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GPs buried under trusts' workload dump

John Ashcroft

  • Changes to NICE hypertension guidelines to go ahead despite workload concerns

    John Ashcroft's comment 28 Aug 2019 7:51am

    The move to offer treatment to those with lower 10year CVD risk is welcome, but overdue.
    It recommends that patients to do home BP monitoring, which is very helpful.
    They appear to have ignored the Sprint trial. The Target BP 135/85 ABPM/HBP on treatment looks very conservative. The Sprint trial started treatment at these levels.

  • NICE set to lower hypertension treatment thresholds for CVD patients

    John Ashcroft's comment 08 Mar 2019 12:32pm

    Probably should comment that I am a member of the BIHS (British and Irish Hypertension Society), but comments are my own.
    I did tell Richard Vautrey last week that the new NICE guidance may be a problem. The new contract has already lowered the threshold for QoF to the target of the last NICE, but there could yet be more.
    The obvious issue that following the SPRINT study my opinion is that the Target BP should be lower.
    Before someone has apoplexy I suggest looking at the SPRINT trial, the results of which have resulted in re-writing of the US, and the European guidelines.
    They took BP in a different way.. no one in the room, a 5 minute delay, automatic BP machine .. but isnt that like Home BP??
    Target was 120/ .. and they got half of patients to target, average bp 123/
    Results .. less heart failure, stroke, CVD mortality,.. and we shouldnt really mention it because it was not a preset target.. 27% reduction in overall mortality.
    I think we should be looking at a target Home BP of less than 130/.
    This is what Europeans came out with, and Prof Cappuccio President of BIHS has stated.
    The 10% threshold is sensible, I see many patients treated at much lower risk on current guidelines. Only caveat is that it should be unified with cholesterol guidelines. At 10% risk you may want to take a statin or antihypertensive; but probably not both.


  • NHS England's top GP resigns following Pulse comments

    John Ashcroft's comment 07 Aug 2018 6:22am

    Googled his previous comments. There’s quite a few. I couldn’t see the one about small practices. Some of his comments could be seen as controversial but one on the feminisation of the profession could have been written by a certain senior member of GPC.
    He has been quite pro pharmacist in practice, so I can see his influence on NHSE there, and as a large practice with a practice pharmacist I will give his dues on that.
    My biggest concern is how NHSE dropped him. If NHSE are going to show so little support to “one of their own”,.... what can the rest of us expect???

  • I’ve learned the hard way to live without patient ‘satisfaction’

    John Ashcroft's comment 24 Apr 2018 4:39pm

    You should try being a 50 something white male GP. I think we are open season for a certain type of complainant, often similar to the demographic I think described here.
    Often it is power thing, a type of abuse where the abuser/complainant gets an emotional gain by their manipulation by use of the complaints system.
    Like may abusers they are serial offenders with years of practice since childhood.

  • NHS Health Checks set to miss cost-effectiveness target with just 40% uptake

    John Ashcroft's comment 23 Mar 2018 8:10am

    This was Gordon Browns baby, and in some ways a laudable idea; he wantedto see the NHS actually being a "Health Service" rather than an illness service and patients getting something that he saw patients with private cover getting.
    However this led to the NHS rolling out a on size fits all scheme and ignored the NICE CG67, lipid modification pathway that had shown with the work from Tom Marshall that you could take the data base that was by then being generated from QoF and target the risk assessment to those most likely to benefit.
    OK Gordon Brown was the priminister...
    What is really bizarre is that in the time of auserity, 10years later, 2 governments, with a Tory Health Minister who makes big statements about using "big data", this gold plated programme continues to be rolled out much the same.

  • GMC criticised by its own regulator for handling of Bawa-Garba case

    John Ashcroft's comment 20 Feb 2018 1:41pm

    Does the profession still have trust in the GMC?
    I would be more inclined to cancel my subscription to the GMC rather than a certain other charity, Oxfam, if I was allowed.

  • Weighting of GP practice funding is 'inequitable', finds study

    John Ashcroft's comment 20 Feb 2018 1:24pm

    Carr-Hill formula was accepted by the BMA because it didn’t “rock the boat”, and why would it, it was essentially a measure of what was being given to patients in terms of GP time in the late 1980s/1990s. Didn’t measure what patients wants were, or their needs; consultation times 5-7minutes. And yet it is still being used today. Why?? Is it that good?
    Read what Carr-Hill said himself in his own CV...

    “Last year, I was contracted by the Department of Health to develop a workload formula as the basis of the new contract with General Practitioners throughout the UK. Despite the almost total lack of systematic data, I was able to generate a formula with sufficient credibility for it to be accepted by the British Medical Association.”
    Get the feeling it wasn’t his best piece of work??

  • Plug the NHS cash sinkhole before pouring more funds in

    John Ashcroft's comment 16 Feb 2018 1:01pm

    Biggest “Hole” is the NHS tariff system that hoses vast amounts in to the most expensive and inefficient part of the system.
    I asked Nicholson about this and his answer was that when large amounts of £££ were being put into the NHS they needed a mechanism to get it in there quickly and create more activity.. but that conversation was 6years ago and we still are still using the same “payment by activity” that came in under the profligate labour years, and you wonder why there is so much waste and why we have such a problem.
    Jeremy Hunt a conservative?? .. just incompetent.

  • GMC defends spending £250k on private health insurance perk for staff

    John Ashcroft's comment 09 Feb 2018 3:13pm

    It goes against a central tennet of the NHS that we are all in it together.
    Its not acceptable and clearly gives the wrong impression.

  • DH and GP leaders 'to review partnership model'

    John Ashcroft's comment 07 Feb 2018 5:50pm

    They have been promising a new contract for years, and there was supposed to be one for this April.
    It just sounds like spin and B......t.
    The partnership model isnt so much broken as the DoH doesnt seem to undestand that GP is a franchise model.
    And what a stupid contract were the cheapest delivers of care take home more money if they do less, and take home less money if they deliver more ?? (employ more doctors, nurses, give more time to patients= warm cosy feeling and empty wallet)
    Crazy.

  • Happy medium: why nirvana is found in mid-sized practices

    John Ashcroft's comment 04 Feb 2018 5:59am

    Not a small practice15,000, same size as mine, and we are one of the biggest in Derbyshire. What is different is the personal list, that’s quite unusual especially for a large practice. It’s something that I think we lack in mine.
    There’s considerable evidence continuity is good for patients, and maybe good for the NHS with lower referral rates, admissions etc. but maybe good for doctors.

  • Happy medium: why nirvana is found in mid-sized practices

    John Ashcroft's comment 03 Feb 2018 6:13pm

    Not a small practice15,000, same size as mine, and we are one of the biggest in Derbyshire. What is different is the personal list, that’s quite unusual especially for a large practice. It’s something that I think we lack in mine.
    There’s considerable evidence continuity is good for patients, and maybe good for the NHS with lower referral rates, admissions etc. but maybe good for doctors.

  • GMC successful in High Court bid to strike off junior doctor

    John Ashcroft's comment 25 Jan 2018 1:02pm

    The laws an"Ass".
    The jury where never put in the position on knowing the truth, and the whole truth, adn the multiple failings of the Trust, so came to an incorrect verdict.
    Even if the verdict was correct; does not a doctor have the opportunity to remediate, ever??
    Practice of medicine in this country has become much more risky, and in the NHS unacceptably so.
    Many doctors put themselves out to try and do the best for patients, good, but only the patients infront of you. Dont try and "save the NHS", dont concern your self that patients may not be seen, you will not be thanked.
    Oh except GPs, our contract says we must see every one who wants to be seen, regardless. An impossible position to be in.

  • NHS England pilot area found front-door A&E GPs 'did not work'

    John Ashcroft's comment 20 Dec 2017 2:54pm

    OHH GP services should be co-located to A+E...
    This isn’t the same as having GPs “at the front door”,

    The separation is an historic construct. If this was done not only would A+E benefit but so would OOH.
    In fact the whole system would benefit.

    And that’s what Taj Hassan has been saying for few years. But no point NHSE listening to someone like him... he’s just president of Royal College of Emergency Doctors...

  • GPs refer patients 'promptly' for cancer diagnosis, finds nationwide audit

    John Ashcroft's comment 19 Dec 2017 2:09pm

    HS-L is spot on with her assessment. It’s not the GPs fault for poor cancer diagnoses but the NHS management. Very poor levels of investment in CT and MRI. And very little availability of these investigations to GPs.
    What is really sad is that both CT and MRI were invented in the UK.
    Great minds but then British industry failure to develop and NHS failure to invest.
    The UK has a problem with management on multiple levels.

  • ​Anger as GMC tries to overrule its own tribunal and strike off junior doctor

    John Ashcroft's comment 04 Dec 2017 11:31am

    Prof. Stephenson may not personally behind this. He is a paediatrician in Nottingham and knows just what paed A+E can be like.
    He has a difficult job but has IMO been active at trying to rebalance the GMC. The numbers of doctors discharge at early stage and avoiding full hearings.
    I don’t know the details but even if a doctor going into paeds has ended up working and acting in such a way as to be felt unsafe then I think we have to ask why this has happened and all to often it is the system that is putting doctors under huge and unreasonable pressures that alters and damages the doctor. “Reflect” on it, you know it’s true, probably happened to you.

  • GPs should use spirometry and FeNO tests to diagnose asthma, says NICE

    John Ashcroft's comment 29 Nov 2017 5:40pm

    I am going to disagree with the comments of my colleagues on this.
    LTRAs are cheap, but they are also safe and simple, a tablet a day. They also help rhinitis which is often present if you care to ask.
    They are a great way to improve compliance and control; I often use them with a step down strategy of the inhaled steroids, which are often used at unnecessarily high doses. For most patient ICS have a flat response curve.

    And when maybe 1 in 3 patients are given the diagnosis of a disease that they dont have for the want of a simple breath test, why wouldnt GPs want FeNO?
    IMO we should have it already. There too much dumbing down of General Practice. We should be given the tools to do our job properly.

  • How GPs can limit tax charges on their pension

    John Ashcroft's comment 16 Nov 2017 12:50pm

    A salaried Service looks more and more attractive. Wouldn’t solve all the pension problems but at least you would know your income and limits to your workload.

  • Online GP provider makes push for patients to switch from their practices

    John Ashcroft's comment 09 Nov 2017 7:13pm

    So sounds like most university practices, even to the extent of asking patients with “difficult conditions” to register with real GPs.

  • GPs to test patients' blood before prescribing antibiotics in pilot scheme

    John Ashcroft's comment 02 Nov 2017 11:45am

    It’s a cheap finger prick test. £3.50 ish.
    Doctors should have the access.
    Probably more help for our triage nurses.
    Also reassuring when the possibility of “sepsis” is raised.

    I put this forwards as a proposal in my CCG but nothing became of it, the chair go so hacked off with it keep coming back with no action by the CCG it was dropped last month.