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A faulty production line


  • Over two-thirds of GPs plan to leave or reduce hours, finds DH-backed study

    3rdGen's comment 12 Apr 2017 1:10pm

    'A DH spokesperson said: 'This sample survey was carried out before we launched our world-leading plan to improve conditions in general practice'

    Well, since this sample survey was carried out, my last 3 remaining partners have all resigned from the practice, leaving me as the last man standing. Thanks DH - I shall look forward to your world-leading funding making a big difference. Better make it quick though.

  • Government urged to explore salaried GP service by Lords

    3rdGen's comment 05 Apr 2017 11:29am

    Above all else, the UK government is determined to control wage inflation in the public sector, which is why extra funding for general practice has been so tightly rationed compared to hospital Trusts. Historically, extra funds going into practices have resulted in increased GP partner income = wage inflation. Extra funds going into hospital departments resulting in extra staff/consultants = no wage inflation.
    Clearly general practice is starved of funds and desperately needs investment, but any extra funding will initially increase GPs' income before practices will invest in extra staff or services. Historically, following investment, governments have invariably frozen funding to claw back this increase.
    Unfortunately, the only long term solution that would permit consistent investment in general practice by UK governments would be a salaried service.

  • GP efforts hailed as CCG saves almost £2m in prescribing costs

    3rdGen's comment 30 Mar 2017 10:42am

    Our practice alone saved £7000 per year by identifying 2 patients taking trimimpramine 25mg daily. The price has increased to £200 per month. Worth looking out for.

  • NHS England considers ban on 'low value' and over-the-counter prescriptions

    3rdGen's comment 28 Mar 2017 11:17am

    Herpetic, not hermetic :-)

  • NHS England considers ban on 'low value' and over-the-counter prescriptions

    3rdGen's comment 28 Mar 2017 11:16am

    I've no issue with banning co-proxamol, but it's wrong to state that these are all unnecessary, ineffective, inappropriate or unsafe treatments. Fentanyl is an ideal choice for many patients with severe pain. Lidocaine plasters are tremendously effective for some patients' pain symptoms, for example in post-hermetic neuralgia. Liothyronine is essential for a small minority of patients who don't tolerate levothyroxine. Likewise, sildenafil simply does not suit some men, when tadalafil does.
    How will the guidance deal with these necessary and justified exceptions?

  • GP appointment waiting times to be published under new access drive

    3rdGen's comment 09 Mar 2017 5:28pm

    This is absolutely right and should be supported 100%:"they would also introduce a GP practice workload tool to measure what is happening inside primary care... the lack of this data on workload pressures had contributed to historic underfunding and was one of the reasons GP services have lost out compared to other parts of the NHS".
    The analysis of data (which should be readily extractable from clinical systems) should however be extended back at least a decade to measure the extent of underfunding over this time period. If 2017 is chosen as the benchmark, the damage has already been done.

  • Practices to receive £250 for 'patience and hard work' in dealing with Capita

    3rdGen's comment 02 Mar 2017 1:40pm

    Per patient?

  • Missing millions: the broken promises on GP premises

    3rdGen's comment 27 Feb 2017 5:33pm

    Frankly, there is absolutely NO money in the treasury's coffers, even for absolutely basic essentials such as GP premises. And if you don't believe me, go catch the HS1 and watch a new Trident misguided missile fly into the beautifully renovated Houses of Parliament next to the Garden Bridge.

  • GP contract deal comes with 3.3% overall uplift to funding

    3rdGen's comment 09 Feb 2017 12:04pm

    Funding for general practice needs to be linked to the total number of consultations per year, which is rising at much more than 3.2% annually.

  • A promising deal, but one key detail is missing

    3rdGen's comment 08 Feb 2017 11:34am

    There is still a disconnection between workload and reimbursement. A 1% uplift in funding assumes a steady state. However this figure does not come close to matching the rising number of consultations per year (and associated administrative tasks). There has been a 50% increase in such workload over the last 10 years, which has been completely unremunerated.

  • Seven-day access costs 50% more than routine hours, warn government auditors

    3rdGen's comment 11 Jan 2017 10:59am

    The problem is that when the pilots have operated in isolation they have been able to attract a pool of GPs from the surrounding regions who are willing to work weekends (for a price). If EVERYWHERE is having to provide 7 day a week access, NOWHERE is going to have a sufficient pool of willing recruits - certainly not to provide traditional OOH cover as well. This will dramatically boost the costs further.

  • Guidelines exist to help, not hinder, GPs

    3rdGen's comment 10 Jan 2017 12:08pm

    We were subjected to 14 months of investigation by NHSE following a malicious referral - the outcome being that 'there was no evidence of poor practice and numerous examples of very good practice.
    Of note, the Terms of Reference for the investigation stated that the practice was expected to be 'NICE compliant'.
    Assessment of NICE compliance was a major part of this process, with investigators seizing on any supposed deviation from guidance.
    In one case I was criticized for treating an 82 year old nursing home resident with a chest infection with antibiotics, as guidance supposedly recommended 'watch and wait'. In fact, the patient had been admitted with pneumonia within the last year, so my action fortunately could be shown to have complied with guidance.
    In another case, I was criticized for arranging blood tests for a patient with symptoms of fatigue, as NICE guidance on the management of fatigue in adults recommends waiting a month before investigation. We pointed out that NICE guidelines on the management of chronic fatigue syndrome do not apply to an 80 year woman with a history of ovarian cancer and hypothyroidism.
    I could provide several more examples of over-zealous application of NICE guidelines.
    The point is that compliance with NICE guidance was obviously considered mandatory, and any deviation from the guidance was evidence to be used against the practice and individual GPs.
    So thank you Professor Haslam, in the real world there is a very significant hazard to all GPs from this misapplication of NICE guidance, and I would consider that in this respect at least it significantly hinders rather than helps your colleagues.

  • ‘An increase in resources not seen in recent years’

    3rdGen's comment 08 Mar 2016 11:05am

    It's not inflation that cancels it out but continuously rising workload. When consultation rates are up 25% over 5 years, there has been an effective cut in funding.

  • GP funding uplift could see 'first increase in earnings for several years'

    3rdGen's comment 23 Feb 2016 10:31am

    This can only be considered as an increase in funding if the increase in intensity and volume of work from year to year are ignored. In reality, the baseline workload is increasing far faster than inflation.

  • The Amazing Jezza, extraordinary magician

    3rdGen's comment 20 Jan 2016 6:04pm

    For sure, any new funding is going to be tied into the new 'eight days a week NHS'

  • GPs should pay off costs of medical training before moving abroad, says MP

    3rdGen's comment 23 Sep 2015 1:14pm

    Electronic tagging of young doctors is the obvious solution.

  • NICE U-turns on 10% risk statins QOF indicator

    3rdGen's comment 04 Aug 2015 12:44pm

    With our practice of 7500 patients, 1500 have a QRisk >10%. The workload involved in initiating, following up and amending prescriptions for statins in this group will be immense. It's possible for GPs to do this work, and the evidence says that it's worthwhile, but practices would need significant additional funding to undertake this.

  • GP partner take-home pay plummets by 6% since April

    3rdGen's comment 29 Jul 2015 11:58am

    Plus the effect of rising Medical Defence subscriptions - rapidly approaching £10k per annum

  • GPs can refuse insurers' requests for patient records, commissioner's office rules

    3rdGen's comment 24 Jul 2015 1:52pm

    We are users of EMIS, and requests for insurance reports are now coming through on iGPR. This system appears to extract the entire clinical record.
    The fee for this is £10, with a £10 'bonus' if provided within a deadline.
    I wonder, what is the value of this information to life insurance companies?

  • Jeremy Hunt pledges £10m to support struggling practices under 'new deal'

    3rdGen's comment 19 Jun 2015 10:58am

    What a waste. £10 million could pay for an advertising campaign to recruit more GPs - target these for prominent positions on the back of buses, or perhaps on the tube.