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Grumpy Old Hector

  • Revalidation paperwork equivalent to 390,000 days' worth of GP appointments

    Grumpy Old Hector's comment 04 Jan 2018 1:19pm

    Fully agree with 'Mavis' at 12.23. Appraisals have had that effect on me and at least 2 other GPs I know.
    An exacerbating factor is inconsistency in appraisal demands in some regions, mainly by their embellishment of the GMC's requirements by (presumably deliberately) conflating them with the RCGP's more onerous recommendations. Also significant differences between appraisers, some being nit-picking pseudo-academic hunts.

  • Practices will have to provide information requests for free under new legislation

    Grumpy Old Hector's comment 15 Nov 2017 9:55pm

    Relevant website as per link in the article or its homepage at:
    http://www.eugdpr.org/eugdpr.org.html (if anyone has the will to look at it).
    Looks like this was passed in April 2016 after a consultation period and with a 2 year transition period.
    Also: https://gdpr-info.eu/art-9-gdpr/
    Was excited by para 1 but exempted by para 2h.
    Did the BMA know about all this? Did they make any representation during the consultation period? Do they care about its effect on GPs?
    I think I know the answers: Probably, but not interested. No. No.

  • Practices will have to provide information requests for free under new legislation

    Grumpy Old Hector's comment 15 Nov 2017 8:34pm

    "A free electronic copy of patient data". What about printed copies - especially if requested in paper format? Also "...adapting rules to the challenges of the digital era..." so what about non-digital data like old paper records? Is that included? I wonder if those drafting this even thought about its application to large, complex medical records.
    Would be helpful if electronic copies of records could actually be easily created. Last time I tried, with Emis PCS you can only create a pdf file of the data protection summary using an add-on pdf printer program, which is most probably not approved. Docman images can only be printed (as XPS files) electronically one by one. Old paper records could certainly be scanned to pdf rather than photocopying, which would be useful if any future requests, but just as time-consuming the first time.
    Would be tempting to create the desired documents in an obscure format that is user-unfriendly to read or impossible to print!
    Introduction May 2018. Leave EU March 2019. Let's hope it's not incorporated into UK law!

  • I voted Brexit for the NHS – now show us the money

    Grumpy Old Hector's comment 15 Nov 2017 7:42pm

    Slogan on bus:
    "We send the EU £350 million a week
    Let's fund our NHS instead"
    At no time did I (or anyone I know) interpret that as a 'Brexit funding commitment' that an extra £350 million a week might be spent on the NHS, but that increased funding of the NHS would be more easily afforded.
    Even if it had been a commitment, the time to 'make good' on it would only be once the UK stops paying for EU membership.

  • Almost two-thirds of GP practices will see funding boost from new contract

    Grumpy Old Hector's comment 15 Nov 2017 5:24pm

    Agree with Glen Sykes. From personal experience, pharmacy ‘support’ creates vastly more work than it relieves. Does to a large extent depend on the individual pharmacist, with some generating considerably more work than others. The administrators seem to think that same qualifications + same courses = identical clones. With increased numbers there is likely to be a higher proportion of unsatisfactory experiences.

  • Scottish GP contract: what is proposed?

    Grumpy Old Hector's comment 14 Nov 2017 2:02pm

    So, probably a reduction in workload for general practices, but not for the general practitioners, whose workload/stress is likely to increase.
    An increase in hassle from the ‘community treatment and care service teams’. The least uncertainty about anything (though relatively unlikely for dressings, phlebotomy or suture removal) and the GP responsible will be phoned or the patient asked to make an appointment - urgently of course.
    External management of CDM blood results are a concern. Will deteriorating but still notionally normal results be noticed? Will there be central protocols for managing trivial but irrelevant abnormalities, or will GPs be alerted to chlorides of 97mmol/l? Who is responsible for errors?
    Community mental health workers (presumably not qualified CPNs) and link workers will no doubt show what a thorough job they are doing by referring their every query to the GP.
    Worst of all is pharmacy ‘support’ which from personal experience created vastly more work than it relieved.
    I remember that in the early stages of all this a year or two ago, it was stated that GPs would not be responsible for anything done by others, but that was rapidly changed.
    Cynical? Me?

  • Half of GPs want to fine patients who don't attend appointments

    Grumpy Old Hector's comment 09 Nov 2017 1:17pm

    Record all DNAs with the same code, with additional freetext if appropriate (e.g urgent appointment or valid excuse) and you soon start to see clearly who the regulars are, which does include infrequent attenders.
    Warning letter first then off the list if ongoing abuse of the system. Helps a bit.
    What particularly annoys me is when running behind the regular non-attenders always turn up!

  • #GPnews: Honour £350m-a-week-for-NHS Brexit promise, says Stevens

    Grumpy Old Hector's comment 08 Nov 2017 12:28pm

    Slogan on bus:
    "We send the EU £350 million a week
    Let's fund our NHS instead"
    At no time did I (or anyone I know) interpret that as a 'Brexit funding commitment' that an extra £350 million a week might be spent on the NHS, but that increased funding of the NHS would be more easily afforded.
    Even if it had been a commitment, the time to 'make good' on it would only be once the UK stops paying for EU membership.

  • Online GP provider makes push for patients to switch from their practices

    Grumpy Old Hector's comment 06 Nov 2017 7:55pm

    Scarcely credible, even with the current DOH politics.
    Highly dubious that it would meet contract requirements. Also medicolegally dangerous. Urgent CQC inspection required?
    As regards the exclusions, perhaps other practices in the relevant areas of London should adopt the same list of conditions which could exclude new patients from registering, advise their local health authority and see what happens!

  • Dealing with a patient angry about rationing

    Grumpy Old Hector's comment 02 Nov 2017 6:16pm

    Privately, a vasectomy in the UK costs usually £400 to £600 though can be double that or more. The NHS cost is reckoned to be about £250.
    Vasectomy lasts 'forever'. Nexplanon, increasingly routine, costs (basic NHS price and for the drug alone) £84 every 3 years. Have areas with a vasectomy ban also banned use of Nexplanon? Probably not, I suspect, as that would slightly reduce a woman's 'right to choose', and we could not have that!
    I would be entirely sympathetic with Mr Angry, point out that there is no point in my referring as 'they' will refuse to accept the referral, but offer to waste a couple of minutes in making the pointless referral if he really wanted. Even if a referral were made, it would probably save time in the consultation and either way would certainly improve the patient relationship.
    One might have expected a CCG with such bans to produce information sheets for GPs to give to affected patients, clarifying that it is not the GP's decision or choice.

  • Government launches campaign to stop patients pressuring GPs for antibiotics

    Grumpy Old Hector's comment 23 Oct 2017 12:00pm

    Is the use of antibiotics in agriculture not of at least equal importance in causing resistance?

  • 'I can't fix your problems for you', Hunt tells GPs

    Grumpy Old Hector's comment 13 Oct 2017 11:16am

    "60-80% of issues can be resolved without a face-to-face appointment"

    An over-estimate in my opinion, and as others have said, mainly a figure decided retrospectively. Also not resolved as safely from a purely medical or medicolegal perspective and still using as much doctor time.

    "Practices who have tried initatives to stream patients to pharmacists or online consultations 'have released 45 to 60 minutes per GP per day', he told delegates."

    He means 35 to 55 minutes of GP time per day deferred to a later date.

  • Revealed: NHS's plans to bar patients from attending A&E without a referral

    Grumpy Old Hector's comment 13 Oct 2017 10:54am

    Dr Helen Thomas said "I think it’s been done in other countries...".
    One might have expected her to be certain and state the countries. May well be true, but I have never heard of such an arrangement.
    Overall, seems like an ill-conceived plan highly likely to have a serious adverse effect on ambulance services once the usual abusers of the service have sussed it out. Also a risk that less assertive ill people may not seek/receive treatment they need. At least it is to be piloted.
    Better plan is to scrap A&E waiting time guarantees (or make it 8 hours) and triage according to need. There would probably be no need for additional seats in the waiting area. Nobody seems to associate shorter waiting times with an increase in inappropriate attendance.

  • Government report on CAMHS to be released in coming weeks, says health minister

    Grumpy Old Hector's comment 08 Oct 2017 7:17pm

    There was probably a time when GP referrals did increase, generated like much of our work by parental and third party demand. However, now that it is pointless to refer for anything other than severe and enduring problems and with the bouncing back of many of these, the number to eventually be seen is probably less than it was over 25 years ago.

    It seems to me that the problem with CAMHS (and indeed also general adult psychiatry) is not so much a lack of staff but poor management of perhaps inappropriate staff.

    In the distant past patients, both children and adults were usually seen by a consultant psychiatrist within 6 weeks maximum and sooner if felt to be urgent. They assessed and dealt with patients quite efficiently and passed them on as appropriate to clinical psychologists, psychotherapists and occasionally other associated staff.

    In more recent years, if successful in passing the initial vetting, patients are assessed after 4 months or so by an unspecified ‘Mental Health Professional’ who fills out a big tick-box form to see what further treatment may be appropriate. After another couple of months they may get an appointment to see the Trainee Puppet Theatre Therapist, or similar. If after 6 months that proves ineffective then an appointment to see a Nurse Therapist is arranged, but the letter usually goes astray and the GP receives a letter stating the patient did not appear - dated earlier than the attached copy of the appointment letter to the patient! (They are incapable of even cheating their own system correctly!) Having ‘failed to attend’ they are punished by having to wait a few months longer than the standard time for another appointment. Eventually a nurse sees them, assesses the situation and decides that the case is too serious for her, so no point starting any treatment. Will have to see a psychiatrist but unfortunately they are now aged 17 so although within the appropriate age range, there will not be time to complete any subsequent treatment plan, so no point seeing them. Will have to wait and be seen by adult services – but no, you can’t refer them until they are 18.

    Matters would probably be improved if they got rid of the inefficient, protocol-driven, waffling paramedicals and had patients assessed initially by experienced psychiatry staff who can make decisions. In many areas there are as many or more psychiatrists as in the past, but they just don’t seem to do much. This is suspected to be due to having passed the advanced diploma in work avoidance, exacerbated by sickness absence from boredom-related depression!
    (PS: the penultimate paragraph is all based on true events over the last few years)

  • GP caution urged as asthmatic children twice as likely to receive antibiotics

    Grumpy Old Hector's comment 13 Sep 2017 11:46am

    Professor Nigel Mathers, RCGP honorary secretary, said: 'Our advice is not to prescribe antibiotics to children with asthma, unless it is absolutely clear that the patient does have an infection that can be treated with the drugs.'
    REALLY? Hope he is willing to act as an expert witness in defence of someone who gets into bother for following that advice!

  • DH urges BMA to 'consider detrimental impact' of mass GP list closures

    Grumpy Old Hector's comment 08 Sep 2017 9:20pm

    Ian Brooman (7th at 4.33pm): Stimulated by your use of Greek words, I suspect Hunt may continue in post until visited by Thanatos. Not sure how he might be summoned.

  • Antidepressant use in pregnancy linked to child psychiatric disorders

    Grumpy Old Hector's comment 07 Sep 2017 12:13pm

    My immediate thought was that those mothers with more severe true depression and more clearly needing to continue antidepressants were the ones who did so. However, this was taken into account to some extent.
    From the study: "The risk for psychiatric disorders among offspring in the continuation group was higher than that in the discontinuation group (hazard ratio 1.27, 95% confidence interval 1.17 to 1.38). This was apparent after adjustment for demographic and psychiatric characteristics of the mothers, including inpatient and outpatient psychiatric treatment and comorbid psychotropic drug use (table 2⇓). The population attributable fraction was 0.5%, indicating that continuous antidepressant use during pregnancy explained 0.5% of psychiatric cases in the study population, assuming an unconfounded causal association." (ONLY 0.5% - my comment)
    Study conclusion: "Antidepressant use during pregnancy was associated with increased risk of psychiatric disorders in offspring. The association may be attributable to the severity of underlying maternal disorders in combination with antidepressant exposure in utero. Our findings suggest that focusing solely on a single psychiatric disorder among offspring in studies of in utero antidepressant exposure may be too restrictive."
    Perhaps the headline ought to be "Mothers with depression, especially if severe, more likely to have children with psychiatric disorders." That would however not be so interesting.

  • GPs set to be banned from prescribing homeopathy

    Grumpy Old Hector's comment 21 Jul 2017 2:02pm

    For those patients already on a regular homeopathic prescription, GPs could, for a small fee, refill the empties with the generic version which is piped into the surgery!

  • 'Gold in them hills' - why pharmacists are the future of general practice

    Grumpy Old Hector's comment 17 Jul 2017 4:03pm

    If general practice were to become 'contaminated' by too many nurses and pharmacists, the poor cost-effectiveness of the newcomers would not be so clear.
    It would be preferable if primary care systems staffed by paramedicals (presumably with a token supervisory doctor) were entirely separate, then they could be shown either to be the cost-effective, efficient future of primary care, or, as I suspect, an inherently dangerous, inefficient and ultimately more expensive mess. I gather that there are one or two practices in the Grampian area largely staffed by nurses with the latter outcome.

  • Tell me something useful... preferably in the next 9.2 minutes

    Grumpy Old Hector's comment 27 Jun 2017 5:34pm

    Your mention of the 'trap door' opening reminds me of your most excellent screen-saver from long, long ago where one of the patient disposal methods was a trap-door! The others I can remember were being abducted by aliens and being struck by lightning (or it may have been a death-ray from the alien spaceship).
    It helped retain my sanity for a few years until the Health Board prevented the use of screensavers. These days some pathetic do-gooders would probably regard your screensaver as in bad taste!
    As regards the article - agreed, though extending slots to 15 minutes or perhaps even just 12.5 minutes would be good for us and the patients apart from increasing the time to get an appointment. So what? Folk will moan no matter how long or short a time they have to wait. If the ultimate experience were improved then on balance they just might be happier - but probably not!