This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

Gold, incentives and meh

David Coleman

  • Matt Hancock: 'We are overhauling GP IT systems'

    David Coleman's comment 02 Jan 2019 4:04pm

    There are whole days when I can’t access the Internet on my work PC; when it does work, it is slower than dial-up Internet. We have to pay for our own WiFi network on the side to have any reliability.

    Additionally I lose between 15-60 mins per day due to EMIS crashes and I can’t access any clinical letters from a 4-5 year period because Docman has stopped functioning since an update. We have been waiting for IT to fix these issues for a couple of months but it hasn’t happened yet.

    I don’t want AI, video consultations, etc. I just want to be able to read and write notes, access letters/results, and use the Internet without the system crashing.

  • Don’t discount non-GP partners – ours saved the practice

    David Coleman's comment 20 Mar 2018 2:08pm

    Interesting article. I don’t think it’s the only answer, but it may be an answer for some practices. Certainly there is a tendency for us to conclude we are the best people to do every job going. I enjoy the business aspects of the job too - but we can only do so much.

    I think this article is essentially praising the value of having a very strong, committed and adaptable practice manager. In your case I sense the partnership was probably just the carrot to recruit someone with top skills to the job. Linking pay to practice performance has pros but also cons - I imagine it’s critical to ensure everyone on board has a similar ethos. I know our goal isn’t profit above everything - it’s a balance of retaining reasonable drawings while offering good service.

  • Dilemma: Tackling a colleague’s racist remark

    David Coleman's comment 29 Nov 2017 11:31pm

    BAP - the scenario is ‘you overhear a partner making a racist comment’. I explored the scenario. Like Matt, I would call it out. I think all partners have a right to know.

    I suggested formal disciplinary action may be the way to proceed if the partner’s racist comment was directed at an employee. I don’t see how that is particularly controversial!

  • What should Pulse do about anonymous comments?

    David Coleman's comment 21 Jun 2016 4:42pm

    Another vote for a username system. Personally I wouldn't make a comment that I wasn't prepared to put my name behind, but can understand why others may prefer not to use their real name.

    The prevalence of anonymous comments makes it difficult to follow some threads and sometimes raises suspicion that one of two parties are posting negative responses en masse.

    If you can use a nickname or alias, I don't see a need for anonymous comments at all.

    Also agree that formatting the comments to allow replies to specific comments would be beneficial.

  • ​Let us know what you think of our new-look site

    David Coleman's comment 24 Sep 2015 4:33pm

    On the whole a nice update - good to see a fully responsive site that works well on numerous devices. This is very readable on tablet or smartphone, although I'd prefer if the adverts didn't break up the content of the articles themselves. If it looks too big on your desktop you can always zoom out a little. Hot topics section is a good idea.

    As previous comment noted, the comments section seems a bit trickier to follow. I would have liked threaded comments, which would be particularly useful due to volume of anonymous posts - threads make it more clear which messages people are replying to.

    Generally though give it a few weeks and we'll all have forgotten what the old site looked like.

  • How our email triage system has saved 35 appointments a week

    David Coleman's comment 18 Sep 2015 11:03am

    9.16am - "As soon as you open up to email, you risk having no control over demand at all."

    E-mail or not, I don't think GPs have a great deal of control over demand anyway!

  • How our email triage system has saved 35 appointments a week

    David Coleman's comment 17 Sep 2015 3:03pm

    10:50 -- Why is this unsafe practice? Because of the mode of taking requests (e-mail) or the fact that the clinician is managing those requests over telephone?

    If the former, surely a responsive system like this is going to identify high risk requests more rapidly than an engaged telephone line or a receptionist booking into a rigid appointment system? There would have to be a contingency plan/safety net in place in the event of a power cut/loss of Internet connectivity. I would suggest an auto-reply message to the e-mail to confirm receipt and suggest the patient contact the surgery by a certain time if they have not received a call regarding their urgent query.

    If the latter, I disagree - telephone consultations are not appropriate in all situations, but a skilled clinician with adequate resources to see patients face-to-face if clinically indicated or strongly desired by the patient should be able to manage the associated risks. At the very least, they are better placed to manage these risks than a non-clinical staff member booking patients into a rigid appointment system with, say, a 2-3 waiting time.

    The teething problems aside, it sounds like this has been reasonably well thought out to me.

    12:34 -- I don't share that experience of a doctor-first system. Our demand has stabilised, A&E/OOH attendances have dropped, and continuity/satisfaction has improved since we've been using our own variant of this model. And it's an established system -- we've been using doctor-led triage for nearly five years. Each to their own, but it works well for plenty of surgeries.

  • Advertisement for 'unqualified GP' post temporarily removed after outcry

    David Coleman's comment 13 Jul 2015 6:04pm

    There are already numerous FY2 posts in general practice. These (should) involve significant supervision. This advert is pitched at doctors who have completed at least FY2, but there is no guarantee they will have any general practice experience. It also hints at a greater level of responsibility. I did my first FY2 in GP and I did not consider myself at all a "senior member" of the practice team at all. The thought of junior doctors with little to no experience being considered such and left to get on with the job is disturbing. Good to see RCGP seeking clarification - will await this with interest.

  • ‘The whole exercise cost us £430,000’

    David Coleman's comment 30 Jun 2015 1:22pm

    I would have spat my coffee out in shock at a figure of £43,000 but this is really surprising. Not wishing to be disrespectful at all, but does this figure include a significant building project other than the decorating costs? I'm struggling to grasp how the spend could hit those heights otherwise.

  • That poster? Ah. Yes. Sorry about that

    David Coleman's comment 03 Jun 2015 2:09pm

    Brilliant.

    Caused a moment of anxiety as I used an image matching that description in our last practice newsletter. Thankfully it was the original, which has something relatively mundane in place of the time wasting line.

  • GP group releases 200 accounts of patients using general practice 'inappropriately'

    David Coleman's comment 24 Mar 2015 8:06pm

    >> GPs report that while such requests are not new, they now occur far more frequently.

    What's the evidence for this? I'm familiar with the admin requests, but I say know if it's beyond contract. Doesn't take a great deal of time.

    The clinical queries in the list are fairly extreme - I can't recall anything in last 3 months of this ilk. Maybe 1-2 cases per year. And I'm full time, dealing with anything from 40-100 contacts per day.

    I have plenty of frustrations with workload (mostly related to political issues) but I don't see this as is our greatest problem.

    Also conscious of numerous patients apologising for wasting my time when they patently are not. Far more worried this debate could push some of the needy and frightened away than I am about a minuscule fraction of my workload.

  • Inappropriate GP dementia referrals double since introduction of case-finding DES

    David Coleman's comment 23 Feb 2015 6:21pm

    I think this is a consequence of the "screening" DES rather than the "cash for diagnosis" DES. Both are ill-conceived, the latter is too recent to have had such a significant impact on the data.

    With the earlier DES there was no financial incentive for referring or diagnosing - I think this just reflects more 6CITs being done, more coming back raised, and more patients being referred. It's just a screening tool and if patients have low mood or a reversible causes we don't have to refer.

    It's a six month wait for a neurology outpatient appointment in our area, which is covered by Sheffield. I'd like to see capacity increased there but it seems like suspected epilepsy, MS, cluster headaches etc. aren't a political priority.

  • Submit your questions for RCGP chair Dr Maureen Baker

    David Coleman's comment 02 Feb 2015 10:30am

    Zishan Syed 9.12pm makes an excellent point.

    On that note, given we have a recruitment crisis, why is there not an option for unsuccessful trainees to continue working in GP, perhaps with a degree of support/supervision from a mentor or training practice, with an option to re-attempt exams in the future?

    I have seen competent, enthusiastic doctors pass their AKT, workplace based assessments and impress everyone at the practice, only to fall at the final hurdle (CSA). These are doctors we would happily employ over a physician assistant. Why should the A&E middle grade rota be the beneficiary here when these doctors can clearly offer something to general practice?

  • Submit your questions for RCGP chair Dr Maureen Baker

    David Coleman's comment 30 Jan 2015 3:36pm

    Just over 12 months ago you stated that "the pressures on general practice now are as bad as they've been at any time during your [career as a GP]."

    In recent months you have argued that the future of GP is "looking bright" and urged young doctors "now is the time to consider a career in general practice".

    My experience is that demand, expectations and workload have all increased significantly in the last year. Many practices in my area are in real crisis. A high proportion of GPs in the locality are close to retirement. Our local training scheme has numerous unfilled posts. I'm sure the picture is similar in many parts of the country.

    How does the RCGP plan to bridge the gap between the present and this much hyped golden future, which itself seems to be entirely based a promise of future investment made in the run up to a general election?

  • A brief rest-bite from the news agenda

    David Coleman's comment 07 Oct 2013 1:19pm

    Pseudo-cream sounds suspiciously like Elmlea to me.

  • Madam, I’m a GP, not a plumber

    David Coleman's comment 04 Apr 2013 12:22pm

    Home visits are sometimes the most rewarding experiences in general practice; they can provide additional information as to how patients are coping (or not coping) at home, and are frequently necessary in palliative care cases.

    They can, however, be a complete waste of time and resources. I audited our visit numbers and noticed a 33% rise in home visits over a 12 month period. With demands on the rise in every domain, this is clearly something that needs managed.

    One idea within the practice was to provide a practice-funded taxi service. I opposed this on the basis that I felt it would be impossible to implement fairly and ripe for abuse. One local practice is actually operating such a service, paying for taxis for patients who say they don't have transport to come up to the surgery as a means of avoiding the need to visit. Local OOH services also offer a similar service. They have reported success but I don't think this should be the GP's responsibility.