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Patrick James McNally

  • GPs can certify death without attending under new emergency legislation

    Patrick James McNally's comment 29 Mar 2020 11:19pm

    I have unpicked the current legislation at:

    twitter.com/triptogenetica/status/1244386420300615680

  • GPs can certify death without attending under new emergency legislation

    Patrick James McNally's comment 29 Mar 2020 11:19pm

    I have unpicked the current legislation at:

    https://twitter.com/triptogenetica/status/1244386420300615680

  • GPs being sent 'out-of-date' face masks with 'concealed' best before dates

    Patrick James McNally's comment 16 Mar 2020 2:43pm

    This may be a reasonable response to the pandemic - but should have been done openly, without any attempt at coverup.

    There is precedent for extending shelf life of medical products. Remember the adrenaline auto injector shortages?

    CDC have issued specific guidance about using stockpiled n95 respirators beyond their specified use by dates.
    https://www.cdc.gov/coronavirus/2019-ncov/release-stockpiled-N95.html

    I would rather have one of those than nothing at all.

    I agree it looks bad for it to have been done without a covering letter or something.

  • Practices' preparation for coronavirus: NHS England's letter in full

    Patrick James McNally's comment 06 Mar 2020 10:27pm

    This runs directly OPPOSITE to the advice also issued by NHS England on the SAME DAY:

    https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/Commissioner-guidance-local-requests-to-suspend-online-booking_050320.pdf

    "A national suspension of online booking is not in place."
    and
    "Rather than seek to suspend online booking, where there are specific
    concerns about infection risks GP practices are advised to change face to face
    appointments offered for online booking to triage appointments. "


    I will ask Dr Kanani to clarify!

  • Open Surgery: Too little, too late

    Patrick James McNally's comment 16 Jan 2020 11:02am

    #ToryMaths

    6000 new doctors in GP;
    50 million extra appts/ year;
    8333.3 appts per doctor.

    If all doctors take 5 weeks holidays and 1 week study leave per year:
    8333/(52-6)=181 appointments per week.

    In comparison,
    I do 50-60 per week; 2500 per year. Working 3 days a week.

    Assuming they schedule their clinics similarly, they'll all need to work 9 days a week to fit it all in.

    These new guys are good!

  • The best way to hold GPs in 2020 accountable? A microchip in our brains

    Patrick James McNally's comment 04 Jan 2020 1:35pm

    Hospital Doc's will have their own version of this, c/o Ronan Lyne (@ronanlyne):

    NHS medical ward, 2039. you look at a patient. your cybernetic contact lens analyses the infrared emissions and calculates their body temp as 37.7°C.

    a sepsis alarm goes off in your cochlear implant, blocking out all external sound.

    you cannot think.

    https://twitter.com/ronanlyne/status/1176845601553747969?s=17

  • Coroner warning over patient death after 16-month wait from 'urgent GP referral'

    Patrick James McNally's comment 18 Dec 2019 8:36pm

    This is not about a lack of guidance. It is about a lack of resources.

    There is very clear guidance in a similar area, suspected heart failure, where a GP may do a BNP to assess urgency. If the result is over a certain level, then secondary care should see them within 2-weeks.

    I had an apologetic letter back from the cardiologist today, regarding a patient who fits the above guidance exactly. The letter said that due to lack of appointments it will be at least 8 weeks before he is seen and I might want to consider frusemide while we're waiting.
    FFS.

  • Pharmacist to dispense high-dose statins without GP prescription under NHS plans

    Patrick James McNally's comment 04 Sep 2019 11:03pm

    Statins used to be like Ramipril.
    Now they're like amlodipine. They used to require LFTs at baseline, 3 months and 12 months.

    Happily my CCG now supports a "fire and forget" approach. So we still do the baseline LFTs, but none thereafter unless symptomatic.

    This simplifies an "offer of station therapy" greatly. If the patient is ambivalent, I do the script, point them to some further reading, put on repeat and forget about it. Either they keep requesting, or they don't.

  • My short-term plan to save general practice

    Patrick James McNally's comment 29 Jan 2019 7:42am

    Nice article.

    which model salaried gp contract provides for a half-day cpd per week?

    my current gms model contract provides for 1 working week, pro rata, per year. That's a big difference!

  • Could knowing the price of NHS treatments help patients grasp their true value?

    Patrick James McNally's comment 21 Oct 2018 9:28pm

    This is wonderful: (from Dr Eduardo)
    "I think that Dr David Turner's idea should not be easily dismissed. Also, Tony's input is a meaningful one. "

    The opposite of the usual critical dismissive attitudes online!

    I have experimented talking with patients about costs of treatments, but usually this does not go well. In one memorable example a patient refused to pay for over the counter medication, because he "pays his taxes". I pointed out that this year we had already spent his taxes on an endoscopy and a scan, but again this was not well received.

    I duly set up the script for paracetamol or loratadine or whatever it was.

  • GPs could be asked to do C-sections under proposals to retain maternity unit

    Patrick James McNally's comment 29 Sep 2018 0:36am

    *ringring*

    "Yes, hello, MDU? I'd like to discuss a change to the scope of my usual practice.

    Yes, I'll be doing the odd C-section on Wednesday afternoons.

    No, I'm not giving up the day job.
    Yes, I am still a GP.
    No, I haven't retrained as an obstetrician.

    Well... I assisted at lots of C sections during my GP training, it didn't look too difficult?
    Honestly, how hard can it be?

    Oh, and I'll be dropping my usual Wednesday afternoon duty surgery, to do this.

    Oh, a £600 discount on last year?
    Sounds great"...

  • A right Royal mess: Why is RCGP still endorsing ‘Emma’s Diary’?

    Patrick James McNally's comment 29 Sep 2018 0:27am

    Congratulations Dr Ryan -
    RCGP have dropped their support for this abomination -

    https://r1.dotmailer-pages.com/p/49LX-45X/my-week-in-focus?utm_campaign=624742_LONDON%20%26%20SOUTH%20ENGLAND_Weekly%20Digest_28_Sept_18

  • GPs should not screen patients over 70 for prostate cancer, researchers say

    Patrick James McNally's comment 29 Sep 2018 0:23am

    Unless I'm mistaken, LUTS are a symptom potentially suggestive of prostate cancer. (A pretty rubbish symptom, poor PPV, sensitivity, specificity etc, the whole lot).

    What 70+ year old doesn't have LUTS on direct questioning?

    So we are rarely "screening", but investigating.

    (There's also a problem with using the word "screening", to mean individual risk assessment).

  • Pharmacists want to be able to swap GP-prescribed drugs for generics

    Patrick James McNally's comment 28 Sep 2018 10:08pm

    Dermot:
    "In fact high street pharmacists should be phased out."

    Are you really a locum GP?
    Or are you a dispensing practice partner?

    Because if we didn't have high Street pharmacies, would you suggest we should all get into the dispensing game?

    In 2018, pharmacists add value to the NHS, on tight margins. They are promised a certain margin over and above cost price, to keep the lights on.

    Script switching to branded generics that undercut the NHS list price, is CCGs trying to undermine this agreement.
    That's not ok, any more than CCGs trying to claw back practice funding.

    http://www.pulsetoday.co.uk/clinical/clinical-specialties/prescribing/medicines-optimisation-schemes-simply-rob-peter-to-pay-paul-gps-should-boycott-them/20035359.article

  • Myth: ‘We know what a normal heart rate is for a child’

    Patrick James McNally's comment 26 Sep 2018 8:28pm

    Playing devil's advocate here -

    Sometimes we need to put our "clinical experience" to one side, and just rely on the algorithm.

    I had a child with fever and tachycardic in my consulting room a while ago. Child looked ok. But no focus (other than pink eardrums, but what child doesn't have pink drums after a bit of crying),

    I was so tempted to say,
    "They'll probably be fine".

    Instead, I said, "they'll probably be fine. However, look at this traffic light triage system".

    I pulled up the NICE traffic lights for febrile children on the screen, and showed mum.

    "The heart rate is red. That means that even though your child looks ok, a few children like this may become seriously not ok in the next few hours. Could you take them to hospital?".

    Child had meningitis, sepais, antibiotics, lumbar puncture, PCR demonstrating viral meningitis, etc. Required lots of inotropes and supportive care to survive.

    It taught me that sometimes I should trust my gut. But sometimes, I should ignore my gut, and defer to the algorithm.

    I saw the child again recently, for nothing too serious, burst into tears after they left, and felt on top of the world for the rest of the day.

  • LMC warns against GPs using practice address to register homeless patients

    Patrick James McNally's comment 08 Aug 2018 6:34pm

    A+E commonly uses
    "No fixed abode
    ZZ99 1AB"

    Or similar.

    I recently accepted this address, in a "synch PDS to spine" for one of my patients who is sofa surfing.

    Unfortunately this breaks electronic and also paper prescribing! Suddenly scripts will only issue as "record for notes" implying that you did a paper script. Needless to say we have gone back to a local address.

    Odd how the hospital gets away with ZZ99 ...

  • In full: Dr Arvind Madan's resignation statement

    Patrick James McNally's comment 05 Aug 2018 5:09pm

    Sorry that comment obviously copy pasted badly into the text box!


    Whatever you think about them, the GMC's guidance on use of publically accessible social media is very clear - if you say you are a doctor, you must identify yourself:

    "Anonymity
    17
    If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely.

    Pulse may be " intended for healthcare professionals only" and require professional registration details, but we should still hold ourselves to the same standards here, as we would in a face to face professionals meeting. I wouldn't say anything here that I would be uncomfortable saying to a colleague.

    I wrote about this back in 2013, when the guidance was newly released:

    http://triptogenetica.blogspot.com/2013/03/doctors-nyms-social-media-good-medical.html

  • In full: Dr Arvind Madan's resignation statement

    Patrick James McNally's comment 05 Aug 2018 5:07pm


    YOU ARE HERE:HOMEPARTNERS PRACTICE BUSINESS
    NHS England's top GP resigns following Pulse comments
    5 August 2018

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    Comments (1)
    The NHS England director of primary care Dr Arvind Madan has resigned following his interview with Pulse.

    Ha admitted that he had been posting provocative comments under the pseudonym ’Devil’s Advocate’ on the Pulse Today website.

    In a statement, he apologised to small practices following his interview in Pulse, where he suggested GPs should be ’pleased’ when small practices closed.

    The BMA has released a statement ’in response to the resignation of Dr Arvind Madan’.


    Dr Mark Sanford Wood, deputy chair of the BMA’s GP Committee, said that the BMA had written to NHS England ’raising concerns and demanding action’ earlier in the day.

    More to follow

    GPs should be ’pleased’ when small practices close, suggests NHS’s top GP
    Read: Dr Arvind Madan’s resignation in full
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    READERS' COMMENTS (1)
    Patrick McNally | Salaried GP05 Aug 2018 5:05pm

    Whatever you think about them, the GMC's guidance on use of publically accessible social media is very clear - if you say you are a doctor, you must identify yourself:

    "Anonymity
    17
    If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely.

    Pulse may be " intended for healthcare professionals only" and require professional registration details, but we should still hold ourselves to the same standards here, as we would in a face to face professionals meeting. I wouldn't say anything here that I would be uncomfortable saying to a colleague.

    I wrote about this back in 2013, when the guidance was newly released:

    http://triptogenetica.blogspot.com/2013/03/doctors-nyms-social-media-good-medical.html

  • NHS England's top GP resigns following Pulse comments

    Patrick James McNally's comment 05 Aug 2018 5:05pm

    Whatever you think about them, the GMC's guidance on use of publically accessible social media is very clear - if you say you are a doctor, you must identify yourself:

    "Anonymity
    17
    If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely.

    Pulse may be " intended for healthcare professionals only" and require professional registration details, but we should still hold ourselves to the same standards here, as we would in a face to face professionals meeting. I wouldn't say anything here that I would be uncomfortable saying to a colleague.

    I wrote about this back in 2013, when the guidance was newly released:

    http://triptogenetica.blogspot.com/2013/03/doctors-nyms-social-media-good-medical.html

  • Analysis: GP prescriptions drop by almost one million

    Patrick James McNally's comment 12 Jul 2018 1:10pm

    For all long-term stable chronic disease management medications, I now aim for repeat dispensing, a batch of three 3-month prescriptions. Obviously medicine is complex so there are many exceptions but this is my preferred option. It means patients will be requesting repeats only once every 9 months, giving me a chance to remind them about bloods, monitoring, etc.

    I simply do not have time to be messing around with short duration prescriptions for long-term medicines.

    I'd be interested to know how practice differs between dispensing and non dispensing practices; I imagine 3 month supplies on one script are a bit less common if the practice runs a dispensary!