Wednesday, July 23, 2008


I've just realised that I haven't updated my blog-roll for ages.

I tend to use Google Reader to keep up to date with those I read. Many of my favorite blogs are not listed on my roll.

If that's you, sorry.

I will try and update the roll soon...

News today

Several front page-type news stories today.

The main one is the release of a report by the Chief Medical Officer, Sir Liam Donaldson, on revlaidation of doctors. In principle, I think is a "good thing". But I am a little worried about the details, because that is where the Devil is. And, in my (not so) humble opinion, Donaldson has failed the profession several times in recent years, the most reprehensible episode involving his lack of accountability for the MTAS/MMC debacle.

What I would support is an annual exercise to check that we are keeping up to date that is more robust than the current system.

What I would have difficulty supporting is anything which involves excessive paper chasing. We GPs are already "answerable" to a couple of dozen different organisations and quangoes, from the PCT, to the Health Care Commission to the GMC, never mind the fact that people can also take us to Court, separately and additionally to all the other ways they can have a go at us.

And I'm not even going to mention the abomination that is Iwantgreatcare... (bugger, I did, didn't I?)

The next story is about GPs prescribing antibiotics: again, I'm in two minds about this one.

I don't prescribe antibiotics at the drop of a hat, and guidance will add to the credibility of my already rather paternalistic and uncomrpomising argument when a patient is insistent that they need "something or I'll get pneumonia" ("You'll need them when you have pneumonia, at the moment you don't.")

On the other hand, the premise that GP prescribing is part of the problem with the rise and rise of the so-called superbugs such as MRSA doesn't have a lot going for it. Dr Grumble and the Jobbing Doctor have already blogged about this failry recently, so I won't bore you further (though I do commend their blogs to you, go and have a read). Suffice to say that the Government should be looking elsewhere for solutions, rather than looking for scapegoats.

Finally, this story: I (and my colleagues) am (are) missing the diagnosis in patients presenting with HIV. Apparently there should be more widespread testing (well, I can't argue with that). But I should also be considering it in anyone presenting with a flu-like illness.

Do these people have any idea whatsoever how many people I see with just that story every week? Even in a good week its half a dozen or more. In a bad week it'll be in the fifties or sixties.

There are 7000 new case of HIV diagnosed every year. That compares to almost 114,000 deaths form heart disease, over 33,000 deaths from lung cancer and a prevalence of diagnosed diabetes of almost 4% of the population (not counting those patients who we don't know about yet).

This suggestion by the National Aids Trust, while laudable, is another example of Ivory Tower speak: they may be experts in their field, but they are patently not experts in mine. It would make much more sense to me to be dishing out free condoms and promoting safe sexual practices.

Finally, I am grateful to the Jobbing Doctor (good grief, 2 mentions in one post. I'm not stalking you, JD, don't panic...) for bringing to my attention something that isn't my fault.

Wednesday, July 16, 2008

Access and Choioce survey 2007/8

Results are out for this survey, available here .

You can search for your own surgery by post-code or street name.

Here's a brief summary of our results (bear in mind that this survey predates the start of extended hours and also predates us setting our website + services up, total respondents 269 out of 5950 patients, so 4.5% of our list):

  1. Happy with phone access 96.6% (last year 92, PCT average 90.4, number happy/number not happy 255/less than 10)
  2. same day or within 48 hour access 98.1% (94 and 92.5, 157/ <10)
  3. Advanced booking more than 48 hours away 58% (29 and 70.7, 47/34)
  4. Book with specific GP even if means waiting longer 89% (84, 88, 105/13)
  5. SAtisfaction with opening hours 90.6% (87, 83.4, 241/25) (although thats 9.4% of sample, that's less than half on one percent of list)
The questions with smaller numerators were usually asked after a different question, so eg my number 3 was after this question: "In the last 6 months, have you wanted to book ahead for an appointment with a doctor?" and only those people who had wanted to, had had to answer the book ahead question.

I'm really pleased, especially with the pre-booking figures. Thats a big improvement, just from telling people as they come in to the surgery. That should improve even more over the next few months; for example, since we launched the website in March, almost 200 people have signed up for the EMIS Access services we offer. We should be at or beyond PCT average by the time of the next survey.

And 5 simply justifies our stance of not doing extended hours, in my opinion.

Of course, the redoubtable Mr Bradshaw thinks otherwise:

"The survey results are a real measure of success for those GPs and their staff who have listened to what their patients think and who have responded with even better access to GP appointments. I congratulate those practices.

"I also want to thank the two million patients who took the time to respond to the survey as these results show the difference patients' feedback can make to the services they receive.

"The NHS now needs to respond to what this latest data is telling us. It is clear patients increasingly need access to primary care at more convenient times. Since the survey took place over a quarter of GP practices have begun to offer extended opening hours and from 2009 the 152 new GP-led health centres around the country will continue to improve provision."

I'm not entirely sure how one can suggest that "it is clear patients increasingly need access to primary care at more convenient times" when obviously so many people are ALREADY VERY HAPPY!

But then, that's why people trust me and not you Ben. You are a politician, whereas I am (now, what was it you said? Oh yes...) mendacious and misleading.

Tuesday, July 15, 2008

Having a laugh

I've just seen Doug. Doug is 79 and has COPD. But that isn't why he came in today.

Doug has had non-specific back pain for some time. No worrying features, other than the fact it isn't resolving. He tends to manage it with simple analgesics.

He has seen a chiropracter recently. The chiropracter thinks Doug may have osteoporosis, based (I assume) on the X-rays that he took. So I'm arranging a DEXA scan to see if he does. He doesn't have any risk factors, but its possible.

The chiropracter also found what he thinks is an abdominal aortic aneurysm. I hadn't had reason to examine Doug's belly before, so I did so today. Sure enough he has a small pulsatile mass just below the belly button.

The trouble is, Doug is tall and skinny, So I'm not sure that this mass is of any significance. S I've requested an abdominal ultrasound scan. I explained what I'd found and why I think we should scan it. I also advised him that I might want to refer him to our excellent local vascular surgery clinic if the result shows it is larger than 5cm.. If not, I will just keep an eye on it myself. For the time being anyway.

Then Doug said something which surprised me a little: "Well, that's a relief."

I asked him what he meant. I thought perhaps that I'd explained something badly. But I needn't have worried.

"I thought you were going to tell me I was pregnant!"

We shared a snigger. He left happy.

Thursday, July 03, 2008

GPs to blame - again

Ben Bradhsaw has accused me and my colleagues of operating a gentleman's agreement to stop patient's having the choice of practice.

Of course he doesn't actually offer up any particular evidence of this.

But he's a Minister, so it must be true.

Quite why he hasn't advised the Competition Commission of the facts that he obviously has to hand I don't know. Agreements of that nature would be a serious breach of the law. Indeed our current contract regulates us such that, assuming we have an open list, we must register anyone within our practice area who wants to register. If our list is closed, we can't take on new patients. That's it, nothing complicated.

Unfortunately the BMA response has been less than robust, describing his comments as "nonsense", rather than "libellous" which is probably what I would have said.

Its all part of the "choice" agenda that they are pushing so hard. If patient's have choice, all will be well with the world. I keep saying it, but patients are less concerned with choice and more concerned with good, local services.

But that doesn't fit in with the current agenda to get private companies involved in health care, particularly Primary Care (for which read General Practice).

And as for the practice in the South of England with only 2 patients.

Really, Ben?

Where is it then?


Put up : evidence in public of these agreements, evidence that GPs are restricting choice, give it to us, make it public.

Or shut up.