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Jo Smit

  • 'I'm being overwhelmed by requests from prisons'

    Jo Smit's comment 25 Aug 2017 11:02am

    Fantastic work being done.

    But with respect any GP reading that would think keep away.

    I imagine prison GP's are rewarded with high rates of GMC referrals and no support from NHSE!

  • GPs, not elderly people, should decide if they're fit to drive

    Jo Smit's comment 24 Aug 2017 4:48pm

    not necessarily a problem: one driving assessment appt a week.

    Not allowed to drive until assessed .

    1 hour assessment appts.

    Await chaos

  • GPs to shoulder costs of reversing patients from branded to generic pregabalin

    Jo Smit's comment 24 Aug 2017 2:58pm

    Usually meds management teams from the CCG like to spend 000's to save a few pennies and are happy to use GP time as its a free resource to them.

    Whats worse is that pharma/ suppliers can easily bypass whatever meds management want to do because they're so slow and inflexible and do not understand pricing mechanisms.

    True savings are possible but need to be dome with GP support not by annoying them and wasting their time

  • 350 fewer GPs than 2015 despite promises of 5,000 more by 2020

    Jo Smit's comment 23 Aug 2017 11:58am

    Can Pulse re publish their article on how NHS digital calculate their figures?

    Because my suspicion is that NHS digitial are being a little bit generous in how they are calculating the numbers and unless that changes the extent of the crisis is being hidden.

    As I now see data from lots of practices - our data suggests very substantial falls in practicing clinical GPs which are not reflected in these numbers.

    NHS Digitals figures don't add up!

  • First 'pharmacy-led' practice set up in bid to counter GP shortage

    Jo Smit's comment 23 Aug 2017 11:39am

    Disgruntled, disillusioned and disappointed

    the only way this will work economically is if corners are cut.

    I.e they're indemnified to do pharmacy work but do clinical work.

    We send out research pharmacists and often when they're involved in research projects they can be based in apractice fro sev months.

    There is mission creep and the pharmacists have to be told to stay within their limits as out indemnity if very clearly defined.

    These projects will fail at the first serious complaint

  • The conspiracy to destroy the NHS is no 'fake news'

    Jo Smit's comment 21 Aug 2017 6:30pm

    Brilliant article.

    The one place where NHSE is likely to fail is that any wholescale contract within an MCP setup has no profit to be made.

    Although MCPs will form the sort of unit size that would interest corporates, the saving grace for the NHS will be the extreme efficiency with which most GP's run.

    Only GP's can make any little 'profit' within the system - there will not be enough for corporates.

    virgin keeps trying but gets its fingers burnt very regularly even with cherry picked contracts on favourable terms.

    No Pharma company wants to touch the NHS contracts with a bargepole.

    Its not much of a saving grace but any vultures flying over are likely to find themselves in big trouble!

  • GP out-of-hours cooperative cuts staff and pleads with NHS to pay more

    Jo Smit's comment 21 Aug 2017 11:54am

    There is a horrible truth to the over expansion of middle management.

    I now attend meetings where I meet manager upon manager whose main job is to justify their existence and their project - regardless of how much harm or pointless it is.

    The nature, meaning and evidence of what they do means little to them as they are rarely judged on that.

    The one sympathy I have is that NHSE /Civil Service has created a culture like this and we should not be surprised at the quality or results.

  • Whole region risks 'losing general practice' due to GP shortage

    Jo Smit's comment 21 Aug 2017 10:19am

    My understanding has been that regions via MCP/Vanguard funding have tried to push nurses into more front end roles, however this has been stopped by lack of nurses and the indemnity associated with nurse led care.
    Practices which historically cut corners using unsupported nurses are suddenly finding those nurses and the NMC advising adequate supervision and named indemnity cover.

    Again qualified GPs turn out to be very (too?) cheap for the roles, expertise and experience they bring.

    New ideas are being tried out all the time, but you can't hide from the evidence that keep coming back from all these Pilots and trials.

  • Patient death was 'knock-on effect' from lack of GP resources, says coroner

    Jo Smit's comment 16 Aug 2017 4:49pm

    I'm glad there was a sensible decision from the coroner.

    In this tragedy the family need to support their practice if they want to see things improve - not complain ( not sure what exactly happened in this case).

    A tragic case like this could be used to put NHSE under real pressure if the family were motivated to do so, and possibly prevent these sort of cases happening every day - which they are

  • We must increase diversity at medical school

    Jo Smit's comment 11 Aug 2017 12:50pm

    Monty | GP Partner/Principal11 Aug 2017 11:57am

    ... as opposed to work?...rather sinister monty?

  • GPs forced to get approval before referring patients to hospital

    Jo Smit's comment 11 Aug 2017 12:45pm

    The whole point of the 'variations' argument is that it is a cover story for deep cuts and also transfer the risk of clinical decision making even more to GP's.

    The only benefit from Brexit it that NHSE wanted to flood the market with primary care practitioners - this will not happen now.

    Hospital consultants are within their right to reject a referral if they think its inappropriate - rarely done though.

    Again referral management pathways have not been tested in court yet and it'll be interesting when they are.

  • The real conspiracy of NHS England

    Jo Smit's comment 11 Aug 2017 10:44am

    Ebrahim Mulla | Doctor in Training

    Well said

  • GPs forced to get approval before referring patients to hospital

    Jo Smit's comment 11 Aug 2017 9:43am

    Easy solution to this. Ask for GMC numbers of clinicians who designed this process and refer straight to GMC.

    Note the use of word 'variations' in care - this is the 5 year forward view in action:

    http://www.wish-qatar.org/app/media/384

    look at the originators of the MP/ACO project

  • First 'voluntary' contracts awarded to GPs and trusts

    Jo Smit's comment 10 Aug 2017 2:07pm

    The precise legal form of the consortium is yet to be agreed

    words to be savoured

    Seriously do these organisations not want to understand what contracts are or can mean!?

    Why are GP's even involved without watertight contracts?

  • Top 10 'real world' tips for GP trainees

    Jo Smit's comment 10 Aug 2017 11:32am

    Vinci

    Any chance you could put your comments together on a blog..I'd sign up for the doses of wisdom.

    I've actually started to cut and paste your comments and quote from them!

  • Private investors pledge £3.3bn to build 'hundreds' of primary care premises

    Jo Smit's comment 10 Aug 2017 10:48am

    If you're a GP with premises you are likely to be in a strong position if you can see this through.

    The risks lie in partnership with long leases and no control of associated costs -i.e service charges. Even MCP/ACOs will not be able to deal with the long term costs.

    The whole point of PFI s is that governments have hidden the long term and ongoing costs without political fallout.

    The property companies will be meticulous in their charging for premises use and service charges will be extortionate.

    Can't see much profit though for them as I suspect many GP's will walk away from those kind of set ups.

  • CQC threatens criminal prosecution of practices who fail to register a manager

    Jo Smit's comment 09 Aug 2017 12:20pm

    The CQC job creation scheme rumbles on.

    One group I'm glad I never have to deal with

  • Online GP consultations don’t save time or money, finds study

    Jo Smit's comment 09 Aug 2017 10:38am

    watchdoc | GP Partner/Principal

    Unfortunately its far worse then that.
    Several of the vanguards/mcp across the south of England are pushing ahead with web gp platforms despite the evidence.

    Often middle managers are pushing these projects as it acts as a justification for their own jobs and they use pseudoscience to justify it.

    For example at a recent presentation in the Portsmouth region one manager claimed they had saved 17000 appts based the number of times people had used the system. I asked had the practices been able to cut a session of doctors time - of course they hadn't - they hadn't saved any real time .

    Also the cost of such systems is in the order of 100's of thousands of pounds over a year regionally.

    The opportunity cost of diverting such funding is criminal in my opinion.

    They are good software packages but deal with low level want not high level needs.

    But in pharma we're producing our own versions which then we will sell - and there are plenty of takers with money to burn!

  • Practices who ditch new 'voluntary' GP contract could lose all their patients

    Jo Smit's comment 07 Aug 2017 9:29pm

    This is an ideologically led project and we know the outcomes.

    Poorer quality of care at greater cost.

    Plenty of funded projects for business analysts and Pharma though!

  • Practices who ditch new 'voluntary' GP contract could lose all their patients

    Jo Smit's comment 07 Aug 2017 6:15pm

    the only route of MCP is for the MCP to formally take over a GMS practice. Which may work out for the GPs involved

    GP practices should not be allowing themselves any involvement otherwise