Tag Archives: primary care

Revised Section 75 regs mire CCGs in a legal minefield

12 Mar

Further trouble not less after Government tables revised regulations on competition for providers. Who would be a Commissioner?

The doctor will see you now… if you are truly ill.

31 Jan

Why is everyone scared of missing cancer? [BBC Radio 4 PM, 30-Jan-2013]

Personally public needs to (wo)man up and face the fact we die. And most of us die from heart disease or lung disease.

Doctors know, though many politicians and public do not, that early diagnosis of cancer often fails to prolong life of patient. For example, read Prof Baum opinion about breast cancer screening

Medical industrial complex loves us diagnosing cancer early because lots of tests, procedures, and drugs will be thrown at the poor patient for “extra” disease free months/weeks. Has anyone stopped to check the ROI for the vested interests in the management of people who are diagnosed early?

Meanwhile, earlier diagnosis of depression may be useful though you know that many people with “affective disorders” and other psychiatric c condition’s are also a construct of the medical industrial complex – DSM V is an opportunity to medicalise more situations that are part of normal living.

Perhaps, earlier diagnosis of erosive arthropathy may have benefits for sufferers. This population of patients is tiny compared with cardiac and respiratory and psychiatric patients.

So to cardiac and respiratory disease.  If the politicians are to be believed, people with BMI 19-25 who never smoke will not develop heart or lung disease.  This is magical thinking. One patient at my cardiac rehabilitation class who was thin, young, with cholesterol < 4 and no family history of heart disease, and never smoked.  Apparently cardiac rehabilitation clinics see significant number of such people.

Sadly there are a large number of people with chronic lung disease who never smoke – many of these people have asthma. Even with good inhaler use and compliance, many of these people will develop COPD which is supposed to be a disease of smokers only.

So in spite of the propaganda, seeing your doctor at your time and choosing is actually not going to save your life.  Remember healthchecks are useless. Thus, the media and many public voices should stop whinging about access to primary care and GPs.

eLearning Needs in NHS Sept 2012 #mobimooc

13 Sep

Mobimooc 2012 is up and running.  2 webinars have been well attended.  Regrettably the timing is not great for me – but the team has recorded the lectures 

By coincidence two new systems are due to launch in my region of UK.  An electronic prescribing system (EPS) and new telephone triage service (NHS 111)

NHS 111

http://goo.gl/ra2IE points to introduction to the system.  The NHS has also provided online introduction with accompanying slideshow here with direct link to the video Introduction to NHS 111

Here is a great example of mLearning in action but the local NHS managers insisted on practice teams send delegates to a meeting somewhere in my town.  Clearly this was a poor use of time for my practice manager.  With such a good presentation created, it is clear to me that the time taken for many people to get to the meeting would be better spent watching the slide show.  How patronising of our service managers!  There is apparently good evidence that the new system will be good for patients and reduce some of the demand on emergency services from (trivial) emergencies.

It does look like no-one locally is aware of mobile learning project management.  Here is  an excellent opportunity which has passed us by!  Notice there is no system on the website to help visitors assess their learning after reading the transcript while watching the slide show.  Why is the slide show an embedded video rather than posted on Slideshare, Brainshark, or other public cloud service?  How hard would it be to have a feedback form?

Whether the UK really needs another emergency number is a moot point now.  As a GP, this system looks to me a threat for the future primacy of General Practice as the first point of contact for health care questions by UK citizens.  This is sad.  In the not too distant future UK may come to regret the demise of the family doctor as an independent gatekeeper to healthcare services.  That is a discussion for a future post.

Electronic Prescribing System

I wish to share the following from my local medical committee concerning the roll out of the new electronic prescribing service because the rational behind it is described and the questions from my representatives focus us on another opportunity for eLearning.

NHS Bedfordshire and NHS Luton are working for Electronic Prescription Service (EPS) Release 2.  This will mean that the PCTs would then be enabled to allow practices and pharmacies to take part in EPS, if the practices and pharmacies want to.  This is part of a national programme.  We were told that EPS has been available in Hertfordshire for some time and that just under 30 practices are taking part in EPS there.  
We’ve seen documentation from Bedfordshire and Luton about what EPS is; what practices would have to do under EPS; what the criteria would be for selecting patients who could use EPS and what participating practices would need to do to support patients in making their choice; how patients would nominate which pharmacy they want to use for EPS and what the participating practice would need to do to facilitate this.

Beds LMC members recognised the positive objectives of the scheme, e.g.
It is supposed to reduce GP work load ultimately
It may be more convenient to the patient
It may reduce waste
It is understood that EPS will be optional for practices.
But Beds LMC members did have some concerns:
To what extent is it a whole new area of unfunded work in general practice?
Beds LMC members thought that EPS would create the following work:
1. GPs will be expected to identify suitable patients.
2. The GP has to look at all applications for it and make sure they do not have any of the exclusions (large groups of patients such as those on controlled drugs, anticoagulants and some others).
3. The GP or GP staff will be expected to promote and explain the process and follow this up in writing and collect a signature 
4. The practice will be expected to telephone suitable patients and offer it to them.
5. Time will be need to train GP staff.  Nothing about backfill for this.
6. All prescribers will have to use smartcards and be wary of prescribing some formulations or brands of medication which do not have a suitable barcode.  Not all practices use their “smartcards” when consulting because they cause their system to run slow and time out.  So clinicians log in and work offline.
Patients with regular repeat prescriptions tend to be patients on chronic disease registers.
On the rare occasions when patients such as this come in “just for a repeat prescription” it gives the GP an opportunity to pick up on preventative care, QoF items and other aspects of the health and wellbeing agenda.  In other words, the aspects GPs do not always have time for when dealing with acute illness in a 10 minute consultation.  Could the use of EPS actually reduce the level of care available for some patients?
Concerns that the EPS will not be a simple scheme, as some items cannot be included in EPS, so there would have to be two prescribing systems for EPS patients: one for EPS-included medications and one for EPS-excluded medications
Is there any evidence that EPS has saved time for GPs or staff in primary care?
If any Hertfordshire practices who are using EPS would be willing to share any of their experiences or would be able to answer any of the specific concerns listed, it would be very interesting to hear from you?

Here is my response:

Wow! How can such a simple idea as electronic repeat prescribing become so complex?

FIrst thoughts: I want nothing to do with a system with more bureacracy to set up. We have enough to deal with without this additional burden.

Second: The system is doomed unless bandwith of broadband connections is increased to cope with the demand from our desktops (and mobile devices). Currently broadband speed is around 10megabits per second down and 0.5 mb/s up, at least in Watford. Divide this by 8 prescription terminals and you can see the speed drop makes the system inoperable.

Third: Barcodes are not immune from corruption; at least several times a week a popup warns there has been a problem and the barcode should be scratched out. How do you do that with an electronic script?

Fourth: The main benefit of EPS is prescribing from mobile devices. With 4G/LTE imminent this seems practical so long as all prescribers have feature phones with the necessary hardware. I fear the powers that be are focussing on the wrong systems. We need secure login systems for iPhones/iPads and android devices to make EPS useful (e.g. prescribing urgent scripts on home visits, or residential facilities)

FIfth: How are pharmacists supposed to be persuaded to adopt this?

Sixth: Prescribing2U is already available. How does this differ from EPS 2?

Seventh: All HCPs who access clinical system must log in with NHS Smartcard. If there are hardware problems managing this, the IM&T teams across our area must fix these before rolling out EPS.

This system is being imposed on us on the background of a longterm agenda to cut the printed script costs.  There is also an agenda to improve security of prescribing.  Since proposed several years ago, IM&T systems and devices have evolved.  Mobile devices are so much more capable than before.  For example, my smartphone (HTC One X) is more powerful computer than my desktop system 10 years ago!

There is nothing in my local medical committee concerns nor in the NHS EPS background documents to indicate any desire to develop a mLearning project to aid in the implementation of this system.


Two new systems are being implemented shortly with the intention of improving patient care in an NHS region.  Two sophisticated organisations are responsible for the roll out of NHS 111 and EPS.  Neither seems to embrace education technology which, in my opinion, would ease the pain involved in changing behaviour of health care professionals and the public.

There is clearly a very long way to go to embed eLearning into the NHS.  This is a terrible state of affairs for a developed society.  It is ironic that some countries with large health care burdens (e.g. sub-Sahara Africa countries; South America countries) may be receiving superb instruction in mLearning systems.

I would love to see some discussion about the particular systems described above – your experiences of similar systems in your country, ideas on how to improve implementation, or anything else you think would be interesting.

Thank you in advance…

5 Apr

Excellent overview about an important health problem

A Place for Todays Discussions

Headaches .. What A Pain In The Neck!

Have you ever opened your eyes first thing before getting out of bed, and thought, “Oh no, not again!”  You are most certainly not alone.  Thousands of headache sufferers rise in the morning afraid to open their eyes or move, in North America alone, every day.  There are several potential causes.  I am not going to tell you what medication to take, or what exercises work the best, because that is between you and your doctor.  I am not a doctor, but I do know that not everyone can take certain medications, nor is it wise to begin any type of exercise unless you know 100% you can handle it, or your doctor gives you the green light.  It’s a matter of moderation and common sense.

There are four main types of headaches I will cover here.  These are the types and a brief description.  I will talk more…

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Investors urged to cash in on NHS

19 Feb

Investors urged to cash in on health service

Jon Ungoed-Thomas Published: 19 February 2012 The Sunday Times

City investors are being offered the chance to make huge profits from a new fund, the first of its kind, that will invest in projects to cut the cost of patient care in the National Health Service.

In a move that critics will claim is a shift towards privatisation in the NHS, the fund is seeking £50m from investors, charitable foundations and financial groups.

Some of the projects could reduce the number of patients using acute care services such as accident and emergency. The savings would be returned to investors as profit with the scheme predicted to see annual returns of as much as 15%.

The plan will divide opinion at a time when the coalition’s healthcare reform bill has attracted the criticism of many healthcare professionals who believe it places too much emphasis on the private sector.

Andy Burnham, the shadow health secretary, said: “This is a further illustration of how the government is trying to put the profit motive at the heart of the NHS.”

Supporters argue that it will provide the NHS with a crucial stream of revenue at a time when it is facing substantial budget cuts and will improve the service offered to patients.

Sir William Wells, chairman of the new Health Impact Fund and a former chairman of the commercial advisory board to the Department of Health, said: “This would provide capital for NHS workers who might have an idea for a project that will deliver savings but cannot get it off the ground. The demand could be huge.”

Wells hopes to raise £10m in the first year with a target of £50m. He said Downing Street and the health department were both “supportive”.

Although investors could lose money if the projects fail, they could alternatively see returns of between 10% and 15% if significant savings are made for the NHS.

The fund is similar to social impact bonds which involve private investors funding government initiatives to help deprived families. Trials of such bonds are already under way in London, Birmingham and Leicestershire.

A document promoting a health fund from Integrated Health Partners, a London firm which works with GP groups to reduce emergency admissions to hospitals, says: “It is a way for socially conscious private investors to become involved with the NHS.”

One potential project has already been proposed by Central Surrey Health, a social enterprise which provides community nursing services. It believes investment in preventive care for the elderly will ultimately cut costs by reducing emergency admissions and bed occupancy.

Money saved by the primary care trust would be used for other NHS services with a proportion returned to the investment fund. A contract stipulating the returns would be agreed prior to the project.

Tricia McGregor, managing director of Central Surrey Health, said the fund could provide capital for innovative projects. “We believe this kind of financing can unlock a lot of potential in the NHS,” she said.

Ratna Singh, who sits on the board of the new fund and works at Integrated Health Partners, said: “We want people to come forward with projects that might be suitable. This can help deliver better care for patients because it brings the rigour of private enterprise into the NHS.”

A spokeswoman for Unison, which represents 1.3m public sector workers, condemned the idea of profit from healthcare. “We need to bust the myth that bringing the private sector in is the only way to run services efficiently. The health service has always evolved to develop new and more efficient ways to treat patients,” she said.

Doctors’ letter to David Cameron, how to sign it

4 Feb

Calling all physicians and surgeons in UK, join the protest and get your name down here please

My main problems with the NHS Bill

30 Jan

More opprobium poured on the Health and Social Care Bill

Ian Greener's Academic Blog

Without wanting to create scare stories, I think it sensible to try and explain the reasons why I think it will lead to problems later on. I’m not alone in foreseeing problems – several other commentators have written about this as well. What I can do is explain my perspective on this, and to try and justify my fears.

I’ve organised the following under three headings: problems about the market; problems about provider failure; and problems about responsibility for the system. I can then end by explaining briefly a different way of thinking about the problem of NHS reform than is in the Bill.

Problems about the proposed market

We seem completely in thrall to the idea that there must be some kind of market for healthcare reform to work. However, I’m not convinced about this at all. I’m very much of the view that the problems of putting in…

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Social Care Faces Looming Cash Crisis, Say MPs On Health Committee

24 Jan

Keeping up the pressure on our politicians!

Dr Alf's Blog

This is an interesting but rather sad article. Check it out!

Social Care Faces Looming Cash Crisis, Say MPs On Health Committee.

As I get ready to travel overseas, reading articles like this will no doubt make me want to stay away longer.

I can remember when I first started working in the early seventies, I was working away from home in Darlington in the North East of the UK. I was unfortunately admitted to Darlington Memorial Hospital for a week with food poisoning.

My memories of the NHS Darlington Memorial Hospital are still vivid forty years later. What I especially remember is the cleanliness, the excellent nurses in their immaculate starched uniforms and the discipline and routine of hospital life. No doubt with years of statistics under Labour and cost cutting under the Coalition Government, I would probably be appalled if I went back.

It’s quite…

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Health and Social Care Bill Must Be Rejected

22 Jan

Red Lines for House of Lords

All UK citizens should fear the future of the NHS and their own healthcare unless the Health and Social Care Bill is thrown out, even at this late hour.

The link offers a legal framework for the challenge.  Everyone is encouraged to make their  loca Peer aware of the concerns.

All UK doctors are urged to contact their College to make their concerns known too.

The following is from http://callonyourcollege.blogspot.com/



Urgent – Lobby Your College

This website has been set up to allow doctors to lobby their Medical Royal Colleges about the Health and Social Care Bill currently in the House of Lords.
In only a few weeks time this Health Bill could become law. Your input is urgently needed.

The Bill 
   – poses an enormous risk to the future of a viable equitable NHS. 
   – allows the elected Secretary of State to abdicate his or her ultimate responsibility for the NHS. 
   – allows local hospitals to use up to 49% of their beds for private patients meaning NHS patients will wait longer for their care.
   – will tranform a cost effective public service into a healthcare market.
   – has no democratic mandate. We were promised ‘no top down re-organisation of the NHS’ prior to the election yet we now see this enormously damaging NHS upheaval before us which is already proving a huge distraction to all NHS workers.

Continuing with the implementation of the Bill carries far more risk than stopping it now and withdrawing it.

The Bill is now opposed by the British Medical Association, the NHS Consultants Association, theRoyal College of Nursing,  Royal College of MidwivesUnison and Unite.

The Bill has now received a damning report from the Health Select Committee

We now ask for the help of all doctors who are members of a Royal College to lobby your own College about the Health Bill, advise them that you are opposed to the Health Bill and ask them to speak out on your behalf.

We ask you to cut and paste the template email below and then click on the link for your own College which should allow you to send the email easily. Of course feel free to design your own email.

It would be helpful to know how many of you have contacted your College so please add your name to the ‘comment’ section below (or initials if you prefer to remain anonymous).

Dear College President,

I am writing to you as a member of our College. I have major concerns over the Health Bill currently in the House of Lords and ask that you speak out and oppose this damaging policy. 

The Bill lacks a democratic mandate and carries enormous threats to the structure and function of the NHS.  It threatens quality, training and standards, all of which fall within the remit of our College. The risks of continuing with this legislation are now felt to be greater than the risks of stopping it.

Our medical leaders need to lobby against the legislation. Please join the BMA, RCN and RCM in publicly opposing the Bill and calling for its withdrawal.

Yours sincerely,


List of Royal Colleges and their email addresses you can click after you have copied and pasted

Royal College of Physicians         infocentre@rcplondon.ac.uk
Royal College of Surgeons           president@rcseng.ac.uk
Royal College of GPs                  president@rcgp.org.uk
Royal College of Radiologists       president@rcr.ac.uk
Royal College of O&G                 president@rcog.org.uk
Royal College of Psychiatrists     reception@rcpsych.ac.uk
Royal College of Paediatrics        president@rcpch.ac.uk
Royal College of Pathologists      president@rcpath.org
Royal College of Anaesthetists    president@rcoa.ac.uk 
Faculty of Public Health              president@fph.org.uk
College of Emergency Medicine  mc.prescem@gmail.com  – Mr Mike Clancy

Chair of Academy of Medical Royal Colleges – Professor Sir Neil Douglas


Receptionists Training/Paitent Confidentality – Taking Responsibility

14 Sep

Common sense. Have used the RCGP confidentiality toolkit originally designed for teenagers with good effect in my own practice. WONCA workshop in Slovenia several years ago was very well received.

Beyond the Reception Desk

Everyone working within the Health Care Sector is bound by patient confidentiality.

Every member of staff should be expected to sign a confidentiality statement when they first start working for you. Confidentiality is vital when you are working with information regarding a patient.

You must only ever disclose patient information in the patient’s best interests.

How many people do you think has access to patient information?

here are a list of some of those healthcare professionals:




HCA (Health Care Assistants)


Ambulance Technician

Other Healthcare Professionals (ie physiotherapists, dietitians, counsellors etc)

Out of Hours Personal



Administrative staff

NHS Managers

Cleaners  (They might see or hear patient information when carrying out their jobs. )

If you are working in a Surgery do you get visitors/workmen to sign a confidentiality statement when they come into your Practice?

There is every possibility that they will see or hear something regarding…

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Illusions of Autonomy

Where medical ethics and human behaviour meet, by Dr Philip Berry

Enjoying every second

Cada lugar, cada rincón, cada momento compartido arreglando el mundo entre imprescindibles

The Commonplace Book

blogs on public health, science, books, theology and more