Politeness isn't free.
It's a skill that takes time and effort to learn, fine tune, and deploy.
Therefore, I don't expect it from everyone, but I am grateful to receive it.
To become a Doctor, I was exposed to seeing extremely distressing scenes regarding human health and death from the age of 19. Im now 41.
At no point have I ever been offered counseling from the NHS.
Counseling for NHS staff should be routine.
A steroid cream is out of stock. The local pharmacist has asked me to prescribe an alternative but won't tell me what's in stock. So now, I have to keep randomly guessing what to prescribe until I get it right.
It's like a clinical game of battleships.
Please don't throw a one-off pot of money at the NHS.
We are exhausted. No amount of money can buy overtime from a workforce that is dead on its feet.
We need a long-term sustained investment that gives us money to buy, train, and care for new team members.
For the 1 billionth time....
No, I don't want to specialise as a surgeon
No, I don't want to work in a hospital
No, I haven't given up on my career.
I chose to be a GP.
I chose to specialise in community care.
GP's are awesome.
I am a part of team awesome, by choice.
Should you be scared that Omicron will kill you?
- Probably not.
Should you be scared that so many people will quickly get ill that crucial infrastructure such as the NHS cant operate?
- Yes. Definitely yes.
Declined referrals are becoming increasingly common in the NHS, meaning the GP has to contact the patient and explain that a specialist is unwilling to review their care.
If a service declines to help a patient, they should write to the patient and tell them why.
Can we put an end to this nonsense that GPs practices are closed and not doing anything?
Primary care has transformed over the last few months, delivering cutting edge healthcare to the entire UK.
We have been pushed to our limits yet continue to deliver.
I am proud of
#teamGP
I'm 200 miles from home and I forgot my warfarin. With a metallic heart valve, I'm at risk of a stroke.
Thankfully, community pharmacy can give me a short emergency prescription and will save my life.
Thank you community pharmacy. You are a vital member of NHS primary care.
Dear healthcare colleagues.
Under extreme pressure we are likely to make mistakes.
Take breaks.
Eat.
Have a drink.
Have a wee.
Read things twice.
Ask for help if you can't think straight.
We are a team. Let's support each other.
I'm now a patient on a ward I worked on 13 years ago in the city where I became a Dr.
I've just been clerked in by a nurse I used to work with who is now a nurse specialist.
Be nice to everyone you meet.
The world is smaller than you think.
I am often asked what it feels like to be a GP during the pandemic.
Over Christmas I've had anxiety dreams and slept badly. I feel anxious about seeing patients tomorrow. I fear for safety.
I'm a senior Dr and will do everything I can to help as many people as possible.
8 days ago the NHS saved my life by giving me a mechanical heart valve.
Without it, I would have been dead within a few years.
Every tick I hear is a thank you ringing out to the healthcare workers that save lives everyday.
You are amazing.
Please don't spend the first 5 minutes of your GP appointment complaining about never getting to see a GP.
We all know the issues.
Telling me that you can't get to see me just eats up our precious time together.
I am increasingly convinced that we need to replace mandatory clinical appraisal with mandatory counselling.
We need less "are you improving" and more "are you ok".
I spoke to a locum GP this weekend who is likely to give up her licence to practice as she has not had enough patient contact this year to prove competence (which is an annual requirement in England).
This is due to a shortage of work, because no one can afford to employ GPs.
Today almost beat me.
That was one of the hardest days in my career to date due to the sheer volume and complexity of patients.
To top it off, a patient complained about not being able to see me for an appointment whilst I was busy with a defib on someone else's chest.
It's now four weeks since I had heart surgery.
The healthcare specialist who I've seen the most, is my pharmacist.
Please support your local pharmacy. It will be devastating when they are gone.
It's time general practice moved to longer appointments and capping the maximum number of consultations in a day.
A tired clinician is an unsafe clinician.
Permission is not needed to do this. The flexibility to practice how you feel is safe already exists.
My day today has started with 110 pathology reports to review and 5 insurance reports to write. None of these will be reflected in the appointment data collected by the government. This is unseen work in General Practice.
There's no such thing as a patient who is a "poor historian".
It's not the patient's job to be an expert on the history of their condition. It's the job of the healthcare professional to elicit information that creates an accurate representation of the medical history.
I'm in hospital.
My doctor is Nigerian.
He arrived in the UK 1 month ago.
He's saving and improving lives.
He's paying taxes.
He's incredible.
Think about that the next time you want to impede immigration.
"Why can't I get a GP appointment?"
There aren't enough GPs. Those we have are tired and burnt out. The government has chosen to train alternatives to GPs as a rapid solution. It is unlikely that this will change for the next decade.
I'm so tired of people thinking that being a GP is easy.
Let me clarify what a day as a GP is like...
Imagine sitting your final exams, for 12 hours.
If you get a question wrong, someone could die.
Repeat
It's rewarding but exhausting.
The NHS is broken
I do not believe that Covid broke it
It broke because of years of
-personal interest healthcare policies
-poor workforce planning
-misdirection of funding
-egocentricity
-ignoring advice
Covid did not break it. Covid revealed the deficits
Let's rebuild
GPs are burning out because
- They are providing complex care that used to be provided by hospitals.
- They take legal responsibility for all of their junior team members.
- They make life changing decisions all day every day.
- They are expected to do more with less.
Normally, I would point out that the GP workforce has been decimated over the last decade and call for more GPs.
However, the real issue here is the lack of decent health education.
We need a mandatory GCSE in human health and care.
Doctors who are being paid late for your services, please note -
Interest on late payments can be levied 30 days after the payment was due. The interest is 8% above the BOE base rate, so currently 13%. You can also charge a one off processing fee.
Tips for new docs - be nice to people.
Really - it's one of the best things you will ever do. Don't learn and regurgitate the toxic attitudes of senior burnt out colleagues.
The GP contract for 2023/24 came out yesterday.
It starts on the 1st April - tomorrow.
I have approximately 200 pages of contract to read and understand today, in between seeing patients.
The way the NHS is run is a farce.
Shout out to the urologist who recognised my patient had a chest infection whilst in their outpatient clinic, started them on antibiotics, and let me know.
You are the real MVP.
Please stop referring to the NHS as "nearing crisis point".
It's at crisis point.
People are suffering needlessly and dying prematurely.
How much more harm needs to be inflicted before we accept that we are in the middle of a crisis and action is overdue?
I've been a Dr for 15 years and only just learned that GTN spray is available over the counter from a pharmacy without a prescription.
What did you learn today?
Dapagliflozin is now officially recommended as an option for treating chronic heart failure.
You will know that I've been jabbering about this for years, so I'm a little excited!
GPs, pharmacists, and nurses - you need to know this, please share!
The dedication and hard work of General Practice and Pharmacy teams during this pandemic to help ill patients at the same time as tackling public health pandemonium has been nothing short of heroism that will go down in history.
Access to GP in the UK is at an all-time low, ranked 37 out of 40 countries.
It's easier to see a GP in Ukraine and Rwanda than it is in the UK.
The UK health service used to be ranked no 1. It is now a global embarrassment
Today, I've had to send a pharmacist home.
My surgery is full and we haven't got space for everyone.
The NHS isn't just short on team members, it's short on physical space.
Due to new pension rules, many senior Drs now have to pay to work.
The news tells you it's just surgeons affected. It's not.
Your cancer treatment. Your heart attack. Your stroke. Your diabetes. Your end of life care.
These will all be affected.
My receptionist has just asked me to act as her bodyguard.
A patient has been aggressive over the phone and has said that they are now coming in...
When did this become normal?
Today I am the lead with 9 clinical colleagues working with me.
2 x Speciality Yr 1 Drs
1 x Speciality Yr 3 Dr
1 x Foundation Yr 2 Dr
1 x Physician Ass Trainee
1 x Physician Ass
1 x Sessional GP
1 x Advanced Nurse Practitioner
1 x Student Dr
This is modern General Practice
Why can patient prescriptions be sent from one country to another across Europe, but my local hospital can't send a prescription to a local pharmacy?
This isn't an innovation. It's simple stuff that could transform patient care for the better.
Please tell GP receptionists what your medical issue is.
They are confidential and can help you get to the right person faster.
A GP is only one member of the primary care team - they are becoming rare and hard to see.
I have decided to adopt a new zero-tolerance approach on Twitter.
Not only am I blocking bad eggs, but I am now also reporting bad medical eggs to the GMC.
You have been warned.
I'm not a pharmacist, but I can offer advice on failing an exam.
You didn't fail. You succeeded in learning. Your personality has just grown and your emotional intelligence has improved. You are more rounded today than you were yesterday.
I'm proud of you. Go celebrate.
I’m so gutted about failing my PreReg gphc exam 😞 I feel so lost. If anyone else has failed please DM me or if anyone has any advice for me 😭
#gphc
#pharmacy
#prereg
A small number of GP "leaders" are unhappy that I'm communicating my own personal thoughts with GPs directly on twitter.
Would you like me to be silent or to continue?
"My GP works 3 days per week. Why is that?"
GPs are overworked and burning out. In those 3 days, it's likely that your GP is still working 36 hours per week. To protect you and themselves, they have chosen to work full-time hours and not more. A tired dr is a dangerous doctor.
"Dear patient
I rejected the referral because your GP didn't give enough information for me to make a judgment call about your health. Please go back to your GP, tell them more, and get them to write again. I will then reconsider your case."
You see how ridiculous that is?
"I haven't been able to get a GP appointment. I think we should cut their pay"
The demand for GP services is record-breaking. You can't get an appointment because there aren't enough GPs. If you reduce the pay, fewer people will train in GP which will make the situation worse
I have a pharmacist with me today who is training to prescribe. He's seeing a broad range of medical problems with my supervision.
With support and resources, pharmacists can deliver far more than we currently ask of them. They are highly skilled and under utilised.
For trainee DPPs or IPs wanting to step up to help train new IPs - don’t forget there is now a FREE flexible (on line /f2f) nationally commissioned
@NHSE_WTE
DPP training package
@ProPharmace
- new dates available - great tutors I’m told too
Lockdown does not mean that GP practices are closed. It just means that we will be extremely busy with sick people. If you are ill - call us, but expect a wait. I am dreadfully sorry, in advance.
Just for context as you read the news about GP this morning....
Theres a £250m rescue package for the whole of England.
Doncaster spends around £1m PER DAY on around 310,000 people.
I am exhausted. I've given everything for my patients and could not give more.
The NHS is not currently capable of providing safe universal care.
Still, I am still against industrial action.
The pen is mightier than the sword. We need to change how we communicate, not attack
To paramedics / ambulance crews.
If you need a place to stop for a rest, a drink, a snack or to use the toilet - please feel free to drop into my surgery.
You will get a warm welcome.
The Oakwood Surgery
Doncaster
DN4 6UN
I'm abusing the NHS app prescription request function to send support to my GP and help them to collect my data.
I adore this app.
Thank you
@NHSX
for revolutionising healthcare.
We need to stop thinking of GP as a one off 10 minute consultation with a clinician
GP has changed
Primary care is about care over time through your life with a range of professionals who provide continuity through teamwork and information sharing
This is Modern Primary Care
I've noticed an increasing trend of patients discharged home from a hospital being told to call their GP for a check-up.
Whilst I would truly love to clerk every patient back to the community, this is impossible with current resources.
Please set realistic expectations.
GPs....
You don't need policy or permission to limit your patient contacts in a day, and to have 15 minute appointments.
Overworked clinicians are tired and dangerous.
Don't wait for permission to take control of your safety and sanity.
The NHS is a risk pooled national insurance scheme and has limited resources that need to be allocated cautiously.
If we give healthy people what they WANT in the NHS, that comes at the cost of denying ill people what they NEED from the NHS.
We should be using pharmacy teams and infrastructure to vaccinate the population whilst general practice gets on with acute and chronic ill healthcare.
General practice is doing an amazing job, but the strategic handling of this crisis needs a rethink before wave 3
Shift number 4 in the Doncaster Covid hub today.
We have Nurses, Health Care Assistants, Pharmacists, Receptionists, Managers, and GPs all working together to ensure patients and colleagues are safe.
I think we need to keep this in place after the pandemic ends.
It's great!
Coronavirus has now been detected in the UK.
Symptoms include...
- Feeling tired
- Difficulty breathing
- High temperature
- Cough
If you develop flu like symptoms, please do NOT go to A&E or your GP
Call NHS 111.
Please RT
I was supposed to attend a Christmas carol event this afternoon, but I've decided to cancel.
I'm making choices that will reduce the spread of Omnicron.
Tomorrow is my last day off in 2020. I I will spend it visiting my cardiologist.
GPs are not closed, hiding, or relaxing.
We are slowly dying on the frontline.
We are giving our health to look after you.
Stay home. Accept the vaccine.
This is everything I dislike about politics. The policies make sense, but the spin is deceitful.
Yes - we need cloud telephones
Yes - we need navigation through a complex healthcare system.
No - this won't end the 8am rush.
No staff = no appointments
Being stuck on hold to your GP when you need to see a doctor is deeply frustrating.
We will end the 8am rush for appointments by making sure patients are either given an appointment immediately when they call or directed to a more appropriate service.
There's a link between how often a patient loses their medication and how many controlled drugs they are prescribed.
I wish this was a cynical joke, but it's really not.
Currently in an emergency meeting convened by
@DrFJameel
of the BMA GPC to discuss the parlous state of primary care.
111 attendees.
It looks like industrial action is on the cards.
My plea is to engage with
@NHSEngland
and bring us back from the brink.
I'm biased.
I grew up in a household where school was the safest place for me and university was an escape route.
However, I was not "known" to the social services.
Teachers - you are more special.and needed than anyone will ever know.
On the topic of growing as a person, my brain needs a kickstart after my stroke, so it's back to school for me.
I'm delighted to say that I will be starting with the
@EdinburghUni
to study Msc Global Health Policy next week.
Cheers to challenges and personal growth.
There's a government pledge to deliver 50,000 more nurses and 6,000 more GPs.
However, there's also a clear statement that there will be no new money for the NHS.
How can you pay for 56,000 new NHS clinicians with no extra money?
Someone is lying.
If NHS colleagues don't stop telling my patients that they must demand an appointment from me the same day because I have a "duty of care", I'm going to go berserk.
Where do you want me to fit all of these patients?
I'm not bloody superman
Conservative MPs are currently writing to GP practices asking for meetings to discuss access issues.
If your practice is written to, please accept the invite and explain politely why General Practice can no longer cope.
If you need help to prepare for your meeting, please DM me
A three day week for GPs is usually 36 hours
The average GP works at least full-time hours.
This article is either poorly researched, or intentionally misleading.
I was asked at a patient meeting yesterday why I spend so much time teaching, when I could be spending more time seeing patients.
If we don't train the next generation of healthcare professionals, there will be no next generation of healthcare professionals.
If you are given a sick note to be off work, you don't have to stay home.
In fact, in most cases, we want you to be up and about.
Light physical activity keeps you fit and healthy.
Interacting with people will reduce social anxiety.
Please don't lock yourself in your house.
Can I remind schools that as "producers and distributers of medicines" Pharmacists are key workers.
Please look after our children whilst we protect lives.
#COVID19