In my last blog I described my time in a goldfish bowl with some 35 GPs on a leadership course—how the process worked, and what I learnt about myself, and how GPs think about me. But what I really meant to describe was our discussion on commissioning, how to do it well.

In particular, I found myself warning against “getting too close to providers.” As I explained in the last blog, one of my many faults is that I don’t know what I’m going to say until I’ve said it. One of the GPs in the “outer ring” of the goldfish bowl picked me up on this: “Did you really mean it?” It sounded so aggressive, contrasting with all the cosy talk of integration. more…

Two weeks ago I spent 90 minutes in a goldfish bowl with about 30 GPs. The goldfish bowl is a process to encourage reflection, and it certainly caused me to reflect.

The goldfish bowl features in the leadership course of the Royal General College of Practitioners. Somebody with some pretensions to having been a leader is asked into a central ring of five or six GPs. The remaining GPs sit in an outside ring. The GPs in the centre have read up on the “leader” and ask questions that aim to explore his or her experiences, thoughts, values, and anything else that might be useful. After some conversation, those in the central ring shut up and those on the outer ring make observations and suggest further topics for discussion. Those in the central ring then begin again, and the conversation may move between the rings. It’s leadership’s equivalent of dissecting a frog. more…

Last night Clare Gerada, chair of the RCGP, spoke in Northern Ireland about the Future of General Practice. This morning she meets our new Minister of Health. She described her vision and what she would like to achieve. She was, perhaps, trying to encourage the wrong audience – those present already believe in her values.  But, this morning when she meets our Minister she has an opportunity to influence our future.  A voice from London may hold more sway – general practice has a problem being heard. I suggested that she might mention the following: more…

“Cash for blubber” is how the Twitter community have dubbed the UK government’s latest bid to tackle obesity. As revealed in the Sunday Telegraph, plans have been made to pay GPs extra for giving their patients “weight management advice” and referring them to publicly financed dieting clubs. But will this nudge fatten wallets or slim waists?

There has been much written lately about the government’s passion for nudging. In case you haven’t read the book that Cameron told his coalition colleagues to read (“Nudge” by Richard Thaler and Cass Sunstein), healthcare nudging is essentially modifying the environment to make the healthiest choice the easiest option. It’s called “liberal paternalism.” more…

Almost all our emergent consortia have completed their elections. Chairs are being identified and the process of change and transition is accelerating. Someone asked me last week whether the process we were embarking on was irreversible. Psychologically, I think it would be very hard to reverse it but, more importantly, across the country the clustering of PCTs has also made it nigh on impossible. The person who asked the question was worried whether the reforms would derail the likelihood of meeting the financial challenge whilst maintaining the quality of services; a good question. more…

In Portugal, general practitioners (GPs) are considered “specialists,” as general practice/family medicine is considered a specialty like any other hospital specialty. This is also the case in many other European Union/European Economic Area (EU/EEA) countries. If there’s a more satisfying moment than qualifying from medical school, it must be finishing specialist training. Becoming a “specialist” is a major milestone in the medical career ladder, and “generalism” is a specialty in its own right. GPs may not be as proficient in cardiology or vascular surgery as a cardiologist or a vascular surgeon, but they are specialists in “people,”—with a whole range of biological, psychological, social, and spiritual dimensions—and are ideally suited to approach patient’s problems in an integrated way. more…

New guidelines on the management of pandemic H1N1 influenza were published recently by the Department of Health. They include guidelines on when to refer patients to hospital (see below) and an update on the epidemiology of the disease: fewer than 1% of cases are admitted to hospital; 12-15% of patients admitted to hospital go on to need high dependency or critical care; and mortality for hospitalised adults is around 6%. more…

My practice recently revamped its provision of short-notice medical appointments by transforming the Emergency Surgery into the (so far so good) Rapid Access Surgery. In essence, patients can now no longer pitch up to the practice between 11 am and 12 noon and definitely see a doctor regardless of their complaint, or lack thereof. more…

With the month of fasting behind me and afternoon blood sugar levels now soaring above 3mmol/l, I’m really quite getting into the swing of general practice. It’s the Russian roulette of the medical world. Your fate is simultaneously within and way beyond your control. After all, it was you that called that patient in during the emergency surgery.

A staggering amount of risk-management takes place in primary care. How long should you hold on to that puzzling patient who conveniently falls between NICE guidelines? The tale of the Brazilian nominee for a Darwin Award in 2002 is a succinct lesson in the potential consequences of not letting go. more…

The bad press heaped on pharmacists this week no doubt raised a few smiles among BMJ readers. But doctors should remember that pharmacists are easy targets for consumer watchdog Which?, whose survey found that more than a third of pharmacies give unsatisfactory advice. more…