Dr Una Coales, blogging about life, family and medical politics

How to save the NHS and the Health Bill

2012-02-12T14:22:00.002Z

How to save the NHS and the Health Bill.

What is the purpose of the Health Bill?It is to SAVE the NHS!

A glimpse into the current state of affairs ofthe NHS. Cracks in the NHS:

· Queen Mary's Hospital in Sidcup closed its majorAccident and Emergency department in 2010. Patients are now being diverted toQueen Elizabeth II hospital in Woolwich.

· Queen Mary's also closed their maternity wingand cancer wards due to lack of NHS funds.

· Queen Elizabeth II hospital declared a deficitof £20 million in 2005 and closed their urology ward to save £1 million. Thatmeans patients with benign urological and even urological cancer patients mayhave suffered. NHS whistleblower, Mr Ramon Niekrash, a consultant urologicalsurgeon, highlighted how his cancer patients were not being seen in a timelyfashion and relayed how one patient was not told he had cancer for 6 months, ashis outpatient clinic appointment had been cancelled and rescheduledrepeatedly, despite an ultrasound scan confirming cancer 6 months earlier. NHScancer patients may well have suffered as he also relays how over 400 patientsdisappeared from the waiting list for cancer referrals. How can we ensurepatients are safe if NHS whistleblowers are victimised, suspended by the trustand end up with a £170,000 legal bill for representation at an employmenttribunal, that they win yet the court does not cover legal costs?

· Helen Ellis, a patient advocate, organised apatient march outside of Queen Elizabeth II hospital demanding better NHSservice at this NHS hospital in Woolwich. She highlighted how elderly patientswere allegedly being mistreated by staff at this NHS hospital. Even nowrelatives of elderly patients come to her to speak up on behalf of what theyhave seen.

· A mental patient at Queen Elizabeth II hospitalwas discharged into the community early and killed a grandmother and injured ayoung lady at a bus stop in October of 2011!

· A GP trainee switched careers and leftA&E and relays he will not go back even for £120 an hour. Why? What didhe see?

· A GP trainee relays how she is working alongsidea NHS hospital doctor hired from Bulgaria who doesn't even speak English. Sowhy did the NHS hospital management hire him?

· Nurses at St Thomas' Hospital in London arescanning patients. Nurse practitioners are seeing patients in clinics at Guys.Nurse consultants are running casualty departments. Patients have a right to betreated by a qualified medical doctor and not a cheaper substitute.

There are so many cracks indicating that the NHSis in crisis and needs help.

We have spent £102 billion in 2010/2011on NHS expenditure to treat the 62 million who live in the UK. Thatworks out to an average budget of £1,645 per man, woman and child inthe UK. Yet an operation can easily cost £3,000. It is easy to see howNHS debt can accumulate in hospitals with a growing ageing population who mayrequire CABG surgery, hip or knee replacements, reduction and fixation of hipfractures, etc.

The Health Bill is asking us to find £20 billionefficiency savings over the next 5 years. We are already doing this. We spent£110 billion in 2008/09 on NHS expenditure, ie from £1,775 per man, woman andchild and £102 billion in 2010/2011, ie £1,645 per man, woman and child. Soover the past 2 years we have already reduced NHS expenditure by £8 billion, ie£4 billion a year. It is possible and is only a reduction of £65 per person peryear.

We are asking help to save this gem inour crown, the NHS.

We are asking to share the burden with theprivate sector. Is it moral to allow NHS hospitals to earn up to 49% oftheir income from the private sector? Yes because GPs and community pharmacists,who are private independent contractors and always have been since 1948, havelong been receiving an income with profit from the NHS. Giving NHS hospitalsthe ability to participate in the profit from the private sector will provideadditional resources for NHS patients. NHS hospitals should only beproviding services to the private sector to the extent that this enables NHStrusts to add to and enhance the service and level of care to NHS patients. YESis it moral to save lives from private sector profits!

Already private hospitals are sharing theNHS burden by allocating up to 25% of their resources treating NHS patientsat their hospitals at marginal cost to the NHS. Already Specsavers is sharingthe NHS burden by seeing NHS patients for diabetic retinal screening, hearingtests and digital hearing aids in their high street shops. Already CrystalPalace sports injury centre is offering NHS slots for physio.

There is more accountability with theprivate sector. If Mid Staffs had been a private hospital, thedirectors would have appeared in court and been sent to jail! Instead some havebeen promoted! It is much easier to fire people in the private sector than itis in the NHS. It is also easier for patients to complain about poor service inthe private sector than the NHS. Although PALS is doing a great job on behalfof NHS hospital patients but for doctor and nurses who blow the whistle, thestory is different. Lansley did introduce more protection for NHSwhistleblowers, amidst tales of £30k-£120k pay offs to be silences, gaggingclauses and illegal garden leaves.

A taxi driver suggested to me that we could even askthe National Lottery to help by giving money to the NHS? The publiccare and want to help. They know we are in a national recession!

How can private income benefit theNHS?

NHS Whiston Hospital in Merseyside is offeringPIP implant replacement for a private top up fee from £1000 to implant Nagor.Nagor is offering free implants to all PIP victims. This means NHS Whiston hasthe potential of making a profit of £1000 on each PIP patient who cannot afford£5000 for replacement on the private sector but can just about scrape together£1000, as only NHS Wales is offering free replacement with removal. If NHSWhiston hospital took on 20,000 PIP victims, (ie those victims that the privateclinics are reneging on their moral duty to provide after care and replacefaulty implants), they could generate £20 million income to pump backinto the NHS for NHS patients! And with NHS Choose and Book, any patientin England may be referred to the NHS Whiston Hospital.

A role for MHRA to do annualsurveillance checks on 120,000 UK medical devices

We could even look at the PIP scandal and see a win:winsolution for the NHS and UK economy. Clearly the DH MHRAshould change from an organisation that only looks at adverse event reportingto one of actually testing and annual surveillance of medical devices on the UKmarket. They could adopt a role similar to the US FDA. They could generate£120 million in revenue by charging £1000 for annual spot check inspections offactories manufacturing all 120,000 medical devices on the UK market.Hotel inspectors who rate hotels do not give notice of their inspections? TheUK medical device industry is a market of £7 billion to tap into, to both ensureBritish patients are safe and generate revenue for the DH to pump back into theNHS.

A role for the MHRA to test allmedical devices before putting them on the UK market.

The MHRA could charge £10,000 for each medicaldevice to be tested by the MHRA labs to ensure they are safe for the UK marketinstead of automatically approving European CE kite marks. £10,000 x 120applications is £1.2 million. £10,000 x 120,000 annual applications is £1.2billion to both build laboratories, testing facilities, create jobs forscientists and offer grants to university students to read chemistry andengineering in Britain! MHRA could also ensure that all applicants haveinsurance in place to pay victims compensation if devices are recalled, faultyor later banned for safety reasons.

GPs lead clinical commissioninggroups.

They will ensure against cherry picking. Theymust also ensure that local bidders have an equal chance of winningtenders as large corporations. Perhaps local patient representstivesshould be included in the panel who decide where tenders go to ensure best careis provided for their local communities. At the heart of all this NHSreform, is a clear message that the NHS patient comes first and has to receivebest care!

So when I hear of NHS patients suffering,nurses taking over doctor duties, NHS hospitals closing vital services fortheir localities, and NHS consultant whistleblowers being victimised, I say weneed to reform the NHS!

Leaked London Risk Assessment; Health Bill and privatisation? What does it really mean?

2012-02-10T22:09:00.003Z

LEAKED NHS LONDON RISK REGISTER. WHAT DOES IT MEAN?

According to a Labour member interpretation of the NHS risk register, we should be worried about the Health Bill. Well I have had a look at this leaked NHS London risk register. Click NHS London Risk Assessment (Annex A Corporate Risk Assurance Framework) and also had it reviewed by an independent economist and we both came to the same conclusion.

The first column is labelled as risk, the second as mitigating control (actions) and the third as assurances. In other words this table lists possible risks, then existing and planned mitigation of risks. In other words, there are assurances of risk mitigation in place or will be in place to offset any risks from restructuring NHS London.

Now let us see what an independent economist interpreted the table as:

'The purpose of a risk register is to identify all the things that could go worng (as opposed to things you expect to go wrong). Once you have identified things that could go wrong, it enables you to put in place mechanisms for dealing with them. If you do this properly the risk is much reduced.'

So both a GP and economist have reached the same conclusion. What is the big deal? So NHS London did a risk asssessment and made provisions for anything that could go wrong. Sensible and logical.

PRIVATISATION AND THE HEALTH BILL. WHAT DOES IT MEAN?

Another piece of scaremongery with the Health Bill is that it will bring about the end of the NHS and introduce privatisation. Hello???? GPs and community pharmacists are private independent contractors paid by the NHS to provide and deliver a service. They are self employed. They do not work for the NHS; they are contracted by the NHS. Are we then asking for GPs to be nationalised? Would GPs consent to be paid the same NHS hospital payscale as NHS consultant employees? I doubt it. The average pay of a salaried GP is £55,000 and the average pay of a GP partner is upwards of £100,000. We could ask all GPs to be nationalised and be NHS employees at a pay scale of say £90,000?

No of course they would not consent to be state employees. They are independent providers who can set their own prices.

Do we like our high street shops? Specsavers offers free NHS diabetic retinal screening, eye exams, hearing tests and digital hearing aids. Do NHS patients have to pay? Nope. It's free. The patient is a winner. Is this private care? Well it isn't sitting for hours in a NHS outpatient clinic but it is still providing you with the same free service but faster and more convenient for you. RECEIVE FREE hearing tests and hearing aids AT SPECSAVERS.

Did you know you can use NHS Choose and Book and be seen and TREATED AT A PRIVATE HOSPITAL FOR FREE as a NHS patient? They have 3 theatres, endoscopy suite, outpatient clinics with NHS/private consultants, ensuite rooms, etc. Click NHS patients seen at BMI Blackhealth Private Hospital.

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To find out more about NHS Choose & Book programme please speak to your GP or contact the NHS Telephone Appointments Line on 0845 608 8888 with your Unique Booking Reference Number (UBRN), which is given to you by your GP.

NHS Choose & Book Clinics at BMI Blackheath Private Hospital

Adult cholecystectomy
Adult vasectomy
Adult foot & ankle
Adult hernia repair
Adult gynaecology
Adult knee
Adult large intestine
Adult cataract
Adult hip
Adult gastroscopy
Adult surgery for prolapsed intervetebral disc
Adult pain management

Would you like to have your PHYSIO FOR FREE AT AN AWARD WINNING PRIVATE SPORTS CENTRE? Click Crystal Palace Physio and Sports Injury Centre. They have slots for NHS patients alongside their private clients and it is FREE PHYSIO to you the NHS patient.

So what is happening? Well the CCGs get to select which provider can offer a more efficient service. It is all about freedom of patient choice! Choice of NHS or private and it is still FREE! And why can we do this, because private providers can charge NHS patients the marginal cost rather than the average cost and their tariff works out cheaper than that of some local NHS trusts who are more expensive.

How to be an empathic GP for a PIP victim

2012-02-10T13:16:00.003Z

I am still hearing some appalling stories from PIP ladies of uncaring GPs and PIP ladies changing GPs up to 5 times to find a sympathetic one. Fortunately I am also hearing stories of good GPs.

Here is how to be an empathic GP for a PIP victim.

GP: 'How may I help you?'

Patient: 'I have a PIP implant and I want a scan.'

GP: 'Tell me more. What has happened?'

Patient 'I had a PIP implant but my private clinic wants me to get a scan first before they will see me. They said I have to see my GP. If it has ruptured, I have to pay them £3,000 for replacement. If it hasn't ruptured, they will charge me £5000.'

GP: 'I am so sorry to hear this. I have heard about the PIP scandal. Are you having any symptoms? Do you think your implants have ruptured?'

Patient: 'There is rippling and it just doesn't feel the same. I am really worried. I have heard horror stories of what happens when silicone leaks. Some ladies have silicone lumps in their lymph nodes and some say they are in a wheelchair because of their implants. I just don't want this industrial silicone to rupture and leak inside my body.' Patient gets tearful.

GP offers a tissue and touches the patient's hand or arm: 'I am so sorry. I am here to help you and will do everything I can to help. Do you mind if I ask you some personal questions please? Do you work?'

Patient: 'Yes I work at a local chemist. But I haven't been to work as I am not sleeping. I am so depressed and worried over this.'

GP: 'I see you are worrying a lot. And you are also having money worries as you now have to find a way to raise £1000s of pounds for replacement too?'

Patient: 'yes, it's a nightmare. Some of my friends have asked their elderly parents for loans but I think I will have to collect credit cards to raise the money. I can't ask my husband to pay as he saved so much for the first time and wanted me to feel better about myself. I only had the operation 3 years ago.'

GP: 'Who else is at home with you?'

Patient: '2 children, toddlers. I feel so bad as I just cannot get this out of my mind. I know I have been awful to be around, and I feel so guilty as I am not being a good mother. I just lie in bed all day and my husband has to look after the children.'

GP: 'This is such a hard time for you. I completely understand. May I examine you? Would you like me to arrange a chaperone for the exam?'

Patient: 'No that's okay. You can go ahead.'

GP takes patient to the examining couch, pulls the curtain and locks the consulting room door so that there will not be any interruptions during an intimate exam.

The GP drapes a blanket over the patient's lap and a paper sheet over her chest. She uncovers one breast at a time to maintain the patient's modesty and self respect. She explains what she is doing and is as gentle as she can be.

Patient then is thanked and invited to get dressed and sit down.

GP: 'Yes I have noted on exam that the right breast is a different shape from the left and there is rippling. I know you are very anxious and I would be happy to arrange an ultrasound scan for you. The policy at our local trust is that it has to be arranged through the local hospital's breast clinic, so with your permission I would like to refer you urgently as you are extremely anxious and this is impacting on your well being, work and home life. The local breast clinic has a special dedicated PIP clinic so you should be seen within 2 weeks. If you have not heard, please call me back so I can chase this. I shall fax the referral so they will receive today. May I check that I have your correct details?'

Patient smiles and says, 'Thank you Dr X. You have listened to me.'

GP: 'You also mentioned that you were unable to work due to this stress. Shall I write you a sick note for 2 weeks to help you?'

Patient: 'Yes please. That would help.'

GP: 'You seem so depressed. Do you want me to arrange for some counselling for you to help you get through this hard time? We have an in-house practice counsellor?'

Patient: 'No that's okay. I think once I get a scan and can find out whether my implants have ruptured or not I can get some piece of mind. Although, I still want them out no matter what it shows.'

GP: 'I am so sorry that the NHS is not offering replacement with removal at this time. However there is one NHS trust in Merseyside that is offering replacement from £1000. This may help you with your finances. Do come back and see me and let me know what the breast clinic says and we can take it from there. I may be able to refer you through our NHS Choose and Book system to have the implants remove and replaced at the NHS Whiston hospital.'

Patient: 'Thank you doctor. I feel a bit better knowing I am not being fobbed off and that you care. Can I see you again?'

The strengths behind the Health Bill and why I support it

2012-02-09T10:04:00.001Z

Amidst outcries that the Health Bill must be withdrawn, I ask myself why? Why are we turning down the only way to save the NHS. The NHS is in the RED, is in debt. There is no denying that the NHS is in trouble. The Coalition government and treasury have decided that it must show £20 billion efficiency savings over the next 5 years. BILLIONS not millions. So obviously 'Houston we have a problem' with our National Health Service and the ever-increasing demands and health needs of a growing and ageing population.

WHAT ARE THE STRENGTHS OF THE HEALTH BILL?

1. COMPETITION DRIVES UP STANDARDS

Some shirk at the word and think this means care will be compromised, profits will go into director and share-holder pockets? Yet what is happening as we speak?

GPs are now heading CCGs (Clinical Commissioning Groups) alongside some retained PCT managers but this time it is the GPs who are in charge and not vice versa, with the LMC Chairs who used to have to sit and listen to edicts handed down by the finance director of the PCT at joint LMC/PCT meetings. Sitting on the Lambeth LMC board in 2010, I asked the GP Chair, 'Why couldn't we control the PCT budget? Why aren't we in charge? Why are managers in charge of us?' She replied this was a problem that needed to be dealt with at a national level as we were just a local body. And so I sat back, reflected and listened in silence to the finance director discuss the 5-year plan for NHS London and show us the breakdown of debt in the millions accumulated mostly by local NHS London hospitals. We were on the backseat, helpless even to challenge hospital tariff prices. Why was an OGTT test being billed to the PCT for £900? Surely £90 would seem more reasonable? Why was banding of haemorrhoids billed at £200 a patient when it could be done for £20 a patient in the community with a visiting colorectal surgeon and a banding gun?

Hey presto, GPs are NOW IN CHARGE OF PCT managers! We should be happy! We can now ask those questions about pricing and demand answers or not pay up! Efficiency savings in progress.

Positive feedback

CCG lead GPs in Halifax, Leicester, West Sussex, Greenwich, Lambeth, Cumbria all tell me in person that their CCGs are working! In Cumbria, the CCG has over 80 local practices on board and if any are poorly performing, they will be asked to leave! Excellent. We have a form of accountability and checking in place led by GPs themselves who know what good practice vs poor practice is. And there is a body above the CCG to whom CCGs are accountable to ensure they too are fair.

Why is it working?

One GP shared that his local hospital was 'overcharging' for a GP ultrasound request. The hospital was lumping a consultant clinic visit to the tariff for an ultrasound ordered by a local GP. Why? On the private sector, an ultrasound costs approximately £150 and comes with a consultant radiologist's report. So why on the NHS do we have to add an additional consultant visit for approx £200 to every ultrasound request? Surely a GP can read out the ultrasound report to his patient. Another shared that he sent a child for a blood test at the local hospital and questioned why the hospital charged over £200 for a simple blood test. The reply was it had to be combined with a consultant clinic visit. Why? A GP can interpret the blood test result as he is the clinician who ordered the test himself? And so with negotiations between the NHS hospital and the local CCG, the tariff for a blood test for a child at this local hospital was brought down to a sensible price that did not require a consultant visit to read out the result.

A Greenwich CCG GP lead organised for a Saturday drop in GP session at the local Morrison's supermarket as patients were not attending surgery. It worked! They were able to offer health screen checks and access their patients for better delivery of service.

A Bexley cardiologist frustrated at the long NHS waiting times for investigations organised a 'heart bus' to take his NHS patients to Harley Street to obtain their echocardiograms there sooner and for less money. Win win for both cardiologist and his NHS patients.

A local GP shares that at her local hospital they charge £55 for hepatitis B screening yet at a private lab in central London they charge only £10 and at Quest diagnostics on Harley Street they charge only £45 for a complete admission pre-op panel of bloods. So why not have a CCG commission lab services in central London for less. Beats having NHS patients wait for hours for a blood test and GPs wait a week for the results to be sent back to them, when patients can be seen faster in a private clinic that only does blood tests and investigations and the results are faxed back to the referring doctor by the end of the same day! Better patient service for less with competition!

The Department of Health Payment by Results is 'pricing' all procedures and investigations in NHS hospitals. There is room for efficiency savings but one has to know the real cost of items, ie like price comparison shopping. A 42 inch plasma tv which used to cost £3000 now costs £500. What is the real cost of a scan, MRI, blood tests, etc.? Can the private sector offer it faster and cheaper than the NHS? Competition drives up standards! Monopolies are at risk of price fixing as there is no competition.

2. HEALTHWATCH ENGLAND, THE ULTIMATE PALS

The Health Bill discusses setting up a national body for patients, called Healthwatch England. This body is for patients and will be the ultimate PALS. So when patients feel they are not heard or have been mistreated, at least this body will listen and intervene with advice and assistance. How can patients not benefit from having a central body of accountability to ensure overall patient safety?

3. INTEGRATION WILL SAVE THE NHS

It is already happening! How can we say the Health Bill will not work when elements are already implemented. With the waiting list initiative, cataract operations are being performed faster in private hospitals to alleviate the strain on the NHS waiting list. Consultants are paid to come in and work on Saturdays to help reduce the burden of the NHS waiting lists.

Crystal Palace Sports Centre offers NHS slots for physiotherapy alongside their private slots. They also are helping alleviate the NHS burden and patients are receiving quality care in plush settings by top-notch physiotherapists. Their physiotherapists even go around educating local NHS GPs to help with CPD education on common knee and shoulder injuries and how to do a 7 minute back exam!

Blackheath private hospital sees both private and NHS patients for in-patient mental health conditions. Which NHS patient would decline care in a beautiful modern setting in a private room for free as opposed to a 6-bedded NHS ward?

Choose and Book already offers patients a choice of NHS and private hospitals for their NHS care. There is no extra charge! It is STILL A FREE NHS SERVICE to patients.

So I have to ask myself, why is there opposition to the Health Bill?

Then I look at what the Coalition Government have lined up for GPs in 2012.... revalidation to commence in December 2012 which will cull a % of the profession if they FAIL and will FAIL a % of GPs every 5 years of their entire working career, CQC practice registration with its onerous checklists and costly premise estimates (up to £30k has been spent by one practice in the private sector) to meet their zealous standards, pension changes means working until a GP is 68 years old (if he is still alive that is, stress does lead to atheromas and sudden heart attacks), pension changes that mean more contributions for less payout?, a push to shift care out of hospitals into the community and onto GPs. This means GPs have to suddenly be as skilled as 'mini hospital consultants in every speciality under the sun from drug misuse, psychiatry, diabetes, heart disease, etc.' which may lead to compounding stress from taking on too much responsibility with potential lack of expertise ('I'm out of my depth' stress). And I EMPATHISE with GPs. It's too much!!! Even patients would crack under this enormous amount of pressure. Alas we GPs cannot write a sick note to ourselves for stress. ENOUGH IS ENOUGH! Compromise! The Coalition Government has got to release the pressure on the noose around GPs' necks. It's too much stress and burden. They are only human not automatons. They have to listen to patients say 'but I pay my taxes. I demand a referral,' vs pressures from the PCT to reduce hospital referrals. They have to read tabloids labelling GPs as greedy and overpaid. Many do not even earn 6-figures. They have to hear of more edicts being handed down by number 10 and say STOP! We can't even catch our breath. And many seek early retirement, immigration to Australia (Blue Mountains is offering $300,000 for GPs), New Zealand, Canada, and are desperate for a way out of this mess.

So what is the solution? COMPROMISE! Scrap something on this huge list of external stressors for GPs....scrap CQC (as a high cost, no manpower to execute properly and little benefit exercise)? Scrap revalidation ( as high cost and little benefit)? And perhaps keep the best of the Health Bill and work with GPs in CCGs (offer more help to CCGs in impoverished areas who have inherited too much PCT debt) to show them you EMPATHISE too with your colleagues and we EMPATHISE too with the Government and its £1.4 trillion national deficit.

Informed-decision making includes patient choice of medical devices

2012-02-06T10:08:00.001Z

I have been made aware that NHS Whiston Hospital Breast Implant Clinic is only offering Nagor implants for the £1k top-up self-pay fee with an expected time of 18 weeks between consultation to operation. May I remind all clinicians and NHS trusts that informed patient decision-making includes giving patients a choice. There may not be many implants to choose from but at least the patient should be empowered to be able to make a choice between those available on the UK market, i.e. a US FDA approved breast implant (Mentor or Allergan Natrelle) or a non US FDA approved breast implant (Nagor or Allergan Cui). To limit a self-paying patient, to one single choice for top-up replacement would be akin to what has happened in the past when private patients were only offered PIP by their surgeons and no choice was offered or discussed.

Patients please ask your breast clinics for a choice of implants and to be included in the decision as to which breast implant medical device you would like to have in place of the banned PIPs. There is no guarantee that we will not be revisiting a 'PIP' scandal in 3-5 years to come (based on past histories of 1999 Trilucent breast implant ban, 2007 PIP Hydrogel breast implant voluntarily recalled by UK manufacturer Cloverleaf PIP, and 2010 PIP Silicone distributed by UK Cloverleaf PIP and manufactured by France PIP banned), so for now please ensure you are included in any and all decision-making of which breast implant you choose to accept. No decision without me!

Instructions for PIP ladies, GPs and surgeons to use online MHRA Adverse Reporting

2012-02-06T09:42:00.001Z

Click Online MHRA Adverse Incident Form for Medical Devices

MHRA has reported a rupture rate of only 1% in contrast to the French AFSSAPS figures of 5%, plastic surgeons Stanek and Berry's rates of 16-34% (in contrast to only 0.87% for Allergan) and PIP patient support group figures collected of up to 31%. MHRA bases their 1% on data collected from Adverse Incident Reporting. This depends on patients and clinicians reporting all incidents. Yet how many surgeons and patients remember to complete an MHRA adverse incident form? Do some surgeons just chuck the faulty implants in the bin and forget to contact MHRA? Are all plastic surgeons remembering to log batch numbers of medical devices they implant? If a private clinic is closed, what happens to the patients' records? How many patients know what MHRA stands for or that there is such an incident form to complete when they are suffering from symptoms (burning breasts, chronic fatigue syndrome, fibromyalgia, silicone in lymph nodes, etc.) associated with a leaking implant? Who notifies MHRA, when a patient goes elsewhere for removal for rupture or silicone bleed? How certain are we that 100% of all adverse incidents are reported to the MHRA to give a completely accurate picture of PIP complications?

I advise all PIP victims to complete the online MHRA adverse incident form. It will only take 5 minutes to enter your details as the patient, the surgeon and hospital details of where you had your PIPs implanted and the surgeon and hospital details of where you had them explanted. It will also ask you of batch numbers if you have them, when you started having symptoms, and of any complications and effects to you and your family/ children.

We as GPs complete Notification of Disease Incident Forms for food poisoning to Public Health when patients come in with adverse effects from eating at a public restaurant. And so too, may we as GPs remind our PIP victim patients that they or their surgeons should in turn be reporting any adverse events directly to the MHRA using their incident forms.

Until MHRA develop their own testing facilities, their role is solely to monitor adverse incidents. It relies on patients and clinicians to supply them with data of adverse effects, i.e. rupture or the results may be under-reported to the Department of Health.

Do your part and fill a report!

PIP breast implant accountability. Health Bill in action. Competition works!

2012-02-04T10:52:00.003Z

Who is to blame for the PIP scandal? Who is to be held to account? What questions need to be raised to prevent this from happening again?

Manufacturer

Jean-Claude Mas the PIP owner has had his charge reduced from manslaughter to involuntary injury for the death of a French PIP lady who died of a rare cancer and the 300,000 worldwide victims duped into being implanted with 'industrial' silicone implants. Pays to have an expensive lawyer to dodge accountability?

We have been here before...certain US bankers and a global meltdown?

MHRA's defence to the Lancet, 27 Jan 2012
The Lancet, Early Online Publication

The Chief Executive of the Medicines and Healthcare products Regulatory Agency (MHRA) states 'under the current system, any medical device can be sold in the UK once the product holds a CE mark obtained in any EU member state. It is the MHRA's responsibility to investigate adverse events.'

I am reminded that under the current system, any doctor trained in any EU member state holding a European medical school degree can be registered with the General Medical Council and work for the National Health Service. It is the GMC's responsibility to investigate any adverse complaints.

Hmmmm...so is the PIP scandal blame being passed back to the EU? If so, then why is the French government not compensating PIP victims in the UK for failures in their government's regulatory processes for medical devices?

We have been here before...
Channel 4 Dispatches question safety regulation of medical devices May 2011. Why has nothing changed and improved since faults were found with heart medical devices (pacemakers) and hip implants?

Telegraph Breast implant scandal inevitable due to MHRA failings Lancet.html

MHRA

In 1996, Trilucent breast implants, approved by the MHRA, were heralded as the latest breakthrough in breast implants! Made from natural soya so if it ruptures, your body will absorb soya naturally. In 1999, the MHRA subsequently banned this breast implant. It was found to be mutagenic and carcinogenic in rats. Interestingly, this implant was an American implant that could only get CE=MHRA approval, so sold 5000 implants to Europe and only 50 were used in the US for testing purposes only. Has the UK and Europe become the new laboratory grounds for pre-testing of US products with its lax European regulations for CE marks and a UK MHRA which automatically accepts a CE mark for the UK market? The UK market for medical devices was quoted by the MHRA in 2009 as £7 billion!

Then came Hydrogel breast implants, approved by the MHRA, and manufactured by PIP Cloverleaf in the UK. Yes that's right, a UK manufacturer of breast implants! This too was pitched as the latest breast implant made from sugar water so perfectly safe. Non-silicone implants are superior to silicone which interferes with mammograms to screen for breast cancer was the message conveyed to the consumer. In 2007, MHRA announces voluntary recall of PIP hydrogel breast implants.

Then we have French PIP breast implants, approved by the MHRA based on a CE mark, distributed in the UK by the same company PIP Cloverleaf. Heralded as cohesive silicone gel so less likely to rupture and leak. Also comes in a special tear-shaped design so it looks most natural. Recommended in ladies with previous ruptures. In 2010, the MHRA banned PIPs.

So over the past decade, the MHRA appears to have a 100% failure rate in successfully approving breast implants that will not subsequently get banned or recalled. Why did the MHRA approve breast implants that failed inspection by the US FDA? Why did the MHRA ignore evidence from the US FDA that in March 2000, 11 deficiencies were found in good manufacturing processes at the French PIP factory? Why did they not take into account that all 3 implants failed to pass US FDA inspection. There had to be valid reasons?

US FDA

The US Food and Drug Administration is the only global independent regulatory body for medical devices who has had a 100% success rate in identifying which breast implants are not up to standards. The US FDA denied applications made by Trilucent, by Hydrogel and by PIP. 100% accuracy rate! No ladies in the US suffered as a result of there stringent regulatory testing processes which take an average of 54 months to complete vs the EU's 11 months. It does not give 2 weeks notice of a site visit, as does the MHRA. The global market for medical devices is £200 billion. Because of the high litigation rates which ensures accountability in the US, the US FDA has to be more stringent and rigorous in their testing and follow up to ensure patient safety.

Allergan vs Nagor?

I get asked by PIP victims which breast implant is better for a replacement implant. Well according to Nagor's website About Nagor they are in the process of applying for pre-market approval from the US FDA to sell to the States. They are offering free Nagors for any ruptured PIP implant in the UK. Sounds good however bear in mind that CE=MHRA approval and they do not yet have US FDA approval. We have identified that the only independent regulatory body with a 100% accuracy rate for breast implants over the past decade is the US FDA. And therefore, in my personal opinion, based on the fact that only Allergan Natrelle and Mentor have obtained full US FDA approval, I would have to select Allergan Natrelle or Mentor for now. However patients may make their own fully informed decision. They must know all the facts and history behind CE=MHRA approval of breast implants over the past decade and subsequent bans or recalls. These applications should never have been approved if the MHRA had a process by which they could do their own testing of these implants before placing them on the UK market to be implanted into humans with just automatic approvals for CE marks. In fact it would cost nil to just change the MHRA policy to only automatically approve US FDA devices and not CE marks, until the MHRA do their own testing or until the EU reform and improve their regulatory testing of devices.

GP's role
Be aware that some PIP ladies may be suffering an autoimmune reaction to silicone gel bleeds which may result in chronic fatigue syndrome, fibromyalgia, burning sensation in breasts, etc. Offer a lymphocyte chemical sensitivity test to silicone. Approx cost £80. Silicone gel bleeds may not be evident on ultrasound so they may still have a leak/bleed/sweating of industrial silicone without a rupture.

Be familiar with NHS Choose and Book which allows any PIP lady to be referred to any hospital in the UK including NHS Whiston and St Helens breast implant clinic as they are the only trust in England who are offering from £1k top up for replacement with removal on the NHS. NHS Wales already offers free replacement with removal.

Private Clinics responsibility
Private surgeons, who are employed by companies like Transform and HMG, are paid low rates of approx £419 for breast augmentation. It is the companies who buy in bulk and decided to buy PIPs. It is the private clinics who should be offering free replacements with removals.

Private surgeons' responsibility
Independent private surgeons are waiving their operating fees (approx £1k) and their anaesthetists (£300-400) have also offered this gesture. Patients are finding they have to self pay for use of day case hospital facilities and the replacement implant. Private surgeons do not buy the implants. It is the private hospitals who purchase and stock implants for their operating theatres.

NHS trusts responsibility
Whether they are seeing a PIP lady for CBT counselling for depression, psychiatric outpatients for anxiety or in breast clinic for scanning, be aware that a scan has a 70% sensitivity and an MRI a 94% sensitivity rate, but that PIP victims may still have an intracapsular rupture or gel bleed as these imaging investigations are not 100% accurate. The only way to be 100% certain is at explantation and private surgeons are now reporting higher rates of rupture and gel bleed than initial scans may have suggested. NHS clinics are being judged by PIP ladies on how they are treated by staff and the system and outcomes.

And so we draw an analogy and parallels again to medicine and doctors and patient safety.
All overseas medical graduates currently sit an IELTS English language test and a PLAB (NHS medicine knowledge test) before they work in the UK for the NHS with the sole exception being doctors from the EU! Overseas countries include surprisingly USA, Canada, ie English speaking countries as well as India, Pakistan, SE Asia, etc. Yet for economical and political reasons, UK does not test any EU medical graduate? Even our own UK graduates are tested. They are subjected to a competitive and rigorous 3-7 year postgraduate medical specialty training programme and have to sit and pass licensing medical exams ie MRCGP or MRCS to work as a GP or hospital surgeon at a higher grade. Why are we then lax with European doctors and exempting them from testing? Are we setting up the NHS for more 'adverse events'?

UK GMC Revalidation of Doctors vs US Medical Board Testing of Doctors. Which medical regulatory body is better? Reminds me of US FDA vs UK MHRA? Which medical device regulatory body is better?
Then comes the UK GMC regulatory body introducing the Revalidation of Doctors, scheduled to commence December 2012 to ensure doctors are regulated and safe. Hmmm wait a minute, they will not be tested! So like medical devices, medical doctors will not be tested to prove they are still safe? Hm so what will be checked? Paperwork evidence, ie can they do an audit of how many male or female patients they see in surgery (yes an audit is anything that involves numbers), can you supply 3 emails of colleagues who will do a multisource feedback about you, can you submit 40 patient satisfaction questionnaires, etc. You get the picture. Where in all this is the medical product or medical doctor tested? No rigorous objective standards testing? So where do they do it properly? Over 600,000 registered US physicians and surgeons agreed that the only way to reliably ensure that a medical doctor is safe is with a 10-yearly specialty medical board exam thoroughly TESTING medical knowledge. And so I fight revalidation on the grounds that it does not ensure 100% that a doctor is up to date and safe and will divert £1 billion a year from strapped NHS funds for patient care.

Another parallel can be drawn between NHS providers competing with the private sector.
What has happened is that consumers, ie the PIP ladies themselves are experiencing what it is like in a world where they are given choice. Here they can see which NHS GP they prefer to see based on how they have been treated. They can also opt on which NHS hospital to be referred to based on word of mouth and what services are on offer, whether it is a one-stop breast clinic, whether they can get an MRI scan with ease or are refused even an ultrasound scan, whether they are offered £1k top up fee for replacement with NHS removal at a NHS trust, etc. With Choose and Book there are no NHS hospital boundaries and patients may choose to be treated at any hospital in England!

And suddenly we see that the NHS hospital that comes out at the top is NHS Whiston Hospital and its Breast Implant Clinic with its dedicated phone number and excellent service. They received £250 million for rebuild and are now establishing a name for themselves as being innovative and caring! How will they be reimbursed? The DH has already stated that a NHS trust may charge a top up. So there is no added cost as it is self-pay, and as implants only cost up to £300, dare I say a little profit to be had? Yet what do we see elsewhere? NHS trusts who are not au-fait with what is happening, some radiology staff being off-handed and judgemental with PIP victims, we see a rise in complaints by these PIP ladies for bad treatment, etc. With competition comes better service!

Here the private clinics see what adverse publicity, marches outside their clinics, ie poor customer service feedback does and the HMG has done a U-turn and are offering free replacement with removal for PIP ladies with less than 6 years implantation.

We see competition among private surgeons to offer replacement with removals for any PIP victim. We see PIP ladies discussing among themselves and sharing information about how they were treated by various surgeons and which did a better job, listened, cared and gave them an excellent outcome. The same is happening among litigation firms. PIP victims have choices for comparison.

Did competition increase patient costs? Well initially some private clinics increased their scan rates to take advantage of these PIP victims but quickly saw that the ones who offered discounts and were more caring, got most of the business. So market forces made them drop their prices and not take advantage of their customers in a competitive market and we see clinics like 108 Harley who from the start dropped their prices and went even lower to a £150 special PIP support rate to scan PIP ladies and as a result, 150 national PIP ladies chose this provider for their scans in the month of January alone, when their NHS provider was unhelpful or was not current with the DH guidance or other private clinics were overcharging. They compared prices and service.

So we actually see better service in action with competition. We see prices fall. We see efficiency in action. We see patients having a choice between NHS and private providers. The Health Bill can work and it takes collaboration not an obstinate complete refusal to work with our government as they try to save this country from economic implosion due to the catastrophic consequences of certain bankers across the pond....

Close all loop holes. Regulation demands accountability. Proper processes and rigorous testing ensure against patient harm.

Instructions for private PIP implant ladies who cannot afford £3-5k replacement

2012-02-02T16:36:00.002Z

The NHS trust of St Helens and Knowsley Teaching Hospital in Merseyside has published an announcement that they are offering top up payment from £1k for private PIP implant ladies to receive replacement at time of NHS removal! Click St Helens and Knowsley Teaching Hospital announcement on PIP

'However, if a patient has had PIP breast implants performed by a private hospital/clinic, the NHS will only fund the costs of removing the PIP implants. These patients can opt to have new implants inserted at the same time which will cost from £1000 at this Trust. We can offer you the expertise and skills to advise you and allow you to have your surgery in this renowned NHS organisation. At Whiston and St Helens hospitals we specialise in various types of breast surgery, involving breast implants and perform more operations than any other Trust in the North West. All surgery is carried out by our expert team of clinicians who specialise in plastic surgery. Our facilities are state of the art with the most up to date technology in ultra clean operating theatres. The Trust provides British made silicone implants which are manufactured using medical grade silicone only.

If you decide to have your PIP breast implants removed and wish to consider having them replaced with an alternative implant, or need advice from one of our skilled Consultant Plastic Surgeons, please contact Whiston Hospital on 0151 430 1992.'

Whiston Hospital received £250 million for rebuild which was completed and opened to patients in April 2010. It has become a beacon of gold standard of care. In a climate of national suffering of 40,000 PIP lady victims, 95% private, Whiston and St Helens NHS Hospitals in Merseyside have come to the rescue with a mutual solution!

Chief Medical Officer Dame Sally Davies made it clear in the latest Department of Health PIP guidance dated 27 January, that NHS trusts could offer top up fees for private services in a NHS trust, annex D. Click Department of Health PIP guidance. This paved the way for the most forward-thinking and compassionate trusts to offer an at-cost top up fee for replacement of the PIP implant at time of NHS removal for private PIP ladies to save these ladies agonising over how they were to raise £3-5k to self pay for a separate operation for replacement.

So how do you access this if you live outside of Merseyside? Ask your GP to refer you to St Helens or to Whiston Hospital breast implant clinic under the NHS choose and book service.

Click NHS patients have a right to choose any hospital in England

'Most patients now have the right to choose which hospital provider they are referred to by their GP. This legal right, which was introduced in April 2009, lets patients choose from any hospital provider in England offering a suitable treatment that meets NHS standards and costs.'

No longer do PIP victims have to weep because they cannot raise £3k for rupture replacement or £5k for non rupture replacement or try to keep sane by taking antidepressants. Now St Helens and Knowsley Teaching Hospital NHS Trust has stepped up and implemented a top up arrangement for private PIP victims. May all NHS trusts offer similar top up fees for their PIP lady victims. Remove and replace! Be safe! No longer do ladies have to take prozac and sedatives to keep their anxiety and depression at bay because they cannot afford self pay replacement. Thank goodness for reason and humanity. Thank you St Helens and Whiston Hospitals and it is no surprise that the Chief Executive of Whiston Hospital is a lady Ann Marr! Hats off to you!

Lansley must listen to Edwina Hart, Welsh Health Minister

2012-02-02T07:44:00.000Z

BBC News PIP Breast Implant Rows

I have huge admiration for a female health minister who empathises with PIP victims. Wales is doing the right thing! They recognise that to leave an industrial worldwide banned implant inside a lady and not replace with a medical implant as the lady had originally consented to, is continued abuse and lack of respect and dignity towards ladies in society. It is patronising and sexist!

I applaud Dame Sally Davies, the Chief Medical Officer, for opening doors with her latest Department of Health PIP guidance issued January 27 which includes an annex D which shows NHS trusts how to offer top up self pay at cost for replacement implants at time of removal. How inhumane to leave ladies with little to no breast tissue as though they have undergone a mastectomy and not offer replacement at cost?

I applaud Whiston NHS Hospital in St Helens, Merseyside, for being a pioneering hospital to offer private PIP ladies NHS replacements from a top up fee of £1k and hope all NHS hospitals follow suit.

I applaud the private anaesthetists who have been waiving their fees to help private surgeons who have also waived their fees to remove and replace ruptured PIP implants. Anaesthetists surely are not at fault yet they are making a collective magnanimous gesture to help their surgical team!

I applaud NHS GPs in Manchester, Warrington and Hertfordshire for showing empathy to PIP victims and arranging scans as per the latest DH PIP guidance. I am saddened to hear of GPs working in the postcodes NP20, CF82, TD15, SA10, SS12, SS17 who are refusing scans or referrals for their PIP lady patients and causing more upset and worry. This then raises an issue that even though NHS Wales has agreed to remove and replace PIP implants for their residents, if their GPs are blocking referrals to hospital, how can these victims access due care?

When a PIP victim receives news that her ultrasound or MRI shows no rupture, she is not ecstatic but often saddened as now she faces immense financial constraints. Private clinics and surgeons are offering free or discounted removal with replacements only if the implant has ruptured. Some PIP ladies are praying their industrial implants have ruptured on their scans! It is so wrong for our society to ask that these industrial implants rupture silicone, bleed gel into the lymphatics and surrounding lymph nodes in the neck and armpits, before we remove and replace them? We know they will rupture in time. Surely we should be promoting preventative medicine. We are now spending NHS money on counselling, prozac, numerous NHS clinic appointments, numerous repeated visits to the GP until these ladies get peace of mind! The PIP implants have already been BANNED and are no longer implanted. Surely then a recall means just that, a recall! Which is why EU and South American countries are offering removal with replacement to all their PIP ladies whether it has ruptured or not.

Please show humanity to these PIP ladies. Please let all NHS England and Scotland follow the latest January 27 Department of Health guidance from Dame Sally Davies and make clear the arrangements so that private PIP ladies may pay top up at cost for replacement. Else they are forced to raise £3k to replace privately or £5k if the implant shows no rupture. These ladies are BRITISH workers and not medical tourists who rob the NHS. They have contributed to the NHS and some even work for the NHS.

Calling for EU doctors to sit PLAB and IELTS to ensure NHS patient safety

2012-01-29T07:06:00.001Z

20,000 EU doctors work in the UK and are registered with the GMC. There are a total of 232,000 doctors on the GMC register. We must ensure patients are safely treated in the NHS.

European Union doctors must sit an English Language Test (IELTS) before treating UK patients

Why are they exempt from sitting the IELTS English language test that the GMC submits all doctors who have trained outside the UK to (except for EU countries)? This means a Harvard medical school graduate who has completed a family medicine residency programme and has worked as a GP in America and only speaks English, albeit with an American accent, has to sit an English language competency test before he can work in the UK as a medical doctor! Yet a Polish medical school graduate can register with the GMC and never have his or her English language tested and go to work immediately in a NHS hospital or GP surgery.

Patients may be put in harms way if doctors from European Union countries are permitted to work in the UK as medical doctors and GPs, without any language test.

European Union doctors must sit a GP knowledge based test before working in NHS GP surgeries or walk in centres.

I question why only EU doctors are exempt from sitting the UK MRCGP licensing exam or equivalent exam testing NHS GP knowledge? EU doctors do not undergo a 3-year 'GP specialist training scheme' or 3-year US 'family medicine residency programme' but may travel by train to the UK, put their name on any PCT performer's list and work in any NHS hospital or GP surgery because they can 'call' themselves a 'GP' straight after medical school as is the case for any doctor who has qualified from medical school in Italy. In Germany there are no GPs. There is no GP training. The role of GP does not even exist in Germany. Chronic diseases are managed by hospital specialists. Women's health is seen by obstetrics and gynaecologists. Children are seen by paediatricians. So how may we accept 'any' German doctor to come work as a NHS GP? Are patients safe when they are being treated by a doctor with no formal GP specialist training or GP testing?

Yet all International Medical Graduates (IMGs) including countries like USA, Canada, S Africa, India, Pakistan, SE Asia, etc. have to sit and pass both an IELTS English language competency test and a medical exam PLAB which tests medical knowledge of UK drugs, diseases and NHS management and treatment of patients. Why do we only exempt doctors who have attended medical school in any European Union Country (France, Germany, Poland, Bulgaria, Italy, etc.)

Detrimental consequences on patient care of exempting only EU doctors from an English and a medical knowledge test

Sadly we have seen the consequence when both language and knowledge of NHS medicine has not been tested and these doctors are put straight to work in our NHS hospitals and GP surgeries.

Case of Dr Ubani, a specialist in cosmetic medicine from Witten, Germany, covered an out-of-hours service as a 'NHS GP' but who had undergone no formal GP specialist training or sat a GP licensing exam (MRCGP) or equivalent GP exam which we subject all our UK GP graduates too before they cover OOH services for NHS patients.

Click Dr-Daniel-Ubani-is-struck-off-but-GMC-concerned-at-lack-of-tests-on-foreign-doctors.

Case of Dr Werner Kolb, a 51 year old German orthopaedic surgeon, hired by the local Primary Care Trust to cover a UK consultant's annual leave, because his CV stated 'consultant' grade. Little did the NHS PCT management know that a German 'consultant' is the equivalent of a training UK 'senior house officer or registrar' grade, and that the German equivalent of a UK consultant is actually a 'Professor' grade. Both his English and surgical knowledge had not been tested at UK consultant level yet we subject our own UK graduates to a 7-year specialist training scheme in orthopaedics and a fellowship exit exam in orthopaedic surgery, before they can be given a CCT certificate of completion of training to operate at NHS consultant grade.

Click Grandmother-died-mumbling-German-doctor-botched-hip-operation-tribunal-told

With the onerous burdens of more paperwork bureaucracy of CQC registration, revalidation of doctors, austerity gatekeeping role of GP, need to find £20 billion efficiency savings in a NHS which is starting from a place of debt, drastic pension cuts and changes to the length of service from 65 to 68 years old, our UK doctors and GPs are retiring early or immigrating to Australia, New Zealand and Canada, countries whose economies are thriving and have no CQC registration or revalidation but allow doctors to focus on 'patients and not paperwork'.

So instead we will see more EU doctors entering the UK to work in our NHS and cover walk in centres, GP surgery sessions, locum for NHS hospitals and Accident and Emergency departments. If your doctor does not speak fluent English, you as a NHS patient have a right to ask to be seen by another doctor who does.

Safety-netting
It is imperative that a medical doctor be able to communicate with you so that both parties are mutually understood to ensure you are safely treated for your medical condition, else NHS mistakes will and have occurred. As economies in Greece and Italy face potential bankruptcy, doctors from Greece and Italy may consider immigrating to the UK. Please bear in mind, NHS employers, that you do not just accept a CV but actually interview prospective employees to ensure they can speak English fluently and check all references to ensure they are clinically competent and up to date. Until the government and GMC change the rules and remove the 'EU exemption' to testing English language and NHS medical knowledge, our NHS patients may still be at risk of harm.

Lansley pushes for language testing for EU doctors Clinical-competence-checks-for-eu-trained-doctors-not-against-rules and suggests PCT responsible officers ensure EU doctors can speak fluent English. Would also like to push for medical competency testing too.

27 Jan DH PIP implant algorithm for GPs

2012-01-28T08:28:00.002Z

The Department of Health and Dame Sally Davies, the Chief Medical Officer, released an updated 16-page guidance for GPs regarding management of PIP ladies DH latest guidance on PIP pdf. As GPs are inundated with paperwork on a daily basis, I have posted the most relevant page, a clear pathway algorithm for GPs to refer to when consulting with a PIP lady. It includes advice to refer to a breast reconstruction team, ie to the plastics and reconstructive team for removal on the NHS.

According to Annex D in the document, it appears that private PIP ladies may request making top-up payments for a new implant depending upon the hospital's medical director. The NHS has offered top-up payments in the past for a combination of NHS and private care. At St Thomas' Hospital in London, one may have antenatal care on the NHS, have the baby delivered on the NHS but pay a top-up fee for use of private aftercare facilities on a private ward with a single room and private midwives to look after your baby at night at St Thomas', ie a combination of NHS and private care for the same condition.

MHRA vs AFSSAPS on PIP implant failure rates including rupture, which is more accurate?

Of interesting note, is that the Department of Health MHRA (medicines and healthcare products regulatory agency) did not conduct their own survey into PIP implant rupture rates but relied on a report from the Adverse Incident Centre (AIC) of approximately 1%. This relies on surgeons reporting failures directly to the AIC. However, we know that many private clinics closed and that a National Breast Implant Registry ceased in 2006, so how reflective and accurate is this figure of 1%?

Contrast this with the French medical device regulatory authority (AFSSAPS) and we find that they are reporting PIP implant failure rates of 5% in France!

Then come the UK private surgeons themselves (Stanek and Berry) who have conducted their own survey on the patients they implanted with these PIPs. They report rupture rates between 16 and 34% in 453 PIP victims, that's 72 to 154 ladies with PIP ruptures!

PIP ladies themselves have conducted a survey among themselves in a PIP support group of over 1400 members, which shows rupture rates of approximately 31% among the respondents.

And finally we await the results of Leeds university who also reached out and surveyed PIP ladies.

Perhaps we could suggest MHRA do their own surveys rather than rely on third party information with the limitations identified.

GPs are the patient's ultimate advocate

2012-01-27T06:34:00.000Z

GPs are the patient's ultimate advocate. If their voices and concerns are not heard, then we go that extra mile and speak up for them.

Live with Gabby segment on PIP implant scandal

Pulse article on gps must show more sympathy to patients with pip implants

International PIP implant postcode lottery

2012-01-27T06:18:00.002Z

PIP owner Jean Claude-Mas was released on 100,000 euros bail yesterday. His charge has been reduced from manslaughter to involuntary injury, yet his PIP victims number 300,000 and span across 65 countries worldwide!

PIP implant ladies want these industrial silicone PIPs out! And many want them replaced with medical grade silicone as this is what they saved up for and consented to. Yet it has become an international PIP postcode lottery as to whether a government will step into the breach and come to the aid of their citizens with free removal with replacement or just offer removal alone, leaving victims in a financial catch 22 situation, as many simply cannot afford to self pay for replacement.

Countries offering free PIP removal with replacement

Argentina (small charge for replacement at time of free removal, health minister is female Daisy Corrales)

Bolivia

France

Gibraltar

Jersey Islands

Venezuela

Wales (health minister is female Lesley Griffiths)

Added 2 February 2012
St Helens and Knowsley Teaching Hospital NHS Trust, Merseyside (from £1k charge for replacement at time of free removal at their St Helens and Whiston NHS hospitals, Chief Executive of Whiston Hospital is female Ann Marr!).

Countries only offering free PIP removal

England (NHS) (except for St Helens and Knowsley Teaching Hospital NHS Trust - see above)

Northern Ireland (NHS)

Scotland (NHS)

French PIP owner arrested and HSC to meet Feb 7

2012-01-26T07:52:00.001Z

The French owner of PIP Jean Claude Mas was arrested Thursday morning at his home in Marseilles on the Riviera.Breast-implant-scandal-PIP-founder-arrested Accountability begins.

A Leeds University research survey into PIP breast implant rupture rates will be released later today.

Jan Stanek and Miles Berry audit of 453 PIP ladies. Two leading private surgeons showed PIP rupture rates between 16 and 34%.

The Parliamentary Health Select Committee will meet February 7 to listen to evidence on PIP breast implants and regulation of cosmetic interventions. Witnesses include Sir Bruce Keogh (NHS Medical Director), Sir Kent Woods (Chief Executive of MHRA), Dr Anne-Marie Slowther (Associate Professor of Clinical Ethics at Warwick), and Mr Simon Whithey (Consultant Plastic Surgeon).

By the end of March 2012, the first review findings led by Lord Howe, the Minister for Quality, will establish what happened in the UK when the MHRA and Department of Health learnt about the situation with PiP implants in France. Department-of-health-sets-out-scope-of-pip-implant-and-cosmetic-surgery-reviews/.

Give back their self respect and dignity!

I continue to call for an end to a national PIP postcode lottery. Every day a PIP lady has an industrial silicone PIP implant is an additional day prolonging their mental anguish and adversely affecting their emotional well-being. Be humane and offer free NHS removal WITH replacement as is the case in Wales, Jersey Islands, Gibraltar and the EU countries. She did not have them put in for vanity reasons but because she suffered from low self esteem, low self image, and low confidence. Let our nation not be seen as the most heartless of all nations, by only removing implants and leaving ladies well-being worse off and doubly traumatized. Many simply cannot afford to self pay for replacement. We are compounding their mental anguish with financial worry. They are in an awful catch 22 dilemma. They are British ladies who work in our high street chemists, work in our NHS hospitals, work for our nation! Say NO to a postcode lottery for PIP. When I hear tales of a mother with breast cancer who has to raise funds for her daughter to have PIP removed or a NHS worker taking out a £5k loan for replacement or yet another PIP victim crying herself to sleep, I say we have failed our country's people.

Let us as a nation unite to help PIP victims

2012-01-23T16:22:00.004Z

Each day a PIP lady knows she has PIP implants is an added day of worry and anxiety. Ladies have cancelled a wedding, numbed their consciousness with alcohol, taken time off work for depression, are unable to take care of their families, weep inconsolably, isolated themselves as husbands have difficulty offering emotional support, attended A+E in frantic hopes of getting a scan faster, etc. 40,000 UK ladies are in distress. 300,000 ladies worldwide were affected by this pandemic caused by one man, Jean Claude-Mas, the French owner of PIP, a man as heinous as Shipman but on a global scale. EU countries, Wales, Jersey Islands and Gibraltar have come to the aid of their citizens and offered free removal and replacement. Yet England and Scotland are slow to proceed and have only offered NHS removal. What good is it to subject a private PIP lady to 2 operations and still have to pay full price for replacement privately, doubly traumatised, doubly victimised? Surely it is logical and humane to offer replacement at cost on the NHS at the time of removal? Many PIP ladies had implants for low self esteem, low self image, asymmetry, and psychological distress. To then remove and leave them with less breast tissue now distorted from being stretched by the implant, will reignite and worsen low feelings of self worth. Already many have been put on antidepressants and given time off work for depression. Why add to their distress? They are the victims.

Tabloids spew forth exaggerated figures of £120 million of NHS money if the NHS funds removal of all 40,000 ladies with PIP and omit the fact that HMG as of January 17 has now agreed to replace PIP implants for free if within the past 6 years and at cost if between 6 and 10 years for all their 14,000 PIP ladies. We await to hear from Transform and Hospital Group. BMI healthcare too offers to remove and replace for free for their PIP ladies. And the NHS only implanted 3,000 ladies with PIP on the NHS. So in actually it is not £3k per PIP lady x 40,000 but far less. Also the NHS has a NHS costs recovery scheme which allows the NHS to recover expenses. Lansley has made it abundantly clear that he will pursue recovery from the private sector.

What does a PIP lady go through? As a GP we live the life journeys with our patients. We hold their hands. They come to see their NHS GP, the first port of call. Some with symptoms of rupture and/or migration of silicone and others with asymptomatic rupture or just a compelling need to confirm by radiology whether their implant has ruptured, extracapsular or intracapsular. Many are not sure whether they have had PIP as many of the private clinics are either closed or do not keep records after a certain period of time has lapsed. The National Breast Implant Registry ceased in 2006. It may be said that this registry should be reinstated. GPs either are sympathetic or I have been made aware of cases in which they question why the lady had them done in the first place, examined them and told them they will not be referred for a scan as their breast exam is normal, or that their PCT has not approved funding for a NHS scan and completely miss the point that their NHS patient sitting in front of them is suffering from chronic stress and anxiety every day they carry these banned PIPs inside of them. Some GPs rely on the outdated December 2011 DH guidance which only sanctioned NHS PIP ladies for NHS removal and replacement and advised their private PIP ladies to see their private provider, but this has been superseded by a new January 2012 DH guidance sanctioning private PIP ladies who are eligible for NHS treatment to receive scans and removal on the NHS and that Lansley will recover the cost from the private sector.

When a lady is referred to an NHS breast clinic, she has to wait anxiously for an outpatient appointment. In places like Folkestone, the NHS breast clinic does not have a one-stop breast clinic, so after a lengthy wait up to 2 hours to be seen, the PIP lady is only examined (yet again as would have been examined by her GP) and told an ultrasound appointment will be sent in the post. The anxiety is prolonged and ladies are leaving distraught. Other NHS trusts like Guys have a humane one stop breast clinic and are more pro-active. They have a dedicated PIP hotline and are advising GPs to refer all asymptomatic PIP ladies for a short profile MRI (wait time 10 days as the MRI just has to target and assess for rupture) and all symptomatic PIP ladies to breast clinic for an ultrasound. Confusion arises when radiologists report different findings on ultrasound. One consultant may confirm intracapsular rupture while another may emphatically deny an intracapsular rupture. Ultrasounds have up to a 70% sensitivity rate. They only pick up 70% of ladies with rupture! The US FDA recommends MRI surveillance in any lady with a silicone implant and never approved PIP. Where there is confusion on ultrasound, please seek an MRI with a sensitivity of 94% and is able to spot 'linguine' lines of intracapsular rupture on MRI. Some private ladies are self paying at high cost for an MRI, up to £700-800 as they are being turned away by their GPs and NHS trusts.

We need clear pathways spelled out to treat 40,000 UK ladies as human beings who are suffering. These are not cases of simple suspected rupture of medically approved silicone and therefore proven to be harmless to the body on rupture, but of 'industrial junk - brick weather proofing filler, window sealant, mattress filler' which if leaked through an extracapsular rupture, has no known study or research into the toxic effects on a human being.

Our nation comes to the aid of countries in debt, countries at war, refugees and other humanitarian causes, and yet when it comes to 40,000 UK tax payers who are entitled to NHS treatment but chose to self pay instead of appeal for NHS PCT special consideration funding for cosmetic surgery due to psychological reasons, tabloids delight in judging these ladies and saying it is costing tax payers £120 million! It is NOT! How much does our nation pay to bail out the EU or to fight in Afghanistan? How much are we spending on the NHS to treat these ladies for anxiety and depression, time off work, counselling, hospital referrals for cognitive behavioural therapy, cost of antidepressants and sedatives? Show mercy and compassion to 40,000 of our British ladies (mothers, daughters, sisters, wives, girlfriends) who suffered and are still suffering from grievous bodily harm each day the industrial byproducts are left inside their body and awaiting a ticking time bomb, extracapsular rupture of toxic industrial waste. The concern is not of cancer but of the unknown effects of migration of industrial silicone sweat and seepage. Their emotional well-being is in tatters. Each one of us may know of a PIP lady victim. Surely this is a national homefront humanitarian cause that needs all our support. Say no to a postcode lottery and treat PIP ladies with the same humanity as is being shown PIP ladies in Wales.

Meeting Lord Geoffrey Howe going strong at 85!

2012-01-18T21:51:00.002Z

After watching the Iron Lady yesterday, I was not sure what I had seen on screen was a true reflection of Lord Geoffrey Howe, Deputy Prime Minister to Baroness Margaret Thatcher and went to meet him in person this evening at the Vauxhall Conservative Association meeting.

He shared with me that he had been a barrister for 40 years and when I mentioned I was a GP, he said he had 3 main clients, Iron and Steel, Medical Protection Society and the Peace Corp. What a surprise to hear he had represented the medical profession! As promised, I thanked him for his 1981 budget which saved Britain's economy. He explained how high income tax had been back then, and how he had decided to reduce direct taxation and increase indirect taxation. He reminded me of how 364 economists had written to the Times insisting it would not work yet it did. His role as Chancellor of the Exchequer ended in 1983, and I could see the 1981 budget was indeed his finest achievement for Britain's economy and a memory he has and will always treasure.

He then gave a speech to the audience in the room, commenting that he was expecting to find himself in a cozy home and instead found himself in a gymnasium (actually it was the modern apartment of the Chair of the VCA). He asked us to focus on the 15 years of his marriage to Margaret Thatcher and not the divorce. He spoke fondly of Margaret Thatcher and reminisced on the tabloid headline 'sex was her weapon'. No one had expected a lady to win. He shared how Margaret Thatcher when meeting Gorbachev said, 'You are a man I can do business with,' which flattered him and helped relations between Reagan and Gorbachev to end the Cold War. And of how Mitterand said he was enamoured when she said yes rather than no. He shared how Thatcher thought the UK was making too much contribution to the EU. He explained how and why he had resigned as Deputy Minister. At this point, I recalled the scene in the Iron Lady. In reality he remarked that Thatcher had said no, no and no to 3 issues that he did not think was the right thing to have done and so had been torn.

When asked from the audience what his thoughts were on Ed Milliband, he replied, 'He makes no impact on me at all.' At age 85, he is still going strong!

What a great politican to have worked in partnership with Prime Minister Baroness Margaret Thatcher at a time when Britain was at its lowest, with the highest levels of unemployment, and yet with great leadership and cabinet support, the Conservatives pulled this nation back to its feet and gave the people wealth and industry until Labour sadly unwound decades of prosperity and growth.

Advice for PIP patients of Harley Medical Group

2012-01-17T21:17:00.001Z

Breast Enlargement PIP Implant Patient Advice17 January 2012

Dear Patients, Firstly, thank you to Laura Burgess, Emma Toone and Rachel Oates, who met us on Saturday as representatives of concerned patients and were on the march in London. Thank you also to all our patients who have spoken to our clinics. Your message came across clearly.We recognise that we should have listened earlier to your individual situations. We would like to say sorry to you all for this and for the experience you are each going through.

We really want to help as we know you came to us because we care, and we do care.We have listened to your worries, the most important one being concern for fellow PIP patients who have discovered that they currently have ruptures and no way to fund their removal and/or replacement. You also identified that we need to improve communications with all our patients as well as our own staff so that there is continuity with what we are saying overall.

As discussed on Saturday we really want to do our best for our patients. We are working hard to find additional surgeons and hospitals to operate on our PIP patients. We know you will understand our first priority must be in managing patients with confirmed ruptures.

We can confirm the following:

•For any patient of The Harley Medical Group with PIP implants who has a confirmed rupture accompanied by a scan within 10 years of implantation, we will remove the implants free of charge.

•For any patient of The Harley Medical Group with PIP implants who has a confirmed rupture accompanied by a scan within 6 years of implantation, we will replace the implants free of charge.

•For any patient of The Harley Medical Group with PIP implants who has a confirmed rupture accompanied by a scan between 6 years and 10 years of implantation, we will replace the implants at cost price. Please note that cost price is dependent on the type of surgery required, which your surgeon will discuss with you during your consultation.

GPs show compassion to distressed PIP patients

2012-01-15T07:28:00.001Z

GPs show compassion to distressed PIP patients.It is affecting their well-being, marriage, relationship, family, finances by not working, causing depression. Arrange an ultrasound and make a breast clinic referral if your NHS hospital says the breast clinic must arrange scan and not you.

I have let number 10 know that this extra breast clinic referral is a waste of NHS resources and GP scan requests should be accepted without question for PIP. I am disheartened to hear of more than one GP who has refused to refer a distressed PIP patient for a scan and one questioned why a patient had them. If a GP is refusing to refer you for a scan, please print the following document Department of Health Letter on PIP implants January 6 2012 and enlighten your GP. Ladies have implants for many reasons, asymmetry, lack of confidence, society's perception portrayed in magazines and television, etc. Whatever the reasons, we GPs are non-judgemental and practice holistic medicine. We empathise with their pain, both physical from the effects of leakage of toxic industrial fillers untested in human beings, and psychological from the immense anxiety that comes with knowing they have banned PIP implants with a 1 in 4 rate of rupture according to Mr Jan Stanek, a leading private surgeon and a PIP support group survey is showing up to 31% rupture!

Private clinics should have malpractice insurance. There must be insurance that allows them to cover removal/replacement for free. Many of these women saved what little they had to have implants privately and now cannot raise the funds for removal/replacement. Many are now unemployed due to taking so much time off work from the effects of these PIP implants over the years. Husbands have left them. Families are affected when they are so depressed they cannot tend to their families.

I say again, 'show compassion to the distressed!' Give automatic approval for GPs to arrange scans at the local NHS hospital for PIP. If a scan does not show rupture but the patient still has symptoms, refer the patient to breast clinic for an MRI scan. And give the patient freedom of choice, to self pay for replacement of the implant at NHS explantation or do as compassionate Wales is doing, offer all private or NHS patients free removal/replacement. 40,000 UK citizens received 'grievous bodily harm'. Let us as a nation come to their aid and not judge them as private or NHS but as human beings who are suffering intolerable torment.

PIP implants - who is to blame? Mutual solution

2012-01-14T10:21:00.004Z

40,000 ladies in the UK received the banned PIP implant. The French company are in liquidation so victims cannot secure compensation. Today a march of PIP implants support group (ladies with PIP implants travelling into London from all over the UK) is being held on Harley Street to protest private clinics refusal to cover replacement for free.

Lansley announced that the NHS will cover explantation but not replacement for private patients with clinical needs, ie rupture and insists they will recuperate costs from private clinics who refuse to remove If your GP is refusing to refer you for a scan, please print the following document Department of Health Letter on PIP implants January 6 2012 and enlighten your GP. Wales and Europe are removing all PIP implants and replacing for their female citizens for free. Wales offers to cover replacement of PIP for free.

A mutual economical and win:win solution, would be offering patient choice. Private patients who want their implants replaced on the NHS at time of explantation, should be offered the choice of self pay for the cost of the new implant (Mentor and Allergan Natrelle are the only 2 US FDA approved implants). This means private patients pay up to £700 for the new implant which should have been covered by PIP if they were not in liquidation. There is no extra cost to the NHS to ask that the NHS surgeon (after removing the PIP) to then insert a new implant at the same time. If the private surgeons are offering removal/replacement at the same time in one operation for rupture at £2,600 then why can't we ask the NHS surgeons to cover replacement at cost at the same time for a ruptured implant as is done for patients in Wales? Using the excuse that 'better to have two operations, so as to let the resulting inflammation from rupture subside' only applies for acute rupture. These ladies have had to wait weeks, months to arrange a scan and the operation itself for rupture so by the time they are operated on, it is no longer an acute event. If two operations are being recommended by NHS surgeons, then why are private surgeons and surgeons in Wales and Europe offering simultaneous removal and replacement of rupture in one operation. From patient experiences of having simultaneous removal/replacement for rupture, it can be done, has been done and is safe. Do not subject PIP victims to a postcode lottery at a time like this.

What is happening now, is that when only NHS removal is offered and covered for private patients with rupture, private patients (who remember are innocent victims) have to then self pay an additional £2,600 for the Harley Medical Group or Transform (in addition to the initial cost of £4-5k) to put a replacement in, have to subject themselves to a second operation with risks of general anaesthetic, recovery time, postop pain, time off work and if no rupture is seen on scan, they are charged £4-5k for replacement. So 40,000 ladies become victimised yet again and private hospitals profit from charging for additional day case surgery.

HMG and Transform are advising their private patients to get scans on the NHS and if it shows a rupture, they will be charged £2,600 for removal and replacement in one operation. If it shows it is intact, they will be charged £4,000-5,000 for removal and replacement of a 'banned' implant!

There is also a catch 22. Some NHS hospitals are refusing a scan for PIP patients, ie St Thomas' Hospital refuses to give an appointment for a scan with a GP scan request form and insists that a scan request come through their breast clinic, ie another referral. I have managed to negotiate for all private patients, a 'PIP support offer' of £150 for a private ultrasound scan at 108 Harley Street radiological services. However an ultrasound scan may not show leakage. If still symptomatic, consider an MRI scan (£315) which is more accurate. A private scan is a backup in case there are delays or difficulties getting a NHS scan and may even be 'cheaper' for the NHS to commission this clinic rather than the NHS hospital tariff for a scan. The NHS criteria of needing to be seen by the NHS breast clinic first before getting a scan is false NHS economy. We already know that PIP implants have been banned and contain 'industrial junk'. Patients now have to wait to be seen by a NHS consultant in a breast clinic (NHS cost ~ £150-£200 the NHS tariff for a consultant's visit), to then be allowed to get a NHS scan (~£198 retail), even with a GP referral (~ £18 GP tariff visit).

So the mutual solution would be:

1. Private patients who have PIP implants removed on the NHS may pay for a replacement implant to be inserted at the same time.

2. NHS scans arranged by GPs should be approved for all PIP patients and not require a separate breast clinic referral for permission to get a scan.

Culpability lies jointly with the government's MHRA for approving the PIP implant and not recalling sooner, and the private clinics for charging to replace faulty implants, some may have failed to fully inform patients of their choices of implants and the cheaper value of the PIPs. An urgent review of the MHRA is called for as the US FDA did NOT approve trilucent, hydrogel or PIP implants, yet all three have been approved and subsequently banned by UK's MHRA. The only person who is being victimised twice is the patient who paid for MHRA approved 'medical grade' implants but instead received 'industrial grade' implants and has suffered both psychological and physical detriment to both their health and peace of mind.

Christmas Service at St Luke's Church, Chelsea

2012-01-04T05:35:00.005Z

The Christmas Service at St Luke's Church, Chelsea was given by Rev Dr James Heard. His sermon for Christmas Day was to 'show compassion to the distressed.' GPs show both compassion and empathy to all patients. Happy Christmas and a Happy New Year!

For movie buffs, this Church was also the scene of the first wedding in the film 'Four Weddings and a Funeral' starring Hugh Grant.

Oxford and Cambridge Club Christmas Dinner

2011-12-17T00:00:00.001Z

IDF Council Xmas Dinner at the Savile Club Ballroom

2011-12-16T09:53:00.001Z

Enroute to the Ballroom

Ascending the sweeping spiral staircase up to the IDF Council Xmas Dinner.

The IDF President explained the history of English private clubs and shared that he had celebrated his 25th wedding anniversary at this same venue. And a consultant's wife shared how she had booked this very ballroom for her son's wedding reception. Apparently this ballroom features heavily in wedding glossies and I can see why!

Chandos House IDF GP Xmas Black Tie Dinner

2011-12-13T09:49:00.001Z

Integration of primary and secondary care. A lovely convivial evening had by all.

December a month of Christmas Black Tie events

2011-12-09T09:15:00.001Z

As the GP Chair of the Independent Doctors Federation, I was invited to the annual BUPA Cromwell Hospital Christmas Celebration at the Natural History museum in Kensington. I met the Chief Executive of the BUPA Cromwell, a lovely Canadian lady and the Medical Director, a former ENT Consultant. BUPA Cromwell is the main sponsor of our IDF GP Christmas Black Tie dinner on Monday.

Many of the BUPA consultants present at the event worked in both the NHS and private sector.

Pudding was a chocolate fountain with choices of dipping donuts, marshmallows or strawberries.

The next evening I was scheduled to attend another Christmas Black Tie at the Quartercentennary Charterhouse Dinner held at the Guildhall in London. I marvelled at how the catering staff delivered hundreds of beef wellingtons on hot plates with clockwork precision. The Charterhouse choir sang on the balconies as we dined in such a historical setting.

Regency Ball at the Oxford and Cambridge Club

2011-11-26T18:14:00.001Z

Every reception room in the Club was used.

The South Library was transformed into a Casino.

Another for the Champagne reception. Some were dressed in authentic Regency attire.

Here a fortune teller offered palm reading, crystal ball gazing and Celtic cross tarot card reading.

Another ballroom offered Regency dancing lessons.

My husband and I had a go at Miss Poultney's delight!

As GP Chair of the Independent Doctors Federation I managed to organise its first Xmas black tie dinner at Chandos House for the 12th of December (as a ball had already been arranged at the Mandarin Hotel for November). Have now completed the seating plan for 65! A great way for consultants and GPs to socialise in a convivial festive atmosphere.

Vision for President of the RCGP

2011-11-26T10:40:00.001Z

Feedback from Members of the Royal College of GPs who have met and been taught by me Click Testimonials from UK and International GPs who are Members of the Royal College of GPs One could ask the GPs who have first-hand knowledge of me, who have been taught by me and are now our working UK GPs (GP partners, salaried, portfolio locum); GP programme directors & GP trainers; RCGP faculty board members; LMC reps; Ministry of Defence GPs; UK GPs who are now working in Canada (B.C., Regina (only one Canadian GP paying subs for MRCGP Intl), Australia (Brisbane, Melbourne, Avoca, Wodonga), and New Zealand; GPs from Hong Kong, Sudan, Saudi Arabia with MRCGP International; established UK GPs who gained the old MRCGP (with Merit or Distinction); GPs who have been short-listed for the Fraser Rose Medal and indeed won a Gold Medal from his RCGP Faculty and so on and so forth. In fact all one has to do is scroll through and read their stories, their testimonials left behind for others.

Vision of the Role of President of the RCGP

When I think of the role of a President of the RCGP, I think of former President Roger Neighbour who transformed general practice education with his book 'The Inner Consultation' and his sequel for GP trainers 'The Inner Apprentice', both books I have read and shared the wisdom with GPs. I think of former President David Haslam and his inspiring speeches at the RCGP Convocation Ceremony for New Members of the College, of his personal anecdote of how he himself was able to pass the viva module of the old MRCGP exam by admitting he did not know the answer but he would ask for help (crucial for GPs to accept their limitations and ask for help from colleagues to ensure patient safety). I think of the book 'The Future Practitioner' written by our forefathers in 1972 describing a perfect GP trainee as someone who must not be arrogant or lacking in empathy. How very true and I incorporate a need for humility, to show empathy (GPs frequently say 'I'm sorry') in my teachings to all GP trainees preparing for the MRCGP CSA exam testing their consultation skills.

A President is a role model for the College of GPs, an inspiring teacher of GPs presenting novel ideas, insights and concepts into what it means to be a general practitioner, and a world ambassador.

What have I already achieved on the RCGP Council for members?

RCGP Nationally-Elected Council Rep

Some GPs who voted for me in 2009, congratulated me as the new Chair as they thought they were voting for me to be Chair by voting on my national council ballot. Even though I won with a landmark College record of 898 national votes for Council out of 21 GPs on the ballot, I had to explain to voters that no, this was just one of 50 Council seats and that a Chair of Council may not be voted on by the members of the College but only this inner Council. Some opponents remarked that canvassing was not allowed, and so I kindly explained that the code of canvassing did allow canvassing but not use of the College database of members. As one of 50 council reps (approx 32 faculty reps and 18 nationally elected council reps), it is difficult to air views for members simply because 18 nationally elected council reps are outnumbered by the 32+ faculty reps (some are College examiners or work within Deaneries) on any council motions or discussions, and as a nationally-elected Council Rep, I must 'apply with a further CV and statement' to join any of the College subcommittees. The subcommittees then decide who they want, again not the members. Two years later and as I am still not 'included' in any of the College's many subcommittees, I voiced a democratic deficit. In contrast, the RCSEng council is only comprised of nationally-elected reps. When attending an MRCGP International conference, native RCGP examiners from Sudan, Egypt, Saudi Arabia greeted me with 'Mashallah' as they had read my PLAB and DRCOG books which had reached their countries. Some asked me why I was not presenting on the day? I could not explain how my application to join the RCGP International Subcommittee and the RCGP Trustee board had both been rejected internally.

So I e-mailed members concerns directly to the Council Executive Committee (either to the CEO, the Hon Secretary, the Hon Treasurer or the Chair), and this has made a difference.

E-portfolio has been called the bane of 3,000 GP specialist trainees and their hospital consultants lives, who have to complete at regular assessment intervals for the first 2 years of GP training and the GP trainers who complete for the 3rd year. I have raised awareness of the long-standing technical glitches with the trainee's e-portfolio, and the Chair has been getting weekly reports from the IT department and the College has hired more IT support. This was brought to my attention in December 2010 by the late Dr Peter Gooderham and members of doctors net.

Accountability

I raised awareness of a significant event analysis when I was the only one of the 21 on the ballot to identify an election error seating the wrong candidate on Council as the 7th GP. Yet 20 other GPs on the ballot had received the breakdown of the results? Why was I and the correct 7th GP the only ones to voice an error had occurred? The Hon Secretary duly arranged a constitutional lawyer to do a proper investigation which confirmed this and to ensure that this would not happen again.

Compassion
I asked College to show compassion for trainees who suffer severe stage fright over repeated failures of the CSA exam; the trauma is unbearable as each sitting costs over £1480, not to mention the time, travel expenses, emotional and financial strains put on the mature GP trainee whilst supporting a young family. I suggested, as did many of their GP trainers, that they be allowed to send in a video instead, as they had proven that they are good GPs by passing the AKT knowledge test, had good patient feedbacks, had a good trainer's report and had passed their e-portfolio assessments. This was declined. The economical implications that result as a consequence may be unmanned regions of remote Scotland, Wales, socially-deprived areas of England, etc. We cannot raise the bar so high after only 1 year of training as a GP registrar, when a GP has his entire life-time to acquire the experience of a senior GP partner.

Inclusivity
I suggested to College that they offer the MRCGP exam to established GPs as an alternative to iMAP. iMAP may be fine for those who are skilled in writing up reams of evidence for this portfolio but then to be allowed only one sitting of the oral component is too stringent. There are many established GPs out there who did not pass their old 4-module MRCGP by one module; show compassion and allow them to be retested with the new 2-module MRCGP exam.

60th College Anniversary in 2012
The College was co-founded in 1952 by Dr John Hunt, a private GP who practiced on Sloane Street in Chelsea and Dr Fraser Rose. Dr Hunt liaised with Parliament to establish the College. He raised funds from his private income to help buy Princes Gate for the site of his College where wise men could discourse and deliver education. His GP son, Dr Jonathan Hunt, took over his GP practice and joined the Independent Doctors Federation (an organisation of private GPs and hospital consultants providing education, support and lobbying action). When 2 former private GP chairs, approached me and asked me to run to be their GP Chair, I explained I was an NHS GP, although I did teach privately. Fully aware, my name was put on the ballot and members present at the hustings voted. My first task was a request passed on to help Dr Jonathan Hunt! Since 2004 he had asked that Chelsea & Westminster add private GPs to their NHS hospital databases as patients who were referred were not receiving follow up letters about what had been done or how they had been treated, and it was affecting patient care and safety. It became a priority to help the son of our esteemed RCGP founder and I am now told by Chelsea & Westminster that the IT department have added new software and I have personally collated and passed on the private GP database for them to add. This I am told will happen by the end of November 2011! The next task was that these private GPs with MRCGP wanted to become Fellows of the RCGP. The new criteria meant that needing to be on a PCT performer's list would exclude private GPs, and even the son and grand-daughter GPs of our College Founder Dr John Hunt! The current President of our College has arranged to meet with IDF on December 2. We will find a way to embrace the family of the Founding GP of our College and the organisation the Founding father's son belongs to! Let us celebrate our 60th College Anniversary in 2012 by including the Private GPs who historically created and funded our RCGP! Inclusivity not exclusivity!

Transparency

I asked the College to be transparent with their exam costings and not mark as confidential. The costings are now public on the RCGP website. I emailed the Chair of College to compensate those caught in the Sept 2010 CSA exam fiasco for their exam, expenses, loss of income as completion of training was delayed, etc. and it was the BMA GPC and many on Council who also came to the aid of 40+ trainees. The bar was lowered for November 2010 but is still much higher than pre September 2010. A significant event looked into what had happened in September 2010, the mistakes and how to correct and I have suggested on Council that deaneries offer help with communication and linguistics skills to international medical graduates (1/3 of the composition of the Feb 2011 CSA exam) from ST1 and not wait until a month before the costly CSA exam at a time close to the completion of training.

As a Council rep and therefore College Charity Trustee, I asked the Treasurer to put a back statement on the Capital Appeal due to the HS2 threat. He took legal advice and added this.

Democratic Deficit

I spoke up on Council about the democratic deficit of this College in my hustings. I wrote the CEC suggesting that all executive seats be nationally-voted, that members wanted to be able to vote for their Chair, their Hon Treasurer who sets the prices for exams, their Hon Secretary in charge of governance, their Vice Chairs who assist the Chair and that these roles should not be taken on by co-opted members who have failed to seat by the national vote or choose to bypass the national vote.

I agreed with Council that we continue with electronic voting for in-council elections which had over a 90% voter return but go back to paper ballot (22% return) for the national ballots as the online voting system for national elections had returns in the single digits. Council identified this could be due to the spam filter, e-mail addresses that had not been updated, e-mail overload, etc.

I suggested to the Chair that 12,000 GP trainees who pay associate membership fees and are included in the 42,000 membership figures be given the right to vote on the national ballot. This was rejected. Yet many of College decisions affect these 12,000 trainees and yet their AiT (associate in training) rep is only given an observer seat on our Council.

So yes, when GPs voted for me to be their national voice on Council, I took my role as 'Lady Justice', campaigner for democratic leadership, fair treatment of doctors and accountability and transparency very seriously.

Clarification of Roles of President vs Chair

Some thought by voting for me for President I would also be Chair, i.e. that the roles were the same. Again, I had to correct them and say no, our College separates the 2 roles. The President is the ambassador who hands out diplomas at the New Members Ceremony, sits on the Academy of Medical Colleges, sits on the Council Executive Committee who are the ultimate body who makes decisions for the College (alongside the Chair, Vice Chairs, Hon Secretary, Hon Treasurer and CEO), visits faculties and and travels the world educating family doctors about UK general practice. It is the Chair who speaks with press on political matters involving GPs and who presides over the Council of 50 (approx 32 faculty board reps and 18 nationally-elected reps).

The President as a GP educationalist, shaping general practice

So how do I fit in all this with my aspiration to re-run as President of the RCGP? Roger Neighbour was my role model when I trained to be a GP. I have since developed a new model of consultation based on all the fore-fathers teachings and exam teachings, called the '10 CSA commandments' which incorporates empathy, pastoral skills, nonverbal body language as a form of communication, reinforcing the need to put the disease in the psycho-social aspect, reinforcing the need for safety-netting, reinforcing shared patient-doctor management and allowing the GP to complete a 10-minute consultation in 8 minutes or less. This model ensures the patient is heard, does most of the talking and leaves a perception that time has stood still and they have received a 30-minute consultation. The consultation room transforms into a place of safety, a haven of tranquility, their GP transforms into a wise man ('who hardly says anything yet reveals all') and they walk away with peace, reassurances and safe medicine. The GP's greatest tools are his communication skills (non-verbal body language, facial expressions, touch, paralinguistics (soothing and calming tone, rate, pitch, accent) and the words he chooses). Making a diagnosis as an experienced GP takes only a few minutes, however giving medicine and appeasement to the soul (peace of mind), is an expert skill nurses and hospital doctors lack.

I have written numerous medical exam books to help our budding GPs. The AKT Hot Topic book (awarded by the BMA medical book awards under the old guise of the MRCGP Hot Topics book) most recently updated last week keeps both GP trainees and established GPs current. GPs do not have time to digest the 50+ page NICE guidances updated every 3+ years or the new August 2011 DVLA guidance so instead I do this for them in one book.

For future GPs, I wrote Transition from Trainee to GP to allow our young GPs to avoid the pitfalls of partnership, to understand the different political roles of GPs and GP organisations, to read a practice accounts (many trainees are not 'shown the practice books'), etc.

The most powerful testimonies are the ones left by GPs, those who have met me and understand why I want to transform this College into a College of the fellowship of caring GPs. And I leave you with one of 1000s of personal anecdotes.

Dr S was an ex-anaesthetist who switched into GP land. He reached out as his entire VTS from X Deanery had failed their video module submission twice! He had asked his Deanery for help. He was told 'adult learning is your responsibility'. He surfed the net and found me. He opted for my postal service and sent me his failed video submission. I could see clearly why he had failed and what needed to be improved. I typed a detailed 5-page report commenting on the transcript of his consultations, the room setting, the positioning of the GP and patient, the nonverbal language that was being communicated, the lack of 'MRCP' meaty type of consultation he was submitting and so on and so forth.

A month later he sent me another DVD. Wow! He had transformed. What I was now viewing was a GP consulting at senior partner level. A child patient looked upon him enamoured by his amazing consultation skills. He had shown such humility by kneeling before the child and talking at eye level with his patient. He was interested in her school and home life. He became her friend. He included the mother and asked the child permission to talk to her mother.

In another case a patient had come in concerned as he was having chest pain. By exploring his deeper concerns, he discovered the patient's younger brother had had a CABG. Of course the red flags were present in both the history and exam but this GP was so caring, he handed him his desk phone and suggested that he himself would leave the room so that the patient could tell his wife about what was happening and she could arrange to meet him at the hospital. The camcorder recorded the patient summarising his understanding to his wife. A novel way to check understanding! When he returned, he returned with a glass of water and aspirin.

Dr S passed this 3rd video submission as did a colleague from the same VTS who also came to me. As a GP educator I become a life-long mentor for my GPs. I followed up and asked him what he was doing after CCT. Sadly he was diagnosed with MS and faced locum GP job discrimination with his illness. I was so sad to see such a bright light now have a new immense struggle. I passed on his details with his permission to another alumnus GP in his area and asked him to buddy and look after him. In 2009, I heard from Dr S. He had renewed his membership with the College just to be able to vote for me for President! I told him, no you need the money, you are struggling to find locum work but he insisted and I felt so humbled at the high financial cost of one vote. This year, he sent me wedding photos, he looked much stronger, healthier, tanned and now reports he is a full-time General Practitioner in Australia. His MS is under control and he now plans to devote his life to being a GP with special interest in MS. I just have to look at the photos to know he has finally found peace in his soul and happiness for himself.

Post Script
25 January 2012

An apology and statement of fact

In response to an erroneous statement that I made between November 26, 2011 and December 2, 2011, and in agreement with the College, I apologize and would like to make the following statement of fact.

'The role of the RCGP President is to be the established head of the College. The role is open to all Members and Fellows of the College in good standing. My assumptions about the qualification and eligibility of the current President Iona Heath were incorrect. Dr Heath passed the MRCGP in July 1981 and furthermore received the College's prestigious Fraser Rose Medal, awarded annually to the trainee who scored the highest mark in the College exam. She became a Fellow of the College in November 1992. Dr Heath was elected to the post of President and took on her role on November 2009.'

Conservative Health Meeting at House of Commons

2011-11-23T20:59:00.001Z

I urge all budding GP leaders to consider joining Conservative Health. Go to www.conservativehealth.org to apply. Only #40 a year! Help shape policy! Here we have a Councillor from Bath (retired NHS hospital consultant), the CH Vice Chair NHS consultant from Liverpool and a young Public Health executive board member! There are 25 of us on the executive board, mostly elected with a couple of co-opted members. The GP Chair seems to know everyone! And just casually announced he was having dinner with Lansley Thursday! Wow!

We discussed our Spring meetings including a Round Table with Stephen Dorrell, a social with Earl Howe and a Spring Conservative Health Conference. Last round table meeting was with Anne Milton. Our young enthusiastic board member will be bringing his new camera to the next meeting to film short video clips of our next meeting! Stephen Dorrell chairs the Health Select Committee, with Revalidation of Doctors on his committee agenda! Getting closer to the source! Fingers crossed we can abolish this 'Emperor's fine robe' as it is just 'hot air' at vast expense to our patients and their frontline NHS services.

Next week will be a reception with Boris Johnson at the Army and Navy Club, Pall Mall!

And no Cornelius Fudge did not emerge from the depths of Hogwarts...

Do go to the Conservative Health Blog for more details...

One of my daughters trialled for England women's football team!

2011-11-21T18:32:00.001Z

A proud GP mum. She trained hard as the lacrosse goalie for her school's team as they competed and won the school nationals in her age category. She also plays football and fences at her school. She was selected and invited each summer to the England women's lacrosse training programme, and this year was scouted and will be trialled for England's women's football team! Well done!

RCGP Annual General Meeting Victoria Plaza Hotel

2011-11-19T22:31:00.001Z

Friday was spent attending the Royal College of General Practitioners Annual General Meeting held at the Victoria Plaza Hotel. It was a wonderful surprise to meet a GP I had taught a year prior receiving his MRCGP. He updated me that within a year of obtaining his Certificate of Completion of Specialist Training he had been appointed a Training Programme Director in the West Midlands and joined the RCGP West Midlands Faculty Board! I was very proud of his meteoric rise! What a record achievement. At the same time, I applauded one of the very first GPs I taught as he received his FRCGP, 7 years later. His wife had just delivered their baby so could not be in attendance but his father was there to share the moment.

Again I urge all GPs with MRCGP for at least 5 contiguous years to apply for FRCGP. Sitting next to me was a young girl drawing pictures to fill the time on a RCGP headed notepad with an RCGP logo all-in-one colour felt-tip. When I glanced over she had written 'I love GPs' at the top of the page and drawn a picture of her family. The next drawing was of a flower and entitled 'I am proud of my mum.' She then realised it was time, promptly leapt up from her seat, took her father's iPhone in both hands, aimed it steadily at the stage and filmed her mother receiving her fellowship, while her father who had been pre-occupied playing an engrossing iPhone action game, having relinquished his gadget, got out a portable camera, aimed and took several photos of his beloved GP wife. It made me realise that when family physicians ask, 'why should I apply for fellowship?', the better question to consider is 'won't this be a wonderful family moment to share and remember for a life-time?'

Amidst brazen headlines in certain tabloids, distorting our profession to sell papers, it may be worth remembering that many GPs have sacrificed much time with their families, to train (working long hours during the day, covering nights and weekends in hospitals for many years) to then deliver a quality service to their patients first and foremost as fully qualified GPs responsible for on average 1700 patients each. With women representing 56% of doctors entering GP training, more and more female GPs are balancing work, life and family for the interests of their patients. Let us extol GPs in the press and the media for the valued contribution they make to our society! Challenge any unfair gossip/rumour to malign our profession or manipulation of figures by press to the Press Complaints Commission. Challenge a culture of blame and bullying, and embrace accountability, responsibility and extol our virtuous profession.

Why I am re-running for President of the Royal College of GPs

2011-11-16T10:24:00.001Z

'Be the change you want to see in the world,' Mahatma Gandhi. Poignant words to live by. How apt, that I have taught 1000s of male GPs to emulate Gandhi, to learn from him how to listen, to show empathy and demonstrate compassion as a GP. For female GPs, I say look to Mother Theresa.

Why am I re-running for President of the Royal College of General Practitioners on the Spring 2012 national ballot to be sent to over 27,000 voting GP members? Because we need a College to promote GPs, to challenge revalidation, to support self-regulation, autonomy, self respect, professionalism and patient advocacy.

Anti-revalidation platform
Because 2012 will be a year that will go down in the annals of history as 212,000 UK doctors (and 20,000 EU doctors) face a Parliamentary decision over the Revalidation of Doctors. It will decide whether our noble medical profession which has survived without government over-regulation 'revalidation' for 150 years and still ranks doctors at the top of the Mori public poll for public trust, will now face ignominy and change forever for ours and our future generations of doctors or will stand up for patient safety against yet another pointless costly bureaucratic exercise at the expense of frontline NHS care for our patients. Only this week did the Parliamentary Health Select Committee criticise the CQC for 'neglecting duty of scrutinising patient care in favour of bureaucratic 'registration' of providers by 2013.'

'Stand your ground!'
My battle is against government over-regulation with revalidation of doctors. I stand my ground with the backing of a silent majority of the good and true wise doctors who are ancient in years but still live among us and give counsel and am pleased to hear that the BMA GPC negotiators are taking up the gauntlet! Finally it is not 'merely a lone lady doctor tilting at windmills, but others now choose to make a stand! If there was ever a time to speak up from the silent majority for auto-regulation of our profession, it is now!'

Are we making GPs obsolete?

Even now government is debating a national roll out programme giving physiotherapists prescribing rights. What about our doctor rights? Most attended 6-8 years of university/medical school and have undertaken 5+ years of rigorous postgraduate medical training, passed medical licensing exams and gained a Certificate of Completion of Specialty Training. Yet this appears to be not enough? Now nurses and physiotherapists are allowed to prescribe medicine to the public? Have they sat a year of pharmacology in medical school, passed medical school finals covering pharmacology and physiology, drug side effects and interactions? Are we re-creating a possible Michael Jackson scenario with patients bypassing their GPs to get addictive narcotic painkillers from their physiotherapists instead? Why with less professional training, do nurses have the same surgical operating room rights (foot ops), running emergency rooms, treating and prescribing for children with mental disabilities as nurse consultants on £60k a year (cheaper labour than a consultant psychiatrist), and same prescribing risks (as nurse prescribers), yet only have to submit to 12 CPD points a year for revalidation? Surely there is more risk with less formal training and experience? 3 years nursing training cannot equate to 11 years of medical training?

What about our doctors' rights I say again? Revalidation for doctors is scheduled to be a slew of paper hurdles like facing a daunting tax audit: 50 CPD points a year, significant event analyses, patient surveys, multisource feedbacks, reflective learning, practice audits, case based discussions and so on and so forth while all other health professionals and professions like nursing, law, chartered bankers, architects, are tasked with just CPD points to show continuing professional development, ie attend a few lectures. And dare I say have we even considered revalidating investment bankers?

Challenging media distortion of our profession

I will continue to battle for doctors' autonomy and self respect, as I would hope our next generation of doctors would have expected our generation to have done for them, and as the generation of 23,000 GPs did in 1966 for the medical profession when last challenged by too much government meddling. Let us extol our hardworking GPs and challenge tabloid headlines that distort how good GPs are and how hard they work. When tabloids manipulate news and cast an unfair light on GPs castigating them as 'rich, fat cats', they harm the doctor-patient relationship. Ask the patient and he or she extols his or her local family GP. Almost half NHS GPs, over 13,000 in this nation earn 5-figure salaries, much less than any other professional career, i.e., banker or lawyer for twice as long a period of professional training. NHS GPs who earn more, may earn more due to London-weighted pay, running several practices, have a dispensing pharmacy surgery, etc. Patients are not paying out of pocket to see a GP, as they would a plumber to fix the kitchen pipes. GPs are commissioned by the NHS to provide a service. The NHS is still free at point of access to all.

Patient Advocacy and Safety

I am a strong advocate for patient safety and ensuring doctors are safe. My baby brother DIED on the NHS (missed intussusception), my adult sister almost DIED on the NHS (misdiagnosed as having constipation instead of endometriosis and a ruptured ovarian cyst) and my own, then 4-year-old, daughter was sent home from the emergency room by junior staff, misdiagnosed as having a urine infection, when she presented with high fever, cough and abdominal pain. We were called back the next day for admission by a consultant radiologist who reviewed the chest x-ray and diagnosed basal pneumonia causing diaphragmatic irritation with referred abdominal pain.

I have dedicated my life to studying and passing many postgraduate medical exams in various specialties so that I, in turn, may contribute to the solution. As well as having saved lives as a US/UK surgeon and then a GP, I have managed to teach 4,000 UK and international GPs on my own. By writing 13 medical books, hopefully I have reached and educated our nation's and world's GPs to be caring, empathic doctors who truly know how to listen to their patients and are also up-to-date with their medical knowledge. This way I hope patients may never die unnecessarily and always remain safe. I am touched when GPs from Egypt, Sudan, Saudi thank me for my PLAB book and one said that when she came to the UK, her friend told her to find Dr Coales in person and thank her! Little did she know 5 years later she would be attending a CSA course at my home and indeed be able to share her story. Based on my experience as a GP educator, I say to pass off a 'paper revalidation questionnaire' as rubber stamping that GPs are safe and the public are safe is so very very wrong!

When my close friend and fellow campaigner for the rights of whistleblowing doctors, Dr Peter Gooderham (a law lecturer and doctor) died young of a heart attack, suddenly and unnecessarily Dr Peter Gooderham's Obituary, I was so upset that I wrote and dedicated to him the book 'How to lose weight, the easy way' to improve public safety. I can never bring him back, but I can show the 13 million who are obese in the UK, that with simple daily walking, asking fast food restaurants to publicise hidden calorie content, understanding our own endogenous peptide YY 'appetite suppressing' hormone Peptide YY regulates appetite, they can easily lose weight without pharma drugs, diet tablets, expensive commercial diet plans or programmes. Obesity kills, and I want so much to help the public understand they can lose weight easily and painlessly. My tv show 'Turn Back Your Body Clock' reached almost 2 million Brits in 2006 and is syndicated worldwide to show the public how to be healthy and live longer. Simple health education is far more cost effective than medicalising and treating the diseases of alcoholism, smoking and obesity (snoring, cancer, adult-onset diabetes, hypertension).

A window of opportunity

But now I see good experienced GPs retiring early (the last straw), GP practices struggling to fill unexpected partner vacancies from early retirement (unsustainable pressures of increased paper bureaucracy), local GP partnerships deciding to step down and hand over their patients and practices to larger corporate empires (mergers and acquisitions), young intelligent GPs from our finest medical schools and top GP training programmes now emigrating to Sydney, Melbourne, Wodonga, Avoca, Brisbane, etc. and almost daily another GP, even GP partner, rings or emails me asking for help to emigrate to Australia or Canada where doctors are respected, valued and do not face revalidation, and I say STAND YOUR GROUND! Alas difficult to compete with sunny Australia with its booming economy, a semi-private healthcare system in which GPs play an integral role, are held in high regard and valued for their skills, automatically upgraded to FRACGP and face no revalidation.

Still we have a window of opportunity to tell the world that a 'paper revalidation questionnaire' at a whopping £1 billion of NHS funds (already spent on appraisals and revalidation pilots) diverted from patient care (closing NHS hospitals, wards, stretching emergency departments (many are at danger points), delaying simple investigations like ECG for 6-8 weeks, discharging patients early, GP surgeries and OOHs being put out to tender by PCTs) is costing lives!!! Please stop spinning to the public that we need to spend £1 BILLION of NHS money to find a Shipman among us. The cross party MPs have already reported a bad doctor to the chief executive of his trust insisting he be referred to the GMC; he is a Revalidation Officer! The very person in his region appointed by the government and GMC to decide which doctors pass or fail revalidation! Who guards the guardians?

Make a stand against bullying and harassment within our medical profession and a plea for accountability and professionalism. Bring back honour, virtue, compassion and fair treatment of all doctors to our College and to our profession. Only then may we ensure our public are safe; all our patients are safe! And my brother, baby H, did not die in vain.

Time-table
NB: Nominations are being taken February to March 2012 for the April-May 2012 election ballot and the term runs from November 2012-2015. Call me enthusiastic! :-) Council voted to bring back postal voting as online voting produced much lower voter returns (need to update emails, spam filter, email overload, etc.) so postal ballots will be asking for members to update their email addresses for future correspondences.

For the 1,168 GPs who voted for me in 2009, my platform remains the same as on my main website www.drunacoales.com. My goal is to achieve 3,000 GP votes next Spring. Wee chance? We can transform this College into a fellowship of caring GPs!

This post is merely a pre-campaign notice of intention and giving voice to my continuing battle to oppose wasteful financial NHS resources being spent on a 'toothless revalidation' at the expense of devastating NHS cuts to public front line services that do more harm to and risk our patient lives. How can we conscionably divert funds from our frontline NHS services to pile on more costly paper bureaucracy, when our nation struggles amidst a financial global crisis?

Encouraging GPs to apply for FRCGP

2011-11-14T17:58:00.001Z

I encourage all GPs with MRCGP who have been contiguous members for at least 5 years to consider your next step, FRCGP. The rules for Fellowship of the Royal College of GPs have changed to allow greater accessibility by reducing the minimum years of membership to apply and by simplifying the process. One does not have to wait until one has been a GP partner for 30 years and a trainer for 20 years facing retirement to be acknowledged for exceptional achievements in family medicine! I had been a medical doctor for 19 years myself when I received my FRCGP. If you are a GP trainer (2 years as a GP to apply to be a trainer), a member of your Local Medical Committee, an academic Dean, a BMA GPC rep, a GP commissioner, a faculty executive board member, a PEC chair, okay a GP partner of 30 years, etc. consider putting yourself forward for FRCGP (Fellow of the Royal College of GPs). The categories include leadership, innovation, teaching and education, academic research, clinical practice, and patient-centred care.

Make it known to your local RCGP faculty that you would like to be considered, and your faculty will find a nominator and 2 seconders who will write 400 words and 100 words respectively in support of your application. You are also asked to write a 1000-word nominee statement. The one-off admin fee is £620 and is paid, once your faculty fellowship committee has met and approved your application and the RCGP Council has endorsed your fellowship recommendation at their next Council meeting. Then attend the AGM or SGM for your family and friends to share this moment with you. I was positioned alphabetically between 2 longstanding GP partners and one said to me 'I suppose you got your fellowship for doing committee work...' Little did he know that I got my fellowship for writing numerous medical books (2 highly commended by the British Medical Association), using media (presenting Turn Back Your Body Clock) to educate a worldwide audience on primary health promotion (tackling obesity, smoking and drinking) and for teaching 1000s of training and established GPs.

This Friday I will be applauding one of the first GPs I ever taught on my very first MRCGP course in 2004 as he too gains his FRCGP for teaching and education, as a GP trainer and partner himself! And I am pleased that he is not waiting until he is close to retirement to receive such a wonderful acknowledgement for contributions to family medicine.

Social Media and Medicine Friend or Unfriend?

2011-11-14T17:23:00.001Z

What a brilliant topic and title! One definitely worth attending. It is open to any GP in the Lambeth and Southwark BMA Division and will be held at King's College Hospital in South London. It will be fascinating to hear all the arguments.

Personally, as a nationally-elected Royal College of GPs Council representative (term 2009-2012), I rely heavily on social networks to engage in discourse with my electorate. There is no hierarchy with bureaucratic edicts being passed top down from above, but rather I seek to understand motivations, underlying concerns and encourage free dialogue with GPs across the country using a secure facebook group so that it becomes a democratic process in order that I may air their views in a bottom up approach and give voice to the silent majority, the grassroots GPs of our nation.

11.11.11 Medical Womens Federation AGM Dinner at the House of Lords

2011-11-11T23:12:00.001Z

11.11.11 one might think that a convention held on this date held only for women may be more aptly nicknamed the 'Witches' convention, and I was surprised that a former President of the Medical Women's Federation, indeed fondly calls this group 'the witches!' So it is a fond appellation we are allowed to use.

The Medical Women's Federation was founded in 1917, 2 years prior to the medical men getting their act together in 1919. On 11.11.11 they held their AGM and dinner afterwards was served in the Cholmodeley Room at the House of Lords, as guests of The Baroness Finlay of Llandaff. Here I am pictured with GP Dr Sara Khan, the Editor of the Medical Women's Federation magazine.

It was inspiring to be seated in between a year 6 specialist paediatrics registrar who had another 2 years to complete training (ie through year 8 to become a consultant); a former President of MWF (a consultant obstetrician and gynaecologist) and her colleague, a consultant anaesthetist, all women. What astonished me was that if a consultant obstetrician chose to do private practice, UK malpractice annual insurance premiums start at £25,000! Gulp!

The winner of the most family friendly NHS trust was Kings College Hospital in South London, and we greeted the male chief executive Tim Smart who accepted the MWF award. It reminded me of, how over a decade ago, it was Kings who allowed me to work to fulfill my obstetrics and gynae rotation commitment as a flexible GP trainee with 3 small children, in other words allowed me to train part-time but on an extended basis. Well done Kings!

For a brief moment, it felt like a medical world full of female GPs and NHS hospital consultants, until I realised this only represented a microcosm and outside, women were still hitting a glass ceiling; these women were the fortunate, who had made it all the way up the predominantly male medical ladder in this country.

British Medical Association GPC meeting

2011-11-09T18:40:00.002Z

British Medical Association General Practitioners Committee meeting to hear from GPC negotiator Dr Chand Nagpaul
Wednesday was spent at BMA House to hear from the GPC negotiators, to ask questions of GPC and of Londonwide LMC representatives. Just like the Department of Health meeting, it too was very welcoming, friendly and a conducive atmosphere for all. Local London GPs, mostly LMC reps, attended and sat in the audience. I was invited as a former London LMC rep to also hear and ask questions on behalf of grassroots GPs.

Some reassuring points of clarification were made.

1. CQC practice registration for NHS surgeries has been put on hold until 2013. This will be a relief for the 7,000 NHS practices out there in light of the fact that many PCTs are not providing money for practice refurbishments and it staves off the daunting task of another 37-page practice document to fill for the government covering practice audits, complaints, access, patient surveys, etc. all of which are already covered or discussed in a GP's annual appraisal.

2. Pensions
Amidst growing concern of a national 'Day of Action' on November 30, the GPC declared that industrial action was a last resort and have not ballotted members YET! So why are GPs upset over the new terms of the pension? Simply put they are asked to pay an increase in contributions with no guarantee they will get their money back. Only reassurances have been given for transitional protection for those within 10 years of retirement. What of the rest of the GPs who are too young to retire in 10 years? Are they making extra pension contributions for no additional returns? Also the Hutton Report suggests raising the pension age from 65 to 68 to collect. As male GPs have a higher mortality rate than female GPs, the concern is how many will be left to cash in on pensions at age 68? Already a former GP colleague of mine dropped dead of a sudden coronary heart attack after turning 46! And when I was a training GP registrar, one of the male partners was diagnosed with spine cancer in what I presume was his 50s and sadly died shortly thereafter. Bankers lead a stressful life yet may cash in on their pensions at 55.19,000 GPs responded to a BMA survey (the largest response in 20 years) and 88% of GPs have seen intensity of consultations increase over the past 5 years. As hospital specialists are handing over more and more responsibility to local GPs, stress levels rise exponentially as they did not undergo specialist hospital training in mental health, cardiology, etc. 13.3% of GPs stated they will retire in 2 years time.

The GPC have received a revised offer from the coalition government and are reviewing...

3. Appraisal and Revalidation
Advice was that appraisal has not changed and that revalidation even though it is scheduled for late 2012 was still being negotiated by GPC on behalf of GPs. I raised the need for fairness as nurses only had to submit one task, 12 CPD points every year or 36 over 3 years for revalidation yet are assuming many of the hospital and GP roles in prescribing, operating, running ER, hospital scanning, etc. And that psychiatrists only have to submit one task, CPD points for their annual appraisals compared to GPs who still have to submit audits, case based discussions, significant event analyses, CPD points, and so on and so forth. Chand Nagpaul reassured me he would ensure fairness for all medical specialties.

GPC advised GPs NOT to submit any multisource feedbacks with appraisals as this tool had not been assessed. Concerns remain regarding locums in the revalidation pilots, ie it is still biased!

I asked if the Form 4 of appraisal was public information and explained how one GP had jokingly put 'ought to cut down on the drinking' in his appraisal statement which should really have been addressed as a possible cry for help, ie stressed and instead resulted in an immediate GMC referral for an appraisal process that is not supposed to be pass or fail but formative and mentoring in nature. The GPC reply was that Form 4 is seen by the PCT.

Department of Health meeting

2011-11-09T18:16:00.001Z

Department of Health Clinical Advisory Panel Payment by Results meeting
Tuesday was spent attending the DH CAP PbR meeting. The DH found an economical venue at Kings College London Strand for the meeting. The last time I ever attended Kings on the Strand was 1996 when I attended Professor Slome's Primary FRCS course for 3 months after delivering my 2nd daughter 4 days prior! Things had changed significantly. Instead of rows of hard wooden seats, the lecture theatre was kitted out with plush wood panelling, individual cushioned seats, rows of desks with individual internet and power points spread evenly across each row and in place of a blackboard with chalk was a huge screen with inbuilt ceiling projector. It was a stark reminder how basic educational tools were 15 years ago!

The DH meeting was attended by a BMA consultants' rep, a part NHS/private GP, a nurse's rep from the Royal College of Nursing, the Royal College of Surgeon's Council Rep was absent this time (apologies), a medical director, a geriatric consultant from Southampton, a consultant anaesthetist and a handful of others. I attended as a GP representative from the Royal College of GPs. The Chair was a GP who was masterful at chairing and ensuring lots of questions were obtained from the floor, and he valued everyone' input and summarised points at regular intervals. DH personnel duly gave powerpoint presentations and asked for feedback and questions after each presentation. This went on for 4 hours. It was really welcoming to see that the Department of Health were making a sincere and concerted effort to hear from representatives from all medical specialties across the country to help shape the 'Payment by Results' tariff to ensure fair NHS pricing.

'Cherry picking' was a hot topic and it was suggested it be renamed 'differential pricing'. There should be 2 tariffs for investigative vs therapeutic tools, ie OGD, as the latter involved pathology costs also. I mentioned that as only one private hospital had an adult and paediatric ICU, it should not be held against them. They were not necessarily 'cherry-picking' as they were not equipped to manage a high risk patient with co-morbidites (morbid obesity) undergoing general anaesthesia.

We saw a presentation on PLICS (patient level information costings survey) or in other words the latest trend in hospitals is to price everything and compare. What has not been done yet is to price and compare specialties with other neighbouring hospitals. I mentioned that GPs already have PACT data which allows them to see their prescribing cost data as compared to other GP practices in the area to see if they are over-prescribing or prescribing more expensive drugs than others. A good idea would be if a pharmacist sat on each GP consortia so he or she could visit the local surgeries and review the medication of their patients to see if they could cut costs. Often times GPs issue repeats and a pharmacist's input as to the latest or more cost effective drug may be invaluable!

PLICS was controversial as some surgeons spent more time in theatre (ie the highest cost was assigned to theatre time) because they had fellows doing coronary artery bypass grafts and not consultants. Do we then ask NHS hospitals to only hire consultants and reduce training programmes to speed up on theatre time and reduce costs? Already cataracts are the most frequent NHS procedure done privately ie catch up lists which may deprive ophthalmology trainees from operating experience.

The most controversial topic was Non-Payment for Hospital Readmissions (with notable exceptions of cancer, maternity and other diagnoses). The plan is to reduce the NHS budget by £339 million by non reimbursing NHS hospitals if they readmit patients, I suppose to prevent hospitals from discharging patients too early. A perverse incentive was raised that GPs may then instead of spending on step up community care for an elderly patient, may instead send the patient back to hospital for readmission. It would cost the GP nil. I think this may be false economy as the debt exists, the cost exists, the hospitals still have to pay staff and the readmitted patient still consumes resources. This just adds to the NHS hospital debt. The good news is that when GPs head consortia they will be managing both local GP and hospital budgets so will be incentivised to deliver value for money in both primary, community and secondary care.

Miss World 2011 in London - Even GPs need a day off

2011-11-07T06:20:00.001Z

113 contestants from all over the world competed for the title of Miss World 2011 at its 60th anniversary held in London.

Taking a break from medical politicking and teaching GPs, I treated my younger sister to a Sunday evening out. When I first saw Miss Venezuela, as she introduced herself to the audience, wearing an amazing pink feather multi-layered dress, I knew instinctively she would win.

Miss World has sparked a debate as to whether it should be judging women on the basis of beauty; some are blessed with natural physical beauty more so than others, with physical beauty fading with time and with age, yet these women were equally highly intelligent and able to hold their own in a debate hosted by Oxford University students.

Audience members stood a few metres apart by the stage, having their photos taken by friends or spouses to mark this momentous event that Miss World had again been hosted in London (last time was 1999 so I was told by a Miss World fan who sat next to me in a sequined evening gown). Yes, some spectators had even donned evening wear just to sit in the audience and feel a part of this event! It was a global event as audience members waved and cheered their nation's delegates with flags and the most vociferous cries for Miss Venezuela vs Miss Phillipines. It was a brief moment to escape the financial worries of a global recession and enjoy a global charity event which raises funds around the world for Beauty with a Purpose and was viewed by 1 billion worldwide on one quiet Sunday evening.

Impending NHS strike over pension November 30, 2011

2011-11-06T08:01:00.003Z

The Coalition government was very generous to offer the same pay to GPs in the GP contract and promise to cover the next 10 years in pension payouts, but it would seem, this is not enough and a strike action is still planned for November 30. By showing equality and fairness with revalidation of doctors versus nurses, grassroots GPs may be more amenable to showing empathy for the national debt. Government cannot force CQC registration and revalidation on GPs at the same time to duplicate and triplicate the paperwork already submitted in annual GP appraisals (audit, surveys, CBD, CPD, SEAs, statement of roles, health, etc.). Pulse has already featured an article that GPs are swamped with 400 pieces of papers from hospitals each week, letters, lab results, etc.

http://www.publications.parliament.uk/pa/cm201012/cmselect/cmhealth/1428/142805.htm It seems 700,000 nurses will be revalidated by the NMC every 3 years with just 35 hours of CPD for revalidation! Yet nurses now do ultrasound scans at St Thomas'. A nurse did my pelvic scan to rule out womb cancer (instead of a medically-trained doctor with at least 3 years specialty training in radiology as I had at St George's, who scanned my shoulder and correctly diagnosed supraspinatus tendinopathy). The nurse even had to ask a colleague in the corridor whether her gloves were latex or not as I had an allergy to latex, and then after a few minutes spent scanning declared 'no cancer!'. I did not feel reassured as a patient! Yet the radiologist doctor at St George's Hospital spent 15 minutes taking a history, examining and scanning my shoulder showing me precisely what he was scanning and what he had picked up. Nurses now run emergency rooms as nurse ER consultants, do foot and carpal tunnel operations and now may prescribe after a 6-month prescription course! So why are doctors having to face an onerous revalidation with 13 checklists and 6-10 pieces of paper evidence over 16 attributes when nurses only have to do 35 hours of CPD yet are assuming many of the GP, ER, surgical and radiologist doctor roles now?

Nurses are brilliant at what they are trained to do at nursing school, hospital nursing, assisting in theatre, covering women's health (pap smears), and offering travel advice and vaccination. It is when they are given doctors and surgeon's roles, that patients may not be given the best care, as they have not undergone 6 years of medical school and 5-7 years of intensive medical specialty training including 2 years of foundation hospital training. Even my teen daughter could spot better care with me, a GP, taking a history, examining her sports injury and diagnosing a Grade 1 ankle sprain, when it did not get better after a week after the local nurse saw her, gave her paracetamol and said it was fine! I was able to give her appropriate exercises and an expected time line for recovery and include her in a patient understanding of the differences between grades 1-3 ankle sprains.

Lawyers in the UK only do CPD points, as do doctors in Canada and Oz.

2/3 of private GPs (many who have MPs as patients) are against revalidation as it stands (results of my survey as of today with 18.69% return). If we treated doctors as fairly as we treat nurses and lawyers, all would submit to just CPD hours of education to keep current as opposed to submitting heaps of paperwork they have already supplied for CQC registration which appears redundant and costly! One GP of 37 years said he has spent £30k to get HCC/ CQC registered and complete the paperwork and still the government is not happy and asking the same questions for revalidation from another department. He feels he is already regulated by the CQC.

I plan to raise this unfair and inequitable treatment of doctors vs nurses with revalidation at the BMA GPC meeting on Wednesday afternoon at BMA House.

Hoping this further insight helps the Coalition government get it right. Over regulation with revalidation now of doctors, nurses http://www.nmc-uk.org/Nurses-and-midwives/Revalidation/ , dentists http://www.gdc-uk.org/Dentalprofessionals/Revalidation/Pages/default.aspx and pharmacists & technicians http://www.pharmacyworkforcenw.nhs.uk/news-revalidation_of_pharmacists_and_technicians.html , will NOT improve care but drive many to quit and find other means to provide for their families. It will only make NHS delivery of care dangerous and unsafe with understaffing. One GP trainee I saw Friday said he was an A&E registrar and has quit to train as a GP and would not go back even for a huge hike to £120 an hour, as it was so short staffed and overpopulated with patients (ie too high risk) and now at least he can spend time with his family.

Over regulation stifles innovation and improvements which we need to find a way of providing care on a tight budget. We need positive deviants and innovators and shapers, not tick boxing workers. A positive deviant in her 30s as a GP partner provided health checks to over 1000 local patients at a weekly Saturday Morrisons as many of the patients worked and did not have time to come to the surgery. Her practice then picked up significant numbers of patients who then required medication!

GMC Reform vs Revalidation of Doctors & Nurses

2011-11-05T08:09:00.001Z

What we want to ultimately achieve is patient safety.

http://www.dailymail.co.uk/news/article-2048050/Why-woman-allowed-hospital-Fury-victims-father-emerges-murder-suspect-detained-before.html

The Daily Mail details how a mentally ill patient was discharged early from the Queen Elizabeth Hospital, in Woolwich, and within an hour killed a local grandmother. A local GP explained to me that this hospital has an extensive NHS mental unit.

I sit on the Department of Health payment by results panel and they propose fining NHS hospitals if they keep patients in too long and fining hospitals who overspend, ie 2 deviations from the mean. Next meeting is coming Tuesday. This emulates the US RAC attack. Here the US hire private companies to audit hospitals medicare charges and if deemed to overcharge, the hospitals are fined in the multimillion dollars range!

http://www.newsshopper.co.uk/news/9330846.Missing_hospital_patient__could_be_danger_to_himself_and_others_/?ref=mr

This is what happened again at the Queen Elizabeth Hospital on 27 October 2011. Understaffing and £1m cuts lead to further risk to the public as a missing mentally ill patient wanders off out of hospital into the public!

This is the same hospital that consultant urologist Mr Ramon Niekrash was suspended for whistleblowing to executive management that his cancer patients were not being seen by him for months, as their appointments kept being cancelled by the hospital. He is now appealing for damages after suspension which led to loss of income. He suffered £180k in legal fees for standing up in an employment tribunal and challenging the suspension. A local grandmother (who looks after injured animals) and who herself was a patient at Queen Elizabeth and witnessed inhumane treatment of the elderly on her ward, is leading a patient campaign to support her noble local NHS surgeon. Better if management had included his input as to how to better provide and improve patient services at Queen Elizabeth Hospital.

Neighbouring Queen Mary in Sidcup closed its large accident and emergency department due to NHS funding cuts. Is it safe for patients to continue to close and cut local NHS services?

And now even their local out of hours service covering Greenwich and Bexley, manned by local GPs called grabadoc, has been put out to tender to the highest commercial bidder.

So how do we ensure patients are safe? Bad GPs are already referred up to the PCT or GMC by all doctors, nurses and patients. In fact the GMC has seen a surge in doctor referrals as everything from swearing, wagging a finger, shouting, seems fit to be referred up instead of dealt with locally.

Who was to blame for Shipman?www.geraldengland.co.uk/gx/shipman/htm Shipman was caught self prescribing a narcotic pethidine which is an injection and not a tablet and was found to keep passing out. He too was referred early to the GMC. Any doctor would know this was a serious red flag concern that a doctor was dangerous! The GMC failed to strike him off. Had they removed his license, he would not have proceeded to be responsible for 216 confirmed cases of patient deaths. If he got a warning, how many of his patients know to check their GP's GMC number to see whether a warning for 5 years has been placed on his medical license?

Would revalidation identify Shipman? No. Paperwork is paperwork. All you need is a good medical student to come to your surgery and type up the paperwork, fill in the boxes, compile a practice audit, hand out patient surveys, ask your staff to rate you their boss (conflict of interest) and suddenly the public think they are reassured their GP is not a Shipman?

What is needed to ensure patient safety? reform of the GMC. I am so pleased the GMC now reports to Parliament's Health Committee but who sits on this committee? MPs? What about doctors who know what pethidine means? Or that propofol which killed Michael Jackson is a drug for hospital anaesthetists to inject, anaesthetise a patient for surgery in an operating room, intubate and then monitor and chart vital signs every few minutes as there is no antedote to propofol as there is to pethidine if picked up in time. Perhaps a system by which referring doctors may appeal GMC cases where they think the public are still at risk of a dangerous doctor the GMC have let off?

Monitor is now the regulatory body for NHS hospital trusts. Poor management have hit the gross misconduct dismissal or GMC referral button instead of sit down with difficult doctors who fight for better service and treatment of their hospital patients. Consultant paediatrician, Dr Kim Holt, refused a £120k gagging clause payout and spoke up that her community clinic was understaffed and vulnerable children in Haringey were being put at risk from under resourcing. Better to have worked with her, a positive deviant, to find a way to provide a service with limited NHS resources than pay for 4 years of 'garden leave' to keep her away from the hospital premises. Baby P could have been saved.

Need to further delay revalidation as systematic bias has been identified by the Peninsula Study on patient surveys against locums, GPs, and non UK trained GPs...we need time to revisit how to properly ensure public safety. The IDF revalidation pilot is also still in progress.

Many doctors may not complete the GMC consultation response papers which ask all sorts of personal details at the end, name, address, job, and so on and so forth so it is hardly anonymous. If it is the GMC who need reforming, who will dare give out personal details and complain about revalidation? The GMC has now come up with a 2012 draft guidance for doctors which contains 82 rules! 82 ways that GPs may be referred to the GMC and includes private life activities too!

NHS Whistleblowers live in fear of a malicious GMC referral. Hospital consultants keep silent over hospital mishaps (missing patients as there are so many patients admitted and moved from ward to ward to ensure same sex policy that they do not know who they are covering, etc.) for fear they will be referred by poor management to the GMC. How does that ensure patient safety if doctors are afraid to work with trust management based on what they see happen to their brave and noble colleagues?

In the States, medical regulation is decentralised to individual state board panel of doctors. The GMC has been given too much power and too many lay panellists. Better to allow GP consortia to regulate their own profession as they can better identify what is good and bad practice. Better to let good hospital management deal with employment issues. Better to have local Deaneries deal with GP trainee issues. Better to have medical schools discipline their own medical students.

The fault lay with the PCT who did not act all the time when bad doctors were referred to them by doctors and patients, as they were lay managers who do not know what the difference is between self prescribing salbutamol vs pethidine. Lansley scrapped PCTs! Wonderful, too much NHS funds spent on bureaucracy and lay managers. Now GP consortia who do have doctors in charge can receive complaints about GPs and know the difference between a malicious referral and a patient safety one. A GP consortium is best suited to identify a bad practice and act swiftly to remove the practice from the consortium and you have to belong to a consortium to get paid! Brilliant! The NHS commissioning board regulates consortia if a practice needs to appeal.

So I conclude by saying, my life has been all about teaching 4,000 UK GPs to be smart, up to date and caring so that patients do not die at the hands of doctors, but when I see a paper exercise being paraded by the GMC as proving a doctor is safe, I have to speak up. When I see £1billion of NHS funds being spent on appraisals and revalidation pilots, whilst brave NHS consultants speak up about staff shortages leading to dangerous risks in hospital to patients and NHS hospital closures, I have to speak up.

It is not 230,000 doctors including 20,000 EU doctors who need further regulating, with nurses next on the chopping block to be revalidated in 2014, but the GMC monopoly who need reforming as currently doctors feel stifled by the immense control and regulation over their lives. We are asking doctors to triplicate paperwork for annual appraisals, CQC registration and now revalidation. They all have the same headings...statement of roles, audits, complaints, patient surveys, health, research etc. Yet because the 2 organisations do not communicate with each other, they do not even realise they are all asking to triplicate the same paperwork!

Devolve power away from the GMC. The GMC should be akin to a High Court and only see cases of clinical negligence or patient deaths. Send back any employment issues to management and suggest ACAS mediation or employment tribunals. The GMC should be for clinical negligence not bad manners.

So please, please defer revalidation which will only pocket £millions for public and commercial organisations who stand to profit from revalidation by offering eportfolio toolkits or patient and colleague surveys x 230,000 doctors every 5 years.

It will cost the NHS up to another £billion of tax payers money every 5 years to deliver, a billion that could have been used to ensure your family are seen sooner for cancer treatment, your streets are kept safe from early discharged mentally ill patients, your local A&E and maternity wards are kept open and not closed. The public lose out on NHS money that could have been spent to keep their local NHS hospital open and delivering safe medicine and saving lives in a timely fashion.

Please please do a proper cost benefit analysis instead of asking doctors to triplicate paperwork questions for each annual appraisal, cqc registration and now revalidation. Ensure patient safety is what we ultimately want to ensure. Spend NHS money on frontline services, care and staffing as the Coalition Government promised to do to ensure patient safety and a great medical service.

US Family Medicine vs UK General Practice

2011-11-02T05:30:00.002Z

A fascinating glimpse into US family medicine - an interview with a US family physician.

Question. What is medicine like at the moment in the US? How is the US coping with the global recession?

Answer: ‎US hospitals are living in fear of RAC attacks. NHS hospitals are also facing huge cuts to services and staff.

Question. What is a RAC attack?

Answer: The US government sends in a private company to audit a hospital, and if they are found to be overcharging for Medicare, the hospital gets hit by multimillion dollar fines, as the government is trying to get their money back! I compared this to a recent meeting at the Department of Health in which the Chair of the Department of Health meeting on payment by results had made a suggestion to impose fines on NHS hospitals who overspent by 2 deviations from the mean!

Question: How are US family physicians coping?

Answer: There is a rise in law suits and malpractice premiums in the States. US doctors are now advised how to dress DOWN in court. No $5k tailored suits, fancy watches, or any outwardly sign of their wealth so the jury can relate. How their body language is assessed to ensure they do not come across as arrogant. How they are coached on how to speak and what words to use in court. In the UK, a medical defence organisation shared that malpractice premiums had to be increased 20-50% due to the surge in GMC referrals and that premiums were higher for private GPs.

Question: How much does a US family physician make?

Answer: If academic, $120,000. If private, $1 million a year. Private family physicians in New Jersey are earning one million dollars a year. In the UK the average salaried GP makes £7k a session or £56k a year versus the average GP partner £110-120k.

Question: How can they earn a million a year?

Answer: They own their own practice, buy or lease an exercise stress test and echo machines, pay hourly rates for a visiting cardiologist to see their patients in their family practice so that the family physican may claim for both the GP consultation and the cardiology specialist referral and investigations on the health insurance policy.

I shared the UK saga of the 5-yearly revalidation of doctors on the horizon. He was shocked! He then asked why GPs were afraid of commissioning? And commented that the food at a GP conference was very healthy compared to US physician conferences. I asked in what way? He said in the States the dinner sizes are huge and extended his arms to show me. He closed by commenting that I reminded him of Dr Mehmet Oz, America's most famous doctor and surgeon and personal friend of Oprah. I have since googled Dr Oz!

http://www.doctoroz.com/

In times of austerity, declutter and shop on Ebay

2011-10-31T07:35:00.003Z

In times of austerity, we have to economise. Either donate your unwanted goods to charity or declutter on Ebay, a worldwide virtual market. Start listing any unwanted gifts, recycle books, sell outgrown children's clothing (proviso with lots of remaining wear to be had), excess furniture, household appliances and so on and so forth. If you do not know the market value, list at 99 pence and ensure the auction ends on a Sunday evening to reach the widest audience.

Did you know that many high street stores have ebay outlet stores? LK Bennett sells clothing at up to 75% off on ebay! No need to wait for twice-yearly high street sales. So cut out the middle man and start shopping on Ebay to make your pound stretch further.

Talking about pounds, have you explored your local 99 p stores? Amazing value for money may be had as every item in these stores are priced at 99 pence! Stationery, postal jiffy bags in packs of 3, groceries, household cleaning products, CDs, books, clothing, etc.

You may not be able to ask for a payrise while the world suffers a global recession so instead shop wisely for you and your family.

25 Reasons to Abolish Revalidation for the Health Committee

2011-10-30T09:24:00.003Z

25 Reasons to Abolish Revalidation for the Health Committee on Revalidation of Doctors (submitted)

Background

Revalidation has its origins in the early days of New Labour. Its potential to raise standards is very limited. It will incur substantial direct and even more substantial indirect costs. It is deeply unpopular with doctors both in the NHS and independent sector. As it stands, it will NOT identify an incompetent GP; it is meaningless.

The RCGP has been tasked with leading on revalidation pilots, collecting evidence and are creating their brand of revalidation ‘e-portfolio’ for GPs to use (free for members but charged for non-members). ‘E-portfolio is a CPD monitoring system under which GPs with sufficient ‘points’ and clinical experience can ‘qualify for revalidation. This process will be supervised by a cadre of newly hired ‘revalidation officers’ .This system was an alternative to an exam-based assessment, the latter of which, ie an 'exam' was requested by Dame Janet Smith in the Shipman inquiry.

The SoS has stated he is awaiting results of the pilots before making any decision, and of course unless we know precisely how many of the 230,000 GMC-registered doctors are expected to fail, we cannot accurately work out a cost-benefit analysis. We await to read an official cost-benefit.

The current plans for revalidation give rise to a number of specific issues:

1. Who polices the guardians (ROs)? Who vets the 1000 responsible officers (ROs)? Is it enough to just make medical directors automatic ROs? Where is the due diligence? An RO has already been brought to the attention of MPs.

2. Would you see a medical doctor who graduated medical school by passing coursework or by passing an exam? We are asking to revalidate 230,000 medical doctors based on paper coursework! This is a fundamental flaw with revalidation asking for paper evidence of competency rather than testing medical knowledge, safety and application through an exam as in the US who test 661,000 physicians.

3. Coursework is not an evidence-based test of competency. This is why we submit our students to A-level exams, our medical students to medical school finals, our newly qualified GPs to an MRCGP exam to be licensed, our cars to a physical MOT test. This is an enormous paper-generating exercise and is not evidence-based to prove competencies as an exam has been proven to.

4. I became a GP because as a child my baby brother died due to a missed diagnosis by a single-handed NHS GP in Tower Hamlets in 1975. He was incompetent. I have been fighting to ensure patients are safe. I repeat the US has over 661,000 physicians and all sit a medical knowledge based specialty board exam every 10 years as medical diagnoses and treatments are constantly evolving. The UK is asking for revalidation without an exam? How can it prove a doctor is up to date without testing ability to make a correct diagnosis and offer the correct and most current treatment? Prior to the 1970s, there was no GP training, so many GPs out there have never undergone specific GP training. Post 1970s came vocational GP training and an exit exam administered by each Deanery called summative assessment (a multiple choice knowledge test to test current medical knowledge and a video of consultations to test bed-side manner). From 2007, it then became mandatory that all newly qualified GPs sit and pass the MRCGP exam which is also a multiple choice knowledge test (applied knowledge test) and a clinical skills assessment (which is a simulated surgery consultation exam). I suggest politicians shelve revalidation as it stands, as incompetent GPs will continue to fall through the net, as their medical knowledge and bedside manner are not tested. A GP's knowledge of intussusception will never be tested in revalidation, nor his knowledge of gynaecological emergencies for women, etc. Revalidation as it stands does not test medicine or consulting skills, it only tests ability to amass paperwork. Do it properly or do not do it at all.

5. October 3, 2011, Channel 4 Dispatches aired an investigation into incompetent GPs who were known to the GMC. Two were male international medical school graduates and one unknown to the GMC was European and a university lecturer. Academic GPs are highly intelligent and would pass any multiple choice exam assessment if this were used as the sole tool for revalidation. What was needed was a GP consulting skills test which is also not covered in the current proposals for revalidation. An experienced peripatetic locum GP, as demonstrated in Dispatches, could assess whether a single-handed GP is safe or not and reported the European GP as 'unsafe'. As a past Lambeth PCT Primary Care Access Support GP, I have worked a single session in over 30 local GP practices in South London and assessed who was competent and who was not by reading their consultation notes. The one practice that I found to be severely lacking was already known to the PCT and the 2 GPs had been removed from practice. Conversely, a single-handed Asian GP in South London was doing a stellar job, and I commended him to the PCT and he received more funding!

6. GMC has a lengthy investigation process. We may be subjecting this to between 5-14% of 230,000 doctors estimated to be referred up to the GMC by the responsible officers. Currently the average length of investigation is 18 months! In the US, if a doctor fails his recertification board exam, he re-sits in 6 months. The GMC may need reform, before we subject 10,600-29,680 (5-14%) additional doctors to the GMC for investigation. It is a career-breaker and NOT a career-enhancer.

7. 57% of 3,000 doctors in official revalidation pilots say revalidation will NOT improve patient care. This was published in Pulse www.pulsetoday.co.uk on 15 July 2011 and read by their readership, 30,000 GPs nation-wide.

8. Legal implications: Cost implication from impending lawsuits due to failing revalidation (i.e. allegations of vexatious patient satisfaction surveys, vexatious colleagues in multisource feedbacks, unscrupulous medical directors as revalidation officers).

9. Economic cost implications: £156 million annual costs to pay for remediation of 9% of 212,000 doctors. Cost of remediating each surgeon is £40,000 and of each medical doctor/GP is £20,000 according to Dr Laurence Buckman, Chair of the BMA General Practitioners Committee. Why create a new expense when the UK is £4.8 trillion in debt????

10. Responsibility for implementation of remediation of 6,360 (3%) UK doctors? Who is going to be responsible for the implementation of remediation of doctors? Low estimate is 3% of 212,000 = 6,360 UK doctors? Has this been thought out thoroughly? 3% is cited by Professor Mike Pringle of the RCGP Revalidation Lead. He says primary care trusts are already aware of 2% of doctors who are underperforming on their lists and estimates a further 1% identified through revalidation.

11. Against EU law: It is against EU law for UK to introduce a new requirement to work as a doctor in the EU when this requirement does not exist in other EU countries. This may lead to further lawsuits as EU doctors are blocked from working in the UK, as they will need revalidation to get on the GMC register and practice in the UK. EU doctors already cover a number of out of hours shifts for GPs and patients.

12. Source within the GMC is against revalidation. ' Revalidation won't alter casualty rates of those being damaged by charlatans. It will only drive mad doctors underground.'

13. Current revalidation pilots bias against locums, part-time GPs with families, GPs who are carers or who have disabilities as they find it difficult to collate 4-10 pieces of evidence over 16 attributes to pass revalidation which explains why concerns were raised in the 10% who undertook the revalidation pilot. That’s 64-160 pieces of paper evidence! Labour legacy. Proves nothing but that you are good at collecting paperwork.

14. Millions of patients face being without a GP: If 5% of 55,000 GPs are referred to GMC, 5.5 million patients will have no GPs. An average GP covers his own list size of between 1,700 and 2000 patients. This does not include 5% of the 157,000 hospital doctors who will be suspended and therefore patient care in hospitals will fall behind due to lack of clinical manpower.

15. 95% of GPs are opposed: Doctors net uk poll showed 70% of GPs voted that revalidation is a waste of time and money and 95% of GPs voted in opposition.

16. 99% of national LMC GP representatives opposed at annual LMC conference in June 2010: I conducted a straw poll of national LMC reps which showed 99% against revalidation.

17. Revalidation discussed for 10 years on the RCGP Council: Doctors still not in agreement here.

18. Concern that without GMC reform, we will see an increase in doctor deaths during GMC investigation: Doctors Support Network 15-page report by Dr Liz Miller to the Health review group confirms 10 doctors commit suicide during GMC investigation each year. Will we see a further increase in doctor deaths due to the 3% increase in GMC referrals?!

19. Caught in GMC cycle of assessments, if referred. One GP partner with MRCGP was stuck in a 6-year GMC cycle of assessments of GMC multiple choice exam x 2 and passed, simulated surgery exam x 2 and passed, after an alleged malicious ex-partner referral, despite past Prime Minister Gordon Brown’s recent intervention! She has given up the battle after 6 years and resigned her license. A salaried GP has asked for BMA backing to clear his name as he is caught up in 5 years of assessments, repeating a GMC multiple choice exam and simulated surgery exam even though he passed his MRCGP exam when he was allegedly referred 'maliciously.'

20. Over-regulation does NOT ensure quality. Of course doctors should be safe and are safe in countries like Canada (no revalidation, just CPD and declaration of no outstanding complaints), like Australia (no revalidation, just 130 points every 3 years (CPD)), like the US (board re-licensure every 10 years by exam) and we have had no revalidation for the past 150 years, and doctors are still ranked at the top of the BMA Mori public survey on public trust. Lawyers in this country just submit CPD points. Nurses just submit CPD points yet now nurses are being given prescribing rights as nurse prescribers and nurse emergency room consultants, so why are they exempt from revalidation as nurses? Bankers submit nothing and yet have caused more damage to society than one Shipman.

21. Undesired effects of revalidation: Competent experienced UK trained GPs are taking early retirement, emigrating to Australia, New Zealand and Canada. My local practice in South London has already lost 4 of its 8 GP partners, to early retirement this year alone. I repeat Australia, New Zealand and Canada just rely on CPD points and no revalidation.

22. We are changing the face of general practice, to salaried and locum doctors with a handful of wealthy managing director GPs. Fewer in medical school would like to be GPs now. And fewer are pursuing medicine at A levels (opting for law or banking). This will lead to the UK relying more on EU GPs to cover NHS services. It is imperative therefore that both language AND NHS medical knowledge be tested, ie by PLAB which is sat by all international medical graduates except for the EU. How may EU GPs be able to pass revalidation? We are facing widespread shortage of GPs to cover day and night shifts!

Female GPs who work part-time due to child-care or secondary income may decide to stop working as revalidation is too onerous for the handful of sessions they cover and cope with child-care. Yet the public often prefer to see female GPs!

Who wants to undertake a career-breaker every 5 years with revalidation? Every 5 years??? This is why bright students are shying away from medicine now and those that are already in medicine are emigrating or retiring early. Lawyers and bankers do not undergo revalidation, and certainly not a career breaker every 5 years of their professional career.

With GP partners selling off their practices to larger companies who own between 15 and 50 NHS practices; these practices are not being manned by GP partners but filled with salaried GPs and nurse practitioners. One company offered a newly qualified GP only £37.50 an hour which is less than a plumber’s wage and offered only 2 weeks paid sick leave which is half that recommended by the British Medical Association standard contract.

23. Dr Harold Shipman was a white UK-trained GP and would have easily passed revalidation in its current form. Revalidation does NOT pick up a dangerous or incompetent doctor. Shipman had good patient satisfaction surveys. The process for multisource feedback requires a doctor to submit e-mail addresses of colleagues to a private company who then e-mails these contacts with a colleague feedback form for the fee of £100. Do you think Shipman would have supplied e-mails of doctors or nurses who suspected him? Shipman was highly intelligent, organised and thorough. He would have sailed through submission of paperwork evidence (audits, patient surveys, MSF, etc.). I repeat revalidation does NOT spot a dangerous doctor.

My local deputy medical director even announced at a local GP locum meeting that she herself did not think appraisal or revalidation would pick up a dangerous doctor and even my own GP appraiser questions the purpose of revalidation and what it is set out to do.

24. BMJ published findings of the Peninsula Study on patient surveys for revalidation on 28 October 2011 are subject to systematic bias against locums and doctors not from European or S Asian countries. A private company charging £100 x 230,000 doctors for surveys will make a turnover of £23 million every 5 years. Why are we relying on subjective tools to assess competency? Would you trust an airline pilot who says he has 30 positive passenger feedbacks or would you rather he passed a test, testing his ability to pilot a Boeing 747 at 10 yearly intervals to ensure he is not suffering from chronic fatigue or loss of intellectual responsiveness?

25. Abolish revalidation (high cost vs. little/no benefit to society). It is about collaboration and cooperation between the government and the medical profession. If revalidation persists, despite high levels of disagreement and costs, with little benefits to patients, this only fuels the current uproar over the Health Bill, 40-page CQC practice registration, £20k a year pension cuts in the GP Contract, and further divides the medical profession and government; the perception will be that government has little value for doctors’ opinions and their outstanding service to the public.

Possible solutions to reduce incompetent GPs.

1. To reduce incompetent GPs, we could ask medico-legal indemnity organisations to start increasing annual premiums on a sliding scale of complaints (claims). This is used in the States to weed out incompetent doctors as the annual renewal premiums become too prohibitive to continue working if a doctor is found to be repeatedly under investigation. MDOs’ know who the incompetent doctors are just as lawyers know who the guilty criminals are. Revalidation does not assess/test medical knowledge, caring, or consulting competence. All it asks is for patients to do a survey, your choice of 3 colleagues to rate you, a practice audit, review a handful of cases and significant event discussions, CPD points with reflection, etc. Where does it test your medical knowledge? Your bedside manner with the patient in front of you? This is why the MRCGP GP licensing exam tests both medical knowledge with AKT and bedside consulting manner with CSA. However 57,000 GPs will not submit to this every 5 years as it is too soon, perhaps every 10 years as a 'summative assessment test' but only if a detailed syllabus is provided as in the States so that exams in the UK are fair and without duress. This is why some doctors are against an exam to test their competence; they need to be reassured it is a fair test and update material is supplied with which to revise so that they may learn and keep up-to-date. Revalidation done properly is a 10-yearly medical knowledge exam. Our medical profession has been without revalidation for 150 years. Australia and Canada have a shortage of GPs so do not ask for revalidation but only CPD point systems.

2. Many PCTs, LMCs, locums, patients, MDOs already know who the bad GPs are. GP consortium now have the power to remove bad GPs/ practices from their consortia. Consortia are led by a panel of GPs who may then auto-regulate their profession with the NHS commissioning board supervising.

About Dr Una Coales

I have 19 years medical experience as a medical doctor (surgeon and GP in both the US and UK), 9 of which spent in GP training and as a practicing NHS GP. I studied and trained in America (Johns Hopkins University, Oregon Health Sciences University School of Medicine, St Lukes-Roosevelt surgical residency training programme) and the UK and have sat both country's medical licensing exams (NY state licensing exam, UK PLAB and the UK MRCGP GP licensing exam). However as a GP educator and author of 14 medical exam revision books, I have acquired extensive insight into assessing GP competencies in over 4,000 established and training GPs to have an opinion as to whether revalidation is fit for purpose; it is not.

I lost a baby brother, and my adult sister almost died too on the NHS due to actions of incompetent 'bad' NHS GPs. I am not satisfied that revalidation as it stands would have identified these 2 'unsafe' GPs, one male international graduate GP and one male UK-trained GP. If it did, I would be its biggest advocate; it does not, which is why I fight revalidation, as I object to the public being hood-winked. Do it properly or do not do it at all. I have lost my good family NHS GP of 18 years, as he has taken early retirement this year due to the threat of revalidation on the horizon for next year. This is the biggest shame of all.

Meeting at No 10 Downing Street

2011-10-26T18:17:00.000+01:00

Every NHS GP's dream is to be able to step inside number 10 Downing Street and be able to voice the ideas, concerns and expectations of all GPs. No more one-sided GP bashing in the Daily Mail, no more sitting in despair and silence over yet another layer of bureaucracy added to a stack of papers about to topple over on one's desk, but finally a chance to speak up and be heard. Finally a chance for our Coalition government to hear from grassroots GPs, as we, in turn, have offered each of our NHS patients...an opportunity for government to listen and GPs' concerns to be heard and addressed.

I was able to raise key ideas that GPs would favour in an attempt to assist with the £4.8 trillion UK national debt:

1. A list of NHS operations that the NHS will and will not pay for. This list could then be shown to a patient instead of GPs struggling to say 'no' in a nice way, so as not to offend. It puts GPs in such a difficult position to say 'No, you can't have your bunions fixed on the NHS because we can't afford to pay for this.' Instead, take this onerous task out of GPs' hands and let there be an agreed national list of what the NHS can or cannot offer.

2. A list of prescriptions that the NHS will and will not pay for. Take off E45 cream and any other moisturiser that is readily available at supermarkets. How many patients complain of dry skin and expect an FP10 prescription for a moisturiser so they don't have to pay at the supermarket? Add shampoos and sunscreens too to the list. Surely we can define what is and is not a medicine?

3. Take sick notes out of GPs' hands. How many patients come in fit asking for a renewal of their monthly sick note? Granted most come with established illness but a handful abuse the sick note system. If a GP examines a patient and says you have no back pain, the patient will then shop around for a GP who will issue a sick note for back pain, ie simply ask to see another GP at the same practice, or even worse lodge a practice complaint against the GP for refusing to give a sick note. Some practices profit from sick notes by charging each and every patient £15 for a private sick note instead of advising them to self-certify on a SC-2 certificate. This is not ethical. It is a no win situation and costs the NHS millions. Give sick notes to the department of work and pensions. In the States the government subcontracts to agencies to assess disability and sickness benefits.

4. Shelve revalidation of doctors.

Instead explore ways to better monitor the banking system. How many Americans have committed suicide rather than leave their homes due to foreclosures? How many lives have been destroyed by the $15 trillion US national debt? Look at the catalyst that now affects the EU and has left Greece struggling with Portugal, Spain, Italy and Ireland next in line and our country facing a referendum.

Revalidation does not do what it says on the tin. It does not identify incompetent doctors.

Here is what revalidation entails. You decide for yourself whether you can spot an incompetent GP, based on the paperwork requested? Bear in mind that 4-10 pieces of evidence will also be required for each of 16 attributes.

1. Statement of professional roles.

2. Statement of any exceptional circumstances.

3. Evidence of completion of 5 annual appraisals.

4. An agreed personal development plan for each of the 5 appraisals.

5. A review of each previous year's personal development plan (5)

6. Satisfactory achievement of continuing medical education; learning credits - 1 hour = 1-2 credits; 50 credits a year; 250 credits in 5 years. Includes courses, practice meetings, on-line modules, etc. Also self-directed learning (though this must be documented) or anything that you learn from and the learning impacts on your clinical practice (e.g. reading a book, or an article or seeing a play which had a significant effect on your practice - though you will need to be able to demonstrate this). Credits to be agreed with your appraisor.

7. Multisource feedback from 3 colleagues. Give 3 emails of colleagues to a private company and pay them £100. They will e-mail them directly for feedback about you. Yes, you pick the 3 names.

8. Patient feedback/ surveys (must demonstrate how it affects your practice). Survey template has not been decided yet but will be administered through a private company for approximately £100.

9. Complaints/ causes for concern (don't hide these; declaring these won't necessarily create a problem for you, appraisor says).

10. Audits of significant events analysis. It is only the person whose event it was (ie who was directly involved) who can use this for their appraisal and revalidation. Significant events don't necessarily have to be a 'negative' event, they must be 'significant' for you or your patients.

11. Audits clinical. Audits can also include 'data collection' though the latter isn't strictly speaking the usual definition of audit. You can collect numerical data (ie how many male vs female patients you see) and then reflect on what you can learn from the data before you and how this learning will alter your practice.

12. Statement of probity and health, ie you do not accept gifts from patients and are hepatitis immune.

13. Evidence related to extended practice, ie non GP clinical work; teaching/training; appraising; out of hours work; GPSI work; research etc.

PS If you are a forensic GP and do occupational health, you will need to be revalidated, ie do all of this over again by the faculty of occupational health and by the faculty for forensic medicine.

I say now work out how many hours, days, weeks it will cost your family GP in time and expense and lack of clinical patient contact time and then compare this with a cost-benefit analysis of revalidation.

Where in all this does it test a GP's medical knowledge? Where does it say 'do you know how to diagnose intussusception in a baby (a missed diagnosis which led to my baby brother's death)?' or bedside manner (we have seen C4's Dispatches on Can you trust your Doctor and witnessed poor bedside manner)? It doesn't. What about English fluency? No, not tested. What about consulting skills? No, not covered. But an MOT is a test? No, no test in revalidation.

NHS GPs now face an incredible mountain of paperwork: 40-page CQC practice registration, enhanced CRB checks every 3 years, child protection courses every 3 years, basic life support skills testing every 18 months, annual appraisals which take 2 weeks to prepare the paperwork every year, pension cuts, and now revalidation, a paper exercise career breaker every 5 years that they choose to work as a NHS GP.

No wonder your local family GP is looking at early retirement, your young GP is emigrating to New Zealand, Australia or Canada with its booming economy and no, repeat, no revalidation, and our bright A level students are not opting for a career in medicine. 212,000 doctors registered with the GMC face a career-breaker paper exercise every 5 years of their professional career, of whom 57,000 are NHS GPs.

As GPs retire early (55 onwards), their practices are being put out to tender, and it is large commercial companies with GPs as managing directors, who often take over and man with salaried GPs with the help of nurse practitioners.

Why would a bright medical student choose a career as a GP requiring 11-13 years of professional training and education, to then be salaried, starting at £37.50 an hour, less than you pay your plumber. Easier to be a lawyer or banker.

Oh and before you say but GP partners make a lot of money. Of the 57,000 GPs on the GMC register 56% are GP Partners and 44% GP locums or salaried GPs. This ratio will of course change as GP partners sell out their practices and more young GPs will end up as locums or salaried GPs employed by the handful of extremely wealthy managing director GPs heading empires of between 15-50 NHS practices.

So if our bright doctors do not choose to be GPs, who will man satellite surgeries under the auspices of a commercial empire? EU doctors already travel to the UK to cover unpopular weekend and out of hour night shifts. If EU doctors also cover day shifts (NHS GP salaries are higher than in the EU), then we have to ensure that their knowledge of NHS medicine is tested with the PLAB exam (professional linguistic and aptitude test) as are all international medical graduates and not just rely on a test of English fluency.

We are changing the face of medicine, if we do not abolish revalidation, a Labour legacy with no thought for the consequences to medicine and patients. And patients will suffer the consequences, when 5-14% of their doctors are told their license to practice medicine may not be renewed, as they have failed to tick boxes adequately for revalidation. Even culling 1-2% of 57,000 GPs every 5 years is significant! At an average list size of 1,700 patients per GP, you and your family may be directly affected and so will waiting list times as hospital doctors and surgeons also have to submit to such OCD scrutiny of paperwork skills, and not medical skills.

Earl Howe explains Health Bill at APPG

2011-10-22T15:05:00.001+01:00

'Local authories or NHS commissioning boards will take on a lot of the PCT duties so that GP Consortia are not overloaded with duties. The NHS commissioning boards will deal with accountability, financial risk and economies of scale. Pathfinder consortia are already rolled out and showing others how it is done. Power is being shifted away from the State. Change from the bottom up. Cultural change to leading a healthier life. SoS will hold the national commissioning board to account. Greater emphasis on patient experience data and patient reported outcomes. Healthwatch England will be the national patient's advocate to provide support to local healthwatchers and will be co-located with CQC with a hotline to CQC. Healthwatch will be patient groups, ie not for profit organisations. There will be a health premium, ie extra money for challenged areas to address health inequalities.' Newcastle consortia already saying 'we see the ability to release so much money. We can reduce unplanned admissions but the system has stood in the way.' £20b efficiency savings in the next 3 years. GP Dr Mike Bewick runs the NHS Cumbria consortia and says he has 87/88 local practices on board.

Lansley approves amendment to NHS Constitution

2011-10-21T21:43:00.000+01:00

So pleased to read that Lansley has approved enshrining legal protection of NHS whistleblowers into the NHS Constitution from 2012. http://careers.bmj.com/careers/advice/view-article.html?id=20005082 'The Department of Health has announced that it will amend the NHS Constitution early 2012 to protect whistleblowers from being sacked, demoted, having their pay decreased, or being passed over for promotion.'

How to lose weight, next time you pose with a model

2011-10-14T11:57:00.000+01:00

I was struck by how slim Elizabeth Hurley was in real life. She looked very fit and toned, and we were about the same age! Yet after looking at this snapshot, I became acutely aware of my upper arms. Yes I had middle-aged bat wings or bingo wings or whatever you would like to describe excess fatty deposits and she did not. It made me start thinking about body mass index. My BMI was normal at 19, yet I had accumulated pockets of fat in unsightly places. Should I resign myself to ageing or could I do something about it?

In fact, the bigger picture as a GP, discussing weight reduction with patients, was the need to address obesity and its health risks. So I explored many weight reduction sites, philosophies, etc. It then occurred to me that yes, there was a simple and easy way to lose weight! And sure enough not only did I get fit but also lost my 'bat wings'. It all boiled down to simple arithmetic.

3500 calories = 1 lb of weight or approx 1/2 a kilogram.

Burning calories

Sleeping - yes we all love to sleep and it burns off 36 calories an hour or 792 calories if I slept 24 hours.

Watching tv on the sofa or in bed - 44 calories an hour or 1056 calories if I watched tv for 24 hours.

Reading - 64 calories an hour

(So far so good, I think I can manage these physical activities and so can you...)

Sitting in meetings - 96 calories an hour

Desk work - 100 calories an hour or 2400 calories if I worked at my desk for 24 hours.

Walking - 260 calories an hour or approx 400 calories every 1.5 hours! Okay now this is where I stopped and so can you. You won't find me doing pilates or competing against 20 year olds on a treadmill but you and I can both walk!

And walk, I did, window shopping, walking up and down the stairs at work and at home, house work, gardening counts too (260 calories an hour) for 3 hours a day. So 260 x 3 = 780 calories. Which meant that after every 4 days, I would lose a lb or 0.5 kg in weight!

Consuming calories

I soon realised that just by asking how many calories were in what I was about to eat, I could decide between 2 sandwiches. One had 200 calories on the packet and one had 400 calories, yet they were both chicken sandwiches, same size, same thickness, etc.

I decided to look at restaurant menus online. Wagamama had 2 choices between a 910 calorie chili beef ramen and a 400 calorie chicken cha han. Both on the lunch menu, same size and both as filling, yet one had double the calories as the other.

It then occurred to me that the food industry were unwittingly making us obese as a nation! How? By hiding the extra hidden calorie content in the foods we eat! We needed to know what the extra hidden calorie count was! So we could pick the one which did not make us fat!

And now the results....simple walking incorporated into my sedentary GP desk job life with asking how many calories before I make a choice between 2 options for breakfast, lunch and dinner, and I have lost my bat wings and gone down 2 dress sizes in 2 months or a lb of weight loss every 4 days like clockwork.

More can be read in my book How to Lose Weight, the Easy Way, available on http://www.lulu.com/ and http://www.amazon.co.uk/. Good luck and watch the weight come off in an easy and painless manner!

Manchester Conservative Conference 2011

2011-10-13T21:51:00.000+01:00

It was my first trip to Manchester and my first Conservative Party Conference. I managed to get £70 first class return train tickets with Virgin Trains from Euston to Manchester Piccadilly. Thoroughly impressed with the first class Virgin lounge in Euston, equipped with a plasma tv showing Boris in the morning, OJ and filter coffee on tap, croissants and fruit nibbles, mobile phone chargers for those who left their charge plugs at home and free wifi. Not to mention a shower room also!

The quiet H carriage also had free wifi with white tablecloth meal service! I couldn't believe my ticket was only £35 each way for this 2 hour train trip travelling in the lap of luxury. Took a cab from the train station to the Radisson Edwardian Hotel. Nice hotel but it seems all the MPs were hanging out in the Midlands Hotel Bar. Next time I will make a point to book the Midlands, although this hotel was within the secure zone so might make getting in/out of the hotel a bother.

Security points meant making 30 minute allowances to get into the conference area. I saw Jeremy Paxman at one of the commercial stands but resisted the urge to approach him like an awe-struck fan of University Challenge! My Conservative colleague took me on a tour of Midlands Hotel and as I stood there, absorbing the ambiance, David Cameron made his entrance with his entourage, looking taller than I had expected in person with a flawless complexion. And again, my Conservative colleague had to restrain me gently.

I was here to hear Lansley on the NHS. He spoke for the first 30 minutes followed by speakers on private wound care for ulcers with healing rates of astonishing 6 weeks at much less cost than the years spent caring on chronic ulcers. Did not ask the recurrence rate though. Dr Neil Bacon was also invited to speak of his website iwantgreatcare.com. I was worried that it would be too one-sided as doctors are not allowed to discuss patient consultations so could not reply.

The evening was abuzz with fringe events and activity in the Midlands Bar. I was too exhausted to attend.

The next day was spent deciding whether to sleep in or enjoy the health spa and sauna. I chose the former and wandered back to the Midlands Bar to see which MP would be up already. It was Oliver Letwin the Minister of Finance. Without my Conservative colleague by my side, I wandered up to him, handed my card and on the back was penned 2 lines on my stance on revalidation which he accepted. Job done and it was then just a matter of waiting for the Cameron speech at 2 pm. I decided to explore Manchester city centre, which is within walking distance, albeit a bit windy, and came across King Street, cobbled with lovely shops like Hermes, Cath Kidston, etc. I thought that was it until I realised there was a huge mall just a bit further up. In fact the mall was so huge it spread into Cathedral Street with a glass walkway sky bridge! I had not given myself enough time! Suddenly I was in a 3 storey mall as large as Lakeside or a Heathrow terminal. As I entered Selfridges, I meandered down one floor only to find myself surrounded by Dior, Chanel, Hermes, Louis Vuitton. I felt like I was in designer paradise! Except there were no sale prices. By entering Louis Vuitton, the store then exited outside to face Harvey Nichols and again I was lured inside.

Meantime, I knew that I had a choice, queue for the queue to enter the conference hall to hear Cameron or indulge in shopper's delight.

Next time I venture to Manchester, I will definitely schedule an entire day or 2 just for browsing the shops! Incredible that this does not exist inside central London and yet Manchester has the equivalent of a US shopping mall.

Revalidation, must always be 2 years away...

2011-10-13T16:23:00.000+01:00

Revalidation, a Labour Legacy, has been discussed for over a decade. The BMA Mori Public Poll ranking professions by public trust, ranks doctors at the top, year after year, and yet one psychopathic GP, the late Dr Shipman, has led to a state of paranoia that lurking among us, is another Shipman. There are approximately 57,000 GPs or 212,000 doctors registered with the GMC.

My baby brother died from mismanagement in the NHS. Our family GP was a poorly performing single-handed GP. He did not have a Shipman with malicious intent to kill but a GP who was substandard. I became a doctor because I wanted to prevent unnecessary NHS patient deaths and have spent my life revising for every professional medical exam I could sit, passing exams at fellowship standard, writing several medical books (2 awarded in the BMA medical book competition) and teaching GPs, now almost 4,000 in the UK, to be competent, top-notch, safe GPs and pass their medical licensing exam. I can vouch for every GP I have ever taught and know patients are in good hands!

Will revalidation uncover another Shipman? In my professional opinion, as a GP, a person whose family was adversely affected by an NHS mishap, and as a GP educator and medical book writer, I have to say NO! If it did, I would wholeheartedly support this, however it does not.

Dr Shipman was a very clever GP with good patient satisfaction surveys. He would have passed any knowledge based test as he was a white UK graduate. He was not an international medical graduate with English as a second language; Shipman spoke fluent English. What part of revalidation would have identified Shipman?

The confusion lies in the stated purpose of revalidation. It is not designed to pick up a Shipman. Shipman was an aberrant with mental illness, a psychopathic killer. He could have been a policeman or a teacher. He just happened to have been a GP by occupation, so why are 212,000 doctors being punished for one man with mental illness?

Revalidation, as it currently stands, is an onerous paper exercise with 12 sections requiring 6-10 pieces of written evidence to support each section or a maximum of 120 pieces of written evidence. I like to compare this to being audited. Imagine if you, as a member of the public, were asked to be audited every 5 years and given no access to a tax specialist. If you tick or enter something into a box that is not acceptable, then you are referred up to a revalidation officer who has the power to suspend you, ie stop you from ever working again. You cannot renew your license to practice medicine. Does this mean you are an unsafe GP or someone who is not good at paperwork? And now imagine, having to face this career breaker every 5 years while you are supporting a family, paying a mortgage, running a surgery, seeing patients, managing a shrinking NHS budget and an increasing population.

I worry that good GPs who did not do A levels in English will fail revalidation, a written exercise. Doctors did A levels in biology, chemistry and physics. I repeat, they did not do A levels in English.

What is the reaction to revalidation? Pop into your local GP surgery and ask how many GPs have retired this year or last year? In my local practice, 4 high quality GPs have retired this year 2011, alone out of 8 excellent GPs. And I know they are not all 65 years old. 2 white female UK-trained GPs, 1 white male UK trained GP who was a programme director for local GP trainees and 1 male GP. What does this mean? Longer waiting times for appointments? Loss of continuity of care?

To me, it is sad when we lose good, experienced GPs, who have dedicated their lives to medicine and now fear humiliation at failing to complete a written paper exercise asking one to fill boxes with eloquent prose. If they wished to be a writer, they would have become a journalist or author. Instead they chose to be hands on doctors and treat patients. The thought of filling in a paragraph with reflective learning prose baffles some.

And so, I fight revalidation. As it would not have stopped my baby brother from dying from a missed diagnosis of intussception. Revalidation is not the answer. I do not have the answer but will recognise it when I see it.

Ask your MP for a cost-benefit analysis on generating reams of paperwork for your hospital doctors and GPs. How many good doctors have we already lost and will continue to lose, with emigration to New Zealand, Canada, Australia, the US (none of these countries have revalidation); to early retirement; to change in career, and how many bright young have we lost, who would have chosen medicine, had revalidation been set aside. Over-regulation does not improve quality, it leads to stress and burnout and this, will lead to poor patient care and unnecessary patient deaths. Unburden doctors and instead support, nurture and mentor them with continuing CPD. Abolish yet another costly Labour Legacy! Apply common sense and logic instead. Let revalidation always be 2 years away...it was yet another costly Labour lunacy that would cost the public their lovely experienced local GP.

Happy Outcome

2011-10-13T15:28:00.000+01:00

Dr Kim Holt, Consultant Paediatrician and brave NHS Whistleblower will finally be reinstated to her former hospital post on November 1, 2011, four years after she was sent on 'garden leave' for expressing concerns about care of vulnerable children.

YouTube - The Power of Conformity_mpeg2video.mpg

2011-10-13T15:17:00.000+01:00

The power of conformity. A candid camera clip from 1962. An interesting comparison of how conformity eventually breaks down individuality, leading to synchrony to the tune of the majority.

The Health & Social Care Bill became very topical among GPs and yesterday saw the last 2 major amendments being overturned. The Bill is being prepared for Royal Assent before Christmas and will be actioned in April 2012.

Inaugural IDF GP Xmas Black Tie Dinner

2011-10-13T14:53:00.000+01:00

The inaugural IDF GP Xmas Black Tie Dinner will be held at the RSM Chandos House on December 12, 2011. This event is open to GPs who are members of the Independent Doctors Federation. If you would like to attend, please fill in the online application form to join IDF on www.idf.uk.net. Annual subs are £175 a year and gives you access to in house IDF appraisals, study weekends in Europe and the UK, breakfast educational meetings, mentoring, lobbying and so much more!

Latest lobbying actions:
1. Exploring the hike in MPS/MDU indemnity fees. Private GPs are paying £12,000 in MPS subs for full-time general practice & aesthetics cover. An alternative that has been mentioned is www.hamiltonfraser.co.uk who offer cosmetic professional liability insurance.

2. Asking local NHS London Foundation Trusts to add local private GPs to hospitals' databases to receive doctor correspondence back on patients they refer to these hospitals.

Conservative Health AGM 2011 at Portcullis House, Westminster

2011-10-13T14:39:00.000+01:00

Appointed Hon Secretary of Conservative Health at this year's AGM yesterday. Delighted to accept and excited to engage and interface more between doctors and MPs on health concerns. Explore the Conservative Health website on www.conservativehealth.org. Next Conservative Health meeting scheduled for Room W1, off Westminster Hall on November 23, 2011. Only £40 for health professionals to join and meet Hon Andrew Lansley twice a year at events hosted by Conservative Health and supported by Lansley.

Daughter awarded Bathurst Scholarship

2011-09-20T20:48:00.000+01:00

My eldest daughter was awarded a sixth form Bathurst Scholarship for scholarly attitude and GCSE performance. Hard work and perseverance are rewarded in life! It is important we ensure our young are taught and engrained with good work ethics from a young age.

Elected IDF GP Chair

2011-09-20T20:23:00.000+01:00

I was chuffed to have been elected GP Chair of the Independent Doctors Federation on Monday and will strive to help private GPs maintain their autonomy and ease their work stresses. The IDF has a membership of over 800 doctors including over 230 private GPs who cover Harley Street, Chelsea, Knightsbridge, the City, Shepherds Bush, Notting Hill, Earls Court and cities outside London. The ethos of private practice is that patients are happy with the service because they have choice! If they were not satisfied, a private GP would not be able to sustain a living. Competition ensures patient choice and quality!

My first IDF GP meeting has been scheduled for November 7, and I shall be seeking members ICE (ideas, concerns and expectations), brainstorming and delivering! Revalidation remains a controversial topic and one I still insist on seeing a cost-benefit analysis!

17th book now out! How to lose weight, the easy way!

2011-09-15T18:24:00.000+01:00

My 17th book is now on sale on http://www.lulu.com/ and on http://www.amazon.co.uk/. I wrote this book and dedicated it to a dear friend of mine, Dr Peter Gooderham, who died young of a heart attack. This book shows you how to lose weight the easy way, no fad diets, no yo-yo diets, no strenuous exercise, no monthly membership subscriptions, no monthly prescriptions, etc. It's natural, easy and permanent. It covers the latest scientific discovery into peptide YY (the natural appetite suppressant), the phenomenon of hidden calories and how walking IS exercise. Also explains how the contributors lost up to 4 stone (56 lbs) in weight in 8 weeks on Channel 4's Turn Back Your Body Clock! So pick a number for your ideal dream weight, and this book shall show you the rest. I hope this will address the obesity epidemic in the UK which is now up to 13 million! Easy, painless and it works!

The late Peter Gooderham's legacy in Private Eye July 5, 2011

2011-07-01T12:40:00.000+01:00

Before law lecturer, Peter Gooderham passed away, he dedicated a lot of charitable time to supporting the rights of whistleblowers, in particular, lending much legal support to Dr Kim Holt, consultant paediatrican, who has been on special leave for whistleblowing. Next week, July 5, 2011, Private Eye has dedicated a 5-page spread to whistleblowers and includes contributions made by Peter Gooderham with coverage of Dr Kim Holt and Mr Ramon Niekrash, two NHS whistleblowers who were put on special leave and suspended for 10 weeks respectively, for speaking up on behalf of the interests of patients and the public. We hope this will result in ministerial support in addressing 'institutional bullying' and finding a way to protect the rights of NHS whistleblowers so that they may speak without fear of suspension or 'garden leave'.

The rewards of years of dedication and perseverance

2011-03-30T18:18:00.000+01:00

I am very proud of my daughter who has persevered with ballet and is now training for grade 8 RADA. Here she is performing on pointe in her senior ballet school company performance alongside a photo of her when she had just started out in ballet.

Dr Peter Gooderham's Funeral

2011-02-24T09:39:00.000Z

Many of us come across a unique individual, an 'unsung hero'. For me, Dr Peter Gooderham is my unsung hero. Sadly he passed away suddenly on February 9, 2011 at the age of 46. He was a former GP turned law lecturer and spent his spare time helping distressed doctors with his profound medicolegal knowledge, given selflessly. He leaves behind GP wife Dr Sarah Tiley. Dr Peter Gooderham will be laid to rest on March 2, 2011. His funeral service will be held at 3 pm at St Chad's Church, Shrewsbury. http://www.stchadschurchshrewsbury.com/. I have submitted a BMJ obituary with the help of Dr Richard Marks of Remedy and GP Dr Adam Pringle and hope the full version is printed to give full justice to a man who helped so many doctors in his time, a doctor for all doctors. Follow up: the full version has been accepted for bmj.com and the abridged version for the April 9 issue of the British Medical Journal. I am so pleased he is being honoured by the BMJ!

Daughter awarded academic exhibition 13+ at Wycombe Abbey

2011-02-24T09:13:00.001Z

Look out for the March 11 issue of Daily Telegraph for the announcement of 13+ academic exhibitions and scholarships. I am very proud of my 13 year old who only had 2 weeks to revise for this 2-day exam, as it was a very last minute decision to apply. She competed against internal and external 13+ girls, some who had been revising for 6 months since September!

She asked me 'how could I possibly win one?' I replied, 'if you don't win one, that is to be expected as you have only revised for 2 weeks, but if you do win one, that will be an added bonus, a miracle.' So she slaved away and revised teaching herself French and Latin grammar that had not been taught yet in class, as well as covering advanced Maths, English and Science subjects and preparing for a 7-minute oral interview in French by herself.

Life is about reaching out and aiming for the impossible as sometimes, the impossible becomes the possible.

Channel 5 News Interview on Swine Flu

2011-01-26T09:29:00.000Z

On December 23, 2010, I was interviewed by Channel 5 News on Swine Flu and discussed which at risk groups with swine flu should see their GP.

Turn Back Your Body Clock aired in Dubai in 2010

2010-12-20T18:34:00.001Z

Turn Back Your Body Clock Celador tv series educating the public on primary health promotion aired in the Middle East (Dubai, Qatar, Arab tv) in 2010 and due to air on TVN Poland March 2011! It has already been broadcast in USA (BBC America), Canada (WNetwork), New Zealand, Australia (Channel 9), Brazil, Singapore and Hong Kong (BBC Lifestyle Asia)! This tv series fights world obesity (couch potato syndrome) and shows you how you can lose weight, get fit, quit smoking and drinking with simple education, exercise, healthy eating and the right motivation. Steve quit smoking and drinking, and lost 4 stone (64 lbs) in 8 weeks!

My 3 Teen-Angels

2010-12-16T07:14:00.000Z

A Christmas treat at New Studio One Burlington for my 3 daughters.

Teen daughter, a future BNTM?

2010-12-08T19:13:00.001Z

My teen daughter turned 16 and towers above me....a future Britain's Next Top Model in the making?

South London RCGP Faculty AGM 2010

2010-11-16T22:52:00.000Z

It was a great pleasure and honour to receive my faculty RCGP fellowship certificate from Chair-Elect Clare Gerada, who was also the guest speaker and gave a moving and passionate speech about protecting the generalist and the NHS.

Transition from Trainee to GP book now published!

2010-09-25T17:13:00.000+01:00

Just finished writing and publishing my 15th book Transition from Trainee to GP containing secrets to success, pitfalls to avoid and covers everything a GP trainee needs to know before embarking on life as a locum, salaried, portfolio or GP partner. All your questions answered regarding the LMC, RCGP, media GP, taxes, practice accounts, life in Australia, partnerships agreement, partners pay, how to write a CV for partnership, MP GP, MOD GP, ways to boost your income, consultation software, pensions, how to get free CPD after CCT, etc. Now on sale on http://www.lulu.com/ and available on http://www.amazon.co.uk/ from October 2, 2010.

Another day, another term teaching at the Oxford and Cambridge Club

2010-09-04T20:23:00.000+01:00

Final Princes Gate Photocall

2010-08-31T20:16:00.000+01:00

It was a great privilege and honour to be part of a historic photograph that will be framed for the new headquarters. Seated front row and to the left.

2010-08-22T19:15:00.000+01:00

Family Holiday in Spain 2010. Highly recommend Port Aventura Theme Park and Cambrils for family-friendly beaches.

2010-08-05T16:34:00.000+01:00

My 14th book is now on sale on http://www.lulu.com/ and http://www.amazon.com/. 10 easy-to-read chapters detail a step-by-step plan to both find Mr Right and keep him. It is written in a tongue in cheek manner to both educate and entertain the reader. Having been happily married for 17 years, I share my advice on how to find Mr Right and achieve long-standing marital bliss.

Published my 12th and 13th books!

2010-08-01T00:17:00.000+01:00

Just finished publishing my MRCGP CSA and my MRCGP AKT Hot Topics books. Now on sale on http://www.lulu.com/. Also on sale on http://www.waterstones.com/, Waterstones bookshop Gower Street, and http://www.amazon.co.uk/. Written to focus revision for the MRCGP licensing exam for our 3000 GP trainees who sit this exam annually.

A scorching afternoon at the Queen's garden party

2010-06-22T20:51:00.000+01:00

Invitation to Queen's garden party at Buckingham Palace

2010-06-02T17:49:00.001+01:00

I am very proud of my husband's charitable achievements which were rewarded with a Queen's garden party invitation to Buckingham Palace for the both of us. He was Treasurer of Charterhouse and is Chair of the Audit Committee of the Institute of Healthcare Managers and has helped both charities with his financial acumen and knowledge of corporate governance. He is now also Treasurer of Self Help Africa.

Fellowship Ceremony May 14, 2010

2010-05-17T13:39:00.001+01:00

I was ecstatic to receive my fellowship from the Royal College of GPs and would encourage all GPs who have been members in good standing for 5 contiguous years to apply for FRCGP.

Online voting for 2010-2013 RCGP National Council Reps

2010-05-17T13:21:00.000+01:00

Voter turnout was only 21% in 2009 so with the introduction of online voting, I am hoping this year we see increased voter returns. The closing date for votes is May 28 and shortly thereafter the results of the 6 successful RCGP National Council Reps will be announced.