There was a feeling that politicians and health service planners had failed to understand the nature of general practice and its purpose in relation to health. The articles in this month’s Life and Times address the nature and purpose of general practice
David Misselbrook discusses how two books, To Kill a Mockingbird and Sacred Hunger, have helped him understand more about why Black Lives Matter matters and have given him his own refresher course in racism.
General practice is well-positioned to identify and intervene in the wider determinants of health. Many of the ingredients are already in place: registered patient lists, extensive data, and the ability to engage both proactively and opportunistically with patients. But primary care’s responsibilities
Judith Dawson reflects on the draft NICE guidelines for the management of chronic primary pain. There is widespread use of ineffective and addictive pain medication of questionable benefit. However, implementing any change will depend on a cohesive approach across primary and secondary
Despite ‘seeing’ more patients remotely, we are becoming more isolated, living our lives in lonely clinics and solitary consultations. The art of medicine becomes abstract, doctors and patients united in their separation.
Under the Prevent policy, NHS Trust staff are trained to spot signs of radicalisation and refer cases to the government. Within a systemically racist social system this policy succeeds only in targeting minority groups and those who are most vulnerable. The abolishment
Ed Warren is a retired GP. He notes that a feature of getting older is that you have more opinions and are convinced that others want to hear them. He reflects on the ageing process, cognitive biases, coming to terms with his
The opportunities to treat more and more patients in less and less time is the unspoken aim of the improving of technology. But as we move into this future, we must continue to courageously ask both ourselves and our employers; is this
The Cumberledge report puts forward the case for radical reform. Dealing with those who have by our actions sustained loss and pain, even as a recognised complication of a necessary procedure, can be exceptionally challenging. It is important to be able to
Baroness Cumberlege’s report describes suffering that was “entirely avoidable, caused and compounded by failings in the health system itself” and her report advocates for radical reform. Let us be forever proud of the response to COVID. Let us urgently examine the collateral
If general practice becomes unsustainable, we will lose the most effective and efficient health service we have, and it will not be easily replaced. It’s time we involved GPs in the critical analysis of the holes in the system, before our capacity
So why am I more exhausted from a full day in practice when I have only seen four patients face-to-face, dealt with 30 or so patients over the phone and conducted a MS Teams practice meeting? The ambience around appears calmer –
Most clinicians will encounter cases of self-neglect during their career, which will vary from mild presentations to really disturbing cases where the self-neglect becomes extreme. What drives such behaviour and how do we manage it?
Described as the 'cornerstone of safe and effective practice', the physical examination has always been an integral part of what makes a competent GP. With recent evidence presenting a decline in GPs' physical examination skills over recent years, GP Simon Morgan reflects
When reading articles on digital innovation in the NHS audiences are finding that they need to update their editorial bingo ticket. Classics like culture change, interoperability or costs remain. But any self-respecting writer must now include something on how the NHS response
Might a headlong rush to implement ICSs erode the trust that those who have to work in and implement ICSs have for those who drive this agenda? When there is such fragility and strain across an entire service, a natural pause in
The effect of being stopped and searched by the police can be psychologically traumatic and leave one feeling scared, powerless and humiliated. I thought about my patients. A lot of patients I look after are black and I wondered about how negative
“Look sorry, right, no offence but we need a white doctor.” Dad looked at the wall as he spoke. It was almost as if something was compelling him. I really didn’t know what to say. I felt myself flushing, the prickle in
Health experts and politicians have warned for over 170 years that health inequality is killing those in the most deprived parts of society. We now witness the poorest in society disproportionately dying of COVID-19, suggesting that the social murder observed by Engels
The new GP contract in England now recognises the necessity for clinical pharmacists to ensure the optimal use of medicines for patients within all primary care networks. What about the benefits to the wider healthcare team within general practice?
Everyone of us in the health service has overheard unacceptable rudeness, sly put-downs, exclusion or smiling say-the-opposite-of what-you-mean British insincerity. We need to acknowledge that it is happening. There is no mysterious genetic or melanin fault causing excess deaths among health workers
How much does it take for us to genuinely express sorrow and compassion for the terrible trials our patients endure? We have pride in the NHS but we have prejudice too. Perhaps it is the NHS clinician that is Icarus, flying too
An individual working as a GP runs the risk of becoming an automaton. Evidence-based medicine and professional standardisation contribute to uniformity and by definition a reduction in diversity. Camus says that “if the world were clear, art would not exist” and I
Some reflections on retirement... Ours is a great community. I look back with thanks, but forward with both compassion for the world and belief in our ability to be better than this. And in a deeper parallel, just as we as individuals
Decision fatigue is something we have all experienced. We each have a finite amount of mental energy that we can expend on decision making before our brain starts to look for a shortcut. Decision fatigue is also a well recognised reason behind
As a 20-something millennial GP trainee, the sudden talk about the future of primary care is exciting. I once heard a futurologist say, “Don’t ask ‘what will it look like down line?’ ask ‘what do you want it to look like?’” I
The many and varied consequences of COVID-19 are felt disproportionally by those with less resources, both external and internal. We would do well to establish Far End practices and networks akin to our Deep End siblings. We should reach out to the
The Changing Face of Medicine project is gathering momentum. As President of the BMA, Professor Pali Hungin launched a project to look into the impact of fast moving technological advances, the shifting role of the doctor, the adequacy of medical education, the
Throughout the last century we have witnessed major advancements for women in the UK, but gender inequalities continue to exist in the workplace. The NHS, established with the intent to treat everyone equally, is no exception. On average, female GPs — who
When I first qualified as a physician associate (PA), I had no intention to work in general practice, at least until later in my career. I was unsure of the impact a PA could have in a GP setting prior to the
David Misselbrook was a South London GP for 30 years. He was involved with GP training, CPD development and medical ethics. He now teaches Family Medicine and ethics for RCSI Bahrain. According to House, “patients lie”. Well, I guess most humans lie.
Dr Katie Barnett is a Post CCT Fellow with Haxby Group Practice in York and an Honorary Clinical Fellow in the Department of Health Sciences at the University of York. She is on Twitter @drkatiebarnett1 and blogs about wellbeing and fellowship at:
Peter Aird is a GP in Bridgwater, Somerset. Judy Garland’s was not a happy life. Last weekend I went to see Renée Zellweger in ‘Judy’. It’s a remarkable performance in a film that portrays Judy Garland towards the end of her tragically
Rachel Handscombe is a GP partner in Derbyshire. She is an activity enthusiast and is keen to share the benefits of exercise to those she meets. I wore my 100 parkrun t-shirt to work today. I was curious as to what my
Philippa Jeacocke is an ST3 GP trainee in Sheffield. She has just returned from a year out of training, during which she worked in a variety of settings exploring her interests in refugee heath and palliative care. Nandika has a huge, beaming
Peter Aird is a GP in Bridgwater, Somerset. There’s a scene in Stan and Ollie, the film about Laurel and Hardy when towards the end of the film, Hardy says to Laurel: “I’ll miss this when we’re gone”. He speaks the words,
Peter Aird is a GP in Bridgwater, Somerset. General practice – the story so far: Last week many of us tried to satisfy our appraisers by proving that we had met their unilaterally determined and arbitrarily applied indicators of satisfactory professional development.
Peter Aird is a GP in Bridgwater, Somerset. Not so long ago, a school uniform committee was set up at the local educational establishment frequented by my children. Predictably enough, though nobody seemed to have a problem with the previously requisite attire,
Adam Staten is a GP in Milton Keynes and is on Twitter @adamstaten. In the last forty years there have been at least fifteen major structural reforms to the NHS. These have frequently been cyclical, rapidly and incoherently implemented, with very little
Paul Roberts was a GP for 30 years in Rochdale then Stoke-on-Trent. He is chair of Willow Bank CIC (a social enterprise delivering primary care) and a director of North Staffordshire GP Federation. It doesn’t happen very often, but it is recognisable
Tim Senior is a GP in Australia and a BJGP columnist. Fans of Douglas Adams will recognise the scene.[footnote]Adams D (1982) Life, the universe and everything (Pan Books Ltd, London).[/footnote] There’s a spaceship landed at Lords cricket ground, but no one notices