RCGP council 26/2/16

  • Junior doctors review of morale: I suggested that the RCGP creates its own review of the evidence on moral and fatigue in junior doctors in particular and uses this as an independent reference and review when the AoMRC undertakes its’ review
  • spoke to issue about post graduate learning and sponsorship of modules – these should be GP led and take account of what is normal;  overdiagnosis of cow’s milk allergy is common, for example (though does exist, symptoms may be transient)
  • incentives in primary care don’t really work and do unintended harms, we lack evidence of how to manage  in multi morbidity and this should be developed but meantime – use peer support, shared decision making, longer consultations and continuity of care- shared decision making though is keen (esp with regard to riskfactorology)
  • concerns about working with agencies who deal with single issues; especially with regard to informed choice about cancer screening. Early diagnosis is only useful if if usefully detects disease that was not going to maim or harm. Otherwise it can only lead to overtreatment and harm.
  • CKD- we are over diagnosing and overtreating; the harms are going unquantified
  • revalidation and appraisal  – do we have any evidence that it works, why not, and what are the harms – we have massive voids in the evidence and have not made a deep enough assessment of the harms. When I wrote about the harms of appraisal in the BMJ I had contact from dozens of GPs who told me they had brought forward the date of their retiral in order to avoid appraisal/revalidation

3 Responses to “RCGP council 26/2/16”

  1. Kit Byatt February 26, 2016 at 9:45 pm #

    Excellent points, Margaret.
    #1 I hope that the RCGP does do its own review of morale – but please don’t exclude pay, terms and conditions (as Jeremy Hunt’s has!).

    #3 I wish there were a better model for closer working between geriatricians & GPs. There is so much we could learn from each other to help improve patients’ quality of life and reduce inappropriate use of a hard pressed system!

    #5 There’s a big difference between CKD caused prematurely by disease, and the simple reduction of GFR with age (see #3).

    #6 Not only harms but also time – if it isn’t delivering useful outcomes, it is eating into precious clinical time. This point applies to secondary care, too!

  2. Tam February 26, 2016 at 9:59 pm #

    Love your work

  3. george hannah February 26, 2016 at 10:29 pm #

    I am sorry I wont be voting for you having resigned from the college when they produced the first Emma’s diary.
    Why are GPs continuing to act as appraisers? Traitors more like. My appraisal this year , which will be my 13th,will be based on nothing but the evedence for appraisal.ie nothing but questions as to why they do it ,,causing so much distress and pointless work for hard pressed colleagues. It is a scam to avoid patients while the apprasers are having a nicey nicey time at our expense. At 59 years old it is time for me to tell them to sod off.
    Overdiagnosis is the unfortunate side to overzealous EBM which is population based then applied to individuals and by practitioners lacking experience. Narrative based medicine hasnt had its day yet but hopefully will soon. Having had even NES accept the idea of a humanities module.
    You are my hero.
    (even though I do miss Des Spence a bit)

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