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Secure environments GP

  • Coffee scalds and razor blades: A day as a prison GP

    Secure environments GP 's comment 15 Sep 2016 0:12am

    Yep. This about sums up some of my days too.
    Spotting genuine illness through the duplicity, splitting of the team and outright threats is challenging but fascinating.

    Every consultation seems to have a common theme - mental health, drugs, assessing risk to themselves or others (and sometimes of immediate risk to me, ducked a punch last week)

    However, most prisoners are respectful of their doctor. The stories heard of dreadful upbringings, survival instincts and motivations for their behaviour are rich in emotional, societal and ethical context.

    Senna, mouthwashes and hand gels go into hooches. Unfortunately there are major problems with ready availability of prescribed, licit and illicit drugs. There is a whole range of diverting or trading of meds.

    The job is not for everyone, 🏳 if the physical Healthcare team is responsible Team is excellence

  • GPC calls off plan to ballot members on mass resignation

    Secure environments GP 's comment 22 Aug 2016 4:40pm

    Give it a chance.
    Whatever is done, it will be like steering around a supertanker in choppy waters, so from what I'm reading at least it's an attempt!

  • We must act now

    Secure environments GP 's comment 06 Jun 2016 10:05pm

    All good comments. However the vision by Chris is indeed enactable, Who can deny the wisdom of adapting to changing environmental conditions; responding to new challenges; learning from one’s mistakes as a profession and nurturing new leaders to grow... Small steps. We're attempting to turn a massive oil tanker around so all the tug boats need to pull in the right direction.

    Agreed it's a brave individual person to risk resignation and it's consequences but if the needs of the many outweigh the needs of the few, unite the profession to mitigate this risk.

  • Forget the hype, but the 'forward view' is a significant shift

    Secure environments GP 's comment 21 Apr 2016 11:44pm

    Indeed an insightful summary. NHSE needs to give more practical genuine rescue packages to fix the "current view", not just a "forward view". Here & Now please!

    I like analogies:
    If I wanted to fix my roof by 2020 I'd be stupid to let it collapse a bit more right now, be forced to build a superfluous conservatory extension first, heat & light the place for 7 days on 5 days of funding. As the years progress not being able to source skilled builders to do the work would be a worry.

    And if my "core building" was collapsing, I'd hardly be inviting all my friends and family around to sit on the sofa with water dripping from the ceiling. Primary care needs it's roof fixing now because the Sun hasn't be shining for 10 years...And don't even ask me how much the insurance premiums are personally costing me.

    We're heading in the right direction but can't help feeling it might be too little too late.

  • GMC to spare doctors with mental health problems from a full investigation

    Secure environments GP 's comment 07 Apr 2016 5:17pm

    Very sad situation for many doctors. We must support them all better in future. This must be the start of a radical re-think and change of GMC processes. The pendulum has swung too far the other way for too long.

    Remember a lot don't take their own lives. But their personal and family lives are destroyed. Financial hardship. Can you imagine the trauma to a family (perhaps with kids), when a doctor as the main breadwinner loses their house whilst under investigation? Then they may actually be cleared. I think we should all try understand matters better rather the fear the unknown. I can't fully appreciate how this may feel. I suspect local resolution of issues is by far the best way.

    It would be nice to hear the narrative stories of more doctors who've lived to tell the tale.

    Defence organisation should defend their fee-paying doctors at least to the full total of their contribution over the years. Ie £7K x years paid to that defence organisation. No discretion for this please. Even criminals get legal defence and a fair trial and crucially compensation if due.

    Failing to attend to the needs of one group of patients (doctors) does nothing to benefit the wider population. Doctors living in fear doesn’t help either. Time for change.

    I work as a GP in prison and secure settings.
    “You can judge a society by how well it treats its prisoners”.
    Fyodor Dostoevsky

  • Comrades, it’s time to play dirty

    Secure environments GP 's comment 26 Feb 2016 10:33am

    Short article I published last year, and thought I had over-egged it. Maybe not...

    NHS GPs are losing this "game of chess" with the UK Government
    Jul 11, 2015

    NHS Primary Care as we know it is dying by a thousand cuts.

    Primary care in GMS / PMS forms are becoming unable to provide the high level of service that is expected from its patients and standards expected of its Regulators. As Noam Chomsky said:

    ‘If you want to privatize something and destroy it, a standard method is first to defund it, so it doesn’t work anymore, people get upset and accept privatization."

    Mr Hunt (Health Secretary) is pushing a privatisation agenda. They obfuscate this, deny it but it "hides in plain site". NHS primary care wasn’t broken and didn’t need fixing. "Failings" in rationing resources are now GPs fault through CCGs, lack of 24/7 services is our fault, etc etc long list ,all our fault, but the Health and Social Care Act 2012 removed the health secretaries "duty" to provide a national health service! All devolved now...

    Jeremy Hunt co-authored a book in 2009 calling for the NHS to be dismantled. See http://po.st/kY1vJj Or Google "the green benches jeremy hunt"

    The profession is divided. It will take those GPs without retirement "in sight" to really "grasp the nettle". To make our choices or force our futures and put ourselves back in the best possible position to serve our patients.

    It's a game of chess and the RCGP and GPC are outmaneuvered EVERY time.

    Mr Hunt was put in position for the "long game". He knows what he is doing and is no fool as some may think. My belief is that collectively GPs have to be smarter and more ruthless than he is at protecting our position which we then know serves the best interest of our patients.w

  • One third of GPs think NHS should stop funding IVF

    Secure environments GP 's comment 05 Feb 2016 1:14pm

    ok then why should those without children have to pay taxes that contribute to Child Benefit? housing benefit for single mums etc

    A fair ethical approach focuses on the fair and equitable distribution of good and harm, and/or the social benefits and social costs, across the spectrum of society. Not having children can be painful and harmful to some. Etc

    Distributive justice is being challenged, this refers to the extent to which society's institutions ensure that benefits and burdens are distributed among society's members in ways that are fair and just.

    It starts with the premise that all equals should be treated equally, and those who are unequal due to relevant differences, should be treated differently in a manner that is fair and proportionate to, or commensurate with, their difference. Why should a 25 year old who has survived cancer treatment be declined infertility treatment by the NHS?

    Why should gender identity dysphoria not be treated on the NHS when we fund "visible" illnesses without question and without judgement?

    Unreasonable discrimination and bigotry won't survive long in the Courts.

  • One third of GPs think NHS should stop funding IVF

    Secure environments GP 's comment 05 Feb 2016 10:37am

    Frankly appalling notion. These GPs clearly have children already then. I could rant about this but I'm not going to this time!

  • Mr Cameron, the NHS is not safe in your hands

    Secure environments GP 's comment 05 Feb 2016 1:20am

    Dr David Barrett MRCGP
    Portfolio GP
    Leicestershire

  • Osborne’s billions are too little, too late

    Secure environments GP 's comment 28 Nov 2015 12:27pm

    Sad but so true and insightful.

    It may take a generation to fix the mess, but what I'm seeing is those "able" to think and act differently are already making wise choices - emigrate, portfolio, locum, retire early, leaving medicine all together. When the generation needed to fix the problem are already leaving in their droves they'll be nobody to sit down on any chairs when music stops!

  • LMC issues letter to patients following Hunt’s ‘penance’ comments

    Secure environments GP 's comment 21 Oct 2015 6:07pm

    Bless me father Jeremy for I have sinned, it is 10 years since my last confession of a pay rise.

    More seriously, it's an abuse of power that he is admitting too, no employer could give this as a legally acceptable reason for underfunding a critical service and under-remunerating hard-working staff.

    Also, he has in effect claimed responsibility for a worsening primary care services and thereby deliberately destroying the NHS out of spite, finally admiting to personally targeting GPs (& therefore their patients).

    The entire issue about 7-day access is perceptual and about apparent convenience. Fundamental to this issue, it has become about meeting the perceived needs of the state and not the perceived needs of the patient. To make it worse, we also have to contend with blind ignorance of the actual workforce crisis.

    7-day access will not solve any issues but it certainly will create a lot. It will require a considerable increase in the number of GPs (and they aren't there), it will create a significant increase in costs (you still need to pay staff), it will increase the amount of litigation - principally because of the failure of continuity of care, and it will increase the unhappiness in the profession. The next point is that there isn't even a proven need just a particular political desire to pander to the perceptions of the electorate which lack any substance.

    The arguments that it will reduce the demand on secondary services and A&E have not been proven. This argument is continually repeated but the evidence that it makes a substantial and ongoing difference is lacking. You will just see the same stuff on the weekend that you did during the week, and the people who were going to go to A&E will go there anyway. So now you have more GPs, more staff, longer hours and no improved productivity with a significant increase in cost.

  • Hundreds of ‘desperate’ practices apply to close lists, but one in three is declined

    Secure environments GP 's comment 21 Oct 2015 10:24am

    @9.51 good plan.

    Also, doesn't GMC guidance put an obligation on us to

    Contribute to and comply with systems to protect patients
    Respond to risks to safety
    Protect patients and colleagues from any risk posed by your ?burnout ?distress ?exhaustion etc
    Work collaboratively with colleagues to maintain or improve patient care

    -
    There surely come a point where this must be used in mitigation for mistakes or complaints to CQC, Ombudsman, Area Team etc

    Confirms the need for Crown Indemnity (Shared Risk)

    Is an understandable reason for performance to be adversely affected by individual clinicians.

    Should we not inform the GMC no one is listening? Pre-empt later problems?

  • Hunt's tweeting of patient names under consideration by information commissioner

    Secure environments GP 's comment 25 Jul 2015 11:08am

    It will set a precedent as the ICO will be judged by how it responds to this.

    In future for anyone else a similar breach or disproportionate sanction/fine can be defended or mitigated using the ICO's example made of Jeremy Hunt.

    Entirely unintentional mistakes have consequences for doctors livelihoods and for patient safety.

    Defunding the NHS as it stands is an intentional choice of Mr Hunt. Spreading stretched routine services thinly over 7 days instead of 5 will be a disaster for patient safety.

    The health professionals in that photo should not worry.
    If I got my public relations guru to photograph my lunch in front of my surgery list screen and put it on Facebook, I can't blame the "lunch".

  • What new deal?

    Secure environments GP 's comment 10 Jul 2015 11:41pm

    Good letter

    Yes at the moment it's death by a thousand cuts !!

    Primary care in GMS / PMS forms are becoming unable to provide the high level of service that is expected from its patients and standards expected of its Regulators. As Noam Chomsky said:

    ‘If you want to privatize something and destroy it, a standard method is first to defund it, so it doesn’t work anymore, people get upset and accept privatization."

    Mr Hunt is pushing a privatisation agenda. They obfuscate this, deny it but it "hides in plain site". NHS primary care wasn’t broken and didn’t need fixing. "Failings" in rationing resources is now GPs fault through CCGs, lack of 24/7 services is our fault, etc etc long list ,all our fault, but the HSCA removed the health secretaries "duty" to provide a national health service! All devolved now...

    Jeremy Hunt co-authored a book in 2009 calling for the NHS to be dismantled. Google "the green benches jeremy hunt"

    The profession is divided as you say. It will take those GPs without retirement "in sight" to really "grasp the nettle". To make our choices or force our futures and put ourselves back in the best possible position to serve our patients.

    It's a game of chess and the RCGP and GPC are outmanoeuvred EVERY time!

    JH was put in position for this "long game". He knows what he is doing and is no fool as some may think. My belief is that we, and I mean collectively as GPs have to be smarter and more ruthless than he is at protecting our position which we then know serves the best interest of our patients.

  • Pulse wins two industry awards

    Secure environments GP 's comment 10 Jul 2015 10:54pm

    Fab! Well deserved. Keep going for us!

  • Osborne announces 1% public sector pay rise

    Secure environments GP 's comment 08 Jul 2015 3:26pm

    Quietly does it, but "The Stevens Plan" calls for an ambitious £22Billion in yet more efficiency savings !

    Ozzy & Co, please listen carefully ...."There is no more blood to get out of the NHS stone"

    1% pay rise for GPs after 6 years defunding primary care... Like really, even if we see those peanuts via DDRB et al trickery, I somehow doubt this will be any "factor" at all to those GPs exercising choices - retiring early, emigating, locuming etc

    Or those with NO choices in having to give contracts back to Area Teams, those trapped in long-term practice leases, burning out because can't recruit new GPs to work at their practice etc etc

    It's a false economy to let primary care remain on an EOL Plan. We will have to refer much much more into Hospital. Prevention can be a luxury when "fire-fighting" like some practices are.

    7 day access to "your GP" on a "shoestring budget" plus 1%. So £100 given us to provide a service for 5 days means £20 per day to work with, £101 to work 7 days means £14 and 43pence per day to work with....it's not rocket science! More undoable demands!

  • Jesus may have been able to perform miracles, but GPs cannot

    Secure environments GP 's comment 04 Jul 2015 1:22am

    Well said Clare, very insightful.
    Excellent, bang on target.
    It reassures many more grateful GPs. We could all do without horrid bullies on this Forum please.
    Ignore them, let them grind their own axe.

    In meantime, I've booked for your event. I appreciate all you do. Thank you.

  • The ‘new deal’ (that wasn’t)

    Secure environments GP 's comment 02 Jul 2015 11:57pm

    Excellent synopsis. I do think Mr Hunt has an idiosyncratic belief or impression maintained despite being contradicted by reality or rational argument....

  • Ten things partners get wrong when recruiting new GPs

    Secure environments GP 's comment 27 Jun 2015 5:28pm

    When a practice cannot recruit a salaried GP paying £110K per year and giving a £20K golden hello that about sums up the problem. Inner city deprived area PMS.

    It would have to be a "dream job handsomely paid" to get me back as a partner again or salaried. Financial risk alone of being a partner with retiring partners to buy out completely puts me off.

    The recruitment and retention crisis is a massive problem in itself. Primary care remains on an End of Life (EOL) pathway. The profession had no viable plan to fix it and the Government clearly has another agenda.

    Trying to Sell that or spin it to a new recruit will present some obvious challenges. Most doctors are smart and intelligent.

  • Listen again: Jeremy Hunt announces the 'new deal' for GPs

    Secure environments GP 's comment 20 Jun 2015 1:21pm

    The video: https://youtu.be/fN0I24FcZZw