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Independents' Day

Andrew Mimnagh

  • CQC chasing more than a hundred unregistered GP practices

    Andrew Mimnagh's comment 26 Mar 2013 2:41pm

    The important words are primary care service providers.
    The default list in my LMC area was 2 and neither where a GP practice.( I suspect both may indeed be exempt from individual registration requirement.)
    lest we forget GP surgeries are not the only primary care provider!

  • GPs to be given legal 'duty of candour' to highlight bad patient care

    Andrew Mimnagh's comment 26 Mar 2013 2:19pm

    For give me but what happened to the professional regulatory body for NHS Mangers?
    A "blacklist" does not meet the same professional and performance standard monitoring as the medical staff currently perform.
    A five year revalidation by a very senior manager from another reigion seems a suitable mechanism for preventing incestous internal appraisal and falling standards in Nhs managers.
    It is odd so little is said about the historical personal patronage of career development for very senior NHS management.
    Perhaps more will follow on this topic from the government when someone develops their gardening interest and retires in the summer?

  • NHS Commissioning Board reveals final specifications for new DESs

    Andrew Mimnagh's comment 25 Mar 2013 2:25pm

    I am afraid the timeline seems unduly hasty and is an unusual take on pressure selling.
    The only good news is some of the pricing is clearly some orders of magnetude short of the actual work involved so can be instantly dropped, but some is so unclear that I could not make an assessment of the business case.
    In these uncertain financial times for practices " a bird in the hand is worth two in the bush".
    I may have to decline any DES that I cannot risk evalute fully."Financial jam tomorrow" does not feed staff wages today.

  • NHS 111 implodes as GPC withdraws support for urgent care hotline

    Andrew Mimnagh's comment 25 Mar 2013 10:01am

    In answer to John O'Malley, the reason this has not hit the national news is simple.
    This is the largest foreseeable mess that the medical profession leadership has been warning about since inception.
    To run a story that confirms the clinical concerns where genuine , altruistic , patient focussed conflicts strongly with the "cold war "denigration campaign that successive governments have run.

    It seems worryingly clear that the political strategy to answer to the conundrum of how you run an NHS with "costly" highly trained medical staff is to get rid of the medical staff.
    This highlights the fact that when you do the quality plummets.
    In a just world this should be front page news and certain red tops backed off the medical profession forever.

  • NHS 111 redirecting 'frequent fliers' back to GPs

    Andrew Mimnagh's comment 20 Mar 2013 9:13am

    (At risk of an irate set of comments from my CCG who have heard my hobby horse too many times) , the basic issue that the NHS management are not adressing is that a substantive majority of frequent flyers have an expectation of professional input to their life for issues that are not appropiate for a health service to adress in any setting, shifting them to "less expensive" settings is not a cure for the "learned helplessness" behaviour.
    I am still waitig the NICE plan "Management of patients with inexplicable physical symptoms"

  • NHS to link up data from GP records and secondary care

    Andrew Mimnagh's comment 18 Mar 2013 8:58pm

    A worrying concept that extracting processing data and them feeding back information justifies the exercise "because it improves individual patient care" leads me to ask :-
    a)if it is not individual patient identifiable how do you ensure this is premise is correct ?
    b) if you currently have the weighting algorithm why not employ it at a practice level in house?

    I suspect the reality is the hope that IF we breach the confidentiality in advance the released aggregated data MAY allow development of an algorithm that has utility-and that is a markedly different proposal ethically!

  • Department of Health publishes full details of 2013/14 GP contract

    Andrew Mimnagh's comment 18 Mar 2013 3:36pm

    Having reviewed the QP indicators for year end "avoidable attendances" , I have not been struck by a wealth of available evidence based interventions that have not been offered to the patients in advance of their attendance at secondary care.

    Unless there emerges evidence of "delivery failure" by these services in the new post Francis transparency, Clinically Comissioned world from 1.4.2013, I am starting to worry the only systemic failure I have uncovered is current NHS Senior manangement understanding regarding "avoidable".

  • DH revises competition rules to include opt-out to preserve integration

    Andrew Mimnagh's comment 11 Mar 2013 5:59pm

    "being provided only by that providor"- slightly weasle words, does it mean "effectively " or "absolutely".
    If it means
    "," because of existing service integration considerations" then I welcome the change in wording.
    The cynic in me however thinks "absolute" criteria i.e. "only one organisation in the world has the patent" may be the implementation in practice, which is not a position change at all.

  • GPs need free time to help elderly in the community, says Hunt

    Andrew Mimnagh's comment 11 Mar 2013 1:43pm

    They correctly say actions speak louder than words. I was intrigued to find this comment given that every GP who spoke to me after a recent appearance of the Secretary of State in the northwest appeared to have formed an opinion along the spectrum of "does not understand primary health care" to " out to wreck the NHS" depending on their own personal political leanings.
    I will reserve judgement to see "outcome" but admit a starting bias- I side with the collegues who think its a synonym for
    " offload the costly work of payment by results to the GP's forced to do it for free under the "Personal Medical Services" block contract."
    I am willing to be proved wrong though Minister.

  • GPs censured over online pharmacy recommendation

    Andrew Mimnagh's comment 07 Mar 2013 3:54pm

    I must differ with Adrian that "a Doctor is in a good position to know" I cannot recall the last time I was on a Pharmacists premises.
    The issues he describes are indeed important and exactly the sort of client feedback that the NHS choices website does contain.
    The NHS strategy is also rolling out NHS 111 free telephone advice to support him in his choice.
    I agree patients are entitled to this advice from the NHS , the only difference is there are professional regulations that mean an NHS Doctor is WORST placed to answer these queries.
    There is cabinet office guidance he should read "Patients not Paperwork" 1992 that makes it clear the taxpayer does not expect an NHS Doctor to give such advice, but does commit the NHS to provide it from other services he can access.

  • No evidence telecare can cut costs, says DH-funded study

    Andrew Mimnagh's comment 07 Mar 2013 10:44am

    There are basically two models of monitoring.
    1)" a person" calls round on a prescheduled basis or
    2)we stick a device to remote monitor.

    "the person" makes a complex multiparameter assessment and instantly inities a reponse as appropriate.

    "The monitor" measure partial parameters, triggers an alert but we still need to send " a person" round to make an intervention.

    In densely populated areas " the person" calling round with short "downtime between contacts" always wins out;
    in remote areas with long downtimes the telehealth wins out.
    In all situations the telehealth adds costs , in remote areas it saves " person time" but not finances.
    In no situation should anyone "sick enough" to meet the admission criteria not get admitted.

    The only way telehealth can "saves money" is if it conceals someone "sick enough to need admitting" so "the person" does not admit them and yet keeps a clear professional conscience.
    "depersonalise the situation; change the response by emotional remoteness".
    Anyone read Francis?

  • GPs censured over online pharmacy recommendation

    Andrew Mimnagh's comment 07 Mar 2013 9:15am

    This is particularly worrying. It is a well established LMC precept that there should be no " direction" to a specified pharmacist to protect against probity accusations.
    There is nothing wrong in indicating several pharmacys, the best way to do this is via the NHS Choices website.
    I hope there is no member of the practice with any connection to the internet pharmacy.
    If you direct a patient to a service you or your employer have a pecunary interest in, especially where you did not mention other options, the GMC takes a very dim view.

  • Gluten-free food prescriptions criticised

    Andrew Mimnagh's comment 18 Feb 2013 10:40am

    I sympathise with both respondents; the "medical" value is in having established the diagnosis. The issue of medical staff altering whether it is white , brown, refined unrefined , loave, part baked, or ready baked, "get a new prescription because the manufactrer has changed the size from 400g to 375g, " from chemists with the " I won't order it unless you prescribe in packs of 8 otherwise I get left with stock that expires" and so on is clearly dissatisfying for all parties and infuriating to the patient.
    It does need to be sorted.
    A certificate of confirmation and some designated pickup /voucher scheme is long overdue.

  • NICE child fever guidelines miss serious infections, BMJ study finds

    Andrew Mimnagh's comment 18 Feb 2013 10:30am

    Regardless of the practicalities of collection of urine in children in primary care, be alert to the fact that the leucocyte esterase test on the dipstick picks up contitutional infections too, not just UTI.
    Care should be excercised where this is the "only" abnormal finding, and UTI on dipstick is only "indisputable" if the nitrate test- from bacterial reduction of urea to nitrate is present with a white cell esterase response. The rare exception being a child ill from other measures with undiagnosed asymptomatic bacturia but I think you would be forgiven for this exception.
    Remember "nappy testing" of stale urine is utterly unreliable and desist!

  • Debate: Can GPs monitor hospitals?

    Andrew Mimnagh's comment 07 Feb 2013 8:15pm

    Interestingly both parties are on the same page.
    Dr Barnum says the "Gp's are ideally placed to..." but argues for resource to do it .
    Prof Esmail is basically saying "if you do it ,you must do it properly and you won't actually get the time or resource to do it right"

    I have to say I side with the Prof - I feel yet another "more works without resource" imposition.

  • Longstanding fears over consent and confidentiality are realised

    Andrew Mimnagh's comment 07 Jan 2013 10:30am

    As the trailing of the Francis Report Mark 2 is currently happening , the growing call for managers that make self evidently poor judgement calls to be permanantly disbarred from public sector service, can we extend the plea to the politicians?
    Those who rode rough shod over a millenia of clinical practice on "obtained consent" to the horror of the majority of reasonable clinicians, are now hanging out to dry some individual who followed their "if they ain't opted out they are in" mantra too zealously.
    A signed ""I want to Join" would have meant forseeable human error failed to create a record on those who wanted an summary record which is less "risky" than the current "forgot to opt out those who wished to" who now have a record they never wanted.
    The "cannot be undone" stance is a compounding strategic faiure of policy making and should be challenged via the European Court.
    To pretend there is a "choice" for individuals then fail to follow the indiciduakls preferred "choice" is malfeasceance in a public office in my opinion.

  • GPs increasingly caught up in family disputes over children's medical records

    Andrew Mimnagh's comment 07 Jan 2013 9:34am

    And this is only the medicolegal aspect of the problem, there is a service delivery implication.
    I have almost a standing Monday block on a few slots for children whose parent arrives as an urgency with a child with self limiting illness who "fell critically ill at the weekend whilst with...(estranged partner in acrimonius dispute).. and they HAVE NEGLECTED him/her"

    I do wonder if some to the OOH and AED increase is a reflection this gaming as the separated parties escalate professional medical attention to "prove they are the better parent" and worthy of custody of the child?
    There must be many "amicable" divorces even involving child custody, but obviously GP's don't get involved in them.

  • Thousands of Summary Care Records created without consent in NHS IT blunder

    Andrew Mimnagh's comment 07 Jan 2013 9:17am

    Not quite the whole truth is it DOH?

    It is the combination of the previous longstanding policy publication of "patients have to opt out" rather than the BMA's preferred "patients must opt in" plus the human error.
    If the DOH had never utilised the "implied consent unless objection recieved" model, the human error could only be " I have failed to create a record on someone who wants one" which is much less detrimental than this occurence.

  • Obesity management 'should be included in QOF'

    Andrew Mimnagh's comment 03 Jan 2013 9:25am

    And the minimum effective length of a motivational interviewing session?
    I don't personally know but I suspect it is longer than the current consultation average.
    The most motivated sucessful longterm weight loss in my practice population seems to be those in the commercial diet and slimming support groups, the least successful the private "pop a pill" medically led sliming clinic.

    It seems to me the
    " I think my weight is someone elses problem to sort out ,so I don't have to try myself"
    mentality with no detectable outcome may be the predictable consequence of "GP ising" weight.

    I must declare an interest ;I suspect I may be on the "compulsory gastric staplling list" of the health facists who require GP's to be vegetrarian olympic fitness standard paragons of virtue to "set the example".

  • Antibiotics dropped from pharmacy access scheme after resistance concerns

    Andrew Mimnagh's comment 02 Jan 2013 10:56am

    Thank goodness common sense has prevailed, its not about stopping use, but ensuring appropiate use.
    Now who is going to address vetinary and agricultural use of antimicrobials?