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Independents' Day

Vinci Ho

  • GP contract funding ‘not enough to solve staffing problems,’ warn financial experts

    Vinci Ho's comment 11 Feb 2020 12:10pm

    The fact that if those who earns more than £150,000 a year will have to expose themselves to the public eyes , is simply adding more adversity to the pension situation/annual personal allowance .
    As I wrote under the other article, why is the system punishing hard working , presumably middle-class , medical professionals while the government allows tech giants and business tycoons to get away free for tax evasion .

  • GPs to declare if they earn over £150k from 2021 for national publication

    Vinci Ho's comment 11 Feb 2020 9:00am

    The argument will propagate further that while high-earning GPs are not known to commit tax evasion frequently, has the government done enough to crack down on tax evasion in those ‘real high-earners’ of our society e.g. tech giants , business tycoons ?
    After all , we(GPs) are the easiest middle-class targets .

  • GPs to declare if they earn over £150k from 2021 for national publication

    Vinci Ho's comment 11 Feb 2020 8:50am

    See this coming long ago anyway .
    Politicians do not need to display this kind of transparency and honesty . But we(GPs) do ?!
    Another point is that GP partnership, being self-employed by default , is a small to medium size business. So this is the way this Tory prime minister and his government would support and encourage small businesses??

  • PCNs to get 100% funding for all extra clinical staff as further roles are added

    Vinci Ho's comment 07 Feb 2020 2:57pm

    The problem is the burden on the CDs . The only alternative thinking is each CD might want to employ a personal assistant (PA) to deal these complexities of the contract , HR issues and bureaucracy while many CDs ( like me) are still actively doing good number of clinical sessions every week in the frontline.
    Time is a more valuable resource than money thrown to us ....

  • GPs to be offered golden handshakes of £20,000 to take up partnerships

    Vinci Ho's comment 06 Feb 2020 6:47pm

    Let’s read the details carefully and properly , especially on PCNs ‘ terms and conditions first .
    We need to screen through the documents and hunt down the devil in small details , if any.

  • GPs 'fuming' as patients kept waiting amid 'nationwide' EMIS outage

    Vinci Ho's comment 06 Feb 2020 12:47pm

    I am not trying to repeat again what you would expect me to say again .
    The pattern of this recurrent failure of IT systems ( EMIS web in here ) is no longer just an alert to NHSE , NHSI etc . The government and these subordinates can have swathes of imagination that general practice , through PCNs , for instance , can deliver so much to solve the crisis in NHS . But I am sorry that if the fundamentals cannot be fixed( new resources with no extra strings attached) , this is not just a blip in the IT system This m is the government-NHSE-NHSI failing their duties to people of the country.

  • Hancock’s comments betray the truth behind networks

    Vinci Ho's comment 05 Feb 2020 12:30pm

    To be honest , I am ‘grateful’ that most of us have now woken up and can see the true reality and faces of those in the hierarchy.
    Of course , from day one , I was a PCN sceptic calling it a Trojan Horse but still ended up being the stupid f*** to take on a CD position (considering the big picture of my predecessor resigned for personal predicament with nobody in the PCN willing to step up )

  • Patient died by suicide after A&E referred him back to his GP

    Vinci Ho's comment 03 Feb 2020 10:31pm

    (1) The million dollar question of determining whether somebody expressing suicidal ideation would go on to complete the task of killing oneself , is perhaps beyond any scientific prediction. For those who have been long enough in the mental health business will probably understand the irony of, ‘ things are never what they seem ‘ for these lives being taken away prematurely and unnecessarily. The truth is , as human beings , we are , in fact, so fragile .
    (2) It would be so simplistic to play sensationalism by blaming those who made a decision to close the book at one particular stage in dealing with these vulnerable subjects . But equally, there is a question about whether the system has provided enough safety net to confer further protection of these patients , other than merely referring back to the gatekeepers of the system who are not really equipped enough to fulfil this duty of care these days . I do not know the subtle answer for this but that , does not necessarily mean there isn’t one existing somewhere, somehow .
    (3) That goes back to the authorities which are supposed to be humbled by these tragedies, seek and search a way by all costs to help the frontline professionals to establish this ‘subtle’ solution . Instead , so far , we have seen frontline colleagues took the fall for the ‘system’ when apology to the public was clearly inevitable. The parody lies where repeatedly ,regulatory bodies seemed to be more ready identifying the ‘scapegoats’ than diligently tracking down the truly malicious, malevolent offenders. Presumed guilty takes less effort than good detective work , I suppose ?
    All in all , it has led to this discouraging, demoralising and denigrating environment which frontline medical professionals have found themselves stuck into .

    Mr prime minister and health secretary, you can say whatever you want to say about keep the NHS afloat but without an introspective , insightful understanding of the values and virtues which had gone missing , you can only see more and more frontline colleagues walking away from their positions they were once proud of ........
    ‘’A minister of state is excusable for the harm he does when the helm of government has forced his hand in a storm; but in the calm he is guilty of all the good he does not do.’’
    Voltaire

  • NHS England pledges to change network proposals after 'significant' GP concerns

    Vinci Ho's comment 02 Feb 2020 12:58pm

    Well , interesting
    Jaimie , looks like you have to respond to this .
    The article was laid out on this platform in such a fashion that comments were allowed to be submitted. And there was no specific notification that comments would not be shown for readers .
    As this is a matter of trust and credibility(as well as freedom of expression), hope Pulse is not to be ‘dragged’ into it.
    Thanks , Jaimie .

  • NHS England pledges to change network proposals after 'significant' GP concerns

    Vinci Ho's comment 01 Feb 2020 10:04am

    I sent this above comment under her article ( it did not show for you to read somehow)

  • NHS England pledges to change network proposals after 'significant' GP concerns

    Vinci Ho's comment 01 Feb 2020 10:01am

    To be or not to be
    Dear Nicki
    You might not know who I am and indeed , as an ordinary grass-root GP, my opinion only stands as one of the thousands amongst my honourable colleagues up and down our country during this most extraordinary ‘feedback’ exercise .
    I am grateful for your sincerity to write this article on this platform at a crucial , critical moment of history of general practice in NHS .
    What is absolutely crystal clear , right in front of us(and the country ) , is a serious GP retention and recruitment crisis and the consequences of allowing this to deteriorate are irrevocable. Question is , whether it is also unforgivable if the current government and its subordinates continue to misunderstand and undermine the genuine reasons why we have reached this hitherto situation .
    The model of a tax-driven , publicly funded health service is understandably under scrutiny all the time . The argument of administrative costs to keep the system afloat could become an unnecessary burden as the level of bureaucracy becomes exorbitantly high . Perhaps , this is one of the reasons why the ideology of moving towards more privately-run models and service providers , is always alluring . I accept that the reality is so often somewhere between the two extremes of argument.
    Then we , human beings , continue to fail in learning from history . The track record of recent government(s) and NHS England in preventing this crisis of GP retention and recruitment is evidently poor . Some might easily jump to the conclusion that it was the government and its associated authorities which had created this crisis . All in all , the story so far has substantially dented the trust of GPs in the government and hence , NHS England . Confucius said , ‘an authority will not stand without the trust of people ‘(民無信不立) in the book of Analects .
    And , Publius Gornelius Tacitus (56-117 A.D.), a historian and a senator of the Roman Empire, said neither good nor bad policies would please the governed if the government is unwelcome, which was later called "Tacitus Trap" in political studies.
    Trust only comes after credibility which is , in turn ,derived from the track record of an authority .
    xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

    This brings back to the fundamental question ,’ What is the current level of trust between general practitioners in NHS and NHS England?’ And I would argue that it is politically naive to claim ‘good’ up to this point of time . We , GPs , are always on the receiving end and it is the obligation of NHS England to bridge the gap . The fashion this draft of PCN service specifications was released on 23/12/2019 and more essentially , its content have failed to slake this desperate quest to re-establish trust between us and NHS England .
    While your predecessors had failed to convince us that they were the benevolent leaders governed by their moral compass , I am cautiously optimistic that you can potentially be the ‘record-breaker’ and help the government to fulfil promises .
    Watching the unfolding of the story of this human crisis of Wuhan coronavirus right in China right now , I am further reinforced in my belief that 21st century politics can only survive with better transparency, honesty and humility.
    Vinci Ho
    A GP
    An ordinary PCN clinical director

  • To engage or not to engage…?

    Vinci Ho's comment 01 Feb 2020 9:50am

    NHSE official admits ‘we need to make changes’ to draft network specifications
    Vinci Ho's comment 15 Jan 2020 0:26am
    Spent four hours two days ago to read through the whole draft and condense it into a power point presentation for discussion with my fellow colleagues in my PCN yesterday. We also had lengthy discussions in our PCN alliance in Liverpool today .
    If we trace back this story from the beginning:
    There is fundamentally a social-norm-broken demeanour of NHS England in how this document was released shortly before Christmas with a deadline set at only two weeks into the new year . This is reminiscent of how our almighty prime minister was trying to block the parliament to debate Brexit through prorogation shortly before the general election last year . Whether this is a conscious effort or not , the impression of an imperious NHS England has undoubtedly generated an extraordinary, omnipresent swathe of negative responses from GPs , PCNs , LMCs etc . In the heat of the moment ,many colleagues are angry fraught with sentiments of betrayal and incredulity.
    Then it is about the substances in this document which in effect , created more questions than answers :
    Before long , every section requires a ‘clinical lead’
    (1) Structured Medicine Review and Medicine Optimisation:- It appeared to be quite logical to have these tasks to be implemented by pharmacists employed through the extended workforce deal in the PCN DES .However , the fact that practices have to pay 30% of their salaries ( in contrast to that in social prescribers) , could always pose additional financial risks on practices . 100% reimbursement , to me , is the only way out to ensure these SMR/MOs can potentially transform general practice in line of the vision of NHS England desired. Realistically, this category easily requires two clinical pharmacists for an average sized PCN with 30,000-50,000 in population.
    (2) Enhanced Health in Care Homes :- this part is widely considered as flagrant violation to how GPs believe that these patients in nursing homes can be looked after , given the current resources available. The evidence of improving quality of care is clearly yet to become credible and plausible for putting this minimum two-weekly ‘home round’ requirement into a black-and-white contract . In fact , one would argue that the ‘evidence’ used by NHSE is estranged from what clinicians would normally adopt and is merely a dogmatic imposition.
    Yes , there seemed to be a leeway of arranging community geriatricians to do these rounds alternatively but it begs the serious question of how realistic that would be .
    Nevertheless, there is also the part where PCNs would bear the obligation to train , educate and even vaccinate staff in these care homes . I would cynically challenge that the owners of the homes would be more than euphoric as they could make some investment savings?
    (3, 4)Anticipatory Care and Personalised Care :- Again , it seems sensible to target certain cohorts of the population and identify them into certain ‘dynamic lists’ . We are already using electronic calculator software in the system to record frailty index for all patients aged 64 and above , from which we identify and label moderate or severe frailty. Other cohorts like end of life , type 2 diabetes and MSK conditions are all mentioned and easily identified . The road has already been well paved .
    But the approach advocated in this document had heavily skewed towards writing up personalised care and support plans (PCSPs) and recording shared care decision conversations , number and quality of which are both measured metrically . Evidence of merit is yet to be established. The obsession of collecting so much health data not only creates enormous amount of administrative workload but also raises the question of the intent of NHS England .
    Furthermore , there is also a very steep and prescriptive timescale requiring so many patients to be referred to social prescribing services . The ultimate ambition was to refer 16-22:1000 weighted population cases to social prescribers . Hence , for a size of 30-50,000 PCN , there would be 480 to 1100 referrals . Patient Activation Measure (PAM: a 100-point, quantifiable scale determining patient engagement in healthcare. ) is another tool adopted to satisfy the gluttony of data collection centrally .
    Of course , last but not the least , we have to measure the number of the most contentious Personal Health Budgets annually .
    (5) Supporting early cancer diagnosis :- very much politically correct as we all have been working our socks off , referring more and more patients by two week wait rule everyday . Thanks to NICE significantly lowering the positive predictive value for cancer screening parameters .
    As I reiterated on this platform time to time , the bottom line issue is about improving cancer survival ( as compared to our OECD counterpart countries ) by shortening the referral to treatment time (RTT) . The recommended target of 62 days is currently well out of reach . The fact that we , GPs , are referring so many 2WR cases everyday , has already well consumed the capacity of imaging , endoscopists, surgeons and oncologists etc .The number of false positive cases to be excluded is burning the system out . Hence , the emphasis of NHSE to push GPs to refer more in order to ‘detect’ earlier is running under the caveat of the law of diminishing returns. No wonder the target of 62 days of RTT is becoming more distant reality. I can only hope the cancer academics and NHSE can come down from the top floor of the ivory tower to face the reality on the battlegrounds.
    xxxxxxxxxxxxxxxx
    Yes , extreme conditions demand extreme measures . It is most disappointing but also ignominious that NHSE is barking up the completely wrong tree as the extreme condition GP currently is namely, recruitment and retention crisis .
    The PCN service specification draft is simply killing the chicken before any more egg can be laid .

  • To engage or not to engage…?

    Vinci Ho's comment 01 Feb 2020 9:44am

    To be or not to be
    Dear Nicki
    You might not know who I am and indeed , as an ordinary grass-root GP, my opinion only stands as one of the thousands amongst my honourable colleagues up and down our country during this most extraordinary ‘feedback’ exercise .
    I am grateful for your sincerity to write this article on this platform at a crucial , critical moment of history of general practice in NHS .
    What is absolutely crystal clear , right in front of us(and the country ) , is a serious GP retention and recruitment crisis and the consequences of allowing this to deteriorate are irrevocable. Question is , whether it is also unforgivable if the current government and its subordinates continue to misunderstand and undermine the genuine reasons why we have reached this hitherto situation .
    The model of a tax-driven , publicly funded health service is understandably under scrutiny all the time . The argument of administrative costs to keep the system afloat could become an unnecessary burden as the level of bureaucracy becomes exorbitantly high . Perhaps , this is one of the reasons why the ideology of moving towards more privately-run models and service providers , is always alluring . I accept that the reality is so often somewhere between the two extremes of argument.
    Then we , human beings , continue to fail in learning from history . The track record of recent government(s) and NHS England in preventing this crisis of GP retention and recruitment is evidently poor . Some might easily jump to the conclusion that it was the government and its associated authorities which had created this crisis . All in all , the story so far has substantially dented the trust of GPs in the government and hence , NHS England . Confucius said , ‘an authority will not stand without the trust of people ‘(民無信不立) in the book of Analects .
    And , Publius Gornelius Tacitus (56-117 A.D.), a historian and a senator of the Roman Empire, said neither good nor bad policies would please the governed if the government is unwelcome, which was later called "Tacitus Trap" in political studies.
    Trust only comes after credibility which is , in turn ,derived from the track record of an authority .
    xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

    This brings back to the fundamental question ,’ What is the current level of trust between general practitioners in NHS and NHS England?’ And I would argue that it is politically naive to claim ‘good’ up to this point of time . We , GPs , are always on the receiving end and it is the obligation of NHS England to bridge the gap . The fashion this draft of PCN service specifications was released on 23/12/2019 and more essentially , its content have failed to slake this desperate quest to re-establish trust between us and NHS England .
    While your predecessors had failed to convince us that they were the benevolent leaders governed by their moral compass , I am cautiously optimistic that you can potentially be the ‘record-breaker’ and help the government to fulfil promises .
    I have re-published my comment (below this one)specifically for the service specifications and it was enclosed in my original personal feedback , in case you were too inundated by all the feedbacks .
    Watching the unfolding of the story of this human crisis of Wuhan coronavirus right in China right now , I am further reinforced in my belief that 21st century politics can only survive with better transparency, honesty and humility.
    Vinci Ho
    A GP
    An ordinary PCN clinical director

  • Jeremy Hunt appointed chair of the health and social care committee

    Vinci Ho's comment 30 Jan 2020 4:31pm

    One can ballot on this :
    End of the world , you are only allowed to choose between these two f***faces to be your company :
    Agent H or Roboco*k

    Which one will you choose ?🤣😝😈😂

  • Jeremy Hunt appointed chair of the health and social care committee

    Vinci Ho's comment 30 Jan 2020 4:02pm

    Ha ha ha
    You see
    I am too f**king busy following all the news(UK , HK and China) on this WN-CoV or 2019nCo-V before I would write a long comment.
    But this is just a ‘great’ news . You all know how much I love Agent Hunt anyway , 😂😈😄🤣

  • GPs having to refer urgent cases for hubs due to 'smart card' problems

    Vinci Ho's comment 29 Jan 2020 12:58pm

    I think we all know that the IT system(s) in general practice (as well as in hospitals ) is not really up to the standard required to deliver all these ambitious objectives by the government .
    Now we are clear that the capacity to run the normal activities ( including two-week wait cancer referrals , of course ) is lagging behind . How often do you come across ‘ a problem with the EMIS system ‘ every week ? Not to mention about the slowing down of speed so often .
    The need for new investment in the IT system(s) is imminent.
    And that is another reason why private providers like the Babylonians are the ‘favourites’ because they were willing to provide the technology upfront , first , so as to win the contracts .
    Once again , the government and its health secretary(and the Chancellor of Exchequer as well ) have a decision to make of what direction to invest these so called ‘new fundings’ in NHS and general practice. If the fundamentals cannot be sorted , there is no common sense to talk about any further ambitious initiatives.

  • Media reports of sepsis deaths 'make parents pressure GPs for antibiotics'

    Vinci Ho's comment 23 Jan 2020 7:59pm

    I blame academics and authority spokesmen creating the confusion when they were interviewed by various media . The reality at the frontline ,where GPs are faced with this dilemma , is never addressed when they open their mouth to these reporters.
    Clearly , one minute the headline is the judgement day dominated by some apocalyptic infections totally unresponsive to any antibiotics. Next minute we have sepsis is killing so many people every minute . The two headlines simply do not add up as far as understanding the difficulties frontline GPs are facing everyday is concerned .
    As a patient or parent , you can easily imagine that all he or she wants is to have ‘correct’ advice and/or treatment to get better (obviously, avoid death !). You just wish these so called authorities would put themselves in other people’s shoes before they open their gob next time !👿😈
    Again , stop interfering and undermining the role of grass-root GPs

  • GP clinical judgement leads to 20% fewer referrals than NEWS score, finds study

    Vinci Ho's comment 22 Jan 2020 2:49pm

    My apology and correction
    It appears the tool is specific but certainly not sensitive enough . That demonstrates precisely the situation when we wanted to call an ambulance to admit a patient but was rejected because the score was not high enough !

  • GP clinical judgement leads to 20% fewer referrals than NEWS score, finds study

    Vinci Ho's comment 22 Jan 2020 2:22pm

    This is the article from Royal College if Physician last year 2018 already explaining the complexity of the dilemma and controversy surrounding NEWS and NEWS2 .

    NEWS 2 – too little evidence to implement?
    Luke E Hodgson, respiratory and intensive care consultant, Jo Congleton, consultant respiratory physician, Royal Sussex County Hospital, [...], and Paul J Roderick, professor of public health
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334094/

    Obviously , this is purely on patients of exacerbation of COPD

  • GP clinical judgement leads to 20% fewer referrals than NEWS score, finds study

    Vinci Ho's comment 22 Jan 2020 2:04pm

    It appears that this screening tool is sensitive but certainly not specific enough