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GPs go forth

tom robinson

  • Trusts breaching GP urgent cancer referral targets every quarter

    tom robinson's comment 22 Jan 2019 12:28pm

    Always terribly difficult to clarify in one's mind what this all means.

    Explaining it to a patient is a daily chore,but made more difficult because I struggle to understand it myself.

    It is of course easy to explain the fear anxiety and indeed dread,a patient can be reasonably told the waiting time will destroy their summer,leaving them with little else on their mind.For a man of about 70 this represents approximately 10% of the remaining summers of his life.

    However,what does it actually mean in terms of life expectancy,more radical treatment,ongoing morbidity,further impairment.It appears to be very difficult to quantify this,and without concrete figures counselling patients becomes guesswork.

  • Reimagining the UK’s shortage of GPs

    tom robinson's comment 17 Jan 2019 10:57am

    Interesting,if not unique,in presenting an alternative narrative to that presented by the college,bma,lmc, deanery ,politicians etc.

    Unfortunately,thereafter it breaks down somewhat.

    It is not the number going into practice that is the concern,rather the number happily successfully and lucratively practising 10,20 years down the line.

    The claim that they are less likely to leave,why ?

    There needs to be some substantiation,have you no data,no measures, no supporting evidence.

    A British deanery most certainly would not have,they do not gather the data,they do not make any effort to find out,they do not consider the question,nobody has ever required them to do so.

    There has never been any evidence,ever to show they are achieving anything other than collecting their pay and gongs.

  • Eligible applicants turned away from GP training despite doctor shortage

    tom robinson's comment 16 Jan 2019 8:15pm

    Dr Bodey added: ‘The bottom line is that no one really knows what happens to the trainees that don’t get a place on their first choice scheme.

    No Dr Bodey,it is not

    What are those,trained at taxpayer expense,doing five years later ?

    How many are practising clinicians ?

    How many are struggling ?

    How many regret their career choice ?

    When the Welsh assembly government funds the deanery, to train hypothecated future clinical GP's, does it understand what it is purchasing, and does it understand what it actually gets, and does it have the the technical ability to recognise the difference ?

    Do the government and deanery agree as to the purpose pf GP training ?

    There are many questions,unlikely to be addressed, fundamentally because the non medical political purchasers do not understand the issues.

    The fate of those who never enter the process is of concern,on the grounds of compassion ,but certainly not fundamental.

    Focus on the needs of the service.

    Focus on your assessment of the technical competence of the deanery .

  • GP practices paid just £13 per month per patient

    tom robinson's comment 20 Dec 2018 1:23pm

    Misleading and disingenuous.Actually it sounds a reasonable figure,the public will assume GP's have thousands of patients and therefore are doing quite nicely thank you.

    Assuming an average GP with 1600 patients consulting 5 times a year each,doing 8000 consultations and earning 80 000 pounds each consultation earns 10 pounds.

    After pension deductions and tax 4.20 pounds per consultation.

    If they bring two problems 2.10 per consultation

    For doing a full history and examination considering the physical psychological social biological individual contextual etc.

    The problem is none of the representative agencies actually see any value higher than this,obsessed as they are with national political policy.

    New and indeed radical representation would be required,focused squarely upon adequate resourcing for our fundamental role

  • Charity requesting GP follow-ups following unapproved heart screening test

    tom robinson's comment 17 Dec 2018 8:32pm


    He does not need evidence

    He does not need research

    He does not need to be reasonable

    He does not need to consider reflect or any other of the things in the med school lectures

    There is no mechanism by which he can be stopped

    There is no-one looking at stopping him

    There is no body with the authority to stop him

    To negotiate a fee we would have to go to war with terrified mothers concerned about the lives of their children.Personally I would duck that one.

  • Charity requesting GP follow-ups following unapproved heart screening test

    tom robinson's comment 17 Dec 2018 2:50pm

    Here we go again;

    At first I thought this was going to be the Christmas BMJ paper.

    The issue here is, these patients attending on a busy Monday morning, stopping GP's seeing actual sick patients.

    Despite the billions of NHS pounds spent on what is called management;

    No professor

    No charity

    No pressure group, needs anybodys permission, before instigating any scheme, that prevents sick patients from obtaining access to emergency medical care.Patients seem oblivious to this and politicians utterly disinterested.

    Of course if one wished to be slightly cruel,one might postulate that terrifying large numbers of fit young people into seeking expert advice might be incredibly lucrative.Overworked GP's might consider referring to a specialist,especially if that is what the patient has been told to expect.After the usual long pointless GP consultation about waiting lists, the patient slowly comes to the conclusion that a private appointment is the only way forward.

    There might also be an increase in sales of Cardiology kit

    It would be interesting to see a list of the sponsors of this charity

  • Government overprescribing review aims for GPs to challenge hospital decisions

    tom robinson's comment 12 Dec 2018 6:00pm

    Just to be clear,pharmacists as highly trained responsible and indeed sane professionals would require to be paid

    Any suggestion of the GP being paid will result in the usual weeping wailing and gnashing of teeth by the insane fundamentalist brigade,as contravening the principle of limitless duty of care.

  • RCGP backs second EU referendum amid fears Brexit will 'damage' the NHS

    tom robinson's comment 26 Nov 2018 4:22pm

    Are we living through the Weimar Republic ?

    The fundamental building block the Fuhrer had to offer was a bizarre convoluted wacky notion of racial superiority,clearly unacceptable in todays PC climate.

    No ,today the pious pontificates at the college shy away from such vulgar, anachronistic ideas.

    Instead they are wedded to the concept of intellectual superiority.You passes the MCQ and CSA so now you are an expert on economics,politics, government etc.Those who have not achieved this are intellectuallt inferior, and unworthy of a vote.If we render their vote invalid ,what next ?

    The BBC resolutely ignores the most obvious political viewpoint.

    What of those ardent remainers who hold democracy more dear than remaining ?

    What if next time they deliver a stronger Brexit mandate ?

    What if a general election then requires them to vote for the most vitriolic right wing candidate simply to preserve democracy.

    The college is playing politics,they should have had the wisdom to remain silent

  • GPs 'should prescribe statins to younger patients' using 30-year risk score

    tom robinson's comment 20 Nov 2018 4:06pm

    It',s a calculation,it's not real,they didn't actually give patients statins for 30 years.

    This is more of a predictive meta analysis,like a medical complex financial product derivative,or as we say in general practice,fantasy.

    There is a vast meticulously researched anti statin literature,however I would suggest none has emphasised some of the key fallacies.

    When putting patients on statins particularly for 30 years the patient should be introduced to the importance of statin holidays.

    The key information,the NNT, is not on the data sheet

    There is a reason for that

  • NHS England launches 'major overhaul' of national cancer screening programmes

    tom robinson's comment 19 Nov 2018 2:21pm

    NHS England,not patients not patients associations,not their representatives,a medical trade body.

    The first question,ideally to the public is do you want this,bearing in mind you get nothing for free,the money has to come from somewhere,you will wait longer to see a doctor when you are ill.One of the tragedies of the NHS is that the public are not required to consider this.

    Screening is not medicine,it is plucking ordinary people off the street,going about their normal business and doing something for them,on the understanding they may benefit.It is not shared decision making,patient centred or individually tailored,it is the opposite of normal practice.

    The patient information leaflets need to be explicit as to how often the test does what it says on the tin.They need to avoid medical jargon and talk about how often the test is wrong,forget sensitivity and specificity etc.

    We are trying to stop people who are going to die of bowel cancer dying of bowel cancer

    If you have the test and you were going to die of bowel cancer there is an 84% chance you will still die of bowel cancer.

    How much frontline everyday clinical care are you prepared to give up for that ?

  • Health boards go into deficit to sustain directly-managed GP practices

    tom robinson's comment 23 Oct 2018 7:43pm

    The BMA is clear,the cheapest way to provide services,is GP's who are represented by the BMA.

    And they're proud of it !

    You would think they would hang their heads in shame,

    Who pays a subscription to ensure their fees are as low as possible

  • Revealed: the awareness campaigns that risk distorting clinical priorities

    tom robinson's comment 06 Oct 2018 7:12pm

    Absolutely first rate Elisabeth,like Smithy I would struggle to remember a better article;

    Entirely in line with the works of,Margaret Mcartney, Malcom Kendrick,Marcia Angel,Ben Goldacre,and the latest offering from the best of them all,James le Fanu.

    All have written brilliantly for the lay audience,but you immediately wonder how many of the lay public read their works.

    However many of these issues were taught in epidemiology lectures in 1978,we do not seem to be making progress.

    Why are GP's so disempowered and disenfranchised,why do our institutions perform so poorly,why were we unable to nail this issue generations ago.

    Is it a failure of education,that leads to an inability to exert economic and political pressure,or are we being controlled by anachronistic institutions.

    Something rotten is going on,and as a profession we need to nail it

  • GPs pursue legal challenge to lift ban on charging own patients for extra services

    tom robinson's comment 01 Oct 2018 6:20pm

    Good luck and good hunting,this is a battle for the future of practice between those who wish to deliver a reasonable service for a reasonable fee,and those who slavishly, mindlessly, adhere to a political doctrine, no matter the outcome.

    This will put practice on a level footing with hospital practice,address the recruitment crisis,improve standards and give patients access to a reasonable service,predictably Tower Hamlets oppose.

    The good book tells us "the labourer is worthy of his hire"presumably Tower Hamlets would take issue here also.

    Oppose this and you leave practice with nowhere to go but the privatisation of Babylon and the Hurley group,with armies of salaried doctors

  • The true privatisation of general practice

    tom robinson's comment 31 Aug 2018 9:31am

    Does anybody actually know what they do?

    85% managed over the phone,or internet!

    In an NHS drowning in academics,where regulators live under every stone,with endless meaningless publications,where is the book of babylonian clinical practice.

    Certainly all the current textbooks need rewriting,the exams restructuring and the hierarchy replacing.Actually that might be one positive out of this.

    If this guy is so powerful and influential could he please publish something,anything,guiding the rest off us as to how to manage a cough etc over the phone.

    Don't the GMC have some requirement to spread innovation to colleagues

  • Bawa-Garba: What happens next

    tom robinson's comment 16 Aug 2018 2:14pm

    I cannot possibly imagine that this matter has come to a close.

    We are talking about arrest incarceration,trial and conviction,as you sit in a cell with Mike the mad axe murderer the intentions of the GMC would certainly not be on my mind,

    The critical error according to the clinical supervisor was to not transfer on receiving the lactate result.

    We have taught for generations that you treat the patient not the result,it appears the judge has reversed that.From a GP point of view this impacts particularly on the high potassium phoned through at 5.30 on a Friday night,which I think now must mean automatic admission.

    The defence offered the workload as a mitigating factor,it appears the judge dismissed this,therefore it does not matter if she had to see 50 or 500 patients or whether the IT system had crashed the clinical doctor carries the full responsibility.The BMA whose behaviour defies description,are in full agreement.Those who subscribe should hang their heads in shame.

    The judge tried convicted and sentenced her in a British court,the problem is the entire medical profession disagrees with him.Unfortunately for us he is a judge and therefore one assumes he may have some understanding of the law.

    Surely our clinical practice will change in light of this,and only time will tell if the treasury can afford the consequences

  • Medical students at Oxford University still deterred from GP career, finds study

    tom robinson's comment 12 Jul 2018 7:17pm

    Agree with utter fool,why the interest in Oxford?

    The issue is the ability to see patients in clinical practice,large numbers of patients,very very large numbers.

    I suspect if you picked any area of medicine e.g. surgery or diabetes these graduates would be in the labs and the libraries not the wards and the theatres.

    No-one ask how many living rooms the winner of the Turner prize has decorated.

    When was the last time you bought a CD by the local professor of music.

    In almost all walks of life the difference between academia and practice is acknowledged.

    However,British GP training has never been able to get it's head around this,hence the relentless destruction of GP.

  • Pharmacist management of hypertension could cut GP workload, study suggests

    tom robinson's comment 12 Jul 2018 8:21am

    How do babylon do it ?

    How does the Minister get his blood pressure checked ?

    If they do everything online, are the patients checking their own bp or is the pharmacist doing it ?

  • Babylon claims its in-app clinical advice is ‘on par’ with GPs

    tom robinson's comment 28 Jun 2018 9:04am

    The exam is set by a committee based upon their knowledge of recognised patterns.It is verbal choreography.To pass you simply follow the recognised steps, and change direction, when the key words or phrases appear.Trainers have taught this for years without the benefit of computers.
    There was surely never any question that a computer would be able to recognise these patterns.
    Remember we are talking about a constructed exam using actors, not real life.
    It of course follows, that if you reverse the program, it could set the exam, and conduct it, thus dispensing with the variability of actors,
    and markers.Nobody is going to accuse a computer of racism.
    The computer could give each candidate an analysis of his performance,where he asked the wrong question, what the right question was,how many marks he lost,what he would have to do to pass.
    Candidates could sit formative practice exams as many times as they wished before the summative one.
    Of course there is more to real practice,but there is not not more to the exam.

  • UK doctor leaders back calls for workload cap 'to protect sanity of GPs'

    tom robinson's comment 26 Jun 2018 3:35pm

    I remember years ago great eminent physicians explaining that we were immune to the effects of fatigue.
    This is a simple technical question,does excess workload impair performance? It does not matter what anyone thinks,least of all Tower hamlets.There will be a simple technically correct answer.
    There must be thousands of experts in this field,though none addressing conference.
    Simply hire one put him on the GPC,and tell him to get on with it.A PR man,ex advertising executive or journalist would also be useful to get the message across.It is always a good idea to throw in a lawyer just for good measure.Is it too much to ask that the profession show a little professionalism ?
    Then get rid of all the amateur deadwood on the GPC.
    You could of course ask the GMC whether they have ever heard of excess workload leading to a medical error.

  • The Friday afternoon dump

    tom robinson's comment 25 Jun 2018 5:44am

    Shaba noted,

    You are surely not claiming that the GPC is anything less than 100% behind the college ! please give us some references, as to the challenges it has made.