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Gold, incentives and meh

Peter English

  • Row over nursing training highlights NHS 'entitlement culture'

    Peter English's comment 21 May 2013 7:03pm

    My son's graduate entry level job includes healthcare insurance. For many people this is a "perk", like many others that employers could provide. I'm not sure that this is an issue I can get too worked up about.

  • RCGP backs drive to boost dementia diagnosis rates by 50%

    Peter English's comment 16 May 2013 1:02pm

    There are clear criteria for deciding whether it is worth introducing a screening programme - see e.g. .

    One of the criteria is the existence of an affordable and acceptable treatment for the condition. Are we convinced that the resources are there to provide necessary treatment for dementia cases?

  • Third of patients presenting at A&E 'could be treated by GPs'

    Peter English's comment 16 May 2013 12:59pm

    I worked in accident and emergency in the 80s before becoming a GP; and then in the later 80s/early 90s did some sessions after becoming a GP.

    While it was true that I could clear the "minors" section of casualty very much more quickly with the benefit of my GP experience than I could as an SHO, it was certainly my experience back then that a considerable proportion of cases could have been treated by GPs - not just as well, but better, given the continuity issues. I couldn't say if things have changed.

  • Why GPs must be free to speak out

    Peter English's comment 10 May 2013 9:50am

    I have blogged about the GMC guidance. I agree that it will have a chilling effect; and the GMC has refused to explain why it changed the wording from the perfectly reasonable version in the consultation draft to a much more draconian version. Oddly, they have attempted to withdraw from in a statement on, of all places, their facebook page, though they say they will not amend the guidance.

    See and subsequent blog posts.

  • NHS Health Checks to be rolled out in all areas 'by 2016'

    Peter English's comment 03 May 2013 10:06am


    This sort of "health check" is a constant desire of politicians; but it is driven by their desire to be elected. It's one of those "obviously good ideas" that is only an obviously good idea if you ignore all the evidence as to whether such interventions actually do more good than harm and are actually effective.

  • 'Hygiene hypothesis' discredited, hospital trust chief executive paid full salary a year after resigning, and do three-parent babies represent 'Frankenscience'?

    Peter English's comment 21 Mar 2013 3:24pm

    The "Frankenscience" stuff is utter rubbish, of course. This is not about eugenics or creating "the perfect baby". It is merely about replacing the mitochondria (the "third parent" for people who have heritable mitochondrial diseases.

  • Hunt to call on commissioners to tackle UK's 'shocking underperformance' on public health

    Peter English's comment 05 Mar 2013 12:08pm

    Another attempt to blame doctors for politicians inactions.

    What is needed is not more action by the NHS or the private healthcare providers that are fast replacing it; but upstream action by politicians. "Health protection" in the sense it had before the HPA comandeered the expression (see,_Fyfe_%26_Tannahill%27s_model ).

  • GPs should not be forced to police immigration

    Peter English's comment 20 Feb 2013 10:54am

    This is a difficult area. As a consultant in communicable disease control it causes me problems from time to time. People who have come from countries with a high prevalence of TB, for example, are asked to register with a GP IF AND ONLY IF the immigration authorities have already decided that they meet the criteria for NHS primary care.

    Often, however, they are denied registration by practices with rules that refuse registration to people who cannot prove that they have lived in the UK for a certain period of time, or who cannot provide e.g. a utitility bill to prove their address and ID.

    Such practices may well be considered discriminatory and illegal; yet I can understand why GPs, caught between PCT fraud teams breathing down their necks, threatening to withold funds for patients registered who they decide were not entitled to do so; a complex set of rules that makes it unclear who is entitled to health care - especially since it rests partly on the person's "intentions" (if they intend to stay less than six months they're not entitled to care, even if they grew up in the UK and only emigrated fairly recently); and concerns that refusing registration to people who are entitled it may be (probably is in at least some cases) illegal discrimination. I suspect that concerns about rationing NHS resources also play a part.

    In my view this should NOT be something that GP practices should have to do. Staff at PCTs (or CCGs or whatever they're called this week) might need to ask GPs to collect a little extra information and share this with them; and then they should take responsibility for this decision. GPs do and should have continue to have a role as gatekeeper for secondary care; but it is not appropriate to ask them to be the gatekeepers for access to primary care.

  • 'Gender-bending' chemicals in our homes, retinal implants to help the blind and coronavirus causes the death of a British man

    Peter English's comment 20 Feb 2013 10:31am

    Final para reads "First identified last year in the Middle East, most of those infected have travelled to Qatar, Saudi Arabia, Jordan or Pakistan. In tota l12 people have been diagnosed worldwide, and six have died."

    That should, of course, say "In total 12 people..." - not 112. Obviously a typo, but perhaps not to everybody...

  • 'Gender-bending' chemicals in our homes, retinal implants to help the blind and coronavirus causes the death of a British man

    Peter English's comment 20 Feb 2013 10:28am

    "The Daily Mail, rarely prone to scaremongering,..." This is intended to be ironic, isn't it?

  • DH to mandate GPs to encourage lifestyle change every time they see patients

    Peter English's comment 19 Feb 2013 10:45am

    I was listening to somebody complaining bitterly about this from a patient's perspective the other day. She bitterly resented that at every encounter her own agenda seemed to be thrust aside, while the bean-counting insistence on doing another blood pressure check, asking about diet, etc., took precedence. She was telling me how startled the practice nurse was when she refused to have her blood pressure taken when she attended for a cervical smear test. As she (patient) saw it, having a smear test makes her anxious anyway; and she wasn't expecting to have a BP check as well, so why should she agree to it. The request made her angry.

    She may or may not be reacting "reasonably", but this is the effect it has on her; and probably on many other patients. Perhaps we should work harder to mobilise patient support, here. "Patients - do you really want us to give more priority to the Department of Health's diktats than to your fears, concerns, and expectations when you make an appointment with your doctor?"

    And in any case, have all the DH diktats which are about screening been agreed as worthwhile by the national screening committee? If not, then why are we wasting time on them?

  • Mid Staffs and the dangers of medicine by numbers

    Peter English's comment 11 Feb 2013 2:35pm

    I enjoyed anonymous' anecdote:

    '"Anonymous | 08 February 2013 9:37pm

    'I can still remember a prominent consultant surgeon rounding up her colleagues and summoned the managers to protest about the state of the HDU

    '"We are not going to compromise patient care, and you'll do as we say or we'll all walk out"'

    Unfortunately, I suspect that a modern NHS manager would respond by reporting the doctor who said that to the GMC for threatening to abandon their patients; there would be a 5+ year investigation during which time they would not be permitted to do clinical work (though, now that suspension is deprecated, they'd probably be given some makework activities); and they'd end up being sanctioned or struck off by the GMC for breach of GMP - for standing up for their patients.

  • Longstanding fears over consent and confidentiality are realised

    Peter English's comment 07 Jan 2013 1:17pm

    If you want healthcare, we make records. We'll take reasonable care to look after your records, but it would be dangerous and irresponsible of us not to keep records. If you don't like it, then you can't have healthcare.

  • GP practices, warring parents and access to records

    Peter English's comment 04 Jan 2013 3:23pm

    What that should have read, of course, was:

    179 calls a year is roughly one every 1.2 days when you rule out weekends and bank holidays - closer to 1 a day than one every other day.

  • GP practices, warring parents and access to records

    Peter English's comment 04 Jan 2013 3:23pm

    179 calls a day is roughly one every 1.2 days when you rule out weekends and bank holidays - closer to 1 a day than one every other day.

  • Pharmacists should fit IUDs, say MPs

    Peter English's comment 04 Jan 2013 3:01pm

    I completed my FPCert years ago and fitted IUDs. I also did cervical smears, cervical swabs, and, when appropriate VEs on patients in whom it was indicated. For this I had undergone lengthy training in obstetrics and gynaecology as a medical student and GP trainee (including six months of O&G work).

    How much training and experience do pharmacists have in doing VEs, visualising the cervix, etc.?

  • British kids disproportionately diabetic, why your patients should ditch the booze and the tough regulation faced by the cosmetic surgery industry

    Peter English's comment 02 Jan 2013 3:19pm

    As I wrote in a blog some time ago: "...regulations should be in place to ensure that any business providing cosmetic procedures must pay into a fund to ensure that these things can be paid for when necessary. This would, of course, make the procedures more expensive, as the cost is passed on to the patient – as it must be, or they’ll be free-riding on the NHS."

  • Are today's whooping cough cases the legacy of a 1980s jab scare?

    Peter English's comment 20 Dec 2012 1:47pm

    Typical. A discussion about a killer disease, and the comments are monopolised by an antivaccinationist maniac.

    I wrote and recorded a podcast on this subject just before the antenatal campaign was launched - see

    The 1980s whooping cough vaccine scare - ill founded as it was (we now know that few, if any, of the people given "vaccine damage payments" actually had damage from vaccines - all the ones who've been investigated since actually had brain damage from other causes) is not responsible for the current increase in pertussis cases. The reason is not straightforward, but probably has to do with the shift to use of the much less reactogenic acellular vaccine, and better case ascertainment (more testing and better, more sensitive tests).

    We don't know, yet, if antenatal vaccination will have a big impact on whooping cough disease; but it's more likely to do so than anything else - short of a better vaccine, which is still years, possibly decades, away.

  • Sugar coating infant immunisation and quicker scans for high-risk pregnancies

    Peter English's comment 12 Dec 2012 5:11pm

    The sugar and imms news is very old news...

  • Why a yawning foetus is a healthy foetus, elderly illness on the rise from cold homes and why eating chocolate might just make you a Nobel laureate

    Peter English's comment 22 Nov 2012 12:09pm

    That chocolate story - a fine example of the ecological fallacy.