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hard-working GP struggling to jump through hoops while keeping up a decent standard of care. Also shameful is the way that practices are ‘named and shamed’, causing distress not only to all the staff under that roof, but also to the patients who trust those looking after them. Until current inspection processes are scrapped and an alternative, which is fit for purpose, is put it in its place, general practice will continue to struggle to progress and move on from this all-time low.


• From a GP in Wales, name and address supplied I have had a think about Professor Steve Field’s pronouncement and what exactly it might mean, and have come up with a slightly different (and perhaps eccentric) take on the whole affair. Have we thrived as a profession? Do we have hordes showering us with money? No. But we do have many agencies coming to us asking us to do their work for free. And we do have hordes of poorly patients coming to us for free treatment, authorisation of handouts, certifications and so on. What do they think we are, a charity? This is not just a frivolous rhetorical question or a dismissive offensive remark. General practice may have failed as a profession, but it has succeeded as a charity. Unfortunately, while both may have high ideals and standards, the two are actually very different in certain basic qualities that are probably incompatible. So, in fact, Professor Field’s pronouncement is high praise indeed. It is just that it is harder to maintain the charity ideals if we do not have pre- existing financial ‘independence’ to fall back on to ensure the bills and staff salaries are paid at the end of the month.


The importance of a doctor’s sixth sense


From an anonymous GP, name and address supplied I recently, at the age of 49, survived an out-of-hospital cardiac arrest. It helped that I am a GP and was on a ward round in a local care home – usually only 5% survive such an event. I did not really have any major risk


factors except a strong family history: four generations of heart disease presenting at a young age. Because of this and some atypical sensations, within the year before my event I had an exercise tolerance test. This was equivocal to the cardiologist, so he recommended I have a thallium scan. This showed no evidence of significant risk for ischaemic heart disease. I was unaware that the sensitivity of thallium scanning locally is 93%, a false negative rate of 7%. I wonder whether I would have requested further tests if this had been discussed with me. It has really made me see how difficult the cardiologists’ jobs are, especially when NICE guidelines are based on risk scores. Because an angiogram comes


40 February 2016 Pulse


What you’re saying Is it time for the GPC to get militant?


‘The time to be militant has long since passed’


‘GPC is incapable of “getting militant” ’


‘Are we prepared for the consequences?’


Join the debate at pulsetoday.co.uk/analysis


with a risk of complications, they are only performed for higher-risk cases. This leaves me wondering about the use of our sixth sense and the importance of medical acumen. If I had been offered further invasive tests and I knew the risks involved would I have declined? Even as a doctor, I reverted to the patient role and relied on specialist advice. The lessons I have drawn from this are: the usefulness of a good consultation, that screening tests have pitfalls and that patients may need to be more aware. In future, I will endeavour to be better informed on the sensitivity or specificity of each test.


Last month’s Pulse


ONLINE And finally...


How our flood-hit practice battled two feet of water pulsetoday.co.uk/ floods


From Dr Peter Weeks, chair of Cumbria LMC, via pulsetoday.co.uk There has been an amazing response by everyone to the floods in Cumbria (‘GPs in Cumbria opening extra surgeries to help patients affected by floods’, pulsetoday.co.uk/news). The emergency services were tireless and the GPs did what they do superbly – their job. Cumbria has massive difficulties in healthcare, with two struggling acute trusts, a recruitment crisis and geography on a vast scale, not to mention all the national problems – but I am incredibly proud of general practice, which just tends to ‘get on with it’. That is one of the true strengths of Cumbria and should be nationally recognised with adequate funding to cope with the difficulties we have. We have contacted all the medical defence organisations, who have agreed to cover members for any work done in connection with the floods this weekend, which is superb and reassuring should this happen again. The out-of-hours organisation Cumbria Health On Call has been magnificent and we all owe it a debt of gratitude. We hope it maintains the call-handling capacity for out-of-hours instead of NHS 111, which has only complicated efforts at this difficult time.


Cumbria 2015 floods: GPs opened extra surgeries


ALAMY


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