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GPs go forth

Live blog: Pulse Live

16:56 Goodbye from everyone on the Pulse team. It has been a fantastic conference- from Professor David Haslam’s opening remarks, to the burnout debate to the live interview with Professor Malcolm Grant. We hope you enjoyed the streams and found the sessions useful, and most importantly, got to meet and chat with like-minded colleagues. See you next year!


16:51 The interview concludes with Professor Grant announcing there will be a consultation on primary care later in the year with the possibility of an all new GP contract!


16:44 A true gagging clause is illegal and should be ignored, says Professor Grant. We don’t need gagging clauses but we do need ‘a more structured way of representing the NHS publically’ rather than ‘slagging off’ other parts of the NHS, he adds.

16:36 Steve Nowottny points out that Pulse’s survey of GPs before the transition to CCGs showed the majority felt they were no more involved in commissioning. Professor Grant says engagement of CCGs is going to be critical to their success. ‘GPs may not be engaged with CCGs yet but I would hope they are at least interested. It’s early days’ he says.

16:26 In answer to a question about whether Jeremy Hunt was right to blame GPs for rising A&E attendances,Professor Grant says the model of A&E needs to be reconfigured. The four hour waiting time is only ‘one measure of success’ he says. Whether it’s the best way to handle the health needs of our population is another matter, he adds.

16:24 Professor Grant says we need a ‘long and intelligent conversation’ about OOH general practice. Sometimes certain diagnoses which would have been picked up by GPs are missed by busy, junior A&E doctors, he said. He says that NHS England will not be creating separate primary and secondary care strategies, but a joint strategy.


16:20 Laughs from the audience as Steve Nowottny asks Professor Grant whether it was a mistake to launch the new NHS 111 phone line over the Easter weekend, given the widely publicised problems.


16:15 Professor Grant says NHS England is different because it is the first board created which is separate from the Government. The Secretary of State cannot tell the Board what to do, he can only mandate outcomes.

16:12 Professor Grant agrees with Sir David Nicholson’s comments that the NHS reforms are ‘so big they can be seen from space’ but says Sir Nicholson’s words were understated.

16:10 Pulse editor Steve Nowottny is about to interview NHS England chairman Professor Malcolm Grant. For the last few days GPs and delegates have been sending in their questions.

15:50 Dr Steve Brown demonstrates the Epley manoeuvre



15:00 Dr Pinnock says a good COPD measure, better than spirometer, is to measure how breathlessness impacts on basic quality of life

14:40 Dr Kartic Modha, the founder of Facebook group Tiko’s GP Group- which has 1700 members- urges GPs to use social media. GPs should be sharing clinical cases, he says, and social media can help GPs feel connected in an isolated world where burnout is common. However, he says GPs should always assume that the public will be able to see anything online, even in a private group. Also worth remembering that smartphones have time and location settings, so if you’re sharing a picture of a patient’s rash on a Facebook group, be aware the patient could be identified.

14:30 In multimorbidity, guidelines are not an exact science. Treat with a pinch of salt, says Professor Mercer

14:35 Professor Stewart Mercer begins giving his top tips to GPs managing patients with multimorbidities (that will be the whole profession then)


14:12 The internet has classically been the realm of the media and students, but doctors should get involved says Dr Kartik Modha

14:30 Afternoon sessions about to begin cover digital health, coping with multimorbidity and human resources advice and are specifically designed to combat post-prandial drowsiness



12:15 Dr Andrew Whiteley starts to talk on how to adapt and survive in a challenging NHS

12.00 Nigel Edwards, senior fellow at the King’s Fund, says GPs must work together, not necessarily in the same building, with each developing a different specialty. Birmingham LMC executive secretary Dr Robert Morely argues that practices will have to merge with one another in order to be able to function in the new commercialised system. ‘To keep what we’ve got we have to think big.’

11.41 The three separate conference strands - Your Practice, Your Patients and Your Future - are now underway again. In the Your Practice session, Swindon GP and QOF expert Dr Gavin Jaimie is offering a practical guide to the new world of QOF, looking at the indicators in the 2013/14 contract.

11.20 Lots of GPs have been queuing up at our ‘Open Newsroom’ in the exhibition hall to take our burnout assessment during the coffee break. All told, more than 300 GPs have taken it in the first 24 hours of Pulse’s Battling Burnoutcampaign.

You can take the assessment - based on the validated Maslach Burnout Inventory - here.

10.35 This is the first


10:09 Despite all paradoxes, the essence of general practice is long term cradle to grave care, says Dr Simon Poole


09:58 Dr Pat Oakley from Kings College London begins the Big Discussion on where general practice fits into the NHS of the future



09:51 House of Commons Health Committee chair Stephen Dorrell says the NHS is harnessing the opportunities that technologies bring, but only slowly.

Steven Dorrell - online

Source: Paul Stuart



09:43 Professor David Haslam says that burnout is important and that special interests that give you a buzz as well as feedback from colleagues can help tackle burnout


09:30 And we are off. The second day of Pulse Live. We begin with a welcome to the conference by Pulse editor Steve Nowottny.



17:00 That’s all from the live blog today. Join us at the same time tomorrow for the second day of Pulse Live.

16:57 And the final verdict?



16:52 Professor Haslam is put on the spot by one GP.


16:47 Dr Kendrick hit back at Dr McCormack’s claim (16:40) - ‘the NNTs can look impressive for using statins in primary prevention of CVD, but the mortality figures are not’.

16:43 Dr Grant Ingrams, a GP in Coventry, has been swayed by Dr Kendrick’s argument.


You can read why Dr Ingrams left his CCG here.

16:40 Dr Terry McCormack, arguing against the motion that the NHS wastes millions on primary prevention, says we are ‘winning the war’ on cardiovascular death rates and one of the factors in that is primary prevention.

16:30 In the clinical debate, Dr Malcolm Kendrick crunches data from the HPA statin study to calculate that on average increase in life expectancy after five years of statin treatment is only 14 days.

16:25 Voters in the main hall decide on whether NHS wastes millions on primary prevention:

15.40 Talking of which, it’s time for another coffee break at the conference. Delegates are returning to the exhibition - and the soapbox is about to get underway again. First up in this break, Richard Ward, a practice manager in Devon, whose talk is entitled: ‘Is it just me - or do we need a new approach to general practice?’

15.31 In the Your Practice stream on reducing emergency admissions, Dr David Carson, director of the Primary Care Foundation, has an unusual suggestion for improving your practice: reinstate coffee breaks.

During the coffee breaks, he argues, partners and staff sort out the smaller issues: leaving formal meetings to focus solely on the large issues.

14.55 Dr Grant Ingrams, a former chair of GPC West Midlands, is one of those at the conference and he’s been talking to our senior journalist Jaimie Kaffash about his decision to step down from his role as IT lead on Coventry and Rugby CCG - a decision prompted by his concerns over the Section 75 competition regulations. Read Jaimie’s full report here.

14.01 Pulse reporter Madlen Davies’ summary of the debate this morning on GP burnout is now up on the site: Profession heading for burnout, GPs at Pulse Live warn.

The story includes a stark warning from GPC deputy chair Dr Richard Vautrey about the workload implications of the imposed contract deal.

‘The Government’s response to burnout is to give us more work, to make us run around the hamster wheel faster,’ he said.

13.20 We’ve now broken for lunch, which is an opportunity for GPs to take to the soapbox in the middle of the exhibition hall,

The subject of one speaker’s rant will come as little surprise:

12:50 Dr Jeremy Tankel describes ways to improve access. His practice introduced a telephone triage/consultation service which has allowed him to save 20 hours of face-to face time a week, caused a drop in NDAs and a 15% rise in continuity of care

12:48 Question from audience about whether commissioning will see any benefits to health service before the next election



12:30 For risk stratification DES, you need to prove you are checking lists every four months says Jan Thomas of United Health.


MPS Richard Dempster: you only have to apologise if there is something to apologise for. #pulselive

— PJ Bowyer (@NHS_GP) April 30, 2013


We need to shift from patients phoning GP and getting appointment to actually thinking about their needs, says Dr Jen Allinson #pulselive

— Jaimie Kaffash (@jkaffash) April 30, 2013

12:20 Dr Richard Dempster, an adviser with the MPS, says GPs shouldn’t have to trouble MPS every time they get a complaint. There is enough expertise within practices to deal with the majority of complaints. A couple of questions from the audience raise the point of increased indemnity costs. There is a fear that they will increase. One GP equates indemnity costs with two months’ salary.

GPs out of date on fibre in IBS - if it ain’t working then stop it. Dr John O’Malley on how to reduce gastro referrals #PulseLive

— Caroline Price (@carolinejprice) April 30, 2013

11.35 The morning track sessions are now underway, with three streams - Your Practice, covering business issues, Your Patients, covering clinical topics and Your Future, where the future of geenral practice will be debated.

In the opening session of the Your Patients stream, Dr Patrick Brooke, chief officer of Solihull CCG, is covering dementia. He says that early diagnosis of dementia is critical and that GPs should remember this is cerebral end organ damage - so much the same as screening for other chronic disease. He urges GPs not to forget carers’ input and emphasises that personality changes and apathy are common signs when cognition is intact.


11.20 It’s been standing room-only in the plenary sessions so far - here’s one of several crowd shots from our photographer on the conference floor.

Pulse Live, crowd - online

Source: Paul Stuart


10:41 Drum roll as the vote arrives. Seems to more ‘green cards’ ie, voters for the motion .. but all in all the discussion more important, says Professor Haslam

10:34 Dr Donal Hynes takes the stand against the motion - and says relationships with patients changing, much more proactive and shared. Now we have more power - our practices will be different places and our role is changing profoundly. Hospitals will cease to exist as we prevent patients going in!

Donal Hynes, Pulse Live - online

Source: Paul Stuart


10:28 What’s around the corner? Seven day working - that’s why GPs should support the motion! Professor David Haslam quips this shows why Dr Vautrey is a negotiator!

10:26 Dr Richard Vautrey - Burnout affects every single GP in this room and across the UK - emotional exhaustion - and the depersonalisation resulting from QOF. Recent Scottish survey of GPs showed two-thirds suffering burnout - this is the reality. Time pressure is the big factor, followed by patient demands and the prospect of revalidation


10:25  Next up Dr Richard Vautrey to tell us GPs ARE heading for burnout.

10:20 Dr Nikita Kanani - newer qualified GPs talk about burn-out more readily - why is this? And is it putting people off the profession. Maybe we need to review how we look at our workload?

Nikita Knanani, Pulse Live - online

Source: Paul Stuart



Battling Burnout Logo

Pulse launches major survey of GP burnout at Pulse Live. Find out more details here.

10:00 Show of hands shows most GPs make time for recreation!

Steve Nowottny, Pulse Live - online

Source: Paul Stuart

09:30 Introduction to conference from Pulse editor Steve Nowottny


09:00 Hello, and welcome to the live blogging of our first ever Pulse Live conference. Running today and tomorrow, we have a vast array of prominent speakers, discussing topics ranging from dementia to emergency contraception to practical tips on improving your practice.

We’ll also be launching our burnout survey, to gauge how GPs have been affected by recent changes to the contract, revalidation and CQC registration, among other things.

We’ll be regularly updating this blog and the website with the latest from Pulse Live. And, if you are at the event, make sure you come and say hello to the news team on our stand in the exhibition hall.

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