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Una Coales. Retired NHS GP.

Una Coales. Retired NHS GP.

Media GP. Retired from the NHS.

  • Cheap steroid cuts Covid-19 deaths in intensive care trial

    Una Coales. Retired NHS GP.'s comment 19 Jun 2020 6:59am

    Looks like other countries have formed their own opinion of the NHS Recovery trial. Has our country become the laughing stock of the world in how we treat covid?

  • Cheap steroid cuts Covid-19 deaths in intensive care trial

    Una Coales. Retired NHS GP.'s comment 17 Jun 2020 7:55am

    No surprise that dexamethasone helps in covid as it has long been used in medicine along with prednisolone another steroid to help as an adjunct treatment for asthma, bronchospasm, chest infections in chronic respiratory illnesses for its antinflammatory effects.

    This comment has been moderated.

  • The betrayal of the BAME community

    Una Coales. Retired NHS GP.'s comment 14 Jun 2020 7:59pm

    Increased BAME Covid risk is due to 1. Vitamin D deficiency due to reduced skin absorption of vitamin D due to melanin and this can be addressed by taking 2000-4000 IU of daily vitamin D. 2. Lack of early covid treatment. The Lancet article denouncing hydroxychloroquine was questioned by 180 clinicians and the article retracted.

    This comment has been moderated.

    I am appalled how this country has blocked GPs from prescribing hydroxychloroquine to treat covid early. Early covid treatment is azithromycin 500 mg a day for 5 days or doxycycline 100 mg a day for 5 days, with hydroxychloroquine 200 mg twice a day for 5 days and zinc 200 mg a day for 5 days. BAME should be started immediately on early covid treatment and anyone over the age of 50 or with comorbidities. 3. Prophylaxis. BAME staff should be offered prophylaxis, ie hydroxychloroquine 200 mg twice a day once a week. I am relying on quinine in tonic water. 2 litres of tonic water contains one full day’s dose of quinine, an antimalarial so 300 mls a day would amount to one full day’s dose once a week. 4. PPE. White doctors may be more likely to get ahold of FFP3 valves masks and wear full PPE in hospitals but BAME doctors are more likely to have to rely on surgical masks, especially if they are GPs as PHE have supplied surgeries with surgical masks and not FFP3 or FFP2 masks. 5. BAME may be less likely to be accepted by paramedics when ambulances come to their homes and even when taken to A&E, they may then be sent home without a covid swab test (this happened to a BAME GP). 5. GP surgeries should have staff check their temperature twice and day, record and check their pulse ox sats once a day. Covid can be silent and only picked up on pulse ox.

    The death rate for covid should be close to zero with prophylaxis and early covid treatment. Sadly over 300 NHS HCWs have died of covid and over 41,000 Brits have died as the NHS policy is to self isolate at home for 7 days on paracetamol instead of proactive early covid treatment in the first week of symptoms.

  • First female GP has died with Covid-19 aged only 56

    Una Coales. Retired NHS GP.'s comment 15 May 2020 7:23am

    RIP Dr Nair, another preventable covid death. India has sent HCQ and paracetamol to 120 countries and protects its HCWs with hydroxychloroquine prophylaxis. Meanwhile in the country with the highest covid death rate in Europe, NHSE blocks 6,648 of the 7,148 (2018 figures) NHS GP surgeries in England from prescribing HCQ to its covid patients and only permits the 500 NHS GP surgeries enrolled in the Principle trial to prescribe and each day we read of an unfortunate BAME HCW dying and can only hail them as a hero.

    Covid deaths are preventable! Every BAME doctor or nurse should be given vitamin D daily (2000-4000IU a day) and weekly HCQ prophylaxis, They should be checking their temperature and O2 sats twice a day and if there is a temperature spike or drop in O2 sats below 95%, they should be considering starting early covid treatment with azithromycin or doxycycline with HCQ and zinc.

    Since NHSE strongly discourages GPs from prescribing HCQ for covid, Brits are buying their HCQ from Europe for £60 through an online pharmacy site which links an EU doctor to prescribe, dispense and post to the U.K. to have on hand for their elderly family members or for themselves if they are working in the NHS in covid hotspots.

    Unchecked covid can wreak havoc and already a GP’s husband has suffered a hemiplegic stroke on day 11 of covid, Patients already on ACEI, ARB, or HCQ for lupus or rheumatoid arthritis are protected as ACEI and ARB are also shown to prevent vasoconstriction in covid lungs.

    I hope every BAME GP reads this and takes precautions to protect themselves and their families. Covid is 100% preventable if treatment is taken on day 1 of symptoms.

  • GP trainees to complete training with recorded assessment replacing CSA

    Una Coales. Retired NHS GP.'s comment 06 May 2020 2:44pm

    Hope this temporary replacement of the MRCGP CSA exam with a video or audio recording submission becomes a permanent change for the sake of British BAMEs and IMGs. Much preferred the old video submission model, as it allowed GP registrars to show real patient consultations instead of pretend with CSA actors.

  • GPs with Covid-19 symptoms should stay off work even if test is negative, says NHS

    Una Coales. Retired NHS GP.'s comment 02 May 2020 2:27pm

    @Anon GP care home residents could be receiving HCQ, azithromycin and zinc against covid as they are doing in Texas nursing homes with success. Instead there were over 4000 care home resident deaths in the U.K. from suspected or confirmed covid between April 10 and 24 alone.

    “I am worried that when looking back, the U.K. will have fared worse by not treating and ‘waiting for evidence’ compared to countries that have treated while waiting for the evidence.”

    Countries that have treated covid early successfully with HCQ include: Korea, China, Turkey, Costa Rica, Australia, India, UAE, and parts of USA ( for example Yale New Haven Health System protocol). Country with a higher covid death per capita than USA and is still conducting RCT on HCQ with the Principle trial for the community and Recovery hospital trial: UK.

  • Some Covid-19 victims are more equal than others

    Una Coales. Retired NHS GP.'s comment 24 Apr 2020 6:20pm

    An Asian male GP colleague was refused a covid swab test in A&E at a local major London hospital when he presented unwell with a week of fever and SOB. He did not get a chest x ray, bloods and nor was he started on antibiotics. He was sent away empty handed. His sister GP is now hospitalised with covid pneumonia in another part of England. One would think hospitals would realise GPs are exposed to covid as patients may present without symptoms and still be infectious. GPs are in a high risk category. Please test our GPs!

    As of now there are 41 free £119 covid swab tests left being offered to any HCW with a NHS email address My GP friends have already requested one from this site, as the Gov site closed before they could request one from the NHS. Hurry up and request one!

  • Some Covid-19 victims are more equal than others

    Una Coales. Retired NHS GP.'s comment 20 Apr 2020 9:29am

    Dear Shaba, I feel your pain and pass on my sincerest condolences to the passing of your family member. I can’t even begin to put myself in your shoes. It is frightening to see the disparity in covid deaths based on BAME ethnicities and I am pleased the BMA has asked for a government enquiry. Shocking to hear ethnicities may not be recorded among hospital covid deaths to give a clearer picture.

    My colleagues, family and I have all started daily vitamin D supplements and one nurse in Arizona has bought vitamin D bottles for all her nurse colleagues where she works! No harm and potential immunomodulating benefit. Interestingly men are more likely to be vitamin D deficient than women! And people with higher melanin. I found it fascinating that countries in the northern latitudes are more likely to be vitamin D deficient and how Spain and Italy do not fortify their foods with vitamin D. For those who are more at risk ie, older male, BAME, anyone with multiple chronic illnesses, have you considered early, aggressive treatment at home advocated by Dr Zelenko in NYC who has successfully treated 699 covid patients with azithromycin, HCQ and zinc? In the NHS, patients registered at surgeries enrolled in the Principle trial may have access to HCQ. Has your surgery considered enrolling in this trial? There are pros and cons as HCQ has side effects of arrhythmia and retinopathy but the benefit may outweigh the risk depending on the individual’s covid risk. In Italy 83 doctors have signed a request for early treatment of patients with azithromycin and HCQ as like the U.K., patients are self isolating at home with just paracetamol for 7 days and then some have presented to hospital with severe covid. For those in high risk groups, it may be worth considering early treatment to reduce viral RNA replication.

    Also I have been suggesting to my colleagues that they purchase their own FFP3 masks on eBay or amazon. EBay has made a concerted effort to stop price gouging and has already removed 6 million such listings on hand sanitizers, gloves and masks. I saw one FFP3 mask that retails for £1.95 being sold for £27! A surgical mask is not adequate to block the covid virus which is 0.1-0.3 micron in size. It needs an FFP3 mask 99% protection or a FFP2 mask 95% protection. One GP friend has converted his scuba helmet into covid PPE to see patients.

    100 doctors have petitioned our government for universal masks. This would help too.

    I understand your concern that BAME doctors and patients may be subject to conscious or unconscious bias as patients and hopefully the government and BMA investigate this fully. My Nigerian GP friend has also seen evidence to suggest this may be happening and advises family members to be firm when sticking up for their ill family member to get fair treatment.

    Be safe! My licence has been reactivated and I am waiting to hear from NHS England.

  • GPs vote for home visits to be removed from contract

    Una Coales. Retired NHS GP.'s comment 25 Nov 2019 7:28am

    @zishan syed it would be amazing if all GPs could have access to and watch all the speeches and debate. Home visits in leafy Bromley were lovely...widowed elderly ladies. This was im stark contrast with Lambeth where the local police told me they know which gangs live in which council estates! And when a male GP partner told me he gave up his partnership after being stabbed in his hand on the desk and another told me he was barricaded in a room, I thought sh*t, why am I the only one hearing this. So yes personal safety is an important issue.

    I have also chatted with a deceased child's father whose whole life's efforts are to destroy the GPs at his local practice for missing an Addisonian crisis in his son during a home visit. The sheer obsession with revenge for years is devastating for both the family and the GPs.

    In USA, patients find transport to GP health centres fully equipped with x rays, labs and even day beds!

    NHS hospital consultants have stopped doing home visits and bedbound elderly patients are brought to their hospital appointment by hospital transport.

    A dedicated outsourced team of say one GP, paramedics and nurses could continue to do home visits to the elderly housebound but this would be funded by the treasury like how oohs is outsourced or GP surgeries could arramge a coop to provide home visits like how they cover oohs among themselves.

    And yes the goal is to reduce the immense workload, paperwork, bureaucracy, funding reimbursement hurdles and challenge the 'discretionary legal representation' clause in medical indemnity t+c's. This means mdo's can decide whether to help you with the gmc or not when referred or facing a fitness to practice trial (£10k to find your own lawyer if refused by the mdo). They assess your financial risk to represent you despite you keeping up with your annual fees.

    In 2002 I loved working as a GP and enjoyed 15 min consults in a leafy suburb but working in a inner city London practice in 10 min slots with extras, scoffing down lunch to fit in home visits while training then returning to check all the lab results, do the repeat prescriptions, then face another full afternoon list, taught me this cannot be healthy in the long run and I did notice how mentally tiring it is to be alert and assessing patients and typing up medicolegal standard consult reports in 10 min slots. It leads to years of chronic stress which may adversely affect your mental and physical health. Poor GP partners also have to deal with not enough funding and having to lay off practice staff and covering for sick or absent staff.

  • GPs vote for home visits to be removed from contract

    Una Coales. Retired NHS GP.'s comment 24 Nov 2019 7:18am

    I just watched Dr Richard Vautrey’s interview on sky news and he was brilliant. As the chair of the BMA GPC, GPs are in excellent hands with Vautrey, and I am positive he will push for NHSE to remove mandatory home visits from the core contract, perhaps an opt in or opt out service and also push for dedicated outsourcing of home visits, like OOHs was outsourced back in 2004 in a massive effort to save general practice from the huge exodus back in 2002-2003. Back then no one wanted to go into GP training so the assessment was just a short interview and MRCGP was optional! The Labour government threw so much money into general practice, golden handshakes, deanery funding, study funding for newly qualified GPs, took out mandatory OOHs cover from the core contract and allowed outsourcing, etc. It enticed many hospital doctors to change paths and go into general practice while increasing the national deficit.

  • GPs vote for home visits to be removed from contract

    Una Coales. Retired NHS GP.'s comment 23 Nov 2019 11:13pm

    @Thinking of Oz they didn't have apps in my days of home visits. I had my husband sit in a car with oyr 3 young children while I did homw visits to check I came out! Scary stuff doing home visits in South London. Ferocious dog on a chain, padlocks, suspected drug den, etc. I used to think this is not common sense to do home visits as a solo female GP? And ooh the male driver would stay in the car as he was too scared to go up a tower block with me! And after my trainer shared how her home visit ended in rape and another male GP stabbed in his hand, that did it for me. After training, I chose to locum and specified I did not do home visits. It was the one thing that stopped me from accepting a salaried or GP partner post...mandatory home visits.

    @decorumest thanks. I covered the false sense of security a home visit gives patients as GPs are like Victorian doctors attending with a small bag of basic equipment (and lack of full computer notes on patients or access to clinic equipment), the dangers of tired GPs missing diagnoses and risk of being charged with involuntary manslaughter and how it should be outsourced. Ran out of time to discuss discretionary legal representation, how the UK is the only country doing antiquated home visits and the abuses of home visit callouts...just to open the curtains.

    @Took early retirement ditto I chose early retirement too. Who can work in a highly litiginous job with high indemnity fees with a discretionary representation clause?

    I had dinner with a 50 yo ex pat GP who left the NHS for Hong Kong where she charges £90 for a consult, £50 for a pap etc. She loves her job and loves her patients. I thought to myself what a contrast to UK NHS GPs who need to retire early by 50 to stay alive!

  • GPs vote for home visits to be removed from contract

    Una Coales. Retired NHS GP.'s comment 23 Nov 2019 11:26am

    I thought this was a monumental and pivotal moment in the history of NHS general practice until I read that this is just a motion for the BMA GPC to put on the table with NHS England. I have googled Simon Stevens to see what kind of chief exec he is of NHSE and it says he was a Labour councillor for Brixton, appointed by Cameron and President of UnitedHealthcare’s global health businesses spanning USA, Europe, Asia and Africa! He is accountable to Parliament for management of the £120 billion annual nhs pot. He seems to promote the modernisation of NHS primary care and hopes to redesign it. This seems promising then as surely outsourcing or even abolishing antiquated home visits would bring primary care into the 21st century alongside global giants like Australia?

    I shall speak up for GPs on Sky news this afternoon. I know many NHS GPs chose early retirement than to submit to a nonsensical pencil pushing revalidation exercise. And there are umpteen reasons why home visits should be abolished!

  • RCGP appoints Amanda Howe as new president

    Una Coales. Retired NHS GP.'s comment 15 Jul 2019 6:21am

    Sincerest congratulations to Professor Amanda Howe. It was a tough time for me on Council trying to hold the RCGP to account and you were very kind to me during your time on the Executive Committee as you tried to mediate between me and the College. You will be an amazing RCGP President and I am super pleased members voted for you.

  • Coroner criticises GPs for not following NICE guidance after suicide of patient

    Una Coales. Retired NHS GP.'s comment 06 Jun 2019 6:54am

    P.S. She suffered from stage fright/performance anxiety! Why was she put on an SSRI? Why not a beta blocker, bach's rescue spray, counselling, speech or drama class, university making allowances for her, etc. She was 1 of 12 student suicides since September 2016 at Bristol university! Shocking! How many were started on ssri's as if they were harmless happy pills?

  • Coroner criticises GPs for not following NICE guidance after suicide of patient

    Una Coales. Retired NHS GP.'s comment 06 Jun 2019 6:18am

    Really sorry for Dr and Mrs Abrahart. My sincerest condolences. I can't imagine the unbearable pain of losing a young adult child. When I read of student suicides at university, the first thing I ask is were they put on an SSRI antidepressant or even worse without the knowledge of their parents? Suicidality increases in young adults under 25 put on SSRIs which is why they require close monitoring.

    In my opinion, no one under 25 should be put on an SSRI. Back in my days at university, no one had heard of SSRI antidepressants. Universities offered student counselling. And people dealt with stress, anxiety and depression by talking to friends, joining clubs for everything from fencing to drama, etc.

    My daughters have all experienced the high level of stress at university these days with coursework and exams and some universities now survey their students regularly for stress, insomnia, depression etc. In fact unsurprisingly, findings are often that most students have experienced mental health issues while cramming for exams.

    I hope we as a society can go back to a time when we were able to cope with stress, anxiety and depression without the help of Big Pharma. I for one am living proof that even after being kidnapped, beaten, raped, robbed and left half clothed in 2 feet of snow by a serial rapist in Baltimore during my time there as a university student, I was able to recover without SSRIs and instead prayed to God for help and He brought a Catholic friend into my life who was like a big brother to me until I graduated. It made me wonder as a Protestant why there was such bias against Catholics from Protestants.

    I also survived 2 vexatious GMC referrals and the long months to get cleared not by taking SSRIs but by relying on many, many friends and getting counselling.

    If anyone can tell you about suicide activation side effect of an SSRI, I can having experienced this in 2004 and would not recommend this on my worst enemy. For those it works on that is fine but we all have different body chemistry and genes, so what works for some, may not for others.

    Now in my retirement, I am refusing statins.

    If a student reads this, please know that an antidepressant is not a happy pill but can have many side effects, one of which is suicide activation or increases suicidality in someone who has never had suicidal thoughts before, especially if you are under 25 or a small adult.

    To the GP who prescribed SSRIs to a student, please read up on suicide activation on SSRIs as it can be as high as 33%.

  • Revealed: more surgeries than ever closed last year

    Una Coales. Retired NHS GP.'s comment 01 Jun 2019 4:01pm

    P.S. I tell you that portfolio, appraisal, revalidation bureaucratic pencil-pushing , mind-numbing tick boxing, endless redo’s because you didn’t word it the way they want the answers worded but don’t tell you how they want it worded, and asked to repeat cycles will drive any sane person nuts! You get marked down if you put too much detail into your portfolio and do not show adequate reflection. It is all left wing jargon. I completed 13 annual appraisals and thought to myself why? Why must I detail everything I have learned each year like a schoolchild? Why do I have to find a patient case to demonstrate I can apply medicine? Why do I need to do an audit each year when as locums we move from practice to practice so it is impossible to stay in a room and ask for extra time and access to their patient records. I then weighed up the increasing mdo insurance fees and thought after taxes, insurance, etc., I am earning less than my daughters! I met many hospital registrars who thought the grass would be greener in GP land until they realised it was a different kind of bleep, when they joined a GP training scheme. Yes they say that half of foundation year doctors leave medicine now as they burn out during their 2 years as a foundation year doc, overwhelmed, out of their depth, lack of senior support, too many patients, needless patient harm, etc.. And if you make it through GP specialty training and its bureaucratic portfolio, you face the akt speed test and costly acting CSA exam which have broken many a GP trainee facing repeated failure having never failed an exam before.

    Until working in the NHS improves, you must put yourself and your family first. Rant over.

  • Revealed: more surgeries than ever closed last year

    Una Coales. Retired NHS GP.'s comment 31 May 2019 1:40pm

    1. CQC inspections too demanding in the context of funding cuts.
    2. Annual appraisals sold as a chat over tea and now extremely onerous and time-consuming endless unpaid paperwork with unpredictable appraisers from overly OCD to supportive if you are lucky.
    3. 5 yearly career ending revalidation, multiple the bureaucracy of appraisals by 5. As in 5 times complete audit cycles, 5 times multiple source feedbacks, 5 times patient surveys, clinical cases, CPD etc. When do GPs have time to see patients?
    4. Lack of GP workforce means no holidays, working overtime, no locums, burnout.
    5. CCGs now delegating what used to be outpatient clinical care onto GP’s laps so many feel out of their clinical expertise and fearful of the GMC if they make a mistake with treating a patient who should be under hospital consultant care but this is now called community care.
    6. 10 minute appointments when in Europe and abroad GPS get 20+ minutes to safely treat a patient. Interruptions and phone consults added in between 10 minute slots or added at the end of an exhaustive list,
    7. Seeing colleagues enjoy the best of both worlds emigrating to Canada or Australia to work safely as a GP.
    8. Pressure from CCGs to reduce hospital referrals, to cut expenditure on prescriptions, to deliver safe care without a minimum practice income guarantee, having to fire staff to make ends meet and watching single mums in tears as they lose their jobs working for practices.
    9. Fear of a GMC referral as investigations may take up to a year during which time the GP may be treated as guilty until proven innocent and God forbid the DM gets ahold of any investigation and publicly shamed a GP before he has had his right to a fair trial.
    10. Students are reconsidering whether medicine is a viable profession when other professions pay double, with free weekends and evenings to enjoy a life and are able to repay student loans. Training is so many years to be a GP. They ask is it worth it?
    11. When you know a GP colleague who has ended his or her life, you start to question whether it is time to retire early, emigrate or change paths.
    12. When you are fearful and anxious, as you may be referred to the gmc for a domestic squabble, raising a voice to a train conductor, drink driving, depression, a jealous colleague, an angry patient who does not get what he or she demands, and think if I were in any other job, I would not be treated like a criminal.
    13. When you decide you need to put yourself and your family’s wellbeing first above the needs of overworking as a GP to an early grave.

  • Half of patients on statins have ‘sub-optimal’ response to treatment

    Una Coales. Retired NHS GP.'s comment 23 May 2019 2:31pm

    I have a vested interest in solving hypercholesterolaemia without the side effects of statins as I have a genetic variant that puts me at high risk of a stroke. It was my adult daughter who came up with a non dairy diet that reduced her cholesterol from 7 to 4 without statins in 6 months. Easier said than done for me who accidentally orders a cappuccino, eats a random piece of chocolate, accepts a slice of cake, eats porridge, orders a 99 cone in Brighton, etc so my cholesterol is 8.6! Doctors are the worst patients.

    I have now worked out how to reduce lipoprotein A. All patients with high cholesterol should have their lipoprotein A checked and then referred to lipid clinic for a carotid scan if they have a family history of strokes, The carotid intima media thickness then indicates how high a risk they are for CV disease based on age group and I am at high risk on both sides.

    I researched the net looking for a way to reduce lipoprotein A. My highest was over 300 nmol/l which made me a walking time bomb for strokes. If you have a patient with super high lipoprotein A consider referring them to Professor Crook at Guys and St Thomas’ lipid clinic. He even gets referrals from Kent as there are fewer lipid consultants across the country now.

    I have reduced my lipoprotein A from 262 to 202 nmols/l with coenzyme q10 100 mg and niacin 100 mg od for 2 months and not 1000 or 2000 mg of niacin. I still have to get it below 75 nmols but am on to a winner so I thought I would share with you GPs especially as 20% of the pop have high lipoprotein A. You add it to the other box on a blood form and it goes in a yellow top tube.

    Having tried every statin and experienced lots of side effects, I am trying non rx methods that have been researched. Now I just need to start a non dairy diet and not slip. There is no profit for big pharma by telling patients to try a strictly non dairy diet for 6 months to see if it lowers their cholesterol but if it works, go for it!

    I plan to enjoy my retirement and not end up in a nursing home with a stroke!

  • RCGP urged to remove Sultan of Brunei's honorary title over gay rights stance

    Una Coales. Retired NHS GP.'s comment 06 Apr 2019 3:52pm

    The college archives show the RCGP executive committee of GPs posing with the Sultan of Brunei in 2013 in full knowledge of his brutal treatment of homosexuals and express gratitude for his £1m substantial donation.

    It was a gay GP who showed me the way when he resigned membership of the RCGP in 2014 in protest and I followed suit. In my opinion, he had more integrity than the entire RCGP executive committee. I wish he had not ended his life because his family could not accept him. His partner continues the fight for openness and acceptance of lgbts.

  • RCGP urged to remove Sultan of Brunei's honorary title over gay rights stance

    Una Coales. Retired NHS GP.'s comment 05 Apr 2019 10:10pm

    Correction it was 2012 and not 2013/14 when President Iona Heath visited Brunei and I objected to the RCGP acceptance of the Sultan's £1 million donation to cover the building costs of the auditorium. The RCGP auditorium is even called the Brunei auditorium! How many lgbt GPs had to sit in this Brunei auditorium during their MRCGP diploma ceremonies? It makes my stomach turn to think this room was funded by a country stoning gays to death. Surely the RCGP could find a more ethical donor?

    Yes @Stelvio, the ethical and moral action would be to return the £1 million, rename the RCGP auditorium and remove the title. From my years on council, I would not bet on the RCGP returning his donation.