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Una Coales. Retired NHS GP.

Una Coales. Retired NHS GP.

Media GP. Retired from the NHS.

  • 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?

    https://www.google.com/amp/s/amp.theguardian.com/education/2019/may/13/natasha-abrahart-inquest-no-support-for-vulnerable-student

  • 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. https://www.nhs.uk/news/mental-health/antidepressants-and-suicide-risk/#

    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

    https://web.archive.org/web/20130118041612/http://www.rcgp.org.uk/news/rcgp-inaugurates-companion-of-the-college-award.aspx

    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? https://www.rcgp.org.uk/rooms-for-hire/venue-hire.aspx

    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. https://www.change.org/p/uk-home-office-stop-the-home-office-from-removing-a-british-trained-doctor?recruiter=32084517&utm_source=share_petition&utm_medium=facebook&utm_campaign=autopublish&utm_term=autopublish&utm_content=ex83%3Acontrol

  • 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.