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Gold, incentives and meh

Vinci Ho

  • Outgoing RCGP chair to head new social prescribing academy

    Vinci Ho's comment 23 Oct 2019 2:30pm

    I have nothing against social prescribing. But it is always about knowing honestly what you are talking about when you talk about ‘something’ . Like PCN ideology , social prescribing has been deemed as the new magic potion to solve all these problems and inequalities currently existing in NHS . As a clinical director of a PCN , I am still yet to know exactly what and how the social prescriber we suppose to employ in PCN , is going to deliver . The generic job description is more rhetorical and ideological than being tangible and practical.
    Perhaps, social prescribing in its ‘true’ nature is going to be therapeutic for some patients with certain medical problems. The common sense tells you that it is not universally life-changing (not even to mention life-saving yet) . I believe the evidences in literature are rather debatable and inconsistent. I would like to know the details of what type of social prescribing helps which type of medical problem definitively.
    The caveat is that we ultimately had ‘helped’ politicians like Mr Hancock to shift attention away from the real problems in NHS which actually require more hard core solutions.

  • Meet Margaret, the world's first robot GP receptionist!

    Vinci Ho's comment 23 Oct 2019 8:10am

    This is not Margret.
    Should be called ‘ Arnie’ instead .
    Do not miss the forthcoming Terminator: Dark Fate , if you are a fan

  • CCG mergers ‘reduce the voice’ of practices, warns LMC

    Vinci Ho's comment 23 Oct 2019 7:08am

    (1) Once again , there is always a risk of an ‘one size fits all’ argument as far as merging-protagonists and antagonists are concerned. Yes, ‘more opportunities to share resources and expertise’ is sound , enticing and worth pondering.
    Question is , have you really got so much ‘surplus’ to be shared from the outset , putting these individual CCGs together under one roof in each case ? If only nine lids are currently available to cover ten teacups( hence , one short) , it does not make sense to gather eighteenths lids together to cover twenty teacups because it will become two short instead .
    (2)The geographical spread in every region of concern(with how many CCGs within) is a valid point for debates . Clearly , too many practices away from the ‘centre’ means less practical representation. CCGs with rural practices are likely to be disadvantaged if the boundary of the CCG is being pushed further outwards . Nevertheless, we all know the demographic (and hence, epidemiological)variation in health inequalities and diseases will accentuate as the ‘region’ is getting bigger and bigger . Financially, it may be more convenient for NHS England to fund by writing ‘one single cheque instead of many’ . The truth is , we all know that this always offers NHSE advantages to impose more draconian measures effectively and efficiently.
    (3)The relationship between CCGs and PCNs is already rather extraordinary. CCGs are constantly under the cloud of NHS England to save so many millions of pound every year while the new kid on the block , aka PCNs are supposed to be fed directly by NHSE( whether the feeding ‘enough’ is another matter ) . As I wrote before , CCGs and PCNs had virtually become a caricature to each other as they are both formed by GP membership fundamentally. Will today’s PCNs become tomorrow’s CCGs ? History will be the judge .
    (4)My gut feeling is that the voices of GPs within currently existing CCGs have already been diluted by layers of top-down bureaucracy laid down by the hierarchy in the system . When you merge more CCGs together , the caveat of further dilution is only logically apparent. And it is quite right to say the bigger providers , hence , players , are the acute trusts in an integrated care system (ICS) . Everybody (every provider) has its own needs . It is always about individual interests superseding ‘common interests’ .If one ICS means one CCG , the acute trusts clearly want to be on front foot to run the show . As a ‘reluctant’ clinical director of a small PCN , I can already smell dissatisfaction of some providers against ‘dominant’ providers within the same system . The bigger the system goes , the more friction can potentially arrive .
    (5) The bigger the better , I will always express my scepticism (rather than detesting immediately) as much as like remaining as a PCN-sceptic . I always believe in Trilemma Theory : Integration , sovereignty and democracy, you can only have two out of three but never three together at the same time .
    Brexit , Catalonia , Hong Kong , Kashmir etc . What a wonderful world 🤓😈

  • Teenager dies after GP mental health referral is rejected

    Vinci Ho's comment 22 Oct 2019 5:51pm

    This is now becoming a ‘pattern’ , no matter what . My worry is people will try to use the new kid on the block namely , GP networks, PCNs , to get them out of jail . Rejection of GP referrals is also a social norm in NHS sleepwalking into more medical disasters at all levels . And I cannot see how Department of Health and Social Care can spin by saying how much money they had ‘invested’ mental health services to have an impact .
    Mr Hancock , I suppose you wanted to consult all your tech-advisors and AI fanatics to help you out on this one??

  • ​GMC referrals to medical tribunal service up by 40%

    Vinci Ho's comment 20 Oct 2019 11:12am

    I would choose not be distracted by our hitherto sentiments towards GMC(CQC , NICE as well ) :
    (1) Given GMC some benefits of doubt , the phenomenon observed could be subjected to ‘normal fluctuation in cases’ . On the balance , I had a bit more confidence to MPTS than GMC actual . This is obviously derived from the story of Dr BG . Hence , more referrals to MPTS , at least , is better than more draconian investigations by GMC .
    (2) Problem is trust ; trust comes from track record before credibility can be established. The credibility and reputation of GMC , at least in the eyes of our medical colleagues, was seriously impaired and compromised. How is it to repair this big gap between itself and us is a task not to be underestimated any more . If GMC remains incredulous and intransigent as far as this is concerned, it will put our medical profession and hence , the whole health service in harm’s way . The superhero complex of GMC to protect the public as their first duty needs a lot of introspection and soul-searching .
    (3) As I was taught by the readings in Analects:
    The hierarchy or establishment would not stand if people’s trust in it no longer exists , no matter how ‘noble’ it tries to be . (民無信不立)

  • BMA culture 'treats women as of less importance' finds sexism report

    Vinci Ho's comment 17 Oct 2019 11:28am

    Chaand , only hope you do not fall into the same abyss as Corbyn facing anti-semitism in his party .

  • NICE revises antidepressant guidance to warn of 'severe' withdrawal symptoms

    Vinci Ho's comment 17 Oct 2019 10:25am

    It is amazing how long it takes for NICE to come out with an updated and amended version of this guidance since these controversies arose last year( and still yet to publish this long overdue guidance ).
    It is kind of alluding that it was caught off guard completely in the first place and did not foresee and expect such a level of backlash from colleagues. Once again , another example in a professional establishment of having a blind spot keeping it out of touch with our frontline colleagues.
    One wonder how many more lessons NICE has to learn before it is introspective enough to change its ‘culture’ and mechanism of arriving at any new guidance?

  • The CQC must turn words into action

    Vinci Ho's comment 16 Oct 2019 7:34pm

    (1) The sentiment of this CQC report could not stop people from relating to a drop( only a drop) of crocodile tears . Every matter has its origin and tail . Every incident has its beginning and ending . Only knowing what is the order and sequence of events , one can learn the ‘true way ‘ .
    Remember what CQC previous chief once said three year ago ?,
    ‘’Professor Steve Field told the Daily Mail that general practice has ‘failed as a profession’ and he was ‘ashamed’ to be a GP because of the poor care he saw in certain practice.’’
    Fast forward the clock to today , how do you feel , Professor? Should somebody be more ashamed of himself instead ?
    In politics , all you need is a bit of insouciance from the ‘key’ leader and disasters will follow . We have seen this too many times .
    (2) CQC was falling into the same slippery slope fallacy and mentality as GMC , that the stronger the regulation and oversight are in place , the health services , especially general practice, will be better . Yes , this is politically correct only when the ‘system’ is fundamentally sound and healthy . Austerity, Health and Social Care Bill , hapless/hopeless government(s) crippled by Brexit fiasco etc , are all background factors contributing to this ‘state’ of GP .
    The presumption that ‘the bigger the provider is , the better ; the cheaper , the better ‘ was never an healthy one but only overcompensating a system completely dried out of resources (money , manpower, expertise and time) .
    Together with the slippery slope fallacy mentioned above , we have a perfect storm.
    (3) Both CQC and GMC are fraught with a superhero complex that their first duty was to protect the public without realising their blind spots of actually killing the chickens before any egg could be laid . As a regulatory body , they have both duties of ensuring the care providers can potentially improve but more importantly, the government is doing all to ensure that these improvements can materialise . This is even more paramount simply because the providers are funded by government in a system called NHS . Blindly protecting the clause ‘ tax-payer money must be used properly’ had , so far , shifted regulator like CQC towards an unconscious (some may argue was conscious) bias . We saw this evidently in their attitude towards general practitioners in NHS , up to now .

    We are where we are in this reality ,l.CQC has a decision to make where it should position itself ,against a backdrop of a dysfunctional government? If its primary duty is still to ‘protect’ the public , their ‘regulation’ must start from the ‘top’ NOT from the bottom........

  • NHS England approves merger of four CCGs in Cheshire

    Vinci Ho's comment 16 Oct 2019 4:50pm

    While I respect the democratic decision , I have a simple arithmetic question:
    Nine lids to cover ten teacups. Minus one .
    Eighteen lids can only cover twenty teacups . Minus two .
    Twenty-seven lids to cover thirty teacups. Minus three .
    And so it goes on .😄😈😂🤨🤔🥴

  • GPs may have to assess mental health and mental capacity free of charge

    Vinci Ho's comment 16 Oct 2019 2:38pm

    So , if we don’t do it , we all break the law ?
    So what , our prime minister loves to break the law , anyway .
    My two fingers are up 👿😈

  • NHS review calls for GP financial incentives to boost screening uptake

    Vinci Ho's comment 16 Oct 2019 1:37pm

    This is not any rocket science . This government and its recent predecessors have simply got what it deserves .
    Desperate measures at desperate times . There must be a ‘decision’ on Capita , first of all .
    PCNs and GPs are not prepared to be the ‘martyrs’ and quick-fix solution for politicians to extract political brownie points in front of the public . The ‘new’ resources given to PCNs are not even enough for bare survival . Anything more the government asking GPs to do need substantially new investments with minimal strings attached.
    Treat us like crap , you get nothing , Boris

  • Lower GP practice ratings due to workforce and demand issues, says CQC

    Vinci Ho's comment 16 Oct 2019 8:25am

    Deliberately waited until you guys had expressed your valuable and honest opinions :
    (1) The sentiment of this CQC report could not stop people from relating to a drop( only a drop) of crocodile tears . Every matter has its origin and tail . Every incident has its beginning and ending . Only knowing what is the order and sequence of events , one can learn the ‘true way ‘ .
    Remember what CQC previous chief once said three year ago ?,
    ‘’Professor Steve Field told the Daily Mail that general practice has ‘failed as a profession’ and he was ‘ashamed’ to be a GP because of the poor care he saw in certain practice.’’
    Fast forward the clock to today , how do you feel , Professor? Should somebody be more ashamed of himself instead ?
    In politics , all you need is a bit of insouciance from the ‘key’ leader and disasters will follow . We have seen this too many times .
    (2) CQC was falling into the same slippery slope fallacy and mentality as GMC , that the stronger the regulation and oversight are in place , the health services , especially general practice, will be better . Yes , this is politically correct only when the ‘system’ is fundamentally sound and healthy . Austerity, Health and Social Care Bill , hapless/hopeless government(s) crippled by Brexit fiasco etc , are all background factors contributing to this ‘state’ of GP .
    The presumption that ‘the bigger the provider is , the better ; the cheaper , the better ‘ was never an healthy one but only overcompensating a system completely dried out of resources (money , manpower, expertise and time) .
    Together with the slippery slope fallacy mentioned above , we have a perfect storm.
    (3) Both CQC and GMC are fraught with a superhero complex that their first duty was to protect the public without realising their blind spots of actually killing the chickens before any egg could be laid . As a regulatory body , they have both duties of ensuring the care providers can potentially improve but more importantly, the government is doing all to ensure that these improvements can materialise . This is even more paramount simply because the providers are funded by government in a system called NHS . Blindly protecting the clause ‘ tax-payer money must be used properly’ had , so far , shifted regulator like CQC towards an unconscious (some may argue was conscious) bias . We saw this evidently in their attitude towards general practitioners in NHS , up to now .

    We are where we are in this reality ,l.CQC has a decision to make where it should position itself ,against a backdrop of a dysfunctional government? If its primary duty is still to ‘protect’ the public , their ‘regulation’ must start from the ‘top’ NOT from the bottom........

  • GP died by suicide after fears over sharing his mental health diagnosis, inquest hears

    Vinci Ho's comment 14 Oct 2019 10:37pm

    .......Now I understand
    What you tried to say to me
    And how you suffered for your sanity
    And how you tried to set them free
    They would not listen, they did not know how
    Perhaps they'll listen now.
    (They would not listen, they're not listening still
    Perhaps they never will)...........

    Don McClean

  • PM aide's advisory role with Babylon 'raises conflict of interest questions'

    Vinci Ho's comment 12 Oct 2019 8:23am

    Cummings is a British version of Steve Bannon ( hence , his infamous motto for Breitbart: “Honey badger don't give a shit.”.) if you have been following the story of Trump , and now Johnson , closely enough .
    Whether you support Brexit or not is really not an issue here , it is about broken code of conduct , malevolence, duplicity and most importantly, lack of integrity.

  • Government stockpiles 400,000 adult flu vaccinations in case of no-deal Brexit

    Vinci Ho's comment 11 Oct 2019 6:14am

    Same here

  • Paramedics may rotate between networks and ambulances under HEE plans

    Vinci Ho's comment 09 Oct 2019 12:06pm

    Let’s keep an open mind . Cannot be too judgmental at this stage 😄

  • Revealed: Why you are earning less than your neighbouring GP practice

    Vinci Ho's comment 05 Oct 2019 9:02pm


    (1) Perhaps , the Carr-Hill formula was not that ‘wrong’ as far as ethos and telos are concerned . At least the small practices were funded more numerically . Problem is that shortage of resources carries a different meaning . In fact , it goes with my philosophy of time , manpower , expertise and then money being one for all , all for one . The smaller practices in more deprived areas as well as rural practices suffer seriously from recruitment crisis , whether the money is there or not . Without the expertise of senior partners (many took early exit) and actual manpower , the task to meet ever increasing demands from all directions for those surviving staff in a practice, would be even more onerous morale-defeating .
    (2) APMS practices , not surprisingly, were funded more . But then , it begs the question for NHS England of why did these practices frequently end up in closing down their businesses? I think that was the same old nightmare stories of Carillion and Capita once again .The desperation of winning contracts at all levels by these private companies precluded honest and astute recognition of what they were really up against in primary care . They would just say yes to all questions laid upon on them in their procurement process . ‘Cheaper the better ‘ was undoubtedly the biggest temptation for the commissioners during the austerity period seen in the last decade . Thanks to the Health and Social Care Bill bestowed by the coalition government. The rest is history .
    (3) The truth is even though we now have a government , led by the most egregious prime minister in history ( my opinion ) which is willing to ‘lavish’ voters with money spent in public sectors including NHS , the crisis in general practice continues to escalate. Whether you genuinely believe that austerity is really over , it only serves as a good subject for cathartic experience in a coffee morning debate . The reality is NHS England is exerting its autocracy on CCGs in making more savings , as we read news in various parts of the country . More CCGs are to be merged into bigger ones as the swinging blades from NHSE are over their heads . My suspicion of NHSE’s draconian ploy to end direct and individual practice funding has never been more acute .
    (4) Then you have PCNs which are the ‘new kid on the block’ and supposed to become the portal for direct future investment in primary care from NHS England . Notwithstanding that CCG is , by default , an organisation of GP membership , the parody is PCNs(also made of GP practices ) became an inevitable caricature of CCGs. GPs are forced away to attend various meetings engaging CCGs . Clinical directors are inundated with all sorts of stipulations and politically correct tasks (while many still have clinical commitments in own practices). Integrated Care Team in the system requires a GP lead from each PCN . OoThere is no clear indication where is the funding for these ‘additional’ engagements with various big providers in STPs . Everybody seems to have ‘high hope’ for this new kid on the block to be the next crusade to get us out of this mess .
    (5) Then we have a health secretary who is so upfront about technology and smartphone apps to deliver general practice that he virtually gave free passes to these private companies cherrypicking relatively younger , healthier ,mobile and obviously internet bound patients from swathes of the country, even though they live miles away or in a different city. The inequality created by this two tier system further complicates the big picture . It has now become apparent that these companies were ‘awarded’ simply because they provide the government free technologies to satisfy this obsession of a 21st century digital general practice underpinned by apps , algorithms , video consultations and eventually AI . I smell the word cronyism.
    xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
    After all , no matter which figures , high or low , one would like to pick from this study kindly conducted by Pulse ( my full gratitude to the editor and his hard working team), the funding rate per patient was still way below what was necessary to cope with this current level of demands in general practice. Pulse used to compare this rate with the annual subscription of Sky TV (especially if you are a football fan) . I suppose these days one can argue Netflix is offering a cheaper , better deal for entertainment. But seriously , are we , general practitioners on NHS , only merely something there to provide ‘entertainments’ for patients ??
    One of my all time favourite songs is ‘Sometimes love just ain’t enough ‘. Read the lyrics if you think many of your patients ‘love’ you (and you still love general practice) .
    But I must draw a conclusion using this song title for this funding data study :
    Sometimes money just ain’t enough .........

  • Pulse Intelligence: shining a light on your practice funding

    Vinci Ho's comment 05 Oct 2019 8:53pm

    (1) Perhaps , the Carr-Hill formula was not that ‘wrong’ as far as ethos and telos are concerned . At least the small practices were funded more numerically . Problem is that shortage of resources carries a different meaning . In fact , it goes with my philosophy of time , manpower , expertise and then money being one for all , all for one . The smaller practices in more deprived areas as well as rural practices suffer seriously from recruitment crisis , whether the money is there or not . Without the expertise of senior partners (many took early exit) and actual manpower , the task to meet ever increasing demands from all directions for those surviving staff in a practice, would be even more onerous morale-defeating .
    (2) APMS practices , not surprisingly, were funded more . But then , it begs the question for NHS England of why did these practices frequently end up in closing down their businesses? I think that was the same old nightmare stories of Carillion and Capita once again .The desperation of winning contracts at all levels by these private companies precluded honest and astute recognition of what they were really up against in primary care . They would just say yes to all questions laid upon on them in their procurement process . ‘Cheaper the better ‘ was undoubtedly the biggest temptation for the commissioners during the austerity period seen in the last decade . Thanks to the Health and Social Care Bill bestowed by the coalition government. The rest is history .
    (3) The truth is even though we now have a government , led by the most egregious prime minister in history ( my opinion ) which is willing to ‘lavish’ voters with money spent in public sectors including NHS , the crisis in general practice continues to escalate. Whether you genuinely believe that austerity is really over , it only serves as a good subject for cathartic experience in a coffee morning debate . The reality is NHS England is exerting its autocracy on CCGs in making more savings , as we read news in various parts of the country . More CCGs are to be merged into bigger ones as the swinging blades from NHSE are over their heads . My suspicion of NHSE’s draconian ploy to end direct and individual practice funding has never been more acute .
    (4) Then you have PCNs which are the ‘new kid on the block’ and supposed to become the portal for direct future investment in primary care from NHS England . Notwithstanding that CCG is , by default , an organisation of GP membership , the parody is PCNs(also made of GP practices ) became an inevitable caricature of CCGs. GPs are forced away to attend various meetings engaging CCGs . Clinical directors are inundated with all sorts of stipulations and politically correct tasks (while many still have clinical commitments in own practices). Integrated Care Team in the system requires a GP lead from each PCN . OoThere is no clear indication where is the funding for these ‘additional’ engagements with various big providers in STPs . Everybody seems to have ‘high hope’ for this new kid on the block to be the next crusade to get us out of this mess .
    (5) Then we have a health secretary who is so upfront about technology and smartphone apps to deliver general practice that he virtually gave free passes to these private companies cherrypicking relatively younger , healthier ,mobile and obviously internet bound patients from swathes of the country, even though they live miles away or in a different city. The inequality created by this two tier system further complicates the big picture . It has now become apparent that these companies were ‘awarded’ simply because they provide the government free technologies to satisfy this obsession of a 21st century digital general practice underpinned by apps , algorithms , video consultations and eventually AI . I smell the word cronyism.
    xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
    After all , no matter which figures , high or low , one would like to pick from this study kindly conducted by Pulse ( my full gratitude to the editor and his hard working team), the funding rate per patient was still way below what was necessary to cope with this current level of demands in general practice. Pulse used to compare this rate with the annual subscription of Sky TV (especially if you are a football fan) . I suppose these days one can argue Netflix is offering a cheaper , better deal for entertainment. But seriously , are we , general practitioners on NHS , only merely something there to provide ‘entertainments’ for patients ??
    One of my all time favourite songs is ‘Sometimes love just ain’t enough ‘. Read the lyrics if you think many of your patients ‘love’ you (and you still love general practice) .
    But I must draw a conclusion using this song title for this funding data study :
    Sometimes money just ain’t enough .........

  • Babylon to expand to Manchester with new GP at Hand clinic

    Vinci Ho's comment 04 Oct 2019 11:12am

    The Eagle Has Landed .
    The catch is clearly if a private company is to provide the costs and expenses for latest technology, why does the government want to bother ?
    Robocock is more than happy to let the Babylonians ‘populate’ throughout the country .

  • A dyslexic GP's problems with the CSA

    Vinci Ho's comment 01 Oct 2019 6:30am

    Brilliant reflection, many thanks Sudeshna
    I stick to my comment under the original article about RCGP on this matter .
    If by any chance it was ‘politically dyslexic’ and failed to interpret what was ‘written on the wall’ , it is about humility , transparency and honesty to make this examination fairer to all candidates from all backgrounds. My opinion .
    The lesson from its pyrrhic victory in the ‘Battle of Unconscious Bias’ must be learnt , after all .