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d in vadar

  • No evidence that online consultations save time, says CCG

    d in vadar's comment 23 Aug 2019 1:55pm

    how to further de skill you medical team as a social experiment - total stupidity. You will reap what you have sown. expect more acute emergencies for missed diagnosis in A&E and later presentations of cancer. the madness continues.

  • Out-of-area regulations should be scrapped, says BMA

    d in vadar's comment 20 Aug 2019 3:49pm

    and that's going to work how in the real world?

  • GPs told to stop closing for half-days or risk losing £40k in funding

    d in vadar's comment 20 Aug 2019 2:48pm

    cant find anything for 2018, evidence is from 2016 survey, anyone got anything later than this?, report does not include actual figures on what they mean by closure and if surgeries are closing branch surgeries or not. if closed for training sessions. it states in the report when surgeries have less than 2500 patients they are more likely to close earlier and have more patients go to A^E but the figures are small. there were 7600 surgeries at the time of this survey. I don't think the pulse comments are properly evidence based, perhaps pulse should do its own audit.

    national sudit report for 2016

    42 Appendix Two Improving patient access to general practice
    Appendix Two
    Our evidence base
    1
    We reached our independent conclusions on whether the Department of Health (the Department) and NHS England were implementing their objectives for access to general practice effectively after analysing evidence that we collected between April and September 2016. Our audit approach is outlined in Appendix One.
    2
    We conducted nine case study visits to local commissioners:

    We visited three NHS England local area teams, as well as two clinical commissioning groups within each area team that had taken on some commissioning responsibility since April 2015.

    We selected our case study locations to reflect key factors including general practice performance and location.

    The case study visits consisted of interviews with key staff involved in the commissioning and contracting of general practice services. We also collected a range of supporting data and documentation from each commissioner.

    The case study visits were designed to assess similarities and differences in monitoring and managing access, to identify the challenges faced by local commissioners, and to assess the quality of support provided by national bodies.
    3
    We commissioned medeConnect to conduct a short survey about GPs’ expectations and experiences of commissioning. The survey was carried out in August 2016 using an existing research community of doctors, from which medeConnect recruited a regionally representative sample of 839 GPs. We used the survey to explore expectations about access, opinions on contract and performance management, and views on the support given to practices. In reporting the findings, we have calculated percentages as a proportion of total responses, including those that answered “Don’t know/Not applicable”.
    Improving patient access to general practice Appendix Two 43
    4
    We surveyed GP inspectors in the Care Quality Commission about their experiences of commissioning in general practice. The survey was sent via email to approximately 190 inspectors in September 2016. We had responses from 75 inspectors, a response rate of 39%. We used the survey to capture inspectors’ views on the availability of information on access, the ability of practices to provide good access and the quality of monitoring and support provided by commissioners. Some inspectors did not answer every question. Non-responses have been excluded from the analysis; these non-responses were no more than seven for any question. We have included those that answered “Don’t know/Not applicable” when calculating percentages.
    5
    We analysed existing data on access and capacity. We looked at data from the GP Patient Survey for 2014-15 and 2015-16, data on opening times for October 2014 and October 2015, data on payments to general practice in 2014-15 and 2015‑16, and data on staffing in general practice at September 2014 and September 2015. We used these to reveal numbers and regional variation in practices closing on weekday afternoons.
    6
    We carried out regression analyses to investigate key associations between opening times, funding and indicators of access, including patient experience and A&E attendances. In carrying out these analyses, we controlled for patient profiles at each practice, staffing levels and some practice and clinical commissioning group‑level characteristics.
    7
    We reviewed the activity and workforce models developed by NHS England and Health Education England. We assessed the methods they use to calculate how many GPs and other staff the system will need going forward, and tested the assumptions these models used. This helped us assess the robustness of their workforce planning.
    8
    We reviewed the available evidence on how well NHS England and Health Education England had implemented their initiatives to improve access and capacity. These initiatives included the GP Access Fund, the Supporting Vulnerable Practices programme, and the Clinical Pharmacists in General Practice pilot. Where it was available, we assessed emerging evidence on the impact that these initiatives have had on access and capacity.
    9
    We spoke to a range of staff across the Department, NHS England and Health Education England. This was to understand how they had set objectives for access, how they were monitoring objectives and how they were supporting general practice to achieve these objectives. We spoke to representatives covering topics including contracting in general practice, the GP Access Fund, digital developments and workforce planning and development.

  • Coroner urges revision of mental health referral form after 15-year-old boy dies

    d in vadar's comment 20 Aug 2019 2:25pm

    you do an urgent referral they get rejected, family take to A^E they get seen by cams. tells you all you need to know about the service. i send a referral letter with the form back with lots of IDK in them. pointless

  • Government urges GPs to promote catch-up MMR vaccines

    d in vadar's comment 19 Aug 2019 1:55pm

    offer cash or a smart phone. nothing else has worked. just a thought

  • GPs told to stop closing for half-days or risk losing £40k in funding

    d in vadar's comment 19 Aug 2019 1:42pm

    you are legally obliged, as an employer, to provide a break after 6 hours of continuous work. so the being open for 52 hours plus for a single handed GP is illegal if they don't shut the practice for a lunch break. just saying.

  • ​Genomic testing in five million patients could worsen GP workforce problems

    d in vadar's comment 16 Aug 2019 1:49pm

    why would you want to know? Why would you want to live an extra long life? if you don't smoke, exercise, normal weight and eat healthily, drink sensibly and lead a stress free life, not much else is going to significantly reduce your risk for any of these conditions, unless you have a strong genetic risk and then you are screwed anyway and I could pick that up from a family history. Plus who has access to the database and your personal genome? If a company sequences the DNA who owns the sequence? you or them? scary stuff.

  • GP referrals being knocked back by referral management system

    d in vadar's comment 16 Aug 2019 1:42pm

    several of my patients have moved house to access NHS services not available or funded in the former CCG. I think this is more common than we realise or care to admit too.

  • GPs should not prescribe antibiotics for impetigo, says NICE

    d in vadar's comment 16 Aug 2019 1:36pm

    i don't this is particularly aimed at GPs as most of them know when and what to use for impetigo. Trouble is most of these cases are now being seen by noctors without our level of experience or training and treat everything regardless and in combinations still. All the recent evidence shows that GPs are reducing their prescribing of antibiotics. Some one has to say whats best to use and when somewhere based on the best evidence available or experts in their fields, otherwise its a free for all. As very few parents would enrol their kids in a research study to see what would be the best way to prevent sepsis one is not going to have much evidence to go on. Fortunately more studies are now being done in children so perhaps the guidelines will improve. Until then its all we have. There is a cohort of GPs who comment on new guidelines and how it effects general practice and NICE are starting to listen to what they have to say. However they don't have control over primary care funding or lack of, as is the case, which is hampering the implementation of lots of these guidelines. they should really be called current reasonable best practice and aspirations rather than guidelines. British farmers have strict rules on the use of antibiotics and also don't want to use them as much as we do. they don't treat UTI in cows, for instance. where they are used, as growth promoters, is a major issue worldwide. perhaps if we ate less pork and chicken and up the price to cover the actual cost of raising farmstock without antibiotics then this would prevent their over usage.

  • Jo Churchill named as new primary care minister

    d in vadar's comment 16 Aug 2019 1:14pm

    she has never worked in the NHS, nadine dorries was a nurse for less than 7 years and left in 1982 - according to both CVs on line. So they have NO recent or valid experience in primary care and feel they have the right to tell me how to do my job. I don't think so.
    Time to remove NHS decisions from parliament control. If they have no valid primary care experience they should not be put in these roles. Would you board a plane with a pilot who has never flown a plane before? because that's how dangerous it is. You make a bad decision at the top and peoples lives are at risk.

  • Government to end 'one-size-fits-all' NHS Health Checks

    d in vadar's comment 16 Aug 2019 12:59pm

    save far more money and lives by banning smoking - just saying

  • Over 50% of patients find it hard to get an appointment with a GP, survey finds

    d in vadar's comment 14 Aug 2019 10:00am

    i once saw a mother with a small child who wanted a emergency appointment and was squeezed in to see me. they came with grandma. Grandma stated the child had a cold and was fine, the daughter was adamant the child was seriously ill and needed to be seen. Grandma was right. This generation of parents are insecure, anxious ridden and over protective. They panic if they make a mistake they will be referred to SS and have their kids removed into care or punished. we should be allowed, as medical professionals, to set boundaries again on patient behaviour and refuse to do work that is not in our remit. We should be allowed to say No without fear of complaint or referral to the GMC. Until then this madness will continue and only get worse.

  • Digital provider secures deal to offer video consultations in 150 NHS practices

    d in vadar's comment 13 Aug 2019 5:27pm

    it will fill up once patients know about it and then there will be a waiting list of over 2 weeks again. its just moving the goal posts. might mean less people crashing into my car in the car park though. personally I don't like phone calls or video chats so this will be a major boost to my early retirement plans.

  • Almost 97% of 'out-of-area' mental health patients are inappropriate

    d in vadar's comment 12 Aug 2019 1:37pm

    is that they were sent inappropriately outside of the area but needed a bed or that they didn't need to be admitted and also sent out of area. I thought all the pysch beds were being closed and care in the community was taking its place, so why are they not being cared for in the community? I was told this was the gold standard which was why a 1/4 of our local pysch beds were cut. strange times.

  • Average GP waiting times exceed two weeks for first time ever

    d in vadar's comment 12 Aug 2019 11:19am

    only allow one week ahead appointments and problem sorted which is what quite a few practices are now doing to try and relieve the issue. even so extra so called 'emergencies' and phone calls up the workload and make the job unpleasant. even with ANP and paramedic support you still get booked to see the patients they cant sort out - which is still quite a lot of appointments. either way the issue is lack of experienced GPs, space and remuneration. as it appears this is unlikely to be addressed in the near future watch the exodus continue. one third of all family doctors in Europe are over 55 years now. doctors are not going to come here from there and elsewhere they would make more money in the US or Canada. its simple economics. plus stealing doctors from developing countries is counterproductive, it just drives up immigration to developed ones so you end up needing more resources anyway. perhaps its time for a national debate on how we fund the NHS in the future and what it will and will not cover.

  • GP settings in medical school imagery 'significantly underrepresented'

    d in vadar's comment 09 Aug 2019 3:56pm

    perhaps its time to have medical schools for hospital consultants and medicals schools for primary care specialists only - now there's a thought. don't like the one you have to retrain in the other.

  • Locum GPs may still face ‘unfair’ pension rules despite new proposals

    d in vadar's comment 09 Aug 2019 3:48pm

    not encouraging young doctors to stay in the UK as it is. shameful.

  • Asthma deaths highest in a decade

    d in vadar's comment 09 Aug 2019 2:32pm

    the actual numbers would go up as we have a bigger population. Most of the deaths are in the very elderly so not really sure why this is an issue. recording of asthma in the elderly with copd attracts more qof payments rather than just coding for one or the other. As practices introduced spirometry in the 2000s its not surprising there is more coding for asthma.
    It is interesting that deaths were dropping after the introduction of QOF and spirometry into general practice and the introduction of new inhalers such as lamas and montelukast but this has gone backwards since 2008 - the time of the financial crash - followed by over 10 years of chronic underfunding of the NHS and loss of staff. this is also combined with poverty, use of food banks and poorer diets and removal of local transport causing more car use and hence road pollution, such that levels are regularly at unsafe levels, even in less urban levels. 5% of all lung cancer worldwide is due to pollution. If this amount of pollution is damaging lungs to cause cancer its not surprising their is now more asthma in the UK and elsewhere in the world.
    So you have a multi factorial issue which cannot be solved by blaming one thing in particular.
    Changing QOF is pointless if you don't have the trained staff in the first place. Considering primary care is becoming more on line and these patients are less likely to see a doctor or having staff to listen to their chest the prognosis for asthma detection is going to be poor. Not listening to patients chests also misses heart valve problems and CCF which i commonly pick as causes of wheeze and sob and are regularly missed. Having today recoded a patient from supposedly having asthma despite normal spirometry to bronchiectasis and emphysema confirmed on a cat scan - to actually make such diagnoses are not that easy and takes years of experience which is certainly not reflected in the QOF payments for the time involved. To do the job effectively takes training, mentoring and having adequate resources to do the job including longer appointments. But if pollution levels increase, as they are, i can prescribe all the inhalers in the world and it will not much make that much difference unless we change our own behaviour as a population. I suggest pollution masks to my own patients to protect their lungs especially if they cycle in traffic on a regular basis. I find it really sad that i have to advise this in the UK now.

  • GPs could prescribe medicinal cannabis under shared care arrangements, says NICE

    d in vadar's comment 09 Aug 2019 1:57pm

    not appropriate for primary care

  • GPs set to be given greater flexibility over pensions contributions

    d in vadar's comment 07 Aug 2019 11:41am

    not enough to stop me leaving early. won't work cause still issue of too much tax, loss of personal allowance contributions and affects any benefits you may be allowed to have. capita still not sorted out lost pension contributions for last 10 years and why would you want to work in the NHS anyway. this is about extra sessions as overtime due to lack of staff - they are under no obligation to do the work. why not sort out the underlying issues - poor pay, poor working conditions, excessive workload and the NHS bullying culture first and you wouldn't need the overtime in the first place.