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GPs go forth


  • Pulse 2018 review: The growing attraction of early retirement

    ObiOne's comment 31 Dec 2018 10:15am

    Just in case anyone needed an extra push.
    Those doing 24 hour retirement and then returning to work will find from April their pay packets might be 40% increase.

    Much more likely is a reduction in sessions. A 7 session partner, taking 24 hour retirement (or just opting out of the pension scheme because they reaced their lifetime allowance) will find they earn, after pension contributions, exactly the same on 5 sessions.

    Once you include lower taxation it might be closer to 4 sessions.

  • GP practices face annual pension contribution rise of around £50,000

    ObiOne's comment 22 Dec 2018 8:19am

    Stelvio - Salaried GPs and other practice staff will not pay any extra. It is the employers contribution that is going up - so the costs (for all staff) will be taken on by partners.

    It might have a knock on effect on overall salaries (i.e. if practices cannot afford pay rises), but that will be small and over time, rather than immediately being applied in April.

  • GP practices face annual pension contribution rise of around £50,000

    ObiOne's comment 20 Dec 2018 11:04am

    Before this change, for higher earning GP partners, it was pretty marginal with regards to the NHS pension being a good investment.

    For many, it will now be better to leave the NHS pension scheme and invest privately. That is particularly the case because:
    -If your partnership lets you keep your own employees and employers contributions (It really should!) then dropping out the scheme would increase your income by about 40% (albeit half goes on tax)
    -You are much more likely to be tapered (with regards to your annual allowance) and hence taxed on pension contributions (which defeats the point)

    The people most happy with this will be financial advisers who can plan for a very good Christmas next year.

  • NICE finalises guidance for hospitals to refer suspected COPD patients to their GP

    ObiOne's comment 17 Dec 2018 5:19pm

    If there are a small number of additional referrals for spirometry, it would mean that a National Enhanced Service paying £100 or so for spirometry is fairly reasonable.

    Not GMS.

  • CCGs 'are merging practices to remove APMS contracts'

    ObiOne's comment 13 Dec 2018 10:54am

    Does this just represent that the GMS/ PMS contracts are hugely under-priced. It seems impossible to tender an APMS contract for less than a GMS payment - and that tender process is probably judging the value/price of the service correctly. Often APMS is 2x a GMS contract price.

    What is needed is re-balancing so that the cost of GMS/ PMS contracts is at least close to the cost applied to APMS contracts.

  • Babylon GP at Hand evaluation will not determine whether service is 'safe'

    ObiOne's comment 12 Dec 2018 6:23pm

    Wish someone would give me 200k for a bit of work, then start my report with:
    - not really sure that you can pay any attention to this report, please don't blame me if it is wrong.

  • Pharmacists could overrule GP decisions during medicine shortages, DHSC says

    ObiOne's comment 07 Dec 2018 12:41pm

    Agree with policenthieves

    Pharmacists are (correctly) very strict at making sure that they are practicing within their competence. How many patients have all of us seen with insect bites because the pharmacist was not willing to reassure the patient themselves.

    If changing a medication, anything more than a generic to branded switch would surely need an entire consultation - and without access to history/ bloods etc it is just not going to happen that often.

    The only thing to avoid is the pharmacist making a switch then chucking all responsibility on to the GP by writing to them and expecting us to check their work.

  • Pharmacies to offer strep throat swab testing and on-the-spot antibiotics

    ObiOne's comment 22 Nov 2018 3:16pm

    Not sure the swab will pick up to to quinsy, tonsillitis cancer or oral hairy leukoplakia.

    Some pharmacisits will pick them up.
    Some GPs will miss those diagnoses.

    But the odds I expect are certainly better with a GP. GPs do a lot of work that patients, and apparently health leaders do not understand. It’s worth pointing that out sometimes.

  • 70% of GPs unable to secure enough flu vaccine for over-65s

    ObiOne's comment 16 Nov 2018 7:02am

    NHS England:
    Dismisses survey as being just over 1% of GPS.....
    But bases GP patient survey and subsequent CQC results on

  • GPs advised to refuse to carry out public health work without a fee attached

    ObiOne's comment 15 Nov 2018 9:22pm

    In our area a separate service was commissioned to deal with flu in a care home.

    They did a crap job, but at least there was an effort to commission the service.

  • Pfizer's failed pregabalin patent appeal means NHS could reclaim £502m

    ObiOne's comment 14 Nov 2018 7:44pm

    So will NHS England seek costs including the costs related to the work done by GPs?
    Or will the BMA do the same?

  • Police 'potentially breaching data law' to gain GP info on firearms applicants

    ObiOne's comment 13 Nov 2018 2:16pm

    I don' think the police need to know if I had an abortion 15 years ago in order to process an application.

    Therefore holding that information is illegal.

    End of story.

  • GPs prescribing diabetes drugs at a cost of over £1bn per year, show NHS data

    ObiOne's comment 09 Nov 2018 10:24am

    I'm with vinci on this.
    Need to look at spending more on bariatric surgery. It should be almost automatic first line treatment for someone with a new diagnosis of T2DM and a BMI 30 - perhaps after a very short term trial of non-invasive weight loss.

  • Part-time revolution: How general practice is adapting as GPs reclaim control

    ObiOne's comment 02 Nov 2018 9:15pm

    There are obvious reasons for part time working, many of those reasons cannot be addressed by the government.

    But there are significant changes that can be made. I would suggest looking at:
    - The problems with pension allowance. It is fairly simple to allow GPs to put in 'up to' their full pension contribution rather than an all or nothing deal. Many reduce their working week to avoid paying tax on pension contributions.
    - The problems with the tax band between 100-125k. My most recent new partner chose 5 sessions instead of 6 specifically for this reason. It is fairly simple to smooth out the tax between 50 and 150k and it must affect other industries just as much as General Practice.

    In general practice alone I think it would make a difference close to 5000GPs, that is 5 billion in training costs, so surely it is worth taking some action.

  • Just one in 10 locum GPs interested in future partnership role

    ObiOne's comment 02 Nov 2018 1:23pm

    I, as a partner, earn more than I ever would as a locum. I suspect my work sessions are more full and I think that my hours at work slightly longer than a locum, but perhaps by two hours per week across 8 sessions.

    Overall though my pay per hour is more than a locum. That applies to all the partners at my surgery (as clearly we get paid the same per session). Yet when advertising for a role we don't get that many applicants (1, after the closing date).

    I think there is an assumption that partners are not earning that much, but there is great variability between practices and those who are looking for a financial incentive should actually look a little harder.

  • Government bids to add postnatal checks to 2019/20 GP contract

    ObiOne's comment 01 Nov 2018 2:25pm

    Although many practices do these checks, there should be an absolute ban on moving any more work in to the contract until the government hits the GP recruitment target.

    It just does not make any sense.

    They must realise that capacity is reached. Pushing one more thing in to the contract means the least measured thing gets worse care. It is often those things which are more important - like automatically booking a follow up appointment for someone getting prednisolone for asthma. Or booking a follow up visit for someone who has had a fall and postural drop in bp (after stopping a medication).

  • GPs to be covered by new 'zero tolerance' policy against abuse from patients

    ObiOne's comment 31 Oct 2018 5:22pm

    The most pressing need is for legal protection for clinicians, hospitals and GP surgeries if care is denied. Everyone (staff, hospitals, surgeries) are too worried about the risk of litigation or complaints if a medical problem develops after denying treatment to a violent patient.

    The law needs to change so that
    1 - A clinician who feels a threat (regardless of the nature of that threat) is protected from litigation, complaints and GMC/ NMC sanction if they change or withdraw treatment as a result of violence (add racism/ sexism/ etc).
    2 - That must include those cases where an illness contributes to the violence - for example delirium, head injury or mental health. Because without that extension a clinician will still be worried about stopping treatment and put themselves at risk.

    There must be no obligation on the clinician to 'prove' that the threat existed or was significant, or else the clinician will be too worried about withdrawing treatment.

    I have only seen one case of a patient being chucked out of hospital (when a house officer) and that was for severe racism (jumping around making monkey noises.... with a charcot foot as well). I have seen 100s of cases of violence.

  • Field: CQC to review impact of GP at Hand on other practices

    ObiOne's comment 30 Oct 2018 7:30pm

    The CQC, who's leadership is appointment by the department of health....
    Is going to investigate a service that the head of the DofH has already declared as amazing.......

    I don't need a time machine to know what the outcome is going to be.

  • GP partners in premises lease dispute told they can’t close branch practice

    ObiOne's comment 26 Oct 2018 7:20pm

    Ninja doc
    He contract for that surgery includes providing a branch surgery.
    If they want to renegotiate the contract they need an agreement, it can’t be one sided.

    In this case though the partners should give notice to close the entire surgery (which they can do unilaterally); they will suddenly find the health board is much more cooperative when faced with the massive bill of running the practice directly.

  • NHS England's flagship GP time-saving scheme frees up '120,000 clinical hours'

    ObiOne's comment 10 Oct 2018 10:46am

    I suspect that if all the scheme and ideas coming of out NHSE were scrapped, and the money was just invested in to the global sum you would:
    - Have less wasted money
    - Have more GPs
    - Have more GP appointments

    It is so simple - but just continuously ignored.