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| Date | Titre | Durée | |
|---|---|---|---|
| 21 Oct 2012 | Working long term as a GP locum in the same practice - NASGP | The art of GP locuming | 00:16:53 | |
Fortunately, our colleagues at the NHSPS take a common sense and pragmatic approach that stays within the parameters of the statutory NHS Pension Scheme (NHSPS) regulations. These regulations do offer a certain degree of latitude.
At the moment, GP practices pay the 14.3% employer contributions for type 1 and 2 medical practitioners, whereas it is the PCT that picks up the 14.3% tab for freelance GP locums, and this is where sometimes disputes can arise.
The NHSPS regulations define sessional GPs in the following ways
a GP locum as a GP who “deputises or assists temporarily” in a GP practice under a contract for services, which means fee based/self employed
a type 2 (assistant) medical practitioner as a GP works for a practice or a PCT under a contract for service (i.e. Salaried GP) or under a contract or services (fee based/self–employed).
So there is scope under the NHSPS regulations for a fee based/self-employed GP to be either a GP locum or a type 2 in pension terms. The benefit of being regarded as a type 2 means you’ll get 24/7 NHSPS death in service cover as well as coverage under the NHS Injury Benefits Scheme
Case studies
Dr Jones works under a contract for services at the High Street Practice for a period of 5 months and 3 weeks working between 1 to 5 sessions a week. She then leaves and does not return; she is a ‘GP locum’ in NHS pension terms and the PCT pays the 14% employer’s contribution, subject to Dr Jones completing her locum pension forms on time.
Dr Smith also works under a contract for services at the High Street Practice, and from the outset it is clear that he will be working there for a period of at least 9 months working between 1 to 5 sessions a week. He is ‘type 2’ from day one in NHS pension terms, and the Practice must pay the 14% employer’s contribution from day one. Dr Smith must also be listed on the enclosed so that the PCT can top slice NHSPS contributions on account as they would do for a Salaried GP.
Dr Green also works under a contract for services at the High Street Practice working between 1 to 5 sessions a week however at the outset it is not known how long she will be working there. From day one she is a ‘GP Locum’ in NHS pension terms and the PCT pays the 14% employer’s contribution. However, if she is still working at the Practice after 6 months she must convert to a type 2 and the Practice must pay the 14% ERs. Her pension rights will not be compromised, in fact they improve by virtue of the 24/7 death in service cover and access to the NHS Injury Benefits Scheme.
This information was kindly supplied to the NASGP by the NHSPS
Have you had any problems with practices or PCTs misinterpreting these rules? Let us know in the comments below.
The post Clarifying employer’s contributions for long-term freelance GP locums appeared first on NASGP. | |||
| 08 Apr 2021 | Difficult GP consultations, with Dr Leila Saeed | ||
Dr Leila Saeed is a GP in Buckinghamshire, and talks to NASGP chairman Dr Richard Fieldhouse about approaching difficult consultations with patients. Original article. | |||
| 16 Apr 2021 | What was it like when Covid-19 struck Wuhan? | 00:22:35 | |
Judith Harvey speaks to Dr Richard Fieldhouse about her article on the critically acclaimed documentary '76 days', shot during the very first days of the pandemic. | |||
| 24 May 2021 | The health of the nation: who’s keeping score? | 00:24:06 | |
How many New Year Resolutions have you kept? If I don’t get around to clearing out the box room, no-one is going to hold me to account and it isn’t the end of the world. How many countries fulfil their undertakings to cut carbon emissions? If the nations of the world fail to cut carbon emissions, the world may indeed end. If it ends, who would hold them to account? What if we had a single measurement for the nation’s health? Judith Harvey outline’s the need for the new Health Index, currently being compiled by the ONS. https://www.nasgp.org.uk/resource/the-health-of-the-nation-whos-keeping-score | |||
| 05 Jul 2021 | My Love, and settling in to age | 00:22:37 | |
Judith Harvey speaks to Richard Fieldhouse about the seventh age of man and her latest article on the NASGP website https://www.nasgp.org.uk/resource/judith-harvey-netflixs-my-love-is-an-uplifting-watch-for-us-gps | |||
| 10 May 2022 | Dr Tina Peers - Management of the menopause | 00:47:47 | |
Dr Tina Peers joins us from The Menopause Consultancy in a talk to 40 NASGP members, followed by a Q&A. View Tina's slides, or view on YouTube. | |||
| 15 Jun 2022 | Diagnosis and management of actinic keratosis by Dr Tony Downs. | 00:46:00 | |
Welcome to this recording of June 2022’s NASGP monthly lunchtime webinar, where we are joined by Dr Tony Downs for a talk on the management of actinic keratosis. As well as hosting as live events, we also publish these as a YouTube video and a podcast, and include a link to the slides in each episode’s show notes. Look out for your Monday morning emails from us with details about the next talk, which in July will be on bowel cancer. Thanks for listening or watching, and hope you enjoy the talk. To view slides https://www.nasgp.org.uk/wp-content/uploads/Diagnosis-and-management-of-actinic-keratosis-by-Dr-Tony-Downs.pdf | |||
| 05 Sep 2022 | Am I burning out - Dr Helen Garr from Practitioner Health | 00:44:37 | |
On 01 September 2022 we were delighted to host Dr Helen Garr, Medical Director from Practitioner Health, to our regular monthly educational webinar. What are the signs and symptoms, and what can you do about it? You can also watch this talk as a YouTube video here https://youtu.be/M1uSNNjgRC8 | |||
| 27 Jun 2023 | Oesophageal cancer: what GPs need to know with Professor Rebecca Fitzgerald | 00:54:42 | |
GPs can learn more about oesophageal cancer by listening to this podcast, or watching a recording of our June 2023 event on YouTube https://youtu.be/dRg2i1WXebk Professor Rebecca Fitzgerald of Heartburn Cancer UK led ‘Oesophageal cancer: what GPs need to know’, NASGP’s clinical lunchtime webinar for June. | |||
| 06 Jul 2023 | Accountancy Q&A for salaried GPs and GP locums | 00:45:16 | |
Terry Bentley-Darby BA (Hons) is a Senior Tax Manager at Randall & Payne, members of the Association of Independent Specialist Medical Accountants (AISMA). He works for a portfolio of clients particularly in the medical sector. Terry answered questions around VAT, slef-employed vs limited company, NHS pensions and much more. | |||
| 11 Sep 2023 | What GPs need to know about eating disorders | 00:46:58 | |
Nick Pollard and Dr Elizabeth McNaught of Family Mental Wealth CIC explain the work they do, provide advice for GPs and answer audience questions at NASGP's September 2023 webinar. Get 50% off e-learning at familymentalwealth.com by logging into your NASGP members offers section for a discount code. Get an invite to our next free event at https://nasgp.org.uk. | |||
| 06 Nov 2023 | GP update: Feno testing/asthma (2023) | 00:45:07 | |
Dr Andy Whittamore has been a GP Partner in the Portsmouth area for 17 years. In that time he has developed an interest in respiratory medicine and gone on to hold a number of regional and national roles. Over the last 7 years he has spent 2 days per week as Clinical Lead for Asthma and Lung UK and has recently worked as NHS England's Clinical Champion for FeNO. The talk was the penultimate NASGP monthly clinical webinar this year, and you can view the slides here: https://www.nasgp.org.uk/resource/slides-asthma-and-feno-testing-in-general-practice/ 00:00 Intro 00:50 Talk 33:33 Further reading 34:00 Q&A Connect with Andy: | |||
| 27 Nov 2023 | Dr Amy Small – Medical activism and my portfolio career | 00:50:48 | |
Welcome to our latest episode, where we dive into the inspiring world of Dr Amy Small. A GP locum with a rich tapestry of experiences, Amy has navigated her career through various roles, from a GP partner in Scotland to a salaried GP in London and a locum in Sheffield. Her journey doesn't stop there; as a passionate advocate in medical politics, she's been a driving force in local medical committees and the BMA. Overcoming the personal challenge of long Covid, Amy has become an advocate for people living with long covid and works for a charity supporting people with the condition, showcasing her tenacity and commitment to health activism. Join us as we explore her story, her unyielding spirit, and her knack for making things happen. Get ready to be inspired by a GP who truly speaks her mind and leads by example. Dr Amy Small on social media Useful links | |||
| 11 Dec 2023 | Cancer and Primary Care: Insights and Strategies | 00:47:45 | |
In this enlightening talk, hosted by the National Association of Sessional GPs (NASGP), we delve into the critical role of primary care in the cancer pathway. The discussion covers early diagnosis challenges, personalised cancer care (PCC), effective referral processes, support during and post-treatment, and the importance of integrated care. This talk is a valuable resource for primary care professionals seeking to enhance cancer care. * Download PDF or presentation Useful links * Macmillan Support Line Services Referral Form - Email to supportlinereferrals@macmillan.org.uk * Macmillan Cancer Support - Learning and Development Hub * Cancer Care Map - Find Local Cancer Support Services | |||
| 08 Jan 2024 | Ovarian cancer as an abdominal cancer - Dr Eloise Elphinstone | 00:38:48 | |
Join Dr Eloise Elphinstone, a GP with a special interest in women's health, as she provides an insightful update on ovarian cancer, focusing on its implications for general practice. In this webinar, Dr Elphinstone, who works in SW London and has extensive experience in menopause and postnatal health, delves into the complexities of diagnosing and managing ovarian cancer from a GP's perspective. This session covers:
Connect with Dr. Eloise Elphinstone Useful Links #OvarianCancer #GPUpdate #WomensHealth #GeneralPractice #NASGP #MedicalWebinar #EloiseElphinstone | |||
| 05 Feb 2024 | Dr Sam Merriel – Prostate cancer update for GPs | 00:37:15 | |
Join Dr Sam Merriel, an experienced GP and NIHR academic clinical lecturer from the University of Manchester, as he shares his insights on prostate cancer diagnosis in primary care. In this informative session, Dr Merriel discusses the risk factors, recent changes in the diagnostic pathway, and the importance of PSA blood testing. Discover how these advancements can help improve early cancer detection and address inequalities in prostate cancer diagnosis and treatment. | |||
| 07 Mar 2024 | Top tax tips & tricks for GP locums and salaried GPs | 00:52:05 | |
Join Richard Fieldhouse and Tori Ferguson as they delve into the world of tax advice for GP locums in this episode of the Art of GP Locuming podcast. Tori, a Tax Advisor for Honey Barrett, shares her expert insights on a range of topics including tax returns, pension statements, and the value of using a tax adviser. She also provides practical tips on how to handle your tax affairs effectively and efficiently. Don't miss out on this informative episode, perfect for any GP locum looking to better understand their tax obligations. | |||
| 15 Mar 2024 | Dr George Moncrieff with dermatology in general practice | 00:50:31 | |
In this informative episode of our dermatology-focused podcast, Dr George Moncrief, a retired GP with a profound interest and extensive experience in dermatology, delves into common dermatological conditions, offering his insights into their diagnosis, management, and treatment. Dr Moncrief shares his journey from practising as a GP to specialising in dermatology, reflecting on the challenges and learning experiences he encountered along the way. Throughout the discussion, Dr Moncrief emphasises the importance of accurate diagnosis, highlighting cases where misdiagnoses led to ineffective treatments. He provides practical advice on the use of topical steroids, advocating for their cautious application and the preference for ointments over creams to avoid sensitivities and ensure better treatment outcomes. Dr Moncrief also addresses several skin conditions in detail, including tinea incognito, discoid eczema, superficial BCC (Basal Cell Carcinoma), and perioral dermatitis. He stresses the significance of considering the patient's history and presenting symptoms to avoid common pitfalls in diagnosis. Particularly noteworthy is his discussion on the management of perioral dermatitis and rosacea, where he advises against the indiscriminate use of steroids and highlights alternative treatments that can provide relief without the adverse effects associated with steroids. Additionally, Dr Moncrief touches upon the psychological impact of skin conditions on patients and the necessity of integrating empathetic care with clinical treatment. He concludes the session by answering questions from the audience, further enriching the conversation with practical tips and clarifications. This episode is a must-listen for healthcare professionals seeking to deepen their understanding of dermatology and for anyone interested in learning about the complexities of diagnosing and treating skin conditions effectively. | |||
| 10 Apr 2024 | Management of asthma – GP update | 00:45:34 | |
Join Dr Andrew Whittamore, jobbing GP and clinical lead for Asthma+Lung UK, as he delves into the latest strategies and treatments for managing asthma effectively. In this informative session, we explore the essentials of asthma, principles of treatment, and how to support patients towards achieving better asthma control. From understanding asthma triggers to discussing the impact of inhaler choices on the environment, this webinar covers it all. Useful links:
Join the Facebook community: Asthma and Lung UK If you're a healthcare professional, this webinar provides valuable insights into optimising asthma care. | |||
| 01 Jun 2024 | GP locuming in New Zealand with Dr Jennie Ferrie | 00:42:32 | |
Join Dr Richard Fieldhouse as he talks with Dr Jennie Ferrie, a seasoned GP with a rich international background, now practicing as a locum in New Zealand. In this episode, Dr Ferrie shares her journey from the UK to New Zealand, detailing the nuances of locum work in rural areas, the challenges and rewards of adapting to a different healthcare system, and the lifestyle benefits of living in New Zealand. This enlightening conversation offers a deep dive into the life and career shifts that come with international locuming, providing valuable insights for GPs considering a similar path. | |||
| 17 Jul 2024 | GP update: Menopause and HRT | 00:49:45 | |
This webinar from Dr. Eloise Elphinstone provides an update on managing unscheduled bleeding in postmenopausal women on hormone replacement therapy (HRT). Key points include new guidance on assessing bleeding risk factors and adjusting HRT regimens. Case studies demonstrate approaches to controlling bleeding through modifying estrogen and progesterone doses or alternatives like the Mirena coil. Guidance is also given on ultrasound results and referral pathways. Options for complex cases involving progesterone intolerance or premature ovarian insufficiency are explored. The talk aims to help GPs confidently manage common menopause issues and determine when specialist referral is appropriate. YouTube of this podcast available here https://youtu.be/2dYJiv8-IIQ | |||
| 12 Sep 2024 | Starting out with GP locum accounts, with Tori Ferguson | 00:46:33 | |
In this informative session hosted by the National Association of Sessional GPs (NASGP), Victoria (Tori) Ferguson, a tax manager at Honey Barrett, shares essential advice for GP locums on managing their finances, tax obligations, and pensions. Tori, a chartered tax advisor, offers a comprehensive guide tailored to GPs who are new to locuming or those seeking a refresher on best financial practices. For further advice on these topics, NASGP members can access more resources and guidance on the NASGP website: https://nasgp.org.uk During the talk, Tori covers 10 key points to help locum GPs successfully manage their self-employment status. She explains the importance of setting up a personal tax account, notifying HMRC of self-employment, and staying on top of record-keeping and software tools like LocumDeck. Other essential topics include navigating the NHS pension scheme, understanding expenses for tax deductions, and planning ahead for tax payments, especially with looming changes such as Making Tax Digital. The session also delves into the nuances of claiming allowable business expenses, the significance of maintaining separate bank accounts, and the critical need for GPs to view themselves as both a doctor and a business. Tori emphasises the importance of investing in financial education to stay up-to-date with ever-changing tax laws, whether through self-learning or hiring a specialised accountant. The Q&A session further explores real-world concerns, such as handling fraudulent use of unique taxpayer references (UTRs) and dealing with the complexities of IR35 and employment status, highlighting Tori’s expertise in resolving practical issues GPs may face. Intro 00:00 Topics covered: 1. Setting up a personal tax account. 02:41 2. Informing HMRC about self-employment. 03:38 3. Importance of bookkeeping software. 05:23 4. Record-keeping essentials for locums. 06:25 5. Navigating expenses and the trading allowance. 08:30 6. Pension contributions and time limits. 12:00 7. Managing a separate business account. 15:15 8. Saving for taxes and avoiding pitfalls. 16:53 9. Viewing yourself as a business owner. 20:21 10. Investing in financial education. 21:52 Q&A 25:41 Highlights: • HMRC UTR fraud cases and how to handle them. 27:46 • Employment status and IR35 for locum GPs. 38:07 For further advice on these topics, NASGP members can access more resources and guidance on the NASGP website: https://nasgp.org.uk #GPs #LocumTax #Pensions #NASGP #HoneyBarrett #SelfEmployment #TaxAdvice #GPFinance #MedicalAccountants #MakingTaxDigital #IR35 #LocumDeck | |||
| 25 Nov 2024 | Spotting acute leukaemia early in general practice | 00:27:38 | |
This podcast features Dr Sarah Smith, a GP and member of the @leukaemiacare advisory panel, discussing the importance of early diagnosis of acute leukaemia. Learn how:
The emotional impact of a leukaemia diagnosis is significant, so GPs must communicate sensitively when raising concerns. #Leukaemia #EarlyDiagnosis #GPEducation #BloodCancer #MedicalEducation | |||
| 16 Feb 2023 | Inflammatory bowel disease: What do GPs need to know? | 00:48:27 | |
Inflammatory Bowel Disease with Dr Charlie Andrews from Crohn's & Colitis UK. GP resources: https://crohnsandcolitis.org.uk/our-work/healthcare-professionals/community-healthcare-professionals | |||
| 21 Oct 2024 | Ophthalmology in General Practice with Nigel Davies | 00:47:59 | |
In this informative podcast, hosted by NASGP, consultant ophthalmologist Nigel Davies from St Thomas’ Hospital shares practical insights on diagnosing and managing common eye conditions in general practice. Nigel offers a structured approach to assessing eye problems, focusing on symptoms and signs, not just diagnoses. The session also covers practical tips on red eye cases, the importance of pupil reactions, and key considerations for conditions like conjunctivitis, retinal detachment, and glaucoma. Perfect for GPs looking to enhance their ophthalmology skills in everyday practice. See YouTube video https://youtu.be/LNklfZ50Joo | |||
| 09 Aug 2017 | Podcast | August 2017 edition of The Sessional GP Magazine - NASGP | The art of GP locuming | 00:27:40 | |
Sara Chambers and Richard Fieldhouse review this month's edition of The Sessional GP Magazine (see below). Are GP hubs all they're made out to be? Do you understand what 'payment on account'? When did you last record the details of the family member wh... | |||
| 12 Aug 2017 | Bloody Hell – the global curse of menstruation - NASGP | The art of GP locuming | 00:17:57 | |
You are 13 years old. Your family is poor. Each month you have to take a week off school. In a few months you are so behind in your school work that you drop out for ever. You live in an African country, in India, in the Australian outback...in Leeds. | |||
| 26 Aug 2017 | Podcast | Get started as a GP locum – part 2 - NASGP | The art of GP locuming | 00:34:24 | |
In our second episode on getting started as a GP locum, Richard and Sara talk about how to develop your booking process (and what that actually is!), and fine tuning your T&Cs. Listen now at the bottom of this page, or subscribe online. | |||
| 04 Sep 2017 | Podcast | Starting out as a GP locum Part 3 – Reactive vs proactive booking, Instant Book and chambers - NASGP | The art of GP locuming | 00:23:14 | |
In part three of our mini-series on starting out as a locum GP, Richard and Sara talk about the concept of 'proactive' and 'reactive' bookings, LocumDeck's Instant Book and GP locum chambers. | |||
| 13 Oct 2017 | Podcast | Review of the October 2017 edition of the NASGP’s The Sessional GP magazine - NASGP | The art of GP locuming | 00:32:45 | |
Sara and Richard review the latest edition of The Sessional GP magazine. In the magazine, Kate runs us through mindfulness, Judith wonders why we don't prescribe placebos more often, Liz gives us the lowdown on selling your rented property, | |||
| 20 Oct 2017 | Podcast | The Best practice conference and eating disorders - NASGP | The art of GP locuming | 00:31:29 | |
It's been a busy week at the NASGP, having published our magazine last week, attended the Best Practice conference in Birmingham earlier in the week, and meeting lots of NASGP members and new GP locums and practice managers. And also, | |||
| 03 Nov 2017 | Podcast | IR35, endometriosis, airline pilots and the Birmingham LMC conference - NASGP | The art of GP locuming | 00:32:06 | |
In our latest podcast, Richard and Sara talk about a recent encounter with an airline pilot; Louise's latest review of the NICE endometriosis guidelines; a new article on the IR35 intermediaries legislation and also some recommendations for podcasts, | |||
| 03 Jan 2018 | Podcast – No es fácil: clinical electives in Cuba - NASGP | The art of GP locuming | 00:18:21 | |
Few things in Cuba are easy. Most countries faced with what Cuba has lived with for more than half a century would be failed states. Cuba keeps going, with hardship and sacrifice, but a shared vision.
The reputation of Cuba’s health service – providing rich-country outcomes on a poor-country budget – attracts interest from politically aware medical students. But arranging an elective there, well, no es fácil. Fidel Castro’s Escuela Latinoamericana de Medicina provides medical training for poor students from other countries, but few people in Cuba’s health service are aware that medical training worldwide often includes an elective. Only the occasional foreign student managed to penetrate the indifference, the bureaucracy, the lack of information and the limitations of Cuba’s IT, and arrange an elective.
I was fortunate to meet a Cuban doctor with the imagination to think outside the restrictive Cuban box. He had welcomed one such applicant. We discussed the practicalities of an elective programme, and in 2010 I started Cuba Medical Link, a UK registered charity with a website to help students arrange electives in Cuba. Eight years, 400 students from 20 countries later, I have closed this programme.
No es fácil, an elective in Cuba. Foreign students are in Cuba on Cuba’s terms. They pay substantial fees for their tuition. They have to speak Spanish. They learn alongside Cuban medical students, they live as paying guests with Cuban families. Being Cuban no es fácil, and students gain an insight into the difficulties of everyday life under the USA’s economic blockade. They acquire a first-hand experience of the Cuban health system and of the social sacrifices and restrictions of political freedom which underpin it.
Once they have surmounted the hurdles of registering in Cuba and donned a bata blanca (white coat) elective students enter a world of shared knowledge of the human body and its infirmities. Cuban doctors are generally welcoming and keen to teach. But practising in Cuba no es fácil. Buildings may be in need of basic repairs, and doctors may have only a thin, shabby towel to dry their hands. But the commitment to patients is the same. Cuban ingenuity keeps antiquated CT scanners working 24/7 and every stroke patient is scanned in A&E – an objective few British hospitals achieve.
Back home, students probably don’t think much about the patient’s diagnosis till they have the results of a battery of investigations. Cuban students have to learn to make a diagnosis without technology, and elective students have to try to do the same. As one British student said, “I felt like an amateur compared to their seemingly vast clinical skills!”
Some differences can be startling. Interactions with patients can sometimes be uncomfortably brusque. And in a country in which people live in each others’ pockets, confidentiality isn’t a consideration. It can be a shock to find two doctors consulting in the same small room and all available space crammed with patients’ relatives and friends, nurses, medical students and even the next patient who has wandered in through the open door.
In many countries preventative health care is given only lip service, or responsibility is devolved to public health departments. Visiting students see how in Cuba it is everyone’s responsibility, and they make the connection with Cuba’s impressive health statistics. They may even take part: a Japanese student was proud to give a talk about reducing their risk of heart disease to a group of abuelos (elderly) at their exercise class. As another student observed “The primary care doctor in Cuba is part shaman, part confessor and this demonstrates both their medical and social roles and how it is difficult, and probably inappropriate, to try to see one without the other.”
Students go to the beach, play football, go dancing with their fellow Cuban students. | |||
| 24 Nov 2017 | Podcast | Should GPs prescribe placebos? - NASGP | The art of GP locuming | 00:19:06 | |
Mrs Jones likes blue pills; they work better than those pink ones – even though they are the same drug. But she wouldn’t touch blue mashed potato.
Wine buffs rate a wine higher if they believe it is expensive. Consumers are sure that a brand name product is superior to an identical generic, whether it be atenolol or cornflakes. The kids won’t eat burned sausages at home but round a campfire they taste wonderful. Turn on a red light, and your blood pressure and heart rate will increase.
We know we are influenced by experience, by context, by sensory input, by our expectations, but most of us don’t realise how open to manipulation our judgments are.
Take food. There is an art to creating expectations of food. And a science too. Oxford psychologist Charles Spence’s field is gastrophysics. All our senses are involved in our appreciation of food and drink – not surprising since without them we would not survive. So Spence is investigating how our experience is shaped by our sensory input.
A £275 ‘ticket’ (plus drinks and service) buys you ‘A Journey’ that a celebrity chef has contrived in a laboratory in conjunction with Professor Spence and transferred to his restaurant. There’s no shortage of customers.
Spence’s research also guides multinational food producers. A reassuring crunch as you open the packet makes even stale crisps taste good. Soft drinks and pre-prepared meals, and their packaging, are designed to appeal to the purchaser’s senses before the product reaches their palate. And who wouldn’t be grateful that insights from gastrophysics about the effect of altitude and engine rumble on taste have led airlines to serve more enjoyable food.
In a world that faces food insecurity, overcoming cultural yuck factors could be literally vital. We all like crunchy food, and insects are an underexploited source of nutrition. It’s a matter of presentation.
Gastrophysics has lessons for health care. After 70, our sense of smell deteriorates. Odour contributes far more to taste than our taste buds, so food needs more flavour. Increasing the contribution of the other senses can make a huge difference to how much a frail, elderly and perhaps demented person eats.
Cue mealtimes and boost the appetite by wafting the aroma of a favourite meal from a plug-in. Consider the lighting. Play sounds that have positive associations with food. Mozart for some, Meatloaf for others. Make the food more appetising by replacing soft grey glop on a white plate with coloured food or contrasting coloured crockery. Add crunch, aurally if her teeth aren’t up to toast. Chat with her over her meal. And in hospitals, colour-coded trays for different diets may help staff get the right meal to the right patient, but research shows that if the tray is red, less of the food gets eaten.
There’s something disturbing about how our ‘objective’ responses can be manipulated. It’s a subject of ethical debate, and our views depend on whether we know it is happening. And on whose behaviour is being manipulated. Doctors, who aren’t big consumers of fizzy drinks, generally support measures to reduce their consumption. After all, people need to be protected from themselves. The libertarian right disagrees, and orchestrates public outrage against ‘nanny state’. So governments study behavioural economics and look at nudging, priming – changing subconscious cues – and other non-coercive influences on our behaviour. It has been demonstrated that customers don’t notice when the sugar or salt content of products is reduced gradually. Health by stealth works.
Increasing the contribution of the other senses can make a huge difference to how much a frail, elderly and perhaps demented person eats.
Some of the strategies which could arise from gastrophysics research suggest that it might be possible to massage our senses to the degree that we don’t actually have to eat anything at all to feel well-fed. | |||
| 12 Dec 2017 | Podcast | The Sessional GP Magazine December 2017 - NASGP | The art of GP locuming | 00:21:37 | |
Richard and Sara run through the December edition of the Sessional GP Magazine 2017. In our 98th edition, Liz clarifies your tax schedule, Nigel has great news for locum parents; Judith's Cuban experience, Kelly's turning her experience to the benefit ... | |||
| 18 Dec 2018 | Podcast | Oh, you’re a GP locum; the rise of the portfolio GP | 00:35:39 | |
Zoe Neill had begun to feel trapped as a GP partner. She describes her journey, and speaks to Richard Fieldhouse in our latest podcast.
Time was when the look of disappointment from a GP colleague would have got me down. “I was a full-time partner for 9 years,” I would proffer, but they had already moved on to someone far more erudite and accomplished: someone who hadn’t failed.
Oh, you’re a GP locum…
But this time the disappointment has a different vibe; “Why aren’t you staying? Can’t you see me next time? You’ve really listened.”
Over the last four years, my GP identity has shifted and morphed, and is very different from when I was first shoved out of the sausage machine of training, a straight arrow through hospital medicine, then a salaried post, then a partner.
On January 3rd 2015, I arrived in a new practice as a newly fledged GP locum, arriving 30 minutes before my first ever locum surgery so that I could teach myself EMIS web. (I do like a steep learning curve!)
Since then, through a variety of planned and not-so-planned happenstance encounters, I’m now a fully-fledged portfolio GP.
My latest appraisal lasted 4 hours (I know…) as my appraiser needed to clarify just what on Earth I had been doing since partnership. His questions got me thinking about how the confines of general practice offer both comfort and isolation.
Now, when I do a locum session, it’s like putting on last year’s winter coat, or sitting in an old chair (usually one in which the levers no longer work). It feels familiar, but uncomfortable if I sit too long.
In the real world, people have one job for a while and then move on. One of my university contemporaries (not a medic), gets twitchy after just 18 months. This is apparently normal. She has ‘catch-ups over coffee’ and within a few weeks is ensconced in a shinier, better-paid and higher-flying role in a area vaguely related to the previous one. No-one seems to mind that she knows nothing when she arrives and in fact she is fêted for her ‘fresh approach’.
When I first started out, my now-deceased GP told me he’d been ‘sitting behind this desk for 35 years’. At 17, I just thought he was being melodramatic. 25 years later, I realise that he was being honest, perhaps even requesting rescue!
Medicine offers some veritable treats when it comes to steep learning curves, with a change of scene every 4-6 months during training. Until it doesn’t. And then comes the slowly dawning realisation that you could stay in the same seat, even in the same chair, until the day you retire.
In 2014, before one afternoon surgery, I worked out I’d got 28 more years to go if I was to stick with the NHS pension retirement age of 68. I stared out through the bars on my consulting room window. I was fast approaching 40, and with every good cliché about mid-life crises, ‘something had to be done’.
Add to that a good dose of burnout, some child-induced sleep deprivation, and a smattering of anxiety and depression, and there was only one way forward.
One of the things GPs say to me now is that it must’ve taken some courage to leave. At the time, it felt instead like it was the only way to survive. Having met other GPs who have fled partnerships, we huddle together as survivors, not pioneers. It is no coincidence that the Doctors.net forum about such matters is called The Lifeboat.
Which brings me on to the incredible support that I have had since that day in 2014. I returned to sessional GP meetings locally, and signed up to the NASGP again, and found my new tribe. I found locums in practice broom cupboards, delighted to have fled their partnerships, enjoying their new-found freedom and autonomy, even if life wasn’t anywhere near perfect. I joined Yorkshire Medical Chambers in 2016, | |||
| 08 Jan 2019 | Podcast | Getting under your skin; a visit to Body Worlds and the art of plastination | 00:22:16 | |
As I was shepherded into a dimly-lit lift, I was expecting an exhibition designed to titillate and shock.
How do you react to seeing a man standing, flayed of his skin, his internal organs on view, his muscles brick red, his blue eyes staring out at you? Or what about the trio posed round a table playing poker? You may have seen them in the film Casino Royale. James Bond stays cool. His interest is not the plastinates but how the villain manipulates their chips.
There was no Daniel Craig the day I visited the exhibition, but a crowd of people, all intensely curious and fascinated. Body Worlds, the controversial exhibition of plastinated human bodies, isn’t voyeuristic. It isn’t the Chamber of Horrors. It turned out to be earnestly educational. And compelling.
The only plastinate I personally found disturbing was the man holding his flayed skin in his hands, but I had recently seen much the same in Jusepe de Ribera’s painting of Apollo flaying Marsyas. Ribera painted to disturb. Plastinates are made to intrigue and inform.
They are the brainchild of anatomist Dr Gunther von Hagens of Heidelberg. Looking for improved teaching aids for his students, he had the idea of impregnating anatomical specimens with plastic. Lay people were intrigued, so he created exhibitions for the general public. He worked out how to plastinate whole bodies, not just of humans – this exhibition includes a man on a rearing horse.
I was surprised that all the human bodies appeared so slim. But they have been stripped of their fat. Forty years ago most people were that lean. Since then we have become accustomed to a population with a thick padding of adipose tissue.
Doctors know how few patients understand the working of their own body. Body Worlds aims to change that. It seems to be succeeding, to judge from the rapt attention visitors bestowed, not just to whole bodies, but to specimens of individual organs. How many people know where their kidneys are and how they work? Or how black a smoker’s lungs are? The information content is serious and substantial, but leavened with videos, cartoons, interactive demonstrations and quotes from sages from Confucius to Kant. You can’t take photos in the exhibition so visitors really engage with what’s on show.
From start to finish the emphasis is on the damaging effects of modern life and what you can do to mitigate them. I did not expect to go to Body Worlds and find myself encouraged to take deep breaths to reduce stress. But I did – and some weeks later I still do.
Around 50 million people around the world have seen versions of Body Worlds, and the overwhelmingly positive comments on TripAdvisor justify Dr von Hagens' mission. As always, there are some who claim to have got nothing out of the experience. And some who complained about the cost. It isn’t cheap – £24 for a ticket bought online, £28 at the door, although curiously entry to the shows in continental Europe is less than €20.
Yes, I was made uneasy. But it wasn’t squeamishness that disturbed me. It was speculating about the provenance of the bodies. In China the lucrative market for kidney transplants was, and may still be, fed by ‘donations’ from executed prisoners. Suspicions have been voiced that Body Worlds’ bodies come from the same source. The trafficking of cadavers and the manufacture of plastinated bodies and body parts are big business in China, particularly in the city of Dalian. The general manager of Dalian’s biggest company was taught plastination by Dr von Hagens, who also seems to have been involved in the business.
So, were the bodies in Body Worlds obtained from what we would regard as an ethical source and with full voluntary consent? Voluntary donations, unclaimed bodies and judicial executions could not possibly supply sufficient fresh corpses for China’s plastination industry. So where do they come from? Many new prisons and a cadaver processing plant have been built ne... | |||
| 23 Jan 2019 | Podcast | Saying farewell to social media | 00:34:49 | |
Scroll down to the bottom of the page to listen to our podcast with Zoe in conversation with Richard Fieldhouse on her journey to a destination that's almost completely free of social media.
I was an early adopter of social networking, in the days when dial-up was it. I had to phone switchboard when I was on nights at the QE Hospital in King’s Lynn to get connected to AOL, to timewaste effectively before the next surgical admission arrived.
I met my husband through Faceparty (so close, guys) in 2003, and when the first Facebook invitations came out, I signed up – late 2007.
The sign of something becoming mainstream, and therefore uninteresting, was when it was adopted by the, er, mainstream. When your Gas Appliance Cover gets a Facebook page, for example.
Fast forward to 2015, and I was fully fledged on Facebook with my kids’ pictures from zero to 6 years, GP survival and Tea and Empathy posts, school mum groups, and all kinds of shared articles and photos. What a great way to avoid doing anything I needed to get on with, and a really great way to stay in touch with my old and new friends. My list of Friends expanded reassuringly, including some long-lost people from my childhood who I’d thought I’d never wanted to see again.
I was a regular Tweeter, with several accounts (Arvind – you’re not the only one who likes to play Devil’s Advocate) and lots of Followers, and no bots, of course!
What better way to spend an evening Liking and retweeting, spreading those important edgy political messages about the junior doctors’ strike and Brexit?
Echo chambers aside, the time it was taking was creeping up inexorably. This was not sociable, or networking: it was more like smoking, or drinking wine.
I posted on Facebook that I was leaving Facebook. For the first time in ages, my Friends actually commented. Real feelings, such as ‘Don’t go! We’ll miss you moaning about lack of sleep!’ or ‘Who else will tell us how bad the NHS is?’ This, followed by ‘We have to meet up before you go!’. I wasn’t announcing that I was terminally ill, nor that I was leaving the country. Just not posting pictures of my boys covered in mud, or a GIF of Jeremy Hunt ringing a bell. It was so pleasant to encounter this desire to keep me Facebooking, that I didn’t leave.
And then I heard that Chamath Palihapitiya, former vice-president of Facebook user growth, had left Facebook, expressing regret for his part in building tools that destroy ‘the social fabric of how society works’. And then in early 2018, Cambridge Analytica happened.
It was time to think much more carefully about my internet footprint, and particularly those of my sons, which would likely outlast me by several decades at least.
Suddenly, I began to wonder if I could discover that pre-internet past where phone calls, and actual face-to-face conversations, and – totally retro – letters existed. Perhaps my ennui would resolve, and perhaps I could find something more useful to do with my time.
It took three long evenings to delete all my Facebook data. Post-by-post, photo-by-photo, like-by-like. Hemingway would counsel being superior to my former self – not difficult, according to my timeline of utter banality. And then the Twitter account. 12,300 retweets. Wtaf? Deleting them was an education and quite a challenge. Eventually, | |||
| 14 Feb 2019 | Podcast | The Sessional GP magazine February 2019 | 00:15:32 | |
Richard reviews the latest edition of The Sessional GP.
In this 105th edition, Sara concludes her article on a fresh pair of eyes; Judith would rather we didn't eat each other; Rachel has some news on medical indemnity; Liz answers your Type-2 queries; Eva and Nicky have both explored specialties outside of primary care that have enhanced their enjoyment of general practice; Kate wants us to get physical, and Louise has summarised Nice's latest on ureteric and renal stones.
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| 07 Mar 2019 | Podcast | Eating people is wrong: Kuru and cannibalism | 00:27:37 | |
Recently, in Tromsø, the Arctic capital of Norway, I came across the name Carleton Gajdusek. That name took me back many years and halfway round the globe to a village in the Fore district of Papua New Guinea. A man is standing in the doorway of his hut, clinging to the doorpost, his head nodding, before making his way unsteadily, emaciated and ataxic, to another hut. He has kuru.
Dr Gajdusek was an American virologist and he spent the last years of his life in Tromsø. He won the Nobel Prize for his work on the aetiology of kuru. Traditionally, the Fore people honoured their dead by eating their flesh, the men receiving the muscles for strength, the women being left with the brain and scrag ends. The custom of eating human flesh had already died out with the missionaries, and Gajdusek hypothesized that kuru was caused by an infective agent – he called it a ‘slow virus’– with a long incubation period. He postulated that it was concentrated in the nervous system, explaining why women were more likely to develop kuru than men. He showed that chimpanzees injected with brain tissue from dead kuru sufferers developed the disease. We now know that kuru, like vCJD and some other fatal neurodegenerative conditions, is a prion disease.
Cannibalism has a deep, transgressive and occasionally pathological fascination. Remember Hansel and Gretel? Cannibalism runs through Evelyn Waugh’s Black Mischief: Basil Seal sees a red beret in a cooking pot and realizes that he has just eaten his girlfriend. In 1991 The Silence of the Lambs attracted huge audiences and five Oscars.
Early maps showed distant continents inhabited by monstrous beings and by cannibals. Geographical features became more accurate but the myths survived. Many of the monsters were clearly imagined. But we cannot be sure about the cannibalism. How far can early explorers’ and missionaries’ accounts be trusted? Depicting the inhabitants as savages permitted Europeans to subjugate them in the name of civilization, and to exploit their resources. Even if sometimes, as in Jamestown, Virginia, in 1609, it was the European colonists who resorted to cannibalism.
Modern techniques show that post-ice-age Britons in Gough’s Cave in Cheddar Gorge butchered other humans.
In the 15,000 years since then, there is uncomfortable evidence of cannibalism almost everywhere researchers look. Though it is rarely clear whether the victims were killed for their meat, or what the purpose was. To honour the dead, to intimidate or punish enemies, to celebrate victory, to stave off starvation, as a remedy or a ghoulish gourmand treat?
I try to imagine what it might be like to butcher another human. Of course I have cut the flesh off a human. A living human. Making that first incision into a draped abdomen was always breaking a taboo. Once inside I just got on with the job, perhaps the same emotional shift happens to people desperate enough to cannibalise. But ‘Eating people is wrong’ as Junior declares in the Flanders and Swann song, so even those who have eaten human flesh as a last resort to survive are reluctant to admit it.
In 1846 a wagon train set out from Missouri for California. Heavy snow trapped the pioneers in the Donner Pass for nearly four months till a relief party arrived. Some of the 48 survivors were unwilling to admit that they had survived by eating the flesh of their dead colleagues.
We don’t know what discussions went on in the Donner Pass, but when the plane carrying a Uruguayan rugby team and their supporters crashed on a remote glacier in the Andes, the survivors agreed that should they die, their bodies should be eaten to give their companions a chance of life. Two months later, 16 people were rescued. Knowledge of the survival pact mitigated the initial horror with which the events were greeted.
Still, acknowledging cannibalism would tarnish the image of true British heroes. No-one survived John Franklin’s expedition to na... | |||
| 19 Mar 2019 | Podcast | I’m a GeriGP | 00:32:15 | |
NASGP member Eva Kalmus describes how she became co-chair of the new GeriGP group of the British Geriatrics Society (BGS), and why being a portfolio GP has never been boring.
When I did my GP training, about half of the GP trainees undertook a self-made rotation of approved jobs, followed by a year in general practice to qualify. Some studied for MRCGP towards the end, and many transferred from other medical specialities.
If I had stayed in hospital practice it would have been geriatrics for me. I was a geriatric SHO for an extra nine months with some wonderful, knowledgeable geriatricians and later held a clinical assistantship on long-stay wards, the NHS’s equivalent to today’s nursing homes. During my first FY1 job I had been inspired by a compassionate and wise consultant geriatrician, appreciated and admired by patients and staff alike.
Years later, as a salaried GP, my practice manager forwarded me an advertisement seeking medical cover for community hospital beds; he said that the practice was not interested, but what about me?
I continued with some GP sessions but had a wonderful 10 years as part of a multi-disciplinary team looking after mostly older people and learnt so much about rehabilitation, pragmatic discharge planning and cross-organisational working.
I also worked in virtual and community wards, providing enhanced care in their own homes to patients at risk of admission to hospital and even dipped my toe in commissioning waters - discovering that I definitely got more satisfaction from patients than meetings!
We can spend more time, and focus on these complex patients as well as developing services offering more proactive and holistic care, than is possible in traditional general practice.
The community hospital moved onto the acute hospital site for a few months’ rebuilding work and I rediscovered my curiosity about the best that specialist medicine could offer to older people. The clinical director offered me an unfilled post for a community geriatrician.
So my job title of Interface Medicine GP was invented, and I have had a rollercoaster four years managing moderate and severe frailty around an acute setting. These patients de-compensate significantly in response to a minor stressor and so are admitted and treated aggressively, but then take a long time to recover - if they do at all - and are often confused, de-conditioned and institutionalised by their prolonged hospital stay. For some, a team - of which I was part - could prevent the admission, but much of the work is smoothing the path to a rapid and effective discharge when hospital no longer offers a net benefit.
It was from these experiences that I felt the need for mutual professional support. Some geriatricians expressed unease that a “mere GP” can undertake some of their role successfully, albeit differently. And some GPs are not aware of the complex issues involved for people with greater degrees of frailty who particularly need continuity of care, advanced care planning and the necessity of good communication with them, their carers and other professionals coming into contact with them.
Over time I’ve probably learnt more than the average GP about the geriatric giants summed up recently as the 5Ms—mind, medication, mobility, multi-complexity and matters most. My knowledge of acute medicine has been updated, but I am not keeping entirely up to date with the latest guidance on contraception, child health etc because I do not think there is enough space in my brain or time to cover it all thoroughly.
However, I reject the concept of being a second-class geriatrician: through conferences, following up leads from appraisers and some good luck, I have now met a growing number of GPs working in a variety of... | |||
| 10 Apr 2019 | Podcast | The Sessional GP magazine April 2019 | 00:19:36 | |
Richard reviews the latest edition of The Sessional GP magazine.
In our 106th edition, Liz takes us through five taxing days, Nigel has some top tips for locums on getting a mortgage, Louise reviews the latest SIGN guidance on alcohol in pregnancy, Sara highlights the roles of locums in quality improvement, Rachel looks at the risks around burnout, Kate on mental health safety, Judith rounds off with singing in the brain, all interspersed with some beautiful paintings by Claire.
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Click to view the magazine | |||
| 09 May 2019 | Podcast | Singing in the brain; music for dementia | 00:25:43 | |
London’s Wigmore Hall is a temple of high culture. The audience is packed with musicians. Sometimes I feel I’m the only person who couldn’t be up there performing the work. But recently I joined forty people, some able, some less able, in mind and body, for a ‘Big Sing’. Everyone seemed to feel at home. In the morning we learned to sing simple songs in four parts, and in the afternoon we went up on stage and sang them. I’m no singer but the opportunity was fun and boosted my morale. So how much more it must have done for the participants with dementia.
Everyone, everywhere, responds to music. We hear it in the womb, it accompanies the important events in our lives, it modulates our emotions. Hearing is the last sense we lose as we die. People with advanced dementia who haven’t spoken for months may perk up when they hear Vera Lynn singing The White Cliffs of Dover. They may even venture into a solo, or go to the piano and play with an ability no-one knew they had. Thinking skills may have atrophied, but musical skills remain. Given the right stimulus, they surface from the depths of a failing brain.
* CPD | Management of dementia
There is currently no prospect of effective medication for dementia. Reluctantly, we prescribe agitated patients chemical coshes. But does music sooth agitation – and more?
Neuroimaging shows that, unlike speech, music lights up lots of different areas of the brain. It finds a back door into even a ramshackle brain. Music may even help to keep neural pathways in the brain open. So far, studies of the effect of music on people with dementia, though small and short-term, are encouraging. But research projects are seeking robust evidence. Can biochemical changes be linked to our responses to music?
What psychological measures can be used to assess benefit? How can music most effectively be used? What opportunities does it offer for carers, care homes, musicians and institutions?
Music therapy is a well established profession, although few care homes can afford a therapist. But graduate courses in using performance arts to help people with brain failure are burgeoning, and charities, local authorities, music schools, music groups, orchestras, arts and religious venues are trying out different interventions. With phone calls and a few visits, I discovered how much there is on offer.
"Through music, families can glimpse the individual their relative once was: the loving partner, the caring parent, the delightful aunt, the indulgent gran. Once again they can share pleasant experiences."
Residents of care homes respond when amateur choirs come to sing. They may join in, although perhaps not singing the same song as the performers. They may rattle a teaspoon throughout the concert, or stand behind the conductor waving their arms. The benefits are fleeting, but any enrichment of barren lives, however temporary, is worthwhile.
Repetition helps. And not surprisingly, participation increases the benefits, too. So a musician, squatting down in front of a wheelchair to encourage someone to make simple music, singing or playing instruments may stir her from apathy for longer. She may start chatting. And so change the atmosphere of the home.
For people with dementia still living in the community there are ‘relaxed concerts’ where no-one minds if you are restless. Other events encourage people to take part. Alzheimer’s Society’s Singing for the Brain is a model: experienced singing leaders run weekly sessions. Volunteer helpers ensure that carers also have some fun and a break – a crucial benefit of community events. There’s a welcome, action songs, familiar numbers and new ones, opportunities to shake a tambourine, | |||
| 10 Jun 2019 | Podcast | June 2019 ‘The Sessional GP’ magazine | 00:18:41 | |
NASGP chairman Richard Fieldhouse reviews the latest edition of The Sessional GP magazine. In our 107th edition, Louise has not one but two COPD-related e-learning articles; Judith has been washing her hands, Liz has been answering your tax questions, Rachel has some advice about medical hierarchy, and Kate has been making stress her friend, all with some more beautiful paintings by Claire.
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| 27 Jun 2019 | Podcast | Now wash your hands | 00:33:04 | |
In post-war Italy TB was still rife and notices in buses commanded “No Spitting”. In Britain in 1946 the message “Coughs and sneezes spread diseases” promoted the use of handkerchiefs to catch the germ-laden droplets. Presumably a reasonably successful public health campaign, although if you are trapped like a sardine in a rush-hour tube train, you may have no alternative but to sneeze into the shoulder of the person jammed in front of you.
Reducing droplet spread is a great step forward, but rhinoviruses are also transferred from noses to hands and so to any surface we touch. They survive there for several hours for the next person grabbing the handrail or turning on the tap to pick up. So do more dangerous infective agents from other sources. Hence the slogan I recall from my childhood “Now wash your hands”. So, a century after Semmelweis published his paper on reducing the spread of infection in maternity wards, his advice had reached the Department of Health. If followed today, it could cut gastrointestinal upsets by a third, reduce sickness absence from school and work, and save the UK economy more than £1 billion every year. But the E coli counts on peanuts set out for grabs on pub bars demonstrate that the general public still isn’t heeding the message. A surgical scrub isn’t necessary, but the more thorough the wash, the better. The NHS recommends washing with soap (antibacterial not helpful) for as long as it takes to sing ‘Happy Birthday to You’. Twice. Though as most of the pathogens are on the fingertips, even waving the fingers under a dribbling tap may be better than nothing.
Wet hands still pass on a lot of pathogens, but effective drying removes almost all the bugs. Dryers in public toilets are a relatively recent introduction – the researchers of the 1965 Good Loo Guide found that less than five percent of public toilets had hot air dryers, though they probably had roller towels. Paper towels came later. Jet dryers (OK, Dyson Airblades ®) are a 21st century invention.
Which works best? Cloth towels are quick and effective, though try finding a clean area on a jammed roller towel. Studies comparing the effectiveness of paper and jet dryers are limited, and the results tend to support the product of the industry which sponsored them.
It does seem clear that jet dryers are more economical than paper towels, which have to be sourced, delivered, stocked, cleared away, and disposed of in landfill. Add in the cost of calling the plumber to unblock the loos and the fire service to put out fires in waste baskets. But on the road to reduction of infection, cost isn’t even a surrogate end point, it’s just a station on a by-line for institutions that are counting the pennies, not the pathogens.
The paper industry claims that jet dryers blast bugs into the air. The jet dryer industry claims more effectiveness and less mess. The only independent study, a literature search by the Mayo clinic in 2012, found (in a 2009 survey) that most members of the US public preferred paper towels, and recommended that single-use paper towels be used in health care settings.
The bottom line is, do people use whatever drying method is provided? And do they use it effectively?
Time is one hurdle. Traditional hot air dryers are too slow. Jet dryers are quick, but not that quick, and if there is a queue and the curtain is about to go up on the final act, you probably shake your hands and rush to your seat.
Paper towels are quicker. But paper towels dissolving to pulp on a wet floor don’t encourage users to spend time doing even a cursory wash.
Poorly maintained facilities may make users feel they need to clean themselves of the grot, but probably make it more difficult to do so. Fastidious users don’t like the idea of contaminating themselves with other people’s germs, | |||
| 14 Aug 2019 | Podcast | The Sessional GP magazine August 2019 | 00:11:59 | |
In our 108th edition, Judith makes a noise about being quiet, Liz summarises everything a newly qualified GP needs to know about getting their tax in order, Nigel helps us plan for when our offspring go off to university, Louise has been making sense of LFTs and Rachel has something to teach us about learning.
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| 05 Sep 2019 | Podcast | Quiet please | 00:33:20 | |
The Royal Opera House orchestra was rehearsing Die Walküre. For more than three hours violist Chris Goldscheider sat in front of twenty brass players belting out Wagner at 90dB. His hearing was permanently damaged. The Opera House argued that artistic standards took precedence over the risk of acoustic shock, but the courts thought otherwise and awarded Goldscheider substantial damages.
A musician’s job is to create sound. Rock musicians ramp up the amplifiers and often lose their hearing temporarily after a particularly loud concert. Many don’t acknowledge the warning. Over time, even violinists can lose 6dB of hearing in their left ear.
Many publicans and restaurateurs foster sound. They rip out partitions, strip out soft furnishings and turn up the music. Chatter turns to shouting and then to screaming, and by the time the sound level is 90dB – that’s the same as a pneumatic drill – they have created the vibe they think their clientele enjoy. At least that’s what many of them told Action on Hearing Loss. I wonder. You can’t pour your heart out, or even chat to your mates, against a wall of sound. When a bartender brings a legal case for acoustic damage, publicans may think again.
"Noise affects patient care. If staff are distracted or unable to clearly hear information or instructions, lives are at risk."
Silence is elusive. Over four days, walking along the Thames path from its source to Oxford, we were out of the sound of traffic for just half an hour. Military jets scream over the remote Highlands and police helicopters clatter over secluded corners of Regents Park. Libraries now entertain kids singing nursery rhymes, art galleries display video installations, and the espresso machine thumps and grinds in cafes where people go to read and work.
Who cares
Hospital calm? Gone are the days! Machines, phones, bleeps, call bells (left unanswered because they’re short-staffed), crashing trolleys, long visiting hours with noisy families . . . the noise level in ITU can be over 100dB.
Noise affects patients. A Swedish study found that loud environments triggered more re-admissions. More hypnotics are prescribed. Patients self-discharge to get a good night’s sleep.
Noise affects patient care. If staff are distracted or unable to clearly hear information or instructions, lives are at risk.
Noise affects us all. Raised blood pressure, increased risk of cardiovascular problems, poor sleep and its attendant consequences, low birth-weight, obesity, diabetes and cognitive impairment . . . these are some of the consequences. My worst experience of noise was in Santiago de Cuba. The ancient, grinding engines of trucks and buses which had long lost their exhaust silencers woke us at dawn and deafened us until nightfall. We found relief at a cliff-top café. There was a pervasive smell of drains but, like most people, we could put up with pollution better than noise.
Nearly 2000 years ago Juvenal listed noise as one of the seven plagues of Rome (along with high rents and fashionistas). Victorians were assailed by the hawkers’ cries, wooden clogs on the cobbles, clattering carts – rubber tyres were a late 19th century innovation.
Now, noise has been weaponised. In Guantanamo it’s been used as an instrument of torture. Holed up in the Vatican nunciature, Panamanian leader General Noriega didn’t surrender until the CIA blared rock music into the building. (You can hear it on YouTube). In contrast, shopping malls broadcast Beethoven to see off hooligan loiterers.
Our valuation of noise is very subjective and poorly related to the damage it does, which is determined by its acoustic intensity and how long we are exposed to it. The decibel scale is logarithmic, so a 70dB sound is ten times more intense than 60dB. The safe exposure time for a 90dB lawnmower is two hours; for 1... | |||
| 14 Oct 2019 | Podcast | October 2019 magazine out now | 00:16:16 | |
In our 109th edition, Alacoque describes a legal case where a locum's tax status was different to their legal status, Rachel's being a Good Samaritan, Judith's been looking at therapeutic spaces, Louise has summarised the Nice hypertension guidelines for us, plus much more.
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| 20 Nov 2019 | Podcast | Social prescribing – I’ve seen the future of general practice… | 00:27:37 | |
A partner in a North London practice was feeling burned out. The crushing target-chasing workload was no longer offset by the reward of helping patients. The BNF had no remedy for the distresses of modern life which patients were bringing into her consulting room. She, like her patients, was ground down.
Casting about for a way of reviving the sense of hope and enthusiasm that had led her into medicine, she contacted the local Transition Group. Three years later a bleak courtyard next to the practice has transformed into The Listening Space – a therapeutic garden where patients and staff get together. They have pitched in to create a beautiful and productive green space. People who no longer have gardens of their own share their expertise, patients help with planting and harvesting, and they cook for seasonal parties. Immigrants are delighted to share their traditional dishes. Patients and staff demonstrate their music talents, and everyone chats.
The ‘Crafternoons’ in the waiting room were slow to take off, but gradually patients plucked up the courage to join in, and now it’s a flourishing social group. Lonely patients in the waiting room are encouraged to participate. While members embroidered ‘welcome’ onto fabrics in their native languages, an old man sat on the edge of the group staring at his hands. Suddenly he perked up, saying “You haven’t got my language ”. Offered blue thread, he insisted on red, gold and green, the colours of his birth nation’s flag. He’s now a regular, and for the first time, staff say, he’s smiling.
Hollowed-out social infrastructures have left us all less connected, and the most vulnerable people easily fall through the holes in the net. They crave worthwhile activities to occupy the long empty hours, to distract them from insoluble problems, to make them feel useful again. But people who are treading water need someone to help them onto firm ground. Medical prescribing for medical problems, social prescribing – referral to a range of local, non-clinical services – for social problems. It makes sense.
In Somerset, Frome was once a busy market town, but over the decades its life-blood drained away. By 2013 the town was flat-lining. The residents were depressed. The GPs and their staff were disheartened and stressed because they couldn’t solve health problems that were essentially social in origin. Again, a GP took the initiative. She worked with the town council and the local Compassionate Communities health group to identify unmet social needs. Now GPs can refer patients to professional ‘health connectors’ who bridge the gap between patients and community resources. As well as practical advice, innovations include ‘talking cafes’, and - so isolated old men can potter in company - ‘men’s sheds’.
Six years on, the people of Frome, their town, the practice - all exude confidence. Patients feel they have choices and are in more control of their lives and health. The attendance figures demonstrate the benefits for the NHS. GP appointments are down 28% and A&E attendances 24%, while in Somerset towns comparable to Frome, demands on the NHS continue to rise.
There’s nothing like a walk, the wilder the better, to blow away brooding thoughts. Studies show that two hours a week in the fresh air is enough for people to feel better, more self-assertive. In the Shetlands, it was the RSPB’s outreach officer who suggested ‘nature prescriptions’. Now Shetland GPs ‘prescribe’ walks, with tips about what to look out for and do en route. Patients are more active, many lose weight, and their physical and mental health improves.
Talking groups, walking groups, reading, drawing, sewing groups, gardening, cooking, singing: for almost any activity there will be someone out there who is anxious to share their enthusiasm with other people. Even the housebound can join a world-wide virtual choir. They sing their part and upload it onto the internet where it is combined with... | |||
| 11 Dec 2019 | Podcast | The Sessional GP Magazine December 2019 | 00:13:09 | |
Richard Fieldhouse reviews the latest edition of The Sessional GP magazine. In our 110th edition, Rachel has some seasonal advice, Tina loves LocumDeck, Claire has some warming paintings for us, Judith unmasks a ruthless dictator, Louise gives a comprehensive rundown of hypertension in pregnancy and Liz has some great tips if you're in the process of making babies.
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| 12 Feb 2020 | Podcast | The Sessional GP Magazine February 2020 | 00:10:03 | |
In our 111th edition, Louise provides a roundup of Nice's clinical guideline on management of thyroid disease, Liz gives some more advice on returning to work after maternity leave, Rachel goes through some scenarios when locums give feedback to practi... | |||
| 13 Apr 2020 | Podcast | The Sessional GP Magazine April 2020 | 00:04:24 | |
Richard Fieldhouse reviews the latest edition of the Sessional GP magazine. In our 112th edition, Liz has summarised the government's advice about financial support for locums; Rachel from MPS has advice on how to practise in these times; Judith's been keeping a diary; Louise has reviewed the latest guidance on leg ulcer management and Nigel's looking after your financial health.
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| 11 Jun 2020 | Podcast | The Sessional GP Magazine June 2020 | 00:08:30 | |
https://youtu.be/gsLTy0Wr2gA
In our 113th edition, Claire has painted another beautiful cover picture, Isobel has been looking at locums as GP tutors; Judith doesn't want us going backwards, and Louise has an update on AAA; Nigel has an update both on DIS and some childcare help; Liz has an SEISS update and Rachel has some good advice for when we're in a rush.
Scroll down to hear the podcast.
Click to view the magazine | |||
| 12 Aug 2020 | Podcast | The Sessional GP Magazine August 2020 | 00:07:08 | |
https://youtu.be/u4wdyASH0UI - In our 114th edition, Claire shares some flowers with us; Victoria is sceptical about the rollout of remote consultations, and Richard has similar feelings about locum banks; Rachel has advice about the coming winter and... | |||
| 28 Feb 2016 | Giving exit feedback to GP practices - NASGP | The art of GP locuming | 00:06:18 | |
Locums work in anything up to 40 different practices a year, from the dysfunctional to the inspiring. Ensure that GP locums are enabled to leave feedback and spread best practice
Podcast on locum GP exit feedback
The post Using GP locum exit feedback surveys appeared first on NASGP. | |||
| 11 Mar 2016 | Ensuring a locum GP is a self-employed contractor, not an employee - NASGP | The art of GP locuming | 00:23:51 | |
The post Ensuring a locum GP is a self-employed contractor, not an employee appeared first on NASGP. | |||
| 04 Mar 2016 | Working as a long-term locum - NASGP | The art of GP locuming | 00:16:53 | |
A long-term locum post at a practice often starts off as a short term venture, but with significant recruitment problems in general practice at the moment, it's likely the practice will want to hold on to you and keep you coming back.
Listen to our podcast on long-term locuming
The post Working as a long-term locum appeared first on NASGP. | |||
| 16 Mar 2016 | RCGP’s new appraisal guide - NASGP | The art of GP locuming | 00:19:46 | |
The post RCGP’s new appraisal guide appeared first on NASGP. | |||
| 01 Apr 2016 | NASGP Podcast | Patient follow-up and handover - NASGP | The art of GP locuming | 00:17:22 | |
We're talking about our new very simple template to help patients get the most appropriate follow-up at the practice. We also discuss what we feel is the best way to record handover information to the next clinician.
The post NASGP Podcast | Patient follow-up and handover appeared first on NASGP. | |||
| 08 Apr 2016 | Podcast | April 2016 ‘The Sessional GP’ magazine and podcast - NASGP | The art of GP locuming | 00:21:01 | |
As well as the launch of the April edition of The Sessional GP, we also give a review in our latest podcast.
In the 88th edition of the NASGP's The Sessional GP magazine, Sonia is being assertive, Aimee is giving frozen shoulders the cold shoulder, Rachel examines the dental pain headache, Judith finds the disease in art, Kevin and Liz unbox the 2016 budget, plus much more. | |||
| 29 Apr 2016 | NASGP Podcast | Home visits - NASGP | The art of GP locuming | 00:18:14 | |
The post NASGP Podcast | Home visits appeared first on NASGP. | |||
| 06 May 2016 | NASGP Podcast | #GPForwardView and King’s Fund pressures in general practice - NASGP | The art of GP locuming | 00:13:54 | |
Busy few weeks in general practice in terms of significant documents that both look at the pressures we're facing and what to do about them. But sadly both lacking insight into the GP locum workforce, and in the wrong order.
As mentioned in the podcast, we're referencing our article on the GP Forward View document published today in Pulse. | |||
| 09 Jun 2016 | Podcast | Review of the June edition of The Sessional GP magazine - NASGP | The art of GP locuming | 00:13:43 | |
The post Podcast | Review of the June edition of The Sessional GP magazine appeared first on NASGP. | |||
| 06 Aug 2016 | Podcast | August 2016 edition of The Sessional GP magazine - NASGP | The art of GP locuming | 00:22:00 | |
Sara Chambers and Richard Fieldhouse give a rundown of what's inside the August 2016 edition of The Sessional GP magazine. | |||
| 10 Oct 2016 | October 2016 Sessional GP magazine review - NASGP | The art of GP locuming | 00:31:38 | |
In our 91st edition, Richard's been eating M&Ms, Judith has trouble recognising faces, Lynda on sick pay for locums, Rachel on working with unfamiliar colleagues, Lyndsay is feeling valued and GP-Update on premenstrual conditions [Read magazine] | |||
| 14 Nov 2016 | Podcast | Sharing information in a practice - NASGP | The art of GP locuming | 00:22:52 | |
In our latest podcast, Sara and Richard discuss their experiences of the difficulties they've had over the years of trying to find local practice-specific information, and how difficult it can be to share information they've gleaned themselves with the practices regular GPs. And how hollywood stars can help explain what some of these knowledge gaps are. | |||
| 12 Dec 2016 | Podcast | The Sessional GP magazine December 2016 - NASGP | The art of GP locuming | 00:12:17 | |
In our 92nd edition, Sara reflects on the importance of being a member of a sessional GP group as an antidote to the social media echo chamber; Judith's been reading a few books which may well be the new must-read for all GPs; Lyndsay on changes afoot in Australia, Rachel on protecting yourself, Liz on what - or what not - to claim for tax, plus much more.
You can read the December edition of The Sessional GP here. | |||
| 14 Feb 2017 | The Sessional GP February 2017 Podcast - NASGP | The art of GP locuming | 00:08:24 | |
Short roundup of February's edition of The Sessional GP. You can access the magazine at www.nasgp.org.uk/magazine. | |||
| 10 Apr 2017 | Podcast | April edition of The Sessional GP - NASGP | The art of GP locuming | 00:07:53 | |
In our 94th edition, Kate helps you to get a good night's sleep, Liz has the latest on IR35, Sonia has more on goal-setting, Judith's intelligence is far from artificial, Rachel on GMC's latest on confidentiality and Louise on what's probably the last thing on anyone's mind after just having had a baby. [The Sessional GP] | |||
| 05 Jun 2017 | Podcast | Get started as a GP locum part 1 - NASGP | The art of GP locuming | 00:41:11 | |
Sara Chambers and Richard Fieldhouse talk about getting started as a locum GP from the viewpoint of having just qualified.
We cover who to notify, the positives of being a locum, what kit you'll need, and which channels for finding work are available, and their pros and cons.
Listen to the podcast below, or download 'From GP registrar to GP locum' here. | |||
| 13 Jun 2017 | Podcast | June 2017 edition of The Sessional GP - NASGP | The art of GP locuming | 00:12:48 | |
Richard Fieldhouse gives a brief tour of the latest edition of The Sessional GP, starting with capturing evidence for NHS appraisal, the latest on ISA savings, NHS pension scheme, Irritable bladder syndrome and much more. | |||
| 06 Jul 2017 | Podcast | Why did we call it LocumDeck? - NASGP | The art of GP locuming | 00:06:08 | |
It actually took us a while what to call it. Richard Fieldhouse and Sara Chambers help explain not just why we call it LocumDeck, but also something about what it does and how it empowers locum GPs.
You can also watch it as a video.
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