Monthly Archives: November 2013


imageAre you looking for free, confidential and impartial advice

The Ealing Advice Service is a new service for the borough of Ealing. They provide avenues to advice and information through the website,
directing you to the organisation which can help you best in your enquiry. It has a broad network of agencies working together to provide the people of Ealing with access to a variety of advice services that can help with debt, housing,health benefits, employment, immigration or family problems.

They also run a telephone advice line where someone will be able to give you preliminary advice and signpost you to organisations which will be better equipped to deal with any problems you have.

imageThe advice line number is 03000 12 54 64 and the advice navigators are available to give preliminary advice on a range of issues or, alternately, signpost you to appropriate advice services

Monday to Friday 10am to 5pm, 7pm on Wednesday evenings.

The services provided range all the way from basic information to advice, to full legal representation from a specialist solicitor or caseworker. The aim of the EAS website is to make information about local and national advice services easily available to the public, including which areas of help are available, who is providing the services and how to find them.

The site itself does not provide legal advice, nor does it recommend any one provider over another. It is a tool to help you find the appropriate information in the main community advice areas.

We do not offer immediate face to face advice sessions but we do operate outreach services around the borough of Ealing in exceptional circumstances for incredibly urgent clients. These services consist of an initial 45 minute appointment with an adviser after which casework may be completed on behalf of the client if appropriate.

imageYou can download a copy of the Ealing Advice Directory from the website of Voluntary & Public Sector Organisations agencies which comply with Advice Quality Standard aswell as those that don’t.
It also provides contact information regarding Solicitors with a Legal Services Commission Civil Legal Aid Contract.
It has been designed not only to enable members of the public to access advice services but also so that organisations or advisers can refer or signpost clients to the service most appropriate for their needs.
Information about public transport, access for disabled people, client groups and a statement from each organisation has been included wherever possible to enable people to find the agency that is best suited to their need.
The Directory is available on line where it can be regularly updated.

Thank you to the patient who recommended this service I thoroughly recommend this to anyone needing advice or if you need to signpost someone for advice


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Posted by on November 5, 2013 in Training and Advice


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What should you expect from your doctor?

We are all aware of the escalating complaints against doctors and read regularly stories of poor treatment. I always feel concerned when I read these articles as when a person develops an illness or medical problem and have to seek medical advise it creates an added anxiety as to whether they are going to receive good treatment or if they are going to be taken seriously.
The number of complaints to the General Medical Council(GMC) – which oversees doctors practising medicine in the UK – increased by 23% from 7,153 in 2010 to 8,781 in 2011 – continuing a pattern which has been rising since 2007.
About two thirds of these complaints are from the general public the remainder are from other public bodies such as the police or coroner services and others healthcare professionals.

However, although there is an increase in complaints it is important to put the figures into context. It is estimated that there are over 100 million patient-doctor interactions each year in the NHS. This ‘complaint-rate’ of less than 0.001% per interaction is something of which most industries would be envious.
Also, as the GMC points out, the rise in complaints may not be due to worsening services, but could be the result of rising patient expectations and an increased willingness to complain.

Nevertheless, we would all like to think that there were no complaints and it is not helpful to hear these figures if you have a serious complaint to make but I thought this would be somewhat reassuring to those who may be having to face medical treatment in the near or distant future.

What are the commonest complaints?

  • concerns with investigations and treatment, such as failure to diagnose or prescribing inappropriate medications
  • problems with communication – such as not providing appropriate information or not responding to people’s concerns
  • perceived lack of respect for the patient – such as being rude or dishonest

Many members of the general public are probably not aware that we are now appraised on an annual basis and every doctor since 2012 will have to go through a revalidation process every 5 years. The appraisal has to show that we are maintaining an up to date portfolio of attendances at educational meetings and literature we have read. We have to discuss how we communicate with our patients, our practise staff and medical colleagues and any complaints we have had and how we have addressed them as well as any accolades we have received. We have produce written proof that all these aspects are being addressed.

In this practise, for more than 10 years we have had a range of medical students assigned to the practise and I am always grateful to patients who are prepared to see them. When they start I am very anxious that they simply get used to talking to all ages and different types of people and learn to extract information in a respectful but effective manner.
I took a group of students to see one of our rather garrulous patients who albeit had a fascinating medical history. One delightful student, a highly intellectual Oxford Graduate in philosophy, who had decided to change tack and study medicine was asked to take this lady’s history. He was amazingly patient and an excellent listener and I decided to not interrupt for about 20minutes. Then I asked him to finish and we thanked the patient and left. When we as a group analysed what information he had extracted it was evident that he had extracted the smoking history of every member of  her family going back two generations and what had happened to them but we weren’t quite sure whether she had ever smoked. We had established how long she had been living in the flat, the price and the prices over the years and who had lived there before including a lady who had put her head in the gas oven and that’s why there was an electric cooker but not much more despite her having numerous medical problems.

I then said to him, “Suppose she then collapsed and you had to report to your senior colleague her main medical problems what would you say?” He then realised his gentle,caring listening manner had been his downfall.

As a group we all learnt from this as to how to focus a patient to get the correct information. As a group we worked with that student who eventually was able to use his listening talent effectively but also extract the relevant information teaching us all important lessons in history taking.
I often ask patients to write down all their concerns in a list to be discussed. This is also useful when attending hospital appointments.

Communication is a dialogue between two people and also involves interpretation of facts obtained.

When I was in practise in Wales patients would frequently report having had a “pull” and this could mean absolutely anything from pain of any sort to collapsing and as it involved careful questioning as well as close observation of the patient’s body language and knowledge of something about them to find out what they meant. Moreover, I soon learnt never to ask what brought them to the doctor to avoid the ramifications of the mode of transport that was or may have been available of ask how they were because the reply could be anything and often not medical!

We all know how difficult it can be to get anything but a grunt from a teenager and in one consultation I had to resort to asking a grunting 14year old boy to tell me what football team he supported and as he said “Chelsea” I flashed an Arsenal key ring in front of him and then words fell out of his mouth.

I have to say that in some parts of the country for example the’ Black Country’ (West Midlands)’ where some of my family come from it is impossible to understand what they are trying to say. As my mother would have said , ” don’t they have a broad accent?”

The Daily Mail were totally misguided when they implied that the communication problem was due to foreign doctors as figures do not support this and after all I was a GP in a Welsh speaking part of Wales!

Surgeons can be particularly poor at communicating as they are ‘doers’ and I have known brilliant surgeons who have weak communication skills. If I am aware a patient is going to have surgery or a procedure I often suggest that if they don’t get or understand the answers or explanations they need or want they can be seen by the GP to get this information. We can phone, email or write to or even meet the consultant face to face to get that information. They are more often than not charming and only too glad for us to liaise with them.

When it comes to rudeness or lack of respect, in the same way patients should not be rude of disrespectful then there should be zero tolerance for a doctor to behave in this manner.

imageThe GMC lays out very clearly the duties expected of doctors and I have reproduced this from literature which is sent annually to every doctor registered with them:-

Duties of a Doctor

The duties of a doctor registered with the General Medical Council
Patients must be able to trust doctors with their lives and health. To justify that trust you must show respect for human life and make sure your practice meets the standards expected of you in four domains.

Knowledge, skills and performance

  • Make the care of your patient your first concern.
  • Provide a good standard of practice and care.
  • Keep your professional knowledge and skills up to date.
  • Recognise and work within the limits of your competence.

Safety and quality

  • Take prompt action if you think that patient safety,dignity or comfort is being compromised.
  • Protect and promote the health of patients and the public.

Communication, partnership and teamwork

  • Treat patients as individuals and respect their dignity.
  • Treat patients politely and considerately.
  • Respect patients’ right to confidentiality.
  • Work in partnership with patients.
  • Listen to, and respond to, their concerns and preferences.
  • Give patients the information they want or need in a way they can understand.
  • Respect patients’ right to reach decisions with you about their treatment and care.
  • Support patients in caring for themselves to improve and maintain their health.
  • Work with colleagues in the ways that best serve patients’ interests.

Maintaining trust

  • Be honest and open and act with integrity.
  • Never discriminate unfairly against patients or colleagues.
  • Never abuse your patients’ trust in you or the public’s trust in the profession.
  • You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions.

I have to say for the most part I find my fellow doctors fulfil these duties honourably and I am proud to be part of the medical profession.
We are all patients and I trust that we all do our part to be as helpful in providing relevant information, cooperating appropriately and working with them to manage our medical problems.

If you do have a complaint please address them to the practise manager or PALS – the complaints procedure is on the website.


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imageA follower of this blog recently wrote to me to suggest that I should write something about the Marie Curie nurses and highlight the work they do.
imageHe had found out that Marie Curie Cancer Care was started back in 1948 following the donation of a single diamond ring left in a Will.
I have worked with Marie Curie nurses for many years and been aware of their professional, discreet input in the the care of terminally ill patients who wish to die at home but their families have felt unable for whatever reason to manage by themselves. I have called at homes at different times of day and night to find these dedicated caring nurses tending their patients in a dignified way and giving the families and carers the support they need at such a difficult time.

Several years ago we provided a venue at the surgery to discuss their cases and to give each other support and we have allowed them to leave a collection box with the familiar daffodil badge in exchange for a donation. They do rely on these donations and legacies to employ their qualified nurses in people’s homes as well as running their hospices.


Marie Curie Nurses, always free of charge to patients and carers, provide home care for thousands of people with terminal cancer and other illnesses across the UK every year. As of 2013 Marie Curie Nurses cared for around 50 per cent of all cancer patients who die at home, working by day or through the night.

They have nine Marie Curie Hospices across the UK providing expert care and the best quality of life for people with terminal illnesses.

They are the biggest provider of hospice beds outside the NHS, and are expanding outpatient and day services at all the hospices. The hospices reached 7,897 people in 2012-13.

If you want to know more about their work and this organisation. You may know of someone who might want to engage a Marie Curie nurse.
click on the following link:-

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Posted by on November 3, 2013 in Training and Advice


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It’s not too late to start growing a moustache for November as a
during November each year, Movember is responsible for the sprouting of millions of moustaches around the world. With their “Mo’s” men raise vital funds and awareness for prostate and testicular cancer and mental health. As an independent global charity, Movember’s vision is to have an everlasting impact on the face of men’s health.

On this occasion I will focus on prostatic cancer, which a very dear friend of mine died of five years ago and unfortunately presented with very late symptoms of back pain. It became worse after doing a sponsored walk along the coastline of Wales in aid of the Church of Wales Children’s Society. This illustrated how it can present with few symptoms.
He was a man of great fortitude, intellect and humour and my memories are of laughter and fascinating intellectual discussions.

What is the prostate?
Men have a small gland about the size of a walnut called the prostate imagegland. The prostate surrounds the first part of the tube (urethra) which carries urine from the bladder to the penis. The same tube also carries sex fluid (semen). The prostate gland is divided into 2 lobes, to the left and the right of a central groove.

The prostate gland produces a thick clear fluid which is an important part of the semen. The growth and function of the prostate depends on the male sex hormone testosterone, which is produced in the testes. Some treatments for prostate cancer work by lowering the levels of testosterone.

Symptoms of non cancerous and cancerous prostate conditions
As men get older their prostate gland often enlarges. This is usually not due to cancer. It is a condition called benign prostatic hyperplasia.

The symptoms of growths in the prostate are similar whether they are non cancerous (benign) or cancerous (malignant).
The symptoms include:-

  • Having to rush to the toilet to pass urine
  • Difficulty passing urine
  • Passing urine more often than usual, especially at night
  • Pain when passing urine
  • Blood in the urine or semen

The last two symptoms – pain and bleeding – are very rare in prostate cancer. They are more often a symptom of non cancerous prostate conditions.

It is important to realise though, that very early prostate cancer generally does not cause any symptoms at all.
If a tumour is not large enough to put much pressure on the tube that carries urine out of the body (the urethra), you may not notice any effects from it.
Other symptoms of prostate cancer
Cancer of the prostate gland often grows slowly, especially in older men. Symptoms may be mild and occur over many years. Sometimes the first symptoms are from prostate cancer cells which have spread to your bones but this is not common. Cancer cells in the bone may cause pain in your

  • Back
  • Hips
  • Pelvis
  • Other bony areas

Cancer that has spread to other areas of the body is called metastatic or secondary prostate cancer. In this section there is information about the treatment of prostate cancer that has spread.

Other symptoms that may occur are weight loss, particularly in elderly men, and difficulty getting an erection (where you haven’t had difficulty before).

We as GP’s have guidelines that tell them the symptoms to look out for, and when we should send you to a specialist for tests. The guidelines say that men who have symptoms that could be due to prostate cancer should be offered.
PSA testing
PSA stands for prostate specific antigen. This is a substance made by normal and cancerous prostate cells and released into the bloodstream. The level of PSA in your blood may go up in prostate cancer because more PSA leaks into the bloodstream from the cancerous cells. PSA levels also go up as you get older and if you have a benign (non cancerous) enlarged prostate. So the PSA test is not a specific test for cancer. There is a range of normal PSA readings for every age group. The upper normal limit for a man aged 50 is around 3.0 ng/ml but this increases to 5.0 ng/ml if you are 70.
This is not done aaa a routine screening test due to the non specificity of the test.

If your PSA level is slightly raised (a borderline result), the guidelines say you should have another PSA test in 1 to 3 months time. The second test checks if the PSA is going up or is staying the same.

If you have a suspicious PSA reading and other symptoms that could be related to prostate cancer, the guidelines say your GP should consider referring you to a specialist for an appointment within 2 weeks.

Your GP may decide to delay doing a PSA test sometimes. There are a few situations that can affect the reading and make it less accurate – for example, if you have a urine infection. A test should be delayed for a month after you’ve had treatment for a urine infection.

Rectal examination
Your GP puts a gloved finger into your back passage (rectum) to feel your prostate gland and check for abnormal signs, such as a lumpy, hard prostate. Doctors call this test a digital rectal examination (DRE).

Screening for men at higher risk of prostate cancer
There is some evidence to show that prostate cancer can run in families. This means that if a relative has been diagnosed with prostate cancer your risk is higher than in the general population. The risk is higher if it is:-

  • Your brother who was diagnosed
  • The relative was younger than 60
  • You have several relatives diagnosed with prostate cancer

If your GP suspects a cancerous prostate gland an urgent 2week referral can be made but if you have any concerns you must inform your GP As soon as possible in order that more detailed tests can be performed as outlined in the following link:-



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Posted by on November 1, 2013 in Training and Advice


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