I'm just a simple man trying to make my way in the universe
NICE in concept is wonderful and is essential in a government funded health system but has lost its way over the last decade.
To stay relevant maybe they can have standards that are divided as standard which everyone has to follow and a gold standard which recognised trail blazers can follow would be an option.
Eg. FeNO testing is made optional where resources/circumstances allow and traditional diagnosis for the rest of us.
If they stick to what can be implemented in every part then it will be quick race to the bottom
Hi Christopher Ho,
If they wish to have a state service only for those who are at the lowest economic group, the options would be to subsidise Insurance for those who can take private Insurance or ability to transfer part of NI payment towards health Insurance and have an NHS for the "rest".
That left over "NHS" would quickly deteriorate and maybe able to provide only basic health service.
NHS is trying to be everything to everyone and that is not working.
Without a significant funding boost to NHS budget it cannot continue as it is. The cost of funding more for NHS would be less budget for other departments -Schools. defence, social care etc- so there we go again
It will be you notorious video consultation platform available for everyone and hey presto waiting list solved.
Never mind the one who truly need our help will not be covered by this.
I hope they increase funding for the ones truly needing help lots of ill people will suffer
If non geographical grouping was allowed, may practices would have joined up from non contiguous sites. they need to postpone the deadline for registering networks as now many more options have opened up.
GMC is a registered charity Charity no. 1089278.
With regards to it’s effectiveness - Apparently only 18% of doctors felt confident in GMC in a survey conducted by the GMC!!!
If doctors have a mere 18% of their patients having confidence in them, they would have lost their license to practice a long time ago....
It is an irony that they are pushing for annual patient survey.
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.
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.
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 is not contributing to the OOH crisis, is it?
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!!!
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
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.
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
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.
As long as they have a the latest iPhone/android phone with unlimited data package, speak fluent English and have private Insurance.
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.
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).
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
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.
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