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A faulty production line

Mark Howson

  • GP practices threatened with bankruptcy due to unpaid rent

    Mark Howson's comment 19 Feb 2020 11:51am

    NHSPS is stand alone and NHSE hopes to sell it for a profit. Unfortunately they are incompetent. One reason practiceS may not have paid is that they have not been invoiced properly by NHSPS.

  • NHS Property Services on why ‘a clean slate’ isn't the answer

    Mark Howson's comment 14 Feb 2020 9:42am

    At one point NHSPS we’re billing us for our own reception staff and we got the odd bill for lunch time sandwiches. Turned out they were bills for another building with a similar name. Then there is the weird things like a yearly test of our lightening rod. I did wonder how the building survived for 50 years without them.

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

    Mark Howson's comment 10 Feb 2020 4:13pm

    I think this plays into GPs hands. The 150k will be taxable income so not include personal SA or employers SA. It will only include NHS GP work. For example a GP who works for NHSE in admin but does two sessions a week As a GP should only declare the pay for 2 sessions. The other work is not as GP. Those GPs who run mega practices are managers and not GPs so should only declare money from GP work. With these rules I doubt there is any GP earning 150k plus. The press will have to admit there are no grossly paid GPs.

  • NHS Property Services on why ‘a clean slate’ isn't the answer

    Mark Howson's comment 06 Feb 2020 4:26pm

    The whole purpose of NHSPS is to establish it as a profit making going concern and then sell it.
    The joke of charging practices 70k when they were paying 10k for services and had been for 40 years allowing for inflation didn’t help. Then not invoicing for the things that are due to NHSPS like the reimbursables gives the impression of incompetence. Then taking years to come forward with a lease gives the impression they are not that bothered by a lease but in fact is just more incompetence.

  • What to do if you suspect coronavirus

    Mark Howson's comment 06 Feb 2020 12:05pm

    I am confused by why the new coronavirus is such a concern. The population of Wuhan is 11 million and number of deaths is about 600 deaths. Deaths from the seasonal flu in Wuhan is predicted to be 2000 by the end of the season. So it looks like similar to seasonal flu. Is it because they are concerned deaths may continue to increase exponentially beyond the season or is it killing more younger people than seasonal flu.

  • GPs are signing 7% more fit notes than a year ago

    Mark Howson's comment 05 Feb 2020 6:57pm

    It would be simpler to make fit notes not the responsibility of the GP but of OH paid for by employer or DWP who want the information over and above the word of the employee.
    Fit notes are really not our business and they get in the way of the doctor patient relationship. I really do not know how long people should be off or how it affects their work.

  • Online GP practice fined more than £18,000 for running illegal services

    Mark Howson's comment 24 Jan 2020 12:39pm

    18000 seems very little when I suspect they made much more illegal profit. And why did it take so long. During that time he put patients at risk. Private healthcare is always a risk for anyone as the people involved are there to make a profit and do not always do what is best for the patient. We see this in patient who come back off holiday having been treated with IV antibiotics for a viral URTI or three of four injections because they felt a little sick.
    It is difficult for the doctor to say no as well as the patient has paid money and expects some magic to be done. While in the UK we are empowered to giver advice when that is all that is needed.
    Of course I generalise but in private healthcare the temptation is there and with 100,000 doctors not all are angels.

  • No details about how GPs’ winter pension tax charges will be paid, warns BMA

    Mark Howson's comment 23 Jan 2020 5:33pm

    I wrote NHS pension to get in writing my wish to take advantage of the scheme pays scheme funded by the government for the winter AA problem.. they replied that had never heard of it and nothing to do with them!

  • Rationing disguised as health promotion?

    Mark Howson's comment 22 Jan 2020 11:56am

    There is some rationale behind it. A family member has a knee problem and previously had an arthroscopy but this time was told would have to lose weight before considered. BMI 34. They went to the gym and changed their diet and lost some weight but more importantly the Gym work strengthened their knee and in the end there was no need for the surgery. They used to go down stairs using the good leg for each step now they go down easily using both. Their mantra was do this not to have surgery but to avoid surgery. To easily surgeons step in to fix things which do not need their fixing and sometimes are made worse. The surgeons mantra is can we fix it yes we can- but sometimes and with some procedures they can’t or they make it worse.
    While having said all this the Motivation for weight and smoking thing is a rationing but it will have the side effect of improving the health of some patients.
    We need to get to a state where the surgeons are more honest with patients and do a good job of explaining there are better alternatives but which might require some effort. At the moment their clinic is judged on conversion rates. Converting a consult to an operation. Perhaps the lower the conversion rate the better the surgeon.

  • Hospital says GPs will manage patients it has told doctors to discharge early

    Mark Howson's comment 20 Jan 2020 10:53am

    Most of the work caring for patients in hospital is done by nurses and HCAs. So if they come out earlier than expected into the community there would need to be a large investment in more community and district nurses. It may actually be a good idea but with a large increase in DN funding.

  • GP practice threatened with breach notice for failing to cooperate with PCN

    Mark Howson's comment 17 Jan 2020 1:19pm

    I would ask to see in writing where this is in the contract. Then pass it to the ICO for advice on breeches of the GDPR by the CCG. The penalties to the CCG if they are illegally sharing data is punitive.

  • This goes way beyond the usual SARSache

    Mark Howson's comment 19 Dec 2019 10:37am

    Redaction as required is not humanly possible so leave it to the computers to redact all names not the patient and relationship words. That’s what we do with SARs. As long as you put a recognised system in place you have done your duty. The problem is anyone with a brain can read between the lines and work out what was said and by whom. So it will always be impossible to prevent harm. But we will have what was required legally so it is not our problem any more.

  • GPs 'not required to share sensitive records' despite contract requirements

    Mark Howson's comment 10 Dec 2019 4:53pm

    For GDPR we almost at the point of automating it. We cannot be paternalistic. If a patient wants their notes for personal use or insurance use or a claim of some kind they can have them as is their right. The only thing we check for is third party references. So we have software that removes all names except the patients and all words like father mother son etc. Then an admin person does a quick scan to make sure they are the right notes to the right person and they are emailed. Admin job 10 minutes. We realised it is humanly impossible to asses notes some of which are over 500 pages long so we let the computer do it and we have discharged our duty.

  • Government still finalising pensions tax scheme details for GPs

    Mark Howson's comment 09 Dec 2019 4:13pm

    The bizarre thing one will find is that to request scheme pays you have to tell them how much. Of course you don’t know and they don’t know for a another year or two. Indeed even more if Capita is involved. When I did it last year I declared I owed 50k as a placeholder and I am still waiting for someone to tell me how much I actually owe. It is scary as last year I earned about 60k But I think I will be due 200k in tax due to pension annual allowance.

  • Hancock approves plan to pay GP pensions tax but warns of 'tax avoidance'

    Mark Howson's comment 24 Nov 2019 8:29am

    I got stung last winter doing OOH. Does this cover the massive bill I got in winter 2018/19. Then there are all the people who got hit last year and haven’t even realised it yet because of capita delays. I know of people with no capita data from 2014 who may be sitting in a tax timebomb. People have been hit hard already and have no faith in an unjust system designed to recover money given by government to fill the bankers pockets with gold. I think the social contract has been broken by this. We should all pay our taxes but our taxes should be demonstrably fair.

  • NHS set for 'worst ever' winter crisis as A&E waiting times worsen again

    Mark Howson's comment 14 Nov 2019 4:49pm

    If it is any consolation it is better than the last time the Tories had 10 years of guardianship of the NHS in the 80’s and 90’s. But it won’t survive another 5 years of Tories guardianship.

  • Drug shortages – how GPs are kept out of the loop

    Mark Howson's comment 25 Oct 2019 6:43pm

    Is this pharma companies gaming the system to maximise profits by supplying drugs to those countries where the price is higher in preference and restricting to others.

  • NHS trusts ask GP practices to identify overseas patients when referring

    Mark Howson's comment 22 Oct 2019 4:20pm

    It would be rare for a patient to request you hold information on their eligibility for NHS treatment. And it is right that you do not have to give the info in your referral letter. You do have to make the patient aware they are not entitled to NHS care or it will come as a big shock when they get the bill and will affect their decision on the nature of the referral so is required for consent.
    If they ask you not to declare - fair enough. It is after all the 2ndry care institution’s duty to check and charge not us. We only have to get appropriate informed consent for the referral.

  • NHS trusts ask GP practices to identify overseas patients when referring

    Mark Howson's comment 22 Oct 2019 12:45pm

    Since 2ndry care is not free to people not normally resident in the UK whether British or not it would be reasonable to see if the patient wanted a private referral to the NHS or to a non NHS service and so it is a discussion that needs to be had with the patient so they are fully informed about their referral. I would have thought it reasonable to inform the service to whom you evenetual refer that this is a private referral.

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

    Mark Howson's comment 18 Oct 2019 1:01pm

    The fluctuation in 200 of two standard errors is 2x square root of 200 and so is about 28. This 28 is about p of 0.05. So the actual fluctuation of 80 looks significant. However we don’t have the actual average over the last few years. If the average was 240 then the 2 std error fluctuation is about 32 which makes the 280 just significant.