MD Soundbites!
6th December 2024
Red Tape Challenge Survey - I cannot be alone in feeling that the level of bureaucracy and red tape affects how effective I am at work. On 3 October 2024, the Secretary of State for Health and Care and the NHS Chief Executive announced a rapid review of the bureaucracy between primary and secondary care – named ‘The Red Tape Challenge’. The aim of the review is to improve the understanding of the issues for patients, providers and commissioners and set immediate, operational improvements that could be adopted. Have your say to try and improve the interface between primary and secondary care. There is already a significant amount of work being done in Somerset but having your opinion heard through this national survey can only be a good thing. Give it some thought over coffee and get your opinions heard.
Best wishes
Justin
29th November 2024
Much to celebrate! We know that things are not easy, but living and working in Somerset is special to be honest. We need to keep it that way and recruit GPs, nurses, allied health professionals and managers that can shape the challenges we face. Take difficult decisions on issues such as Collective Action, innovate using new technologies, work in partnership with others to make each of our practices the very best they can be.
The LMC want to celebrate some of the great work that you are doing to inspire others, we want to bring to Somerset the very best young people who are inspired by you. I have been inspired this week by a group of GPs who have had to make brave decisions about how they address ‘professionalism’ in their practice, by a GP who inspires others through their teaching. We have some amazing people working in General Practice so let’s celebrate it!
We want to hear what being a GP in Somerset means for you so we can continue to promote our General Practice in Somerset programme. We would also like to attract health professionals including dentists to work in our communities. Help us celebrate Somerset as a place to live and work. If you want to promote your practice and your area, get in touch by emailing us at somersetlmc.office@nhs.net. We want to celebrate your successes to recruit the right people for our very special county.
Best wishes
Justin
21st November 2024
AI - the good, the bad and the ugly!
Almost every week someone teaches me something new. This week some of my LMC colleagues have shared details of an AI system that scribes the consultation details – they predicted that no one will be writing notes in 2 years! Check it out at Kiwipen a New AI scribe at Best Practice 2024 and Kiwipen. Another is an AI Meeting Assistant that allows meeting notes to be taken!
However, AI cannot do everything. A question I was asked this week was ‘ Can AI write a complaint response?’ We are all looking at how we can be more efficient, but MDU guidance recommends that it’s best to be cautious when considering its use in complaint responses. Their guidance is worth a read. The MDU recommends that ‘AI may act as a prompt to get you started, but it is no substitute for the human touch when responding to complaints in a suitably authentic and reflective manner’. Also, how would you feel if a patient challenged your response? Could get ugly!
Remember before using any AI system check out the governance arrangements with the ICB.
Best wishes
Justin
15th November 2024
National Insurance blow for GPs! There are calls for government to reimburse costs for National Insurance contributions but there is uncertainty if this will be agreed. The BMA are worried about the impact – useful summary. To have any chance of securing the funding that is absolutely needed the BMA have this week created a NI calculator. You can use this to calculate costs. The BMA position is that the government must rethink this decision – please consider using the calculator and sharing your data anonymously with the BMA. If you would like to talk to the BMA media team about how this will affect your practice you can e-mail mediaoffice@bma.org.uk.
And if you need further convincing that we have a battle with this read the headlines ‘Streeting says GP practices not formally part of the NHS and rules out tax exemption’.
Best wishes
Justin
8th November 2024
Listening and learning through Collective Action
Justin and Tim held the first weekly webinar this week to discuss Collective Action. What is clear is that practices are seriously considering what actions to take and many have taken some considerable steps to push back and stop doing work that is not funded. To understand more about what services practices may want to stop (serve notice on), LMC committee representatives will be e-mailing their constituents next week. Please look out for that e-mail. Somerset LMC is committed to protecting your patients and your GP practice (https://www.bma.org.uk/our-campaigns/gp-campaigns/contracts/gp-contract-202425-changes). One action is to stop engaging with e-Referral Advice and Guidance - unless it is timely and clinically helpful process in your professional role. Cinapsis is NOT contractual – practices do not have to use it (many do and it works very well). Please let the LMC know if your practice is told that you can only refer via Cinapsis – contractually this is not the case.
1st November 2024
So what do you think of the budget? It is very easy to get tangled up in how this affects us but this week the BMA and the RCGP have produced some helpful headlines.
There is certainly additional investment, 3.5% additional funding in real terms for the NHS over two years with the aim that there will be further ‘reform’ to underpin the plans to move care from hospitals to communities, analogue systems to digital and a focus on treating problems to prevent them – I expect we will hear more about this over the next few months.
There is also additional funding for capital investment with dedicated funding to upgrade surgeries (await the details). There are however, concerns regards costs for practices as the minimum wage for those over 21 has increased from April 2025 and there is a 1.2% increase to employer NI contributions (13.8 % to 15%). This will put significant pressure on practices as there is no extra funding to cover this. At a time when practices are facing increasing financial pressures there is a need for further clarity – we await what this might be. If you fancy a podcast on this Talking General Practice is worth a listen.
Best wishes
Justin
25th October 2024
Little nuggets of information go a long way – or they do for me at least! You know how it is; long day, bit worn out but there were a few learning needs that cropped up and you wonder when you will get the time to address them. Well, I was chatting to some colleagues this week over coffee and the value of podcasts popped up. Over the last few weeks I have found a podcast that I have really enjoyed from Red Whale. They are short and focused and with the Red Whale PEARLS (all free) they are definitely worth a look (the LMC have no affiliation with Red Whale). Closer to home there are the excellent array of face to face and online education events through the SGPET – if you are new to Somerset and are not familiar these are educational events open to Somerset GPs, practices and their staff in the Somerset LMC area – check it out as the array of events is impressive.
Best wishes
Justin
18th October 2024
Our ambition to rebuild general practice – this was the title of the speech when The Rt Hon Wes Streeting MP spoke at the RCGP Annual Conference on 2 October 2024.
The NHS is broken. That’s what 2 in every 3 patients believe. I suspect a poll of NHS staff would find the same sort of result. I’m yet to speak to a GP who tells me - on many of the visits I’ve done in the last few years - everything going really well, my workload is entirely manageable, this is just what I signed up for.
And I want to be clear about something else too: the NHS is broken, but GPs didn’t break it.
He further stated
In Lord Darzi’s words, “GPs were to all intents and purposes set up to fail.”
We’re left with a status quo that isn’t working for anyone. Not for patients, 2 in 3 of whom aren’t satisfied with the service they receive - a record low.
Nor does the status quo work for staff - you are working harder than ever before, pushing you to burn out and in too many cases pack it in.
It is pleasing to see that there is recognition of the pressures and that general practice is a specialism. However, at the moment we all know general practice is struggling – your LMC want to help you implement safer working though BMA collective action. Please communicate with your practice manager, discuss things as a team and let us know what you really think. We are all stronger together.
Best wishes
Justin
11th October 2024
GPCE’s vision for general practice
GPC officers have been meeting with NHSE and we are told that there is a relationship of equals, the need for co-design and co-operation and negotiation in good faith – let’s hope that continues. The need for increasing investment is essential. The value of funding into the national contract is at a nadir with GP practices receiving 5.5p in every NHS pound. At an individual patient level, the average core contract payment equates to £112.50 per annum, around 31p per patient per day!!
We all know that we need more GPs and stability to stop the GP ‘brain drain’. Patients first and why general practice is broken and how to fix it is worth printing out and putting on the practice coffee table! The BBC have also highlighted the shortages of GPs – worth a read. Perhaps with the facts being laid bare we will start to see the changes that we all need.
Best wishes
Justin
26th September 2024
Domestic Abuse... You know the moment when you hear a story when things go wrong and you just wished the outcome had been different for someone. This week I met with a safeguarding lead and they shared an account of how someone had come to severe harm from domestic abuse. Members of our GP teams are in the frontline for helping those that are maybe at risk.
Multi Agency Risk Assessment Conference (MARAC) is a meeting where information is shared on the highest risk domestic abuse cases between representatives of local police, probation, health, child protection, housing practitioners, Independent Domestic Violence Advisors (IDVAs) and other specialists from the statutory and voluntary sectors. Shortly GP practices will receive information if one of your patients has been discussed at a MARAC meeting for information.
Resources for professionals is a great link.
12th September 2024
Moral Distress and Moral Injury… of course you have heard of them! You all know what it feels like when you cannot provide the care you really want to – it affects you. The BMA survey on this topic is an excellent read and perhaps best summarised by this comment:
‘By their nature, doctors always want to do the right thing and find solutions to problems. When you cannot [do] that, due to circumstances beyond your control, it is extremely distressing.’
Simply – moral distress is a feeling of unease stemming from situations where institutionally required behaviour does not align with moral principles and moral injury can result when moral distress leads to impaired function or longer-term psychological harm.
But we can do something about it. It is no longer acceptable to say we just have to be more resilient. Our systems are under huge pressure and many of us are struggling – how we manage this is to some extent in our hands and implementing the BMA safe working, empowering GPs, developing an open culture and supporting one another will help.
Best wishes
Justin
22nd August 2024
Medical programmes are not usually my thing but ‘Saving Lives in Cardiff’ had an impact on me this week. (This programme lifts the lid on how the surgeons at three hospitals in Wales’ capital make the difficult decisions of who gets treated next and takes audiences to the heart of compelling and life affirming patient stories).
Watching these surgeons do what they do is phenomenal – the ability to work under such pressure. It was however, the comment from the vascular surgeon Lewis Meecham that hit me. After almost 7 hours of doing emergency surgery he commented that his day is a perfect example of how the NHS reacts to urgent need over everything else. He commented that at the age of 37 he cannot keep going like this for another 30 years, stating that if he does he will be dead!
It resonated with me on many levels. As GPs we are not saving lives in the same way as hospital surgeons. However, we affect the physical, social and psychological lives of our patients in so many other ways. We are constantly balancing the needs of a large group of patients and those with the greatest perceived need are often seen first. We are not always getting the time with those that have the greatest actual need. Like Mr Meecham GPs cannot go on like this either. Things have to change to allow us to deliver the care that our patients need, and the time and mental space for us to provide it. As the BMA collective action develops we must remember that the actions we take must not breach local or national contracts and the changes need to be safe for patients and our colleagues. Just maybe this collective action will improve the interface between primary and secondary care as we are all facing the same overwhelming pressure.
I will certainly be watching episode 2…
Have a good Bank Holiday.
Justin
15th August 2024
Colleagues keep you going… on three consecutive days this week I have spoken to colleagues and friends in general practice who have all commented that it is the professional relationships that they have at work that keeps them going and coming back for more. The Executive Summary of the GMC Workplace experiences 2024 document reads ‘The UK health system is in a critical state and it is imperative that action is taken now to rebuild systems and support doctors’. It further states ‘In 2023, out of the main doctor groups, general practitioners (GPs) were the least likely to be satisfied (42% compared with 53% of all doctors) and most likely to be struggling with their workload (48% compared with 33% of all doctors)’. It is all incredibly gloomy but some are succeeding….
One of the key challenges every practice faces is workload. Unmanageable workloads can lead to a spiral of low workplace satisfaction, high levels of burnout which can lead to less staff coming back for more! Listening to staff, implementing NHS employer guidance and making meaningful change can help. Adopting BMA safe working practices and adopting some of the collective actions will help. Make progressive small safe changes to manage workloads to help make certain that your staff and colleagues always want to come back for more….
Best wishes
Justin
2nd August 2024
Well we have some clarity…. ‘GPs braced for collective action’. The LMC update this week provides a comprehensive update on what collective action may look like. In your practices I hope that you will consider these but will they make a difference? Honestly, I think they will. Do not however, expect anything to change overnight. Taking the words of Dr Bramall-Stainer Chair of GPC ‘This will not be a big bang. It will be slow burn’. What I hope is that this action will allow our government to recognise that what we do is hard on the best of days, but to provide good care when facing high levels of demand and complexity is not sustainable for our patients or us unless things change. All the proposed actions have merit but limiting daily contact to allow us time to provide good care and not doing work we are not contracted for may just be where we should start.
Best wishes
Justin
28th June 2024
Little things make a difference … The LMC has for the last few weeks been sighted that GPs are being asked to write letters about ‘toilet passes’ for children. Access to safe, timely and appropriate personal hygiene is considered to be essential to human dignity.
If you are asked for such a letter we have sourced a template (Somerset LMC thanks Lancashire and Cumbria LMCs for use of this letter) that you may find useful.
Best wishes
Justin
21st June 2024
GPs Are On Your Side
The BMA updates on this are really good and do hit the mark! We know that every practice in the country is struggling with the capacity / demand mismatch and highlighting to patients we are struggling and why may help. The BMA have created a suite of information that may just resonate with patients – have a look and consider using in your practice.
Remember the GPC England Non-Statutory Ballot
This is open to 29 July, non-members can join the BMA for 3 months free membership, all the details can be found here.
Best wishes
Justin
13th June 2024
Digital Systems
We all know that digital systems are developing in medicine. I learnt about RPA this week and the impact that it is having within hospital settings – could we develop this in general practice? If you are thinking what is RPA you are not alone. RPA stands for Robotic Process Automation and is software technology that that uses software robots to automate the digital activities usually performed by people. For guidance on how this is developing in the NHS please have a look here. Lots of companies are doing this but there is an interesting overview from blueprism. Definitely something to be aware of as these systems can support and enable staff to digitise and / or enable clinical and business processes across organisations – examples being patient administration, appointment scheduling and report generation to name just a few. If you are thinking about digital solutions link with the ICB Digital Team.
Best wishes
Justin
6th June 2024
Making our team flourish… can be a bit of a challenge at the moment but it is possible! Many GP practices in Somerset are doing just that and demonstrating immense resilience. However, we are often working in environments that are overwhelmed and perhaps resilience as a term is being overused. Be resilient? What do you think I’m doing? Definitely worth a look at over coffee!
Another document that has grabbed my attention this week is ‘ When a doctor leaves.. ’ loads of hints and tips in here to consider – are you doing everything you can to create wellbeing which according to Prof Shanafelt, is esprit de corps, roughly translated as ‘our connection with colleagues’
Best wishes
Justin
30th May 2024
Political Leaders
The first head-to-head general election debate will be hosted by ITV next week and there is an opportunity to have a say – some of the LMC team have already submitted questions. Our BMA representative leaders have indicated that this is a prime opportunity to make noise about general practice and help broaden awareness. If you are tempted to submit a question go to the form. One question to consider:
‘Primary care receives 7-8% of NHS funding but sees 90% of patient contacts. Should you win this election, how will you guarantee that general practice stops haemorrhaging GPs, is fairly funded within the wider NHS, and that GPs have autonomy to do our jobs?’
Also please remember Wednesday 19th June, Devon LMC is hosting an evening with Dr Katie Bramall-Stainer (Chair of GPC England) and Dr Julius Parker (Deputy Chair of GPC England) at Exeter Racecourse – if you wish to attend click here to register and find out more.
Best wishes
Justin
23rd May 2024
We will have to see what the impact of the general election will be, but one thing is certain - regardless of the party that is elected, our patients will continue to need access to good, safe general practice. To achieve that we need GPs to have a sustainable workload.
The BMA have created the ‘GP Diary – Your essential tool for workload management’ - the aim is to create a tool that allows a better understanding of how you manage your work. If you want the headlines (for those that like videos) – click here
So if you continue to work over your contracted hours, and feel you need a better handle on where time is being spent this GP diary may help.
It will help provide information to leverage change.
Best wishes
Justin
16th May 2024
GP leaders in England vote to launch a ballot for collective action!
Hot off the press this week the BMA have announced that GP leaders have voted to ballot on potential collective action in England. The ballot will be open to GP contractors/partners and, if there is a majority vote, then doctors will be able to take action immediately; the BMA will not direct GPs to breach their contracts in this initial phase.
So if you are a partner you will have a major voice, as long as you are a BMA member.
Best wishes
Justin
10th May 2024
Seven ICBs are to test new ‘operating models’ and one of them is Somerset! While the details are yet to be released, HSJ this week has reported that the scheme will begin with an analysis and baselining of demand in general practice. I know you will agree with me but there never seems to be a day in practice where demand and complexity is anything other than high. However, how good are we at evidencing our demand? Could Somerset be the county where general practice grabs the initiative and manages to measure demand to devise better systems for our patients? Having spent the afternoon with the LMC committee yesterday I am hopeful ?
Best wishes
Justin
3rd May 2024
Are you measles ready? Knowledge up to date? Know how to manage? IPC measures in the practice updated?
Most of us will not have seen many measles cases. Perhaps best to take a few minutes to refresh our knowledge. The ICB updates are excellent and the statistics of 100 susceptible people (not vaccinated against measles) who are exposed to the virus results in about 90 people with measles and 7 with complications, certainly hits home the need to be immunised and be measles aware.
Key facts:
1. Symptoms before the rash (2-4 days before the rash)
2. Fever escalation at rash onset - offers opportunity to suspect the diagnosis
3. Koplik spots – usually disappear on day 2 of the rash
4. The rash usually starts on the face
All cases must be reported to the Health Protection Team (HPT) on 0300 303 8162 / swhpt@ukha.gov.uk. The HPT will co-ordinate testing and any subsequent actions. Remember reporting is also appropriate for patients who you suspect have measles from a telephone assessment.
Risk assessment of contacts is important – know the process. Measles Update NHS Somerset is an excellent summary. Full NHS guidance click here.
Best wishes
Justin
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
