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A faulty production line

Andrew Mimnagh

  • International doctors advised they have 'strong legal case' against RCGP exam

    Andrew Mimnagh's comment 31 Dec 2012 5:55pm

    I do not know the merits of the specific issue but would make two general points.
    1) Every loosing party in a court case has a lawyer who advised them " you have a strong case" so the only certain winner is the legal profession.
    2) an examination based on knowledge of the prevalance of and consensus management of illness in a geographical location is likely to favour those who trained or have practiced extensively in that location.
    I suspect my personal deficiency in the knowledge of the management of venomous snake/lizard and spider bite may mean I do rather poorly in an Australian higher professional exam.

  • Managers admit evidence to support continuation of QP indicators is limited

    Andrew Mimnagh's comment 21 Dec 2012 3:50pm

    Regarding request for enlightenment on:-
    "It appears to be a system that distracts GPs from their main task, gives them something to do while their sphere of competence is eroded and at the same time does nothing whatsoever to reduce the incidence or prevalence of chronic or acute disease."

    I suspect it is you should be giving us the enlightenment ,as that looks a pretty acurate global assessment to me.
    There are limited examples of subsets that buck the trend , but the overall package, especially the 2013 indicators would fit that observation nicely.

  • Buckman scotches commissioning boycott ‘rumours’

    Andrew Mimnagh's comment 03 Dec 2012 3:56pm

    Having attended the LMC secretary conference and heard the souce discussion I think it important to put this topic in context.
    The GPC where in usual negotiations with NHS bodies , it is purely when a government bully boy ultimatum of "we are imposing a contract again, come and choose how you will be hurt" that they declined.
    It was said experienced civil servants form the "other side" where personally emabrassed and dismayed at the political hardening of what had been productive negotiation to that point.
    I do feel the stance of " we do not negotiate on an imposition , only on matters for mutual agreement" is the correct ethical response in all circumstances.
    Undoubtedly when the imposition is revealed the GPC will be vocifereous in outlining the impositions many shortcomings.

    This is sensibly waiting for the target to appear before shooting, not a deficit of ideas.

    We have an unspoken difficulty in that the profession has never been more divided;
    those with ideological opposition to "market forces" seeking to derail clinical commissioning "on principle", whilst simultaenously "G.P.preneurs"- I believe from DDRB data about 90 around the country with multiple medical and pharmacy contracts do earn the kind of figure the "Daily Mail" bandies as the GP norm rather than the extreme outlier result.
    Although I hate to generalise, as some are rural dispening practices unable to be excused 24 hour responsibility, some undoubtedly have embraced the free market ethos of the previous 3 Conservative, 3 Labour and current coalition governments.
    Add in the "profit sharing partner" vs salaried vs sessional performer tensions we see around us on finances, education, revalidation and the reality of leadership becomes clear.
    You can only lead people in the general direction that those following wish to go.
    We are currently a divided profession and unable to give a unifying manadate of support to our leaders.

    I defy anyone without messianic personal attributes to be an effective leader of this riven profession.

    This is the time to build common purpose in the GP grass roots and reflect on the core values of our profession.
    If we can agree an agenda we would all be in agreement to follow, then I suspect you would find our leaders to be most effective

  • Family photographs

    Andrew Mimnagh's comment 03 Dec 2012 3:42pm

    Hazel and Teresa are both right right.
    My single handed GP trainer ,(God rest you Peter), in a deprived area was very clear on the matter for the community of practice of his day he told me to paraphrase ,:-
    it shows you are human , have a life and understand their issues;It also shows you are human not some robot to be called out without thought.

    This was when he worked a 1:1.
    He had moved the consultation site from his residence into a health centre, then moved to a modified dwelling as the health centre was "too impersonal".
    His medicine was a vocation a way of life,;his consutation room was his private space he happily shared with know patients, but not the "public".
    Today in our spotless souless scrupulosly clean "clinical areas" with strict working time limits and statutory breaks these objects are an anathema.
    But look how easily we have moved from "vocation" to " job" in one generation.
    Why as we are entreated to regard patients as "indivdual and unique" do we find Doctors are required to be faceless and generic?

  • CCGs to influence GP contracts

    Andrew Mimnagh's comment 26 Nov 2012 11:28am

    I sometimes get the feeling this is a mechanism to ensure that future primary care can only be commissioned outwith general practice, by waving conflict of interest flags.
    Provided CCG appreciate they can commission from practices subject to appropriate negotiations with a Local Medical Committee then I am less troubled.
    Where there is an issue is where the CCG and the LMC areas are co terminous as it cannot take an indisputable "independent probity stance" if the same members are in both organisations.

  • Study finds no evidence to support GPs in A&E wards

    Andrew Mimnagh's comment 23 Nov 2012 12:26pm

    Steve Kell is right- the dynamic is always :- "A generalist undertakes activity usually done by specialist, uses fewer widgets, gets caught by the rare exception case( that would have been picked up by the specialist usual custom and practice) and is quality manged into behaving exactly like a specialist thereafter."
    Specialist /generalist are complementary roles.
    "which is best" seems to me to be a chalk and cheese discussion, which has always smouldered on, historically fostered by overly self opinionated clinicans on both sides, currently fanned into a conflagration by a DOH that thrives on the ill willl and fractionation of the medical profession that results.

  • CCG constitutions legally binding whether signed or not

    Andrew Mimnagh's comment 14 Nov 2012 4:14pm

    I have just completed drafting a contract with her majesty's government entering into a partnership with myself and claim a 50% equity of the gross national product of the United Kingdom Of Great Britain and Northern Ireland.
    Unfortunately a party to the contract has not signed it , but I am so glad it is binding.
    I regret I do not consent to any other person entering the partnership, but I will think of you all when I am reclining on the 50% timeshare on Necker Island courtesy of the other contract that another party to the contract also has not signed but is clearly binding by the same peverse logic.
    I am also marrying Kathryn Jenkins without her being present or signing the marriage contract, to accompany me.
    I cannot believe anyone seriously belives that several hundred years of contract law can be dispensed with in the manner the government suggests.
    "the Party of Business" - not if they do not know contract law.

  • NCAS reports sharp drop in GP suspensions

    Andrew Mimnagh's comment 05 Oct 2012 6:46pm

    It is sad that the tone of official comment from NCAS on the drop in issues in general practice is again presumptive of guilt and may be summarised as"they are happening but we are not finding them."
    I am aware of a difference between NHS Sefton PCT which has had 100% GP appraisal uptake for many years and an adjacent PCT which has never attained 100% uptake ,in terms of number of performers under investigation. Fewer where more comprehensive appraisal coverage has occured.
    I personally hope the ftrend shows us the profession have "worked through the backlog" and that the time and effort expended on appraisal and revalidation is being rewarded with higher professional standards of practice.
    Let us also be aware that NCAS does operate an excellent assessment of health performers , but on a "paid per case" basis so there is a vested financial interest in Lynn Hugos comment about maintaining a high referal rate to the service