You don't need to calibrate a stethoscope or an ECG you need confidence and experience. Glucose measurement is more reliable these days provided that you use it with care and primarily for screening but as you move further into NPT you need to ensure that your results are accurate and consistent. The laboratory service provides reassurance that their results can be trusted because they have rigorous quality assurance both internally and externally to support them. The tests are performed under laboratory conditions which ensures reagents and equipment are kept in ideal condition and to ensure that one set of results on a patient can be compared with the last set or the next. With the best will in the world how reliable and consistent will your NPT results be and will you be certain of the results?
NICE = Detachement from Reality
For example, paracetamol. Does it matter what advice NICE gives given that millions of tablet are sold over the counter, not just in pharmacies but in supermarkets, unless of course NICE is genuinely suggesting that it should be controlled. Same with Ibuprophen, what is the NICE position or are they simply useless?
When I consult any medical practitioner I consider that matter to be private. I cannot contemplate going off to the pub to share the experience of treatment for my piles or prostate with family or friends, though perhaps I may contemplate discussing the ludicrous idiocy of NHS England in considering that this suggestion has any plausible merit. Perhaps more worrying is that they may consider it valid and are willing to use the scarce resources provided to the NHS in this frivolous way.
@Dylan Summers 19 September 8:20am
We are constantly told that there are excessive pressures on the NHS budget but it is ok to allow the money to be spent on anything you fancy? Perhaps theatre tickets, perhaps a holiday or visiting family in Australia, all of which would be nice but as you can't afford them yourself but they would make you feel better then the NHS should pay? Really??
If the government wishes to improve peoples lives then it could make changes many aspects of its policies not simply misuse funds allocated to healthcare.
"Expanding the scope and utility" still using jargon to confuse their intention while attempting to make some justification for spending vast amounts of money to create a database that would cause considerable concern and distrust to most patients. Wouldn't it be better just to lose this project in the file of bad ideas that should never have been allowed in the first place and stop wasting any more money.
Fascinating piece of useless research. Outcome is based on the inate ability of the body to recover but meanwhile it hurts and being told by the GP that it will eventually be ok if you do nothing will not be appreciated. Either you will need to give a better alternative, even opiods if that is considered reasonable, or a relatively safe one that they will probably go and buy over the counter anyway after they have lost confidence in their GP. No one has ever suggested that paracetamol cures back pain, it just makes it easier to manage. The patient may just try paracetamol or they could borrow grandma's pills or try one of the many readily available dodgy remedies supplied by an "alternative unregistered pharmacy".
Sadly, the purpose of team meetings is primarily to diverse the blame rather than to ensure an effective response. It's a form of musical chairs where no one has the last seat.
Patients would 'embrace' care.data if they understood it, jet lag cure, crackdown on slum landlords and exploding cells to fight cancer
There is undoubtedly a considerable amount of potentially valuable data contained within the health records of perhaps 100 million or more records of current and past patients. Unfortunately the Care.data team thought that they knew better than anyone else and they could bludgeon their way into people's lives with scant regard for the fears of the individual patient and an apparent disregard of the data issues.
To protect the patient the data should be anonymised within the GP practice ie at source, and there should be a guarantee, not just a politicians promise, that there will be no possibility of reverse engineering to reconnect to the individual. Any attempt by anyone, at any time, to do so will be a criminal offence, in perpetuity.
There must also be an appreciation that in this large database, there will be a considerable proportion of errors, especially in historic records. We do not have positive patient identification, certainly not in A&E or the community and most hospitals still use hand written wrist bands. Patients arrive, often confused with carers in a similar state and identification can be unreliable. Elderly patients are often known by preferred name rather than true name, expanding the scope for error. Although, eventually, the true identity may be made it is not uncommon for some data to be sent between various hospital departments and agencies which are not always rigorously checked and updated. With historical records the risk of error is even worse as the "integrated" systems were simply not.
Care.data could have been a valuable resource if there had been a clear effort to ensure that both the patients were treated with respect and that the data quality could be reliably assessed and improved.
"It says that the care.data programme will support economic growth by reinforcing the UK as a ‘global centre for life sciences and health research’ and creating a ‘vibrant App market place’ by making comparative data available to app developers and website designers."
Doesn't that say everything about the mentality of the proposers? It sounds like an advert for crowd funding for games developers.
As others have said this could seriously damage the patient /doctor relationship. If the patient loses trust and withholds information that could be vital for their treatment or they may delay making the early visit to their doctor that could prevent early diagnosis and treatment. This is a critical, sensitive relationship which could be easily damaged.
Given that there is yet no effective prognostic indicator for prostate carcinoma or to allow reasonable differentiation from BHP, PSA remains as the only quantitative test available. Is it not reasonable to offer PSA with onward monitoring rather than dive into biopsy without further consideration? Where there is no clear effective determinator is it not reasonable to suggest that the PSA test should be repeated in a few months and monitored again where reasonably justified? Where there are clinical indicators to suggest that the patient is in a higher risk then biopsy could then be offered.
GPs hit with breach of contract notices after NHS England checks up on practices closing early over Christmas
What a waste of time and resources. Practices will know their local needs and respond accordingly. Typical London centred approach having no logical or rational appreciation of requirements for local service. Perhaps it would be more rational to get rid of the NHS exec and allow services to be provided by local services.
Mary is not looking so good today, a bit off colour and she needs some water tablets, the pink ones, mind you the last ones were green.
By the way Doctor she likes to be called Mary in here but we think that she is is actually called Joyce so we think we found the right record and put this comment here. If it is wrong could you transfer the note to the correct record.
Unfortunately Tony, you have a job to do whereas for politicians it is more important to be seen to do, though anything will do as long as it seems to be, what's the word of the moment, ah yes, robust.
In response to the question posed previously -
"What I like to know is - why isn't Hunt & Government being held to account for this fiasco?"
Andrew Lansley tried to remove the the ultimate responsibility for the NHS from the Secretary of State for Health but lost out by a whisker. However The Department of Heath has devolved responsibility to NHS England for the 111 fiasco and they in turn to the CCG commissioners who blame NHS Direct for contracts failing.
It would seem that the Government is responsible for nothing but praises itself if something does work, though this is increasingly rare. Perhaps fewer levels of bureaucracy and more direct accountability may remove the high cost of government and might focus the minds of ministers.
Isn't it simply a case of the DoH saying we tried and screwed it up so you had better do it?
By the way does Jeremy Hunt or the DoH have any real understanding of the difference between provision and commissioning and what's more does the public care?
If the SCR is to be of use then it must be accurate, up to date and complete. As the only person who can be held responsible for this is the GP, then they must be obliged to ensure that every entry for all of their patients is correct. This means that all current medicines are included from what ever source they are obtained and to regularly check that the patient is taking them and had no adverse effects.
All laboratory reports must be scrutinised to ensure that they are accurate and are from samples taken from their patient, therefore they should exclude, until verified, any results that are unexplained outliers, especially if they relate to examinations not raised directly by themselves.
The problem as I see it is that if a GP sees their patient in their surgery, they will assess the patient and check any recent results or medication. If they have any doubts about information they see they can decide to check a result, ignore it or make a reasonable judgement of how it should influence their treatment.
The OOH or A&E department has no such prior knowledge or ability to assess the value of the data.
Another problem for reliance on the SCR is the positive identification of the patient, particularly in unusual locations such as A&E. With currently 21,000,000 records how do you identify them, given that we are not yet chipped or bar coded? Especially if the patient is confused or unconscious and the person who accompanies them could be poorly informed source of information, even if well meaning? The elderly patient who is always known as Doris could really be called Millicent or Dorothy. How many John Smith's are there and how many are known as Jack or use their middle name, of George or Dave?
I have excluded my record from the SCR until I can be assured that every detail from every source is correct and until there is a positive patient ID system in place so that I am treated as me and not someone else with the same name. Mean while treat me as you see me and not according to the computer.
There is a world of difference between a contractual gagging clause whereby the contract demands your obedience and silence, and the matter of individuals who need persuading by their colleagues to respect each others opinion.
In public service there can be no moral justification for gagging clauses in contracts, it presumes therefore that those requesting it fear they will have something to hide when their actions should be subject to full impartial scrutiny. It is therefore inappropriate for any professional working in the public service to accept a contract where these clauses are included.
Surely as Secretary of State for Health any statement he makes on health matters should reflect the view of Government, after all we are constantly told that Government Ministers have corporate collective responsibility in the decisions made. When Parliament chooses to have a free vote following a debate it is conceivable that even ministers could vote according to their conscience but shouldn't they resign their ministerial post first before voting against the collective view particularly one for which they are accountable?
Perhaps he neither understands his responsibility as a minister nor the medical evidence, not a particularly endearing position, and worrying for the future of the NHS.