Ed Turnham @EdTurnham Twitter profile

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Ed Turnham

@EdTurnham

3 years

I’m aware of 4 high-profile interventions by doctors in the last week blaming NHS staff for the woes of the NHS. Two were private GPs, one a private cardiologist, and one an ophthalmologist who died in 2016. There appear to be no living NHS doctors who believe this rubbish 👍

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Ed Turnham

@EdTurnham

1 year

A thread on this week's other GP controversy. Here's why more specialist services should be accessible without a GP referral, and why we should stop thinking of GPs as 'gatekeepers'. @TomPMarshall @mancunianmedic @BenAllenGP @doctor_katie @ClareGerada @dave_dlt @MinalBakhai

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Ed Turnham

@EdTurnham

1 year

Access hubs. Cancer diagnostic hubs. Now Acute Respiratory hubs. When GPs struggle to meet demand, the national response is often to add an extra service, rather than invest in GP. The result? GPs are pulled into the new services, destabilising core GP further. Downward spiral.

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Ed Turnham

@EdTurnham

3 years

Just had my first sick note request from a hospital staff member struggling to cope with the idea of working through a third wave. Life is tough in GP, but my thoughts are with our hospital colleagues who are about to be made to go through it all once again. 🙏

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Ed Turnham

@EdTurnham

2 years

Plans to automatically give all adults online access to their full GP record are failing - for the third time. Let's look at what's wrong with this project, and what it tells us about the problems with NHS IT and management.🧵:

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Ed Turnham

@EdTurnham

3 years

Many in the government and media are pushing for GPs to return to face-to-face (F2F) appointments being the default. I have spent much of the last 3 years supporting GPs to adopt different ways of managing patients' needs. So why don't GPs just see everyone F2F? A thread 🧵⬇️

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Ed Turnham

@EdTurnham

3 years

When are patients going to stop hiding away and start seeing us GPs face-to-face again? I just tried to talk one into having a home visit, but she said she's confident in managing her symptoms and just wanted a prescription

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Ed Turnham

@EdTurnham

1 year

There is one strong argument in favour of moving to large-scale salaried General Practice. Even so, this is a very risky approach that could throw away most of what is good about GP. A thread: @wesstreeting

Wes Streeting MP

@wesstreeting

1 year

Labour will be consulting on phasing out the GP partnership model in favour of salaried GPs (and more of them), more ‘front doors’ to the NHS in primary care. The current system is stretched to breaking point. We are thinking radically. More here 👇🏻

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Ed Turnham

@EdTurnham

4 months

My jaw just dropped. 1. Specialist service asks GP, for the patient's convenience, to perform test which is the responsibility of the specialist. This happens lots. 2. Specialist service funds the GP to do so. This has never happened to me before! NHS hospitals: take note!🙏

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Ed Turnham

@EdTurnham

1 year

@HealthRegLawyer Hard to believe anyone saw fit to end a nurse’s career over this. I remember nurses giving me paracetamol from the drug cupboard for a headache as a junior Dr. These tablets cost pennies. Often there is nowhere to buy OTC meds on a hospital site.

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Ed Turnham

@EdTurnham

1 year

Every few months I see a group of friends who trained as GPs with me. We used to talk about interesting patients and our love of the job. Today’s lunch was different. Everyone talked of unbearable workloads. The partners despaired about collapsing income.

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Ed Turnham

@EdTurnham

3 years

Out & about in Norfolk today as the out-of-hours visiting GP. Two people independently expressed fulsome support for the work of GPs and said they hoped our morale was OK. 🙏

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Ed Turnham

@EdTurnham

2 years

The NHS is not being overwhelmed by "inappropriate demand", or "an epidemic of health anxiety", or time-wasters abusing A&E. Misdiagnose the problem ➡️ find the wrong solution. The solution is not more "choose well" campaigns, or fees to see GPs, or extra barriers to get help.

John Burn-Murdoch

@jburnmurdoch

2 years

First, we can look at how many people are turning up to A&E. Numbers have just about recovered to the pre-pandemic trend, but they’re certainly no higher.

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Ed Turnham

@EdTurnham

3 years

So do I get some kind of #medTwitter badge now or does this not count as an achievement any more? @zackferguson @drphiliplee1

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Ed Turnham

@EdTurnham

1 year

But if you kill off the independent contractor model in search of that extra efficiency, my best guess is that you will end up with something much worse. 70+ years of success down the drain. And it would be extremely hard to get it back.

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Ed Turnham

@EdTurnham

1 year

Professionals such as physiotherapists are trained to pick up red flags. Why don't we trust them, when we already trust dentists and opticians to see patients without a GP referral? It is an accident of history that only some of these services lie behind a GP gatekeeper.

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Ed Turnham

@EdTurnham

1 year

To conclude: the partnership model of GP has been the jewel in the crown of the NHS for 70+ years. It's failing because of underresourcing, not because the model is fundamentally flawed. It's not perfect. It could be substantially more efficient.

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Ed Turnham

@EdTurnham

3 years

Early thoughts on today's @NHSEngland guidance on GP access: a short thread🧵

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Ed Turnham

@EdTurnham

1 year

@VirtueOfNothing There’s a @zackferguson -style joke in here I’m sure 🇺🇸: The hospital gave me oxygen so I could keep working through T1RF! 😀👍 🇬🇧: Doctors please stop using the O2 for yourselves, this is stealing from the patients

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Ed Turnham

@EdTurnham

2 years

@DrSelvarajah Our practice, serving a deprived multi-ethnic population, is losing all funding on one vaccine indicator (£1700) this year because ONE family got their jabs late @NikkiKF

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Ed Turnham

@EdTurnham

3 years

Lots of people blaming patients & their ‘trivial’ problems for the GP workload crisis. I honestly think I saw just as much trivia in the old days. Most people don’t know enough medicine to know what’s serious. Last time I thought someone was wasting my time, she had a PE.

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Ed Turnham

@EdTurnham

1 year

🫁 Undifferentiated presentations such as chronic breathlessness are an area where GPs really add value, and cannot (usually) be replaced by a triage algorithm. To describe this work as 'gatekeeping' demeans it: this is holistic medicine.

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Ed Turnham

@EdTurnham

1 year

Why does this nonsense persist? a) Politicians dislike spending money on the IT and skilled managers needed to transform the system. b) Transforming access to a specialist service requires engagement from their clinicians, which is hard when they are constantly fire-fighting.

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Ed Turnham

@EdTurnham

3 years

GPs should be proud of how they have continued to provide a service to their patients in incredibly challenging circumstances, while often giving a better service than ever before. We will continue to work in whatever way we think is best for our patients.

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Ed Turnham

@EdTurnham

3 years

Lots of debate recently about triage in GP. Here's a thread with a detailed argument: @MinalBakhai @SteveLaitner @dave_dlt @dr_musgrave @sib313 @stevekellGP @HelenRSalisbury @H_Atherton @jacobnhaddad @SiliconPractice

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Ed Turnham

@EdTurnham

2 years

It's fashionable to question whether the UK can continue to afford a decent healthcare system, with funding that keeps pace with our increasing needs. Even @BBCNews is joining in. @NickTriggle Let's examine this idea. Short 🧵:

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Ed Turnham

@EdTurnham

3 months

@Azeem_Majeed Common issue in GP. But is the problem that doctors are expected to still see the same number of patients as they did before? I would be happy to see a whole list of complex patients if given appropriate time to do so.

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Ed Turnham

@EdTurnham

1 year

✋"This will deskill GPs" We GPs can't have it both ways: complaining we have too much work, and complaining when someone takes work from us! If it's such a problem, why not also make patients with dental problems go through a GP so that we can keep our dental skills up?

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Ed Turnham

@EdTurnham

2 years

So the GP practice suffers the huge administrative burden of curating the 'gold standard' patient record - now with even more legal liability than before - because of a national failure to invest. GPs are at risk of becoming "data controllers with a sideline in healthcare".

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Ed Turnham

@EdTurnham

2 years

There should no need for the GP to hold all this data. If the UK had invested properly in healthcare IT, the patient's record would be formed from multiple electronic records held by different organisations, all pulled together in milliseconds when required.

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Ed Turnham

@EdTurnham

1 year

👨‍🦼 GPs often act as triagers and gatekeepers for other professionals whose time is much less expensive: wheelchair services, podiatrists, physiotherapists, audiologists, and lots more. I can understand why an outsider would describe this as 'bureaucratic nonsense'.

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Ed Turnham

@EdTurnham

1 year

🩸 Our lady with bleeding is one of many who could be triaged direct to a specialty without a GP appointment. There is little chance of the GP 'avoiding' a referral in her case. There is evidence that gatekeeping worsens cancer outcomes.

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Ed Turnham

@EdTurnham

1 year

c) Getting a GP appointment acts as a hurdle which keeps referrals low, so the specialist services may see little incentive to change this. d) This gatekeeping work is funded by a capitated GP budget, so the unnecessary work is not seen by the rest of the system as a cost.

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Ed Turnham

@EdTurnham

3 years

In short, I worry that practices that have followed all the @NHSEngland guidance over the last 2 years, and striven to provide the most effective model of care for their patients, will now be told off for doing so.

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Ed Turnham

@EdTurnham

1 year

Continuity of care has broken down in many surgeries anyway, such that many patients don't know "their GP". Anything that relieves pressure on GPs could help to reverse this.

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Ed Turnham

@EdTurnham

4 months

This feels like an important moment. This surgery has decided that significantly cutting GP provision is necessary to stay financially viable (many others have achieved the same thru natural attrition). They’re probably right.

Molesey and Thames Ditton GP redundancies due to 'new ways of working'

All 11 GPs at the surgery received a letter informing them of "the start of an HR process".

www.bbc.co.uk

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Ed Turnham

@EdTurnham

1 year

In fact, specialist doctors now considerably outnumber GPs. The burden of triage can no longer fall so heavily on a dwindling number of GPs.

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Ed Turnham

@EdTurnham

1 year

@RoshanaMN The “blame the patient” narrative tends to conflate two concepts: 1) patients with problem X should have easy access to appropriate professionals (eg therapists) rather than “see your GP” being the default [correct] 2) these patients should stop asking for help [wrong]

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Ed Turnham

@EdTurnham

3 years

Was *that* letter a bit of reverse psychology to get GPs to embrace the benefits of triage? Seems to be working 😉 @NikkiKF @NHSEngland

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Ed Turnham

@EdTurnham

2 years

Patient sends online form at 10:26 about urine infection. We respond online at 10:29 with an antibiotic prescription. Can anyone beat that? @dave_dlt

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Ed Turnham

@EdTurnham

1 year

Continuity of care has fallen off a cliff. This leads to unhappy patients, unhappy GPs, greater use of healthcare resources, and shorter lives.

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Ed Turnham

@EdTurnham

2 years

Today in 'Fix the small things': as an out-of-hours GP I am routinely taking 5-15 minutes to find an open pharmacy near a patient. often not updated with bank holiday opening hours. There are 69 patients in the call queue. @NikkiKF @NHSDigital

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Ed Turnham

@EdTurnham

6 months

Email from the ICB Medicine team on Tuesday: please switch everyone on Adcal to Calci-D Discharge letter from local hospital today: we have switched your patient's Calci-D to Adcal in line with our formulary

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Ed Turnham

@EdTurnham

2 years

I could go on. In short, 6000+ GP practices are all expected to come up with ways of managing the risks that online record access brings, when it would have been far cheaper and more effective for the risks to be mitigated once at national level, using good technology.

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Ed Turnham

@EdTurnham

3 years

This increased efficiency has allowed us to HALVE waiting times. An incredible achievement - at a time when other parts of the NHS have ballooning waits and GP numbers are falling.

GP appointment waiting times cut by around half since before Covid

PPP

www.pulsetoday.co.uk

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Ed Turnham

@EdTurnham

1 year

We could build an automated triage system that would stream such patients direct to specialist services. Those who don't clearly fit into a pathway would still be directed to the GP.

Ed Turnham

@EdTurnham

3 years

Part 1. Here's my view of what triage should look like. It's v different to what we have, but mostly could be achieved with a level of tech that is standard in other industries. Our patient has a medical problem. She goes to her practice's website/app.

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Ed Turnham

@EdTurnham

1 year

But we have already seen major damage from scaling up GP practices. Patients at larger practices have more consultations, probably because their GPs feel less responsible for dealing with the patient as a whole, and GPs have less incentive to manage patients efficiently.

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Ed Turnham

@EdTurnham

2 years

So, what could we do differently in future? - invest in NHS management, including at the national level. Otherwise managers at local level have to reinvent the wheel 42 times or 6000+ times, and it will be less effective than if it were done well once.

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Ed Turnham

@EdTurnham

1 year

Expanding direct access is in the latest NHSE guidance, but we should seek to go much further.

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Ed Turnham

@EdTurnham

1 year

Yes, a GP appointment *might* save a referral to the breast clinic, but every time it doesn't means 2 appointments where there could have been one. This would only make economic sense if a GP's time were worth much less than a specialist's time.

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Ed Turnham

@EdTurnham

3 years

New data suggests GP Online Triage/Consultations do NOT lead to increased patient demand: THREAD @MinalBakhai @HelenRSalisbury @mgtmccartney @keithgrimes @MartinRCGP @murrayellender @fhussain73 @bcdelaney1 @ClareGerada @prof_tweet @jacobnhaddad @dave_dlt @sib313 @DrLindaDykes

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Ed Turnham

@EdTurnham

1 year

There is *perhaps* a best-of-both-worlds: large GP practices which work hard to deliver continuity of care between a patient and a single GP, or a patient and a small multi-disciplinary team. There are super-practices in the UK that do this, and comparable models abroad.

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Ed Turnham

@EdTurnham

1 year

✋"This will lead to unnecessary specialist appointments." There are several pathways that lead inevitably to a specialist appointment, where the GP adds little. I'd go further: why not allow direct access for conditions such as breast lumps, where certain criteria are met?

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Ed Turnham

@EdTurnham

1 year

Lovely evening discussing triage, gatekeeping, digital, and the role of GPs with the very hospitable RCGP council @ClareGerada @KamilaRCGP @michael_mul1 @Steve_Mowle @VictoriaTzB

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Ed Turnham

@EdTurnham

2 years

Next: very little work has been done nationally to support GP practices to do the extra work required in redacting contentious data. Once again, we are stymied by years of under-investment in IT.

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Ed Turnham

@EdTurnham

1 year

✋"Patients with possible cancer should have the support of their GP through the process". Many cancers are already picked up through screening programmes, with no GP involvement. Specialists can be empathetic too!

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Ed Turnham

@EdTurnham

1 year

With thanks to @Azeem_Majeed for the excellent articles on this topic from him and his colleagues

Rethinking primary care’s gatekeeper role

Geva Greenfield and colleagues ask whether it is time to reconsider the role of the GP as gatekeeper to specialist services, and call for more evidence to guide future policy Gatekeeping is the term...

www.bmj.com

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Ed Turnham

@EdTurnham

1 year

✋"Bypassing the GP stops us from developing the GP-patient relationship" The average patient goes to their GP surgery twice as much as a couple of decades ago. We could cut out many of these visits and still see patients more than we used to.

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Ed Turnham

@EdTurnham

3 years

Why that @prof_tweet modelling paper does NOT show that online triage increases GP workload, and what we can learn from it. THREAD⬇️ @MinalBakhai @HelenRSalisbury @padsbigsis @mgtmccartney @keithgrimes @MartinRCGP @murrayellender @fhussain73 @bcdelaney1 @BenXGowland @ClareGerada

Chris Salisbury

@prof_tweet

3 years

In 2019 we wrote a modelling paper predicting that ‘digital first’ would increase GP workload. By the time it was published, digital first was the norm, and our assumptions were out of date. We’ve updated our model. The results are interesting …. (thread)

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Ed Turnham

@EdTurnham

2 years

- invest in IT, and build a system that doesn't depend on every hospital letter being duplicated in the GP record - extend the CNSGP to cover data breaches - ruthlessly cut programmes that are consuming management headspace for little benefit

What's covered by CNSGP? - NHS Resolution

Am I covered under CNSGP?

resolution.nhs.uk

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Ed Turnham

@EdTurnham

3 years

@DrSelvarajah What do you call a doctor who works 40+ hours a week, with a mix of clinical, management, teaching etc? If they're a GP: "part time" / "portfolio" GP. If they're anyone else: "full time doctor". Let's change the terminology.

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Ed Turnham

@EdTurnham

3 years

@HelenRSalisbury @GMC @MHRAgovuk should be congratulated on a brave, pragmatic decision. I think most of our elderly patients will be happy that this will reduce the delay in protecting their friends and relatives, and reduce the risk of hospitals being overwhelmed.

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Ed Turnham

@EdTurnham

1 year

Specialists must play their part in devising triage algorithms and the manual triage of patients who want to access their service. More should be done to develop non-doctor specialist practitioners who can be the first point of contact within narrowly-defined pathways.

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Ed Turnham

@EdTurnham

1 year

Move to a fee-for-service model and the incentives will be all wrong. Rather than being as efficient as possible, we'll be bringing our most straightforward patients back for as many follow-up appointments as possible.

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Ed Turnham

@EdTurnham

2 years

Great new GP due to start with us on Monday. International graduate. Just completed 3 years GP training in UK. But she won’t be starting on Monday due to visa delays. Our patients will have to wait to see their new GP. @ukhomeoffice @BMA_GP @parthaskar

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Ed Turnham

@EdTurnham

1 year

To be clear, I'm not proposing that patients can just choose to go straight to a consultant. Direct access to consultant-led services would be for patients who meet tightly-defined criteria. Let's look at some objections to this proposal:

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Ed Turnham

@EdTurnham

1 year

You could abolish the Independent Contractor model and hand GP to NHS Trusts. The leaders of these Trusts will be moved on every few years, rather than being GPs who stay for 30 years and have deep knowledge of the area. @prof_tweet

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Ed Turnham

@EdTurnham

10 months

Very surprising tweet and I wonder who sanctioned this. There is no policy to screen for prostate cancer in England. If there were, I'm sure it wouldn't be to tell 10% of the population to see their GP. If they all did so it would use up 2 weeks' worth of all GP appointments.

Department of Health and Social Care

@DHSCgovuk

10 months

One in eight men will get prostate cancer. Men at higher risk are: ◼️ aged over 50 ◼️ those with a family history of the disease ◼️ black men over 45 If that’s you, speak to your GP. Check your risk in 30 seconds:

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Ed Turnham

@EdTurnham

1 year

A third funding option is to pay according to quality of care. But this is really tricky. Quality of healthcare is largely subjective, and not the same as patient satisfaction. Much of the good work we do doesn't bear fruit until years later.

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Ed Turnham

@EdTurnham

3 years

A toddler with a sniffle and a cough, if they are running around and drinking well, can be safely managed over the phone. A F2F would waste time on a pointless examination, while perpetuating the myth that everyone with a cough needs their chest 'checked over'.

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Ed Turnham

@EdTurnham

3 years

By faithfully following the guidance & recording all of these remote 'appointments', practices reduce the proportion of recorded GP appointments that are F2F. This now opens them up to criticism for not doing enough F2F appts.

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Ed Turnham

@EdTurnham

1 year

A huge amount of this time could be saved by protocolising care using technology. For the majority of patients who don't have complex multiple health problems, much of their care could be delivered with much less human intervention - at higher quality.

Ed Turnham

@EdTurnham

3 years

A man's Hypertension review is due. He needs a BP check and blood test. With no human intervention, the IT system sends him a notification via SMS/email/app. ❌ He does not respond. A week later, he is automatically sent another notification. ❌

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Ed Turnham

@EdTurnham

3 years

First, the patient perspective: most of the time, most patients seeking GP help do *not want F2F*. For most things it is more convenient to get a phone call or message.

askmyGP

@askmygp

4 years

@EdTurnham Here on Consult mode preference, you can see that now it's down to 8% asking for f2f, from 30% pre-covid. We haven't changed advice, that's patients adapting to the situation.

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Ed Turnham

@EdTurnham

6 months

A rare perk of being a GP Partner is never having to worry about frozen income tax thresholds

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Ed Turnham

@EdTurnham

1 year

But the first two cases showed there is a huge opportunity to use technology-assisted triage to help patients go straight to specialists. This will provide more timely care, preserve NHS resources, and relieve strain from GPs.

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Ed Turnham

@EdTurnham

2 years

49 questions on @TaviAndPort child gender referral form, not counting tickboxes. Similar for ASD, ADHD etc. Not a sustainable burden on GPs. Need digital platforms to support referrals made collaboratively by patients/parents/GP/school etc, or purely self-referral.

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Ed Turnham

@EdTurnham

2 years

The GP practice is the data controller, not just for our own consultation records, but for huge amounts of letters created by hospitals, mental health services, etc. So the practice is expected to redact any contentious information in data created by other organisations.

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Ed Turnham

@EdTurnham

3 years

Even digital doctors like face-to-face contact occasionally. Great to meet friends at @HETTShow , some for the first time, and make new connections @rob_tam @DrSelvarajah @healthyopinion @MinalBakhai @LJ_Ali1 @Masood_Online @EmilyClairWells @fhussain73

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Ed Turnham

@EdTurnham

3 years

Dr Tony Goldstone

@goldstone_tony

3 years

@pkonline84 @gmcuk @thetimes @RCSnews @IpsoNews Just to confirm, there are two Dr. Martin Spiro's Dr Spiro - radiologist, sadly passed in 2016. Dr. Spiro FRCS (med school 1949) is alive & sending nonsense letters to @thetimes He responded to my email below (as per the email address in a previous letter he had sent)

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Ed Turnham

@EdTurnham

1 year

✋"GPs have to assess these patients first to avoid missing red flags that need emergency management". A good triage algorithm would pick up these red flags straight away. Would every GP practice's appointment system do the same?

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Ed Turnham

@EdTurnham

3 years

By saving time managing some issues remotely, we free up time for patients who need it most. I now often spend 30-40 minutes on a F2F appointment and can deal with a complex issue in one go. Very satisfying all round.

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Ed Turnham

@EdTurnham

3 years

I’m using @TPP_SystmOne appointment invitations to let patients book face-to-face slots with me, after I triage their online request. Far from perfect, but saves me time & patients like the choice of slots. A step closer to how Digital Triage is meant to work. @DrJohnParry

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Ed Turnham

@EdTurnham

2 years

Congrats to the @NNUH Virtual Ward project for being singled out by @sajidjavid in his speech to #HSJdigital ! @EmilyClairWells @ProsserSnelling @NHSNWCCG

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Ed Turnham

@EdTurnham

2 years

Lastly, this is yet another huge demand on the limited management capacity that exists in General Practice, at a time when we're already stretched by complex projects of dubious benefit such as Enhanced Access, and trying to stay afloat in a collapsing healthcare system.

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Ed Turnham

@EdTurnham

1 year

The leaders' priority will inevitably be to implement the many demands of NHSE/DHSC, rather than necessarily do what is best for primary care. Every decade or so the organisation will be restructured according to national whims, and will take several years to recover.

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Ed Turnham

@EdTurnham

3 years

This fall in waiting times, and the flexibility we now have to give patients the time they need, has undoubtedly saved lives. But there is no way to say whose lives have been saved. These lives don't make headlines, unlike the rare cases where things go wrong.

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Ed Turnham

@EdTurnham

2 years

I don't blame the individuals working at @NHSEngland on these projects. They are dedicated, impressive people. But there are too few of them (even before the coming 40% job losses!) and we are not investing anything like enough in technology.

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Ed Turnham

@EdTurnham

3 years

The guidance assumes that it is inappropriate for less than 20% of GP appts to be F2F (face-to-face). I'd be fascinated to see the evidence that shows this is inappropriate. Unfortunately there is no reference to such evidence in this document.

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Ed Turnham

@EdTurnham

2 years

But it also brings risks. When it goes wrong, the GP practice is liable to be sued, or fined by @ICOnews . GP practices are small businesses owned by partners, whose income has already been squeezed to the point that they could earn similarly as locums or salaried GPs.

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Ed Turnham

@EdTurnham

1 year

But in GP we use a patchwork of basic IT systems that don't talk to each other. Much administrative and clinical time is spent triaging & booking appointments, processing documents, recalling patients, or repeating the same information over & over to different patients.

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Ed Turnham

@EdTurnham

1 year

Or you could keep independent contractors but encourage the growth of super-practices, owned by partnership or corporations. Some of these might succeed along the lines of my vision above. But others would seek to maximise profits while providing the minimum quality of service.

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Ed Turnham

@EdTurnham

1 year

This, I think, is the strongest argument for a new large-scale model of general practice. It could allow for sophisticated, efficient models of care that would free up clinicians to use their skills managing the complex patients who don't fit the algorithms.

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Ed Turnham

@EdTurnham

3 years

Let's not get too hung up on the semantics of 'triage', please. I use it as a shorthand for 'getting a problem dealt with in the most appropriate way, by the most appropriate person, in the right timeframe'.

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Ed Turnham

@EdTurnham

4 years

I’m not sure she’s right about facemasks, but the existence of @mgtmccartney is often the only thing that gives me hope for the future of medicine.

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Ed Turnham

@EdTurnham

1 year

Let's look at 3 patients that currently have to go through a GP for specialist care. 🩸A 60-year old woman has vaginal bleeding. 👨‍🦼A disabled man wants a wheelchair. 🫁 A 70-year old ex-smoker, with previous heart disease, has worsening breathlessness over 6 months.

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Ed Turnham

@EdTurnham

2 years

Some patients are at particularly high risk of harm from having online records access, and it's possible to block them from getting this automatically. Again, it would really help if the national project team had developed a system for identifying these patients. No such luck.

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Ed Turnham

@EdTurnham

3 years

I want to clarify again that it turns out this was a letter from a genuine surgeon, even if he hasn’t worked in the NHS for a long time. I’ll delete the previous tweet now out of fairness to the Times.

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Ed Turnham

@EdTurnham

3 years

For longer-term problems, such as weight loss or fatigue, F2F with a GP is often needed. But these problems often require 3-4 contacts with the GP, including discussions about test results. Only one of these contacts needs to be F2F, with the majority being by phone or message.

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Ed Turnham

@EdTurnham

6 months

@gem1509 @iDrSunny I understand the concerns about non-doctors filling 'doctor' rotas, but I'm fairly relaxed about this case. The tradition of rotating doctors being thrown into holding the SHO referral bleep for a new specialty, often with minimal training, is hardly safe. I've been that doctor.

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Ed Turnham

@EdTurnham

1 year

Those who can't use the online triage process could be taken through the same algorithm, perhaps by a 111 call handler or GP receptionist.

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