Month: October 2015

GP in crisis: how does European family medicine compare?

Mary McCarthy is a GP in Shrewsbury., She is on the GPC and is interested in comparative health systems. She is the BMA rep to UEMO. UEMO (Union Européenne des Médecins Omnipraticiens) represents GPs in 26 European member states. It develops policy and projects to support family medicine and to share best practice. It also provides an opportunity to look at other health systems and to learn from them, studying alternative ways of working and investigating ideas that may help with UK general practice. Earlier this year, a questionnaire was circulated by the UK delegation that asked about workload pressures in...

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Junior doctor pay changes will damage general practice: the trainee view

Ravi Parekh is an academic clinical fellow in General Practice in North-West London with an interest in Medical Education. I am a GP registrar working in London and over the past few months I have felt increasingly apprehensive about the future of general practice training in the UK. The latest blow to our training comes in the form of the recommendations from the DDRB report on the future of doctor’s pay.1 This independent report states the GP trainee supplement should be removed (currently 45% supplement) and replaced with “a flexible pay premium” known as a RRP (recruitment and retention premium), with trainees paid for the amount of unsociable work that is carried out, and a possible flexible pay premium adjusted locally, to help target problems with recruitment. Firstly, in the majority of cases, this change will mean a substantial pay cut as trainees progress from a SHO (ST1 and 2) to a registrar (ST3). A large number of hospital rotations will include a substantial amount of unsociable work, which currently is remunerated with normally between 40-50% banding on top of the basic salary. However, the new proposals will mean despite career progression, increased responsibility within a higher risk setting, and working far more independently in the registrar year, there will be a significant pay cut. This would equate to a substantial penalty for choosing general practice as a career....

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The Ten Commandments for patient-centred treatment

Richard Lehman gives some background on the BJGP article The Ten Commandments for Patient-Centred Treatment published in the October issue. The Ten Commandments for Patient-Centred Treatment had a gestation of nearly four years. And their true parent was John S Yudkin, Emeritus Professor of Medicine at University College London. In presenting this version for primary care doctors I have just been acting as a very slow midwife. John’s original set of “10 Commandments for the New Therapeutics” first appeared as an addendum to my weekly BMJ journal blog in January 2012 and then in print in The Good GP Training Guide edited by Matt Burkes and Alec Logan. With the help of John and our Canadian co-authors I have tried to apply the main principles of John’s original commandments to our daily practice. Their original focus was on long-term treatment which we all felt – back in 2011 – was being increasingly foisted on people without any attempt to explain the marginal benefit for each individual. A lot of it was not even informed by evidence of real long-term benefit or possible harm, especially for conditions such as type 2 diabetes and hyperlipidaemia. Late that year John rang me to say he was writing a piece for the BMJ about these surrogate markers with two mutual friends, Kasia Lipska and Victor Montori. He was looking for the right word in the...

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BJGP Letter: A bleak future for future GPs in England

Guy Rughani is a Foundation Year 2 doctor working in North London. He wrote this short letter to the BJGP. Contribute to the BJGP at http://bjgp.org/letters. I want to be a GP, but the government is doing everything it can to stop me. Mr Hunt’s brilliant answer to the crisis in GP recruitment is to slash trainee pay by 30%, penalise doctors taking maternity leave or extra degrees and extend normal working hours.1 Morale amongst my peers about to apply for specialty training is catastrophically low. As a result, the majority of my friends are looking to move from the NHS and take a ‘Foundation Year 3: FY3’ because they perceive that their immediate future here is bleak.  At a time in our careers when we should be optimistic and enthusiastic, it’s tragic that the state of the English NHS is leaving us so disillusioned. Scotland has dismissed the new junior contract, making a move North ever more tempting. We need a strong positive message from senior doctors that there is a bright future in English General Practice, and a commitment from government that our incomes will be protected and our efforts valued. 1: BMA Junior and Consultant contract negotiations explained:...

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Review: An interoceptive moment with your neurobiological self

Alistair Dobbin is an honorary fellow at Edinburgh University medical school, an ex GP, a researcher and charity director. Book Review: How Do You Feel?: An Interoceptive Moment with Your Neurobiological Self by A.D. (Bud) Craig. Available at Princeton Press: http://press.princeton.edu/titles/10405.html Groundbreaking scientific discovery sometimes comes through not accepting the status quo, for instance John Harvey’s discovery of the circulation of the blood. If you want a fascinating ride through the neuroscience of emotions (and cognition with which it is intricately linked) and a completely different formulation of how the anatomy and physiology work you should definitely read this book. Originally a mathematician Craig accidentally strayed into a neuroscience class where they were doing single cell analysis of the thalamus and he was hooked and changed course. Once he started studying the textbooks he was struck by a number of anomalies in the description of the sensory pathways from the body to the brain. He could not understand why the pain and temperature pathway took a completely different, contralateral, course to the ipsilateral mechanoreceptor (2 point discrimination, and proprioception) pathway. He has carried out a series of studies using many different methods of inquiry (all clearly explained in the book) sometimes spending weeks trying to isolate a single neurone in the thalamus. It turns out that pain and temperature (and many other sensations) are in fact homeostatic emotions; they provoke action...

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