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At the heart of general practice since 1960

Pulse Live....Live!: Copperfield's unofficial guide to the event

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Wow. Today, that’s day two of Pulse Live, is going to have to go some to beat yesterday, that was day one of Pulse Live. There was a real buzz about the place and I don’t just mean the 30 seconds of Hendrix-level feedback we all suffered at the exhibition area during the afternoon tea-break.
The thing is, GPs are rarely made a fuss of, or given the forum to network, or offered the opportunity to have a rant. All of these things happened yesterday. Also, there were pens.  Remember free pens? I haven’t had a free pen for years. Yesterday, there were more free pens than I could eat. I nabbed one from every pen-giving stand. I was so delighted with my collection that I went round again. I have 17. I know, because I just counted them.
Sweets, too. People – complete strangers – kept giving me sweets. For free. It was like I’d somehow been rocketed out of the trials and tribulations of Planet Primary Care and landed in a strange but wonderful world of free Smarties and biros.
There was some work involved, of course, though it didn’t feel like it. Listening to David Haslam make simple and wise sense of complex issues in the opening address wasn’t exactly onerous. Nor was a debate entitled, ‘GPs are all heading for burn out’ in which Richard Vautrey, supporting the motion, snatched victory from the jaws of defeat with a mesmerising shimmy of political logic. Glad he’s on our side.
Clinical stuff, as well. Everything from rhinitis to dementia, with stop-offs including AF, contraception and neuropathic pain. Add a tour-de-force ending with a battle over whether we’re overstatin’ the case for statins. In one corner, Terry McCormack, the voice- of reason, and in the other, Malcolm Kendrick, the sceptic’s sceptic. It was so close that the Chair suggested they settle it outside. Next year, maybe they will. I’d pay to see that.
All of this punctuated by visits to the conference nerve centre, aka The Hub, where you could wander past exhibitions, chat to Pulse’s editorial team and listen to whoever was on the soap box. With stands promoting elephants and tomatoes, GPs ranting in full-on Speaker’s Corner mode and everyone looking so darned happy and shiny, plus that feedback, it all became a bit out-of-body psychedelic at times. Made me wonder what was in those Smarties. I’ll have some more today and let you know.

9.00 OMG Biscuits. Free biscuits. Loads of them.How did I miss them yesterday? It just gets better and better. Makes me think general practice/I might have a future after all. Which is the title of the next session…

9.15 In the live debate on the place of general practice in the future, David Haslam has pointed out that the golden age of general practice is always 25 years ago. So in 25 years, we’ll be longing for today. Imagine that.

9.40 We’re really in The Thick Of It. Stephen Dorrell has just talked about a Reimagination of care. And taking a helicopter view. Everything points to us becoming public health doctors/preventists. Yikes.Not sure that’s what I came into this job for. Not sure it works, either. After all, Malcolm Kendrick yesterday pointed out that all this preventive stuff doesn’t save lives, it just delays deaths.

10.00 Big cheer for Simon Poole, GP, for describing the bonkers world we’re practising in and for warning those prepared to listen that we need to hold onto the core values of general practice. Yay.

10.15 Interesting question from the floor asking whether we can learn anything from Europe in terms of shaping our health service’s future. The answer is Holland, apparently.They’re consistently 5-10 years ahead of us. So the future’s orange.

10.20 Nice one. In response to Dorrell’s helicopter view, someone from the floor has commented that we GPs feel like we’re being carpet bombed.

10.25 It’s not Holland, it’s the Netherlands, apparently. But it’s still orange.

10.40 Back in the exhibition, away from great strategic debates and back to nitty gritty practice. There’s a bloke promoting a treatment for dry nose. I’ve never had a patient with a dry nose.Drippy nose, blocked nose, broken nose, yes. Dry nose? Never. Am I missing out?

11.00 Blimey, there’s everything here. Software for slashing the time it takes to process letters. Something to boost QOF scores. A DIY machine for blood pressures, BMI etc. And still pens, more pens. Latest count 29…

11.15 Decide to immerse myself in ‘The new world of QOF’.

11.17 I realise the new world of QOF may be light years from our current practice. What I didn’t realise was that the location of the talk was light years from the hub.I arrive sweaty and breathless but with an improved GPPAQ score.

11.20 Listening to King of QOF Gavin Jamie saying that the official QOF guidance document is ‘readable’. In the same way that the phone directory is readable, I guess.

11.30 More gems from Dr Jamie: sending three reminders two days apart is not considered ‘good’; QOF is currently obsessed with cycling; the brief intervention for exercise will have to be ‘bloomin brief’ because it’s only worth about four quid.

11.40 A real cracker. Some of the male diabetic patients we’re supposed to ask about ED are currently only 17. Cue, suggests Dr Jamie, a Daily Mail headline ‘GPs paid for asking 17 year olds about their willies’.

12.00 An uplifting end as we’re told to return to our constituencies and prepare to ‘Exception report without shame!’ Actually, I’ve never found it a problem…

12.15 And so to cost effective prescribing. Shocking stat: apparently, on average, 18 prescriptions were issued per head of population in 2011. Blimey. And it’s going to get worse because we’re all getting older. Eek.

12.30 Yet again the message that most patients have multi- rather than uni-pathology, a recurring theme of the conference. Good that everyone is starting to recognise this, less good that no one knows what to do about it. NICE is going to grasp the nettle, Dr Haslam reassured us yesterday. Does that mean it might have to recall all its existing guidance on the grounds that they don’t reflect reality? An interesting thought, but not one I’m prepared to pursue because I’ve just noticed the lunch queue.

13.15 Awesome lunchtime workshop giving refresher on examining knee, back and shoulder. Especially liked the excellent trick with the thumb when doing shoulder movements. Can’t describe, sorry, you had to be there. Why weren’t you? Don’t worry, though, it’ll be on a video on the Pulse site somewhere soon.

13.40 Passed the soapbox just as whoever was on there exclaimed, ‘Codswallop!’ I have no idea what he was talking about, but I wholeheartedly agree.

14.00 ENT. Why? Why not? I just feel a bit otorhinolayngologically rusty, OK? Besides, as one of the bullet points states, I need to ‘Remember tuning forks’. I do remember tuning forks. I just don’t remember what you do with them.

14.20 More on multimorbidity. Note, that’s the correct term. Say goodbye to co-morbidity. This session was great, not least because it contained the best typo of the conference: ‘Pharmacisist’. That’s presumably a very self absorbed pharmacist.

14.40 We need guidelines on when to STOP things, says our Master Of Multimorbidity, Prof Stewart Mercer. Who, obviously,is now my new best friend.

15.00 Now in The Future. Not literally, obviously, just the name of one of the parallel streams. Weird how things can turn out. I went to ‘Patient participation and engagement’ expecting to feel all furious and cynical Dr C and came out more like an evangelical Mother Theresa (only alive). Check out http://timebank.org.uk/ to see why - it came up in the session.

15.40 Back at the Hub. Feeling bad about my pen hoarding since the 15.00 epiphany so am now going round the stalls putting pens back.Getting some pretty strange looks.

16.00 Final session and a biggie. Our esteemed editor interviewing Malcolm Grant, live, on stage. Lots of stuff on CCGs, 111, A&E attendance, gagging clauses and, er, maybe a new contract. On that bombshell…all I have to do now is fill out a feedback form. If only I had a pen…

Readers' comments (6)

  • I attended this as I am thinking about returning to General Practice after a few years off.
    I found it utterly depressing. There were lots of older demoralised and crushed older GPs struggling to hold on to some kind of enthusiasm for the job whilst reminiscing about conferences where you were given a leather bound folder containing a lovely pen and pad to take our notes on. Is that really too much to ask? In the evening we would attend a fabulous a la carte meal courtesy of a drug company and relax feeling valued and important. I truly don't believe this ever affected my prescribing. I usually couldn't even remember the name of the drug company. It just made me feel valued.
    I struggled to find anything to write notes on at this conference, sat on the floor to eat my lunch and paid for my own buffet supper which I ate alone in the equivalent of a motorway service station. As for the biscuits.... The nastiest driest cheapest ones I've ever encountered which kind of reflects how valued I feel as a doctor nowadays.
    The good bits were the actual educational bits, but I was staggered at how little medicine is practised nowadays and how much bead counting needs to be done. Do we really need to be told to check if someone with a chronic disease is depressed as well, or has adequate support at home. Surely these are just part of sensible compassionate care.
    If I then add in the scary possibility of complaints, the ludicrous defence fees and the fact that I seem to be unable to refer anyone anymore for several weeks even if they have what used to be red flag symptoms, I came home really depressed and I doubt if I will return to medicine after all.
    Good luck to the naive enthusiastic thirty year olds. I used to be like that once.
    Incredibly sad. I'm just relieved that my children have decided on different careers.

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  • Above - get some dry nose cream and rub it on your biscuits.

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  • I have brought back some of the offending biscuits and some of the dry nose spray, as well as the two pens which I managed to snaffle and a shower cap. (I couldn't afford any tomato tablets which may or may not have improved the biscuits). That was the sum total of my goodie bag. The children were devastated.
    I have taken your advice and it improves the biscuits dramatically. Thank you for cheering me up. :))

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  • PS I wish I'd known Dr C was at Pulse Live as I've always had a bit of a crush on him as he seems like a bit of a rebel.

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  • Re Anon 5.22pm - now you tell me...

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  • I look forward to stalking you at the next conference (if I manage to stay in medicine that long)

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder