This site is intended for health professionals only

At the heart of general practice since 1960

pul jul aug2020 cover 80x101px
Read the latest issue online

Independents' Day

Mark Howson

  • Should remote consulting remain the default option post-Covid 19?

    Mark Howson's comment 04 Jun 2020 6:12pm

    The price the patient pays is an opportunity cost so if the consultation is on the phone or video done from home then it is very convenient for the patient but the opportunity cost is zero to the patient so hoards will take advantage of the completely free service and it will be overwhelmed in time.
    That’s why I like sit and wait clinics- with boundaries like being limited so any patient arriving after 10:30 has to come the next day. But sitting for an hour to see the doctor means it costs something.

  • Care homes advised they can reuse their patients' medicines during pandemic

    Mark Howson's comment 30 Apr 2020 10:44am

    We don’t need to be involved. We issue scripts and advice on treatment. It is for others to dispense and issue and administer and audit that which they do.

  • Coroners clash with BMA over death verification during coronavirus pandemic

    Mark Howson's comment 29 Apr 2020 1:02pm

    Just say no. Our OOH has a specific protocol which says we do not get involved in verification. We are busy with other things. In the day job we have a duty to the living surviving family if they have a medical problem but not to verify death.
    If the coroner insists then they are obliged to find someone prepared to do it for them who I suspect will charge them a fee. I would just say no. The family are competent or the FD is competent to do it.
    There is no discussion needed just say no.

  • GPs can expect to work over May bank holidays, signals NHS England

    Mark Howson's comment 17 Apr 2020 2:37pm

    Don’t see the point. It is much quieter now people have figured out they don’t need to see the doctor for many things as it turns out.
    This must reflect the fact that the centre is guessing rather than experiencing.
    Last bank holiday OOH was operating as well in our area.

  • GPs should continue to refer patients to secondary care, says NHS England

    Mark Howson's comment 17 Apr 2020 2:34pm

    Interestingly I referred someone Urgently to Leeds for a neurosurgery assessment- a service not provided in York and got bounced with Leeds saying they will not see out of area patients during a covid.

  • NHS England urgently calls on GPs to offer spare time to Covid-19 triage service

    Mark Howson's comment 07 Apr 2020 9:48am

    A relative with covid symptoms rang 111. After two hours on hold was summarily dumped with a try later message. Only way to contact GP was email. So emailed and got a straightforward email back saying sounds like covid call 111.
    Now at this point they only need simple advice. But part of that advice is safety netting in case deteriorated. They got nothing. If this is happening across the country then yes people will die at home when they deteriorate and get no input until the desperate 999 call.

  • GPs trying to access NHS England’s ‘emergency’ PPE told to buy their own

    Mark Howson's comment 01 Apr 2020 10:39am

    I suppose if you run out of PPE you are
    obligated to direct patients with possible Covid symptoms to that part of the NHS that has access to PPE to protect yourself and your staff- with an apologetic letter to A&E explaining that you have no protection.

  • PPE problems 'completely resolved' for hospitals 'and other care workers'

    Mark Howson's comment 20 Mar 2020 7:10pm

    We have six masks per room. So I am saving them in case someone comes in by mistake with respiratory symptoms. Most people are dealt with on phone but those who do need seeing I am seeing but trying not to touch unless necessary. I am 59 and have had a quintuple bypass and although fit I am a little worried.

  • NHS to offer staff hotel rooms if members of their household show virus symptoms

    Mark Howson's comment 20 Mar 2020 8:33am

    without testing you have to assume they are already infected

  • 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.