Nicholas Grundy
@nick_grundy
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Zombie Marie Curie! Complain to PCSE: pcse.complaints @nhs .net Complain to NHSE (pensions): england.pensionescalations @nhs .net
London
Joined January 2009
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As a taxpayer, it makes me sad and angry that when Liam Fox "overclaimed" £22,000 in expenses, a high court judge had to force him to pay it back to the public purse.
But sure, let us all have your views on public service, you shyster.
As a former NHS doctor, it makes me sad and angry to see doctors involved in action which I believe to be unethical and unforgivable, given the harm being done to patients and the NHS itself
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This morning we have received 166 covid19 test results for our patients going back several weeks. None were requested by us. No one mentioned these would be arriving. Unclear who if anyone has acted on them.
If this is "test and trace", it's a bloody shambles.
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So,
@SteveBarclay
has suggested to the media today that giving nurses pay rises will "take money away from frontline NHS services".
NURSES ARE FRONTLINE NHS SERVICES.
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Please remember, when reading about government claims that an AI will help solve the GP crisis, that their main NHS technological achievement over the past decade has been to ban fax use. Twice.
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Your occasional reminder that the NHS pension scheme has returned net profit to the Treasury pretty much every year since its inception. Time to rebalance the reporting on it, I'm afraid.
NHS alone £1trn. Really time to rebalance NHS pay and pensions
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Words can't adequately express how ignorant you would have to be about the "gatekeeper" role in the NHS to suggest allowing self-referral to hospital,
@wesstreeting
. 1/n
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"Is everyone ok?"
"No, the building is half the size it should be, we have a 40% vacancy rate, there's no social care, and we're at least a decade away from the workforce crisis being solved."
"Have you tried a team huddle or a kindness ripple?"
No. No I haven't.
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You may have seen a very retired surgeon suggesting vets give better service than GPs.
I have it on good authority from people who've worked with him that they wouldn't have let him operate on their pets.
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So, so fed up of non-clinical dinosaurs who've enjoyed decades of cushy non-clinical roles, lecturing those of us doing the actual work on the ground about the nuances of clinical competences and safety.
If I want advice on how to take a gin & tonic, I'll ask you, okay?
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Dear hospital clinics,
ORGANISE YOUR OWN SODDING BLOOD TESTS.
Thanks to those who do, obvi.
love,
GPs
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The NHS appointments dashboard currently shows that we offer 0% face-to-face appointments.
This will surprise the ~60% of patients we saw F2F last week. It doesn't surprise me, however, because the NHS invariably churns out bullshit data like this.
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If you want efficiency in the NHS, incentivise hospitals to be taken over by primary care.
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Having slept on the appalling decision by
@NHSEngland
to reward
#Capita
's unbroken track record of failure by extending their contract, this needs called what it is: an unelected and unaccountable quango doing the indefensible. 1/n
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Oh dear. NHSE's latest wheeze to prepare for winter is here:
Spoiler: it's even more delusional than usual. 🧵1/n
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Amusing to hear the attempts to smear GPs doing vaccination as being "in it for the money".
It's £12.36 a dose, I think.
If every man, woman and child in the country had three doses, it would cost about £2 billion, or about 9% of what Test and Trace has already cost.
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A trite lecture on teamwork from someone who:
-has never worked in any medical team
-failed to be elected an MP 3x
-as a lord was responsible for Test & Trace
-...which failed, and overspent by £15 billion
This is factual, not unkind.
When AA/PAs say they feel shamed and bullied by a campaign of intimidation, this distasteful thread is the sort of thing they mean. 👇
Anyone could do something similar for any profession. But I hope they do not because life depends on collaboration and teamwork so we should act
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General Practice has stayed open throughout the pandemic. Lots of us worked 7 days a week for the first few months to make we *could* stay open in the way that we did.
I know most of you know this already, but it is worth restating given the spin campaign currently going on.
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Regretfully, I have today deleted the NHS email we used to allow patients to contact the practice. They were great - but we were swamped by other healthcare organisations finding it in the directory and sending us stuff dangerously and inappropriately. 1/n
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If doctors were actually practicing medicine and doing their full duty to patients, rather than peddling diet books and touting themselves as "leaders", we wouldn't have a collapsing NHS.
Think about that. Really think about it.
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I don't know a single GP who believes
@NHSEngland
have changed the Covid vaccine rollout "because the science has changed", or "to get to hard-to-reach groups".
They royally screwed it up, and are backing down because no one else can do it. They're pathologically dishonest.
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@dr_merritt
The national training surveys - which are also anonymous - suggest that the feedback you're dismissing is widespread. Harder to brush those off, I suspect:
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If your child swallows a button battery, they need to be in A&E, ideally within 2 hours...
Please re-tweet to everyone you know. Thanks. Mike
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Really what Streeting is proposing is another radical reform, because he knows best. The article is Lansley 2.0, a hubristic, ignorant, destructive set of changes-for-change's sake dressed up as "to benefit patients".
You don't know what you're talking about, Wes.
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It's profoundly sad to see a Labour shadow health secretary so devoid of ideas, so ignorant of how the NHS works, and so keen to usher in what would be a two-tier NHS.
Of course that's already happening, but I'd hoped for better from a prospective Labour government. 13/13
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Next time you hear an ICB talking about its values, and how much it cares about people, bear in mind that
@SWLNHS
has just refused maternity for one of its GP leads because they've found a loophole which means they don't have to count working in general practice as employment.
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The absolute brass neck of these grifters and shysters! "We can't fund the NHS forever" - why did you think you'd get more money than anyone else for doing the same job?
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Dear
@NHSEngland
. I now have to complete a FIVE PAGE form to get my GP trainees onto the Performer's list. I already complete, with them, an entire portfolio which covers exactly the same areas in much more detail. Please stop wasting GPs' and trainees' time with this rubbish.
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Have written to the Health Select Committee to ask if I can submit something to them about the workforce impacts of PCSE and NHSE's ongoing failures with GP pensions. Please RT if you think this is a good idea!
@DAUK_GP
@NASGP
@Krishanx
@cgps_gp
@drbrown1970
@vanmellaerts
Coming soon… my select committee will be taking an in-depth look at General Practice. Why have we seen an exodus of GPs and how can we turn it around before patient safety is compromised?
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Four years ago,
@cgps_gp
and I raised a case where a doctor going through a divorce risked losing his house because PCSE and
@NHSEngland
had failed for almost a year to provide him with a pensions statement (CETV). 1/n
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Then you have the line about GPs regarding vaccinations as "a money spinner". Nice to see the incredible work of GPs delivering covid vaccinations, with the voluntary sector in many cases, glossed *by a Labour shadow health secretary* as driven by greed. 6/n
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@kingkauto1
@ShaunLintern
@RoyalLondonHosp
Wait times in a&e are for the usual stuff- sprained ankles, drunks, etc- which comes in off the street. You don't keep an ambulance there for the a&e wait time!
These are ambulances unable to offload patients because there are no beds in majors/resus for them to be seen in.
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My advice would be to spend the £200k on staff overtime at external locum rates to perform elective surgery, and never to commission this sort of cut-and-paste, happy-clappy, positive-thinking bollocks ever again.
An extract from an EY report on how an NHS trust can cut waiting elective waiting lists. £200,000.
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I don't think I'm alone of being fed up of this sort of puff-piece, when what we need is a 10-year plan to train enough staff to look after people, & the beds to do it in.
Look after yourselves this winter, people. Not sure we can in the NHS.
On which cheerful note...
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Just popping on to say that when I was a FY doctor, esp in F1, the nurses were pretty universally wonderful to me and the other trainees. Sad to see that, if
#medtwitter
is reflective, some of the current group do not meet those high standards.
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This is a man without any meaningful understanding of the problems of the NHS proposing a series of half-baked rehashes of previously failed policies, under the umbrella of "reform".
It gives me no pleasure to say it, but he would be a disaster.
I will not be voting Labour.
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The talk of "surge hospitals" is ridiculous.
(1) "Beds" are not useful if you're sick. You have a bed at home.
(2) You need a "staffed bed", and here's the problem.
(3) There aren't enough staff for the existing beds.
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600 more people vaccinated against
#Covid19
today at
@GCC_HamptonHill
thanks in large part to their wonderful volunteers. Thanks also due to local residents,
@PawsforCoffeeUK
and
@thecavanbakery
for providing rolls and sandwiches for the staff!
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If I were at responsible for the
#NHSWorkforcePlan
this graph would have made me pause before suggesting training more staff would give us more doctors.
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There is a world of difference between saying:
"We would like to train more British staff to work in the NHS" and
"We would like to have fewer foreigners working in the NHS".
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Streeting's article is riddled with basic logical inconsistencies like this. Do more in the community, by sending more to hospital. GPs are inefficient so we'll "reform" the model, even though GPs always run to budget and the hospitals don't. 5/n
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"What did you do in the covid-19 crisis?"
"I tweeted that people working in a hospital were bad people because they ate donuts, and threatened to report them all to the GMC."
#donutgate
#nhs
#savinglivesamillionatatime
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Desperately sad to say that Julian Bradley, one of our partners who retired a year ago, died yesterday. Forty years' service to the people of Teddington: he is sorely missed.
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The CQC's last in-person inspection of my surgery resulted in an obviously copy-pasted report. Mentioned types of staff we'd never employed, wrong # of rooms in the building, and added an extra toilet.
That extra toilet would have been the only useful part of the experience.
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I've supported
@timspector
's ZOE study throughout Covid to my patients. Given his recent pronouncements on general practice, however, I am delighted it's had its funding pulled. It's not fit for purpose, and needs dismantled to meet the needs of the population.
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There's an awful lot to dislike in the shadow health secretary's tweet here - but most of all it's the blinkered ignorance of what medical training is like, and why training at the moment isn't working for staff or patients. 1/n
Not the headline I expected...
The BMA needs to accept that Labour’s plans to train 7,500 more doctors a year must be met with higher standards for patients.
In contrast, other health unions are being reasonable - it’s the government who are stubbornly refusing to negotiate.
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Why do
@NHSEngland
think it's okay to write to children on the
#genderidentity
waiting list telling them the waits mean they will be too old to be seen in years' time, and that they need to see their GP, again, for a new referral? Transfer the referrals yourself, NHSE.
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The GMC are a national embarrassment. Quibbling over naming while they endorse the degradation of the workforce and ignore the fact the NHS is burning down around us.
If they won't stop fiddling while things burn, they need done away with and replaced.
#unfit
Interesting debate on titles-
The Medical Act (1983) almost always refers to ‘medical practitioners’ not doctors (or medical professionals).
#GoodMedicalPractice2024
means AAs and PAs once in UK regulation will have to follow the same high professional standards as doctors.
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Throughout the vaccination campaign, we've had messaging on significant, complex changes to who we need to vaccinate and how delivered not by
@NHSEngland
to those doing the work, but through the media to the public. 1/n
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Brilliant news that
@NHSEngland
have agreed to allow
#primarycarenetworks
to pay voluntary sector organisations and charities some management costs for social prescribers. Sensible and allows charities to do this without going bust!
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Over the last decade, the government and NHS Digital have failed at the absolute basics. Records routinely fail to move electronically when patients move areas, and basic comms between hospital and GP are unreliable / nonexistent. This AI stuff is nonsense - get the basics right.
We've announced £100M funding to accelerate
#AI
in healthcare & life sciences.
👉 Helping us harness the latest tech to improve patient care and support NHS staff.
👉 AI tools are already having results – helping halve the time for stroke victims to get treated in some cases.
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(1) General practices are ~ all closed for bank holidays
(2) Advising patients to contact them is therefore grossly irresponsible
(3) They are not an emergency service anyway, so anything urgent should go to an urgent care service or A&E, the clue being in the name
#primarycare
#GeneralPractice
is here for you this bank holiday weekend if you require urgent medical help. 👩⚕️
Do not hesitate in contacting your
#GP
for advice. 👨🏽⚕️
#PrimaryCare
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Don't get me wrong, digitising the red book would be great. But: it's been talked about for years and never done - so "how" would be nice here. And more importantly - is this really the Big Idea for the NHS? That's the scope of ambition? Because if so we are all screwed.
Labour will digitise the red book, so children’s health records are on the NHS App.
More information and more control, giving power back to patients.
Only Labour will reform our NHS to make it fit for the future.
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Reading NHS England's chief workforce officer expressing concerns about staffing levels is like reading field marshal Haig expressing concerns about troop morale at the Somme.
Perhaps NHSE could focus on being less catastrophically bad at their jobs? Thanks awfully.
BREAKING
Exclusive: NHS England leaders have for the first time said doctors’ strikes are "causing significant disruption and risk to patients”, including to those needing urgent heart and cancer treatment
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Just for the record, I do not regard myself as in any way represented by those who regard medical campaigning as trying to have more followers on twitter than someone else.
That is not an achievement.
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Lovely to see another pie-in-the-sky "NHS winter plan" from the "government".
Oddly, no mention of where they propose finding the extra staff needed after 12 years of neglecting to train anyone and driving staff our the service. Cloning?
No workforce plan = no plan.
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Absolutely THIS.
Junior doctors are not worth a third less than 2008 - I stand with them.
Strike hard.
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It's of course also massively disrespectful to the many GPs who do dermatoscopy, and handle enormous numbers of patients without burdening the hospitals with them. If, as you say in the article, a hospital visit costs ten times a GP visit, why do more in hospitals? 4/n
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The next action: more call handlers in 111 and 999 services. Because patients are crying out for more people reading from scripts on the phone.
Next time you're at your GP, ask them to summarise how they find 111 in a single word.
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Doing so flies in the face of years of work to improve the quality of referrals, in in dermatology (taking your "I had a lump on my back" example) including GPs trained in dermatoscopy, and/or teledermatology pilots. 2/n
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Again, this is rehashed health policy, in that it is basically the PCN / ARRS model which we're *doing at the moment*.
This isn't reform. It's a lazy and dishonest attempt to mug off the public with a few cosy personal anecdotes and a lot of brass neck.
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Hospital outpatients already have enormous waiting lists. Letting patients self-refer will hugely worsen that problem, by increasing unnecessary outpatient reviews which could have been handled in primary care. 3/n
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The retired crew at
@rcgp
are seeking to make the climate emergency *part of GP training*. This is probably the stupidest idea they've had since Brunei: the problems we have are not ignorance in the under-30s, and are not solved by recycling sodding letters.
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@ortrudethevegan
@ERunswickBMA
Melanie thinks if you pay for pizza at Christmas, and then try to eat some of that pizza, you're presumptuously intruding on other people's celebrations. Don't be like Melanie.
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@PeteDeveson
@alwaysthedutydr
@thedoctorkhan
@MattHancock
@NHSEngland
@BBCNews
@SkyNews
@jonsnowC4
@doctor_oxford
@cgps_gp
@drphilhammond
@LBCNews
It's a probity issue. An actual human being has chosen not to say "here, these are out of date but probably better than nothing", and instead to actively deceive NHS staff at risk to make the response look better than it is. Liars.
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The funniest thing about this article is the suggestion the NHS App saves a GP 3 minutes every time a prescription is done digitally. Laughable.
The app takes hours of my time weekly explaining to patients why it still doesn't work properly!
NHS adds digital prescriptions to app after successful trial
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@alwaysthedutydr
@MattHancock
@NHSEngland
@BBCNews
@SkyNews
@jonsnowC4
@doctor_oxford
@thedoctorkhan
@cgps_gp
@drphilhammond
@LBCNews
I just checked ours. Exactly the same here.
@pulsetoday
@HSJnews
@GPonlinenews
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It is indefensible that the GMC has not struck off Aseem Malhotra for lying about how e.g. Shane Warne died so he can personally profit. It's dishonest grift harming the public, and the GMC are a toxic, hypocritical, worthless organisation which should be abolished.
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What Streeting means when he talks about seeing a wider range of healthcare staff is that you will see staff trained for significantly less long than a GP, with a narrower scope of practice, and much less experience dealing with undifferentiated illness. 11/n
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Dean is an embarrassment to the profession. Thank god he got turfed off the GPC when he did.
"I think at the moment he's winning this argument."
"It is inarguable that Rishi Sunak is right here; strike action has led to a deterioration of the NHS."
GP Dr Dean Eggitt and
@TomSwarbrick1
conclude that Rishi Sunak is fair to blame waiting times on strikes.
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On the
#NHSDataGrab
, after discussion with our wonderful Patient Participation Group, Park Road Surgery will be opting everyone out by default. You can opt back in if you would like. Details here:
@TeddingtonNub
@Teddington_Town
@TeddingtonSoc
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@1904Irrelevants
@alwaysthedutydr
@pchapman24
@MattHancock
@NHSEngland
@BBCNews
@SkyNews
@jonsnowC4
@doctor_oxford
@thedoctorkhan
@cgps_gp
@drphilhammond
@LBCNews
If someone had been honest about it, and told us "it's this or nothing", fine. But they weren't - they put me and other staff at risk of infection and lied about the usefulness of the protective gear we received.
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So he wants "modern health centres with a wider range of facilities" in place of GP surgeries. Darzi centres and polyclinics, anyone?
Labour tried this in the early 2000s. Did no one tell you? Or - let me guess - was it those nebulous "vested interests" again?
8/n
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I suggest that GPC release their proposed contract for General Practice, and then tell practices to start following it, on the basis that they consulted with NHS England on it and apparently that's fine. Who needs agreement?
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@DrRaniKhatib
@WYpartnership
@NHS_RobW
@DrJamesThomas1
Odd that a pharmacist like yourself objects to being asked to issue medication. Your trust is, quite literally, paid to do this work. I suggest you get on and do it.
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Stephen Powis: NHSE medical director since 2018
Navina Evans CEO of HEE 2020-2023, NHSE head of workforce since
Sheona Macleod was looking at "enhancing
#juniordoctors
working lives" in 2017
1/2
@HelenRSalisbury
That’s not the view of Professor Sir Steve Powis FRCP, National Medical Director, NHS England. Dr Navina Evans CBE MRCPsych, Chief Workforce, Training and Education Officer, NHS England. Professor Sheona MacLeod FRCP, Director of Education and Training, NHS England.
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Also, I don't want to sound negative about virtual wards (but I am, so that's how it comes out), but my area had these back in 2018. They died a death, & are now being reanimated *as if they were a new idea*. No one seems interested in why they didn't work last time.
19/n
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Dropped my son off at the bus stop, went for a run, had a coffee, set up a filter on my NHS mail so that everything with "SOP" in the body goes straight to the bin.
It's been a good morning.
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There will be *some* actual beds - specifically "a mix of new physical beds, virtual wards, and improvements elsewhere in the pathway."
"Don't worry, Mrs. Jones. We don't have an actual bed for you, but you can sleep in this pathway improvement."
18/n
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Superficially, "war rooms" to "manage demand and capacity" in the NHS this winter sound great.
Two problems: you can't manage demand, as the failed experiments of the last decade show, and there isn't any capacity.
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Perhaps all these near-retirement consultants suggesting their junior colleagues should not ask for a pay rise would like to continue working until say 85 to cover the workforce shortfall their venal virtue-signalling will create?
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One of the reasons I like our SPs is because they know their role, and it sure as hell isn't keeping acute patients out of A&E. It's medium- and long-term preventative and enablement work.
9/n
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Sex education in schools! Do you want the rules on this set by (a) teachers who spend their entire careers figuring out what's right and wrong for the kids in their care, or (b) a bunch of clueless, inept ideologues in government who've broken everything they've touched?
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Just got an update locally on
@NHSDigital
's plan for prospective notes access from November.
The summary?
They haven't put in place any of the tech required to make this work. That being, you know, their job. 1/n
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Follow-up. The last time government decided they could deliver a service better than the greedy GPs,
@wesstreeting
, was with GP out of hours twenty years ago. You may want to look at how that service is now it's run by the private sector before making the same error.
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@eleonorasfalcon
@DoctorAngry
Yup, GP here - thought the mention of "our patients" might have made that clear!
My concern is that lots of people who requested tests never got the results - are they now going to get them from us?
If so, some warning would have been nice!
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Vaccinating again tomorrow - so far Hampton PCN have given more than 20,000 vaccines.
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Bored of lockdown?
Yes, so is everyone else. However, you still need to be at home.
COVID-19 has plateaued. That means your risk of catching it now is still effectively the same as it was at the peak, and has never been higher. 1/n
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God, the irony of Javid talking about GPs being to blame for "an underinvestment in prevention".
You're responsible for where the investment goes, idiot - we chase the targets *you* set.
Unless he means "prevention of people going to hospital" rather than of, you know, illness.
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@JimBethell
It's quite something to make wild claims about complexity in a job you aren't remotely qualified to do, to push your political workforce agenda, and then to back those claims up by citing Very Important People who've been a complete disaster on workforce. I know, 3/2. But really.
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It's disappointing that they're still putting out this garbage.
The public deserve honesty about the scale of the problems the NHS face, the fact there are no quick solutions, and an acknowledgement that this is because NHSE and government have failed, over years.
27/n
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I get that politically it's easier to persuade the public recruiting more NHS staff is better, and harder to persuade them that paying the existing ones fairly ("more").
It would just be nice to see some courage and some honesty from the opposition.
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There is a profound arrogance in the presumption they've repeatedly shown going to their chums in the media to say they've "instructed" us all to do something crowdpleasing without any understanding of what we do. I have had enough. 9/9
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Physician Associates, like many Allied Healthcare Professionals, can be brilliant assets to teams. The problem is not the people, although there are ignorant gobby ones in there as everywhere.
It's the relentless, dishonest attempt to market them as the solution to the NHS' woes.
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Clare Gerada again pushing for so-called "reforms" which would see small GP surgeries hoovered up by the likes of the Hurley Group. Which she owns:
It's not just US firms who are the enemy, people.
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The main change to those campaigns this year? They've cut the funding per-Covid vaccine and for care home residents, so a real commitment to this "core objective" there.
On flu, I guarantee that NHSE will yet again not be able to meet demand, and will then blame GPs.
7/n
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If you're in that situation, please e-mail PCSE and NHSE to complain - see my twitter bio for details - and state you want the complaint dealt with "under IDRP". Demand compensation for your lawyers' time, and ask the court to demand a CETV direct from NHSE. And good luck. 15/15
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To be fair, acute trusts have done a lot of work to tackle waitlists - but they've also turfed huge numbers of patients off waiting lists "because Covid". Those people have largely been re-referred now, but show as having shorter waits than they've really experienced. 3/n
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The
@gmcuk
once again proving they are covert, dishonest, and not fit for purpose.
They need abolished and started from scratch, because no one would invent the corrupt, self-serving organisation we have now.
The GMC's minutes from their MAPs Programme Board meetings over the last twelve months make for some hair-raising reading.
"Is it time for us to lead, to convene, or to follow?" asks the GMC of itself.
Some things that particularly stand out:
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Did
@JonAshworth
really say GP surgeries are "not physically open"? If so, you should retract and apologise - I've seen patients face-to-face, in the surgery, every day I've worked there since March, seen Covid positive patients too, as have most of us.
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