Co-proxamol was a thoroughly dangerous drug - I had two patients inadvertently kill themselves taking someone else's tablets so am pleased to see the back of it. A difficult problem as none of us like seeing patients in pain. Guidance from above is always helpful though.
I actually read the title as 3000 GPs shot and thought that might be an April Fool!
Having worked as an appraiser and doing my own appraisal, I do not think it shows competence at all but merely an ability to fill in the form and be able to turn up to the prerequisite number of meetings. Used to do this before appraisals and will continue doing as long as in work.
Agree completely with the first post - those advocating either foisting their own beliefs on vulnerable patients or those not respecting the beliefs of the patient are in my view equally bad.
There were a number of problems with Co-proxamol. Firstly it can cause fulminant hepatitis - usually fatal in a small but definite population (I saw this tested on a liver ward when a houseman when one quarter of a co-proxamol caused a severe hepatitic reaction).
And secondly, it mixed particularly badly with alcohol, often with fatal results. Anecdote I know, but a young 30 yr old patient of mine, because she had back pain, took some given to her by a friend and mixed this with drink with fatal results. I think it was found she had taken 4.
I had one patient on it for years after it was effectively withdrawn as she had a combination of renal and cardiac failure and it was the only effective analgesic for her as the others all tipped her one way or the other. When she eventually died of old age, no-one is now prescribed it in our practice.
This is a potentially dangerous drug masquerading as a relatively mild analgesic. GPs can of course prescribe what they like but would have to be able to justify their choices in the event of a problem. Defending its use would be tricky in my view.
Don't think there is any money for the pay rise but paying indemnity would be a big bonus!Probably save money in the long term and reduce some of the defensive medicine.
Agree with you - the problem is that all services are paid with essentially one pot of money - slicing it up doesn't make more. Make it fee for service and those doing the work will get paid accordingly and we can afford to increase staff - Of course getting staff is another matter altogether!
Completely agree Dr Ashcroft. Last year was a bit of a disaster through no real fault of either the doctors or indeed the drug companies. It does worry me that the forum here is becoming increasingly negative. I know Primary Care is in a parlous state, but we should be trying to support each other and the allied professions. I could not do my job properly without the help of the district and practice nurses and I have a very good working relationship with our local pharmacists. I am not a dispensing practice and value the help we are given with advice especially when we have been struggling with unavailable drugs.
9.24 - but it is costing you and the patient money - where do you think the money comes from? I agree that we have a ridiculous workload and money is not being put where it should be, but surely wasting money only makes this worse?
1:37 - this is not 'The Government's money' - this is money allocated to the NHS which could be paying for something else.
1.58 - drug companies make huge profits - they have patents to protect their rights and once these are over, other companies can step in and make these drugs at nearer to cost price. If we simply pay top branded prices, there will be no money for anything else.
It is up to us as GPs to make sure we do not waste resources so that our patients can benefit the most from the resources the NHS can offer. To waste money by not caring seems completely alien to me. I will prescribe drugs that are expensive if these will help my patients but will always try to choose the most cost effective treatments. Isn't that part of our job?
I have to confess that I don't think doctors should strike either. But I also think that their pay and conditions should be left in the hands of an independent body rather than at the whim of a politician, in which case they should not have to. I also think that nether Mr Hunt or the BMA have come out of this with any real credit - Mr Hunt because he is disingenuous with his spin of an 11% pay rise and no junior doctor losing out (apart from doing more antisocial hours and only keeping the same pay because of a time limited protection scheme) and the BMA for failing to explain to the public the reasons for the strike - to bang on about patient safety and not explain why is not going to garner sympathy.
I fully support the junior doctors but am appalled it has been allowed to get to this stage. The 2004 contract unfortunately for us GPs also has the clause that the SoS for health can impose any changes he wants - lost in the euphoria of losing out of hours, in itself a mistake. Far better had we retained control and developed the co-op model. However we are well past that and with the change in work force, it would be impossible to go back.Besides the 20% cut in GP pay in real terms since 2005 means there are no longer enough GPs.
I don't hold out much hope for a settlement if this is his negotiating stance!
Excellent reply - very helpful - and, coming from the area covered by Dt Tomson, a typically helpful response from an excellent consultant.
Daft headline - surely should read 'GPs will increase emergency capacity on days of junior doctor strikes' !!
This was allowed to happen because they were so pleased in 2004 that the out of hours was removed that they ignored the clause allowing the SoS for health to do whatever he wanted in later times. This was pointed out at the time but was lost in the euphoria of losing night work.
Of course you should refund - has certainly happened in our practice very infrequently but we would always refund - our mistake.
Always open till 6.30 - however usually have the on call doctor alone in the afternoon - there are others timetabled to be in but if no takers after lunch, they tend to go home. I see no point in staff sitting around doing nothing as long as the situation is under control and that no-one is turned away who wants to be seen.
But the effect of statins is not going to reduce strokes by 10% - make it probably 1-2% and this delays rather than prevents in all probability. There is however a 10% risk of side effects. I agree statins should be offered but to go back to your lottery analogy, yes, a statin is like a free lottery ticket but if someone hit you over the head with a baseball bat each time your bought a lottery ticket, how many would you buy?
But I take it that other Junior doctors are getting the 30% cut? Not acceptable -there needs to be co-ordinated action by ALL doctors to fight this.
The last on line petition made such a difference.....