This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

CAMHS won't see you now

Nick Mann

  • NHSE official admits ‘we need to make changes’ to draft network specifications

    Nick Mann's comment 15 Jan 2020 9:25pm

    We need voices of the profession to be heard, otherwise all we hear is NHSE/DHSC management spume.

    When you add up the components of PCN DES - including intended "exponential" expansion in some areas (with merely linear expansion in others!); sneaky addition of OOH; phenomenal bureaucracy; dodgy-metrics-managed future of Medicine; massive miscalculation of cost and workforce; the loss of 26% of qualified FTE GP workforce in the last seven years; lack of staff to fill PCN roles; absence or misrepresentation of proper evidence (eg e-FI, MRH, PHBs); forgetting to mention the other two impending spec requirements ('CVD prevention and diagnosis', and 'Tackling Neighbourhood Inequalities'); and their total lack of attention to our existing crisis, yet blithe promotion of 'demand' - one has to realise that, on the part of NHSE, this was never about saving and supporting general practice. Perhaps, given the Global Health watermark evident in its design, quite the opposite. I'd guess it's got McKinsey all over it.

    Offering to "cut" (ie postpone) two of the specifications actually shows their intention is to 'get this done', one way or another.

    There's no reason to fear being unreasonable here when the initial proposition is so egregiously untenable and ill-considered.

    This is a long way of saying I'm out.

  • RCGP urges NHS England to restart development of PCN specifications

    Nick Mann's comment 15 Jan 2020 8:44pm

    Thanks to RCGP for speaking up.
    We need voices of the profession to be heard, otherwise all we hear is NHSE/DHSC management spume.

    When you add up the components of PCN DES, including intended "exponential" expansion in some areas (with merely linear expansion in others), sly addition of OOH, phenomenal bureaucracy, dodgy-metrics-managed future of Medicine, massive miscalculation of cost and workforce, a loss of 26% of qualified FTE GP workforce in the last seven years, lack of staff to fill PCN roles, absence or misrepresentation of proper evidence, and total lack of attention to our existing crisis - one has to realise that, on the part of NHSE, this was never about saving and supporting general practice. Perhaps, given the Global Health watermark evident in its design, quite the opposite. I'd guess it's got McKinsey all over it.

    Offering to "cut" (ie postpone) two of the specifications actually shows their intention is to 'get this done', one way or another.

    There's no reason to fear being unreasonable here when the initial proposition is so egregiously untenable and ill-considered.

    This is a long way of saying I'm out.

  • Network proposals prompt GPs to resign as clinical directors

    Nick Mann's comment 10 Jan 2020 3:38pm

    As NHSE made clear in the PCN DES specifications, this is designed to be the bottom of a very steep slope.

    This is the global health model of "managed care", which started for GPs as light-touch QI with QOF in 2004, followed by DES, LES, POLCV, MOLCV, EBI, etc.

    Stratification and QI tools and metrics are extremely inaccurate, generating much unnecessary work for which there is little or no proper evidence at all. But it is intended to make these the basis for funding, or not funding, future general practice.

    If this is supposed to be the acceptable face of the bottom of the slope, then no-one will be able to climb it. NHSE set out their stall by declaring that, if GPs can't make PCNs work, then we will become forcibly salaried to 'other providers'.

    What to do now? I don't believe that GPC can renegotiate a truly viable contract, or one which can protect general practice for the future.

    Would I rather lose a leg, or renegotiate to lose just a hand?
    We need to follow the lead of BBO LMC and advise members not to sign up to PCNs in 2020. Clinical Directors should resign forthwith, en masse. We risk signing our own death warrants here.

    Since 2012, qualified FTE GP workforce has decreased by 26% in real terms (GPs per 100k population). That's *10,218* FTE GPs lost from a 40,000 workforce. PCNs will make this worse, not better.

  • LMC issues urgent call to GPs on 'viability' of practices following network proposals

    Nick Mann's comment 08 Jan 2020 8:28pm

    PCN DES is a wishlist with no possibility of renegotiations delivering a viable contract. Every paragraph a stunner.

    Also disappointed to see NHSE misrepresenting the evidence on Medication Related Harms to justify SMRs.

    I'm awaiting reply from Nuffield Trust, because I have calculated that England's FTE GP workforce has diminished by 26% since 2012.

    This utterly staggering cut to GPs has been entirely ignored by NHSE in their plans since 2012.

    PAs, paramedics, physios and pharmacists are not replacements for GPs.

    We will have to act and do so decisively.

  • Pulse 2019 review: Practices closing in record numbers

    Nick Mann's comment 01 Jan 2020 12:45pm

    Simon Stevens announced in 2014/15 that small Practices would be "allowed to wither on the vine".

    So yes, all according to plan. And if - with falling GP FTE and GPs' time increasingly diverted to PCN meetings, committees and contracts - PCNs are deemed by NHSE to have 'failed', we will become salaried to "other providers".

    As an independent medical body, GPs are a hindrance to the Global Health industry. This is their agenda.

    We must fight for survival of NHS general practice, or we'll be goaded into obsolescence.

  • What is in the Conservatives' in-tray for general practice?

    Nick Mann's comment 16 Dec 2019 9:00pm

    We are dealing with a government that will tell you that rising is falling.
    The many regulatory and operational factors pitted against us just trying to do our jobs, would be easy to ease if they wanted to.
    This bunch of free trade bombasts see us as an obstacle and an annoyance, not as doctors.

  • GP leaders demand end to seven-day routine access scheme

    Nick Mann's comment 25 Nov 2019 8:05pm

    I suspect we are heading towards wholesale dumping of PCNs after all.
    Next time, we'll be pushing for viable GP:patient ratios, hence longer to spend with patients.
    Downskilling and stratifying is not the way...
    Immediate plan for GP rescue? Obviously money, bigtime, for retired and refusenik GPs currently hiding in the wings (240,000 docs are registered with GMC).
    We need to fight for or lose our NHS model of general practice, because managed care does not care what we think once we've signed the contract.

  • LMCs call for GPC to reject PCN model in favour of new GP contract

    Nick Mann's comment 13 Nov 2019 7:57am

    PCNs should be disbanded.

  • GP leaders to call for removal of home visits from contract

    Nick Mann's comment 11 Nov 2019 7:16pm

    Same LMC branch with same motion as last year? I'll vote against.

    Let's refuse to do pointless DES contract work first, rather than ditch clinical work which serves the most vulnerable.

    As for some comments suggesting we get patients to self-pay for home visits... I'm shocked at this attitude from doctors.

    Did you leave your values in Belgravia?

  • GP practice warns new patients they will not routinely prescribe opiates

    Nick Mann's comment 06 Nov 2019 7:36pm

    We're all paying the price for opiate Pharma companies' desired effect of their illegal hyping and marketing of their products, but we do need to be careful to avoid reflex pendulum overswing.

  • I've a shortage of patience

    Nick Mann's comment 26 Oct 2019 12:04pm

    Yes, this is exactly the grim (un)reality of general practice now.

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

    Nick Mann's comment 25 Oct 2019 12:00pm

    #HostileEnvironment. This cannot end well.

  • Judge finds in favour of GP practice that refused to post medical records

    Nick Mann's comment 21 Oct 2019 8:31pm

    "Stelvio | Locum GP21 Oct 2019 11:33am

    Making records available within the Practice fulfils your SAR obligation. You can charge under Medical Records Act if you supply copies."

    If Stelvio is correct, then I'd go with the idea of - in the case of any third party request for medical records - providing a SARS copy directly to the patient. Third party can get it from patient, or pay for a further copy.
    I agree it is an issue for BMA.

  • PCNs are a chance to redefine general practice and feel empowered about the future

    Nick Mann's comment 12 Oct 2019 11:42am

    Contractually, logistically, operationally and politically, PCNs are a fool's errand.
    The recklessly forced timescale, future uncertainty of GMS with new PCN contracts under ICS/P, usurping of GP model by Govt-backed cowboy 'digital first' private sector companies, and the "last chance" threat to the GP model by NHSE from the outset... should sound alarm bells and demand a more circumspect purview.
    As future funding and more forced activity are increasingly channelled through PCNs via non-evidenced DES, NHSE will have us exactly where it wants us.
    Remember : "H&SC Act will put GPs in control"... many of us knew what would follow. We were right, and will prove to be right again.
    Sorry Krish, I know you mean well. Please stop and think again, for both GPs' and patients' sakes.

  • Four in 10 GPs in favour of charging patients for appointments

    Nick Mann's comment 11 Oct 2019 5:18pm

    Some quite bizarre answers from those supporting charges... implying the NHS is free and comparing Health services to plastic bags.

    Charging doesn't seem to have put off many in the private sector, but of course poor people can't go there.

    I sense some pejorative attitudes towards patients in these comments. Patients are not time-wasters or commodities. Ditch the zombie narratives and start pushing upwards. Patients are the easy target, but not the right target.

  • Four in 10 GPs in favour of charging patients for appointments

    Nick Mann's comment 10 Oct 2019 5:03pm

    Before comparing oranges with apples, note that France/Germany put £20-24bn more per annum into their health services than does UK.

    Charging is for zombies. Costs more to administrate than is recouped (see prescription charges).

    Not a single commentator anywhere ever seems to have noticed, let alone counted/costed/analysed, the proportion of GP time/appointments occupied by forced initiatives from NHSE....all the healthy people on whom we do NHS health checks, 'proactive' appointments, care plans, bloods, reviews etc etc etc.

    No evidence, no analysis.

    My suspicion is that the money doesn't end up covering the extra work and staff required. Same for the new work of PCNs.

    It's time we checked our own backyard properly before blaming and punishing patients.

  • HEE to push for five-year GP training pilots in every deanery area

    Nick Mann's comment 25 Sep 2019 11:33am

    I can see the attraction of geography-based training for general practice, but I am concerned about the quality of medical/surgical knowledge available from purely GP-based training.

    As a GP with 30yrs experience, I rely on a daily basis on the knowledge I accrued from hospital practice and specialty training.

    In fact I would say that most of the core skills which now underpin my practice as a general medical specialist were learned in hospital practice, then later developed over years in the community.

    I think it is a mistake to assume that medical training in hospitals is not relevant to general practice. Medicine is Medicine, with a number of steep learning curves along the way.

    The key medical/learning and experience from hospital training is easily transferrable to the GP environment, where we learn to adapt our practice in light of community/family/psychosocial factors. Almost all GPs I've spoken to agree that their practice benefits from the mutual insight gained from having experience from the hospital perspective.

    We need GPs to retain a high degree of medical/surgical knowledge and I sincerely doubt that wholesale transfer of GP training to the community will be able to achieve this.

  • General practice responsible for £88m of fraudulent behaviour, claims NHS report

    Nick Mann's comment 17 Sep 2019 11:40am

    Capita dumped medical records they had been paid to deliver, diverted money that should have been paid into pensions etc etc...
    So when NHSE said they would hold Capita to account but then did nothing, NHSE became complicit in NHS fraud.

    This constructive insinuation from NHSE is the lowest of the low: a resurgence of Jeremy Hunt's calumniatory attempt to undermine Junior Doctors' reputations in 2017.
    BMA response needs to show a very large, qualified, middle finger.

  • Artificial intelligence blunts any residual patient intelligence

    Nick Mann's comment 03 Sep 2019 7:30pm

    Well done to Pulse for instigating some much-needed field testing - responding to concerns of clinicians and others.

    NHSE have signally failed to do so.

    Facts on the ground do not support current NHSE/DHSC policy.

  • GPs should not prescribe antibiotics for impetigo, says NICE

    Nick Mann's comment 15 Aug 2019 1:02pm

    Facial impetigo is likely to represent URT carriage of pathogenic Staph/Strep.
    Topical treatment of any kind does nothing to address this.
    The patient remains a risk to themselves and to any contacts.
    Cases of neumonia, sepsis and scarlet fever have increased. Who is researching the impact/harms of not treating?
    Too many agenda guidelines based on too little medical evidence.