my comment from yesterday has also been removed.

    It says the comment has been removed as opposed to deleted, I don’t know if there is a difference?

    I did not want my comment to have caused any offence and I apologise if it had done.

    I didn’t mean to offend to Dr. Khan and I’m sorry if he felt offended or if anybody else did.

    Some of the post was a little sarcastic and perhaps could be interpreted as offensive although that was not my attention.

    I don’t want to cause any offence to anyone and as I said yesterday I don’t support any form of intolerance.

    I’m not against migration and I believe immigration has brought many benefits to the UK.

  • Why I'll leave RCGP if Julia Hartley-Brewer speaks at conference

    Dr. Matt's comment 22 May 2019 12:40pm

    This comment has been removed

  • Dr Bawa-Garba allowed to return to practice from July 2019

    Dr. Matt's comment 09 Apr 2019 6:48pm

    The GMC acknowledge how difficult this has been for Jack Adcock's family.

    Losing a child to sepsis is the most awful thing and my heart really goes out to them.

    Blaming Dr. Bawa-Garba for this death or anyone else in this case was not the answer. She was the only doctor in perhaps the most difficult circumstances who probably did the most to try to save his life on that day. Mistakes were made however we have to put them in context and we do not know whether the outcome would have been different had those mistakes not been made.

    I just do not know why Jack’s mother is convinced that Dr. Bawa-Garba is to blame for the death of Jack? Who told her she is to blame? Is it because she was convicted by a jury? Is it because the GMC said she should be struck off? Why does Jack’s mum feel that Dr. Bawa-Garba is not going to be safe doctor, when all the evidence points the other way?

    Jack's mum, Nicky Adcock said in 2015 regarding the nurse who was struck off and of Dr. Bawa-Garba "..I want to rip their heads off because the truth is they didn’t do their best for him. If it hadn’t been for them, he’d still be here today.”

    How did she come to this conclusion?

  • Succeeding as a locum GP

    Dr. Matt's comment 12 Sep 2018 3:51pm

    I feel that locuming, which should have been occasional extra work done by salaried GPs or Partners has become a lifestyle for a good proportion of the GP workforce.

    There’s good reason to do it, there’s plenty of work due to shortage of GPs, there’s often less paperwork or choose your own amount of paperwork and get paid for it and it’s completey flexible.

    Is it good for Practices, the NHS and patients?

    The fairest system would be if all GP work was shared out equally between Partners, salaried and locum GPs and we were paid for the amount work we did.

    It’s really unfortunate that some Practices are having to pay a huge amount of money in order to be able to provide a service to their patients.

    If most locum GPs actually started working as Salaried or Partners - it would probably reduce the amount of work the salaried / Partners currently do as the paperwork would be shared out and they would probably see an increase in their income - as they’re not spending so much on locums.

    Just a thought.

  • Hancock received £28k from chair of group advocating NHS insurance system

    Dr. Matt's comment 10 Jul 2018 8:58pm

    We need a better model than the current NHS system. Listen to what Kate Andrews from the IEA says.

    We’re spending more money than ever, nursing and doctor morale is increadibly low.

    GPs are working under immense pressure and when mistakes happen, which they inevitably will do, they’re to blame.

    A different model is definitely needed.

  • At least 456 patients died after inappropriate opioid prescribing by GP

    Dr. Matt's comment 20 Jun 2018 2:34pm

    Who knows what actually happened?

    Can I ask the GMC why they did not ask for this doctor to be erased as she was involved in the deaths of 456 patients? When they were apparently given opiates inappropriately to shorten their lives?

    Why did they prusue the erasure of a paediatrics registrar who was doing the job of three doctors and mistook hypovolaemic shock for sepsis - although had given antibiotics within a few hours when she realised?

    I would really like to know.

  • Government announces £20bn increase to NHS funding

    Dr. Matt's comment 18 Jun 2018 11:59am

    When will people realise that spending more money on the NHS will not solve its problems or fix it.

    Inflation adjusted NHS spending has gone up more than 10x since the 1950s and has more than doubled since 1997 and yet the NHS is in crisis like it has always been.

    What is actually needed is a radical new way of thinking about healthcare funding and spending.

    Have a listen to Kate Andrews from Institute of Economic Affairs says on how things should change:

  • GMC criticised by its own regulator for handling of Bawa-Garba case

    Dr. Matt's comment 20 Feb 2018 6:57pm

    I still do not understand what Bawa-Garba did that was truly exceptionally bad.

    We are all doctors and we are meant to be thinking doctors and not always following pathways / guidelines blindly.

    If we all followed "sepsis" pathways nearly all the children that we see in General Practice would receive antibiotics - even those with viral illnesses / gastroenteritis.

    This child was afebrile, had diarrhoea and dehydration. Hands up if there are any doctors who would prescribe antibiotics at this point? Raised lactate can be for hypovolaemia shock not just sepsis.

    Infection was in Bawa-Garba's differential - she ordered a chest x-ray and antibiotics were given within one hour of her reading the x-ray. There was a delay in reading the x-ray - but Dr. Bawa-Garba was having a day from hell and was doing lumbar punctures etc in that time. In any event it was read within ~ three hours.

    From all accounts the child was un well from the day before - this is according to the mum. They had already missed the boat for early antibiotics if that was a big "failure" on this occasion. Presumably the child received enalapril the night before he was admitted?

    The child improved both clinically and biochemically from the treatment Bawa-Garba gave.

    We all know children can deteriorate quickly and things in medicine can evolve unpredictably.

    This was a child with a previous heart issue, presumably some heart failure and taking a good dose of enalapril.

    He had a good going infection and then was given enalapril which may have tipped the scales.

    No one can say for certain that Jack would have survived had he received all the perfect treatment. There is a good chance that he may have still died? It is difficult to say.

    Terence Stephenson who is Chair of the GMC and a Paediatrician himself should at least say that the conviction for manslaughter feels wrong in this case even if it is law?

  • GMC is using right to appeal tribunal decisions 'appropriately', says chief

    Dr. Matt's comment 14 Feb 2018 3:17pm

    The GMC is saying that gross negligence manslaughter is rare and that they had to follow the original court ruling.

    The GMC also say they are listening to doctors concerns.

    My concern is that this doctor who was working under extraordinary pressures didn't actually do much wrong if anything.

    This doctor did what any other doctor may have done. She diagnosed hypovolaemic shock as the signs/ symptoms fit that diagnosis initially. She then organised a chest x-ray - which showed pneumonia and so her management changed. When the crash call was called for the boy, she confused him with someone else for 30-120 seconds. Given the staff had moved the patient, the patient had an oxygen mask on and given the doctor had worked for 12 hours without a break - the hiatus in CPR is understandable. The hiatus in resuscitation did not have any bearing on the outcome.

    Mr. Massey if you are listening, which you say you are can you tell me what this doctor did that was so wrong that it warrants erasure from the GMC register?

    If you answer with ".. because she was convicted for manslaughter"

    Then how can this be manslaughter? (And please don't answer that with "it's up to the courts".

  • Guideline of the month - updated guidance on abnormal LFTs

    Dr. Matt's comment 10 Jan 2018 8:38pm

    @ Dylon 5:02pm - you mean 6 million patients?.. not 600 million!!

  • Labour vows return of independence to GP pay review body

    Dr. Matt's comment 25 Sep 2017 10:52pm

    Labour will promise the Earth.

    They'll say the rich will pay for it - although we all know that increasing tax rates on higher earners does not increase revenue - it never has done in the past.

    In the end they will borrow more money - asking the next generation to pay for things so that they can bribe voters to vote for them at the moment.