This site is intended for health professionals only

At the heart of general practice since 1960

pulse june2020 80x101px
Read the latest issue online

The waiting game


  • Wales out-of-hours services at 'crisis point' as providers unable to cover weekends

    ObiOne's comment 10 Apr 2019 5:23pm

    Don't worry - a significant cut in the global sum payments for Wales will definitely help the recruitment crisis.

  • GPs to receive training on tackling unprofessionalism from GMC

    ObiOne's comment 03 Apr 2019 11:17am

    Am I the only one who read the headline and got it the wrong way (or maybe the correct way).

    GPs to receive training or tackling....
    'unprofessionalism from the GMC'

    i.e. how to tackle the GMC being unprofessional. I think we can all agree that would be useful.

  • Doctors not prescribing medical cannabis due to lack of knowledge

    ObiOne's comment 02 Apr 2019 5:47pm

    Medicinal cannabis pressure group says doctors are not prescribing enough medicinal cannabis.

    In next weeks edition:
    Sugar lobby says sugar is a good source of energy. And oil lobby says fast cars are super-cool.

  • Networks 'should include' pharmacies, optometrists and dental providers

    ObiOne's comment 01 Apr 2019 6:32pm

    Surely April Fools?

  • Locum GPs set for 'discriminatory' pensions rules from next week

    ObiOne's comment 26 Mar 2019 7:48am

    The whole concept of tiered pension contributions for GPs should end. All it means in reality is full time GPs pay a higher contribution (percentage) than part time GPs. That is not necessarily fair and anything which discourages working longer hours should be removed. We clearly cannot change the overall tax system, but small changes like this might make a difference in terms of increasing the total number of GP sessions available.

    The sickness system needs to evolve too. Why should a GP with 2 five session partner roles at different surgeries have better NHS sickness coverage than a GP with a 10 session role in a single surgery? Seems to just penalise working full time.

  • Capita to be stripped of NHS cervical screening contract following issues

    ObiOne's comment 20 Mar 2019 10:24pm

    It has been stripped of cervical screening because of poor service.
    Why is the same not happened with the poor performance of primary care services in general?

    I would say their handling of primary care and pensions is much much worse than their handling of cervical screening.

    The only difference is cervical leads to more headlines, but if NHS England are making decisions solely based on what hits the headlines most; they are doing something very wrong.

  • We have ‘listened, acted and delivered’ in new contracts, says GPC chair

    ObiOne's comment 19 Mar 2019 2:21pm

    For one (I might be the only one) I agree with him.

    I think over the next 12 months a 10000 GP practice will benefit from
    92p/ patient uplift minus 45p/ patient less extended hours = 47p/ patient
    1.50 patient for simply signing up to do the network business, even if your network does no work, employs nobody and does not actually do anything.
    I wont include the funding for network admin - as that does not help the practice run, but it is funded and fairly generously.
    AND the 10 half time GPs that run that practice will have their indemnity reduced from 8000 to 800 saving 70000 - or 7 pounds per patient
    Minus losing 10000 in the partial indemnity refund - so more like 60000 or 6 pounds per patient.

    So an uplift total of
    0.47+1.5+6 = 8 pounds per patient.

    When was the last time GPs had an uplift of anywhere near 8 pounds/ patient?

    There might be some boring admin with networks - but making them effective is just an opportunity and totally optional. The extended hours should just be devolved down, and the network can decline to employ anyone and you will be fine. If you 'choose' to have a 70% discount on employing staff via the network, that sounds like a good deal to me.... but it is optional.

  • GP screening and care plan programme for older patients 'increases NHS costs'

    ObiOne's comment 17 Mar 2019 6:34pm

    The real cost is surely calculated by ADDING together the extra work created by this scheme to the work that could have been saved if the same funding was delivered to primary care without any strings attached.

    At a time when every practice is wasting thousands and thousands of pounds joining and administering networks, surely someone must realise that the control group of giving that finding directly to existing primary care, without political strings, might deliver better value for money.

  • Networks to receive 45p per patient less through DES for providing extended hours

    ObiOne's comment 14 Mar 2019 5:43pm

    @fedup and turnout the lights.

    The reason the price per session seems so low, is that you think it is for GP sessions. In the current extended hours enhanced service, there is no stipulation for there to be ANY GP time.

    A 50000 GP network would need 25 hours a week for 1500 pounds per week (based on 3p a week, so a little higher than the actual figure.)
    60 pounds per hour is certainly not enough for GP time, but is more than enough for phlebotomist time.

  • Networks to receive 45p per patient less through DES for providing extended hours

    ObiOne's comment 14 Mar 2019 12:04pm

    SO what your saying is the global sum has actually NOT increased by 92p;
    it has infact increased by just 47p; with an extra 45p which is to be put towards extended hours.

    So giving practices an extra 47p/ patient; and expecting all staff to have a 2% payrise out of that is slightly concerning maths by all involved.

  • CCG axes GP minor injury service amid warnings of 'morbidity and fatalities'

    ObiOne's comment 12 Mar 2019 8:41pm

    As above
    MUST say no.
    Use it as an opportunity to review what else you should be saying no to. Anything related to a catheter is a good example.

    AND use it as an opportunity to decide if other enhanced serviced are undervalued and need to be declined. E.g. EVERY surgery declining to take blood would be interesting.

  • NHS England may scrap four-hour A&E target due to 'well-documented issues'

    ObiOne's comment 12 Mar 2019 1:40pm

    The main issue with the 4 hour standard, is it consistently shows that the current NHS, under a conservative government, does much much worse than the NHS under the last labour government. At that time the target was 98% and regularly being met. Now it is 95% and routinely missed.

  • Female GPs 'perform better than male GPs' in GMC clinical tests

    ObiOne's comment 08 Mar 2019 5:40pm

    I agree it is impossible to say what the exact causes are:
    - Could be that one group is better than the other.
    - Could be that female and male GPs have a different range of skills, but that the assessments focus more on the female skills and less on the male skills.

    IF it is the second statement that is true - then men should be given an artificial head start in assessments (i.e. 5 bonus points for being a man or similar).

    The same logic can apply to the actual referrals. You are much more likely to be referred to the GMC as a man. Is it because of a higher number of errors? Or is it because patients (and coronors/ colleagues/ etc) who ultimately complain or instigate referrals are much less forgiving to men - therefore refer more easily. If that is the case, there should be some type of correcting factor - like men being given 'an extra life' if struck off or suspended.

    Now just to be even more controversial. Swap out men/ women and replace it with ethnicity, race or even social class - they try to work out how to correct all the social injustices in the world; while applied to a medical career.

  • Over half of GPs unable to refer to 'overflow hubs' because they are full

    ObiOne's comment 05 Mar 2019 12:17pm

    Surely the only way overflow works is if there is unlimited access.
    So that if they are 'full' patients should just pile in and wait their turn. Then there is a sort of self-selection where those who have a minor cold can't be bothered to wait - leaving those with real medical issues a boring long wait, but at least access to a GP the same day.

    That is the only way it will work when supply is nowhere near demand. The whole point of overflow hubs is to take managing this demand AWAY from practices. If it is just about having 3 more appointments per practice, it would be far more efficient to just deliver that at the GP practice - by giving them the funding.

  • Funding for new staff could be removed to 'offset' practice costs in case of inflation

    ObiOne's comment 26 Feb 2019 6:27pm

    D in vadar you can refuse the contract and return it at any time.

    However I disagree. In my practice of 10000 patients we (as partners) will see:
    10000*0.92p global sum increase
    + 10000 *1.50 for just signing the box that says network.
    + A further £24000 savings for not having to pay the indemnity costs of salaried GPs (having left some over for the remaining cheaper indemnity)
    + £35000 in partners indemnity costs.

    Overall that works out to be over £8/ patient. Which is huge.

    Then moving forward we would probably have hired a paramedic or two, pharmacist or two over the next few years - because there are no GPs. We will now get them at 70% discount through the network.

    Not sure the social prescriber will be useful.

  • Number of qualified FTE GPs drops by 2% in a year

    ObiOne's comment 22 Feb 2019 5:35pm

    @Christopher Ho

    Withdrawing seniority does not save the government money, because the money saved from the scheme is automatically added to the global sum - separately from any overall uplift in GP funding. It only makes a minuscule difference to the global sum. Stopping that process would mean that newish GP partners like me, would lose some income, but actually it is a very small amount.

    The system encourages (encouraged) GPs to work more years and in fact might encourage some to become partners rather than salaried doctors/ locums. But not any more.

  • Number of qualified FTE GPs drops by 2% in a year

    ObiOne's comment 22 Feb 2019 0:22am

    There are 2 solutions possible to improve the number of FTE GPs, but strangely government policy works directly against them:

    1 - Reduce retirements. The fading away of seniority will just push people to retirement. A 10k pay cut is not the way to keep people coming in to work. I don't get much seniority, so it is not a personal issue for me, but I can see that stopping it will directly lead to retirements. Keeping it will stop those retirements and not cost government a single penny.

    2 - Encouraging people to work more sessions. But there are just loads of disincentives to do so.
    - Why should a 10 session doctor pay a higher pension contribution than 2 separate 5 session doctors in the same practice?
    - Why should a 10 session (higher earning) partner be forced to publish their earnings, whereas two 5-session partners in the same practice do not?
    - Why should a 10 session partner be stung with a pension contribution tax whereas two 5-session partners don't have to?
    - Why should a practice who has a 10 session doctor sick (or on maternity leave) have to pay for half of their locum costs, but if there were two 4 session doctor and a 2 session doctor all off sick at the same time have all their locum costs covered?

    The 'war' on full time working has to end. People should have the choice how much they work (and certainly not forced to work more sessions); but people should not be penalised for working a higher number of sessions.

  • Dispensing GPs are more likely to prescribe higher cost drugs, finds study

    ObiOne's comment 20 Feb 2019 9:20am

    Having worked in both dispensing and non-dispensing practices I dont think I prescribe differently between the two.

    However in one of those practices I have had patients attend specifically asking for a certain statin because they felt it was less likely to cause muscle pains. Or specifically ask for a certain inhaler because they had read about it in the news.

    Furthermore when performing blanket switches (to save money) - the number of patients demanding a switch back was much higher in the leafy rural practice rather than the town practice.

  • GPs must email patients instead of sending letters, says Hancock

    ObiOne's comment 14 Feb 2019 8:50am

    Surely at least ask just one GP before coming out with these statements. The biggest worry about emailing a patient is them replying. Even if the email says 'we don't monitor this inbox please dont reply' some moron will reply asking what to do about his chest pain, then die over the next few days waiting for a reply.

    No doubt the doctor will then be hung out to dry.

    In an ideal world we would be able to use email AND have the resources available to monitor all the incoming mail and manage accordingly. But if you want that to happen it MUST begin with getting the right number of GPs. Come back when there are 6000 more GPs and we can restart the conversation.

    Keep up your end of the deal before creating extra work for everyone else.

  • ​Council's drastic public health cuts will leave GPs 'unable to cope'

    ObiOne's comment 07 Feb 2019 2:36pm

    I think it is pretty hard to decide if your local scheme for falls prevention is a waste of time. It is very hard to measure 'hip fractures prevented' or 'falls hospital admission prevented'.

    I think in our are it has actually been organised and delivered well. Similarly I cannot say with certainty that it has reduced fractures/ hospital admissions/ people requiring care.

    At the same time I cannot say with certainty that treating my next 100 hypertension patients improves their heart disease and stroke risk. All I can say is the medical evidence suggests it should have helped.

    If you need objective evidence that each intervention helps, you need to become a surgeon, ideally an orthopedic surgeon.