I understand that the previous Care Plan enhanced service was withdrawn because it increased use of health resources (including admissions) without any clear improvement in outcomes.
Is there any evidence that frailty reviews will be different?
Surely neonatal screening raises massive ethical questions?
I was always taught that the only screening of children that was ethically acceptable was for diseases that need treating in childhood - for other diseases, screening must wait until they are old enough to consent.
The maths is worse than your calculation suggests.
A full time GP may work 50 hours a week, but doesn't provide 50 hours of actual appointments, when you factor in all the other things a GP does in their working week.
I can only assume that Dr Mackereth feels that calling a patient by a particular name / pronoun in some way represents agreement with the thinking behind that name / pronoun.
This seems absurd to me. I have a mental health patient who styles himself "Professor". I call him Professor because it is promotes our rapport, but this doesn't mean I agree he has the relevant qualifications.
I see no problem with calling people what they want to be called.
When a patient requests a letter to describe their level of disability (which is better known to them than to me), I generally ask that they write down a description of their symptoms and limitations.
I then just add a standard letter, on a template that includes active problems and medications, to say "The attached account is consistent with the medical records. Please review your benefits decision taking this into consideration ".
This avoids using scarce primary care time to craft a report which will, after all, generally be no more than a rephrasing of the patient's own claims.
It would be good to select on the basis of traits like conscientiousness, empathy and emotional intelligence but how?
Most ways of assessing these can easily be gamed.
USPFA appear to be a pilots' organisation. Is this a typo? If so, what organisation do you mean?
How can this have got ethical approval??
I always understood that, due to issues around consent, no DNA test would be offered in childhood for diseases that only present in adulthood.
HS-L: "...it’s important that regular reviews are undertaken..."
But if the problem is that primary care time is being wasted on poor-value interventions, regular reviews will only worsen the situation.
I don't recall completing these forms - is it a common thing?
@11:23 I was under the impression that NEWS2 hasn't been validated in primary care settings, and that there was little evidence available in such settings.
EG: "there isn’t much clear evidence to support their use" - from researchers at:
It's a nonsense to arbitrarily deem X to be responsible for Y when there exists a massive body of medicolegal case law establishing who is - in legal fact - responsible for what.
I do not, in legal fact, have any extra responsibility for Mrs Smith's care just because my name appears in her notes as her named GP.
This sounds like an unusually complex situation: how often do we have to deal with a patient jumping in front of a train who happens to have had an unrelated cardiac arrest the previous month and who also happens to have an unrelated terminal illness and an unrelated degenerative disease?
There is a danger that if we alter systems to better cope with this type of very rare case, the result will be increased bureaucracy when dealing with simple cases. And this increased bureaucracy will itself put other lives at risk by taking up more clinician time.
Good point. When I was at school a billion meant a million million, and this gives a figure of 0.007%. But now the US meaning of a thousand million is normal, giving 7%.
Interesing discussion above.
Improving health doesn't guarantee a reduction in healthcare demand / social costs, which may paradoxically rise.
EG fewer premature cardiac deaths means more people surviving to old age with concomitant risk of dementia, care needs etc
It may be a fact that inhalers are being over-prescribed in chest infections.
But even if so, that doesn't necessarily make it a problem.
I think the problem is more subtle: what proportion leads to action that is almost certainly pointless?
(Vitamin D, I'm looking at you... marginally raised TSH, I'm looking at you... eGFR of 54, I'm looking at you... hba1c of 42...)
Actually I don't want my guidelines nuanced. I want them to be simple enough to memorize...
...or, if not memorable, at least comprehensible at a glance on a single page / screen.
But I agree having a link to more detailed info would be nice.
There was a BMJ review saying the same in 2012
Since then I don't really use them except to diagnose PMR and inflammatory arthritis, and I gently discourage my trainees from using them.
I have not so far had a complaint / medicolegal issue arising. If one arises I feel I have the evidence to justify my decision.
(Unfortunately they still form part of various referral pathways in our CCG including memory clinic!)