New book. I feel frustrated by the care provided to many people at the end of life. For something that’s inevitable we seem fairly poor at many things – especially enough accurate information and support around choices at the end of life. This is the book in 14 tweets. 1)We are all going to die; […]

1) CQC. I think I said that the data dump by the CQC was mince and that I was very concerned about the lack of proven validity and the chosen targets which supposedly exemplify quality. I should have a column in the BMJ about this soon. 2) Obesity. I reiterated that GPs do not have […]

  Sent in tonight. I’m very concerned that it’s going backwards in terms of having a safer NHS, more transparent doctors acting professionally in the best interests of their patients. A blame and shame culture ultimately harms patients.   http://www.gmc-uk.org/concerns/fitness_to_practise_consultations.asp I’m very concerned about the proposed changes.   1) Taking action in all cases where […]

COMARE report Click to access COMARE_16th_Report.pdf In recent years there has been an emerging use of CT to scan asymptomatic individuals. This issue was covered in the 12th COMARE report (COMARE, 2007), which determined that the benefits to the individual would not be the same as those for a symptomatic patient and that the practice […]

The weekly columns I write for the BMJ are – hurrah – all now open access (at least they should be, there are still glitches.)   recent columns include Dementiagate – how politicised pay prevents GPs from working for patients What use is mass flu vaccination ? Does the GMC deserve it’s current powers? Have we […]

    NICE recommendation on anticoagulant machines http://www.nice.org.uk/Guidance/DG14 Lancet systematic review on safety http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61294-4/fulltext NICE cost effectiveness report https://www.nice.org.uk/guidance/dg14/resources/dg14-selfmonitoring-coagulation-status-in-people-on-longterm-vitamin-k-antagonist-therapy-who-have-atrial-fibrillation-or-heart-valve-disease-pointofcare-coagulometers-the-coaguchek-xs-system-and-the2 Scotland about 1% of patients are using INR test strips http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg_-_evidence_notes/evidence_note_50.aspx Scottish questions on warfarin self testing in parliament Click to access WA20140321.pdf

Complaint to the ASA https://www.betterasone.co.uk/about-us/ this is not much better after previous complaint http://www.asa.org.uk/Rulings/Adjudications/2014/7/Better-asone-Ltd/SHP_ADJ_264546.aspx#.VD_wqfldU41 “Even if you have private medical insurance, you have to go through your GP to see a specialist and can experience frustration and delays” – where is the evidence of this “Our patients are diagnosed right first time privately, ” I […]

Old HPA poster Click to access illness.pdf up to date but less snappy PHE advice Click to access Guidance_on_infection_control_in_schools_11_Sept.pdf Welsh booklet http://www.walesonline.co.uk/incoming/article7916970.ece/binary/The%20sickness%20absence%20booklet%20distributed%20to%20parentsReports from Wales  http://www.walesonline.co.uk/news/health/sickness-guide-parents-provokes-fury-7917908 Attendance in secondary schools in Wales report – where medical conditions only make up a small portion of failed attendances http://www.estyn.gov.uk/english/docViewer/329401.8/attendance-in-secondary-schools-september-2014/?navmap=30,163, some school policies which manage to confuse the principle […]

NHSH interim evaluation medicine sick day rules   Kidney injury and ACE inhibitors http://www.plosone.org/article/info:doi/10.1371/journal.pone.0078465   http://www.nhshighland.scot.nhs.uk/Publications/Documents/Newsletters/Pharmacy/The%20Pink%20One%20No%20104%20June-July%202013.pdf

Who the NHS says should have flu vaccination http://www.nhs.uk/Conditions/vaccinations/Pages/who-should-have-flu-vaccine.aspx Click to access CMO(2014)12.pdf Summary page of Cochrane and flu reviews http://www.thecochranelibrary.com/details/collection/978807/Influenza-evidence-from-Cochrane-Reviews.html Cochrane on flu vaccination and children http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004879.pub4/pdf Click to access seasonal%20influenza%20vaccination%20of%20children%20and%20pregnant%20women.pdf Adults over age of 65 http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70295-X/abstract http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004876.pub3/pdf people with asthma  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000364.pub4/pdf http://www.cfp.ca/content/56/11/1137.full chronic bronchitis / COPD  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002733.pub2/abstract Click to access rev_COPD_Vaccinations_March.pdf