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GPs buried under trusts' workload dump

Secure environments GP

  • GP threatened with breach-of-contract notice after following BMA workload advice

    Secure environments GP 's comment 20 Feb 2015 9:56am

    It is unhelpful to contractors and a risk to patient to safety for NHS England not to recognise an unsustainable workload and permit a solution in a practice unable to recruit.

    Whether this will work in mitigation with the GMC, Ombudsman, CQC and the Courts for a life-threatening mistake made under pressure is a moot point....

    General practice is in a dangerous state...mortally wounded...

  • BMA criticises decision to cut GP trainee pay

    Secure environments GP 's comment 03 Jan 2015 1:00am

    The BMA needs to do more than politely asking the band on The Titanic to put down violins. Would they mind awfully re-arranging and tying down the deck chairs instead? This will make Captain Hunt very happy. He has issued a "stern warning" stating that a rapid unplanned "movement" will be unpopular with the wealthy and those of social prestige.

  • GMC to introduce 'emotional resilience' training after finding 28 doctors under investigation committed suicide

    Secure environments GP 's comment 31 Dec 2014 4:19pm

    We are now at 300 posted comments ! Is that a record?

    I work as a GP in prison and secure setting from time to time.

    “You can judge a society by how well it treats its prisoners”.

    Fyodor Dostoevsky

  • GMC to introduce 'emotional resilience' training after finding 28 doctors under investigation committed suicide

    Secure environments GP 's comment 29 Dec 2014 3:10pm

    What a long thread of comments.!!.. Please can we have some response from PULSE editors? Any chance of interview with Dr Gerada?

    It makes disturbing reading. I am tempted not to read these comments any longer... It's upsetting all this doom and gloom. Does anyone have any good news? :-)

  • GMC to introduce 'emotional resilience' training after finding 28 doctors under investigation committed suicide

    Secure environments GP 's comment 23 Dec 2014 5:58am

    I make no apology for pointing vulnerable doctors towards the right help in a crisis. Many services are truly anonymous I suspect if you don't give your name. I've never needed to ring them so I'm not certain granted.

    However, I have helped many doctors and treated several as registered patients over the years and when I worked as psychiatrist for 8 years.

    I'm signing off now, this thread is becoming too negative and unproductive. Oh well.... I know how CG feels now.
    Merry Christmas and a Happy New Year.

  • GMC to introduce 'emotional resilience' training after finding 28 doctors under investigation committed suicide

    Secure environments GP 's comment 22 Dec 2014 8:09pm

    One suicide is one too many, anyone distressed consider all the excellent help available. Caring people are all around you and prepared to help.

    BMA Counselling is staffed by professional telephone counsellors 24 hours a day, 7 days a week. They are all members of the British Association for Counselling and Psychotherapy and are bound by strict codes of confidentiality and ethical practice. You can even choose to remain anonymous when you call.
    Call 08459 200 169 (landline: 01455 254 189) - 24 hours a day, 7 days a week

    The Doctor Advisor service runs alongside BMA Counselling giving doctors and medical students in distress or difficulty the choice of speaking in confidence to another doctor.

    If you wish to use the service call 08459 200 169 and ask to speak to a Doctor Advisor - you will be given the name of a doctor to contact and details of their availability.

    CAPITA Insurance Services
    Stress Counselling & Confidential Tax
    Telephone service only
    for GPs and GP families
    0800 174 883

    British Doctors and Dentists Group


    Telephone: 07771 642 682

    British International Doctors Association

    Address: ODA House, 316A Buxton Road, Great Moor, Stockport, SK2 7DD.

    Telephone: 0161 456 7828

    Doctors' Support Network

    Peer support group for doctors with a wide range of mental health problems.



    Telephone: 0844 395 3010

    Doctors’ Support Line

    Helpline dealing with any problem from career and family to mental health problems. Staffed by doctors and fully confidential.

    Telephone: 0844 395 3010

    NHS Practitioner health programme

    Free and confidential services for doctors with a mental health, addiction or physical health problem affecting their work. Patients outside London area will be dealt with on a case by case basis and maybe required to seek funding for inpatient or specialist case if required.


    Telephone: 020 3049 4505

    Primary Care Support Service

    The Primary Care Support Service is a direct access, confidential counselling, support and educational service for GPs (doctors), general dental practitioners and community pharmacists working in Wales. It is funded by the Welsh Assembly Government but is run as an independent service with co-ordinator input in each of the three Welsh regions.


    Phone: 01248 675899

    Royal Medical Benevolent Fund

    RMBF offers support to members of the medical profession and their dependants who, through illness or misfortune, find themselves in financial hardship. The website also provides a wide range of other sources of help and support.



    Telephone: 020 8540 9194

    Fax: 020 8542 0494

    Royal Medical Foundation

    The Royal Medical Foundation exists to support doctors and their dependants who find themselves in financial hardship.


    Telephone: 01372 821 010

    Fax: 01372 821 013


    Confidential emotional support 24 hours a day.



    Telephone: 08457 90 90 90

    Sick Doctors Trust

    24 hour confidential telephone helpline for doctors with drug and alcohol problems.


    Telephone: 0370 444 5163

    "CONTACT” West Midlands Region
    Clinical Psychology for GPs by phone
    and face to face
    0121 558 0278
    Confidential Service

  • GMC to introduce 'emotional resilience' training after finding 28 doctors under investigation committed suicide

    Secure environments GP 's comment 22 Dec 2014 1:08am

    Sorry to hear that. It shows we are all up against this together. I agree such an aberration needs addressing high up amongst a long list to sort out. Dreadful situation for any GP in any role. There are some specific circumstances when the model BMA contract affords some protection still. Any salaried GP should contact the BMA, their LMC, ACAS and/or an employment lawyer immediately if any type of dispute or problem. This is a complex area so best not get into specific cases. Salaried GPs can also join Unite Union.

    The unfairness, multiple jeopardy, limited legal recourse and financial hardship are all part of this "toxic uncaring NHS" working environment. (As Dr Gerada has described it)

    Explains why I know 7 colleagues now who've emigrated. When each one goes I think of this line:

    "If you're swimming amongst Sharks, eventually you've got to jump out"

  • GMC to introduce 'emotional resilience' training after finding 28 doctors under investigation committed suicide

    Secure environments GP 's comment 21 Dec 2014 7:00pm

    Please keep on message. This debate is not about salaried GPs. At least if suspended you get an income. Save that for another time.

    This is too important for infighting. Keep up the good work Clare. Your efforts are extremely welcome.

    Back to this Report, we do not live in The Dark Ages. Our health and welfare is essential if we are to work for the benefit of patients. As doctors we are also patients in every sense of the word and deserve the same respect and legal rights.

    Clare - I shall be at the next Group Analysis Event again. This is one of many ways that change can be given a chance. Collective inertia of thousands of doctors won't change anything. Thank you.

  • GMC to introduce 'emotional resilience' training after finding 28 doctors under investigation committed suicide

    Secure environments GP 's comment 21 Dec 2014 2:29pm

    OMG - Can you imagine the pilot of a Boeing 747 having the rest of his career, livelihood and fitness to fly "imagined" and judged by people who have never sat in a cockpit? (or only flew a Cessna in 1975). Never had some orientation training and opportunity for them to develop insight.....

  • GMC to introduce 'emotional resilience' training after finding 28 doctors under investigation committed suicide

    Secure environments GP 's comment 21 Dec 2014 11:46am

    I'm pretty frightened reading these stories, out of negativity I'm trying to seek positivity and optimism. Only way I can do this after a long reflection last night is philosophy.

    So I hope these help in some way, highlight "Risk" is that - what you fear may not happen and to keep us going under what feels for some to be oppression (for want of a better word) :

    Every man has the right to risk his own life in order to preserve it. Has it ever been said that a man who throws himself out the window to escape from a fire is guilty of suicide? – Jean-Jacques Rousseau

    My fellow revolutionaries, liberation is a noble cause. We must fight to obtain it.
    - George Weah quotes

    “I've had a lot of worries in my life, most of which never happened.” ― Mark Twain

    There are people who are always anticipating trouble, and in this way they manage to enjoy many sorrows that never really happen to them.
    -- Josh Billings

    A ship in harbor is safe, but that is not what ships are for. – John A. Shedd

    There are more things, Lucilius, that frighten us than injure us, and we suffer more in imagination than in reality.
    -- Seneca

    No man is worth his salt who is not ready at all times to risk his well-being, to risk his body, to risk his life in a great cause. – Theodore Roosevelt

    You’ve got to keep fighting; you’ve got to risk your life every six months to stay alive. – Elia Kazan

    Every society honors its live conformists and its dead troublemakers. – Mignon McLaughlin

  • GMC to introduce 'emotional resilience' training after finding 28 doctors under investigation committed suicide

    Secure environments GP 's comment 19 Dec 2014 6:29pm

    Heart-wrenching. This is the caring profession... How many empty seats at family Xmas tables in 6 days time?

    What an awful time it must be for them and for this kind of reminder right now..... when so I am led to believe, the report has been ready to publish for almost a year.

    Clare, thanks for your work. Let's get some more people around the table and change things. This is not just about this report, looking at all pressures on today's doctors - "All that is necessary for the triumph of evil is that good people do nothing." (adapted - Edmund Burke)

  • GP training in turmoil with 'one application for every four roles'

    Secure environments GP 's comment 19 Dec 2014 2:25pm

    When I applied for a place on a VTS in 2003, I asked on the day of the OSCEs and interview what the level of competition was like.

    40 doctors were applying for each place !! I pitched my performance accordingly. They had some great Actor patients that day.

    What does that tell you about the state of general practice and recruitment ?
    (Becoming a GP "seemed like a good idea at the time" is my new catchphrase)

  • GMC to introduce 'emotional resilience' training after finding 28 doctors under investigation committed suicide

    Secure environments GP 's comment 19 Dec 2014 9:15am

    Una is very brave.

    I also meant more like Dr Gerada openly discussing these challenging matters, those who've heard and seen the effects on colleagues (and their families).

  • GMC to introduce 'emotional resilience' training after finding 28 doctors under investigation committed suicide

    Secure environments GP 's comment 19 Dec 2014 8:59am

    I wish to read the full report.

    Enlightening comments so far. Very sad situation for many doctors. Let’s support them all better in future. A radical re-think and change of processes is essential now. 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 (with kids), with a doctor as the main breadwinner losing 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 cannot fully appreciate how this may feel. I suspect local resolution of issues is by far the best way.

    Locum doctors and GP partners in particular are put on a roller-coaster of what must feel like total annihilation. We should be hearing 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 £6K x years paid to that defence organisation. No discretion for this please. Even criminals get legal defence and a fair trial, compensation if due.

    As I’ve said many time before, 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.

    Can doctors please be brave enough to name themselves when making comments, why anonymous?, have the courage of your convictions and uphold your right to (carefully constructed) free speech...

  • 'Now is the time to consider a career in general practice'

    Secure environments GP 's comment 17 Dec 2014 10:41pm

    “Optimism is a strategy for making a better future. Because unless you believe that the future can be better, you are unlikely to step up and take responsibility for making it so.”

    ― Noam Chomsky

  • CCGs tell patients to question their GPs

    Secure environments GP 's comment 17 Dec 2014 2:25pm

    Potentially a positive and welcome move. I can imagine at point of a serious diagnosis this should help, say with a relative present and there is a lot of information to recall. Reading them it reminds me of the way a fully supported patient in an outpatient dept receives a cancer diagnosis. If it used proportionately to circumstances it is a useful aid memoire to both doctor and patient in most other settings as well.

    I think we do have to be realistic under current pressures and have to come up with ways of giving advice that actually makes a difference for patients.

    Ideally a visit with the doctor should be 15-20 minutes (as the RCGP has advocated for some time). Perhaps, only this amount of time can be used to build a very powerful relationship and transfer crucial information that will make our patients healthier. Sometimes a global view of the day and of what is best for as many patients as possible is realistic. There is only a finite about of energy, time and caring that can be done in a day, and whilst every patient should expect this MAGIC card approach is it deliverable?

    The MAGIC cards may give patient's more of a sense of responsibility which with some it does not sit easily. It might give the impression that you cannot trust your doctor to cover or consider these areas so they need reminding. It may highlight a dysfunctional consultation if these areas are not covered OR it may not at all for an otherwise competent clinician focussing his skills across a day of 60 patient contacts.

    I think most experienced GPs practice in the way the questions assert especially if they have longer consultations - 20mins to spare or over several consultations. However I might get a bit miffed if these cards were pulled out every other patient when they have obvious minor illnesses etc and have an expectation I must detail a response whilst I am running 45mins late. We also need to be focussed, pragmatic with our use of e.g the hypothetico-deductive model. Sensible shared decision making is always part of the contract between Doctor and patient. I just hope that doling out these cards all around the waiting room will have the desired evidence-based effect. Because we have so little time, we have to be able to devote our time in a sliding scale of potential seriousness or risk and to the things that will make a difference.

  • GPs urged to ring vulnerable patients over weekend in attempt to cut A&E attendance

    Secure environments GP 's comment 15 Dec 2014 9:45pm

    Well he lobbed a grenade in. Mind you I sometimes think the Pulse Team likes to selectively abstract the good stuff to see us vent cathartically :-)

    Perhaps the source of the problem best be brought to NHS England's "the one and only Adam Bland's " attention. Look what is easy to find to add context:

    Cutting in Yorkshire
    Take Yorkshire Ambulance Services Trust (YAS) – it’s looking to slash its budget
    by £10.3 million this year alone. Its ‘cost improvement plan (CIP)’ sets out a new operational model which threatens mass downgrading for ambulance staff and the loss of professionally trained technicians on ambulances altogether replaced by driver roles. Posts are not being filled and crews are driving from one 999 call to the next without the time to check or clean the back of their ambulances or have ad- equate rest breaks.
    To top it all off, YAS wants to do away with its ‘urgent tier’, opening the way for profit making companies like Virgin Care and Serco to move in and profit from our emergency care.

    The cuts are driving down wages and shrinking the publically-funded ambulance service to its bare minimum – this is the softening up before private companies pick up the slack and the
    creep of privatisation spreads even deeper into
    our NHS.
    So I would say DEAL WITH THAT rather than asking General Practice currently "dying by a thousand cuts" to stop late and call 200+ elderly and say;

    "This is Dr B. Would you mind awfully not calling an ambulance this weekend...(silence...cold call confusion response)...No I'm not selling over 50 life insurance, funeral expenses cover/plans,,,,no not PPI either. The ambulance service is too busy so "the NHS managers" wanted me to remind you to..., say, think about calling Bob from over the road to take you to hospital if you have another fall. Actually best don't walk around too much...don't forget to take your tablets..."

  • Practice manager salaries decline by 1% over past year

    Secure environments GP 's comment 12 Dec 2014 5:18pm

    Instead of no comments, best put this note.

    Practice Manager's do a difficult job, sometimes at the epicentre of stresses running a practice. Not infrequently GPs are unaware of the full extent of work they do.

    I have heard of several PM's just walk, leave the job, no notice as it has been so bad. So best to pay them enough to feel respected, rewarded and a bonus to reflect the extra work they do out-of-hours.

    If you can find a super-efficient practice manager who works 9-5pm and gets everything done let me know so I can pay them £50K.

    There are plenty of middle-high corporate management jobs out there for professionals with their skill sets. The recruitment crisis is bad enough without losing good practice manager's.

    So give them 1% annual rises and 2-3% bonuses depending on efforts. GP's doing the PM's job when they go off sick for months etc is not fun. Trust me!

  • Pulse named 'magazine of the year'

    Secure environments GP 's comment 08 Dec 2014 6:39pm

    Fantastic, you all do a great job, insightful, exciting and up to the minute journalism. Very professional outfit and very much appreciated by your readers (and contributors...)

  • CCGs a 'déjà vu’ of PCTs, NHS England lead says

    Secure environments GP 's comment 05 Dec 2014 10:52am

    Coca-Cola and Pepsi, can barely tell the difference...

    Just a crazy waste of money, which could have gone to front-line services and perhaps at least "taken the edege of" the mess we're in now.

    "Re-arranging deck chairs on the Titanic" also comes to mind.