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GPs buried under trusts' workload dump

Andrew Mimnagh

  • GPs should initiate gender dysphoria hormones in 'exceptional circumstances'

    Andrew Mimnagh's comment 01 Jun 2016 10:53am

    "'We would expect GPs to acquire the knowledge and skills to be able to deliver a good service to their patient population... "
    Correct- in the 50 hours of postgraduate learning per annum specified by the GMC;
    based on an assessment of the practices populations needs and most benefit from time spent as per appraisal and revalidation.
    The thorny issue is the circumstance arises so infrequently that spending the time for one or two individuals looses out to the hours of " mandatory" child protection; Information governance etc.
    and keeping abreast of the changes in therapy that benefit hundreds of patients in a what little time remains after an increasingly complex and expanding service delivery of care.

    Definition of a specialist "someone who looks after a small section of health needs in a 30-60 minute outpatient appointment because the condition is "beyond GP capability" - until the condition rises in prevalence at which point it becomes a "GP problem" but unfortunately still in a 10 minute slot and not a sixty minute one........

  • Junior doctors' strike suspended after last-minute agreement

    Andrew Mimnagh's comment 30 Nov 2015 5:01pm

    The contingencies are in place, operations are cancelled.
    This is months too late irrespective of whether junior doctors present for "routine " work tomorrow.
    A wholey avoidable detriment to patient care from state intransigence will still occur.

  • GPC 'happy to discuss' extended GP opening hours, says Nagpaul

    Andrew Mimnagh's comment 03 Sep 2015 7:25pm

    I can see the logic( as Chand is a reasonable man )in not taking an "obstructive NO" policy position, given the co-ordinated media spin that is put out whenever the BMA try to draw a firm line for negotiations- remember the Miners strike?

    This has to be balanced against the fact you cannot "negotiate" with an utterly unreasonable party in any meaningful way.
    The utter unreasonableness of the government demand is not getting the coverage it requires in the lay press at present.
    Second point.
    The BMA and GPC articles require a minimum of one clinical session a week in the area of representation to claim a clinical basis- for those who asked- but please remember the role is "medical politicians" and I would expect my representative to be a" full time politician" in the negotiations to stand a chance against a Nation State resources.
    As with 1969 this situation will only change if the profession is united in taking a strong action against this demand; the support for the BMA industrial action that was called was underwhelming to say the least.

    Sorting any percieved "Leadership" issue is relatively easy and utterly futile- it is not having mass united ranks following that is the weak spot.

    I would strongly contend its a "Back Em, Not Sack Em" moment.

  • For Pever and ever

    Andrew Mimnagh's comment 06 Jul 2015 7:31pm

    don't get envious on numbers alone- Mr Hunt will get 300+ comments if a dead dog pawed it.

    Like primary care itself we take the excellence of your contribution for granted and pass no comment.

  • 'A CQC inspection should not be a burden for a well-managed practice'

    Andrew Mimnagh's comment 24 Jun 2015 4:04pm

    I do not doubt the sincerity of Professor Fields in this statement.
    All I ask that he do is reflect on the inspections as experienced at the practice level.
    The following news articles may allow him to draw some parallells with best practice in another regulatory body, in the hope he can avoid making the same classes of error.
    as this news story unfolds over the last 18 months it is all too familiar to this GP whose wife is a schoolteacher..
    http://www.bbc.co.uk/news/education-33198707
    http://www.bbc.co.uk/news/education-18353533
    http://www.bbc.co.uk/news/education-20756653

  • Hunt confirms rollback on pre-election pledge of 5,000 new GPs

    Andrew Mimnagh's comment 24 Jun 2015 3:49pm

    Such a pity Mr Hunt as 5000 is the minimum needed to deliver 7 day service.
    As your view that you can find the necessary number is changing please change your view on how thinly you can spread the current GP resource.
    If it helps my practice is willing to close Monday and Tuesday and open Saturday and Sunday, we are all used to working flexibly.
    I haveheld a GP principle contract with cover ever since I qualified and worked for out of ours services since the contract split to core and out of hours.
    Please be advised the contract was divided to prevent burnout and excessively long hours of work to maintain recruitment- you clearly don't read the cabinet backpapers or you would not be repeating the work that was done in 2001 on inappopriate service requests to GP's from the begining again.
    I appreciate "Making a Difference" is a poor title linking to over 2000 Government publications, I enclose the link
    .http://www.gpcwm.org.uk/wp-content/uploads/file/A-Z%20DOWNLOADS/M%20DOWNLOADS/Making_a_Difference_cabinet_office_march_01.pdf
    Stop talking politics and start taking useful action.
    I am afraid I am of the Ian Fleming persuasion on your actions..
    "a first deteriorated outcome for your input is happenstance;
    A second deteriorated outcome for your input is co-incidence;
    A third deteriorated outcome for your input is ENEMY ACTION.

  • GPs told to avoid codeine completely in under-12s

    Andrew Mimnagh's comment 21 May 2015 10:05am

    I am old enough to remember the launch and demise of "formulix registrered trade mark, "- paracetamol codeine syrup from the makers of "tlex" registered trade mark.
    I suggest as the nhs is "discovering" the same problems I know from decadess ago I am long past retirement, only my desire to retain bragging rights "I was in post " the day the NHS Dies" keeps me going.

  • Oxford medical school director: 'The variation in GP numbers between medical schools is not undesirable'

    Andrew Mimnagh's comment 01 May 2015 11:41am

    So the researchers who promote NICE guidance that is impractical in the real hands on clinical world come from an ivory tower background in an university that is unashamedly content to be an ivory tower.
    Think even the "red brick pleb GP" like me had already worked that out thank you.

  • Bring back the desktop steriliser

    Andrew Mimnagh's comment 30 Mar 2015 11:37am

    PRION disease- I seem to recall a dentist struck off recently for still using a desktop steriliser- and reported to GDC by CQC.
    The solution is not "can we return to the old days" but that we should have a minor surgery remuneration that allows us to use disposable or autoclaved instruments to the highest safety standards.
    Quality costs, the problem is the system seems reluctant to pay when it involves the GP componenet of primary care.

  • Area team offers over £1,000 for Easter Saturday session

    Andrew Mimnagh's comment 15 Mar 2015 10:27pm

    Firstly congratulations to the area team for setting a specification that actually could impact on urgent care needs.
    Secondly with about 2 truly urgent cases in the entir period at a cost of over 500 pounds to the taxpayer, would it not be worth adopting a "horses for courses" approach and leaving GP as the volume providor for "sometime" and the AED for the genuinely "within 4 hours or bad outcome" cases and actually tackling the "it's urgent because it's happening to ME" consumerism attitude?

  • Contribute to Pulse's general election manifesto

    Andrew Mimnagh's comment 12 Mar 2015 7:07am

    Politicians cannot be honest regarding the NHS,
    Their sell of "unlimited healthcare at "no cost" "is clearly too good to be true; the tax take required to sustain the current "health professional to blow your nose within 2 hours for all viral infections" would ensure any party admitting it where not elected.
    So the current paradigm :-"lie about the tax and abuse (financially) the workforce" will continue.

  • Dietitians to be given greater prescribing powers to reduce demand on GPs

    Andrew Mimnagh's comment 02 Mar 2015 11:40am

    Making a difference Public Sector Reulatory Team Cabinet office March 2001 and i quote page 17
    "Outcomes"
    From Decenber 2001 GP's will no longer need to issue repeat prescriptions for Gluten free foods"

    As I am still issuing FP10 as I suspect most GP's are and the various NHS mangements since claim unable to comply, including my "membership organisation CCG" forgive me if I do not believe a word of another pre election promise.

  • GP indemnity costs to be covered as NHS England looks to fill out-of-hours shifts

    Andrew Mimnagh's comment 06 Feb 2015 4:03pm

    Dot Sticking Plaster solution for a bleeding artery.
    Where do we magic the GP's from?
    We are working 14 hour"routinel" days plus often extended hours for scheduled appointments in the evening.
    If you covered my indemnity I could not be at "out of Hours" as I am stiill completing the "in hours" workload.

  • Secret GMC complaints files will continue following DH consultation

    Andrew Mimnagh's comment 02 Feb 2015 7:03pm

    This is utterly unacceptable.
    It is a fundamental tenet of UK common law that the accused has a right to face their accuser.
    The complaint is either groundless in which case it should be expunged and the complainant anonymity remains , or worthy of merit and recording even if "not proven" in which case the party suffering allegation has a right to know of the existance and identity of complainant.
    The excuse "discourages complaint" is an inverted logic;
    a "free swing without any counterbalance" is contrary to natural justice..

  • GPs to be offered incentives to delay retirement under £10m strategy to solve workforce crisis

    Andrew Mimnagh's comment 26 Jan 2015 10:37am

    74% of GP's report unsustainable work pressures.
    The solution on offer either ties you to an unsustainable workload or bribes you to enter an unsustainable workload.
    The DOH either clearly does not understand that papering over the cracks in a subsiding building does not stop the subsidence or is tarting the structure up for sale to a poorly discerning buyer.

  • 'Disappointment in primary care demanded highlighting'

    Andrew Mimnagh's comment 21 Jan 2015 1:27pm

    I cannot believe the blatent cynicism - reduce current Quof activity to help the system at providor risk- that you will be able to put more routine through in March, despite the fact you cannot magic staff or time to do so.
    If this is a serious request to be able to convert scheduled capacity to unscheduled capacity the only fair solution is total suspension of quof promotion activity and payment of all attainment as per previous year.
    Can the hospitals in the area demonstrate cessation of elective payment by results cases to free capacity for unscheduled care?
    thought not -
    so why does the system expect GP surgeries to take the cash hit for the system?

  • Rise in A&E attendances caused by NHS 111, emergency medicine leader claims

    Andrew Mimnagh's comment 16 Jan 2015 6:18am

    Though as 111 is a computer algorhythm (NHS pathway) the public is a factor in the GIGO* effect Dr Mann and ourselves notice.
    It is precisely because we do not challenge the patients input to the occurrence because it comes through a 111 proxy that it is the logical place to start for a inappropriate service expectation
    *GIGO American commuter acronym 1960's garbage in: garbage out.

  • Patients to be allowed to self-refer for cancer diagnostics without going through GP

    Andrew Mimnagh's comment 12 Jan 2015 10:56am

    Well at least it may permit some of our consultant colleagues to move their personal thinking on from:-
    "stupid GP's refer too many people who don't have cancer"
    to
    " there are a large number of people very worried and presenting symptoms suggestive of, but who do not have cancer."
    The only absolute in my book is that the direct access service must manage the repeated attendances for rechecking and not deflect them onto the GP, given the published body of evidence that
    "reassurance investigation"
    increases frequency of future presentation.

  • Trust tells staff to get GP note for 'any period of absence'

    Andrew Mimnagh's comment 07 Jan 2015 8:14pm

    http://www.gpcwm.org.uk/wp-content/uploads/file/A-Z%20DOWNLOADS/M%20DOWNLOADS/Making_a_Difference_cabinet_office_march_01.pdf

    Unsurprisingly despite Department of Health being a signatory and therefore foundation trusts obliged to follow the policy I bet they have not seen it.
    If you can get over the shock of a young Tony Blair page 3 it is worth reading and seeing how many promises have been kept ;how many never happened and most annoyingly as in this case,how may prohibited activities creep back.

  • Doctors need resilience training like soldiers in Afghanistan, GMC head says

    Andrew Mimnagh's comment 07 Jan 2015 11:07am

    If we are having Military service comparisons where is the "Health Services Covenant" where all staff in this demanding role recieve occupational health support and priority care to allow them to return to their State care role most effectively?
    Although health care staff can and do die from "injuries sustained in the line of duty" I do not think this is an appropriate nor desirable model for comparison or emulation.