This site is intended for health professionals only

At the heart of general practice since 1960

pulse june2020 80x101px
Read the latest issue online

GPs go forth


  • GPs' working conditions are 'lonely' and 'damage' patient relationship, warns GMC

    ObiOne's comment 15 Nov 2019 10:56am

    Health secretaries, and in fact everyone working at the department of health should have to apply to be on a GMC register, and face the same scrutiny as doctors.
    Or in fact the slightly stricter enforcement by the NMC.

    Would see quite a few struck off for dishonesty.

  • Do you want to be stranded at the top of your licence?

    ObiOne's comment 12 Nov 2019 11:37am

    Does practicing at the top of our licence mean we can tell politicians and other health care professionals to get lost when they say GPs are best placed to:
    - Do welfare checks
    - Check the central heating
    - Address loneliness
    - organise blood tests
    - coordinate social services
    - fill in referral forms
    - Address DNAs or bounced referrals

    None of those tasks are working at the top of our licence -and all those tasks should be shelved and passed on to someone cheaper. The ONLY reason they are done by a GP is that the unique way GPs are paid means that it seems to come across as 'free' if the work lands at the door of a GP.

  • A honeymoon period in the PCN marriages of convenience?

    ObiOne's comment 04 Nov 2019 12:53pm

    There really should be some control areas.

    Like a few areas where the same amount of funding was given directly to practices, with a review in 6/12/24/36 months to decide which way works best.

    I (and almost every GP in the country) would agree that giving the money directly to practices is more efficient. I would automatically save thousands per practice in:
    -clinical director costs
    -legal costs
    -accountant costs

    And mean that practices would be able to be more agile with their spending decisions. Maybe one practice could do with a pharmacist, another with a physio.
    Maybe one practice has too many clinical staff already, but patients struggle to make appointments/ get through on the phone - they need a receptionist not another pharmacist.

    And practices who struggle to recruit one particular professional can spend the money where they see the most efficient outcomes.

    Anyway - we wouldn't want evidence to get in the way of policy, so best not to trial it properly.

  • CQC chief inspector: no 'concessions' will be made for GP capacity issues

    ObiOne's comment 25 Oct 2019 11:56am

    So the CQC can blame practices with under recruitment - or blame the department of health who are the ones actually tasked with making sure there are enough GPs.

    They are choosing to blame individual practices rather than central government.

    This definitely is not related to the fact that central government appoint and pay the people in charge of the CQC.

  • BMA: Government pensions plans are 'worthless' and won't stop GP retirements

    ObiOne's comment 24 Oct 2019 7:11pm

    It seems they think about what is the minimum possible they can do to appease the complainers rather than thinking it is actually an opportunity to increase the supply of medical advice in a system that is creaking at the seams.

    Just think bigger, how about the nhs pension scheme pays all annual allowance tax for anyone in the nhs pension scheme. Not out of your pot, just pays as part of the contract from central government.

  • MDU admits 'dwindling funds' to cover GPs' future claims

    ObiOne's comment 23 Oct 2019 1:28pm

    @Meg and others who are worried:
    - I suspect you might be left with having to pay an extra premium to get your backlog of protection covered by the government. Which will actually probably be less than the gap between what you actually paid and what the MPS members paid.

    So the government might say that they want 30k to take on the lifetime risk of litigation from previous years (per member), the MDU are arguing for 25k, but government is not budging - they are likely to ask members to pony up for the remaining 5k.

    The numbers are guesses - it could be 100k and 60k - meaning a much bigger bill of 40k, but i suspect that the bill would be in the order of 4 figures (i.e. 1-10k).

  • Outgoing RCGP chair to head new social prescribing academy

    ObiOne's comment 23 Oct 2019 1:23pm

    “social prescriptions on the NHS as readily as they do medical care.“
    So a service that is so underfunded that you get some attention much later than you should and so understaffed that you get a maximum of 7 Minutes a month with a suitable member of the team - and then only if you are skilled enough to game the appointment system.

  • NHS trusts ask GP practices to identify overseas patients when referring

    ObiOne's comment 22 Oct 2019 3:00pm

    CDR - because you don't have permission to share that information.

    I really don't think it counts under the implied consent that you have to share information about the patient's medical problems. I don't think it counts as a serious arrestable offence or significant harm to a named/ specified individual.

    So if you share it you are breaking rules related to good medical practice and data handling.

    I do agree that it being optional is good - but I would want to specifically get permission (express consent) from the patient before ticking the box.

  • NHS trusts ask GP practices to identify overseas patients when referring

    ObiOne's comment 22 Oct 2019 2:14pm

    @Mark (and others)

    IF the patient says they want a referral to the NHS hospital, but do not want you to tell them that they have only been in the country for 3 months - what would you do? You would certainly warn the patient that they should be charged for their care (more than the cost of treatment if I remember correctly), but they still say they do not want you to share that data.

    I supposed you could add a comment - 'as far as I am aware this patient is entitled to free NHS secondary care' to all referrals, and leave it out of this referral. That would work very well with a tick box that you couldn't tick for this patient.

    But the opposite in that specifically pointing out how long they have lived in the country without their permission is probably not allowed. That would be sharing information that is not relevant to their medical problem, specifically for the reasons of billing the patient, specifically against their consent.

    It puts GPs in a complicated position. But when that happens you tend to be less likely to be blamed if you put the patient first, unless required to do so by law.
    - someone planning a terrorist attack, call the police.
    - someone who stole an apple from the grocers - ignore it.
    - Someone planning to stab their partner, call the police
    - Someone planning to fraudulently view sports online, ignore it.
    - Someone planning to fraudulently access free medical care - ??? - I would ignore it.

  • MDU admits 'dwindling funds' to cover GPs' future claims

    ObiOne's comment 22 Oct 2019 1:55pm

    Hmmm... the government has agreed a deal with the MDDUS and MPS, but the MDU says that the government is not engaging.

    None of us think that they will back one organisation over another - it is just the MDU looking to do it on the cheap, because they have undercharged.

  • NHS trusts ask GP practices to identify overseas patients when referring

    ObiOne's comment 21 Oct 2019 11:20pm

    That will be a no.

    Surely you can only put something in a referral that is relevant and what the patient consents you to share. There is an implied consent that you will tell the hospital that the patient has chest pain, high blood pressure etc.

    But no implied consent to share residency status.

  • NHS review calls for GP financial incentives to boost screening uptake

    ObiOne's comment 17 Oct 2019 11:11am

    As per Shabi

    If incentivising screening, there must be equal payment for someone who has informed dissent.
    AND practices should not be judged (negatively) on high ‘exception reports’ as it probably just represents better consent.

  • Lower GP practice ratings due to workforce and demand issues, says CQC

    ObiOne's comment 15 Oct 2019 3:12pm

    If there is a 'trend' to drop grade based on difficulty meeting demand; then there needs to be a re-think about the required standard.

    The standard should be normative - that is to say that a comparison is made to the typical standard of other practices. Otherwise the trend just represents an expected worsening of performance because the resources provided do not match the demand. If it is a trend to get worse then criticism should be reserved for Whitehall/ NHS England or those who negotiate the GP pay uplifts.

    If the assessment is accurate and normative, then there should always be a similar number of practices not making the grade.

  • Doctors with dyslexia are less likely to pass the CSA exam

    ObiOne's comment 30 Sep 2019 5:37pm

    This was d

    So while I know my opinion my not be popular, I just think I should clarify what I think.

    I am absolutely happy for more time to be available for the AKT. That mode of examination is not the same as practice and does not test the same things as running a consultation.

    But if (and a big if) the point of CSA is to match the environment that a GP works on a day to day basis, the ability to pass the CSA should be the same as the ability to safely run a clinic.

    If the two don't match, then the exam needs to be updated or scrapped.
    If the two do match then the ability of certain groups of individuals to have adjustments must be made carefully. It should only be what is available in actual practice; and therefore should be available for everyone.

    If, for example, you need more time to accurately read the notes in the CSA, you would need more time to accurately read the notes in real life. If that is acceptable in real life, then more time should be available to all in the CSA. If that is not acceptable in real life, then you cannot have GPs passing the CSA just setting themselves up to fail in real life.

  • Doctors with dyslexia are less likely to pass the CSA exam

    ObiOne's comment 29 Sep 2019 1:50pm

    So the CSA should be assessing a standard that is the absolute base minimum to be an adequate GP.
    If you are just about good enough to be a GP you should scrape through the exam.
    If you are not good enough to be a GP, by only a little bit, then you should fail the exam by one mark.

    If there are adjustments that are reasonable for GPs to make in their working life, then ALL GPs can make them, and that should be allowed in the CSA for everyone.
    If there are adjustments that are not reasonable for GPs to make in their working life, then they shouldn't be allowed for those with extenuating circumstances.

    So needing lots of paper - allowed, for everyone.
    But needing more time, extra breaks or colour coded numbers - unrealistic in the GP surgery - so should be declined in the CSA.

    This is likely to be an unpopular opinion - but ultimately if this is an accurate assessment of the minimum standard to become a GP, then there should be no reason to lower that standard, at all.

  • GPs requesting ambulance will have to provide a score for level of emergency

    ObiOne's comment 27 Sep 2019 10:35pm

    I have to say that the whole reason I am paid well over 100k, is because I can do more than just a NEWS score. If life was as easy as a score, then there would not be a need for a GP.

    The patients I remember the most are:
    1 - the chap who basically presented with a migraine, who I still sent to hospital 'for no particular reason' - had a CT and had a glioma.
    2 - The child who had normal obs, but the parents 'knew' something was wrong. I admitted to hospital in an ambulance where he remained for 3 weeks.
    3 - And of course the one that I got wrong and will remember forever.

    What is similar about all those cases - is they would have scored 1 or 0 on NEWS2. And at lease cases 2 and 3 benefitted from a more urgent response. For what it is worth I think I score 4 based on BP and pulse, sometimes 6!

    I suspect I will be learning where the cut off is and their NEWS2 score will seem to be directly related to how quickly I think they need an ambulance - i.e. there will be a lot of 7s. I suspect that a national audit of GP ambulance referrals will have a fairly 'unusual' distribution of NEWS2 scores particularly around the number 7.

  • What do the pensions proposals mean for GPs?

    ObiOne's comment 12 Sep 2019 9:46am

    So the problem (for GPs specifically) is that when people were opting out of the scheme they were electing to work a lot less. This is because of the large increase in actual income (about 1/3rd before tax) mean that they had more income. Or it meant that they were being pushed in to a penalty tax bracket (e.g. just over 100k) meaning that they would not be much worse off working less.

    So someone working 8 sessions for 100k income and 28k pension contributions, comes out the scheme and earns 128k, but a huge amount of that extra 28k goes on tax/ lost child benefit etc. They instead choose to work 6 sessions for just under 100k.

    All these changes will do is accelerate that process. It IS better for the individual than the current all or nothing situation.
    However it is idiotic for the NHS, will do nothing to improve retention and nothing to encourage GPs to work more hours/ closer to full time.

    This problem will get a LOT worse come April 2020 when the 'reward' for dropping out of the pension scheme will be much greater.

    What the government needs to do is incentivise doctors heavily to work full time and in particular for many years.

    It is like a system is needed to reward clinicians for working many years as a GP. It can be incremental and increase the longer you work for the NHS as a GP partner. I can start after 6 years of practice and be just a few hundred pounds per year; but increase dramatically and once working for 30 years payments should be significant, lets say 15k or more.

    I would call it 'seniority' or something similar.

  • London GPs told to cut back out-of-area hospital referrals

    ObiOne's comment 10 Sep 2019 9:07am

    All of these:

    "-Repatriation of 15% of elective work referred out of sector back to acute providers;
    -Significantly reducing consultant to consultant referrals, follow ups and outpatient procedures;
    -Reducing the £18m spent on over-the-counter medicines."

    Sound like generating a lot of extra work for GPs - an area which is not exactly overflowing with surplus resources.

    It will have a knock on effect that is hard to measure beforehand, but that does not make it any less expensive. Just because it is hard to predict how expensive that will be - does not mean it should be ignored.

    Emergency hospital admissions can be reduced by taking work away from GP practices - not by creating more work for GP practices.
    That will save a lot more money than a few dodgy referrals.

    If you don't want consultants to do the referrals - then commission a service (not involving GPs!) to do the work instead. P erhaps a group of nurses and administrators that actually manage the referrals (getting all the workup done and organising and acting on advice) rather than just a yes/no gate.

    That is likely to be much cheaper than using GPs overall - it is just that the funding has to come out of the CCG rather than out of the other workload of the GPs.

  • Pharmacist to dispense high-dose statins without GP prescription under NHS plans

    ObiOne's comment 05 Sep 2019 2:12pm

    Although I think it won't work with statins, I do think the underlying theme is a good idea.

    So many things get moved to the GP domain - from hospitals and the general public. That for once it is a good idea to move something away from GPs.

    But before considering statins how about asking someone else to sort out:
    -people who break up with their boy/girl-friend
    -people who refuse to go to school
    -children who behave badly because they have terrible parents
    -anything that is at all related to a tooth
    -anything that is related to gardening and home maintenance
    -anything which needs a letter from a doctor just to prove the patient is not lying; including MED3s and benefit claims
    -anything which is at all related to occupational health.

    There are literally HUNDREDS of things which are more important to move out of GP care than actual medicines. Start with those first.

  • GP earnings rise by 2.5% as expenses hit 'record high', reveals new data

    ObiOne's comment 30 Aug 2019 12:54pm

    Maybe some unpopular replies here:

    - The 113k figure is the average for a partner, who is working an average of 3.5 sessions/ week. Many people find partnership work much more enjoyable than being a locum. Importantly partnership income is much more variable.
    You are in a sense correct, I would want almost twice that to be a partner - which is exactly what happens.

    Anonymouse3 - you are right - there are plenty of people earning a lot more than the average. If you look a the profit bands in the raw data some 15% earn above 150k and 4% above 200k. These percentages are of ALL GPs not just full time/ 9 session GPs and are reported clear profit after all expenses including indemnity, but before tax.

    I think the hidden understanding behind these figures often prevents talented GPs from becoming partners - particularly in comparison to being a locum. But the highest earning GPs are still partners, not locums. My partners and I earn more per session than a locum (albeit probably work a harder/ busier session).

    My apparent happiness of partnership income in comparison to locum income does not change the overall picture. In real terms partnership income is 30+k/ year less than it was in 2006 - and it is not increasing according to these figures. Although I think partnership income will increase over the next few years it (just a guess!) is not going to bridge the 30k drop anytime soon.

    Anyone asking why it is so hard to get a GP partner or GP appointment must be pointed in the direction of a 30k drop in real terms earnings.