Dr Ivan Benett has been a GP in Central Manchester for 30years. He has held various educational posts, served on the LMC Executive, has been PCG chair and chair of the PCT professional executive until 2005. Following this he gained a PG diploma in Cardiology & became a GPwSI in cardiology. He has been on the NICE guideline groups for CKD, Post-MI care, chest Pain, Parkinson's & AAA, and expert group for Quality Standards in Heart Failure and CKD care. He is a Fellow of the RCGP & RCP and standing member of a NICE Quality Standards Advisory Committee. He was the Clinical Director Central Manchester CCG until December 2015. Currently he sits on the GM Clinical Senate and is a Non-Executive Director at the Central Manchester University NHS Foundation Trust with an interest in Patient Experience and is 'Freedom to speak out" guardian
Please can we ban the word Tsunami’ from this sort of headline. Yes we should expect a large increase in thus far unexpressed need. But tsunami is a different order of natural tragedy that we can’t do much about.
Sure, we should prepare for tsunamis, as Government should have done for Covid. Sure, we should react quickly, as this pandemic has shown, rather than play it down, joke about it or escape to the country.
Certainly we should organise the tidying up process to get back to normal. It is very bad, devastating for those who lost love ones.
Ok, maybe it is like a tsunami.
BAME risk of Covid mortality - Geneticists have turned up intriguing links between DNA and the disease. Patients with Type A blood, for example, seem to be at greater risk. It may be that there is a genetic explanation, or at least an association.
Curious | Locum GP15 Jun 2020 9:30pm Una, you keep repeating this, but there is no evidence to support your position - yes I agree. I does no one any favours by making these assumptions and assertions. At present we just don’t know why there is this very clear discrepancy in outcomes . We need to know urgently, meanwhile let’s provide individual risk assessments; optimal mitigation; maximum protection and rapid identification & isolation.
What an odd headline.
Of course lockdown saved lives - drr that’s what it was meant to do.
The more shocking headline should be how many lives should have been saved if not for dither in starting the lockdown, delay in getting testing, denial of a PPE shortage and Disaster in protecting the most vulnerable in Nursing Homes.
I am not frightened of death. It will happen. I don’t know what happens after, but I am hopeful.
However, I AM frightened of dying, I frightened of loosing control. I’m frightened of pain. I’m frightened of being alone.
So I ask if patients want to talk about dyING, rather than death. When they are ready, and with sufficient time and empathy (fear of all those things), it goes well usually. I find an even closer bond with patient and loved ones if they are there.
This is a shocking indictment now at least 4 months since knowing C-19 was on its way. Speaks to lack of preparedness, complacency and incompetence. It’s no good waiting until it’s all over and an inquiry. They could be years away. Need action now. Probably need to wait before reopening.
As Boris would say “ Si enim hortus et in bibliotheca es in omnibus indigetis”. Or something like that :)
Andrew Bamji | Hospital Doctor25 Apr 2020 10:30am
“Hindsight is pretty well infallible. At the outset there was no evidence that this thing would be this dangerous so everyone (and remember the government has been guided by scientists and medics) was walking into the unknown”.
Not really unknown. We’ve had pandemics before. We knew this virus was on its way.
Well we did have 2 months experience of other countries to go off. The actions themselves weren’t wrong as far as the disease was concerned, just delayed, incomplete and slow to implement.
PPE it was agreed should be used, but not every carer, many places didn’t get them and there weren’t enough. Test - all the above but mainly didn’t start manufacture soon enough.
Of course apologist will excuse anything. But people have died who shouldn’t have. If a doctor had cause these deaths by omission or commission we would have been struck off, or at least held to account. As for nursing and care homes, it’s a National scandal.
Thanks Kailash. I agree with almost everything except: “Only an independent public enquiry will satisfy the public that the loss of lives was not in vain.”
The Government need to be held to account right now! Sure we should have a lessons learnt inquiry after the event to know how to respond to the next pandemic.
However it is today that we need to hold them to account for their woeful logistics, ill-preparedness and prevarication.
The various right wing sycophants posting above variously disagree no doubt. We cannot wait for more patients & front line workers, especially from BAME communities, to die for lack of action.
As for the comment from someone about holding China to account. Well of course, if they are culpable. But it doesn’t detract from what we should be doing here.
The SLOW SLOW SLOW headline summed it for me, although I’d have gone further and said Smug, Complacent and Incompetent regarding the government response. Boris catching the virus is a metaphor for their performance (I’m glad he’s recovered on a personal level)
Strangely, I find myself in total agreement with Vinci Ho. I’m going to say it shameful and disgusting how the Government has dragged its heels on protecting the front line.
If only clinical decision making were a simple as feeding a figure into an algorithm. Set aside the issue that risk is an estimate based on (usually) 95%confidence intervals, themselves based on study populations that may not reflect our patients, and all the other weaknesses of studies.
Perception of risk varies from one to another, the value placed on harms varies as does the value of a potential benefit. Societal norms, and health beliefs and peer group or family pressure also play a part. The JW's rejection of blood transfusions has little to do with an assessment of harm or benefit.
Whole patient medicine means taking all these factors into account and coming up with a join decision with the individual.
But it would help if Pharma, Government and Researchers would come up with better ways of informing us accurately, rather than telling us we're getting it wrong, and undermining our confidence and credibility.
"Christopher Ho | GP Partner/Principal02 Mar 2020 10:57am
"Austerity my arse, Ivan."
At least you make me laugh! Seriously, you don't believe there has been an austerity agenda? Seriously, you don't believe it's had an impact on health and social care? Seriously you believe a 'big state', by which I think you mean more public spending on public services, leads to poverty. And you reckon I don't understand economics? I'd say don't make me laugh, but it's too late.
Last Man Standing | GP Partner/Principal03 Mar 2020 6:05pm
SENIOR GMC STAFF SHOULD LAY DOWN THEIR PENS AND SPECIALIST LATTES AND SO SOME REAL WORK SEEING PATIENTS BUT OH NO THEY CAN@T PUT THEMSELVES AT RISK....ARMCHAIR WARRIORS....
Such strong and unsubstantiated sentiments...Anonymous too....it's almost as if you've been in trouble with them.
I agree with Kailash and would add that the biggest impact on the NHS has resulted from swinging cuts to social care. This has limited our ability to prevent people needing admission to hospital, and impeded our ability to discharge people home. Longer lengths of unnecessary stays lead to exponential increases in hospital acquire morbidity.
However, dwarfing all of this has been how austerity generally has impacted on determinants of health, in particular poverty, clean air, and social resilience.
Boris has made big promises. He needs to deliver now. I hope these pages (amongst many others) will hold his Government to account.
I called for advice as to whether I needed testing. As in Venice 10 days ago. It took 60 minutes to get the advice I wanted! Many would have not bothered holding on. Staff were all very polite. Surely at times of predictable high volume there should be more people on the phones
I think the ‘mythical’ doctor in Devon was Doc Martin, a caricature of a surgeon who becomes a GP because he can’t cope with blood. In my 35yr experience there are very few genuine time wasters. So called time wasters present repeatedly with minor symptoms because they have concerns that they may be serious or some other covert issue that troubling them.
Charging people will only increase unmet need and exclude those in most need. There is already a rule of halves which estimates that 7/8 chronic diseases are not optimally managed. Charging will also aggravate the inverse care law so eloquently described by Tudor Hart. Even today Marmott has described worsening of health inequalities.
I suggest you take these issues up with your trainer, course organiser and fellow trainees.
Simplistic populist views like yours are all to prevalent in these pages. They are not a solution to increasing demand.
Very amusing I’m sure. Indeed there has never been evidence of long term benefit from intra-articular steroid injections.
However, there IS overwhelming evidence that statins reduce MI, stroke and death in people with coronary disease, cerebrovascular disease and peripheral vascular disease.
Whilst these populist articles can be entertaining, and I hope I’m not a kill joy, I do think that they should restrain themselves from spreading falsehoods.
You can’t on one hand promote EBM, then ignore the evidence you don’t like.
The more we reduce the role of General Practitioners, the less we are able to maintain continuity and proactive care. We will lower our status and diminish General Practice. Like giving up 24hr responsibility we threaten the list system of Primary Care which in the cornerstone of the NHS. More fragmentation of management of LTCs will leader to ever higher demand on in-hospital and community services. Stopping GP visiting will lead to a worse service. It is the wrong thing to do.
At the risk of ending up in the dog house, you shouldn’t let the tail wag the dog. Your work load sounds a bitch. Perhaps pack in some of the longer hours.
Back in the day of course we would see 30 patients a surgery, two surgeries a day. 9-10 surgeries a week. Plus home visits, about 5 usually, but up to 10. Night calls to the house on a rota plus weekend surgeries and on call. Siriusly, every dog has his day.
More don’t. Charging people for appointments undermines the very principles of the NHS and would penalise the poor, the least assertive and the very ones who need to see a doctor. It is an appalling idea in every sense and will worsen current inequalities
As previously discussed this is a good idea so long as there are appropriate safe guards and pharmacists are adequately trained. Patients must retain the right to be actively involved in decision making. Their decision note to accept advice should remain paramount