In 1975, our 3 GP practice in Sussex had a combined list size of 7,500 patients - 24 hrs coverage, including out-of-hours calls and visits, was the norm on a 1:3 schedule, as was the Saturday morning surgery - a round of home visits was the norm Monday to Friday. Sunday was on a call-out basis.
The practice had 2 receptionists and 1 bookkeeper.
None of us were burnt out or 'demoralised.
What happened? You tell me.
Status: -British National, British trained (Edinburgh) and a principal in UK GP practice for 7 years before leaving to practice in Canada.
In 2004, after 30 yrs has a full-time, full service (including hospital in-patient care) GP in Canada, I decided to do UK Locum GP work.
Although it took around 6 months, various documentation and a fee, GMC allowed me to transfer from the Overseas list to the Active List - but only then advised this did not permit me to practice - I would require a Certificate to Practice.
A very long story shortened: of all the 'categories' to obtain the Certificate, 'Equivalence' (as per Dr. Trash) was the only option. Equivalence meaning being able to show that one's training and experience was equivalent to the then GP vocational training programme.
The 'Acquired Rights' route, which one would have thought would be applicable based on UK training and UK GP practice, was deemed not to apply and was only available to graduates from the EU, whether or not they could speak English (in 2004 there was no requirement to show English language proficiency).
Over a 4yr period, 2004 - 2008, all involved 'Committees' maintained that, despite having produced evidence of full & continued Medical Education programmes and peer references of a high quality professional practice, I did not qualify for Equivalence and would need 6 months training the UK practice before a Certificate could be issued.
Needless to say, politely, I told the GMC & their Committees to shove it and challenged their decisions by dragging them to the NHS Litigation Authority. The dossier they presented to the Authority to defend their actions contained factual inaccuracies and misrepresentations, lies really.
Outcome: - NHS Litigation Authority took time to review the situation but ruled in my favour and, again putting it politely, advised the 'talking heads' to get their heads out of the sand and immediately issue me with a Certificate to Practice'. GMC took their time but did so.
So, 4 years is a long time - but as they say, 'it's never over until the fat lady sings'.
In 2008, I returned to UK locum GP practice and then had to deal with Appraisals &, finally, Recertification -successfully.
Along the way, a frequently heard comment from friends and peers was 'You must be mad'. They could have been right - but: -
Illegitimi Non Carborundum.
I was born in Leeds and know Bradford - I would have thought a Bradford GP would have more on his plate than a walk in the park. But then £6.88 is not to be sneezed at - £6.89 would be better, mind.
What a crock.
If 'incidence' is to mean the occurrence, rate, or frequency of a disease, then screening tests neither increase not decrease the incidence' - they may, or may not, detect the presence of a disease.
The Headline is for 5000 per year, the first sentence is for 1500 per year.
Regardless, the practical possibility of achieving any significant increase is zero.
Hunt's previous pipe-dream, which included the pillaging of doctors for other countries, was laughable and its failure confirmatory.
They'll say anything to achieve their primary goal, that of being in 'Power'.
You missed the dark red nail polish which when accompanying the sunglasses used to an odds on bet for a somewhat disturbing past...
My GP career began in the NHS in 1969 and lasted until 1975 when I opted to escape and emigrated to Canada and it's medical care system. Final GP locum work was in 2016 including some returns to England for GP locum work.
Choice of General Practice was on a personal belief that it was the 'backbone' of medical care with GPs providing service to 95% of patients and the other 5% serviced by 'specialists'.
I echo all Dr. Zigmond's comments and they equally apply to Canadian practice.
GPs here insist on the moniker 'Family Physician', when in reality and as described by Dr. Zigmond, they are no such thing: Fragmented care of individuals is the norm.
There are as many, if not more, 'continuing medical education' programs devoted to 'management' 'leadership' etc as there are to actual Medical Disease; the Business Model. Unfortunately, many sponsored by the Medical Associations themselves.
Would be helpful for the test to decribed and named - what biomarkers????
I had a similar experience:- A British National, Edinburgh Graduate working in Canada but doing locums in UK from 2008 - on Sussex & Weald Performers List - recommended Appraisals and Revalidated until 2018 - but kicked off the Performers List because of not having worked in the region for 12 months. When challenged, reason given was 'administrative reasons' - I could 'always re-apply'. Right.
Prior to that I had a 4 yr battle, ending with the NHS Litigation Authority, to obtain a Certificate to Practice. Despite being a Principal in UK General Practice for 5 years before leaving for Canada, followed by 35 yrs as a fully certified Canadian GP, I was deemed ineligible to practice and would have to go back into training for 6 months. Right.
If I had been trained elsewhere in the EU, the Certificate would have been granted automatically (and at that time without any need to show English language ability).
My 40 yrs of total GP experience was deemed not 'Equivalent' to the 2 year GP vocational training program - which did not exist when I qualified.
Anyway, the NHS Litigation Authority ruled in my favour and instructed the various GMC Committees to (get a life and) issue the Certificate.
I'm now retired!!!!!
All correct except advising a 'dummy' - the sucking on which results in aerophagy, resulting in gastric distention, resulting in bloating, discomfort, burping et al .......?colic & GERD.
And a quick wipe on the sleeve after the repeated drops to the floor (the dummy, not the baby) is not very antibacterial.
Unless toxic level doses are taken there is no harm in Vit D supplementation - other benefits of supplementation are recorded.
No need to test and waste money, simply add RDA Vit D to the COPD regimen.
p.s. include all Scots with or without COPD!!
The RCGP should stick to GP & in-the-field medical issues - and try to get those right - they have no mandate to don a mantle of political direction purporting to be representative of its membership.
There's so much wrong with this decision, difficult to know where to start. Except within the confines of their particular practice, 'specialists' overall know less about medicine in general and less about other 'specialists' practice than do general practioners.
Ask the dermatologist about medications or current protocols for heart failure or the cardiologist for targeted therapy with biologic agents.
The old maxim that specialists know more and more about less and less until they know all about nothing has validity.
They certainly have no insight, nor wish to have, into the actual lifes of patients.
Still, since there is little known about the real, rather than anecdotal, therapeutic benefits of cannabis, maybe that 'nothing' will fit well with their practices.
Whether cannabis should be prescribed at all, whether it should be decriminalised or legalised (as per Canada Oct. 2018) is the fundamental question.
However that question is answered it should be on based on the BIo-Psycho-Social Model. If it is to be prescribable, it is the GP who works within that framework, not any of the anatomically / system based specialists.
Until cannabis has been vetted in clinical trials as any other pharmaceutical / 'drug' and has been determined to efficacious and safe, it should not be a prescribable medication, by anyone.
Finally, maybe there is something in the distorted thinking that only a 'specialist doctor' can prescribe unlicensed medicines, this on the base that they will not know anything about it anyway.
Nothing could be clearer about the GMC's lowly view of General Practice as a 'decision must made only by a secialist doctor - not a GP'. Apparently supported by the BMA GP Committee's endorsement.
If the 'Specialists' had any sense they would refuse to accept this politicised responsibility.
At age 70, the CV risk based on age alone is 10% and the risk is stated to double every 7- 8yrs.
Medical marijuana has been prescribable for years in Canada, and it soon be fully legalised - nontheless the deaths from opiate overdoses continue to rise. British Columbia has the highest rate where it's about 4 per day, though March was high at 162 and July 134.
So that's one argument out the window.
Agree with David Banner's commentary.
Marijuana will be fully legalised in Canada this year after being available as 'medical marijuana' for a number of years. it is an entirley political decision unrelated to factual, data based evidence for efficacy in any but a very small cohort of medical disorders, e.g. reduction of seizures in Dravet's syndrome.
It's political philosophy/stance is to 'protect our youth and to get the criminals off the streets', verbatim from the Provinical and Federal Ministers responsible.
This is rhetoric and nonsense, if only because of the same intention relating to the succes of keeping alcohol and cigarettes out of the hands of the underaged. What a joke. Current study estimates that around 43% of 15-19yr old use, or have used, marujuana, and this while has been illegal.
There are currently 111 licensed commercial growers in Canada and the estimate of their combined production is over 400 tons annually of dried marijuanaamte. The 'average' joint is stated to contain about 0.5 grams. You work it out
Additionally, every household will be legally entitled to grow 4 plants for their 'own' use.
This is sheer madness and a long term social distaster in the making.
Canada will become the new Panama-Columbia. The largest Canadian grower, Canopy Growth, which has 1,000,000 sq ft of greenhouse space, already exports to Germany.
The only benefit for physicans will be that the 'needy' requests for 'medical' marijuana will be more easily refused.
Regarding prescribing marijuana, it is akin to precribing a bunch of foxgloves t.i.d. for heart failure.
Clear conflict of interest. As well as been a shameful proposal, it yet again illustrates the completely different and divergent mindsets of the bureaucrats 'managing' the NHS to those of physicians. A general misunderstanding of how the practice of medicine functions.
Based on her undoubtedly vast field experience in the actual provision of General Practice primary care, ask her how many patients per hour and how many work hours per week she would deem necessary for GPs to be recognised as 'delivering enough'.