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GPs buried under trusts' workload dump

Una Coales. Retired NHS GP.

Una Coales. Retired NHS GP.

Media GP. Retired from the NHS.

  • 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.

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

    Una Coales. Retired NHS GP.'s comment 05 Apr 2019 9:39pm

    As a past RCGP council rep, I raised concerns at the time 2013/14 when then President Iona Heath travelled to Brunei to meet with the Sultan of Brunei for a £1 million donation to the RCGP to fund the costs of the auditorium. I made it clear to the RCGP Chair that Brunei stoned homosexuals and that gay GPs would object to both the donation and receiving their MRCGP diplomas in an auditorium funded by him. How would they feel if they put his name on the auditorium door? He was given the title of Honorary Companion of the RCGP for his £1 million donation and the RCGP accepted his money in full knowledge of his country's barbaric treatment of gays.

    I don't envision the RCGP returning the £1 million donation in order to rescind his honorary title.

    I am only surprised it has taken 5 years for the lgbt medical community to object to the RCGP's actions.

  • NHS England's top GP resigns following Pulse comments

    Una Coales. Retired NHS GP.'s comment 06 Aug 2018 8:47am

    @PatrickMcnally appreciate your blog. Yes I sat down with the GMC in a roundtable to discuss updates to the GMC guidance on social media and pushed for no anonymity for doctors if using social media publicly as it may lend itself to trolling without consequences. I was a St Thomas' GP SHO for CG and AM in their Hurley clinic many moons ago. I did notice they preferred hiring salaried GPs instead of handing out partnerships and now they run a string of surgeries with predominantly salaried GPs. This model of salaried GP alligns itself with the US HMO model. I would much prefer GPs adopt the Pamela Wible MD model of independent practices like dentists, plumbers, salons, etc. Always better to be one's own boss than forever an employee.

    That said if you are a salaried GP in a lovely NHS practice that is stress free, then that is fine too as is being a freelance locum. But I have had several salaried GPs approach me for help when their bosses do not comply with employment law so I know it may not be perfect. The key to financial freedom is independence. My two cents.

  • BMA: GPs 'likely' responsible for care of psychiatric inpatients in their area

    Una Coales. Retired NHS GP.'s comment 10 Apr 2018 5:00pm

    The reform thinktank were suggesting giving more work to GPs, ie offloading from hospitals into the community as GPs were cheaper and there were more of them. I was aghast! I still remember a lovely but overworked S London GP partner and trainer who told me he felt he was not equipped to look after patients with acute schizophrenia but because the hospital were offloading into the community, he was now in charge and had to manage weekly like a hospital consultant psychiatrist. Next I heard he had a brain haemorrhage and died young in his 50s. I never learned about his funeral until too late so I was never able to show my respects. I was a maternity locum for that practice as well as ad hoc locums for years. Devastating.

    Please make your plan B asap. Yes, even in your 30s. Even if your practice closes, patients will find another and another until they are all turned into supersurgeries. Your patients will forget you as the NHS is the medical care bargain of the century! It is free! It was rare for me to see a working patient when I was seeing patients so I would venture to say that many who used the services may also be the ones who do not pay NI. And once you are retired, you stop paying NI yet enjoy free full cover medical care.

    Self preservation has got to be the motto now for you and for your family. When I retired from 17 years of service for the NHS, I quietly disappeared into the night. No medals or gold watches. You are simply a worker who has ceased to be of use.

  • Fighting the fight

    Una Coales. Retired NHS GP.'s comment 07 Apr 2018 6:08pm

    Jaimie and pulsetoday need your voice to amplify this petition to save a NHS GP trainee from being chucked out of the country 5 months before qualifying. I am so gobsmacked.

  • BMA applies to 'intervene' in Bawa-Garba appeal case

    Una Coales. Retired NHS GP.'s comment 07 Apr 2018 11:53am

    In my opinion, having seen how the BMA got involved in the IMG fight for a fair CSA exam, I would advise against any involvement of the BMA in the B-G case. I agree with the thoughts of posters.

    This B-G case highlights the flaws of this gross negligence manslaughter charge. The hospital should be held to account for system failures, not a mother working as hard as humanly possible with lack of staff and support.

    Dr Chris Day highlighted the flaws of whistleblowing, ie that training doctors cannot fight at ET as their job contract is renewed annually and does not count the many years they have already spent in their specialty training programme. So the hospital managers can apply the clipboard phenomenon and find any dubious reason to remove a whistleblower from his job. If you are a trainee, check to see if your hospital has a £150 million PFI debt like the QEH has. It means management are under enormous pressure to cut costs to meet the monthly interest repayments so they are less likely to use a locum staff agency to fill gaps.

    And doctors who have been referred to the GMC have highlighted how their medical defence org has discretion NOT to represent you or help you in your response. Imagine facing a GMC appointed barrister in a fitness to practice trial on your own if you cannot afford £10,000 to pay for a lawyer and that again for a barrister. GP partners pay £10-£12k in indemnity yet the coverage has a discretionary representation clause!

    Also doctors are not aware that each time you ring your mdo for phone advice, that counts as a mark against you and yes there are doctors who have been refused insurance by all the mdos! Imagine, you then cannot work! You cannot control the number of complaints when they have an online complaint form for anyone to fill anonymously on you. I have heard of an ex gf of a GP getting even by filing a practice and GMC complaint! Go figure!

    And finally there is your mental and physical health to take into consideration. Do a head count of how many GPs you know who have died early, retired early, are burned out, are about to crack, have emigrated. What makes you any different? Soon it will be your turn. Chronic stress leads to both mental and physical illnesses. Self preservation becomes a priority for your family's happiness as well as your life.

  • Fighting the fight

    Una Coales. Retired NHS GP.'s comment 06 Apr 2018 7:30pm

    Couldn't have summed it any better. No wonder you got the editor's job! Congratulations!

  • Minister blames 'counsel of despair' GPs for poor training uptake

    Una Coales. Retired NHS GP.'s comment 06 Apr 2018 5:19pm

    Sadly in my opinion, we may have been sold out by the BMA, our trade union, as Hunt is now tipped to be the next leader of the Conservative Party for taking on the doctors and WINNING! Apparently the only Secretary of State for Health who beat the doctors! He is a hero within the government. Yes there is now talk behind the political scenes that he may be our next Prime Minister! I told you we lived in a topsy turvy GB! I was gobsmacked to hear this from reliable sources! Best to think of yourself folks. There should be a rule that as a doctors's trade union BMA chair, one cannot accept a gong! Major conflict of interest in my grassroots opinion.

  • Minister blames 'counsel of despair' GPs for poor training uptake

    Una Coales. Retired NHS GP.'s comment 04 Apr 2018 7:18pm

    It is a shame the public can't read the pulsetoday comments. If they could they would see the truth of how NHS GPs are working themselves to an early grave for the sake of their patients, their vocation and their mortgage and children's school fees. Remember the entrepreneur billionaire who said that doctors are the lowest people in (British) society. Doctors do not even get a mandatory 30 minute break after 4 hours or 1 hour for 8 hours of work and certainly no extra pay for overtime.

    I recall my bls training and it said to make sure you were in a safe situation before you approached. But the NHS has made work high risk and simply unsafe for both doctors and patients. The government are selling off the NHS as if it were simply a commodity to the highest bidder. The national debt is now closer to £1.6 trillion that means forget cashing in a pension any time soon as the pension pot may be depleted by the time it is your turn to dip in.

    Of course our young doctors need to be informed of the dire situation so they can make a fully informed decision. The Bma once said the safest GP to patient ratio was 1:1,500 not 1:12,000. I did my own risk-benefit assessment and decided to retire. Chronic stress, the threat of involuntary manslaughter charges for fatal human error, ocd bureaucracy, etc...well I couldn't think of one benefit so it was all pretty much risk, risk, risk.

    You will live longer if you retire early. Please think of how you can achieve financial independence sooner. Do not put all your eggs in the nhs basket. Your life depends upon getting out before the job kills you. A good GP partner friend said he had bloody diarrhoea throughout the day yet still had to see patients. I ask myself, if he wasn't under years of chronic stress, would he be cured of his autoimmune disease? I pray he gets out alive. There is life after the NHS. He should read Dr Adam Kay's book.

    It is okay to quit being a doctor and to change career paths or to emigrate as a doctor. And it was a Health England statistic that said female GPs leave on average at age 34, that made it ok for me to quit in my late 40s.

  • RCGP reviewing whether MRCGP exam is ‘fit for purpose’

    Una Coales. Retired NHS GP.'s comment 02 Aug 2017 7:52am

    I commend BAPIO (British Association of Physicians of Indian Origin) for taking the RCGP to High Court over the acting CSA exam. A moral victory was needed to expose how failure to control unconscious bias may have resulted in the huge disparity between white and non white doctor pass rates, which had not existed when real patient video consultations were used to assess doctors for the MRCGP exam. It is incredulous that the acting CSA exam is still operating in the 21st century. IMO Martin Luther King Jr would be turning in his grave.

  • GPC to submit mass resignations once 60% of practices opt in

    Una Coales. Retired NHS GP.'s comment 26 Jan 2017 6:30pm

    Well done BBC NI and GPC NI!

  • GPC to submit mass resignations once 60% of practices opt in

    Una Coales. Retired NHS GP.'s comment 26 Jan 2017 3:48pm

    @Downtoearth you are right! Complete media boycott on news of the historic NI GPC vote to ditch the NHS GP contract. I even emailed the link to the BBC health editor. I wonder why government wants to keep this news hush, hush...? Afraid that English GPs will seek independence too from an untenable underfunded contract?

  • GPC to submit mass resignations once 60% of practices opt in

    Una Coales. Retired NHS GP.'s comment 25 Jan 2017 9:24pm From Pulsetoday to the houses of 2 million C5 news viewers. I made sure this breaking NI GP news would not be buried. The public need to know how hard GPs are working with a fraction of the funds they had before MPIG cuts. It is only a matter of time before they fight back and regain their self respect. And it is not just general practice, a junior doctor has been made to work 22 days in a row without a day off! How long before hospital doctors crack too?