Category Archives: Current affairs
Chocolate beans in a pod
28 March 2015 to 12 April 2015, 11am to 4pm
Cocoa is a good source of iron, magnesium, manganese, phosphorous and zinc. It also contains the antioxidants catechins and procyanidins.
The dietitian’s verdict
She says: “A range of health benefits from the consumption of cocoa products have been investigated, particularly in relation to cardiovascular disease, with early results showing promise.
This was introduced from March 2nd 2015. I was prompted to write this after seeing a patient who was distressed because of the behaviour of many of her work colleagues who use cocaine regularly and often prone to get into rages as she said, ‘ just like road rage’.
Any exposure to illegal drugs will render people over the limit and will leave them over the limit for up to 36hrs. Drivers face prosecution if they exceed limits set for the presence of eight illegal drugs, including cannabis and cocaine, which can be tested using a “drugalyser” at the roadside. Police officers will also be able to test for these and other drugs including ecstasy, LSD, ketamine and heroin at a police station, even if a driver passes the roadside check.
Also, there is a list of legitimately prescribed drugs on the list shown later in this article. For those people who use prescription drugs “the onus is on the individual to assure themselves that their driving ability is not impaired”.
If you need advice about this please ask your doctor. Advice I give is:-
* You should not drive if you feel dizzy, clumsy or sleepy
* You should be particularly careful when you first start or increase the dose of certain drugs, because side effects are often worse around this time.
* Take care if you have started a different medication which might interact with your existing drugs.
The new regulations set low levels for the eight illegal drugs, with higher levels set for eight prescription drugs, including morphine and methadone.
Drugs and driving: the law
It’s illegal to drive if either:
* you’re unfit to do so because you’re on legal or illegal drugs
* you have certain levels of illegal drugs in your blood (even if they haven’t affected your driving)
Legal drugs are prescription or over-the-counter medicines. If you’re taking them and not sure if you should drive, talk to your doctor, pharmacist or healthcare professional.
The police can stop you and make you do a ‘field impairment assessment’ if they think you’re on drugs. This is a series of tests, eg asking you to walk in a straight line. They can also use a roadside drug kit to screen for cannabis and cocaine.
If they think you’re unfit to drive because of taking drugs, you’ll be arrested and will have to take a blood or urine test at a police station.
You could be charged with a crime if the test shows you’ve taken drugs.
It’s illegal in England and Wales to drive with legal drugs in your body if it impairs your driving.
It’s an offence to drive if you have over the specified limits of certain drugs in your blood and you haven’t been prescribed them.
Talk to your doctor about whether you should drive if you’ve been prescribed any of the following drugs:
* clonazepam – prescribed to treat panic disorders or seizure
* diazepam ( also known as Valium) – prescribed for anxiety disorders, alcohol withdrawal or muscle spasm
* flunitrazepam ( also known as Rohypnol) is a sedative used in hospitals for deep sedation in the 1970’s
* lorazepam – prescribed to treat convulsions or epileptic seizures
* morphine or opiate and opioid-based drugs – prescribed for moderate to severe pain.
* methadone – prescribed for heroin addiction and pain relief
* oxazepam – is used to relieve anxiety, including anxiety caused by alcohol withdrawal
* temazepam – originally prescribed for sleep problems (insomnia) although rarely these days as it has been found to affect chemicals in the brain that may become unbalanced and cause sleep problems (insomnia)
You can drive after taking these drugs if:
* you’ve been prescribed them and followed advice on how to take them by a healthcare professional
* they aren’t causing you to be unfit to drive even if you’re above the specified limits
You could be prosecuted if you drive with certain levels of these drugs in your body and you haven’t been prescribed them.
The law doesn’t cover Northern Ireland and Scotland but you could still be arrested if you’re unfit to drive.
Penalties for drug driving
If you’re convicted of drug driving you’ll get:
a minimum 1 year driving ban
an unlimited fine
up to 6 months in prison
a criminal record
Your driving licence will also show you’ve been convicted for drug driving. This will last for 11 years.
The penalty for causing death by dangerous driving under the influence of drugs is a prison sentence of up to 14 years.
Other problems you could face
A conviction for drug driving also means:
your car insurance costs will increase significantly
if you drive for work, your employer will see your conviction on your licence
you may have trouble travelling to countries like the USA
Last updated: 12 March 2015
THERE HAS BEEN AN OUTBREAK OF MEASLES IN
If your child is not vaccinated make an appointment as soon as possible for a MMR vaccination “to protect themselves, their loved ones, and the community at large.” The best protection against measles is a two dose regimen of the MMR vaccine, which is safe and more than 99% effective.
Complications of measles can include pneumonia, neurologic involvement, and death. It is well documented that about one in 1000 people with measles will develop meningitis and about one in 1000 will die. “Measles is not a trivial illness. Measles can be very serious, with devastating complications.”
A reader sent me this interesting article which gives food for thought !!!
Are you aware of the appropriate healthy temperature in your home? Ealing Council provide these thermometers.
The COSIE project, Cold Weather Support in Ealing, aims to help counteract the threat of deaths and hospital admissions during the winter months. Do you know someone who needs its help?
It offers advice, help and support for vulnerable people whose health may be affected by cold homes. The project is running on a first come, first served basis from February to the end of April, as long as funds last. In Ealing it is being managed by the council’s sustainability team.
Sustainability officer Janet Rudge said: “An estimated 14,500 households in Ealing are ‘fuel poor’, meaning they cannot afford to adequately heat their homes. The COSIE programme targets those who are particularly vulnerable to ill health as a consequence of cold homes. Good energy advice can help people to save energy and money, keep warmer and help them access support available to improve their homes and avoid fuel debt.”
You can refer anyone who you consider to be vulnerable in one or more of the following categories:
*More than 75 years old on pension benefits.
*People < 75years old with disabilities or long term conditions.
*People on low income (in receipt of income-related benefits), including those with young children < 5years of age.
*People whose health is threatened by poor heating conditions – or leaving hospital to return to a poorly heated home (in receipt of income-related benefits, or discretionary for emergency situations).
You can call the COSIE referral line
(0800 083 2265 – available from 9.39am until 5.30pm)
to discuss eligibility and if appropriate to arrange a home visit from a qualified energy advisor, the Green Doctor. Applications can also be made on- line
Qualifying residents could also benefit from free home visits by ‘Green Doctors’ who can offer tailored energy advice and support, including winter warmth packs with home and personal heating accessories such as fleece blankets, thermal socks and flasks. Energy saving measures, such as draught-proofing, low energy light bulbs and reflective radiator panels could also be provided.
When anyone hears this name they immediately associate it with death and tradegy. It is not surprising that on several occasions I have seen a child in surgery with a fever and they have been unusually fearful because they are frightened they have contracted Ebola.
We can reassure, act appropriately and educate our children in so many ways:-
* Remind our children that we live in a country that has clean running water and an excellent sewage system which saves countless lives especially from infections. Did we not see the adverts on the TV at Christmas asking us to contribute to a provision of a pump in a bush village which had no running water?
* Educate our children to wash their hands before meals and after using the toilet and put our hands to our mouths or turn away when we have cough?
* Make sure you are up to date with immunisation and seek advice when travelling for recommended immunisations and health care with the practise nurse or local travel clinic
* Encourage healthy living especially with regards diet and exercise.
* Appreciate and treasure our health service and not take it for granted that we have a service which is accessible, free and can offer a comprehensive range of treatments comparable to any country in the World.
Expectations are high – I can be sure that at least 50% of patients attending on Monday morning will have minor ailments which could be treated with Over The Counter remedies or just reassurance. If I sit in out of hours clinics the story is much the same!
Nevertheless, when I have had to admit or refer a patient with a serious illness for the most part I am pleased with the prompt response and standard of care. Moreover, if the outcomes are not satisfactory as a GP I have a voice to be able communicate dissatisfaction and facilitate change and as a patient there is also the same opportunity through PALS our Patient Liaison Service (details obtained at the surgery or on the website NHS choices)
More about Ebola
Nearly 40 years after Peter Piot was first dispatched to investigate a mysterious new virus.
He was 27 and still in training, he had one of the greatest opportunities an aspiring microbiologist could dream of: the chance to discover a new virus, investigate its mode of transmission and stop the outbreak. It all started when his laboratory at the Institute of Tropical Medicine in Antwerp received a thermos from what was then called Zaire. It contained the blood of a Flemish nun who had died of what was thought to be yellow fever.
From that sample, however, his lab isolated a new virus, confirmed by the Centers for Disease Control in Atlanta and subsequently called Ebola, after a river about 100km north of Yambuku, the centre of the epidemic. It turned out to be one of the most deadly viruses known.
In early September 1976, Mabalo Lokela, the headmaster of the local school, had died with a high fever, intractable diarrhoea and bleeding. His death sent a shockwave through the small mission community. Soon the hospital was full of patients with a similar illness and nearly all died within a week.
There have been several outbreaks since that time but the present outbreak is the worst.
How is it transmitted?
It is believed that the virus originates in fruit bats. It circulates in populations of wild animals including gorillas, fruit bats, monkeys, antelopes and even porcupines.
It is transmitted through contact with bodily fluids. Eating fruit collected from the forest floor, that an infected fruit bat had bitten, could spread it. So could contact with the blood of an infected animal that had been butchered for bush meat.
Monkeys, apes and antelopes are commonly eaten in the areas where the outbreak began. If someone were handling the raw meat and had an open cut on their hand, that could transmit the virus.
Once the virus is in human circulation, it becomes far harder to contain. Health care workers have been at particular risk because they have come into direct, close contact with victims.
Traditional burial ceremonies among many of the communities affected involve direct contact with the body of the dead, and this is believed to have been a major factor in the early spread of the virus, before public safety messages began to get through to people.
The virus can also be transmitted through sex. The WHO says that even men who have recovered from the virus can still transmit it through their semen for up to seven weeks after recovery.
Signs and Symtoms of Ebola
Abdominal (stomach) pain
Unexplained hemorrhage (bleeding or bruising)
Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days.
Recovery from Ebola depends on good supportive clinical care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years.
The latest advise from NHS England is illustrated below:-
I clearly remember one day in Summer 1980 after morning surgery discussing with my GP partner at the time an article he had read in the New England Journal of Medicine. It was a discrete article postulating that a rare cancer called Kaposi Sarcoma was more common amongst sexually active homosexuals. The reason we were discussing this was because a patient, who was homosexual had returned from the USA and had heard a rumour that there was an increased risk of his developing cancer. My partner was was wondering if he should share what he read with the patient or not. We decided that as the article was so small on balance it was probably not appropriate. In 1994 it was found to be caused by a virus and confirmed as an AIDS-defining illness.
HIV/AIDS was formally identified in the 1981.
I came to London in 1982 and I was working as an Examining Medical Physician which involved home visits to disabled people to assess for Attendance Allowance and Mobility Allowance (benefits which preceded Disability Living Allowance). One day I visited a man in Chiswick and after waiting at the door for a while whilst he struggled to get to the door he greeted by saying “I hope you are not going to be like the last doctor and take flight without completing the examination”
He then told me the tale of how an elderly doctor had visited and began the examination assuming the man had Parkinson’s Disease. The man interjected by telling the doctor that actually he was suffering from AIDS and the doctor promptly got up from his chair and hastily left the house. That was how people reacted at that time and believe or not 30 years some people still react in this way!
However, I shall always be grateful to this man as he gave me my first tutorial on this condition and the dreadful side effects of the anti-viral treatment at that time,as it was a
‘new’ disease the majority of doctors had very limited knowledge. He knew that his life would soon be coming to an end.
It is comparatively recently that as doctors we have felt confident to suggest blood testing in the surgery. One such patient we carried out the test and it came back positive and it was necessary to break the news to him. Although, devastated he told us how much better it was to be given the news by the doctors he had known for some years rather than by an unfamiliar doctor and sent Dr Livingstone and myself some flowers. However. sadly this delightful young man died suddenly before we had chance to thank him. Again a reminder of this devastating disease and the stigma that still remains.
Many of the facts and details can be obtained on the following website http://www.nhs.uk/Conditions/HIV/Pages/Causes.aspx
but I feel it is important to outline these by reprinting them in this blog to inform and in respect to those patients I have met over the years and particularly those who have been my main source of education.
HIV stands for the Human Immunodeficiency Virus. It is a virus which attacks the body’s immune system — the body’s defence against diseases.
Highlights of facts about HIV in the UK:
- Over 90% of people with HIV were infected through sexual contact
- You can now get tested for HIV using a saliva sample
- HIV is not passed on through spitting, biting or sharing utensils
- Only 1% of babies born to HIV positive mothers have HIV
- You can get the results of an HIV test in just 15-20 minutes
- There is no vaccine and no cure for HIV
How common is HIV?
At the end of 2011, there were an estimated 96,000 people in the UK living with HIV. The majority were infected through sex (40,100 gay and bisexual men and 51,500 heterosexuals).
Around 1 in 4 people with HIV (currently approximately 25,000) do not know they are infected.
Around 1 in every 650 people in the UK has HIV but the two groups with highest rates of HIV are gay and bisexual men and African men and women, where the rates are 1 in 20 and 1 in 25 respectively.
The World Health Organization estimates that around 34 million people in the world are living with HIV.
The virus is particularly widespread in sub-Saharan African countries, such as South Africa, Zimbabwe and Mozambique.
How is HIV spread?
HIV cannot be transmitted
HIV is found in the body fluids of an infected person, which includes semen, vaginal and anal fluids, blood and breast milk. It is a fragile virus and does not live very long outside the body.
HIV cannot be transmitted through sweat or urine.
The most common way of getting HIV in the UK is by anal or vaginal sex without a condom. According to statistics from the Health Protection Agency, 95% of those diagnosed with HIV in the UK in 2011 acquired HIV as a result of sexual contact.
Other ways of getting HIV include:
- using a contaminated needle, syringe or other injecting equipment
- tranmission from mother to baby during pregnancy, birth or breastfeeding
- through oral sex or sharing sex toys (although the risk is significantly lower than for anal and vaginal sex) sweat or urine.
- The most common way of getting HIV in the UK is by anal or vaginal sex without a condom. According to statistics from the Health Protection Agency, 95% of those diagnosed with HIV in the UK in 2011 acquired HIV as a result of sexual contact.
The main ways the virus enters the bloodstream are:
by injecting into the bloodstream (with a contaminated needle or injecting equipment)
- through the thin lining on or inside the anus and genitals
- through the thin lining of the mouth and eyes
- via cuts and sores in the skin
HIV is NOT passed on through:
- being bitten
- contact with unbroken, healthy skin
- being sneezed on
- sharing baths, towels or cutlery
- using the same toilets and swimming pools
- mouth-to-mouth resuscitation
- contact with animals or insects such as mosquitoes
There are now more people than ever living with HIV in the UK — around 100,000 — with a quarter of those people are unaware they have the virus.
Where to get tested?
There are various places to go for an HIV blood test, such as:
sexual health clinics, also called genitourinary medicine (GUM) clinics
clinics run by charities such as the Terrence Higgins Trust
some GP surgeries
some contraception and young people’s clinics
local drugs agencies
at an antenatal clinic, if you are pregnant
a private clinic, where you will have to pay
Home testing kits are also available, which allow you to take a saliva sample or blood spot and send them off to a laboratory for testing. These are available online and from some pharmacies, but you will generally have to pay for them.
From early 2014, it will also be possible to buy self-testing kits that will allow you to test yourself and find out the results immediately. It is important to check that any test you buy has a CE quality assurance mark and is licensed for sale in the UK, as poor quality HIV self-tests are currently available from overseas.
It is your choice where you would be most comfortable having the test.
Your nearest location can be found on the NHS choices website
Symptoms of HIV
Most people who are infected with HIV experience a short, flu-like illness that occurs two to six weeks after infection. After this, HIV often causes no symptoms for several years.
The flu-like illness that often occurs a few weeks after HIV infection is also known as seroconversion illness. It’s estimated that up to 80% of people who are infected with HIV experience this illness.
The most common symptoms are:
fever (raised temperature)
Other symptoms can include:
swollen glands (nodes)
The symptoms, which can last up to four weeks, are a sign that your immune system is putting up a fight against the virus.
These symptoms can all be caused by conditions other than HIV, and do not mean you have the virus.
However, if you have several of these symptoms, and you think you have been at risk of HIV infection, you should get an HIV test.
After the initial symptoms disappear, HIV will often not cause any further symptoms for many years. During this time, known as asymptomatic HIV infection, the virus continues to spread and damage your immune system. This process can take about 10 years, during which you will feel and appear well.
It is important to remember that not everyone with HIV experiences early symptoms, so you should still take an HIV test if you have put yourself as risk, even if you experience no symptoms.
2 There is no job which someone can’t do specifically because they have HIV
3 Treatment can mean that people living with HIV are no longer infectious
4 Men and women living with HIV can become parents of an HIV free baby
5 BUT people living with HIV still face stigma and discrimination
Come and cheer on the ECIL All Stars, who are running to raise funds for disabled people and carers in Ealing. The Half Marathon starts in in Lammas Park from 9.15am. If you’d like to sponsor us, contact Wendy on 020 8840 1566 or firstname.lastname@example.org.
Ealing Centre for Independent Living. ECIL is an organisation of disabled people working to eliminate the barriers preventing disabled people from living full and independent lives.
Come to ECIL for everything you want to know about Disability, but were too afraid to ask. We offer advice, information and we can help you get what you need to live an independent life. It’s FREE to join, so why not become a member.
The 2nd Ealing Half Marathon will take place on Sunday 29th September 2013 in Ealing, West London
One of only three fully road closed half marathon events in London the race will start and finish in Lammas Park, one of West London’s most picturesque parks and take in parts of Central Ealing, Montpelier, Pitshanger, West Ealing, Hanwell and St Stephen’s before returning to Lammas Park.
Ealing Mini Mile
Ealing Half Marathon are pleased to announce the Ealing Mini Mile for 2013. It’s our new race open to children aged 6 – 11 years of age with the route taking place in and around Lammas Park.
The children’s race is run over a course of approximately 1 mile and starts at 9:30am (after the runners have left Lammas Park at the start of the Half Marathon). Entry is £5 with prizes up for grabs for different age categories plus a medal and t-shirt for all finishers.
The race is well supported and will become a popular feature of the day with many children from local schools competing as will the offspring of the Ealing Half Marathon runners and junior members of local athletics clubs.
Free workshops for carers return!
Supporting carers is something that we as a practise, part of a network and the ECCG want to strongly support. Many people of all ages act as carers without payment, unconditionally giving all-round help and support to a friend, neighbour, relative or another person.
Many people who are caring for someone do not necessarily see themselves as a ‘carer’. Rather they are mothers, fathers, daughters, sons, partners, husbands, wives or neighbours. However, being identified as a carer by the council can help you get the right support you need to look after the person whom you care.
The Carers’ Centre is a resource and support centre for all unpaid carers, of any age, in the borough. The centre is managed, in partnership with Ealing Council, by Carers Connect, a consortium led by the Ealing Centre for Independent Living and including Ealing Mencap, Dementia Concern Ealing and Crossroads Care West London.
Following the success of the pilot course for carers earlier this year, Ealing Carers’ Centre is once again running a series of FREE workshops at the Carers’ Centre in November.
The aim of the course is to improve the skills and confidence of people who are caring for a family member or friend at home, and to help them find ways of making more time for themselves. It is NOT designed to train people to become paid care workers. Twelve places are available and the aim is for participants to attend all the workshops. The workshops are open to all carers who live in Ealing and/or care for someone who lives in Ealing. The closing date for reserving a place is 7th October.
If anyone reading this blog has taken part in the half marathon or wants to make a comment about any of the organisations for which money has been raised please make a comment or email
The week beginning October 7th marks the arrival of the Flu Vaccination for Winter 2013/2014. There are allocated clinics but vaccines can be given opportunistically by any of the doctors or practise nurse.
Who should have the flu vaccine?
If you come into any of the following groups it is advisable to consider having a flu vaccine to protect you from the risk of more serious effects
• aged 65 years or over
• living in a residential or nursing home
• the main carer of an older or disabled person
• a household contact of an immunocompromised person
• a health or social care worker
or you have
• a heart problem
• a chest complaint or breathing difficulties, including bronchitis or emphysema
• a kidney disease
• lowered immunity due to disease or treatment (such
as steroid medication or cancer treatment)
• liver disease
• had a stroke or a transient ischaemic attack (TIA)
• a neurological condition, for example multiple sclerosis (MS) or cerebral palsy
• a problem with your spleen, for example sickle cell disease, or you have had your spleen removed.
If you have a two- or three-year-old child, you should take them for the vaccination when invited by your surgery. If you do not hear by about the middle of October, contact your surgery to make an appointment.
Information concerning this vaccination is available on the following pdf
Read the following link to advise what symptoms to expect and when you should visit your doctor.
If you do develop flu – like symptoms and you are fit and healthy and don’t come into the above groups treat yourself with over the counter preparations.
Antibiotics are not effective in treating a viral illness
In order to protect the vulnerable with whom you may not be aware you are in contact
Remember to try to prevent spread of flu.
When an infected person coughs or sneezes, they spread the flu virus in tiny droplets of saliva over a wide area. These droplets can then be breathed in by other people or they can be picked up by touching surfaces where the droplets have landed. You can prevent the spread of the virus by covering your mouth and nose when you cough or sneeze, and you can wash your hands frequently or use hand gels to reduce the risk of picking up the virus.
IN THE SURGERY
Originally General practice attracted a fee for services and the doctor would treat people who couldn’t afford the the fee on a charitable basis as his contribution to the community.
I entered General Practice in 1979 and was in partnership with Dr Noel Thomas who was the fourth generation of a well established practice in a South Wales town called Maesteg. The population I cared for were miners, steelworkers as well as farmers and their families. They were hard working and there were many diseases which were particularly common in this part of Wales- miners contracted pneumoconiosis as a result mining coal alongside silicon rock and heart disease was rife. Also, back problems and other orthopaedic problems were common due to high number of men in heavy manual work. There was a high incidence of cystic fibrosis and spina bifida in children.
It was at this time that his son Dr Bell Thomas started to treat workers particularly miners and steelworkers in General practice. General practice covered workers under the Lloyd George’s National Insurance Act of 1911, but not their wives and families, whose proper demands were restricted by the need to pay fees for service.
At that time nearly about 35years ago it was found that a patient would have a better chance of survival staying at home rather than being admitted to hospital.
Medical diagnosis was often of academic rather than practical importance. Treatment was limited to insulin, thyroid extract, iron, liver extract for pernicious anaemia, digitalis, the new mercurial diuretics, barbiturates, simple analgesics, morphine derivatives and harmless mixtures.
In my experience medication such as Ipecac et Morph ( for coughs ) or Gentian ( tonic) Mist Pot Citrate ( known as cockles water) for cystitis Mist magnesium trisilicate ( ant- acid for indigestion) ,mandrax and barbiturates for sleeping and intravenous heroin for heart attacks , adrenaline for asthma were medicines I prescribed and administered regularly.
It was difficult to keep track of prescribing, all prescriptions were hand written often illegibly and I am sure compliance and abuse was not uncommon.
Records were in Lloyd George wallets and belonged to the Secretary of State and for written records this is still the case. Electronic records only started to evolve in 2001. Generally record keeping was poor and frequently doctors wrote inappropriate remarks on the notes such as PIN ( pain in the neck ie difficult patient) or a diagnosis of GOK ( God only knows) but this stopped when patients were allowed access to notes after 1990.
The NHS Act 1946 provided a family doctor to the entire population. The Bill emphasised health centres that were to be a main feature. At public cost, premises would be equipped and staffed for medical and dental services, health promotion, local health authority clinics and sometimes for specialist outpatient sessions. The programme was aborted before it even started.
Whereas Bevan had persuaded consultants into the service in part by merit awards, the GPs had been unwilling to join until virtually the last moment. The public, however, were encouraged to sign on with those doctors willing to enter the scheme, leaving others with the choice of joining as well or losing their practices. Within a month 90 per cent of the population had signed up with a GP. Twenty thousand GPs joined the scheme as they saw private practice disappear before their eyes.
The NHS Act made it illegal to sell ‘goodwill’; instead a fund was established that compensated GPs when they retired, but it was not inflation-linked. The GPs’ contracted for a 24-hour service, the nature of the complaints procedures and even the patients’ NHS cards were virtually unchanged (and still are). GPs, fearing that they might be no more than officials in a state service, argued successfully for a contract for services rather than a contract of service. As a result they remained independent practitioners, self-employed and organising their own professional lives. The Spens reports determined pay, which was entirely by capitation.
GPs’ income depended on the number of their patients; even their expenses were averaged and included in the payment-per-patient. Their independence thus assured, GPs were taxed as though they were self-employed, yet, unlike most people in small businesses, they could not set their fees. With a few exceptions, such as payment for a medical certificate for private purposes, no money could pass between patient and doctor. This system, combined with a shortage of doctors, provided no financial incentive to improve services, but neither was there any incentive to over-treat patients.
Now many doctors are salaried working for self employed doctors or in PCT(CCG) health centres.
In 1966 the Royal College of General Practitioners submitted evidence to the Royal Commission on Medical Education. This was to prove of decisive influence in shaping the recommendations of the Commission when they were published in 1968 (Todd Report). The Report made a powerful case for the recognition of general practice as a separate discipline within medicine, requiring its own form of postgraduate training organised by general practitioners. The fulfilment of the College’s work came in 1976 when parliament approved legislation making vocational training a requirement for any doctor seeking to become a principal in general practice and set up new national organisations to administer the act.
I was one of the first doctors to be selected to be part of a Vocational Training Scheme which took 3 years to complete and involved 6 months in 6 specialities. I worked as a junior doctor in General Medicine/ respiratory medicine, obstetrics & gynaecology, paediatrics, orthopaedics and trauma and ENT and General practise and at the end of this received the post graduate degree MRCGP following an external examination.
I decided to work for a further year in paediatrics before becoming a Partner in a practise in Maesteg,South Wales.
It makes sense to direct services where they are needed Southall needs more diabetic consultants and cardiologists than Reigate. Also to find out what we are doing well and what we are struggling to do effectively .
Based on results of this analysis and other audits it has become apparent how costly it is to use secondary(hospital) care if it can be done more or just as effectively and less costly in primary care.
However, it is paramount to knock down barriers of communication between hospital and primary care staff and I have seen great changes to improve this. Does a patient need to attend a hospital to hear everything is fine?
Blood tests can be carried out in general practise. Type 2 diabetes without complications does not need a specialist diabetic consultant and a mechanical back strain does not need an orthopaedic surgeon to treat. A few examples but there are many more and this has convinced both parties that a more rationale approach is needed to decide where a patient is best managed. Albeit, there are still health professionals out there who are vehemently hanging on to what they have always done but each year they are getting less and -at meetings those voices are disappearing.
The 2022 GP.
The 20th century model of healthcare – splitting up hospital and community-based care, as well as health and social care, is ‘outdated’, the report says.
‘We are moving instead towards a 21st century system of integrated care, where clinicians work closely together in flexible teams, formed around the needs of the patient and not driven by professional convenience or historic location.’
GPs will increasingly work in federations, leading multidisciplinary teams encompassing nursing and hospital staff, using electronic records to support co-ordination of care.
Contractual arrangements will be varied, with many GPs employed in salaried roles by federations, foundation trusts, and third or private sector providers, alongside independent contractors, the report suggests.
As the NHS celebrates its 65th birthday, it is entering what the RCGP identifies as a new era.
Over the next decade, patients will face ‘more complexity, morechoice and more uncertainty and will rely on the expertise, skill and compassion of their GP like never before’.
The college has called for 10,000 more GPs and a sharp rise in funding to help the profession absorb the pressure.
But to remain fit for purpose, it says, general practice must evolve, not simply expand.
So what is the RCGP’s vision for general practice in 2022 and how
realistic is it?
Adapted GP role
The RCGP is clear that as part of this shift, ‘the role of the GP will need to be adapted’. The report, co-authored by RCGP chairwoman Professor Clare Gerada, outlines a vision of the 2022 GP as an ‘expert generalist’.
This new breed of GP will be trained to manage increasingly complex patients with chronic conditions and polypharmacy, handling ‘urgent and routine needs’, and providing ‘first-contact care to the majority of children and those with mental health conditions’.
GPs can no longer stick to the 20th century model, in which they are considered ‘omnicompetent independent doctors’, the RCGP argues. Instead they will need to work ‘as part of a family of interconnected professionals’ that could include hospital specialists given additional generalist training.
Many Medical students now do 4 months in General Practise as part of their registration which now takes 2 years. until a few years ago it was 12 months and was 6 months general medicine and 6months general surgery. Two thirds of medical students will become GP ‘s.
During the past year we as GP’s are meeting with specialised consultants to discuss complex patients and consultants are visiting GP’s to discuss management of particular conditions and communicate which type of patient needs referring.
Meanwhile, GPs will train to take on extended roles in core areas that need ‘a generalist approach’ – perhaps care of those with dementia, homeless patients or those in nursing homes.
This month care of all nursing home patients in the defined Ealing CCG area has been taken over by a group of GP’s who will manage the care of residents and be accountable for the standard of care.
This model will be extended to other groups of patients if it is successful.
Practices will also need to reshape their services to meet the needs of more and more patients with complex chronic conditions.
Forming ‘micro-teams’ that bring together primary care, social care staff and clinicians from other specialties, such as paediatrics or mental health, could help provide continuity of care to named groups of patients in need of extra support.
This team-based approach may also provide the solution to rising rates of doctors working part time, the report suggests, through an ‘increased focus on team-based continuity’ and more ‘buddying up’ arrangements between doctors.
This has been attempted over many years with great resistance but the climate is changing and those not wanting to comply will be under great pressure from CQC inspectors.
The standard 10-minute appointment slot will become a thing of the past. GPs of the future will offer ‘flexible lengths of appointments, determined by need’ and will need to ‘adapt their working day to offer fewer but longer routine appointments for review of patients with complex needs’.
A generation of patients brought up with the internet will mean many ‘will expect to interact with their general practice team virtually’, with traditional face-to-face GP visits ‘no longer accepted as the default way to access care’.
We already use emailing as a a way of communicating with patients and ordering repeat prescriptions. Also more recently patients will check their own blood pressure in a pharmacist, supermarket or using there own machine and having face-to-face much less frequently. Pre-consultation questionnaire will be used to prioritise what needs to addressed in the consultation.
My only concern is that opportunistic screening and the doctor- patient relationship will be limited. However, with doctors working less hours and larger practises the norm and finances strained this will be seen as the only way forward.
Better planning across federated practices will improve co-ordination and continuity of out-of-hours care, although GPs will not be required to offer direct patient-to-doctor access out of hours.
The RCGP vision also sets out plans to train GPs to have a better ‘understanding of the needs of their practice population’. This could help shore up the profession’s role in commissioning, amid Labour pressure to hand more control to local authorities.
Professor Gerada and her co-authors acknowledge that without substantial investment to expand the GP workforce and premises, ‘the vision will be made much more difficult or will become impossible’.
Small practises will not be viable and CQC will have the power to lose a surgery that does meet the required standards. This will encourage mergers of small practises but in my opinion it is better to look around and plan this before someone else does. Working in these multidisciplinary groups at present is helping finding like minded GP’s that can work together. There are some delightful caring young GP’s in the area who I would have no problem working with and they need to be nurtured.
Step one is winning the battle of ideas – an action plan in the report highlights a need to ‘promote greater understanding of the value generalist care brings to the health service’.
RCGP council member and deputy GPC chairman Dr Richard Vautrey believes this battle will be won over time, simply because no alternative exists. ‘It is economically essential for the NHS to be built on a primary care base, it’s in politicians’ interest to value it as the way the NHS can survive and thrive long term,’ he says.
The RCGP vision is realistic, he says, because many of the innovations in the report are already being delivered by GPs in parts of the UK.
We have formed a network ( a smaller section of the ECCG consisting of all local practises and meet regularly 1-2 times each month with other health care professionals to discuss complex cases and we have found ways of sharing resources and experiences which have most beneficial in managing patients biopsychosocial needs aswell addressing our own learning needs.
But he adds: ‘One concern is that as practices struggle with workload, it is hard to develop in the way they want to, because they don’t have the resources. Resources are crucial.’
The ball is in the government’s court – it must invest and build on the innovation and modern working of GPs across the country, or miss out on what The 2022 GP calls ‘a historic opportunity to harness the power of general practice to transform the health service we will have in 2022’.