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Independents' Day

Peter English

  • GPC to seek change to firearms licensing procedure following GP outrage

    Peter English's comment 18 Nov 2016 5:16pm

    Anybody who requires a gun license in order to do their job should have their suitability for this assessed by an occupational health physician, as it is an occupational requirement; any request for an assessment for a gun license for occupational purposes should be paid for by the employer (or by the individual, as a business expense, if self-employed).

    I still, however, view part b) of the motion passed yesterday to have been ill-considered.

    Sharing a patient's full health record - even with consent - may breach DPA and confidentiality rules if information shared is not objectively needed by the party with whom it is shared. The onus should be on the patient to share information about their medical history with the doctor assessing them. With criminal sanctions for anybody who obtains - or retains - a firearms license by witholding medical information. And, as with DVLA, the onus should be on patients to report their illnesses to whoever controls their license.

    Any risk that information might be shared, against the wishes (if not contrary to their consent) of the patient would risk them not sharing that information with their GP, and thereby risks a patient failing to disclose signes or symptoms that would lead to a diagnosis and successful treatment, thereby harming the patient, as a result of compromising the GP-patient relationship.

    Thus for ethical reasons (possibly supported by the DPA and confidentiality rules) GPs should NOT, IMO, share patient's medical records with the physician doing an assessment for a firearms certificate.

    IF there is an agreement that data must be shared (and I reiterate, I would oppose agreeing to this) there must first be objective, evidence-based criteria for deciding what information needs to be passed on.

    Given that looking after sick patients and preventing illness must take a priority over non-NHS discretional matters such as firearms licensing, we need to find a way to keep the workload to a minimum, and must ensure that any such information-sharing requires only an automated search of the patient record, looking for Read codes for the necessary information; with no manual trawling of the records.

    Alternatively, patients should be asked to request a copy of their records from the GP and share them with the licensing authorities. This gives the patients the responsibility for deciding whether they are willing to share the information. If they choose not to, they can withdraw their license application (or risk prosecution for witholding information).

    If GPs are expected to maintain a register of gun-owners and report any illnesses that give concerns (and as I've said, I think patients should be made responsible for reminding their GP that they have a license, and for reporting such concerns, analogous to the DVLA requirements) then there must be an annual retainer fee for doing so, for as long as the patient holds the license.

    Furthermore... The GMC rules on conscientious objection relate to those situation where a doctor has an objection to a medical procedure (such as termination of pregnancy). They only relate to occasions when a practitioner does not wish to refer a patient for a particular medical procedures. They do not relate to other things patients may request, so they should not relate to this. I do not believe there is a GMC duty to refer a patient on to another doctor in this instance.

    I also stand by previous comments that a doctor (or a practice) should be able to inform the local Chief Constable that they will not be undertaking any firearms assessments, will not be replying to any requests to do so, and that not receiving a reply does not mean there are no concerns, just that the CC will have to find another way to get that individual assessed.

  • Pharmacists to treat sore throats 'to free up GPs and cut antibiotic use'

    Peter English's comment 14 Nov 2016 3:30pm

    Is this something which NICE has said is worthwhile and cost-effective?

    If not, is it a purely political initiative for purely political motives?

    ps - knocking pharmacists doesn't help; we're all professionals in it together, don't allow DH/politicians to use divide-and-rule tactics.

  • BMA suggests GPs should receive a 2% pay rise next year

    Peter English's comment 09 Nov 2016 10:39am

    Is that after taking into considerations such as increases in rents, CQC fees, etc.?

  • 40 treatments to avoid? More like 40 ways to raise my blood pressure

    Peter English's comment 07 Nov 2016 2:02pm

    Sadly the (PHE/HPA endorsed) guidance on postpiercing care currently recommends home-made saline. No evidence of benefit whatsoever. (

  • DH unable to guarantee 76% CQC fee hike will be fully reimbursed

    Peter English's comment 24 Oct 2016 2:01pm

    Of course, before treasury started to cap DDRB payments, this would have been picked up automatically as a business expense.

  • Two years into general practice, I feel like I know less than ever

    Peter English's comment 13 Oct 2016 11:32am

    I think impostor syndrome is very important in all sorts of ways...

  • NICE sets out plans for GPs to drive up ‘unacceptable’ child vaccination rates

    Peter English's comment 02 Sep 2016 12:13pm

    The vast majority of people who don't get vaccinated don't do so because of structural problems - they didn't get the invitation/reminder; the clinic wasn't at a time and place they could easily get to... Only a small minority don't get vaccinated because they actively decided not to.

  • How do I write a response to a patient complaint?

    Peter English's comment 19 Aug 2016 12:19pm

    Is it just me, or are there grammatical errors in the recommended versions of how to say what you might want to say? ("'I am so sorry if I caused you to feel that I had not taken you seriously, and [for] the distress you have experienced as a result."; "At times I have found your approach to myself and the staff quite difficult to manage and, whilst I can understand that when patients are unwell and feeling distressed it can reflect in their manner [something missing here?...".

    Of course, many doctors will choose to let off steam on the medical forum of their choice, and then write a sensible response, despite the encouragement they may receive on those forums to be forthright.

  • GPs can charge local authorities for safeguarding reports, says GPC

    Peter English's comment 18 Aug 2016 2:14pm

    Is there a way to declare that the report will be written and made available once the fee is paid?

    You can't be accused of not having done the work - you've written the report; but why should you share it before receiving payment?

  • Should drug possession and use be legalised?

    Peter English's comment 12 Aug 2016 1:57pm

    it's curious that both debaters have looked at this very much from the point of view of the individual drug user, or the doctor treating them.

    A vast amount of harm is caused - not just to the users, but to society overall - by the consequences of criminalisation. Illegal drugs are expensive (although cannabis and opium - and their analogues) can be produced at low cost if you don't have to worry about criminality. In order to fund their habits, people are forced into crime, prostitution, destitution. People involved start to carry knives and other weapons - and to use them. The consequences of this on the rest of us are that we become the victim of those crimes.

    In the process, young black men in poor areas, for example, get drawn in; and many who are not involved are taught to resent the police and to feel outside society by being stopped and searched when they haven't done anything wrong.

    In order to wage this war on drugs, crime fighting bodies wage an arms war on the drug pushers and smugglers, at great cost to the taxpayer, with a lot of collateral damage, and with very limited success.

    Even from an individual user's point of view (and that of the doctor caring for them): some might use more drugs if they're more accessible, but at least, if the drugs are regulated, they will be safe and free of the contamination common to street drugs, which can be cut with substances which are poisonous or contaminated with pathogenic organisms.

    Looked at from the point of view of society, the argument is overwhelmingly in favour of decriminalisation.

  • GPs should refuse all firearms licence requests, says BMA in U-turn

    Peter English's comment 04 Aug 2016 10:08am

    I responded previously saying I didn't see why practices should have to respond to such letters more than once (to the first one they receive) - saying you won't respond to future such letters.

    On further consideration - what duty is there on GPs to reply to such letters at all? Why is the BMA advising that it is not acceptable not to reply promptly? This is not part of the work contracted from GPs, so what contractual or other duty is there on the GP to respond to a letter from a third party about a patient?

  • GPs should refuse all firearms licence requests, says BMA in U-turn

    Peter English's comment 28 Jul 2016 4:45pm

    If you have to respond promptly, as per the BMA advice, can you write to the chief constable and say "we will not be providing any reports; should you ask for any, there will be a charge of [x sausages] for returning the letter to you; unless we hear from you to the contrary we assume you agree to these conditions."?

  • GPs should refuse all firearms licence requests, says BMA in U-turn

    Peter English's comment 28 Jul 2016 12:14pm

    The guidance still says that practices should respond to such letters "without delay" ("We are now advising GPs to return the letter to the police without delay").

    I would have thought it acceptable for practices to inform the police - once - that they will not be responding to any such letters, and thereafter to file them in the round filing container (ie not respond to them). Why should they be obliged to keep responding, when they've already said they won't?

  • Ridiculous indemnity costs? How GPs can take back control

    Peter English's comment 25 Jul 2016 11:03am

    In priniciple, of course, it shouln't matter too much. If all GPs have to pay an extra £5000 in indemnity fees, the DDRB would automatically award all GPs an extra £5000. In practice, of course, the DDRB has been leaned on by government not to award the correct amount, and the government has refused to award the full DDRB recommended amount anyway... But if the system were working as it was designed to...

  • How should GPs respond to backdated property service charges?

    Peter English's comment 14 Jun 2016 11:23am

    If they charge you for catering (which they don't provide) and for paying your staff (whom you pay directly) this is clearly fraudulent, and a police matter!

  • Meningitis patients twice as likely to have taken antimicrobials, say researchers

    Peter English's comment 12 Apr 2016 4:48pm

    This does not surpise me.

    We know that oranisms such as the meningogoccus exhibit "competitive inhibition". In other words, if your nasopharynx is colonised with a (harmless) Neisseria organism, this will make it harder for a new, potentially pathogenic to establish itself in that ecological niche.

    We know that if you're going to get ill with a particular strain of meningococcus, you get ill within 5 days. (OK, people sometimes, though rarely, get ill within 7 days; and one case has been reported where the exposure seems to have been more than 7 days previously; but in practical terms it's within 5 days...) If you survive 5 days after exposure without getting ill, you're very unlikely to do so.

    The purpose of chemoprophylaxis (antimcrobials to eliminate meningococci) for meningococcal disease is to eliminate the hypothetically more virulent strain from the person the case acquired it from.

    I've always explained that if you give somebody chemoprophylaxis to people who are NOT in the fairly close group of people we identify as contacts, you could be increasing their risk by eliminating the harmless Neisseria organisms that are present in their nasopharynx, providing a degree of protection via competitive inhibition.

    This study supports the advice I have long given!

    It also makes me question (again) the advice about chemoprophylaxis. If antimicrobials increase the risk of meningococcal disease in the general population, what do they do in close contacts of cases?

  • GPs must put protocols in their proper place

    Peter English's comment 25 Mar 2016 10:50pm

    Guidelines are useful for novices. One of the early projects looking at decision support systems (for abdominal pain) showed that practitioners in their first few months made better decisions using the tool - and also that they learned more quickly through using the tool; but after a fairly short time the tool became redundant.

    The same applies to many guidelines - they are most useful for uncommon things you see rarely. But identifying the well/ill child correctly is a core GP skill.

  • How the end of imposition of the junior doctor contract unfolded

    Peter English's comment 11 Feb 2016 1:52pm

    Trade Unions gave us a two-day weekend.

    This government has pulled this away from junior doctors. The rest of the population - at least those employed by or contracted to the government - can expect the same.

  • Mr Cameron, the NHS is not safe in your hands

    Peter English's comment 05 Feb 2016 3:53pm

    Dr Peter M B English (Public Health Physician)

  • E-cigarette use 'associated with reduced smoking cessation', study claims

    Peter English's comment 20 Jan 2016 3:13pm

    "many vapers report using an e-cigarette to cut down and ultimately quit."

    Isn't that what they call anecdote? Is the plural of "anecdote" now "evidence"?