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CAMHS won't see you now

Peter English

  • 'Seven-day access fairytale is not deliverable'

    Peter English's comment 09 Oct 2014 2:35pm

    I'm afraid that our idea of what "beneficial" means, and a politician's idea are completely different.*

    To us, the question "is it beneficial?" usually means to "do patients (or possibly service providers) benefit from improved services, better treatments, fewer delays, better quality of life, or whatever?"

    To a politician, however, the question "is it beneficial?" means one thing, and one thing only: "will it get me more votes?"

    So tot complain to the PM that his "vote-winning" policy is not beneficial to patients will simply confuse him. If it's "vote-winning" then, by definition, it's beneficial; and you're obviously a complete idiot.

    When you refer to a "vote-winning" policy I suspect you mean a policy which serves no purpose other than to win the policy maker votes; but a politican will never understand this.

    * (Indeed much of the problem could be that politicians speak a different language to the rest of us: it sounds similar enough so you think you can understand it; but key words have a completely different meaning. But it's not really a secret language. Most MsP are now career politicians who've never worked in the real world, and they simply don't recognise that the words they use have a different meaning for the rest of us.)

  • Disparaging social media comments - is a ‘zero-tolerance’ policy acceptable?

    Peter English's comment 25 Sep 2014 2:28pm

    Instigating a ‘zero-tolerance’ policy against complaints on social media - isn't that what King Canute is famed for doing?

  • BMA wants ban on indoor e-cigarette smoking

    Peter English's comment 01 Sep 2014 5:12pm

    Despite their purveryors' claims to the contrary, e-cigarettes clearly are being marketed to young people with sexy, glamorising adverts.

    It's obviously best for smokers to give up. Second best is to convert to e-cigarettes (very much safer; but maintains the addiction and possibly the likelihood that they'll smoke again).

    Worst case scenario is that e-cigarettes will be more dangerous than we realise (we don't know how safe/dangerous they are), and will be a gateway product that get lots of young people addicted to nicotine.

    See and

  • Appraisals could be used to 'name and shame' GPs over cancer referrals, local leaders say

    Peter English's comment 15 Aug 2014 2:37pm

    This sounds very much like a research project, not merely evaluation or audit.

    Does it have ethical approval from an appropriate research ethics committee?

    If it is a research project and doesn't have ethical approval, then any doctor who participates in this study is risking their GMC registration.

  • Consultants refuse to accept GP referrals for smokers

    Peter English's comment 12 Aug 2014 4:10pm

    This topic conflates two issues:

    * A judgement of a patient's lifestyle, and the likelihood that their condition was caused by their lifestyle.

    * An evaluation of the efficacy of the treatment.

    It is not ethical to deny patients treatment on the basis of a judgement of how their lifestyle may be responsible for their decision. If we start down that road... It's easy to condemn some lifestyles (smoking, illegal drugs, alcohol); but sedentariness or its opposite, dangerous exercise could be equally blameworthy...

    On the other hand, if a treatment is not likely to be effective due to a patient's ongoing lifestyle, then we are not obliged to offer a useless treatment; and given that resources are tight and treatment has to be rationed, it be provided only if it meets cost-efficacy criteria. It may well be that vascular surgery is unlikely to be effective in smokers, in which case it is not a beneficial treatment, has no cost-efficacy, and should not be offered, at least, not using state funds. This is not a moral judgement on the patient, merely rational use of resources.

  • Government advisors consider hep B jab for infant schedule

    Peter English's comment 25 Jul 2014 12:05pm

    As I predicted.

    1. English P. Should universal hepatitis B immunisation be introduced in the UK? Arch Dis Child 2006;91(4):286-9 PMID: 16551785. (

  • Quik-Vanish! Citrus-scented problem-remover in a can

    Peter English's comment 18 Jul 2014 11:02am

    In the context of NHS England's Marie Antoinette like statement yesterday this is devastating satire!

  • Obesity could be fuelling asthma epidemic, dementia sufferers feel uncared for and Cameron tackles antibiotics resistance

    Peter English's comment 03 Jul 2014 5:10pm

    It wouldn't be entirely facetious to suggest that if some dementia patients "feel uncared for", it could be that they did receive care, but couldn't remember receiving it...

  • Letter: GMC has not banned doctors from treating family

    Peter English's comment 27 Jun 2014 2:10pm

    Part of the problem here is - as so often with the GMC - that it produces guidelines that are vague and woolly.

    Clearly there would be issues with e.g. prescribing controlled drugs for a family member without the detachment necessary to be cope with manipulation; or with treating a seriously ill family member when it's outside your competence without asking for help.

    But there are so many instances when there is no good reason why a doctor shouldn't treat a family member, if they'r competent to do so. A GP who prescribes antibiotics for a routine infection in the same way as they would for a patient with the same clinical picture is surely doing no harm.

    But the way the guidance is written makes it difficult to behave in the way we tell our patients to behave. We ask them to self-care instances of minor illnesses (for themselves and their children). Are doctors permitted to give their febrile (but not apparently seriously ill) child paracetamol? That's treating the child, after all.

    "Oh, but the GMC won't be interested in that!", you'll retort. But they will if the febrile illness turned out to be the onset of a fulminating septicaemia. The fact that given what you saw at the time it was perfectly appropriate, exactly what you'd expect any parent to do at the time, and you'd need a crystal ball to know the child was going to be dead from meningococcal infection in the morning won't stop the GMC from hounding you to suicide, especially if the gutter press get in and give you a kicking first. (They do respond more punitively when there's press interest as we've seen on many occasions.)

  • District nurses going extinct, ban drunks from A&E and the return of school milk

    Peter English's comment 17 Jun 2014 4:28pm

    Ban drunks from AED? Yes, indeed! That'll work well. There'd be deaths within the first week...

  • A demented bloody waste of time

    Peter English's comment 17 Jun 2014 4:27pm

    Is this another example of a non-screening test (by which I mean a screening test implemented despite no recommendation from the national screening committee because it doesn't meet the modern equivalent of Wilson and Jungner's criteria)?

  • Dilemma: Vulnerable patient reveals relationship with receptionist

    Peter English's comment 13 Jun 2014 12:25pm

    In smaller communities it's hard enough for the GPs not to have relationships with patients outside work. We have professional bounds that we must comply with.

    I do not think that there are any such professional obligations on receptionists - other, of course, than maintaining confidentiality etc.

    If finding another practice will disadvantage the patient then requiring them to do so seems disproportionate.

  • PM announces major expansion of seven-day GP access pilots

    Peter English's comment 14 Apr 2014 12:33pm

    Innovations in primary care are frequently successful during piloting but less so when rolled out.

    Part of the problem is the nature of the pilot - it's seldom done on something like an "intention to treat" basis, but rather, using volunteers.

    We saw this with previous changes like GP fundholding.

    An enthusiastic group of early-adopters takes up an idea which is well funded by a government keen to see its ideas adopted. The pilot is a roaring success.

    The innovation is then rolled out to other practices who are less enthusiastic and who therefore don't invest the time and interest into making it work; and it's less well funded so even if they did, it would be less successful.

    So the final roll-out is a shadow of the success of the pilot programme...

  • Common painkiller 'almost doubles' heart risk, clean drug addicts get shopping money and how Google glass will 'revolutionise' medicine

    Peter English's comment 10 Apr 2014 12:41pm

    Remember - if the absolute risk is very low, doubling it still leaves a very low absolute risk, and a very small increase in the absolute risk increase...

  • Activity levels in mums and children are 'directly linked', cancer and CV disease leads to 60% of deaths in Australia and the dangers of roadkill cuisine

    Peter English's comment 25 Mar 2014 3:31pm

    Ah, the police! Well known as an authority on public health in general, and zoonotic disease in particular.

  • NICE should be handed broader remit to consider wider impact of NHS spending, says Burnham

    Peter English's comment 17 Mar 2014 12:02pm

    Very sensible. And why stick at public spending and not whole society costs?

    If, for example, a parent has to take a week off work to look after a sick child, and loses a week's income, surely that should be considered? They not only lose the income, but society loses out from the lost productivity and taxes... I know that vaccination recommendations come from JCVI rather than NICE but the same principles apply: it does not make sense to consider only health care costs, particularly when an intervention may have a long-term effect.

  • GPs told to specify counter-terrorism lead when applying for enhanced services contracts

    Peter English's comment 03 Mar 2014 2:33pm

    Feel free to cite my brief letter to BMJ in your response.

    1. English PM. Doctors should not agree to identify potential terrorists. BMJ 2011;343. 10.1136/bmj.d4211 (

  • GP occupational health services in jeopardy as NHS Commissioning Board reviews funding

    Peter English's comment 27 Feb 2014 11:34am

    It must depend on who the "successor organisation" for the Health Authority is in this respect. It must, surely, be either NHS England or the CCG. But the guidance to Health Authorities still stands, apparently.[1]

    1. 1. Department of Health. The provision of occupational health and safety services for general medical practitioners and their staff. London: Department of Health, 2001 (May 2001); 1-32 (

  • Teenage mental health 'timebomb', chocolate regulates insulin and why the newspapers are suddenly talking about

    Peter English's comment 20 Jan 2014 12:35pm

    In terms of quality of life, mental health issues are surely just as important as physical health ones.

    Sadly, resources for these conditions don't seem to be a priority.[1]

    1. Hawkes N. England’s mental and community health services face deeper cuts than hospitals. BMJ 2014;348. 10.1136/bmj.g289 (

  • Charging migrants - crackdown on health tourism or just health?

    Peter English's comment 08 Jan 2014 11:12am

    Certain diseases are exempt from any charges for public health reasons - see e.g. .

    While we must take care to ensure that these exemptions are not inadvertently removed, I think it extremely unlikely that any government would deliberately remove them.