MD Soundbites!
26th April 2024
Some of the LMC were lucky to listen to Dr Katie Bramall–Stainer, Chair GPC England this week, at the meeting of the South West Association of LMCs... It was refreshing to hear a leader who is so aligned to the real pressures that we are facing in general practice. We know all too well the pressures GPs face. The GPC are pushing for us to work in a safe environment and critically trying to help our patients understand the value that GPs bring.
GPC are looking at measures that practices can implement to ‘protect ourselves and our practice teams’ safely. While the details have yet to be finalised it is exciting to hear that the proposed suggestions are due to start later this year. It does feel that these actions may just take us a step forward to highlighting the ‘iceberg under the water’ if our contract does not alter.
Best wishes
Justin
18th April 2024
We are now in dispute!
Hot off the press this week is the BMA update entitled ‘GPs in England go into dispute with NHS England over contract’. In the BMA referendum more than 19,000 GPs voted, with 99.2% voting not to accept the contract. This included votes from nearly 75% of the BMA’s GP contractor/partner members.
The letter to Dr Amanda Doyle is worth a quick read. Let’s watch this space…
Best wishes
Justin
12th April 2024
The BMA update on Consultant pay is an interesting read. However, the part that struck me was the section on Solidarity.
‘At the heart of this dispute was our concern for patients and the future sustainability of the NHS. Without valuing doctors, we lose them. Without doctors, we have no NHS and patients suffer’.
The BMA recognise that the contract changes, which will be imposed by the Government and NHS England from 1 April 2024, include a national practice contract baseline funding uplift of just £179m for England’s general practices, way below inflation in recent years, will mean that many practices will struggle to stay financially viable over the next six to 12 months and risk closure.
The BMA update further reports that ‘Consultants have shown they are not afraid to act when they need to, and ministers, whether present or future, should be warned that we expect to be treated fairly and if the Government fails to do so in future, we will once again find ourselves in the midst of an industrial dispute’.
Our BMA team are battling to help us nationally but what do you think general practice in Somerset should do? The Somerset LMC are keen to know more about your thoughts on the challenges you face daily. We are considering holding a regular ‘Ask the LMC session’ online to hear your concerns and thoughts? Do you think that Somerset general practice can show solidarity in finding solutions? Would you welcome this? If you wish to share your thoughts do e-mail me on justin.geddes2@nhs.net.
Best wishes
Justin
5th April 2024
Training… have you completed your Oliver McGowan mandatory training on learning disability and autism? This is not a box ticking exercise. The videos that Oliver’s mother, Paula McGowan OBE has produced to facilitate the training on e-lfh are really informative. They left me feeling in awe of her bravery to turn such a tragic event into something where we can all learn and help prevent avoidable deaths. A full list of resources can be found here. The NHS are promoting the importance of the training including the NHS Chief Executive Amanda Pritchard. If you have not done so already, set aside some time and get it done – everyone has something to learn here about the needs of autistic people and people with learning difficulties to make a real difference. Oliver McGowan Training is also available on training courses. Bookings via training@autismsomerset.org and any queries to somicb.olivermcgowantraining@nhs.net.
Best wishes
Justin
28th March 2024
Collaboration in the face of a crisis.. I could not help but reflect on the results of the BMA referendum and the overwhelming support that GPs have given to the imposed GP contract for 2024/5. I would agree with the impressive Chair of the GPC, that this contract does not give practices stability or hope. However, while we await how this referendum will unfold nationally perhaps now is an opportunity to reflect on working together to overcome obstacles in a crisis. The new National Funding Framework (NFF) that has been agreed with the LMC and the ICB is a great example of collaboration on a local level and I continue to meet GPs weekly who seek to sort local problems by collaboration. Whether the problems we face are at a practice, PCN, county or national level I think we can all learn from ‘Smarter Collaboration’ and ‘promoting collaboration in a Crisis’ . NHS professionals produce a nice summary ‘The key steps for collaboration in the NHS‘.
Best wishes
Justin
15th March 2024
Fragmented, fractured, futile are some of the words that I have heard this week about the state of health care. No one is denying that everything seems so extremely challenging at the moment but we can influence it. The LMC has previously shared information about rebuilding GP and I would encourage your leaders to look at this. Engagement with our patients is essential to implement change. The BMA update ‘Patient and public involvement: a tool kit for GPs’ while written in 2015, is perhaps more relevant now. I became a GP to make a difference to patients on an individual basis and 20 years on, I believe that GPs have a more critical role now, than perhaps they were then. The Rebuild General Practice Campaign has excellent information that you can share in the practice. A strong general practice is critical to the survival of the NHS, our patients need to support us to achieve this. If you need inspiration about how valuable GPs are to the vulnerable, listen to Professor Graham Watt at the RCGP AC 2018 if you were not there.
Our profession needs to have a stronger voice. Our patients may just help us get there through the Rebuild General Practice campaign.
Best wishes
Justin
8th March 2024
Staff feeling battered…. This week I met a patient who was working in a large hospital and they spoke about the challenges of working within the NHS. They gave the impression that they love their job. Too much to do with too few people was the theme. At a practice event this week, I met a practice team who face insurmountable pressures almost every day. The same theme of too much to do for too few people. They talked about having great colleagues, and making a difference to patients. This is inspiring, but how can we practically keep our staff under such pressure. Colleagues make work fun. The update this week contains the news of the proposed new contract that is all rather bleak. However, little things can help. Improving staff retention a handbook for NHS employers is worth a look. It contains some meaningful actions that leaders and managers can take to make a difference. It is no good saying its tough we just have to get on with it! Staff need to know that you know it is tough and you are doing something about it – albeit this may fall short of what you would ideally like to do given financial and other constraints. Compassion and inclusivity costs nothing at the moment - we all need to feel and know we are valued.
Best wishes
Justin
23rd February 2024
Contracts and working within them... The GPC have indicated that they expect that the final contract for 24/25 will be available imminently and put to GPs in March in a formal ballot. They have also indicated that there will be social media posts and information for patients that will be welcome. As part of the contract negotiations the government is refusing to include GPs or nurses in the additional roles scheme, useful update in the BMJ update this week. The BMA are pushing at the very least for a safe working environment. I was sighted on a clinical safety incident this week when discussing who is responsible for actioning tests. The reality is that almost every GP is stretched to capacity and beyond - we must work safely. The BMA does provide useful templates on pushing back on inappropriate workload which are accessible from the Somerset LMC website. You may not have time to action this but perhaps one of your team does. These templates might just keep you a little safer and more sustainable.
Best wishes
Justin
16th February 2024
Sepsis guidance - are you sighted on new guidance … Suspected sepsis: recognition, diagnosis and early management? The guidance has reviewed the evidence and made new recommendations on the management of suspected sepsis for people aged 16 and over who are not and have not recently been pregnant, in mental health, ambulance and acute hospital settings. There are some good tables in the guidance that are useful to have in your mind when you think ‘could this be sepsis’. Also if you are not already familiar with Sepsis Trust templates have a look as they can ack as a good aide memoir. Personally I have found these to be exceptionally useful particularly the sepsis screening tool for telephone triage. RCGP learning is also worth a look – good CPD.
8th February 2024
Good medical practice... the GMC Good new guidance 2024 came into effect on 30 January. As you will be aware this is a frame work of professional standards to guide you caring for patients and working with colleagues. The GMC are clear that these are not a set of rules but to be used using clinical judgement. The pressures that we face daily remain high with no imminent plans for this to change. These pressures bring significant challenges in being a GP. Perhaps reminding ourselves of these is timely. The GMC have updated five key areas:
- Create respectful, fair and compassionate workplaces for colleagues and patients
- Promote patient centred care
- Tackle discrimination
- Champion fair and inclusive leadership
- Support continuity of care and safe delegation.
Advice on remote consultations also provides a useful prompt.
Best wishes
Justin
25th January 2024
At the SW LMCs meeting we had an opportunity to listen to Dr Victoria Tziotziou-Brown (Vice Chair RCGP External Affairs).
What is the RCGP doing? Are you still a member? Largest Royal College in the UK, 54,000 members!
‘Cum Scientia Cariatia’ – Compassion (empowered) with knowledge seems to be as appropriate today as it was when it was created.
However, how is this going to be implemented? RCGP General Practice Manifesto – seven steps to save general practice and safeguard the NHS. Reassuringly we were advised that the General Practice Committee and RCGP are working together.
The SW LMCs asked pertinent questions – what do you think? At the Somerset LMC we know things are tough. This quote helped me from Ruth Baber!
‘Don't be distracted by emotions like anger, envy, resentment. These just zap energy and waste time’. Ruth Baber Ginsburg quotes.
Best wishes
Justin
19th January 2024
Safeguarding… Once in a while you find information that makes a real difference. Previously I have shared my concerns about EHA forms (we are awaiting the outcome of the review) but from conversations that I have had this week help is at hand. If you are not aware then you can call ‘The family Front Door Consultation Line’ on 0300 123 3078 and they will help. Also on this site there is a tab under working with children where you can locate some very helpful policies procedures such as ‘Bruising in Babies and Children’. We know that the EHA form does not work for us but please continue to be vigilant about safeguarding issues as the safety of many children and adults can only be helped by us continuing to report concerns when they arise.
Best wishes
Justin
12th January 2024
Rebuild General Practice
I have commented on this before but as we enter a year where general practice will be a key part of the governments health agenda perhaps is now a great time to look at this again. GPs from local practices and the LMC had an opportunity this week to listen to a team that are entrusted to help create influence on rebuilding General Practice.
The main message of this is an umbrella to keep patients safe, protect the NHS and rebuild general practice - collective alliance of GPs, patients, politicians and NHS colleagues. A key theme is about sharing the message of what it means to be a GP on the ground. I am really proud of being a GP and meeting with like minded colleagues was inspiring at this meeting to help build a better future. The Somerset LMC are behind this Rebuild General Practice.
Justin
4th January 2024
A thank you would help…. a very long time ago, I worked for a rather eminent vascular surgeon who asked me what I planned on doing in my career. When I replied that I wanted to be a GP he looked me up and down and said ‘ good luck with that, you will get the chance to do amazing work, but it will not be recognised’. It was a comment that has stayed with me for over 25 years! As GPs we do some incredible work and while it is not frequently responding to medical emergencies it saves lives in many cases and definably improves the quality of patients lives. I have been reminded this week of some of the highs and lows of being a GP and how I hope for a better 2024. I had a consultation with someone who having seemingly obtained the information they wanted from me then proceeded to stand up and walk out and another who was extremely grateful because their frail elderly relative achieved their wish of dying at home. Few of us get the recognition that we deserve for a job well done but as we start the year we must remember that we are providing more with less and 2024 has to be a year where we all look after ourselves.
Happy New Year everyone.
Justin
22nd December 2023
Last one of the year… this time of year is always one for reflection. When I reflect on 2023 as a GP I see it as one of immense challenge to our profession but also one of hope. Just this week I was speaking with GPs about what makes things worthwhile for them and two things materialised – close colleagues at work and patients where our impact has made a difference. Reflecting on our time as a doctor can help us with our wellbeing and development - the GMC does produce guidance and the ten tips on reflection are worth a look. Working at Christmas is thought provoking!
Perhaps we can all make some time to reflect on our experiences as a GP in 2023 and move forward as a stronger team in 2024. You are doing an immensely difficult job and that needs to be celebrated.
Happy Christmas to you all – enjoy some well deserved rest.
Justin
15th December 2023
The power of being able to listen… you all know this right? I have been involved in some GP teaching this week about listening and reflecting on the power of really understanding and seeing the benefits that this brings. It brought me back to some of the GP consultations models and certainly made me smile about how my GP Trainer many years ago helped me to understand the Inner Consultation and how this can help doctors listen, think, ask, talk, negotiate and plan all in a short period of time. However, perhaps just listening is the most important of them all in getting the diagnosis right. The same is true in implementing change in organisations and the NHS. Perhaps we all need to do it a little better…
Happy listening ?
Justin
8th December 2023
Measuring continuity…. May not be so hard!
Most of the practices in Somerset are innovating every week as they juggle the rising demand, workforce shortages, juggling finances and politics. At the heart of good general practice is continuity of care and the advantages that this brings to patients and doctors. However, as we struggle to meet on the day demand, continuity of care is more difficult to provide. Did you know that you can measure continuity in your practice? SLICC (St Leonard Index of Continuity of Care) Method provides a framework. Perhaps this is something that your medical students, GP registrars could look at? For those innovators out here have a look at some BMA guidance – Exploring innovation in general practice.
Best wishes
Justin
30th November 2023
Private healthcare and the GP kickback…. with more patients going privately some GPs are starting to question what their duties are. The BMA provides guidance on General Practice responsibility in responding to private healthcare. There is some very useful information in this document but one element of the guidance is ‘shared care’ with private providers.
All shared care arrangements are voluntary, so even where agreements are in place, practices can decline shared care requests on clinical and capacity grounds. The responsibility for the patient’s care and ongoing prescribing then remains the responsibility of the private provider.
There is also guidance on pushing back on inappropriate workload - some letter templates that your team may find helpful.
Hope this helps.
Justin
24th November 2023
Sharing the learning…. Is the pace at which you are working stopping you from learning from others? At the practice this week we rekindled our SEA programme and it was fantastic. An opportunity to establish some sensible ground rules, discuss some interesting cases, and walk away feeling that everyone had benefitted. It made me reflect on how practices can develop and share their learning and evidence quality improvement for CQC. If this is a process that you would like to develop further then perhaps have a look at these links
CQC GP mythbuster 3: Significant event analysis (SEA)
RCGP Reporting and learning from patient safety incidents in general practice A practical guide
Medical Appraisal Scotland Domain 2: Review of Significant Events
The guidance on Good Practice for Team-Based SEA Meeting is worth a look.
Best wishes
Justin
17th November 2023
Please be flexible!!! Why is it that some practices can retain their workforce and others struggle… there are a significant number of factors but one that is overlooked is how flexible the employer can be. Flexible working: raising the standards for the NHS as published in 2022 and is worth a look.
NHS defines flexible working as ‘an arrangement which supports an individual to have greater choice in when, where and how they work’ and combines three organisational themes: patient/service upset and staff experience, service delivery and work-life balance of colleagues. Perhaps time for us all to give this some renewed thought. NHSE provides some useful links here.
Best wishes
Justin
10th November 2023
ADHD …. Got me in a spin!
‘Thanks for the call doc, I have been without my ADHD meds for the last 3 weeks as they are out of stock – I am going to lose my job if you cannot help’.
Alternative, ah… where is that guidance I started to think. Rescued by Catherine – fellow MD who is more organised with filing than me, I was able to work through the problem to help. If you are faced with similar challenge this week this guidance may help.
This guidance from Avon and Wiltshire is useful also.
Justin
2nd November 2023
Being inspired… an e-mail landed in my tray this week and it immediately inspired me.
‘Kindness Respect Teamwork
Everyone Every Day’
Almost every day I meet someone who inspires me. Whether that is a patient who shares their story, a colleague who delivers excellent care or just someone who makes the world a better place in some small way. This particular quote was shared by a GP after they raised concerns about how a patient in their practice was managed. However, rather than rant they shared this quote!
Need to be inspired? Consider the podcast ‘Inspiring doctors’ - it is worth a listen.
Justin
27th October 2023
State of Care
CQCs State of Care 2022/23 report is a very challenging read. Almost every aspect of this report shows that our health system is in difficultly. It is the health and care workforce section that I wanted to bring to your attention.The NHS workforce sickness absence rates have increased. Working conditions are more stressful. Over the last 2 years NHS staff have generally been more than twice as likely to record ‘anxiety/stress/depression’ as the cause of their absence than any other reason. This accounts for 20 to 28% of staff sickness absence. With the challenges being so real it is hard at times to see a way forward but retention of staff has to be key. We know that our practices are adapting with many now employing an array of health professionals to support. Reflecting on conversations with colleagues this week perhaps the only way we can ‘survive and thrive’ is to firstly take a look at our culture and make the time at work as positive as it can – for me that is making time for each other and getting the simple things right. Working in healthcare remains an absolute privilege but working within the right team makes that a reality! ‘Workforce and Wellbeing’ is part of QoF 2023/24 but the one aspect that sticks out for me in the Overview of the QI module is improving staff wellbeing!!
Take care everyone.
Justin
20th October 2023
World Menopause Day….. this was the 18th October this week for those that are not aware. Almost every week a full time GP will have a consultation with a patient who is going through the menopause. We focus and aim to provide the best possible care to our patients. However, are we doing everything to help our colleagues in the work place? We have real workforce problems and need everyone at work but are we tackling this issue?
Women between the ages of 45 and 54 alone make up a fifth of all NHS employees, and so up to a fifth of our workforce could be experiencing menopausal symptoms. Many of our services in general practice are led and delivered by women, therefore we must create a safe environment for menopause to be discussed in the workplace. Some links to help think about how we can help our colleagues going through the menopause, I hope you find useful.
- BMA Advice and Support
- ACAS also provides some helpful guidance
- I found the BMA menopause survey discussion really informative
- Supporting or NHS People through menopause
For those on half term next week enjoy some family time.
13th October 2023
General Practice Improvement Programme
The modern model of general practice….. needs to be able to manage on need not wants. I have written before about the safe working and managing workload but I do want to promote again the national General Practice Improvement Programme (GPIP).
Every day many practices in Somerset are being overwhelmed by the numbers facing you in the waiting room or the number of calls that need to be made. We all know you can only see one patient at a time. This GPIP needs to be tackled in a step by step manner. If we want to stem the flow and provide safe effective care and have a more meaningful day this programme needs to be seriously considered.
Perhaps designate this to a clinical lead and give them time to consider how this could work for you…
Happy reading.
Justin
6th October 2023
Cancer diagnosis is always tricky …. ‘if you have not heard in 2 weeks please call the surgery’. I have been saying this for years but the guidance has changed and to help us manage our patients' expectations and call backs to the surgery we need to know the changes.
From 1st October the 10 existing guidelines are streamlined into 3 – these are:
- Faster Diagnosis Standard: a diagnosis or ruling out of cancer within 28 days of referral (set at 75%)
- 31-day treatment standard: commence treatment within 31 days of a decision to treat for all cancer patients (set at 96%)
- 62-day treatment standard: commence treatment within 62 days of being referred or consultant upgrade (set at 85%)
So perhaps we need to change our safety net advice… but critically it does not alter the way we refer.
Further information on the background of this can be found here and here.
Justin
29th September 2023
Good Medical Practice… 1995 and beyond. In 1995 (when I was at medical school) the first edition of this document was published and I clearly recall the seriousness that the medical school attached to this publication – it has always stayed with me. Move on almost 30 years and there is a new edition that will apply to doctors in 2024.
The standards focus on behaviours and values which support good team work, make everyone feel safe to speak up, and empower doctors to provide quality care
Five key themes:
- create respectful, fair and compassionate workplaces for colleagues and patients
- promote patient centred care
- tackle discrimination
- champion fair and inclusive leadership
- support continuity of care and safe delegation
It can only be a good thing to discuss this important document and be fully aware of what is expected - don’t forget the footnotes!
Happy reading and sharing.
Justin
22nd September 2023
Being the team you want to be… one of my colleagues this week conveyed their frustrations as they gave an account of getting a complaint when they believed that they had done nothing wrong. What struck me was how comfortable they felt about discussing the issue being new to the team.
Being able to discuss problems that arise, develop better ways of working and supporting one another is so important. But why do some teams function and others not…. Part of my week has been about looking at organisation culture and why some organisations and teams support one another better than others. I was reminded about the five dysfunctions by Lencioni which are…
- Absence of trust
- Fear of conflict
- Lack of commitment
- Avoidance of team accountability
- Inattention to team objectives
There is no doubt that together we are better.
Best wishes
Justin
15th September 2023
Meeting great people…this week we had the LMC educational event of ‘What does good look like? Taking back control of General Practice’ and if you weren't there you missed a valuable day (but you can catch up with the presentation slides here). There were some inspiring speakers.
Do you remember when you were a medical student or a junior doctor and you had been taught a technique but when under pressure it falls to a bag of bits – this happened to me in taking arterial blood gases once! Those gases are important because clinical decisions are based upon them. Scott McKenzie, from Scott McKenzie Consultancy, described many things including the importance of culture. Well consider how important the culture of your organisation is, how welcoming, supportive and facilitatory it is. However, what is it like when it is stressed? Is it still so welcoming? Successful organisations have great people and great cultures – taking time to build it matters.
Heard of Allyship? Emma Symonds, from NHS Somerset gave an inspiring talk on developing and looking after your team. Do have a look! Guide to Allyship.
We heard from many people wanting to take back control and build a better general practice for Somerset – we are lucky to have great people but we must work hard to keep them.
Have a good weekend.
Justin
8th September 2023
Leadership… Most of us are not that interested in ‘medico-politics’ but we definitely need GP leaders who are. This week I was sighted on a feature article in the BMJ that filled me with hope - Better and safer: an new ambition for GPs in England. In this article Dr Katie Bramall-Stainer, the new Chair of BMA’s GP Committee (GPC) Chair in England, as of the 3 August, sets out her vision.
Bramall-Stainer believes wholeheartedly in the partnership model with continuity of care as its heart, but says that this has been undermined by politicians of all parties, with some suggesting that it could be replaced with a totally salaried GP workforce. “That would cost billions. And where is the evidence that it’s going to bring efficiencies?”
It seems that we have a leader that really understands our pressures.
I expect that the temperature in the negotiating room is going to start to mirror the heat we are facing at the coal face!
Have a good weekend.
Justin
1st September 2023
12th September … there is only one place to be! Well not quite, but I did want to bring to your attention the LMC / STH Study Day at the Taunton Racecourse on the 12th September where one clinician and one non-clinical lead can attend. We hope the day will be useful in helping us all reflect on what ‘Good’ looks like and taking a little bit of control back in our working lives as we face the winter. It is not too late to get involved, click here for the agenda and if interested book here.
Taking control but being kind in the process seems key to me. Yesterday, I had completed a telephone consultation and the lady on the phone suddenly said ‘That’s great doctor – here is my husband’. Having already spent 15minutes on the phone I was slightly taken aback and without me catching breath, he proceeded to ask me about his blood results and tests at some pace. After a few minutes I politely asked if he could keep his scheduled appointment to address his concerns which he kindly accepted. One small example of the constant demand for more of our time. For most of our clinical days it can seem that we are running a race… a race against the clock to complete the list of clinical questions in a set time. We do not have time for those extras and having multiple extra tasks or queries can make the day overwhelming. It makes it doubly hard to always give your very best and be kind when stressed. The BMA this week talks about ‘Why be kind?’ It seems so obvious, but as we battle to meet our patients needs it is a very good reminder that being kind not only helps our patients but helps us. Worth a look over coffee. However, to always be kind we need time to think at work. That requires time for us to think and change how we work.
Our study day may not change the NHS but may in a small part help us share ideas for Somerset general practice to continually be ‘good’, learn some new skills to take some control back to deliver the care and kindness that we are proud of.
Justin
10th August 2023
Sharing is caring…
For the experienced GPs out there, I am sure you will agree that you have seen most of the problems you are encountering many times. You rely on those experiences and knowledge to provide the best care possible. However, how do you cope when you are not so certain? I was reflecting for my appraisal this week and reading through an entry that I wrote some time ago where I was uncertain about how to manage a patient who was end of life. The circumstances were complex. I had some concerns and took a few minutes to collect my thoughts asking myself ‘who is the best person to ask ‘. I needed to sense check my thoughts and know that I was on the right path. I spoke with a very experienced palliative care nurse and that 20 minute conversation helped me know that the care I was planning was ok, I was right. I had confidence that the patient was receiving appropriate care and my anxiety reduced. Working in our world seems to becoming more complex and more time pressured. A close colleague said to me this week ‘it's like we are meant to be consultants rather than generalists in all specialities these days’. It made me think…. we cannot know everything so work within your competences and do not be afraid to make time to ask – team work is related to performance.
Take care everyone and enjoy the sun… they tell me it is coming. More soundbites in a few weeks ?
Justin
28th July 2023
Thinking Cancer
Cases that make you think!! I know you may be thinking what a daft thing to say as every patient and every important diagnosis makes you think. But there are those cases that stick with you, that hit at your soul. The first time I really experienced this was when I was SHO doing oncology and I met a young man who was in his late 20s (as I was at the time) and he was dying of bowel cancer. The day he died on the ward I felt he took a part of me with him, probably because at the time his wife was expecting their first child, my wife was too and he never saw his unborn son. I recall him saying that because he was so young no one at the time considered he had cancer. We have all had such cases and in our privileged position we have to try and diagnose cancer early. It is often far from easy. However, often there are resources out there that are so close to home that we miss them. Have a look at the bundles of information in the SWAG (Somerset, Wiltshire, Avon and Gloucestershire) Cancer Alliance and GPs Talk Cancer that has just started! There is also a free set of courses on cancer that look promising (have to say I have registered but not started them yet) but perhaps worth a look too.
Happy holidays!
Justin
21st July 2023
Collaboration is the name of the game… you would have to be living under a rock to not be aware of junior doctors strikes, consultant strikes, GP surgeries stressed and in Wales reports that unless urgent action is taken the service is at risk! BMA NEWS
Here in Somerset there are overwhelming pressures but within our county there are leaders, GPs and practice teams driving change. The landscape at the moment is difficult but listening to a collective group of providers, patient representatives, voluntary sector providers at the Western Somerset Access to Health Care event this week in Dunster gave me hope. One service that you may wish to look at to help your patients, colleagues and friends is Open Mental Health.
There is some inspiration stuff in here and having seen the benefit that a male patient has had from this, it makes a difference.
Tough times mean tough choices but as Christopher Reeves said ‘Once you choose hope, anything is possible’ . For me this is about sharing our struggles and making time to discuss them.
For those about to have your summer hols with family and friends enjoy!
14th July 2023
Workforce – we all agree we need more of us… For those that have not had a chance to look at it the NHS workforce plan is out there and it is ambitious. There is some fantastic stuff in it at least on paper – the number of GP training places to increase by 50%, GP trainees to spend the full three years of training in primary care, experienced doctors to work in primary care (under the supervision of a fully qualified GP), all foundation doctors to spend 4 months in general practice and so the list goes on. Surely this must help …. I was left hoping so after listening to an elderly patient this week who needed to tell me at length that access to doctors was unacceptable and we must put the care of patients at the heart of everything - I could not disagree but we all know the pressures. However, the reality is that to provide the care that is needed we need more of us, for me the NHS workforce plan provides hope and perhaps a platform that we can use to turn the tide and inspire as many doctors as possible to be JUST A GP in Somerset. See Just a GP campaign and A behind the scenes look at life inside and outside the the surgery in Somerset.
Best wishes
Justin
30th June 2023
Just sometimes I think things will change… can you imagine a GP land where there is the time to see patients, have the resources to make meaningful change in our practices, time to reflect and learn and the removal of meaningless bureaucracy. Well that is the vision for the BMA as negotiations start for the 2024 GP contract. The BMA ‘Call to action for General Practice' hits the mark and filled me with hope. Have a look, because the BMA in due course will want to hear your views.
22nd June 2023
Professionalism…. we know how important this is but there are times when it is tested to the limit. In discussion with colleagues this week I was reminded (and experienced first-hand) the abuse that patients can give doctors and our staff. Some of this is nothing other than shocking and unacceptable, an article from The Guardian this week indicates that abuse of doctors in the UK is not going away. My reflections this week in speaking with colleagues is how hard our role can be but the importance of maintaining a level of professionalism at all times cannot be undervalued and the importance of sharing your experiences with colleagues.
The Medical Protection Society have historically produced some excellent guidance and the GMC is clear of the importance of professionalism in action.
Taking this seriously at all times will help keep us and our patients safe in tough times…
16th June 2023
E-mails that make you stop and think…. it is almost impossible to read everything but I was sighted on the fatal accident inquiry in 2001 of Emma Frame who died of adrenal insufficiency following communication from the ICB Medicines Management Team. The full report can be seen here and the lessons from the inquiry. While this case happened over 20 years ago it is still very relevant to our practice today. The array of medications that we are expected to consider in practice today is vast and perhaps one simple lesson for us all is just double check the dose before clicking and issuing!
9th June 2023
Planning normally helps…conversations about end of life care can be challenging and normally require dedicated time, space and considerable thought. We all know that it normally helps if you know the patient well and the family. Sometimes there is a need to have the conversation over a few consultations. It can be difficult and requires time, the latter being something we often have little of. The letter in the BMJ this week ‘Helping people plan end of life care’ just triggered me to reflect on some recent clinical encounters out of hours where I have met patients and families where the planning has been done exceptionally well and in other encounters where further documentation in EMIS or on the TEP would have helped. As GPs managing end of life care we have the opportunity to make a huge difference to those facing death and their families. The organisation Compassion in Dying may help some patients have the conversation and for us to remember these conversations can really help others be in control of their end of life wishes. They also help the doctor make the right decisions when they may have to visit at the weekend and overnight!
1st June 2023
Ethical challenges…. Sometimes these can be tough and having a framework can help. Often there is a relevant law or regulatory framework that we can rely on but there are occasions when things may be less clear cut. I found myself in such a scenario recently when asked to review someone who had rapidly deteriorated following a short illness. I found myself asking myself questions of ‘is this right’, ‘should I do this’. Simply if we are asking if something is ‘right’ or ‘wrong’ we are asking an ethical question.
The BMA have released a useful framework.
- Recognise that you are facing an ethical question - if so STOP and think!
- Identify the ethical components… what are the views of the patient.
- When necessary seek additional information… if the patient cannot give you the information then seek ways of obtaining their wishes, feelings and beliefs.
- Identify relevant legal or professional guidance… remember the law and GMC guidance is binding. While guidance may not be law a decision made in line with professional guidance is less likely to be challenged.
- Critically analyse the question… just think is your decision reasonable and defensible in the circumstances. Record how you reached your decision!
- Support the decision with sound arguments. Discussion with other doctors without breaching confidentiality can help but YOU need to make the decision and do so in conjunction with the patient as much as possible.
Try it out….
Have a good weekend.
Justin
