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GPs buried under trusts' workload dump

Peter English

  • A body blow to a profession on the brink of burnout

    Peter English's comment 07 Jan 2014 11:37am

    That link didn't appear clearly. Try this:

    http://tinyurl.com/qynjtxz

    The full citation is:

    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 (http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4006976).

    The foreword states:

    "The primary care work force represents a substantial part of total NHS staffing. It has long been an aspiration to make occupational health services universally available to all who are engaged in NHS health care, including general practitioners and their staff, as well as those in hospital and community trusts.

    "The provision of these services will, by improving the health and environment of the primary care workforce, ensure that General Practitioners and their staff make the best possible contribution, both individually and collectively, to improving health and patient care in primary care.

    "That is why the Government announced in the NHS Plan that Occupational Health services would be extended to General Practitioners and their Staff from 1st April 2001.

    "We are therefore delighted to bring you this guidance which gives details on what Health Authorities need to commission, funded through additional allocations to their budgets to provide these services. This guidance is the culmination of many months of work by the Department of Health, the British Medical Association’s Occupational Health and General Practitioners Committees, the Faculty of Occupational Medicine, the Society of Occupational Medicine, the Royal College of General Practitioners, the Association of National Health Occupational Physicians and the Royal College of Nursing. It recognises in the most practical way the commitment of the NHS to its staff and through them to the people it serves.

    "No doubt lessons will be learnt as this most important project goes forward and occupational health services in primary care are developed. We welcome this beginning and look forward to the future."

    While Health Authorities have long since been abolished the duties imposed on them were transferred first to PCTs, and then to CCGs and NHS England. So, as I understand it, if NHS England decides to cease funding occupational health services for primary care, it will be in breach of its duty to do so.

  • A body blow to a profession on the brink of burnout

    Peter English's comment 07 Jan 2014 11:20am

    Can they do that? Is http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4006976 no longer current?

  • Farewell, Year of the Complaint

    Peter English's comment 05 Jan 2014 8:32pm

    What makes you angry is that often you are not given an opportunity to prove you're a good enough practitioner; the cards are deliberately stacked against you so you don't have a chance. Any evidence in your favour is not allowed to be presented.

  • Light(en) up

    Peter English's comment 16 Dec 2013 12:10pm

    More to the point, smoking keeps the economy going!

    Not only do they pay a lot of duty on their tobacco products, but smokers are more likely to die at retirement age, so they don't require pensions or health or social care in their old age.

    It is hard to make an economic argument against smoking.

  • The state of dementia in the UK, the merits of male HPV vaccination, and an EU bid to ban e-cigarettes

    Peter English's comment 29 Nov 2013 11:59am

    Forcing e-cigarettes off the shelves would, indeed, be crazy.

    But permitting tobacco companies to place large advert glamorizing the "vaping" lifestyle is surely done only to entice non-smokers (particularly schoolchildren - see http://peterenglish.blogspot.co.uk/2013/08/on-e-cigarettes-and-smokeless-tobacco.html) into an addiction to nicotine.

    Sure, e-cigarettes should be available as a safer alternative for smokers, or to support them to quit; but advertising should be banned or at the very least tightly controlled.

  • Four common assumptions about GP whistleblowing - and what to know before making a disclosure

    Peter English's comment 07 Nov 2013 10:52am

    AIUI, your contract outranks a lot of other policies etc., especially any imposed by an employer.

    The NHS consultant contract includes the line:

    “A consultant shall be free, without prior consent of the employing organisation, to publish books articles, etc and to deliver any lecture or speak, whether on matters arising out of his or her NHS service or not.”

    Employers widely try to infringe this. As LNC chair for my organisation this will be on the agenda at the next LNC meeting...

  • Many grassroots GPs may back the Government's migrant levy - but they won't if they have to police it

    Peter English's comment 23 Oct 2013 12:23pm

    I blogged about this recently: http://peterenglish.blogspot.co.uk/2013/10/should-gps-decide-whether-people-are.html

  • Shingles vaccine shortage blamed on GPs 'multiple ordering' as Public Health England imposes further restrictions

    Peter English's comment 11 Oct 2013 12:45pm

    Edited and corrected:

    In November 2005 David Salisbury of DH went on the Today Programme and accused GPs of wasting flu vaccine (which he seemed NOT to know had been purchased by and belonged to the GPs), when actually the apparent shortage was because DH had divided the amount of vaccine available for England by the population of the United Kingdom.

    Since then I've been rather suspicious of this sort of "let's blame the GPs for a vaccine shortage" stories.

    That said, with a new vaccine, rolling out for a programme with limited supplies, if some practices order more than had been anticipated, that would cause problems. I'm not sure if there's a global supply problem or not - I suspect it's that DH didn't front-load their order sufficiently, the way that many practices (probably very sensibly) have done.

  • Shingles vaccine shortage blamed on GPs 'multiple ordering' as Public Health England imposes further restrictions

    Peter English's comment 11 Oct 2013 12:36pm

    In November 2005 David Salisbury of DH went on the Today Programme and accused GPs of wasting flu vaccine (which he seemed to know had been purchased by and belonged to the GPs), when actually the apparent shortage was because DH had divided the amount of vaccine available for England by the population of the United Kingdom.

    Since then I've been rather suspicious of this sort of "let's blame the GPs for a vaccine shortage" stories.

    That said, with a new vaccine, rolling out for a programme with limited supplies, if some practices order more than had been anticipated, that would cause problems. I'm not sure if there's a global supply problem or not - I suspect it's that DH didn't front-load their order sufficiently, the way that many practices (probably very sensibly) have done.

  • GPs must speak out against plans to charge migrants

    Peter English's comment 10 Oct 2013 12:13pm

    I tried to comment, but the website gave an error message on several attempts - so I blogged my response: http://peterenglish.blogspot.co.uk/2013/10/should-gps-decide-whether-people-are.html

  • Perplexed over childhood flu

    Peter English's comment 02 Oct 2013 12:01pm

    Children can be seriously ill with flu. It's a common disease, so even a low rate of death and serious complications can add up to a lot of cases.

    And, yes, children are very efficient vectors of flu - a former president of the European Society for Paediatric Infectious Diseases, Ron Dagan, memorably described children as "bioterrorists" because they are so effective at transmitting gastro and respiratory infections like flu and norovirus to others. So vaccinating children reduces flu in others.

    As for the pilots... Well, first there's an issue with quantities of vaccine; and then there is genuine uncertainty as to the most efficient way to deliver the vaccine programme. Would you really have wanted to have the pilot programme implemented as a part of the national programme on top of the pre-school programme? And if it were implemented without reasonable evidence of the best way to do it, based purely on somebody's best guess, would you be happy? Or would you rather it was delayed for a year while they gather more evidence on the best way to implement it? Sometimes the DH can't win.

  • Nicholson says competition is 'harming efforts to improve patient care', study finds most C Diff infections are 'not hospital-spread' and a grave warning about...the French horn

    Peter English's comment 26 Sep 2013 11:03am

    The triangle a safe bet? Sat there in the middle of the percussion section? I doubt it!

  • GPs to have new 'duty to share' confidential patient data

    Peter English's comment 13 Sep 2013 12:49pm

    It's an unfashionable view, and I'm not sure where I stand on this yet, but...

    People in the UK get most of their care free - or heavily subsidised at the point of delivery.

    In order to maintain the most efficient health care services, we need data about their usage. We also need to be able to link records for example to monitor the effects of an intervention.

    It is not impossible to get this with completely anonymised data - you need to see if the person who got intervention x went on to have complication y or positive outcome z.

    Part of the quid pro quo to the cheap/free medical care could, quite reasonably, consent to your pseudonymised data - used very carefully - in this way.

    Another issue was raised yesterday by the Department of Health media centre who tweeted:

    'DH Media Centre @DeptHealthPress
    "Medical notes should be available everywhere in the system whenever a patient consents - care home, hospital, GP surgery and 111"'

    I have recently been involved in managing a serious untoward incident in which a patient died, partly at least because of a failure of communication between different health sector bodies - a failure that might not have occurred if rules on sharing information were relaxed. Requirements that block such sharing does cause deaths, and no doubt less serious adverse consequences.

    From an ethics point of view - how many deaths and serious adverse incidents need to be avoided to outweigh the very minor incursion into the perceived "rights" of many people that would arise if hospitals could routinely access their GP notes and vice versa?

  • A real history

    Peter English's comment 03 Sep 2013 6:41pm

    We've all met patients like this. Thanks for reminding me! They are so humbling.

    A beautifully written piece.

  • Stop exploiting GPs’ goodwill

    Peter English's comment 03 Sep 2013 12:57pm

    "It also fits far too neatly into the ‘greedy GPs’ narrative pushed by some of the national media. ‘Just say no’ is an all-too-tempting mantra, but one that could backfire."

    I disagree. Sure, it might generate some more "lazy GPs" stories. But we all know - and so do the public - that these are black propaganda. Fear of such stories is not a good reason to do unnecessary, unpaid work. Unless GPs say no - and do so collectively - they will be expected to do ever more unpaid work, when their workload is already unsustainable.

    It is, of course, important to communicate clearly why GPs are saying no to this work; but to throw in the towel and do it for fear of negative headlines will only accelerate the headlong rush to disaster.

  • NHS 'at war', a near doubling of never events and why fashion-conscious nurses should rein it in

    Peter English's comment 03 Sep 2013 12:51pm

    In response to anonymous' comment about nurses' appearance... As long as there's no infection or health and safety risk, I don't care what they look like.

  • Almost famous

    Peter English's comment 30 Aug 2013 1:09pm

    Enthusiasm is good!

    But... earlier diagnosis may be a good thing in some circumstances, but this doesn't always mean that screening is good. See http://www.ganfyd.org/index.php?title=Screening .

    And celebrities can be very useful; but only if what they do is useful. They can also be very damaging - e.g. when high profile celebrities coming out to support antivaccination pressure groups (Carol Vorderman and Juliet Stevenson both campaigned against MMR vaccination, for example).

  • Government told to ‘stop treating NHS like a bank’ as waiting lists reach all-time high… and why do Welsh doctors prescribe more?

    Peter English's comment 16 Aug 2013 11:58am

    Cut beds, cut hospitals, cut funding, then express surprise at the consequences. Usual HMG approach.

  • Call for HPV vaccination to be extended to young gay men

    Peter English's comment 17 Jul 2013 5:08pm

    This is a good idea, though not a new one.

    1. English PM. Who should be offered the HPV vaccine outside the planned programme? Vaccines in Practice 2008;1(1):1-4. (available via http://www.vaccinesinpractice.co.uk/_year_search_review.aspx?pageid=168&JID=9&Year=2008&Edition=99 - free registration/login required)

  • Give GPs freedom to sign-off patient group directions, says BMA

    Peter English's comment 10 Jun 2013 4:10pm

    Many people consider that PGDs are essential for opportunistic vaccination, and that the ability to do opportunistic vaccination is essential to achieving the levels of vaccine uptake that are needed.

    While it can be quite tricky to get a PGD right - and they do have to be right - this is much less true if you are adapting a previously existing PGD. PHE has, for example, produced a template PGD for rotavirus vaccine, and I'm told it plans to produce PGDs for fluenz and shingles vaccination.

    Groups of practices or other bodies could produce template PGDs which could be adapted by individual practices.