GPC report July 2012

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

20 July 2012

The first meeting of this session of GPC took place, unusually, in Edinburgh, due to the Olympics dominating hotels and BMA House this month.  The city is lovely to visit, though I didn’t get to see much of it due to a pre-meeting meeting of the Commissioning and Services Development Sub-committee.  Although if I’m honest, that last was my own fault, as it was I who suggested meeting beforehand rather than after, as I had a plane to catch.

The first thing to report is the election of the GPC negotiating team: five candidates stood for four positions.  As has been widely reported in the medical comics, those elected were Richard Vautrey, Peter Holden, Chaand Nagpaul and Dean Marshal.  Beth McCarron-Nash was not.  This caused some consternation amongst some of those attending the meeting.  I suspect the result is at least in part down to the vagaries of the single transferrable vote system used.  However, the end result is that the negotiating team is perhaps less demographically representative than GPC as a whole, which is less demographically representative than the profession as a whole.  Richard Vautrey was also made Deputy Chair.

After the elections were held, discussion moved to the progress of negotiations with NHS Employers .  Unfortunately much that was discussed is confidential and I am under threat of death by suffocation if I reveal any details of the debate.  Nevertheless, I am prepared to tell you that the proposed changes to LES arrangements are at the very pinnacle of the mountain of issues the negotiating team intend to address.  There are numerous issues around this which we can discuss in committee if you wish.  Additionally, Julius has already written to colleagues about the contractual status of CCG constitutions, or rather their lack, and a physical signing may not be necessary, nor may 100% uptake.  However, much is uncertain as there are currently no regulations or guidance to assist anyone.  The Health and Social Care Bill (HSCB) of course mandates in clause 28 that all practices in England must be a member of a CCG from April 2013.  With regard to NHS 111, problems continue to be raised with the project board and the official report on the pilots will apparently be published later this month.

We had an opportunity to be addressed by our new Chairman of Council, Dr Mark Porter, an anaesthetist, though this should not be held against him. As you may be able to imagine, his main topic was that of pensions and industrial action.  I am sure you are aware that BMA Council decided, narrowly, to not pursue further industrial action.  He made several points about this, most of which has already been reported in the press but which can be summarised briefly as:

• No other unions will be taking further action and Labour will apparently not be opposing the Public Sector Pensions Bill;
• The only escalation which could be reasonably planned would be a full strike and it is unlikely the majority of members would engage with that;
• The DH and in particular the Treasury are determined not to make any concessions.  However, we took IA to get them to talk to us.  We have now been offered the chance to be involved in the review of the impacts the changes may have, the “Working longer” Review, and other Trades Unions are keen to have us there.   So we are talking.  Just not negotiating.  We could not be a member of that group if we were to take further IA. Being part of it allows at least the potential for influence and mitigation.

Dr Porter made the point that this is not the end.  There will be a campaign to make it clear to all what our position is.  It is perhaps arguable that we should have done that already.  However, regardless of how one feels about the IA taken already, a further escalation is likely to divide the profession and perhaps damage both the profession and our Trade Union permanently.  Having said that, it was obvious, reading between the lines, that there are many differing view points, both on and off Council.  But I probably didn’t need to tell you that.

There was some discussion about how to deal with Premises issues especially how to achieve improvement in funding arrangements.  I note this to advise that this is the case, but this is one of the issues I may not currently discuss in detail.  I can report that the Northern Ireland model is of considerable interest.

Revalidation was discussed again.  There are still many issues unresolved, especially how remediation is to be funded and how certain groups of colleagues such as freelance locums will be able to engage with the process.  However, I am not certain that much will be resolved before the Secretary of State for Health signs the process off as ready and fit for purpose.  The situation on the ground does not seem to be the same as that which is being discussed in the meetings reported to us at GPC.  No doubt it will all come out in the wash.  I just hope the rinse cycle doesn’t damage any of us in the process.

Finally there was further discussion about the non-Commissioning bits of the HSCB.  There is actually little to report.  A summary of most of it could be “meetings are continuing”.  There are some IT developments, in that the DH hopes, by 2015, to have achieved four things, that patients will be able to book GP appointments and request repeat prescriptions, which is achievable, given that many practices already offer this; access to patient records may not be as it is fraught with governance difficulties; e-consultations will for most patients not be their main method of communication with their GP I suspect, but it appears the focus groups the DH uses think it is a good idea.   Who knows, for some, patients and doctors, it may even be workable and secure.

I hope this report is useful.  Given it is my first, any feedback offered will be considered carefully.

Dr Russell Brown

GPC and Chair East Sussex LMC

Yet another phoenix (or possibly not)

I have just been elected to GPC, this time to the regional seat of East and West Sussex.  Given blogging seems to have deserted me (!), I shall, perhaps use this blog to provide reports for my constituents from now on, roughly monthly.

As my 3 year term begins in July, it may well be from then that reports appear.

PFI - we did tell you at the time.

http://www.parliament.uk/business/committees/committees-a-z/commons-select/treasury-committee/news/pfi-report/ 

The Treasury Select Committee has published the report of its inquiry into PFI, available. Many of the Committee's concerns echo those raised in the BMA's written evidence to the inquiry, particularly around the inflexibility and lack of value for money of PFI projects. A summary of the key points is below, prepared by the BMA's HPERU unit.

• Analysis undertaken by the Committee’s Specialist Adviser suggests that, all else being equal, paying off a PFI debt of £1bn may cost the same as paying off government debt of £1.7bn. This would mean that a 70 percent increase in investment could be achieved for the same long term cost if government funding were used instead of private finance.
• Allocating risk to the private sector is only worthwhile if it is better able to manage the risk and can pass on any subsequent savings to the client. The main benefit highlighted by PFI providers was the transfer of construction risk. However a PFI contract which lasts for 30 years is not necessary to transfer this risk.
• In the area of design innovation and building quality there is some evidence to suggest that PFI performs less well than traditionally procured buildings.
• The fixed nature of PFI contracts means they are likely to provide more certainty regarding price and time. However there is no convincing evidence to suggest that PFI projects are delivered more quickly and at a lower out-turn cost than projects using conventional procurement methods. On the contrary, the lengthy procurement process makes it likely that a PFI building will take longer to deliver, if the length of the whole process is considered.
• PFI contracts are inherently inflexible. There is little evidence of the benefits of PFI arrangements, but much evidence about the drawbacks, especially for NHS projects. The inflexibility of PFI means that any emergent problems or new demands on an asset cannot be efficiently resolved.
• The Value for Money appraisal system is biased to favour PFI. Assuming that there will always be significant cost over-runs within the non-PFI option is one example of this bias. There is an incentive for both HM Treasury and public bodies to present PFI as the best value for money option as it is often the only avenue for investment in the face of limited departmental capital budgets
• For too long PFI has been the ‘only game in town’ in some sectors which have not been provided with adequate capital budgets for their investment needs. This problem is likely to get worse in the future with capital budgets cut significantly at the Spending Review. If PFI is the only option for necessary capital expenditure then it will be used even if it is not value for money. A much–needed reappraisal of PFI needs to be accompanied by a similar reassessment of its effects on overall capital spending in the public sector
• The price of finance is significantly higher with a PFI. The financial cost of repaying the capital investment of PFI investors is therefore considerably greater than the equivalent repayment of direct government investment. The Committee has not seen evidence to suggest that this inefficient method of financing has been offset by the perceived benefits of PFI from increased risk transfer. On the contrary there is evidence of the opposite. The Committee does not believe that PFI can be relied upon to provide good value for money without substantial reform.
• Owing to the current high cost of project finance and other problems related to PFI, there are serious doubts about such widespread use of PFI. There are certain circumstances where PFI is likely to be particularly unsuitable, for example, where the future demand and usage of an asset is very uncertain and where it would be inefficient to transfer the related risks to the private sector.

Central servers

Is it just me? I fell distinctly uncomfortable with the prospect of universal, centrally held servers.

Oh, I can see the advantages, sharing info between practices, easy transfer of records etc.

However, as the data controller, how can I guarantee control when I don't physically have access to the server? I am less than reassured by the presence of robust audit trails etc, as that sort of thing is very useful after a breach has occured but useless to prevent such a breach occuring in the first place.

http://www.ehiprimarycare.com/news/6054/inps_wants_vision_360_to_be_gp_system

That is the article that has got me thinking (again) about this. I understand that EMIS Web will be the only EMIS product with accreditation for EPR2. That is a shame, as many practices will not wish to change just for that, and EPR2 is one part of the CfH schema that may actually be of use and benefit to practices. It appears that INPS will be keen to see a move to their new system, though of course Vision 3 will remain compliant.

There is a part of me that hopes that IT spend will be part of the devolved budget that comes through with the commissioning changes. GPs could once again then start driving the process of development rather than reacting to it.

Another example of where control needs to be wrested from the PCOs.

Practice Boundaries: a proposal

Text of a press release follows:

BMA sets out its proposal for how to reform general practice boundaries


The BMA today (Tuesday 26 January 2010) sets out its solution for how to reform GP practice boundaries* and make it easier for patients to see a GP in a place and at a time that is more convenient.

The government wants to abolish practice boundaries by October 2010 and the Conservatives have said they want patients to be able to register with the practice that best suits them (near their home or work). A government consultation on practice boundaries is to start shortly.

The BMA paper, Reforming General Practice Boundaries, explores the possible consequences of completely abolishing practice boundaries and suggests a solution which, while not a total abolition, would significantly improve choice and access for patients without the huge cost, upheaval and unintended consequences that completely free registration would cause.

Dr Laurence Buckman, Chairman of the BMA’s GPs Committee, said:

“Complete free choice of registration is a good idea in principle and we want patients to be able to choose the GP surgery that is right for them. However, we don’t want it to come at the expense of continuity of care or for it to lead to increased risks for vulnerable patients and a widening of health inequalities.”

The BMA believes that total abolition of practice boundaries could have a number of unintended consequences. Examples of issues that would need to be addressed in advance of completely free registration include:

* How to reform the home visiting system so continuity of care for patients, who are registered with practices far from their home, isn’t affected
* Current IT projects, such as the electronic patient record transfer project, would need to be accelerated so GPs could have access to full patient records in order to make safe clinical decisions
* How to avoid widening health inequalities – this could happen if frail people or those without access to private or affordable public transport are not able to access practices further from their home, while others can
* Systems would need to be put in place to protect and track ‘at risk’ patients who could be vulnerable if they are regularly re-registered at practices not within their social services boundary
* Funding arrangements for GP practices would need to be reformed to ensure that, with increased movement and changing patient demographics, funding for all practices is fair and equitable
* Popular practices that had reached the limit of physical capacity would need to be helped to improve their premises in order to match patient demand
* Primary Care Trust (PCT) funding would need to be completely changed in a way that would take into account the impact on hospitals and social services. This would be extremely complex if the patient lived in one trust but registered in another.

The General Practitioners Committee’s solution is to combine a series of local improvements with a national change in the current “temporary resident” arrangements. Local solutions should include permitting the widening of the boundaries of all practices in an urban area so patients have greater choice, the introduction of videophone and webcam consultations, as well as formally allowing patients who move outside a practice boundary the option of staying with their GP. The change in the temporary resident arrangements would mean unregistered patients could be treated by a distant practice on an ‘ad hoc’ basis whenever necessary, while their normal GP practice would still oversee their care. It would have the added benefit of encouraging patients, who might otherwise inappropriately attend A&E, to go to the nearest GP surgery instead.

Dr Buckman added:

“Getting rid of practice boundaries altogether is fraught with difficulties. Having worked through various alternatives, we believe this solution is the best option for the health service at this point in time. Not only will it be the most cost effective solution, it will also serve patients far better. They will get more choice and are less likely to be adversely affected by the new set of problems that total abolition would create.”

An explanation

Hello, been a while.

Someone noted that I haven't blogged for a while. I thought I should explain.

I have been busy. I am now very much part of the establishment, being Chair of East Sussex Local Medical Committe. Additionally, in June of last year, I was elected to the General Practitioners Committee of the BMA for a year. I am not sure whether I will get re-elected this year, time will tell.

As a result, given I do not (and have never) blogged anonymously, I partly have no wish to cause our negotiators difficulty by commenting publically on matters political, but mostly I have less time to post and comment.

Consequently, my blog has fallen by the wayside almost entirely. I spend sufficient time discussing medico-politics during the day, one way or the other!

On which note, I'm hoping to start using my camera more as a means of relaxation, so you might get some photos on here, interspersed perhaps with the odd bit of politics.

(By the way JD, it was nice to be missed. Thank you. That also to the few dozen people (or at least aggregators) who have persisted in checking my blog every week.)

Flickr

This is a test post from , a fancy photo sharing thing.

Darkness at the Heart of the Labour Party

I don't normally re-blog what others have, but this one is illuminating.

A greek chap I read pointed me to the blog of Frank Field MP.

"Harold Wilson asserted that the Labour party was a moral crusade or it was nothing. The McBride affair has left Labour members looking at nothing. That is the reality check that McBride has wrought on the party.

The whole of the government's energy should be spent on governing now and building a programme from which, within and year, we will be seeking permission to rule for another five years.

Far from helping sketch out a new roadmap, the McBride activities shine a searchlight on the paucity of the government's programme."

Please, go and read the rest.

How to work out your increase in funding

This one is for GMS GP readers (and possibly practice managers, I've no idea if any of those read my blog).

What does the DDRB recommendation mean for your practice? I was rather confused initially, so after working it out (with some help including an illustration by Dr David Shaw on DNUK) I wrote a very short paper to share with others.

So here it is. A quick guide. Except that I wrote it in Word to start with and discovered that copying and pasting from Word into HTML is an interesting experience, one that I will try and avoid in future. Anyway, I retyped it here.

How to work out your GMS funding

There are 4 components to it:

1. Global Sum (GS) increases by 2.4%
   
2. Global Sum Equivalent (GSE) which equals the GS plus your correction factor (if you are an MPIG Practice). This increases by 0.7%
3. QOF points increase by 1.7%
4. Enhanced services (ES) funding increases by 1.7%

For non-MPIG practices, your GS goes up by 2.4%, QOF and ES go up by 1.7%. Simple.

For MPIG practices, it is slightly more complex. Obviously the QOF and ES bits are the same, increasing by 1.7%. But for the rest of it, keep reading:

• Calculate both your new GS and your new GSE.
• If the uplifted GS exceeds the uplifted GSE, you move off MPIG (congratulations).
• If not, the GS component of GSE is uplifted by 2.4% and the CF is likely to drop to give an overall increase in GSE of 0.7%.
  

What this actually means in practice is that your Practice Manager will be able to see if Primary Care Support Services are paying you what they should each month.

Obviously your QOF and Enhanced Services monies will vary from practice to practice, but you should (at least) be able to work out how much each QOF point is worth to you practice. Ask your LMC rep if your PCT is uplifting the Enhanced Services Floor by 1.7%. They should be.

A couple of worked examples to illustrate differing magnitudes of CF:

Practice 1

• GSE £101,000, made up of GS £100,000 and CF £1,000
• GSE increases by 0.7% to £101,707
• But GS uplift gives £102,400
• This is bigger the GSE, so you no longer have a CF and you move off MPIG.

Practice 2

• GSE £110,000, made up of GS £100,000 and CF of £10,000
• GSE increases by 0.7% to £110,770
• GS uplift is also £102,400
• CF=GSE-GS, so =£8370
• So the net effect is an increase of 0.7% with a decrease in reliance on MPIG with a reduced CF (goes down by £1630)

Addendum: the CF is recycled into the GS, so as more Practices move off MPIG, there is no loss of money from the overall pot.

A decade

I really haven't been very good at keeping up with this blogging lark.

Part of the problem is my decision at the outset NOT to be anonymous. Consequently, much of the material others publish is not possible here as I have no wish to identify anyone, even if inadvertently, that I have seen in surgery.

Nevertheless, this week marks my tenth year at Manor Park. I think that deserves a mention.

I initially wrote a long piece about my time at the practice so far but frankly it was boring. However, the fact is that it can be summarised quite briefly: The patients keep coming because they need us, we are seeing more and more people all the time, I am still enjoying the clinical side of things greatly. The admin side of things gets increasingly onerous as time goes by. The "light-touch, high-trust" contract which was brought in in 2004 has proven to be anything but, though we are much luckier in our relationships with our PCT than many.

I have seen many changes in the last 10 years, some of which have happened to me and some of which I have been instrumental in.

The gradual adoption of our computer system's facilities has been a very significant change, one which I initially led. We now have a website as well, where patients can pre-book appointments and request repeat prescritions.

The new contract in 2004 was an eye-opener. Initially I can confidently say it improved matters in Primary Care. However, as is the nature of these things, the consequences (intended or otherwise) are playing havoc with General Practice, not helped by a predatory and antagonistic Government who seem to feel the need to grind us into submission when all we want to do is do our job. This despite our patients constantly supporting us in whichever survey you care to mention.

I have also been an active member of the East Sussex Local Medical Committee since 2000. I suppose this makes me a politician. I try my best to contribute in a meaningful way, though it is for others to say if I am successful. Whether any of those others read this blog, though, I have no idea. I can't see the pointing in whinging about things if you're not prepared to do somethig about it. So I try to.

I've also changed in the last decade. My experience base has grown. My practice has, too. I've been divorced, remarried and made a father again. I swear (a bit) less, laugh as much as I ever did (quite a bit) and I think I am both more considered by more adamant in my viewpoint and espousals. I guess I've grown up some more.

Anyway, I'm starting to ramble.

I will try and post more frequently...

Self confidence

"I'm a Normandy veteran you know. Yeah, I won the war.

Well, me and another bloke, but he was rubbish."

I love these old veterans.

Darzi and coffee

Honestly, he really has no idea, does he.

(With thanks to Hairy Aerosol for the image)

Scarey stuff

Pandemic flu planning.

I'm in charge for my practice. I was quite relaxed until I started reading the official planning docs. Don't mean to worry you but thought you might be interested in some official figures. These are being used as a basis for planning and for once planning is on the basis of a worst-case scenario. But that shouldn't reassure you. That ranges are actually not that broad.

When it comes (as it inevitably will, we just don't know when) 50% of population is likely to get it (either in one or more than one waves, each wave lasting 8-15 weeks, with first wave peaking 50 days after the virus arrives in the UK, which in turn will be about 4 weeks after it erupts wherever). That's 30 million people.

25% will get complications. 7.5 million people.

4-5% will need hospitalising. 1.2 million people if its 4%. The UK has about 390 beds per 100k population, so about 234k beds.

1-1.5% will need intensive care. 300k. There are only 3500 ITU or high dependency beds in the UK including the specialist beds in cardiothoracic centres, trauma beds and the like. There a re a small number of paediatric ITU beds in addition to that.

2.5% potential mortality. That is three quarters of a million people.

Staff absence at any time (including health workers) expected to run at 25% (closer to 35% for smaller businesses) so fewer nurses/medics, tanker drivers, electricity engineers etc. Schools will be closed reducing the number of people able to work further. Of course, some people will not go to work to try and avoid exposing their families, which will make matters even worse.

Lets hope it doesn't come till the next century.

On a happier note, Panama by Van Halen is currently playing on Planet Rock...

National guidance and evidence base

I've been reading this:

http://jac.oxfordjournals.org/cgi/content/full/61/5/976

Just out of interest really, as there seems to be a belief amongst certain noctors in secondary-care-land that GPs are filthy creatures who are responsible for a fair few MRSA infections.

Two main thoughts came to mind on reading the document.

Firstly, that most community acquired MRSA seems to be in people who've had recent contact with secondary care in some manner. Which is odd, as we seem to have a pelthora of posters up at the moment advising us to wash our hands at every available oppotunity so we don't kill people. I'm not aware of any evidence to suggest that GP surgeries are foci of infection, which this guidance would seem to support.

Secondly that the evidence base for this guidance is so poor. The vast majority of the recommendations throughout the document are graded as D (in other words, they are based on the opinions of the great and good rather than sound scientific data).

I can't help wondering whether HMG should be spending money on acquisition of reliable evidence for things like this rather than wasting it on white elephants (by which I mean NHS Direct, rating GPs on NHS Choices, Darzi centres and the like).

Dementia

Lots of fuss this morning about this.

Apparently all us GPs are to receive training to recognise dementia much, much earlier. Once we've diagnosed it we will send people with it to memory clinics for treatment.

Right.

Well, I've been diagnosing dementia for years.

I've been referring for years.

Support services for people with early disease are rudimentary. Most people with early disease are able to live completely independently.

The disease is characterised by an inevitable and inorexable decline. There is no treatment that works and even the treatments which are said to slow the progression of the disease have recently been said by the government to be too expensive. Just talking about the possibility of having it scares most people rigid. The vast majority of those with it die of something else well before the dementia itself gets severe enough to carry them off.

Which rather leaves me wondering what the point of this announcement is.

Oh wait: Parliament is in recess and Christmas is coming up...

Oh dearie dearie me

http://www.theregister.co.uk/2008/11/12/dr_scot_gmc_probe/

The saga continues.

Other blogs have covered this in much more detail.

I would expect the investigation to be robust, but we will see.

Bless her.

6 years old, known her since birth (the joys of GP).

Flare up of eczema since the heating went on. Not too bad, but obviously irritating.

I say to Mum "Increase the frequency of the diprobase to three times a day."

Little one pipes up, very loudly: "Oh Doctor Brown, I HATE diprobase!"

"Why's that then?"

She of course goes bright red and looks at her feet.

"S'itchy on my back mumblemumblemumble"

"Want to try a different cream?"

"Sss, plsss..."

"Ok, lets try something else than diprobase then."

Cue big grin and another satisfied patient.

Her first steps into an independent relationship with her health.

Great job this, innit?

Sick notes

Specifically with reference to getting them from hospital doctors. The guidance is available here.

This is NOT a rant against my colleagues in secondary care. Hopefully some of my readers are secondary care docs. Some of them may learn something from this post. Or they may not. (grandmothers, eggs, natch...)

There are 2 main types of sick note patients will come across. The Med3 and, less frequently, the Med5.

The Med3 is the white certificate you might obtain from your GP if you need more than seven consecutive days off work. Its duration can be open (specified typically as "two weeks" for example) or closed (when a specific return to work date is recorded). It cannot be backdated. The patient must be physically seen, in the flesh. Telephone consultations, although they seem to be ignored by the DWP, actually fall outwith the regulations governing these certificates

A Med5 has two possible functions. One is for a doctor to backdate a certificate, but only if he or she has seen you in the recent past and for upto only a month from the date of signing. The other is to provide a certificate (without necessarily seeing a patient) on the basis of a recently received (within a month) letter from another doctor. In this instance, the certificate cannot be backdated (again the DWP seems to ignore breaches when this inevitably happens).

As a GP I do a lot of these.

Not infrequently, patients come to see me after operations or hospital stays to get one because they have not been furbished with one at the time of discharge or they have been given one for a shorter period of time than will obviously be necesary (for example 1-2 weeks after a hysterectomy rather than the 6 weeks virtually everybody needs).

This irritates me. Greatly.

I would imagine it occurs mostly because of ignorance of the regulations by hospital junior doctors. I would hope that it isn't just laziness.

Because you see the guidance is quite clear:

The duty to provide a statement rests with the doctor who has clinical responsibility for the patient at the time. Hospitals are required to provide all certificates for social security and Statutory Sick Pay purposes and doctors' statements for both in-patients and outpatients who are incapable of work. The Med 3 should be issued on discharge from hospital where a hospital doctor advises a patient to refrain from work, and the doctor was attending and had clinical responsibility for the patient at the time this advice was given. In such cases the Med 3 should be issued for an appropriate forward period. Responsibility for issuing further certificates rests with the doctor who assumes clinical responsibility for treating the incapacitating condition. In cases where the GP has not taken over responsibility for the incapacitating condition, responsibility for issuing further certificates will rest with the treating clinician.

I am sure that, at times, junior doctors are advised by others (perhaps administrators or nursing staff on the wards) that sick notes are not available, or that "we haven't got any". It certainly happened to me when I was training.

I have written twice this year to senior colleagues at my local hospital advising of these regulations. The second time I offered to go and do a session at their twice-yearly inductions for the junior doctors. I didn't receive a reply to my second letter, but there you are, some people are just rude. Such is life.

However, given all the problems around the accountability of the GMC (as well as to it) together with increasingly draconian messages regarding probity coming from it, I suspect that in future, I will be regretfully apologising to patients as I do now. But the focus will shift from an apology that my secondary colleagues have somehow abrogated themselves of responsibility for the sick note and provide it whilst steaming quietly in my chair, to apologising that I may not provide a note for them and directing them back to the hospital consultant. I will show them a copy of that paragraph, and will give them a copy to show the consultant.

Hopefully the message will sink in, bit by bit. I will repeat my offer to educate if the opportunity arises (which sadly, I suspect it will). Letters will be written, patients will be inconvenienced.

Does that make me stroppy? I don't think so.

Doctors and freedom of speech

Story here.

This has been covered by other medical bloggers. I don't blog as much as I used to because I often feel generally pissed off with the way the NHS and the Medical Profession generally seem to be heading.

But I am really very cross about the way that the events leading to the Pulse story have been dealt with. Go on, click on the first link in this post if you haven't already read it. Professor Paice's comments about free speech are quite enlightening.

The Jobbing Doctor has also posted that various out-spoken bloggers have gone quiet. That worried me. But I'm not anonymous, never have been.

So we can say what we like, as long as we mind how we say it, or by implication, who we say it about?

Well, as an alternative, how about I say what I like and you put up with it?

This isn't Stalinist Russia. It isn't even the USA. If you don't like it, I do believe you can bloody well put up with it.

Despite the fact I am a professional, I am also a citizen of this country and am entitled to express my opinions to whomsoever I choose in whatever way I see fit within the bounds of the law.

Not the bounds of others sensibilities.

I haven't really said much about MMC/MTAS and the utterly ridiculous and reprehensible way in which our junior colleagues have been dealt with, and I specifically include the young surgeon in Scotland in that comment.

Someone should be held to account.

It will be interesting to see the GMC's attitude to the reporting of Donaldson to them by RemedyUK.

And I don't think its any coincidence that iwantgreatcare.org is out now. I would very much like to see a definite statement about it from both the Department of Health and the GMC, specifically with regards to their level of involvement in the project.

But I won't hold my breath that anything of any substance will occur.

Apologies

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...