- 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
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