People’s March for the NHS

06/09/2014

A number of good ladies have marched from Jarrow to Trafalgar Square.

I saw this video about a month ago.

So I joined the march today, the final leg to Trafalgar Square.

For about 5 miles, I walked with an 80 year old man from south London; this man has had two knee replacements (on the NHS). He was marching because he was worried about the NHS and the next generation.

Later, nearing the Aldwych I saw a placard; I asked the owner if I could photograph it. Her husband asked me to share it with my friends.

So I Tweeted it. So far it has, it seems, been Retweeted by about 400 people, and favorited by 150. The Huffington Post online has asked if they can use it. I said of course.

 

 

 

 

 

 

 


80% of GP practices have one or more GPs suffering from Burnout

26/08/2014

All About Youth

Are you in despair for your future in General Practice – Final Report

In 2013, my practice advertised in the British Medical Journal, on two occasions, for a salaried GP with a view to partnership. This recruitment process resulted in only one credible candidate. At the time my surgery constructed an unconvincing narrative to explain our failure to recruit. During the year and early in 2014 we spoke with other surgeries in Oxfordshire and realised that we were not alone in being unable to recruit.

In April 2014 we ran a Survey Monkey questionnaire across GP practices in Oxfordshire. We received 167 replies in the space of a few days. This convinced us that there was a serious situation developing that could affect the future of General Practice. At the end of June 2014, at the request of a group of concerned GPs from North and North-East Oxfordshire the survey was…

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Tweet to Dr Sarah Wollaston, new Chair of Health Select Committee

26/07/2014


Save Our GP Surgeries March Route July 5th 2014

05/07/2014

March Route July 5

 

March Route July 5 a

 

 

 

 

 

 


How does registering with a GP near your child’s school benefit you? Question to CEO of Patients Association

28/06/2014

28/6/14

Dear Katherine Murphy,

I am a GP in Tower Hamlets and have been following the Government’s policy regarding GP practice boundaries with some bewilderment over the past 4 years. I became aware that the Patients Association was also keen to abolish GP practice boundaries in the interests of giving patients more ‘choice’. You will of course be aware that the policy will be rolled out in England, on a voluntary basis, from October 2014.

My difficulty has been that the proponents of this policy do not seem to take into account some very practical problems inherent in the policy, and have made claims for the benefits of such a model which simply do not add up.

One suggested benefit will be that patients will be able to register at a practice near their child’s school. The Department of Health mentioned this in their December 2011 launch of the Choose Your GP pilot, you mentioned it in your Huffington Post posting in March 2013, it is mentioned in the first section of the Proposal by the team who then evaluated the pilot, and it has been repeated in the press.

I question the wisdom of this proposal and have asked Jeremy Hunt, the Department of Health, and NHS England the questions below, but they have not answered me. Because you have also gone on the record publicly proposing this as one of the incentives, can you please give an answer to the following questions:

a. what benefit accrues to a child or parent(s) by registering with a GP practice near their child’s school? What might they be hoping to gain from this? Does this mean a parent registering with the practice, or the child, or both? Would all the children of the family register with the practice? Would both parents, in two parents families, register with the practice?

b. how would this work from a practical point of view? When would they want to be seen? How would they make appointments?

c. what, if any, are the possible risks or drawbacks with this arrangement?

I would be grateful for your comments on this.

 

With best wishes,

George

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

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24/7/14

I have not heard from Katherine Murphy or the Patients Association. I wonder why….

Is it the same reason why the Department of Health has not answered these questions, or NHS England?

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12/10/14

I have just sent the following email to the Patients Association:

Dear Katherine Murphy,

I sent you the email above on 28/6/14. I have not received a reply, so I am trying again. I will send this in the post as well in case there is some glitch in the system.

Best wishes,

George

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

[the above items sent in Royal Mail 24/10/14]

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My email to The Patients Association in June 2011.


It is now crystal clear: the Choose your GP Pilot ‘independent evaluation’ in no way evaluates the actual policy

12/04/2014

Yesterday the practice manager of a large Tower Hamlets practice (and CCG Board member) and I went to meet with Professor Nicholas Mays and two other authors of the Evaluation of the choice of GP practice, 2012-13 at the London School of Hygiene and Tropical Medicine.

We outlined the reasons why abandoning practice boundaries in Tower Hamlets would not be in the interests of our aim to provide good quality primary care services to our local communities. Quite to the contrary, why it would be harmful and destabilising.

We had an interesting conversation about the pilot, about the various competing aims, about unintended consequences, about politicians, and about pilots.

I believe their report is well written and contains a number of important points, and they have done a serious piece of work. But they were clear that their evaluation only evaluates the pilot, and not the policy. The pilot had small number of patients and in no way ‘tested’ the policy; in fact, the sorts of risks I have highlighted in my Submission to the Health Select Committee are not revealed by the pilot, they are hidden. (I expressed these concerns in an article for Pulse in December 2012.)

It is as though you invited smokers over the age of 70 to meet you at the top of a tall hill, and you asked them if they liked smoking and if it had impacted negatively on their health. It is likely that they would say that they enjoyed smoking, and it caused them no problems (hence their age and ability to get up the hill). You might conclude that smoking was a harmless pleasure.

 


A question for NHS England (London) on GP boundaries and patient access

31/01/2014

I have read a draft version of your Primary Care Commissioning Intentions for London 2014/15 London Region (v 1.1) and the following caught my eye:

….access to primary care services continues to be problematic for many Londoners. We are sure that the reaction and response to Call to Action will enable us to develop plans to improve access and the patient’s experience of access. Already, as part of the GP contract settlement for 2014/15, we will see a number of changes designed to improve access:

  • Choice of GP practice. From October 2014, all GP practices will be able to register from outside their traditional boundary areas without a duty to provide home visits. This will give members of the public greater freedom to choose the GP practice that best meets their needs. Area Teams will need to arrange in-hours urgent medical care when needed at or near home for patients who register with a practice away from home.

Can you explain how boundary-free general practice is going to improve patient access? Here in Tower Hamlets we cannot see how this will help.

Please leave a comment below.


If abolishing GP boundaries is such a good idea, why won’t the Department of Health answer some basic questions?

25/01/2014

I have written on three occasions to the Secretary of State for Health, Jeremy Hunt, copied to the Health Select Committee members (and miscellaneous media outlets) about some very basic problems with the Coalition Government’s flagship policy to abolish GP practice boundaries.

On each occasion, I have had replies from the Department of Health. None of these replies have remotely addressed the warnings I have raised.

It is as though an able seaman were to send an iceberg alert to the officers, and receive in reply the rota for cleaning the toilets on Deck C. Not once, but three times…

In the third reply, the Department of Health official writes:

“I note that you have contacted the Department of Health previously on a number of occasions about this issue.  The information given to you by my colleagues is the most up-to-date and accurate available, and there is nothing further I can add to this.  The Government’s position remains as set out in previous letters.I am sorry if this is not the reply that you were hoping for, but as there is nothing further that the Department can add, we must now consider this matter to be closed. ”

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First email to Jeremy Hunt

Department of Health response

Second email to Jeremy Hunt

Department of Health Response

Third email to Jeremy Hunt

Department of Health Response

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NHS England have done no better; see their reply, and my second attempt to get them to answer my questions.


Department of Health response to my second email to Jeremy Hunt

24/01/2014

This is the Department of Health’s ‘response’ to my second email to Jeremy Hunt:

Our ref: DE00000813924

Dear Dr Farrelly,

Thank you for your further correspondence of 13 October to health ministers about the removal of GP boundaries in six primary care trust (PCT) areas .  I have been asked to reply.

I am sorry that you were dissatisfied with the Department’s previous response (our ref: DE00000807059).  However, there is little I can add on the matter.

With many people working some distance from home, it is not always convenient for them to see a GP in the area in which they live.  The piloting arrangements were introduced to allow patients, who wished to do so, to register with a practice away from the area where they live, perhaps closer to where they work.  Arrangements are in place to ensure that, should patients wish to register away from home, they are still able to access primary medical services should they need them when at home.

The arrangements were trialled in a limited number of areas and the results have been evaluated and passed to NHS England.  It will be for that body to decide whether they wish to roll out the arrangements on a wider basis.  Should you wish to raise your concerns with NHS England, you can do so at the following address:

NHS England

PO Box 16738

Redditch B97 9PT

Tel: 0300 311 22 33

Email: england.contactus@nhs.net

I am sorry I cannot be more helpful on this occasion.

Yours sincerely,

Lindsey Cox
Ministerial Correspondence and Public Enquiries
Department of Health


Third ‘reply’ by Department of Health to my warnings about problems with abolishing GP boundaries

24/01/2014

In my last email to Jeremy Hunt and health ministers, copied to the Health Select Committee, I wrote:

So far you have evaded the issues I have raised in my previous emails. I am saying that this policy is unworkable, that in some cases it is unsafe; overall, it will impact negatively on the functioning of general practice. If harm comes to patients because of this policy and you and others have wilfully neglected a proper risk assessment, will you be accountable?

I require the following by way of response:

A. I challenge you and your officials at the Department of Health to respond, point by point, to my Submission to the Health Select Committee.

B. In the Department of Health’s media launch of the so-called ‘pilot’ in December 2011, we read: “The pilot, which will begin in April 2012 and last for one year, will also come as a relief to people who are moving home and wish to remain with their preferred practice, and families who would like a practice near to their children’s school.”

This detail of families registering at a practice near their children’s school is repeated in the evaluation Proposal submitted by Professor Mays in May 2012.

So you think this is a good idea? I challenge you and your associates at the Department of Health to answer the following questions about this particular idea:

1. What benefit accrues to a family if they register with a practice near their children’s school? Why would they want to do it?

2. How would this work practically? (Details please, full details of the mechanics of this).

3. Are there any risks or problems with this proposal?

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This is the ‘reply’:

Our ref: DE00000834110
Dear Dr Farrelly,Thank you for your further correspondence of 13 January to the ministers of the Department of Health about the removal of GP boundaries.  I have been asked to reply.I am afraid that there is nothing that I can add to my colleague’s previous replies of 20 September and 23 October (our refs: DE00000807059 and DE00000813924).It is not always convenient for people to see a GP in the area in which they live.  Alternative arrangements were trialled in a limited number of areas and the results have been evaluated and passed to NHS England.  It is for NHS England to decide whether to implement the arrangements on a wider basis.  NHS England can be contacted at:NHS England
PO Box 16738
Redditch B97 9PT

Tel: 0300 311 22 33
Email: england.contactus@nhs.net

I note that you have contacted the Department of Health previously on a number of occasions about this issue.  The information given to you by my colleagues is the most up-to-date and accurate available, and there is nothing further I can add to this.  The Government’s position remains as set out in previous letters.I am sorry if this is not the reply that you were hoping for, but as there is nothing further that the Department can add, we must now consider this matter to be closed.  Unless you raise a new question, any further letters sent to the Department will be logged but may not receive a reply.Yours sincerely,Charles Podschies
Ministerial Correspondence and Public Enquiries
Department of Health
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