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The waiting game


  • GP at Hand improves health access for migrants and homeless, finds review

    ObiOne's comment 15 Aug 2018 7:03pm

    Not sure my homeless patient in Newcastle will find it that easy to access a face to face appointment, in Fulham, when it is ultimately needed.

  • BMA poll reveals 90% of doctors say GP pay rise is 'unacceptable'

    ObiOne's comment 07 Aug 2018 5:33pm

    emergency only strikes, meant to mean elective only strikes.

  • BMA poll reveals 90% of doctors say GP pay rise is 'unacceptable'

    ObiOne's comment 07 Aug 2018 5:32pm

    The answer has to be firm and clear cut.

    For employed doctors I would recommend a start date for long term continuous strike. It worked in Iceland and NZ. Don't muddy the waters with talk about steps to improve patient safety etc, just a strike because the pay package was unacceptable. Also do not draw it out with harmless one day and emergency only strikes - because that just makes it easier to drag the whole problem out, we want a quick resolution. There will be enough non-members to keep people safe.

    For contractors it is more complicated. I suggest cancel all appointments AND appointment systems and limit the number of appointments per day. Insist that all practices operate a queue (like the post office). When the recommended number of patients have been seen EVERYONE else gets turfed to A+E - including emergency prescription requests, red flag symptoms and obviously emergencies.
    Then they can start queuing for the next working day.

    I doubt any of that will have traction, but it would work if it was introduced. Someone smarter than me can work out if it is in line with the GMS contract - I think it is. At the very least the queue system would limit workload.

  • NHS England's top GP resigns following Pulse comments

    ObiOne's comment 07 Aug 2018 4:15pm

    I had an interesting read of some of Devil Advocate's comments, from this page:

    It looks like some of the comments are there, but there is one (or maybe some) which have been removed.

    In particular a comment from 29th June 2017. PULSE EDITOR, can you confirm that there was an comment on that date, and what it was?
    I have a copy if it helps.

  • Health charity offers £250k grants for GP continuity-of-care initiatives

    ObiOne's comment 03 Aug 2018 2:26pm

    250k available for continuity of care....
    and how much is available for working at scale?

  • GPs should be ‘pleased’ when small practices close, suggests NHS's top GP

    ObiOne's comment 02 Aug 2018 7:41am

    He has made the terrible mistake of assuming small means poor. That makes him a moron. Not only are there some excellent small practices, but small practices are more likely to be excellent when considering important clinical data. The worst practices in my areas are mostly large. (I don’t work in a small practice)

    Finally he has assumed that the other businesses (practices) want to add customers because that makes them more viable. It might apply to Tesco or Amazon where prices can be set to make sure customers are profitable, but for most GP surgeries with limited space, little infrastructure investment and difficulty recruiting quality GPs; expansion is certainly not profitable or stabalisibg. For that system to work the price per gms patient must be pushed up to the point where practices compete for them. That is unlikely to happen soon.

  • The sting in the tail of the 2% 'pay rise'

    ObiOne's comment 27 Jul 2018 9:42pm

    Time for some real action.
    We all know full strike action is unlikely to work. Those with successful practices are unwilling to risk breach of contract notices.

    So what is needed is progressive movement towards working to rule. Simple things like directing ALL emergencies to a&e. (No contractual obligation for emergencies)

    2 weeks later all go practices withdraw from extended hours.
    2 weeks later a total cap on appointments seen, rest directed to A&e
    2 weeks later ALL shared care deals get referred back to sole secondary care
    2 weeks later all GP practices stop phlebotomy
    Etc etc

    Always pick stuff within the contract rules (might lose enhanced service funding) so no breach notices
    All visible to the general public, planned and up front
    All cost the hospital sector a lot of money.
    And there are probably more than a years worth of tasks we can take out of our workload.

    Even if not successful, It might change the approach of GPS for the better.

  • Government to trial child and adolescent mental health four-week referral deadline

    ObiOne's comment 26 Jul 2018 10:46am

    I agree with last man standing, the service (in pretty much every area) is just shoddy.

    I had a urology problem I was deeply worried about - called a consultant, spoke directly to them, patient was seen the same day in clinic and everything was sorted.

    Can anyone get this level of service from a consultant psychiatrist for a child? Without meeting the (appropriately tough) sectioning threshold, there is almost no way to get your patient the advice of a consultant psychiatrist.

    There is too much of a push to get patients seen, and not enough emphasis on getting them seen by someone appropriately skilled.

  • Sorry Mr Hancock, but 2% 'pay rises' won't boost recruitment

    ObiOne's comment 26 Jul 2018 9:47am


    In our surgery, like many others, it takes a long time to get through first thing in the morning.

    I didn't realise it was correct to half the pay of all the reception staff so that we can hire more receptionists. I might go and tell them now and see what they say.

  • Let's give our new health secretary a chance - he has a lot of mess to clear up

    ObiOne's comment 24 Jul 2018 3:09pm

    I was giving him a chance but in the 14 days since he has taken over he has:
    - Said that improving GP recruitment was vital and he will take steps to make GPs feel wanted.
    - Then over-ruled the independent (albeit government appointment) DDRB advice (of a 4% pay increase) to instead give GPs a real terms pay cut.

    It took him just 14 days to lose the trust of primary care. Well done.

  • GPs to get 2% 'pay rise' as Government moves to 'multi-year' negotiations

    ObiOne's comment 24 Jul 2018 1:47pm

    The DDRB report is an interesting read. It clearly recommends a 4% increase for GPs, as that is what is required to improve recruitment. That is after taking in to account the government has already set Health's budget on an assumed 1% increase.

    Nevertheless the DofH has gone for a pay cut in real terms. He has only been in the job for a couple of weeks, said that GP recruitment was really important, then acted in completely the opposite way.

    Well done.

  • GPs don’t have an (NHS) choice in the matter

    ObiOne's comment 19 Jul 2018 9:02am

    NHS England and the Department of Health really should have an NHS choices page.

  • Patients told they need GP firearms sign-off after police updates guidance

    ObiOne's comment 18 Jul 2018 6:03pm

    No medical need to have a gun...
    no reason for me to write a letter.

  • Over 400 GPs at risk of deportation as NHS is unable to sponsor their visas

    ObiOne's comment 12 Jul 2018 12:33pm

    It's okay- GPs only cost 1 million each to train.

  • NHS 111 boosts clinical input 'to reduce pressure on GP practices'

    ObiOne's comment 12 Jul 2018 9:28am

    Ultimately they need to be able to:
    1 - See the notes in full.
    2 - Prescribe if appropriate. (Via EPS)

  • NHS 111 boosts clinical input 'to reduce pressure on GP practices'

    ObiOne's comment 11 Jul 2018 10:54pm

    I don't quite get why they are not all handled by clinicians.

  • Hancock received £28k from chair of group advocating NHS insurance system

    ObiOne's comment 10 Jul 2018 5:58pm

    @Big and Small

    It does not really matter if Neil Record/ The IEA is correct or incorrect. It is more if the new Health Secretary is receiving donations to influence future policy decisions.

    The most important question is where does Neil Record live? If the donations were to support his work as an MP, but Mr Record is not one of Mr Hancock's constituents, then there might be something fishy going on. If however he resides in Mr Hancock's constituency, then it might all be considered above board.

    I actually don't know where he lives. He is chairman of Record Plc, which is based in Windsor, not near the West Suffolk constituency of Matt Hancock. He has lectured at Cambridge, which is not too far from the West Suffolk constituency.

    I think people have to make up their own mind. But it is not a good start.

  • GP recruitment issues push locum rates to £1.4k a day in one area

    ObiOne's comment 09 Jul 2018 5:12pm

    @truth finder - you are (I think) quoting retail lawyer prices, rather than what individual lawyers earn.

    From that figure, most will have write downs (where the bill is reduced to match the quote) and admin time/ educational time/ business time etc (which is not billed directly to a client).

    For comparison you would need to see what your practice charges for a private 10 minute appointmnet (say for a medical) and multiply that by 6. Ours charges £45 for a 10 minute private appointment - so £270/ hour - which is not dissimilar to a lawyer.

    There are some who clearly earn more (Slaughter and May partners earn something like 2M/ year) but most lawyers outside london will have a retail price not dissimilar to a GP surgery.

  • Government considering DDRB findings on GP pay

    ObiOne's comment 09 Jul 2018 3:34pm

    The recommendation must be at least 1% above RPI. The DDRB is clearly carrying much of the blame for GP shortages, as they insist on putting government policy on funding (1% pay cap) ahead of the government manifesto promise of 5000 more GPs.

    This year, the government has not put a cap on pay, but the promise for increased number of GPs still exists.

    Furthermore, the government must fully implement, or beat any recommendation set out by DDRB. At least until it has delivered the promised new GPs.

  • GP recruitment issues push locum rates to £1.4k a day in one area

    ObiOne's comment 06 Jul 2018 6:02pm

    Agree with Fedup - something dodgy.

    I cannot believe a GP in Dumfries would do a locum fo £90/ day - or even £80/day.

    I suspect they represent a locum hour (i.e. staying on an hour longer than planned), being reported as a day.

    Similarly - might NHS Orkney, being so rural represent a 24 hour shift?