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  • Pariah practices have patients that 'deserve care’, says RCGP chair

    Bornjovial's comment 27 Mar 2019 8:13pm

    It is a it rich that the chair of RCGP - a partner in a two star practice and in the lowest quartile in overall satisfaction in the the whole on England calls other practices as pariah practices.

    Pot calling the kettle black.

  • MDOs warn of 'substantially' increased costs from reforms to indemnity schemes

    Bornjovial's comment 28 Feb 2019 3:15pm

    My understanding is the new NHS Indemnity scheme would NOT cover
    1) Good Samaritan acts
    2) Non NHS work (Any private or fee paying work undertaken)
    3) GMC proceedings
    4) Coroners cases
    5) Criminal investigations
    6) Patient complaints from past medical treatment provided

    This is a tentative list and we await for clarification of the scheme as it is made up as we go along.

  • Sometimes only a patient complaint will work

    Bornjovial's comment 27 Nov 2018 5:32pm

    Agree with Dylan,
    There are not enough doctors to sit and explain every test face to face. Although it is not our fault that the situation is that way, we have to make the best of the available resources and arrange for follow up via any appropriate medium - including Nurse clinics, Phone calls from junior doctors, SMS to inform scan/test was normal etc etc.
    What is NOT acceptable is allowing patient to be on tenterhooks about a result with no follow up booked in as it seems to be often the case at present

  • Partnership model may be ‘contributing to recruitment crisis’, suggest GP leaders

    Bornjovial's comment 13 Nov 2018 6:03pm

    Partnership model is not contributing to the OOH crisis, is it?

  • GPs should refer patients to Skype outpatient appointments, says NHS England

    Bornjovial's comment 09 Nov 2018 3:20am

    Used carefully this can be an useful tool in select patients in selected circumstances.
    However To a man with a hammer, everything looks like a nail - should not apply it indiscriminately.

    I offered to pilot Skype/ Conference consultations between patient, GP and lipid clinic consultant who almost never needed to examine a patient more than a GP can.
    The hospital was not interested as they don't get paid HRG tariff!!!

  • GPs 'should stop co-prescribing mirtazapine and SSRIs for depression'

    Bornjovial's comment 02 Nov 2018 10:28am

    NICE has accepted that Mirtazapine and SSRI combination in its previous guidelines as one of the few exceptions where 2 antidepressants are used together.
    Obviously we need to consider the study effects.
    We need to note that SSRI`s themselves have very high placebo effect (in excess of 50%) and we still use them, so I hope the study had enough numbers to be statistically significant

  • ‘No benefit’ of lowering hypertension treatment thresholds, finds major study

    Bornjovial's comment 01 Nov 2018 10:39am

    Common sense prevails at last.
    However few caveats on this conclusion- its only 40,000 patients which for a low risk population by definition does not a high confidence interval of accuracy for the billion people worldwide who are estimated to have hypertension.
    Data from GP records is based on in clinic readings. In future validated measurements from patient held machines which can generate lot more data (?accuracy) would be used to model outcomes with a bigger dataset.

  • Superpractice partners with Push Doctor to offer GP video consultations

    Bornjovial's comment 11 Sep 2018 11:17am

    I think the CMO of Push doctor Dr.Dan Bunstone has resigned as chair of a CCG after majority of practices in the CCG expressed no confidence in him according to HSJ.

    Also interesting to note the comments from LMC on this compared to their choice of words when Babylon wanted to start recruiting in Birmingham.

    Don't we live in interesting times

  • Government to ease red tape for Australian GPs to work in the NHS

    Bornjovial's comment 24 Aug 2018 10:49am

    Most of my GPVTS cohorts went to Australia ,New Zealand or Canada.

    Most are not coming back even if they roll the red carpet out.

  • GP at Hand improves health access for migrants and homeless, finds review

    Bornjovial's comment 16 Aug 2018 8:37am

    As long as they have a the latest iPhone/android phone with unlimited data package, speak fluent English and have private Insurance.

  • One fifth of GP appointments avoidable, finds NHS England audit

    Bornjovial's comment 20 Jul 2018 9:41am

    This is a retrospective decision. What we need is a prospective trial of triaging into alternate practitioners and then see how many they are able to manage and what proportion is reverted back to GP`s.
    One should also look at vicarious liability.
    I have come across patients with unusual presentations like a heartburn which was a acute MI (in a 40 yr old lady), a sore throat which was acute leukaemia, an "asthma flare up" which was Eisenmengers reversal, 2 shoulder pains which were lung malignancies etc. Admittedly these are rare but the medical negligence costs will have to be weighed up against the saving. 1 significant missed diagnosis would offset years of savings by offsetting workload to alternate health professionals and GP`s carry the vicarious liability now.
    Obviously if the government underwrites all medical negligence then this becomes more interesting.
    The "doctor as a medicine" concept is also lost but some patients prefer 20 min with the nurse rather than 10 min with GP partially offsetting this.

  • Patients to book GP appointments through new app by end of 2018

    Bornjovial's comment 02 Jul 2018 12:47pm

    Today I have been told
    "There is a national problem with Patient Access in that it is very slow and patients struggling to access it today. Being investigated"
    The app would be single point of failure for primary care for the entire country and single point of infrastructure attack for any hostile entity which wishes to cause chaos in England.

    20% of our patients are booking their appointments online and this will increase with time. However there are several access points such as telephone, a visit to the surgery as alternates to book appointments.
    There are positive sides to this as well as there is standardization of access to practices, albeit for digitally enabled citizens.
    As with anything new, it does not flatten the playing field but creates new winners (app developers, IT staff, more control of primary care by NHS) and new losers (GP surgeries, elderly patients).

  • E-consultations resolve ‘40-60%’ of GP consultations without attendance

    Bornjovial's comment 24 May 2018 3:02pm

    We are trialling e-consultations in our practice very very carefully.
    This may increase, decrease or have no effect on available appointments.
    Extremely small reductions have be noted in some studies while in others it had no statistical improvement.
    Significant reductions in appointments are likely to be fantasy of some vested interests.
    If it were so successful NHSE should pay practices extra 40-60% of primary care budgets ASAP to implement this

  • 150,000 patients with resolved AF 'should still be on anticoagulation'

    Bornjovial's comment 14 May 2018 10:30am

    even resolved AF has risk of recurrence and increased risk of CVA (exception being lone atrial fibrillation which has no evidence). So yes this consistent with known evidence regarding AF.

  • GP practices set up not-for-profit company with trusts in bid to attract staff

    Bornjovial's comment 09 May 2018 10:29am

    Advantage- GP`s and staff can be paid as independent contractors which NHS Organizations and surgeries are prevented from doing(IR35).
    Freedom to organize as they see fit

    Private providers have to pay VAT (charities are exempted I think, as are NHS trusts.
    Form should follow the function and the function is presumably to be ready for ACO contract!
    Don't we live in interesting times

  • GPs urged to suspect cancer in over-60s with weight loss

    Bornjovial's comment 11 Apr 2018 10:32am

    Medicine is not an exact science- if it were algorithms would have replaced us by now.
    Unplanned/unexpected weight loss is always a very important symptom when assessing the elderly.
    NNH (unnecessary tests and worry) maybe more than NNT (actual cancer) and would need to be formally assessed in a study before including it in guidelines.

  • Revealed: how reflections were used in the Bawa-Garba case

    Bornjovial's comment 02 Feb 2018 12:20pm

    *.*, the consultant on-call on the day Jack Adcock died. Did he review patients in ward rounds?. Why was he away from the hospital that day. How come his notes were used when he should be questioned as well?

    The judge and Jury make decision on the information provided to them.
    I am not sure the information provided was accurate, without bias (of self preservation) and complete.

    I suspect the original manslaughter verdict may not stand the rigor of retrial.

  • The real problem with Babylon

    Bornjovial's comment 04 Dec 2017 4:59pm

    I agree that no one should be allowed to openly discriminate like this new service.
    Vinci Ho is as usual right on the theology of the need (as determined by us) and want ( as determined by patient).
    Never the twain shall meet!!!
    However in a changing society how to improve access to "want" without pushing the overall financial envelope?
    I disagree anyone is allowed to openly cherry pick (I say openly as I have seen some GP`s have practice areas which exclude the deprived areas....)
    However managing patient want is a issue esp in cities where continuity is important for lesser number of patients.

    Also if the cost of healthcare is not reaching the working population who by definition will contribute to productivity of the country (which is lower than most comparable countries)then the cost spent is not recovered indirectly via productivity, taxes etc.

    Maybe they can have a new iPMS contract for internet only companies which can have such exclusions but be paid far less to increase the GMS value to traditional brick and mortar (B&M)GP surgeries. iPMS contractors should pay the going market value whenever their patients attend a B&M surgery to compensate for their loss of business. It brings it own issues as there will less B&M surgeries due to the same.

  • Patients are more satisfied with practices owned by GP partners, finds study

    Bornjovial's comment 03 Nov 2017 9:12am

    Very true and also patient satisfaction drops off after about 15-16 k patients. #
    Smaller practices have better overall satisfaction, less admissions and less referrals but have more variability between the group more due to sample size being smaller than in cohort of larger practices.
    It would be interesting to study other outcomes such as OPD referrals, inpatient admissions, Overall cost per patient in relationship to partnerships vs APMS, limited companies and also size!

  • Government launches campaign to stop patients pressuring GPs for antibiotics

    Bornjovial's comment 23 Oct 2017 11:37am

    Well this is one good thing from NHSE and I support the same.
    I hope to be able to put it on our practice display in the waiting room.