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Paul Cundy

  • Death certification: links to guidance

    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 guidance

    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 guidance

    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

  • Continuity of care has worsened 'due to part-time GPs', says NHS England chief

    Paul Cundy's comment 09 Mar 2020 5:59pm

    Dear All,
    Totally agree, if FT were bearable and had no unintended consequences many would do it but it isn't and does have. Continuity is more than just having FT GPs as other have said, you can have continuity with part timers but its a reduced capacity. There are also other factors, as life expectancy and multimorbidity expand the numbers needing continuity increases. At the same time HMG's policies of fractionating care into pathways and settings reduces continuity. The access idiocy has undoubtedly conbtributed as well. Many factors with most being traceable to a pair of buildings in Whitehall.
    Regards
    PauL C

  • First coronavirus patients detected via opportunistic GP testing

    Paul Cundy's comment 08 Mar 2020 7:46am

    Dear All,
    Why only opportunistic. Surely, as Dylan implies, they should be testing everyone to in these 100 surgeries to establish the true prevalence. Testing opportunistically won't tell us the absolute prevalence. Then perhaps we might scale down this pandemic of panic?
    Regards
    PauL C

  • GP practices must prepare isolation spaces for coronavirus, says NHS England

    Paul Cundy's comment 01 Mar 2020 6:19pm

    Dear All,
    Well there's lots of vacant space at Skipton House.
    Regards
    Paul C

  • Government to expand GP streaming service as '10%' of A&E patients diverted

    Paul Cundy's comment 18 Feb 2020 2:02pm

    Dear All,
    I'd suggest there are two problems here;
    "
    Why is A+E expensive? Case: A+E consultant did PSA test which was raised on a 98 year old (uncertain why it is an emergency test) and told the GP to refer to urology. Sent to Urology and the urologist told the GP off as an inappropriate test as most 98 year olds would have prostate cancer and it makes no difference to life expectancy".

    1) the A/e consultant doing unnecessary tests
    2) a GP doing what the A/E consultant tells him.
    The word "No" is a completed sentence. GP 2) should have said what a waste of time and moved on to the next patient.
    Regards
    Paul C

  • Government to expand GP streaming service as '10%' of A&E patients diverted

    Paul Cundy's comment 18 Feb 2020 10:50am

    Much is written about problems meeting the 4 hr A/E target, but is the target the problem? Everywhere in the NHS care is delivered according to a balance of need, resource and evidence. Suspected cancer cases are seen before the obviously benign. Suicidal patients are seen urgently by specialist led teams whereas the chronically mildly anxious might be directed to on-line treatments. A 35 yr old man’s 3 week itchy crutch ringing my surgery for an urgent appointment will offered a routine appointment a few days later. But not if he were in A/E, uniquely, there he is expected to be treated in the same timeframe alongside patients with suspected heart attacks, blood clots, pneumonia or broken bones. There are other unintended consequences, attempting to meet the 4hr target leads to perverse distortions in the allocation of resources and funding, sucking up money that could go to community care. The target was introduced in 2008 by a beleaguered SOS wanting to avoid adverse headlines, not after any research, studies or objective assessment. A/E should now be freed of this political whim and allowed to respond to clinical need. Does our newly emboldened government have the courage to do so?
    Dr Paul Cundy
    General Practitioner,
    Wimbledon

  • GPs need to feel more enabled to diagnose lung disease early

    Paul Cundy's comment 16 Feb 2020 8:01pm

    Dear All,
    Oh yes and I quote; "I’ve met far too many people who could have led vastly different lives if every time they visited their GP they had received Very Brief Advice by someone correctly trained to deliver it.". So the assumption is that patients do what they are advised (PC comment from PC).
    And muggins believes they've never been told (oops sorry PC police, been advised / counselled / encouraged / guided / directed / latest fashion alert - SIGNPOSTED ) to the right service, so every person they'd ever seen before they had the honour of being at your feet was bar but a twat?
    Then truly you have the world solved.
    Regards
    Paul C

  • BMA and NHS in talks over funding for networks with multiple care homes

    Paul Cundy's comment 21 Jan 2020 7:57am

    Dear All,
    Huzzah, they've discovered the holy grail, 100% accurate predictive care that works in the complex multiply morbid population, to quote NHSE's expert; "There may be occasions where what is required is either a one-off intervention and again this would be predicted on the personalised care and support plan for people who have been identified by the care home staff." They have a tool that will PREDICT the need for interventions. Can it not be rolled out across the entire NHS?
    Regards
    Paul C


  • GP practice threatened with breach notice for failing to cooperate with PCN

    Paul Cundy's comment 18 Jan 2020 8:17am

    Dear All,
    This is nonsense. Dr Shashikanth should stand his ground. He is the Data Controller and if he is not happy to disclose data, then he does not have to do it. The CCG need to provide him with lawful reasons why he should disclose the data, including not only GDPR justifications but also Common Law duty of Confidentiality justifications. As his PPG has said they don't want their data shared, the latter cannot be satisfied.
    Regards
    Paul C

  • A&E departments suffer worst four-hour wait performance on record

    Paul Cundy's comment 12 Jan 2020 8:07pm

    Dear All,
    So what?
    If anyone who turns up in A/E, even those with itchy bottoms they've had for 3 months, is guaranteed it diagnosed and treated by a 6 yrs in training professional, then is the problem the target, or not hitting it?
    Rhetorical question.
    The 4hr target was a political pronouncement to assuage adverse redtop headlines. It is nonsensical, stupid, idiotic, non evidence based and results in massive distortions in the allocation of resources.
    It should be scrapped.
    In future, if you turn up in ACCIDENT and EMERGENCY with some thing that is not an ACCIDENT or an EMERGENCY, then you should be told that you will be seen, but according to your personal clinical need, you can wait, but it may be a long one, and anyone with a genuine ACCIDENT or EMERGENCY that comes in will be slid in ahead of yours.
    Lets have clinical need dictate response times in A/E, just as it does everywhere else in the NHS.
    Regards
    Paul Cundy

  • Is this what you signed up for?

    Paul Cundy's comment 09 Jan 2020 9:30pm

    Dear All,
    Answer to the question?

    No.

    What do others think?

    Regards
    Paul C

  • Practice forced to declare ‘serious incident’ following IT failure

    Paul Cundy's comment 06 Jan 2020 10:37pm

    Dear All,
    May I enquire as to how some of the doctors who work at this practice, who had "flu", how it was that their physiological interactions with their personal pathogens, viruses or otherwise, were interlinked with the physical network connections of the practice? As suggested in the article?
    If I'm absent tomorrow from my surgery due to a snotty nose will my practice's NHS broadband connection be down-regulated? If so how do they know? Is there a link between my WBC and the physical interface?
    Regards
    Paul C

  • Was this Matt Hancock's briefing before his Big Interview in Pulse?

    Paul Cundy's comment 06 Dec 2019 0:42am

    Dear Katie,
    nice one, well done, insightfullness score; 100%+
    Paul C

  • GP leaders to call for removal of home visits from contract

    Paul Cundy's comment 11 Nov 2019 7:34pm

    Dear All,
    Bad idea. Bad politically and bad strategically. If you didn't know your contract does not say you have to visit, it only expects you to visit if you agree its necessary, which will be the housebound, EOLC etc so all you gain is a public own goal, asking for what you already have but being labelled as uncaring for wanting it.
    And paramedics doing the other "non" visits, another bad idea, we all know how good they are at reducing expectation, not doing onward referrals and generally saying no.
    lets hope the emotion and symbolism doesn't cloud the debate.
    Regards
    Paul C

  • The many disappointments behind this appointment

    Paul Cundy's comment 04 Nov 2019 11:49pm

    Dear All,
    Well how's this for mad lunacy, our local eRS service has a deadline of 3 days during which we have (sic) to attache the necessary documentation. If they aren't attached within the 3 days they cancel the referral. So they helpfully send out reminders. The reminders are sent via their fax to e-mail to whatever system. These messages take 11 days to arrive in our in-boxes.
    So their "we might cancel your referral unless...." messages arrive 8 days after their deadline has closed.
    Simply brilliant
    Regards
    Paul C

  • CQC chief inspector: no 'concessions' will be made for GP capacity issues

    Paul Cundy's comment 27 Oct 2019 6:38pm

    Dear All,
    It is absolutely staggering that she can utter these words within days of her own organisations report recognising the realities and extent of the GP capacity problems.
    Clearly someone who believes in the beatings continuing until morale improves. On a score of "How to connect with those you regulate?", are negatives allowed?
    Regards
    Paul C

  • Judge finds in favour of GP practice that refused to post medical records

    Paul Cundy's comment 21 Oct 2019 10:41am

    Dear All,
    Good news but lets not be too hasty, Pulse has not reported the story correctly. In fact the case was not about GDPR or DPA 2018 directly. The Case was about what are known as the "Court Rules", in this case a rule that requires records to be disclosed. The Judge dismissed the case because he decided that the court rules were not applicable, because the records had already previosuly been made available under a SAR, therefore there was no need for the rule to be applied.
    Don't get me wrong, i'm as delighted with the result as you are but we cannot at the moment jump to too many conclusions about SARs. I imagine the GPC IT Team and BMA lawyers will be looking at this in detail.
    Regards
    Paul C