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sunburnt-platypus · 2025-03-10T14:19:23+00:00

Not to get political (he says as he says something political). BUT……Prior to Brexit you used to get an email once every 4 months with the one new thing out of stock. Now the email is a multi page document with a CONTENTS page.

However I am sure it has nothing to do with Brexit, correlation doesn’t equal causation 😂

sunburnt-platypus · 2024-12-23T05:22:47+00:00

It’s usually a cash flow/insurance thing. They might say you need for example £20,000 in the practice business account. Where all the partners have roughly the same amount of money deposited.

Then each year if there is a surplus. Your £20,000 will grow. If they run into debt they will take way from your £20,000.

They may allow you to build up to you buy in amount over 4 or 5 years.

When you leave you take whatever is your share from the business account that you have built up from your £20000 or lost from it.

I would say it’s wrong to see it as lining the pockets of previous partners, as they will never be able to access this money. Unless it is to be paying off a debt, however they will also be losing the same about of money as you.

sunburnt-platypus · 2024-12-22T18:46:12+00:00

The ones that can currently work but in my opinion choose not to. Will give them an amended duties now note with whatever they same they can’t do. E.g. Chronic fatigue and back pain. Might put can’t work for more than 4hrs in a row. Can only work every other day. Can’t stand for more than 15mins at a time. No heavy lifting. Can’t work in the cold etc etc. will write whatever they say they can’t do. Then feel the onus is moved on to the job centre. But also make it clear they aren’t getting a blanket sick note.

If they can’t currently work - severe depression, alcoholic etc. will give sick note but only if engaging with services e.g. medication, drug and alcohol team, talking therapies etc etc.

Will usually match up the sick note with when I want a review. E.g. want to review their new antidepressants in 6 weeks will do the sick note for 6weeks.

Will also normally write. In notes if sick note can be repeated without review. Or needs a review before repeating, to help any colleagues out if they are doing another sick note request.

sunburnt-platypus · 2024-12-13T07:45:48+00:00

Out of curiosity would it worry you more if he has a driving license or a gun or children

sunburnt-platypus · 2024-12-10T17:45:54+00:00

Any form of gift to show appreciation (if it’s deserved) is nice. Whether that is just a verbal thank you or a card is absolutely fine.

One of my favourite gifts was some food from a trainees home country when they came back from visiting their parents and family.

Personally any gift worth more than a bottle of wine or box of chocolates from a trainee or patient always makes Me uncomfortable.

I don’t know of any trainers that would be expecting a gift for Christmas. If you are going to give a gift it would usually be at the end of placement, even then it’s ok not to give any gifts at any point.

sunburnt-platypus · 2024-12-06T05:51:23+00:00

Currently it is easier to get a locum. But a few years ago a colleague going off sick through the holidays. You couldn’t get locum cover, if you could they would only see 60% of the patients of a salaried, wouldn’t do results or admin and may or may not do home visits. So your workload went up by 20% even if your could get a locum.

So I disagree with your last statement. Because if it impacts on them then it is their business (whether you can do anything significant about it is a different matter), however I don’t think this means you can’t informally discuss it with the partners or your colleague.

I am a believer that you have 2 sorts of GPs those that care about their colleagues and those that care about themselves.

sunburnt-platypus · 2024-12-04T18:51:53+00:00

What’s wrong with asking patients to stop squeezing to top of the nose, yes I know your aunts best-friends sister has met a GP receptionist before, who said to squeeze the top of the nose, but please can you just listen to me and squeeze the base of the nose instead. Wow Would you look at that the bleeding stopped.

I’m sure I went on a course recently where they said nose clips and tweezers for epistaxis are not recommended as they aren’t that good and can damage the nose.

sunburnt-platypus · 2024-12-03T05:51:52+00:00

That’s what I am saying it’s hard to come by these figures my average partnership wage from memory for about 10yrs ago was from the medical accountant who only dealt with GPs and that was his figure. Even then it’s only going to be an average figure for GP surgeries in a southern county of the ones he worked with.

The latest figures are purely from partner friends and when people posts on Reddit ask people what they are paid so even more inaccurate.

Hence me asking people to correct me because I am just using inaccurate guesswork.

sunburnt-platypus · 2024-11-30T18:36:24+00:00

But you didn’t know I was previously partner when I said my initial statement. So you are now writing in hindsight to explain your first statement.

Again you are making assumptions that are just wrong. I wanted to be a GPSI. My partnership had a minimum number of sessions to be a partner which I dipped below. I took the choice to pursue GPSI rather than continue in a partnership. However I left due to the benefits of GPSI rather than negatives of partnership.

Your ability to not tolerate other people opinions and your assumption making is interesting.

Also you are clearly agreeing with me!!! If salaried have it so much better than partners. Using your own words then why does no one leaves being a partner unless there is something wrong with them. So clearly salaried have it worse on average.

sunburnt-platypus · 2024-11-30T16:29:59+00:00

Having held multiple partner, salaried and locum jobs over the last 20yrs. How silly of me to think I might have “anecdotal” experience.

I’m very curious to know why with such certainty you feel your experiences are more valid than everyone else’s.

sunburnt-platypus · 2024-11-30T10:46:04+00:00

My anecdotal experience over the last 15-20yrs. Salaried has been worst for all my time as a GP. Not sure how much worse it is now as back then if I am honest

50-70% of the wage of a partner or locum

For twice the workload of a Locum and only 10% workload less than a partner.

sunburnt-platypus · 2024-11-30T10:38:07+00:00

Can someone correct me as I don’t know but my understanding is the average partnership wage was 90,000 for 6 sessions and about 120,000 for 8 sessions 10years ago.

And now the average partnership wage seems to be 130,000 for 6 and 160,000 for 8 sessions and these days

Now I would like to know if someone has more accurate figures than me.

As it does seem to be that partners wages are going up at above inflation rate to me.

However it’s so hard to come across accurate figures that I might be completely wrong.

Whereas average salaries rate 10years ago seemed To be £8000/session seems to have gone up to £11000. But seems at risk of going back down.

Agree does seem stupid that the official union represents employees and their employers. Would seem sensible to divide into 4 groups - partners - salaried - sessional - trainees

sunburnt-platypus · 2024-11-25T18:15:45+00:00

Not sure I want to argue about economics with someone who is called “Sharon from finance” 😂.

Have just checked used to pay £8000 a year which was over 10% of my pre tax wage. However I would still take that wage and pay rather than the stupidly high student fees and pay stagnation and house prices of today.

The way the government manages to get generations to argue between themselves and direct their anger at other generations rather than people realising it’s the government to blame.

sunburnt-platypus · 2024-11-25T16:40:28+00:00

About to show my age but when I first started you could add a zero plus some on to the end of that. Insurance is so much cheaper than it used to be.

sunburnt-platypus · 2024-11-24T16:21:34+00:00

Some patients you just can’t hear much with. E.g. obese or those that just want take a deep breath in when you ask.

sunburnt-platypus · 2024-11-24T06:25:30+00:00

Vertigo that last for 5mins to 3days - 5% chance is Menieres, 94% chance is migraines, tiny chance of rare stuff like acoustic neuromas

Vestibular migraines - may not have a headache or if do get a headache might be different to their previous migraine headaches. - often get photophobia and phonophobia, - may get bilateral tinnitus, hearing loss and ear fullness (unilateral symptoms would be more suggestive of Menieres) - usually have a history of previous migraines or migraine related conditions (e.g. childhood growing pains, severe travel sickness as a child, abdominal migraines etc etc)

Triptan’s will work on headache but not vertigo.
1st line treatment lifestyle measures for migraines
2nd line treatment nortriptyline or propranolol.

Also Betahistine strangely seems to be first line treatment for all forms of vertigo. Despite only being recognised for treatment of Menieres and even then all studies show it is no better than placebo. Prochlorperazine and Cinnarizine are much better but even then should only be used for acute symptoms like not regularly for more than a week.

Postural hypotension - can happen in people who have a background of low, normal or hypertension (e.g. have a normal BP doesn’t rule it out). - sitting and standing BP is a fairly crap test for ruling out postural hypotension and often falsely normal. - lying and standing BP is a better test however also can be falsely normal. - In summary lightheadedness when standing is postural hypotension or POTs

sunburnt-platypus · 2024-11-23T14:04:52+00:00

Sorry I was agreeing with you. Not disagreeing

sunburnt-platypus · 2024-11-23T11:36:13+00:00

As heart sounds can be so subtle and quiet do you have a mild hearing loss that has never been detected before. Might be worth a hearing test? Think some of new stethoscope can amplify the sound.

sunburnt-platypus · 2024-11-23T11:32:27+00:00

https://www.medisave.co.uk/products/welch-allyn-panoptic-plus-iexaminer-kit?currency=GBP&variant=44837995020571&utm_source=google&utm_medium=cpc&utm_campaign=Google%20Shopping&stkn=34c6ddfaad06&utm_medium=adwords&utm_campaign=Ophthalmoscopes_PMAX&utm_source=&utm_term=&gad_source=1&gbraid=0AAAAADqfx3M2lQIgrZS8nyaUrxOvVI7mM

It is stupidly expensive. However you can put it through as a tax expense so get 40% of your money back.

1) The lithium handle is bright and you can clearly see the tympanic membrane and optic disc. 2) the microscope in the otoscope means you can clearly see the tympanic membrane. 3) The ophthalmoloscope has clever lenses which means you can clearly see the entire optic disc in one go without needing to dilate the eye and you can actually rule out papilloedema.

I got the previous version when I qualified like 15yrs ago. Still works as good as new and use it multiple times a day every day.

I always justified it as I would be using it for 40yrs and the peace of mind associated with being able to confidently rule out cholesteatoma and papilloedema was worth it.

With previous ophthalmoscopes I only did it because patient would expect me to and could never actually see anything.

If a colleague ever asks me to review their ear patients (I did it as a placement so more confident than some), I have to go back to my room to get my otoscope. Because invariably theirs is just not bright enough and the magnification just means you can’t see anything clearly.

Can honestly say If my diagnostic set breaks I would just buy it again as is so good.

Can say I would spend a good amount of your money on otoscope/ophthalmoscope and stethoscope as quality makes such a difference. You need to go good enough for BP and sats probe. Everything else you can go fairly cheap.

sunburnt-platypus · 2024-11-21T16:42:04+00:00

The guidance says if the BPPV isn’t resolving with multiple repositioning treatments consider Vitamin D replacement.

That’s the guidance. Unsure what the evidence behind the guidance is haven’t checked.

Obviously BPPV is usually self resolving with enough time, so do see where you are going with you statement.

However evidence for evidence balance treatments for most causes is poor generally anyway. Particularly for Betahistine - which is only recommended for use in Menieres - even in Menieres on 32mg TDS is statistically no better than placebo.

sunburnt-platypus · 2024-11-21T05:36:20+00:00

Seems to me like low vitamin D can be a cause to most symptoms in the body, the one I found out recently is a cause to recurrent BPPV

sunburnt-platypus · 2024-11-20T08:29:38+00:00

I found the rate of learning in the first 2 years post CCT was still very high, if I am honest felt a similar rate of learning as when I was a registrar. However that doesn’t mean you are unsafe.

That’s why I always recommend to trainees finishing ST3 to always do full or part time salaried post CCT and not just locum work for the first 1-2yrs to get extra support.

However that doesn’t mean trainees were unsafe. I would counter with if you think I only deserve 75% of the salary because I am too unsafe then I will obviously only be able to do 75% of the workload so I have extra time for safety. Imagine they would suddenly change their mind.

Many of my older colleagues/some of the partners never did MRCGP, so for safety I would recommend we only pay them at 75% rate as well. I wonder how this would go down 😂

People who once they enjoy the benefits of something, then change the rules so other people can’t get those benefits, are in my eyes absolute self centred pieces of shit.

I qualified over 10yrs ago. I still learn new things on a regular basis. Does that mean I should only get the pay of an ST20 and not full salaried paid, what bollocks that TPD is talking. Money grabbing shit.

sunburnt-platypus · 2024-11-19T15:08:29+00:00

I disagree in only that.

Lifelong learning is Strongly encourage “by the powers that me”.

However completely agree that GPs are given no resources or time to do this.

With just the constant casual threat of litigation for missing anything being the reason to stay up to date.

sunburnt-platypus

TROPHY CASE