This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

GPs buried under trusts' workload dump

Grumpy Old Hector

  • '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!

  • GPs 'need extra funding' to identify postnatal depression

    Grumpy Old Hector's comment 27 Jun 2017 4:54pm

    Perhaps it is true, but I wonder if there was any attempt to check, in those who claimed they were not asked, if there was in fact some record of such enquiry in the GP records.
    Even if 100% were asked, there is a proportion who would deny that they had any emotional problems. I have occasionally had clearly depressed women, claiming through tears at their post-natal examination that they are fine! In my experience it is (or was) usually the health visitor, prior to or subsequent to the post-natal examination, who becomes suspicious about post-natal psychological problems. The Health Visitor service has however been run down and in some areas is now staffed mainly by box-ticking nurses with little additional training.
    Perhaps it is the Health Visitors, who see mothers and babies on a few occasions (not just once at 6 weeks) who should be criticised. The National Childbirth Trust, not well known for balanced opinions, are probably more enthusiastic to bash GPs.

  • NHS deal to hand GP data to immigration officials causing 'serious risk'

    Grumpy Old Hector's comment 03 May 2017 12:02pm

    (Meant to say...dramatic reporting by Pulse of hysterical liberals)

  • NHS deal to hand GP data to immigration officials causing 'serious risk'

    Grumpy Old Hector's comment 03 May 2017 11:51am

    Quote from article on 25th January:
    "The MoU highlights that no clinical information will be released, but NHS Digital will release personal details, including full name, date of birth and registration with the NHS, last known address, and GP contact details in certain circumstances."

    I see absolutely no problem with that, except that some of the names and dates of birth are wrong.

    Quoted above:
    Health regulators have warned that public health is at ‘serious risk’ due to the NHS passing patient information to the Home Office as part of its drive to trace immigration offenders.

    How on earth can public health be at serious risk due to this? Perhaps a concern that some with communicable diseases may not seek medical attention in primary care? Perhaps dramatic reporting by hysterical liberals?

  • GPs 'should be cautious when declaring patients fit to run marathons'

    Grumpy Old Hector's comment 18 Apr 2017 1:29pm

    I very rarely actually say anyone is 'fit' for anything, instead stating (where appropriate) that on the basis of the medical records and without specific examination for the purpose, there would not appear to be any obvious contraindication to Mr Bloggs swimming the Atlantic, or whatever the event may be.
    Have always presumed that would be medico-legally safer but there is the concern that an individual participant could still think that they were being certified as 'fit', as requested by the organisers, with the bereaved family taking legal action on the basis that the fitness certification was misleading.
    Saying no to these requests is the better option except for our relationship with patients. If all GPs were formally advised by the defence organisations to never provide such information then the vast majority of the requests from events organisers would rapidly cease.

  • Will the NHS deliver 5,000 extra GPs by 2020?

    Grumpy Old Hector's comment 03 Apr 2017 1:39pm

    You never know. Maybe also in 2020 the pope will convert to Islam.

  • How can I get a pharmacist for my practice?

    Grumpy Old Hector's comment 02 Feb 2017 9:25pm

    At least in Scotland their priorities are not ours, but those of the Health Board. They do almost nothing to help us and generate a vast amount of extra work.
    Also incredibly inefficient, thanks to ridiculous, cumbersome protocols taking 2 weeks to do stuff that I can do in an afternoon.
    There is an oversupply of pharmacists and we regard these plans as an employment scheme for pharmacists.

  • GPs 'could do more' to help NHS recover costs from overseas patients, MPs say

    Grumpy Old Hector's comment 01 Feb 2017 1:15pm

    Having been distracted before sending above post, I did not see Sceptic Monkey's post. I wonder if that is an NHS England thing as current advice in Scotland is (or was until very recently) different, quite detailed with, for example, specified minimum intended stays for different groups, usually including dependents but not non-dependent relatives.
    Certainly the English DOH advice needs revised. I wonder if the idiots who drafted it confused getting seen by a GP with actually registering. At one level better for GPs to have them registered rather than seeing for free, but there are significant disadvantages too.

  • GPs 'could do more' to help NHS recover costs from overseas patients, MPs say

    Grumpy Old Hector's comment 01 Feb 2017 12:58pm

    Is it not a myth that we cannot charge foreign patients?
    We cannot charge them for immediately necessary treatment but it they are not entitled to register with an NHS GP then other contacts are chargeable and the money belongs to the practice.
    Have I missed something? Ignoring waffly 'recommendations' ridden with words like 'ideally', 'should', 'preferable', 'normally', etc can someone show I am wrong?
    I this were formalised then it would highlight who is not entitled to NHS treatment at GP level and increase the likelihood of any secondary care being chargeable.

  • How to make sure complaints stay in the practice

    Grumpy Old Hector's comment 01 Feb 2017 12:43pm

    Any initial complaint sent to an organisation other than the GP practice should be bounced back with a note requesting a copy of their complaint to the practice and the response. If they lie and claim there was no response or lie significantly in their complaint, then no matter how serious, it should be declared null and void.
    About 12 years ago we had a complaint which went directly to the Health Board, who correctly asked for it to be initially handled at practice level. A (different) letter of complaint was then sent to us and the complainant remained dissatisfied so it returned to Health Board level.
    At that stage all communications were made available to all parties and the initial complaint to the Health board was scarcely credible! Three total lies and several statements that were severely exaggerated and embellished, presumably so that the Health Board would take it more seriously.
    The matter was then dealt with appropriately, the complainant remaining dissatisfied. I wanted to sue the bitch for the stress caused to us but my more sane partner advised against.

  • Inhaled steroids in COPD: a classic case of overtreatment?

    Grumpy Old Hector's comment 31 Jan 2017 7:39pm

    Just wait for the legal action and Daily Wail articles against GPs who 'killed' patients by stopping their 'asthma' inhalers.
    Such changes need to be dealt with very slowly, carefully and thoughtfully on an individual basis. Also best handled by GPs rather than the average asthma nurse. Our asthma nurse is good but I would not be comfortable delegating this to her.

  • Government admits it has no idea how many GP patients attend A&E

    Grumpy Old Hector's comment 19 Jan 2017 7:44pm

    Occasionally an A&E report mentions that the patient could not get a GP appointment - mentioned I'm sure in only a small proportion of those who actually make that claim. Whevnever this occurred, I used to write on the report the number of appointments available that day at the time the patient attended A&E and fax it back to them. Was quite therapeutic. Sadly the hospitals have done away with faxes so I now remain angry and frustrated.

  • Guidelines exist to help, not hinder, GPs

    Grumpy Old Hector's comment 10 Jan 2017 7:30pm

    Is part of the problem in guidelines being used against us due to the inadequacy of the defence organisations in standing up for their subscribers? The short-term gain of settling out of court (perhaps fearing the impact of any guidline non-adherance) may become a longer-term loss. Also, if such cases go to court and if the management has been otherwise appropriate, does the defence fight back against those sanctimoniously quoting guidelines?
    I agree that NICE guidelines should all be amended, making it clear that they are simply current best advice on management and that particularly as all patients and clinical circumstances vary, other treatment plans may be appropriate or even PREFERABLE.

  • GPs in A&E and care homes can cut unnecessary attendances, says Hunt

    Grumpy Old Hector's comment 10 Jan 2017 6:51pm

    They should dump this politically motivated nonsense of waiting time guarantees in A&E. Would discourage much of the inappropriate attendance and the true accidents and emergencies could be triaged to be seen quickly.
    Long ago, when young, enthusiastic and poor, I did casualty sessions in our local A&E department, not as a GP but as normal A&E doctor. Most of the rubbish that was deemed 'GP stuff' would have been inapproariate even for the GP. When the department was very busy there was much less in the way of inappropriate attendances.

  • PM to end 'injustice' of GPs charging ill patients for protection from debt agencies

    Grumpy Old Hector's comment 10 Jan 2017 6:29pm

    The 'Debt and Mental Health Evidence Form'(link in article) can be completed by: 'general practitioner, mental health nurse, social worker, psychiatrist, clinical psychologist, occupational therapist or other (please give details)'.
    I wonder what proportion are completed by anyone other than GP, as even if the patient asks one of the others they will no doubt be told that it would be better completed by their GP. Better of course mainly for the workload of the other health professional!
    In my experience in most cases (can think of only a couple of exceptions over many years) where such information is requested the health condition is being used as an excuse for getting into debt, not paying rent etc and is totally irrelevant to the situation.
    GPs are liable to complaints from patients if we don't give them what they want (especially if paying even a token £5) and potentially from the GMC if we were to acquiesce by being dishonest. Others would generally just do whatever the patient asks.
    Best plan would be for the financial institutions concerned to seek info directly from GPs, including the patient's consent and a reasonable fee.

  • Hundreds of GPs hit by pension scheme errors as accountants warn some face five-figure tax bombshell

    Grumpy Old Hector's comment 17 Dec 2013 10:19pm

    Using the ‘Scheme Pays’ option to settle the tax bill for exceeding the Annual Allowance would obviously reduce the pension, though no doubt in some complex, unintuitive way. The Lifetime sum would also proportionally reduce but even if the new LTA has been exceeded, it may not be appropriate/necessary to reduce the amount if intending to retire early.
    As the Lifetime Allowance for GPs is calculated from the pension figure it can be ‘safe’ to exceed it to some extent if you intend to retire early. When the pension is actuarially reduced to, for example, about 84% if retiring 3 years early, so does the related LTA. This is something I had confirmed by the pensions people though it is a little puzzling not to have seen such advice written down anywhere. Perhaps it is so obvious that it does not seem important to mention it?

  • Patients 'distressed by dementia diagnosis'

    Grumpy Old Hector's comment 22 Jan 2013 4:06pm

    Whilst 'Anonymous @11.11am' has a valid point, an equally and possibly greater related concern might be the suboptimal management of patients in secondary care DUE TO having such a label.
    Non-discriminatory protocols are all very well, but the 'demented man' in bed 1 may not be treated the same as the man in bed 2 who gets a bit confused at times.
    Then again, increasing the prevelance of the diagnostic label might reduce that tendency to prejudice.

  • GPs should not block personal budgets even if treatments have no evidence, says RCGP

    Grumpy Old Hector's comment 11 Jan 2013 7:35pm

    Homeopathy in A&E:
    Copy link to browser. Very amusing.