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Independents' Day

Paul Cundy

  • Home truths from Chesterfield

    Paul Cundy's comment 28 Jun 2020 9:56pm

    Dear All,
    The evidence is against her, as is the behaviour, she should apologise or resign.
    If she does not do this in equal measure to her indiscretion, i.e. on national radio, then she should be reported to the GMC and her employers.

    Regards
    Dr Paul Cundy
    GMC 2582641

  • GPs refute briefing claims that they are 'referring large numbers to A&E'

    Paul Cundy's comment 26 Jun 2020 6:15am

    Dear All,
    Will she comply with her professional responsibilities as set out in Good Medical Practice, and apologise?
    Regards
    Paul C

  • Face coverings are not mandatory in GP practices, DHSC confirms

    Paul Cundy's comment 16 Jun 2020 8:30am

    Dear All,
    Err thanks for that, but actually as the contract holder and employer i think i'll decide who does what in my surgery.
    Regards
    Paul C

  • NHS England plans to launch Covid swab testing in primary care

    Paul Cundy's comment 10 Jun 2020 9:16am

    Dear All,
    Oh yes that wonderfully clear situation with antigen and antibody testing, see a 10 second explanation in this video; https://photos.app.goo.gl/ZTYW6DZukphm2e8z6

    Regards
    PaulC

  • NHSE primary care lead acknowledges 'huge' increase to GP workload

    Paul Cundy's comment 31 May 2020 9:11am

    Dear Philosopher,
    I am pretty certain your figures are wrong but in any event the German health system has profound differences to our NHS. Such bland adumbration is of little relevance here.
    I suspect "Dr in training" is the clue here. I wish you well in surviving the real world, by all means challenge but be prepared change your views. ALso your arguments have greater weight when not shouted from behind the shield of anonymity.
    Regards
    Paul C

  • 'All' care homes successfully signed up with clinical lead after 'record' GP uptake

    Paul Cundy's comment 22 May 2020 8:40pm

    Dear All,
    Please make a note and use this in the future;
    "With regards to funding, NHS England has said GPs will be reimbursed for any ‘additional’ resources required to support care homes via the General Practice Covid Support Fund."
    You read it here.
    Regards
    Paul C

  • 'All' care homes successfully signed up with clinical lead after 'record' GP uptake

    Paul Cundy's comment 22 May 2020 8:38pm

    Dear All,
    "In April, practices were told to start virtual weekly care home rounds from this month as NHS England moved into the ‘second phase’ of its response to the Covid-19 pandemic. "

    NHSE moves into its second phase as the pandemic moves into its 4th......

    Regards
    Paul C

  • 'All' care homes successfully signed up with clinical lead after 'record' GP uptake

    Paul Cundy's comment 22 May 2020 8:35pm

    Dear All,
    This article is just one that goes on giving;

    "Draft guidance on deterioration in care home residents with Covid-19 has just been through the academy of royal colleges for approval and will be published soon, NHS England added."

    Great, guidance (sorry draft guidance) just after the problem has passed.

    Regards
    Paul C

  • 'All' care homes successfully signed up with clinical lead after 'record' GP uptake

    Paul Cundy's comment 22 May 2020 8:32pm

    Dear All,
    We look after 5 nursing / care homes and have VMO contracts with several as well as having a "register with us for all" general policy with them all. So you'd expect us to have been asked if we were prepared to be the Clinical Lead for them. Its unlikely anyone else could do it. So who are these mystical persons?

    Perhaps the same as those elusive 100,000 tests that in fact turned out to be half as many.

    Double dealing liars the whole lot of them.

    Regards
    Paul C

  • A heartfelt letter from the GMC to Dr 6113072

    Paul Cundy's comment 20 May 2020 11:23pm

    Dear All,
    Not sure about the GMC but CQC's actions, utterly lamentable cowardly and unbecoming of any professional attribute, shame on them.
    As I've said before any registered medical practitioner who works for CQC should examine their conscience, you are by public evidence amongst the most reviled by your colleagues.
    Regards
    Paul C

  • CQC will phone to check in with GP practices in England starting next week

    Paul Cundy's comment 14 May 2020 10:46pm

    Dear All,
    Thank heavens we are all now able to remotely verify the absence of life in the dead, at least we'll be able to tell when CQC are calling.
    Regards
    Paul C

  • The stormy night that shaped my views on death verification

    Paul Cundy's comment 14 May 2020 10:40pm

    Dear All,
    so if a person falls to the ground and we suspect an arrest, what do we do before starting CPR. confirm death, ooops that'll be another 15 minutes before anyone who can do it properly arrives, so they'll sit by and wait......

    What on earth is the logic in having a higher threshold for verifying death than the one you expect every citizen to exercise to start life saving CPR?


    No matter how you cook this it just never adds up.

    If you want to verify every death in person by all means do so. Get your colleagues to cover you whilst you are away, wear a mask, use a face shield and don't touch anything.

    Meanwhile i'll get on with caring for those who can benefit from it.
    Regards
    Paul C

  • Coroners have no right to tell GPs they must verify death in person, says MOJ

    Paul Cundy's comment 13 May 2020 3:05pm

    Dear All,
    And remember this will apply after the pandemic is over. They have never ever had any mandate and there is nothing in the Coronavirus Act. So even after the pandemic is over what we develop now will persist, there will be no need to restore archaic practice nor bolster medieval beliefs.
    Regards
    Paul C

  • GPs advised to contact CCAS-referred patients within 30 minutes

    Paul Cundy's comment 05 May 2020 10:54am

    Dear All,
    We do not run an emergency response service.
    Regards
    Paul C

  • GP urgent cancer referrals decline by more than 70% as 'fewer patients come forward'

    Paul Cundy's comment 24 Apr 2020 7:14pm

    Dear All,
    The national positive pick up rate from the two week referral scheme is 11%. so 89% of patients referred through it do not have cancer. Maybe a 70% reduction in referrals is not a bad thing?
    Think laterally.
    Regards
    Paul C

  • Nine in 10 GPs have no eye protection, finds BMA survey

    Paul Cundy's comment 07 Apr 2020 9:11pm

    Dear All,
    No we've got plenty in South West London, came from Screwfix, my garden shed and B&Q.
    Thanks Mr Hancock.
    Regards
    Paul C

  • Death certification: Links to funeral director guidance - 27 March

    Paul Cundy's comment 01 Apr 2020 9:52am

    Here is the detail.


    Part 18 of the 2020 Covid Act refers to Part 1 Schedule 13, which contains temporary modifications to the provision of MCCDs. So the Act itself changes parts of the 1953 Act as amended in 1987 but via the devil in the detail hidden at the back.

    Thus Schedule 13 Part 1 England and Wales can in my opinion be read to mean;

    Para 2
    Funeral Directors can now provide the Registrar with the details of the dead person, namely the MCCD and may now sign the Register in place of family to formally record the death.

    Para 3
    Giving information to the Registrar other than in person. Information from the informant (the informant is not the doctor signing the MCCD) i.e. the information on the MCCD, may be given to the Registrar by phone or by other means as guided by the Registrar General. See Para 5 later, electronic delivery.

    In particular Para(3)(4), people who are ill, caring for others, at risk of infection or for any other reason, including Registrar Office staff shortages, can be exempted for giving information to the Registrar. (so what happens if no one wants to do it? What does the Registrar do then?).

    Para 4
    These are the important changes.

    Para 4(2)(a) and (b).
    These relax the 1953 Act requirement for the MCCD to be signed the doctor(s) attending during the last illness. Now ANY Registered Medical Practitioner can complete the MCCD where the attending RMP is “unable to” or it is “impractical for that” RMP to do so,

    as long as,

    The RMP who does sign is able to state to the best of their belief an opinion as to the the cause of death.

    So any GP in the practice can sign on behalf of any other GP who may be ill, in hospital or isolating.

    And this is an even bigger change.

    Para 4(3),
    now any RMP can sign even in the case of a patient NOT attended during their last illness. So you can complete an MCCD for any patient. Yes, any RMP can sign for any patient providing they are able to state to the best of their belief a cause of death.

    Para(4)(b)
    These relate to the MCCD. In the case of Para 4(2)&(3) where the RMP was not in attendance, the words relating to “last seen” and “seen by my after death”, can be ignored, for obvious reasons.

    Para 5,
    This para says that if you sign under Paras (2)&(3) above, i.e. were not in attendance, you still assume all the other duties and responsibilities under the 1953 Act and the doctor who did attend, but is unable to sign, is absolved of them. You sign you are responsible.

    Para 6,
    This relates to the Registrar and their reporting deaths to the Coroner if the patient were not attended by an RMP. They can now accept the MCCD even if it is completed by an RMP who did not attend the patient, i.e. under Para 4(3) above.

    Para 5
    This is the bit that says that the MCCD can be “delivered” by any means, electronic or other means as long as its authorised by the Registrar General.

    Para 6
    This relaxes the obligation on the REGISTRAR to report any death to the Coroner (please note not the RMP) if the RMP has declared that did not seen the body after death or in the 14 days prior to death. It is now 28 days before death.

    Unless I have misinterpreted this could this be a problem, because they have not catered for the Para(2)&(3) where obviously the answer is going to be never, so will they have to report every instance of a Para 4(2)or(3) MCCD? Should the RMP annotate the MCCD to the effect they are signing under Covid 2020 Para 2 or 3?

    Para 7
    This says you do not have to report to the Coroner any MCCD signed under Para 4(2)&(3) above.

    Para 8
    Any death notification processes started under the old laws will continue under those regulations.

    Para 9
    Says any death notification process that starts under these new laws will continue under these rules to completion even if the rules are changed meantime.

    Any documents delivered under the electronic process as at Para 5 will still have to be eventually delivered or sent to the Registrar within 3 months of the ending these new rules. So keep the originals



    It also says the Registrar General may change the dates on which documents have to be delivered and may change any of the above!


    Covid 2020 also makes changes to the Cremation Regulations.

    Part 19 paras (1) to (11) of Covid 2020 has detailed modifications to the 2008 No. 2841 CREMATION, ENGLAND AND WALES, The Cremation (England and Wales) Regulations 2008

    They can be taken as a whole and simply mean that the Form 5 is expunged from any and every aspect of the Medical Referees duties and responsibilities. The Medical Referee can rely entire;ly upon the single Form 4.

    Please note these new laws do not make any changes to the law that relates to the signing and completion of the Form 4. All the previous discussion and debate regarding whether you are compelled to complete, who can complete, what you record in the response to the questions, whether you have seen the body before or after death, truth and honesty of your answers; all remain unchanged. The Covid 202 Act does not change anything in relation to the completion of the Form 4. The only mention of the Form 4 in the Covid Act is in referenced to its being equivalent to both itself and the Form 5.

  • Death certification: Links to funeral director guidance - 27 March

    Paul Cundy's comment 01 Apr 2020 9:51am

    Dear All,
    to further the point the only changes to the signing of the MCCD under the emergency Act is the relaxation of having "attended" the deceased. Now you can sign an MCCD even if you did not attend. Nothing else has changed.
    Regards
    Paul Cundy

  • Death certification: Links to funeral director guidance - 27 March

    Paul Cundy's comment 01 Apr 2020 9:49am

    Dear All,
    I am sorry DO NOT USE THIS CHART, it is wrong. There is no 28 days limit as to whether you can complete the death certificate.
    Paras 4(2)&(3) of Schedule 13 of the Covid 2020 act now allow any doctor to sign a death certificate for any patient and there is NO time limit. There never has been. All the 1953 Act requires is that the doctor attended the patient during their last illness.
    Also the reporting to the Coroner advice is wrong.

    DO NOT FOLLOW THIS ADVICE IT IS WRONG.



    Regards
    Paul Cundy

  • GPs and hospital doctors 'will die' without proper PPE, BMA warns

    Paul Cundy's comment 26 Mar 2020 0:20am

    Dear All,
    On Tuesday, as a GPC member i sent in a mail asking what happens when we need a new supply of PPE, I had lost the previously circulated contact details. I was re-sent some contact details. We contacted them. They said they were only ever tasked to provide the initial first dump and if we wanted more we should contact commercial suppliers and buy them directly. Other practices confirmed the same experience.
    I sent in a message to the GPC to say this was unacceptable. I was assured this would be taken to the highest level to sort out.
    At roughly 3pm yesterday Mr Hancock was on the web in a streamed press conference stating there were 7 million items of PPE and that front line staff would get them asap. There followed a TV News item showing an army lorry delivering boxes to St Thomas's. We were told by e-mail that a new revised re-supply service was being set up. This morning we asked for the contact details of this new revised re-supply service. We contacted them, same message, buy them yourselves.
    So thats two times in two days that the Secretary of State for Health, Mr Hancock, has lied to front line staff about provision of PPE, placing us in peril of our lives.
    We have under 200 masks left, let alone the face shields we have had to buy ourselves from B&Q and ToolStation.
    When we run out, which at current rates will be monday, we will close our doors to everyone.
    Thank you Mr Hancock.
    Regards
    Paul Cundy
    GMC 2582641