LinkedIn: 2025

Usually very well'

Usually very well“ “Attended conference with DTLs each of” “Whom represent multiple practices

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I'm really enjoying doing these interviews!

I’m really enjoying doing these interviews! Learnt lots from GP friends / colleagues who I thought I knew well! - some amazingly varied careers out there - showing one of the real positives about general practice - its ability to deliver a portfolio career. We have some more interesting talks coming up - funded by Cheshire East education hub.. I’d like to do more of these on a national scale.. if anyones got some funding…. doesnt need much… :-)

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Another post about Microsoft copilot for the NHS?

Another post about Microsoft copilot for the NHS? does anyone know if as a GP practice we could use it given we had an email recently saying its now included in nhs mail? to create a RAG (Retrieval Augmented Generation) system or has anyone done this. As a practice we have loads of policies procedures clinical guidelines local newsletters - id love to put them in a folder have a RAG access them then have a onscreen chat bot interface that any user in the practice could ask. Ive seen this kind of thing in videos in small companies as a demo of how AI could be useful but would like to do it internally as cheaply as possible!! thoughts on copilot or other options??

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Interesting discussion from a clinical safety pov on a digital board meeting ive just…

Interesting discussion from a clinical safety pov on a digital board meeting ive just attended. Microsoft copilot is being give ?free to nhs mail users (I welcome this). We have been told as its not a clinical product it doesnt need a clinical safety case.. but.. what if I use it to compose a reply to a complaint or create a patient information leaflet or a coroners report or use it to analyse an excel spreadsheet with patient data that affects care - does it it cross a line? while the license may say not to do this with it - does every gp/pm/nurse know this?

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Shameless nepotism - have a look at my daughter - Meredith Paul’s profile.

Shameless nepotism - have a look at my daughter - Meredith Paul’s profile. Please think about connecting with her ! She’s a second year biomed student at Essex uni. She was top of her year in first year and made the deans list for achievement (so proud) She’s looking for a placement year in either a nhs lab or industry ideally from aug/ sept 26-27 up here in the north west(ish) as“ “Part of her course. If you have any connections or are able to help please get in touch :-)

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This week I have been in at least three meetings with different practices and providers…

This week I have been in at least three meetings with different practices and providers represented where the future of reactive to proactive care is the multidisciplinary team meeting done on a cohort or segment of population identified by analytical tools. Blinks has it from end to end - a powerful analytical tool that works across multiple organisations able to identify relevant segment and now a powerful work board functionality that could be used at the heart of an MDT

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IT & AI Can Help Us Deliver Commercial Research at Scale

How IT and AI Can Help Us Deliver Commercial Research at Scale in Primary Care

If we want to grow commercial research in primary care, our digital systems have to catch up. We’ve already talked about new workforce and site models — mobile teams, shared hubs, flexible sites — but those ideas only work if the tech supports them.

1️⃣ Smarter data to find the right patients
Too much time is still spent running separate searches at each site. We need federated or cross-organisation tools that can find eligible patients across a network in one go — securely and consistently. AI can then take this further, scanning coded data (and even free text) to flag likely candidates, or surfacing prompts just in time during consultations.

2️⃣ In-consultation prompts and data quality
AI could quietly improve data quality and research recruitment at the same time:
“This patient might meet inclusion criteria for the diabetes study — recent HbA1c > 58 and on metformin only.”
It helps clinicians spot opportunities without extra admin — and builds richer real-world data.

3️⃣ Streamlining the paperwork
Imagine e-worksheets that pre-populate from the record and feed directly into the sponsor’s EDC. No re-keying, no missing fields, fewer errors. The same goes for delegation logs and screening forms — all digital, all traceable.

4️⃣ Smarter IMP and logistics management
A shared digital inventory could track where every vial or kit is, temperature included, across a network. That enables “just-in-time” delivery — matching supply to actual demand and reducing waste.

5️⃣ Safe remote access for PIC and satellite sites
Controlled, read-only access or blinded data views would let support sites contribute without compromising privacy or GCP compliance. It’s the key to true scalability.

AI and IT won’t replace good people or relationships — but they can give us the visibility, speed, and consistency we need to deliver at scale. If we get this right, digital stops being the paperwork after the work — and becomes the thing that makes the work possible.

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Are current ways of delivering trials working

We hear from industry and government that they want to run more commercial research in the UK — but are the current ways of delivering trials in general practice actually working?

Practices want to participate, but uncertainty over time, training, and return on investment can make it hard to commit. Setting up a study can be slow and costly: contracting with multiple practices, navigating monitoring visits, training staff, and managing IMP logistics all add friction.

I recently heard of a study where 300 practices competed for just 15 places — a striking example of inefficiency and duplication. It’s easy to see why practices might feel disenheartened. Some practices despite investing in kit and rooms and training have yet to do a study.

My plan is to give some of my thoughts on how we could make commercial trials in primary care faster to setup, more efficient, higher quality and genuinely collaborative — covering workforce, data, AI, IMP logistics, training, and network models.

I’d love to hear your experiences: have you tried and struggled, invested effort without payoff, or found ways to make it work? Or do you work for a Sponsor or CRO that is keen to try new ways of working (some are!)

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One of the biggest challenges in scaling commercial research in primary care…

One of the biggest challenges in scaling commercial research in primary care is IMP (Investigational Medicinal Product) handling. Most systems still assume a single GP site, a static team, and a cupboard fridge. That’s not how we’ll deliver modern, multi-site trials.“ “ “The model we’re developing is built for networks — where trained staff, validated kit, and clear SOPs move to where participants are, while governance, temperature control, and accountability remain watertight.” “ “IMP doesn’t always need to live in one place. Depending on the study, product, and protocol, stock could be centrally stored, held locally under validated conditions, shipped just-in-time, or even delivered directly to patients at home using temperature-controlled packaging and real-time digital monitoring. In some areas, community or hospital pharmacies could share responsibility for storage, dispensing, and returns — a real opportunity for joined-up working across sectors.” “ “To make this safe and efficient, we need central IT visibility — a web-based IMP management platform showing exactly where every product is, who holds it, its expiry, temperature history, and where it’s heading next. Combine that with proper logistics and just-in-time (JIT) expertise — people who understand routing, validation, and flow — and we can run high-quality trials across multiple practices and mobile teams.” “ “But this only works if sponsors meet us halfway. Global study designs and systems are still written for a single-site model. They need to adapt — to handle multiple active locations, shared storage, home delivery, and digital delegation and temperature logs. It may mean allowing blinded IMP to be held safely at more than one site, or building workflows for home dispensing and courier-based returns. The technology already exists; the flexibility just needs to follow.” “Yes, it sounds like extra work — but the goal isn’t more work, it’s smarter, faster, larger-scale research. Centralise what must be central, make everything else mobile, validated, and visible. That reduces duplication, improves efficiency, and unlocks capacity.” “ “This is how we protect patients, reassure sponsors, and give UK primary care the infrastructure to deliver commercial trials at real scale.

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Exciting news - team work makes the dreamwork thanks to James Perry Jennifer Crooks and…

Exciting news - team work makes the dreamwork thanks to James Perry Jennifer Crooks and David Lewis who asked Dr Carolyn Paul and me partner with them on this.“ “ “I’ll keep posting some of my ideas which hopefully the new PC-CRDC will enact. If you are a practice in C&M ICB get in touch as we want to work WITH you.” “ “If you are outside - more than happy to do some consulting.

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interested in a DPO service?

interested in a DPO service? get in touch!

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Smarter Model for Primary Care Research

We Need a Smarter, Layered Model for Research in Primary Care

If we’re serious about scaling commercial research in general practice, we can’t keep pretending every site can — or should — do everything.

The current model, where each practice tries to be self-contained with its own contracts, kit, and staff, is well-intentioned but unrealistic. Most don’t have the capacity, space or continuity to deliver full studies from end to end. The result? Investment spread thinly — and few truly research-active sites.

Instead, we need a smarter, layered model — one that recognises different levels of involvement and builds a collective system around them.

Some practices will work best as recruitment or screening sites, identifying participants through searches or opportunistic invites.
Others could act as local delivery hubs, hosting visits, samples and IMP storage with dedicated staff.
A few might evolve into super-hubs, running full trials with monitoring and complex governance in place.

The key isn’t to make every practice a “site” — it’s to make sure every practice can contribute meaningfully, supported by a centrally coordinated workforce that moves flexibly across the network.

That means some staff working locally, some remotely, some mobile; some full-time, some part-time — all sharing training, templates, and quality systems. Experience flows both ways: seasoned staff mentor newer sites, and practices bring patient access and insight in return.

Sponsors and CROs need to buy into this too. A flexible network may look complex on paper, but it offers the scale, consistency and resilience they actually need — a single framework, one governance standard, multiple delivery points.

It won’t be easy, but it’s a better use of resources than everyone buying their own -80°C freezer or duplicating GCP records.

If we get this right, research in primary care becomes a collective enterprise — not dozens of isolated practices competing for scraps, but a connected system where everyone helps make trials possible.

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From Competition to Collaboration

To deliver more commercial clinical trials in the UK, maybe the answer isn’t more competition — it’s more collaboration.

Primary care has already shown that working at scale — through PCNs, federations and partnerships — delivers consistency and resilience.
So why not apply the same idea to research?

Imagine a provider collaborative with a central team managing setup, contracting, data sharing and oversight across multiple practices. A Joint Venture Agreement (JVA) could formalise this, avoiding the need for separate companies — and the VAT and governance headaches that come with them. The central team would handle governance, budgeting and monitoring, while local practice teams deliver patient-facing work. Funding could be pooled and shared fairly — rewarding engagement, delivery and reach, not just whoever gets picked for a single study.
Everyone takes a smaller slice of a much bigger pie.

We’ve already seen this work in practice. During COVID, many practices seconded staff to central vaccination centres — matching capacity to need and being paid fairly for it. Why not the same for research?

Great work is already under way to link databases, speed up contracting and improve feasibility — and that’s hugely positive. But this goes a step further: beyond data and process, toward a new delivery model combining shared workforce, governance and funding — making research part of routine general practice rather than an occasional add-on.

Superhubs, local hubs and mobile teams could deliver studies flexibly — including remote and telephone activity — making trials faster and more inclusive. Working at scale also helps reach under-doctored areas and reduce inequalities. Patients stay within the NHS research family, building trust and participation. And the preparation work — coding, pre-screening, data checks — improves data quality for all patients.

Of course, this won’t happen overnight. It will need:
• clear data-sharing agreements
• workforce planning and flexible research roles
• a live capacity & capability matrix
• strong governance and digital integration
• new funding and contracting models
• and, above all, cultural alignment — seeing research as our network’s work, not my practice’s study.

Six big areas to focus on next:
1️⃣ Workforce & Skills – shared teams, training and defined research roles.
2️⃣ Data & Digital Readiness – interoperable systems and clear governance.
3️⃣ AI & Automation – tools to identify participants, track data and reduce admin.
4️⃣ IMP & Logistics – flexible ways to handle medication and monitoring.
5️⃣ Contracting & Governance – shared templates, faster processes, consistent quality.
6️⃣ Network Models – federations and superhubs that deliver at scale, fairly and efficiently.

If we can align incentives, share infrastructure and build trust, UK general practice could become the best place in the world to deliver commercial clinical research — efficient for sponsors, rewarding for practices, and good for patients.

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Scaling Research in General Practice

There’s been a real and positive shift in primary care research in recent years. More GPs are now trained and recognised as Principal Investigators (PIs), which has been a great success — particularly for non-commercial and academic studies. Many of those projects are straightforward to deliver: reviewing notes, evaluating care pathways, or engaging patients through surveys. They’re accessible, clinically relevant, and help build research confidence across general practice.

Commercial trials, though, are a different story. They’re protocol-driven, time-sensitive, and operationally demanding. Each visit might involve multiple measurements, bloods that need spinning and aliquoting, samples packaged on dry ice, courier logistics, and complex data capture. The PI remains crucial for oversight and governance — but most of the actual delivery happens around them.

If we want to scale research in general practice, we need to build teams that can handle this kind of work efficiently. It’s not about using more partner time; it’s about using the right level of staff for each task. A sustainable, scalable model might include:

• Sub-Investigators (Sub-Is) — who can take on delegated clinical tasks and patient contact under PI supervision. These might be portfolio or salaried GPs, or in time physician associates, depending on the practice setup. To make research financially viable and scalable, it makes sense to reserve partner or senior GP time for oversight and decision-making rather than routine study activity. To be sustainable, teams need to be efficient, effective, and productive — using the most appropriate (and often most cost-efficient) person for each task, while ensuring everyone works at the top of their capability.
• Research nurses and practitioners — running visits, collecting data, managing safety, and ensuring protocol compliance.
• HCAs acting as study technicians — performing routine measurements, phlebotomy, ECGs, and sample processing.
• Admin and data staff — handling entry, query resolution, and documentation so clinicians can stay focused on patients.
• Coordination and logistics roles — managing IMP storage, courier bookings, and communication with labs and sponsors.

With the right mix, the PI can concentrate on leadership and quality while the delivery team keeps the study moving. Practices can take part in more research without it becoming unmanageable or unprofitable — and patients still gain access to new studies locally.

Local senior GPs need to support recruitment and engagement. Modern trials depend as much on coordination and logistics as they do on clinical skill. If we invest in those roles, research becomes something any practice can do — not just a few with spare capacity.

These staff need to be able to work in a mobile flexible way. We need some full time research staff but also a “bank” of staff that can be called on to work in their or nearby practices to meet the study timelines.

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I’ve known Lee over the years and always been impressed with his dedication, hard work…

I’ve known Lee over the years and always been impressed with his dedication, hard work and persistence. I’d recommend interviewing him.

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Anyone GP practices or others have any experience taking digital retinal photographs?

Anyone GP practices or others have any experience taking digital retinal photographs? Any advice on kit? Is there training on using the kit available?

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Can we get rota management in EMIS?

In a previous post, I asked about rota management software. I received quite a few names, and my practice management team have investigated several of them. Some of them look absolutely excellent; however, we’ve yet to come across anybody that can actually put the appointment schedules that the rota software generates into EMIS. Has anybody managed to do this? I suspect the API will be poor and not allow it to be done directly, and I suspect it may need an RPA bot-type solution. Just to be clear, not only are we trying to track things like holidays, but we also have up to 32 doctors working here, all with different hours and on different rotas. We have clinics and nurses; some clinics happen regularly, some happen irregularly, and we’ve certainly come across rota software that can handle this inside its own software. However, what we need is the appointments to be put onto EMIS.

There’s no point in using software that then requires us to use the same administrator who worked it all out manually to just sit there and type it all in, copying it across. It doesn’t actually save us that much time and effort. What would save us time and effort is basically the the appointment schedules being added automatically into EMIS once sorted. Have we just missed a company that’s done this?

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New process for PPA Drugs Claims?

Just found a process that must be affecting every GP practice in the country and needs computerising and streamlining - looking at Healthtech-1 or other companies… EMIS?

Just found my finance team surrounded by prescriptions. all piled in neat piles. Every quarter - we do a PPA drugs claim. These are drugs we buy in - we use for example - B12 injections - Lidocaine for minor ops. We issue the prescription and sign it by hand and rather than giving it to the patient we keep it to claim the reimbursement - ok there is a small profit in this. However the system is a nightmare.

Every prescriptions needs to be put into a pile of which GP authorised it. Each drug and for which there are many needs to be counted separately e.g. 412 vials of lidocaine 1% etc. Some docs/nurses forget to issue the script loosing us money… Then this all needs to be recorded on paper - yes paper - by doctor, by drug with the prescriptions attached (we have 32 GPs)

What!! all other scripts go EPS - is there no way this couldn’t be automated? Come on EMIS or someone - you must be able to get this info from the EPR - count all of these and create a master sheet that could be submitted electronically. What is the PPA button for?
My team says its takes a day. ok we are large but for 6000 GP surgeries - this must be a huge waste of time - and who knows what the PPA do at the other side having 6000 GPs surgeries worth of paper and prescriptions arrive!!

Am I and my surgery mad - have we missed a better way of doing this -has anyone solved this?

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It’s the Friday before a bank holiday quite a lot of my colleagues are on holiday already…

It’s the Friday before a bank holiday quite a lot of my colleagues are on holiday already and I’ve just finished for the evening having signed about 500 prescriptions. Almost every single prescription had some form of warning on it yellow triangles, red triangles, green triangles alert pop-up boxes and guess what - I pretty much ignored them all. I ignored them for a variety of reasons - our prescriptions team are amazing and run all set sorts of safety searches and double triple check things, I have 30 years of experience behind me and my brain just seems to catch things that don’t look right but mainly as most of the warnings are absolute rubbish mean nothing or are inaccurate or inappropriate.“ “ “So here’s a suggestion for an AI app or new Epr system - that would enhance patient safety reduce clinician workload-have a warning system that only actually warns when there’s a reason to warn. Check the patient records check their results check what other medications are on and only flash up stuff that is significant above a certain threshold.

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Not sure why this post didn’t get more attention- so reposting in case it was missed in…

Not sure why this post didn’t get more attention- so reposting in case it was missed in the deluge from me! “ “ “Ps this is an interesting article has anyone done something similar in gpland “ “ “Method to apply temporal graph analysis on electronic patient record data to explore healthcare professional–patient interaction intensity: a cohort study” https://lnkd.in/eD3JhAVX

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Competition Time?

I’m thinking of initiating a competition for any primary care clinicians around; however, I need some help in deciding how we do this.
Early today, I was visiting another practice as part of a research study, and frankly, I was quite blown away by how quick, speedy, and responsive the person’s computer was. I couldn’t quite believe it, so much so that I looked to see under the Windows settings what computer it was - it looked like an identical box. I won’t go into the details, but according to Google it was a much newer processor running at a much higher speed with more cores and with 32GB of RAM compared to the 8GB of mine.

Is it any wonder mine feels like treacle ? Now I’m wondering, is there something like Geekbench that’s downloadable and runnable without admin rights, that we could have a competition with to see who has the slowest and who has the highest?

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Interesting feature that could help practices a lot!

Interesting feature that could help practices a lot!

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Some of the reels i've seen about EPIC from US docs make me afraid - very afraid!

Some of the reels i’ve seen about EPIC from US docs make me afraid - very afraid!

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Interested in Big data and some of the insights you can get from it?

Interested in Big data and some of the insights you can get from it? Have a listen to this really fascinating podcast, particularly the first third that deals with Uber and the introduction of tipping to Uber, and some of the social experiments that were done around it, but more importantly, the big data insights they got from it.“ “ “What’s fascinating is they know lots about the drivers and lots about the passengers. They know things, for example, age, sex, preferred language, age of locality, routes, times of operating, age of care etc., etc. What they were able to do was create quite detailed profiles of what types of behaviours or activities in drivers increased tip rates and also what types of people tip and what types don’t or when they might and why. Fridays and Saturdays particularly evenings have more tips possibly the effect of alcohol. Newer cars get more tips etc to give some spoilers.” “ “Now, clearly, we’re not interested in tipping in GPland.. though i do like the odd thank you card and do wonder my one of my female colleagues gets more than me! But there’s a lot of talk about population health and population profiles at the moment and it strikes me that while, yes, there’s a huge vogue to categorise people based on their illness levels, for example, into the Johns Hopkins PNGs, Rub scores, frailty indexes, there’s a lot more information that could be extracted and analysed. Some of which might help predict behaviour or allow us to influence them?” “ “There is potential interesting information to be gained from looking at the interaction between GPs as consultors, patients as customers, and whether or not any factors can affect both the quality and, I guess, the productivity, efficiency, or satisfaction levels of that consultation. For example, for GPs, we may know or be able to find out medical school, place of training, years of qualification, qualifications, possibly interests, hours of work, age, sex, and preferred language but also things like type of room, cleanliness of room, reputation? town. For the patients will know all sorts of things: location, age, job, marital status, family status, as well as diseases or chronic diseases. Perhaps there are useful insights to be gained, maybe just interesting ones, from this. What types of interactions work well? What don’t work so well? What generates a lot of work? What doesn’t? Why are some more efficient than others? What can we then do to improve that?” “ “https://lnkd.in/eUAMfHgM

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an interesting infographic

an interesting infographic

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Really useful and interesting - Thanks!

Really useful and interesting - Thanks!

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Any informatics experts out there interested in a short term commision?

Any informatics experts out there interested in a short term commision? Looking for specialists in presenting data in interesting novel informative ways.“ “ “We have access to tens if not hundreds of information sources about our PCN and our Practices. Some of which are public domain some are health domain some are practice/pcn level. We know of most of these (or at least a lot) and most of them you can pull info out of. “ “ “We want someone to take that and present interesting bits of it to us.” “ “Not in a massive excel spreadsheet where we spends hours moving it around.” “Not in a big database that we have to query and spend hours trying to discern any useful information out of. “ “But a series of infographics or similar that perhaps compare our performance between us and compared to external. Or information about our population.” “ “Have you done anything similar or know of same? No time wasters please and our budget i’snt huge… Comment or DM me.

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So my desktop at the surgery has been upgraded to windows 11!

So my desktop at the surgery has been upgraded to windows 11! “ “ “Now it takes about 3 minutes longer to load. Surgery Connect from X-on no longer connects to EMIS and I’m getting more random crashes than i was…. oh joy!

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Do Apple users have better wellbeing?

I’m fascinated by the use of big data and mixed data sets. A classic example is how mobile phones - pinging their nearest call towers can give live traffic congestion information.

Our ICB has a big data store mixing some SUS data with primary care and Local authority/Public health but what could be added to make it richer? Came across the report below on internet/computer usage by area/neighbourhood ? Could that have any correlation to health outcomes? Do Apple users have better health outcomes? How does that help?

There may be all sorts of data on populations out there that could feed interesting insights from a pop health POV. Have you got any examples? or thoughts of what might make interesting cross over data.

https://lnkd.in/eKpG_urv

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Clinical Trials

Do we need more collaboration and less competition in primary care clinical trials?

I’ve been delivering clinical trials for almost 20 years. It used to be a niche area and few practices did it. During covid there was a dip in commercial studies (apart from vaccine ones). Over the last year or so - there appears to be an explosion of interest. More clinical trials are coming, NIHR and others are strongly pushing primary care to get involved and indeed more practices than ever before are seeing doing clinical trials as a potential income source so are interested in how they get involved but struggling to deliver. RRDNs to be fair are doing a good job, funding and educating and supporting new practices but I think we need to think of a different model.

Loads of practices in the last 6m have contacted me asking for advice. What do they need to do - how do they get involved, what staff, skills, equipment do they need? - I tend to offer advice but basically I’m shooting myself in the foot by doing so. Most studies seem to want 20/30/50 sites across the UK. Site selection can be quite a competitive affair and quite frustrating from our side but that’s another post. If I train up (or the RRDNs help) loads of sites get research active - it just generates competition and means that any one site is less likely to get a study. That in itself means that any investment in people/equipment/time is harder to justify and while sponsors might like the eagerness - they are dealing with lots of inexperienced sites all recruiting small numbers. multiple contracts, multiple contacts, lots of questions, lots of issues.

A collaborative model seems to make more sense to me? Let an experienced site like mine - work with a number of less experienced sites - not as PIC sites where all they do is feed in recruits but as satellite sites with trial deliver from each base or each locality - where perhaps staff and resources are shared and knowledge and expertise can improve recruitment, retention, data quality etc..

You agree Im sure but.. the system doesn’t seem to allow this. We need model contracts both between the practices and between the sponsors and the lead practice provider. we need sponsors to understand this model (they keep wanting to set everyone up as a separate site) and to build their IT and IP management around it. At the moment particularly for double blinded RCTS - IP dispensing systems don’t seem to want to cope with IP on multiple sites. Monitoring also tends to be site specific but with some easy IT enhancements a lot of that could be done centrally or even remotely.

Keen to hear your views? have you got multi-site working? do you use a central workforce? central PIs? what models/agreements are you using? some of the big commercial players are getting into this game (or already there) and they are taking the fees and passing on chicken feed to the practices - done right practices could be getting a real income from this.

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The insidious lack of uplifts in line with CPI for all sorts of payments is real.

The insidious lack of uplifts in line with CPI for all sorts of payments is real. Headline uplifts to core funding which is increasingly a smaller proportion of turnover doesn’t counter balance it.

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Announcement today below - my PCN is pushing NHS app uptake..is yours?'

Announcement today below - my PCN is pushing NHS app uptake..is yours?“ “ “From September, the NHS plans to start sending results from the NHS Cervical Screening Programme, utilising the NHS App.” “ —“ “In September, those who have a negative test result will be notified of this by an NHS App message. It will also appear as an NHS App notification. If the NHS App message isn’t read within 72 hours, a letter will be sent as a failsafe.” “ “ “Abnormal result letters will continue for the time being to be delivered by post.” “ “ “This change follows the successful rollout of digital invitations and reminders in June 2025, where since the launch, 9 out of every 10 invitations are being sent digitally, with the remainder being sent by post.

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Very interesting summary sent to me - apparently of BMA's view of new contract:'

Very interesting summary sent to me - apparently of BMA’s view of new contract:“ “ GMS will remain in place. We know some are suggesting it will disappear, BMA have confirmed that it can’t. It’s a contract in perpetuity and the BMA have it in writing that Single Neighbourhood Providers will sit alongside GMS. “ “⁠⁠The Govt wants to see general practice taking on SNP contracts.” “⁠The Government has committed to longer term renegotiation of the GMS contract and GPCE anticipate this will be a multi-year process. GMS remains. “ “The Govt. know they need to set out a clear roadmap of the three funding streams and timelines and securities: “ “1.⁠ ⁠what is the funding for the SNPs and what will those contracts look like?” “2.⁠What is the funding for the MNPs and what is that intended to do? “ “3.⁠⁠what is the funding for the new GMS, what do we want in it and what do we want from it? (acknowledging they have already described Carr-Hill reform as a key part of this.)” “⁠BMA have been told will have the funding envelope for GMS 26/27 by the time of their next meeting. But what is becoming more clear from discussions with external third party experts, is the economic forecasting paints a grim picture. Previously many of us hoped that we could use a new contract as a means to secure transformational funding. If the transformational funding opportunity is simply not going to be there, or anywhere, or rather, the new contract will be there but nowhere near enough of what GPCE originally wanted, what would the profession want to do? “ “ “Before you decide that - ponder this too:” “•⁠ ⁠Chances of funds increasing ahead of the end of this Parliament feel unlikely, and tax rises more likely. “ “•⁠ ⁠⁠It is clear that NHSE are keen for the PCN DES to remain. How strongly DHSC/Govt feel is less certain. Pushing ARRS to a practice-level of investment would be a clever cost-neutral solution for a Govt to claim an increase in % NHS proportional spend into GP.” “SNPs will be separate to the PCN DES. And likewise any shift to an available single neighbourhood contract will be voluntary – so for those not wanting to have a stake in it, they can stick with GMS / PCN DES.” “NHSE have said that their aim is to create a contract that:” “•⁠ ⁠Is an overlay/to sit alongside GMS. That practices will not be asked to ‘give up’ GMS in order to take up a single neighbourhood contract (but that remains to be seen).” “•⁠ ⁠Will have greater flexibilities around staff/resourcing than the the current GMS/PCN DES contract” “⁠Provides a contractual level for neighbourhood health services.” “NHSE expect the SNP contract to be most appealing to single practice PCNs and “highly collaborative multi-practice PCNs looking to lead neighbourhood health service delivery.”” “NHSE are still working through the contractual form for both the single and multi neighbourhood contracts (might they revisit the former MCP contacts from a couple of years ago?). The NNHIP is for the first wave of trial runs for the MNP.

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Apologies if you have seen this before - but just came across it and find it a very…

Apologies if you have seen this before - but just came across it and find it a very useful and informative document with some really good questions at the end.

Attached document (PDF) →

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Let me know if you would like to see my thoughts on how to get more GP practices involved…

Let me know if you would like to see my thoughts on how to get more GP practices involved in primary care commercial trials!

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Ok what strategies are people using to find patients to target in population health…

Ok what strategies are people using to find patients to target in population health initiatives?“ “ “People talk about finding the “rising risk” population. People talk about finding - the “hard to reach” the “high frequency attenders” “the high cost” patients.” “ “Different teams are using different search strategies - what are you using? I heard from one PCN,place that they were looking at pts over 18 that had attended GP 10x+ in year, A&E 2x+ in a year and then they looked at total last years health spend and reviewed the top 2% who were costing the system millions. They felt this was a good cohort - not sure why they chose it?” “ “Some choose based on a high risk of admission, or high frailty score, or RUB score, or a combo of any/all,” “ “There is a lot of worry that you come across the regression to the mean issue when you do these things. There is worry that you just ID those acutely unwell, or those that you know well and have tried everything with. There is a concern that using a search strategy relies on data and its those without data you need. There is a worry you ID those that dont want to engage.. or those that you have tried everything with.” “ “There is the want to ID those with an intervention opportunity. For example 2 patients with a QRISK of 30%. One comes in every 4 weeks and is on every drug and under several consultants who have optimised care - versus a person with the same QRISK who is perhaps a smoker with high cholesterol and unknown BP. Clearly in the later the risk is the same but the potiential to affect their risk if they engage is much higher and therefore perhaps more worthy of effort or in other terms more bang for buck on an invest to save pilot.” “ “We have all seen case studies of initiatives that have helped Annie in some profound and touching way but took multiple MDTs, large numbers of staff, multiple visits and make good copy but spending the same time and resources on say AF screen might have more benefit? “ “ “So what are you doing? Why? Has it worked?

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New GP Technologies

Recently I posted asking what new technologies might be out there from a communications point of view that GP practices might be using in the near to mid future that I might not be aware of. 18 months ago I hadn’t heard of ambient scribe tech but now I use it every day.

Well - the main thing that people seem to have told me is RCS? apparently next level SMS. no more fragments, rich text, links, pictures, its more than MMS.

Little birds tell me - ICBs are increasing worried about SMS costs and looking to cut costs - despite - the benefit to practices - silo’ed budgets perhaps… ok there is a push to NHS app… but where does RCS fit in? What are the major suppliers planning?

Apparently the next iOS has it built in… so it will become a thing - any thoughts?

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I recently did a couple of workshops demoing the Ambient Scribe technology in Lexacom to…

I recently did a couple of workshops demoing the Ambient Scribe technology in Lexacom to GPs. Most were blown away by the potential time savings - a colleague of mine reckons its saving him half an hour a surgery… “ “ “for me what was interesting was the number of GPs already using some form of speech recognition in their every day workflow - I hadn’t appreciated how many used this - and how many were a little unhappy with it - despite paying for medical grade versions of well known software.” “ “During the demo - I switched from demoing ambient which they liked to the new version of Lexacom Echo - powered by the comprehension engine and rattled off a few dictations into Emis consultations then into tasks, then emails both EMIS and Outlook then Word and the quality and speed really got some of the GPs more excited than scribe had. Also many said they felt they could use it straight away whereas many are still waiting for ICB/CSO approval for scribe. “ “ “My point - Lexacom AI speech recognition isn’t just scribe.. its next level speech recognition in your workflow speeding up many things that you do not just consultations.

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I think this is very informative of the debate especially around money, however I also…

I think this is very informative of the debate especially around money, however I also believe some of the “residents” issues are with poor training - lack of respect/ understand with regard to where training places and rotations are making it difficult for couple/families. Huge exam fees and other costs why do you need to pay GMC fees? why doesnt the Trust pick those up? Also the loss of the “firm” - loss of identify - constant full shifts with no regular consultant supervision, no real appreciation form the trust they work in…being used for service…

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Anyone get any meaningful data / reports out of eRS?

Anyone get any meaningful data / reports out of eRS? The NHS E-referrals system? I’m convinced there could be all sorts of useful info in there but I’ve never seen any sort of report or dashboard - anyone got any insights ?

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Could AI be the answer

Are we running a blood‑letting empire in medicine—and could AI be our salvation?

Every month, thousands of patients get the familiar ping: “Please book your blood test.” Annual reviews, quarterly checks, dose‑change panels… the cycle never ends. Behind the scenes, an entire workforce orchestrates reminders, bookings, form‑filling, car‑parking logistics, carbon emissions and, of course, mountains of paperwork. By the time the results land, nearly 100% are normal.

Here’s the kicker: after 25 years of routine DMARD and medication monitoring, I can count on one hand the routine checks that flagged anything actionable. (I’m not talking oncology protocols or acutely unwell patients—those are a different ballgame.)

First, do no harm… but what about the stress, clinic bottlenecks and the “blood‑test fatigue” our patients feel? Patients spend more time coordinating their phlebotomy than managing their symptoms.

Could AI slice through the tedium?

Frontiers in Medical Engineering highlights how scalable AI models can sift hidden patterns in routine labs—beyond what classic decision‑support ever spotted—and drive smarter, leaner monitoring protocols (Frontiers).

An ICU study showed machine‑learning algorithms predicting which future blood tests would actually change clinical management—potentially cutting unnecessary labs by up to 25% without compromising safety (PMC).

Imagine a world where:

Young, fit patients on stable regimens get 6‑monthly rather than 3‑monthly tests;

AI flags only those with a high probability of an abnormal result;

Lab teams focus on the critical 5%, not the 95% of normals.

A Provocative Thought

Are we over‑monitoring stable patients out of ritual rather than risk? If you’d trust an AI‑powered “blood‑test concierge” to decide your next phlebotomy slot, would you cut your visits in half?

Further Reading

Santos‑Silva et al. “Artificial intelligence in routine blood tests” (Frontiers)

Lee et al. “Predicting information gain in ICU lab testing” (PMC)

Over to you!

Have you ever had a routine test uncover something critical?

Would you feel safe if an AI model told you, “Not due for bloods till December”?

How could we pilot AI‑driven lab protocols in your clinic?

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The Holiday That Brought My DSLR Back to Life

Just back from the families annual holiday (Langkawi - it was amazing!) and have spent the last few hours putting together a photo book. I’m a huge photography fan and have been since I was about 13 - developing my own black and white prints on a Pentax Program A. Around 18 I switched to Canon then for a while the Fuji Mirrorless X series before switching back to Canon pre covid.

I’m not bad - I’ve previously shot a friends wedding, helped a friend get a modelling contract by shooting a portfolio of her and I’ve done some event photography and even portrait work for a Music group (all in my spare time).

However like many for a few years I’ve just been using my iPhone to take snaps and my DSLR kit has been being ignored. I made an active decision to take it with me this year and a couple of lenses and a flash. For me the proper use of flash can take photography to the next level.

I’ve been musing while editing and for me what is missing from smartphone photography is semi-pro flash. Wireless “ETTL” multiflash for smart phone - why isn’t this a thing? is it? have I missed it? maybe its the next tech coming? Also given one of the reasons people like smartphones is their connectivity and their ease of use - given there are things like CarPlay - strikes me as odd that there isn’t a PhotoPlay or similar. Either a GUI touch screen DSLR or the ability to attach your existing phone similar to how you can on a drone.

Next week back to medicine and health tech.

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One of the interesting things I've heard today is the crippling cost of SMS to the NHS…

One of the interesting things I’ve heard today is the crippling cost of SMS to the NHS that they want to get rid of - I know the push is to use the NHS app but other options do exist - WhatsApp, Messenger, ?snapchat, email… I know some of these cost as well. Thoughts? Is the comms in NHS app good enough? or is there a role for a feature rich secure comms app that other providers could send messages to? what features would it need? would users use it? have we run out of ideas in the comms space or is there something..yet to come?

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Since they had a stand at Howbeck Healthcare Limiteds AI conference I’ve been giving…

Since they had a stand at Howbeck Healthcare Limiteds AI conference I’ve been giving medwise.ai a go. I love it! Have to say I thought about creating something similar but they beat me to it!“ “ “If you are a health care professional wanting to look something up give it a go! Ai produced results from curated sources. Free to use in basic form! “ “ “More people should be using this! And my gp fed is looking into creating a localised version” “That would include local resources and info

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Get in touch if you want to hear more about our service!

Get in touch if you want to hear more about our service!

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Sound good if up to date and reliable

Sound good if up to date and reliable

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Have we just seen the end of PCNs?

Have we just seen the end of PCNs? Single neighbourhood providers at 50k scale are their probable replacement but who is going to run them is the question! Multi neighbourhood providers at a scale of 250k will be taking over commissioning of primary care from ICBs - who will run them? acute or community trusts or gp provider collaboratives?

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Just been reminded of this product Kinesis from https://lnkd.in/eDEnCw2s that I really…

Just been reminded of this product Kinesis from https://lnkd.in/eDEnCw2s that I really liked the look of but local commissioners never bought. given the new emphasis on frailty falls from the BCF maybe its time to revisit *no conflict of interest just liked it.

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A week or so ago I shared an earlier version of this document.

A week or so ago I shared an earlier version of this document. After comments and feedback we are now on v3! It has been produced by the Howbeck DPO/IG/CSO team - Feel free to share - as long as you keep the attribution. If you are interested either as a supplier in our help - we offer a CSO service for suppliers or as a practice in having our help in adoption of AI products either from a CSO / IG/ DPO/ pov or just in terms of training and support and product implementation - get in touch. “ “ “If you are a small independent CSO working in geographic areas complimentary to us and are interesting in partnering discussions we would also be happy to hear from you.

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Bugger better write My presentation I’m on in 10mins

Bugger better write My presentation I’m on in 10mins

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Dr Valeed Ghafoor fascinating post.

Dr Valeed Ghafoor fascinating post. I often have similar thoughts. “ “ “My feeling is recognise that you cant deliver perfection. Try to do the best you can with the limited resources available and as a huge fan of the Star Trek films balance the needs of the many with the one. Do want you can for the person in front of you with the time you have but think of population health initiatives too. Perhaps we should measure total absolute risk reduction. Getting a load of people to say stop smoking may have more overall effect than treating one persons BP ever more strongly..” “ “In my clinical trials role I often have the luxury of time to review a persons care before enrolling them on a study (its important for a clinical study that the subject is on the “best” current treatment before randomisation so any improvement is due to the IP) often you find things not done, not optimised, not chased up. I have with my entrepreneurial hat on wondered if there was a market for a private complete care review service.

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This is an interesting article and topic.

This is an interesting article and topic. When I started as a GP Partner in 2000 in south Cheshire. We like most areas had a large scale GP cooperative - run on a not for profit basis with all the local practices taking part providing 24/7 cover. We had a central urgent care centre - we had cars with drivers and nurse practitioners triaging the calls. There was a board of directors - managers running it. It was all disbanded by the government at the time without any evidence that I saw - presumably because they thought the hospitals could do it better and cheaper….

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A great success .. or a poorly evaluated one?'

A great success .. or a poorly evaluated one?“ “My worry is policy is decided on headlines not robust numbers.

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Could RPA help with this problem?

Could RPA help with this problem? or have people another solution?“ “ “Our local community services are on EMIS (now optum) community. We are on EMIS web. we have a data sharing agreement in place and can “see” each others records through the “see all records” tab. and this is good…“ “ “However in a lot of cases there is data in one set of notes - that could do with being in the other set so its searchable. e.g. ethnicity, BPs, whole range of data.” “ “EMIS doesnt appear to have any way of copying across pre defined sets of data from one record to another. Could RPA solve this? have 2 windows open - one logged into each system - select a pt - check for data in one system - copy it to the other??” “ “OR is there an API answer to this? I know this has caused a lot of issues.. what do others do.

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What are we printing?

Despite the reduction in printing prescriptions since eps practices still spend a lot of money on printer consumables. Although in theory we get our printers for free the consumables we pay for. As we get printers in drips and drabs we have a variety of different models all of which seem to take different cartridges or toner. We have a store cupboard full of these sort of which may be out of date some of which may be for printers that we no longer have despite the fact that you can pretty much order everything next day if not same day delivery we must have hundreds of pounds tied up in that cupboard.

I was recently speaking to Lee Brear about an idea that he proposed and I wondered if anybody had done something similar or was interested in speaking to him about it. I’m not on commission and there’s nothing in this for me other than promoting what sounds like a good idea and seeing what you all think of it.

His idea is to replace all the printers in your surgery with a brand-new Internet connected printer of one type. The printers speak to a central supply source about when they’re running out of ink and the ink that is needed arrives in the post with a message on it saying please put me in printer X. This is all done for a small monthly fee. He claims he’s done audits in practices to show that this can save up to 50% of their consumable costs. It also means that practices get brand-new printers which in theory saves the CSU/ICB money. Of course part of the audit is rationalising how many princesses you need because there’s no point having three per room…

So thoughts, what am I missing? Is it a good idea? Anybody want to speak to Lee about it?

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Really useful feature that will reduce phone calls to general practice as well as…

Really useful feature that will reduce phone calls to general practice as well as pharmacies

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Ambient AI is so exciting and a complete game changer.

Ambient AI is so exciting and a complete game changer. However understanding the rules/goverance and legalities are important. This is a document Howbeck Healthcare Limited has produced for the practifces we work with. Feel free to share (but please keep the attribution)

Attached document (PDF) →

Attached document (PDF) →

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Apparently I’m not meant to call'

Apparently I’m not meant to call“ “It the PEEP show

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Great to have you there and cool to hear about all the things you are developing and…

Great to have you there and cool to hear about all the things you are developing and delivering

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I thought we had a great session and nice to see positive comments

I thought we had a great session and nice to see positive comments

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We are rolling out Lexacom's Ambient AI to our practice.

We are rolling out Lexacom’s Ambient AI to our practice. One of my partners last night knocked on my door and said - “wow it really makes you faster - I actually ran ahead for once and was waiting for patients to turn up” “ “He’s a slow 2 finger typer and he likes to record a lot of information. He also admits he cant spell or punctuate - and he was impressed by the speed and quality of the text.” “ “He’s also a GP trainer and thinks it will help GP registrars concentrate on the consultation and connecting with the patient not the note typing which many of them find difficult as they aren’t used it to from hospitals.” “

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Wi-Fi in the Sticks!

A bit geeky this, but living rurally I’d put up with dreadful broadband until about 2 years ago then FTTP arrived I think part funded through some rurality fund. (yeah!)

Now despite being bit of a geek I just let them install their standard modem and APs. OK, it worked and the quality of the internet connection was so much better that I didn’t question it however, I’ve been having a few problems and I’ve realised that of course the ISP are using a cheap as chips router that was just Wi-Fi 6. Now with a lot of gadgets in the house - up to 4 kids and their friends all with new devices that’s old tech - I’ve just upgraded to a Uquiti system (no affiliation) and quite a marked difference. Some devices are connecting on Wi-Fi 7 - I’ve setup a separate 2.4G channel for older IOT devices and perhaps its confirmation bias but everything seems snappier.

I’m not sure what the lesson is: Don’t accept what you are given? Upgrading can be good? Keep reviewing your performance?

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R u a research trained and experienced nurse and or practitioner who lives/works within…

R u a research trained and experienced nurse and or practitioner who lives/works within commutable distance of South Cheshire.“ “ “We are thinking of expanding our amazing team and although no JD/advert just yet Im keen to speak to anyone interested in discussing opportunities.

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Whatsapp - everyone uses it.

Whatsapp - everyone uses it. Even senior Americans who get new jobs for using it. Ive been added to about 20 groups in the last 2 weeks. “ “why? well it clearly works? it clearly has the right functionality or is at least as close to doing what people need as it can be.” “its free” “its cross platform” “however we also use it for home/hobbies etc and it can get messy who you are messaging about what. also really active groups are hard to keep track off - as there is no AI summarisation - yet??” “Anyway should we have a NHS version? thats secure and UK based and owned/run by us and linked to nhs mails? Some areas use Teams but Demises? is that the right word seem to get in the way” “Ive used Slack before and its also great but not free - or at least for big use.” “A load of people use Discord servers - are they an alternative - I appear to get updates from groups ive not read recently which is quite a nice feature” “ “thoughts? does the nhs need a. IM platform or just leave it to whatever in vogue?

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the agenda looks great - with some great speakers'

the agenda looks great - with some great speakers“ “the range of sponsors looks amazing - lots of useful products and tools to help practices!

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My wife Dr Carolyn Paul presenting today in London at a research conference on patient…

My wife Dr Carolyn Paul presenting today in London at a research conference on patient recruitment and retention on which she is an expert with a fantastic track record

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Secret AI Club?

OK this is a first. Just been complimented on the quality of my Advice & guidance request by a local consultant who is known to be shall we say a little grumpy about some referrals.

Well when I say me… I mean Lexacom’s ambient AI although he doesn’t know it.

It was a particularly difficult consultation with lots of symptoms - lots of drugs - quite a few changes in meds/ changes in symptoms. The advice I was wanting was quite technical about dosing and further tests needed to be done.

Well my response from A&G not only complimented the info given, the clarity of the questions being asked - it answered them all and I now know what to do and when to refer. Of course the A&G request was written by the AI not by me - I proof read it of course and made sure it said what I would have said if Id had the time to dictate it.

Of course, what if the reply was from an AI? Would an AI compliment an AI to get more AI being used?? Is this some secret AI club?

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Come listen to me talk about AI in general practice.

Come listen to me talk about AI in general practice. Im speaking at the virtual MPE event on Tuesday.“ “ “This is ahead of chairing our very own NW AI conference next month in Chester.” “ “My talk on Tuesday will cover - what is AI? (in simplistic terms), types of AI, how AI is being used in primary care including my experiences of ambient AI - and things to think about when implementing AI - if we get time I may cover how it might be used in the future.

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I realise i may have asked something similar before but what 'GP' rota software do people…

I realise i may have asked something similar before but what “GP” rota software do people use and find useful. “ “ “we have over 100 staff. 25 docs. 10 nurses. etc not so bothered about tracking holidays.. and not looking just to track on calls. we need something more - something that can cope with different departments have minimum staffing levels, perhaps copes with different staff skills and always need someone in who can deal with X, something that tracks room usage to make sure that we dont have more people in than rooms.

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Really pleased to have some more big name sponsors.

Really pleased to have some more big name sponsors. Over 200 delegates great talks. if you want to come.. get in touch

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Does anyone have a definitive or near definitive list of which conditions count as…

Does anyone have a definitive or near definitive list of which conditions count as needing reasonable adjustments?

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Commercial Research Sessions

As well as being a MedTech Guru - though I am thinking of changing that to Healthcare Futurist (thoughts?) - you may not know that for 15 years I’ve run a clinical trials unit from my surgery doing a range of commercial and non-commercial research.

Well today, with the help of my amazing team, we have achieved a first for us. We have just recruited the first patient in Europe for our new study being run by AZ!

Here is the email - “Dear Neil, Lorna and BaxDuo Research Team at Ashfields Primary Care Centre and Kiltearn Medical Centre,

I just wanted to take a moment to extend my heartfelt congratulations to each one of you on randomising the first patient in Europe - what a phenomenal milestone!

Your dedication, collaboration and commitment to excellence have truly paid off. It’s a huge achievement not only for your site but for the study as a whole and we are incredibly proud and grateful to have such a passionate and hardworking team driving this forward.

Thank you for your tireless efforts in getting us to this point. Let’s continue the momentum!

Kind regards, The Study Start Up Team“.

I’m thinking of running some sessions on how to get into commercial research - anyone interested??

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It’s amazing I’m Loving it - possibly the biggest change in GP IT since SMS messaging…

It’s amazing I’m Loving it - possibly the biggest change in GP IT since SMS messaging possibly bigger!“ “ “And Lexacom customers get it as a free upgrade

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Ok slightly different post to usual - my younger daughter Rebecca is in an art…

Ok slightly different post to usual - my younger daughter Rebecca is in an art competition and as well as the judges prize there is a public vote - with a separate award - id be grateful if you had a look at the competition and voted for your favourite- if that happens to be Rebecca’s then thanks! The piece is one of her A level pieces and it’s very conceptual - she is currently in her first year studying at the University of The Arts London and wants to be a professional artist. A win or high place would be amazing for her“ “ “https://lnkd.in/e3irruYZ

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Over 200 GPs and Practice managers all keen to know if your software/service/product can…

Over 200 GPs and Practice managers all keen to know if your software/service/product can help them.. and now a couple of community healthcare IT managers looking for products that could help hundreds of community staff - can you afford not to come and show off your wares :-)

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Thanks Ben Foster the Howbeck Healthcare Limited team enjoyed helping deliver the…

Thanks Ben Foster the Howbeck Healthcare Limited team enjoyed helping deliver the training- happy to work with others!

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Anyone know of an AirTag like device that is affordable but would work for medical…

Anyone know of an AirTag like device that is affordable but would work for medical equipment?“ “ “We have 2x £700 hand held paediatric pulse oximeters. We have 2 floors, 30 clinicians and lots of rooms. Finding it - especially when people haven’t taken it back is hard and time consuming.” “ “Is there an AirTag like thing (not sure airtag would work) that we could use to track / find it (them)” “

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Anushta Sivananthan time to buy into AI?

Anushta Sivananthan time to buy into AI?

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Do you use GPteamnet at your surgery?'

Do you use GPteamnet at your surgery?“ “Im going to be honest - not my favourite piece of software.. however their new App called Huddle which i only found out about this week looks good - gives me direct access to my holidays and some other practice info. maybe more coming??? good start!

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Load of NHS E docs out today!'

Load of NHS E docs out today!“ “https://lnkd.in/deke-Fqb” “

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A great example of PCN working with IT.

A great example of PCN working with IT. My DTL Lois Hockenhull has just used Paco connect from Blinx Solutions to run a cross practice (7 practices) search IDing kids suitable for the Covid spring booster campaign from across the PCN.“ “ “She has sent an email and sms text invite to them/parents/carers and has setup a centralised appointment book in Paco connect for them to book into. The service will run at our hub location - staffed by PCN staff using Paco appointments on the day.” “ “Practices havent had to do anything other than sign up to the data sharing agreements. Quick efficient and joined up! We haven’t had to have 7 logons, get 7 PMs to answer emails (they do know we were doing this) and coordinate. All practice invites went out at same time. We even imported a CSU built EMIS search into PACO to ID the kids.

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Time to Allow Specialist Nurses to Sign Death Certificates?

Is it time for specialist nurses to be allowed to do death certificates?

Palliative care and end of life care has for years been increasing done by specialist nurses in palliative care teams. They provide excellent holistic care and while I know they are busy too with large case loads - I might say with more time than I have. We are now at the stage where some people don’t really see or interact with their GP in their dying few weeks. In some cases it might not be the same GP who sees them through working days/hours, though here is a group where continuity of care should be strived for if at all possible.

With the new death certification process we now have the weird situation where the new rules say the doctor seeing the patient has to have seen the patient at some point in past. At a meeting yesterday it was discussed that in theory you could do a baby check on a person and be asked to certify them 40 years later having never seen them in the meantime.

Given the palliative care teams often know the patient really well. Given they and the medical examiners (who are to my knowledge doctors) have access to the full records - why cant where appropriate these teams put forward a cause of death for the death certificate?

If needs be make it two of them needing to counter sign they agree - or have the GP sign off from the notes that the COD provided makes sense. Is it an anachronism that it has to be the GP doing this?

Now where is the IT you say? well… the whole current process seems a mess with paper and emails and variable access to records in different parts of the country.

Surely something like GP connect to provide access to records and a decent website - where details could be uploaded and tracked and email reminders or tracking of which persons details needed doing and who was tasked and where we were up to shouldn’t be that hard to develop?

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Interesting post. Agree with Gus - a practice's commitment to triage and whether or not…

Interesting post. Agree with Gus - a practice’s commitment to triage and whether or not they are given/bought for makes a huge difference. “ “ “There is a wider point - I know of lots of cases where a practice when choosing an IT product to deliver something - defaults to the “free” one from its CSU/ICB rather than actually doing any assessment of whether it fits with their ways of current or planned future working.“ “ “Practices need to be proactive and willing to spend their money in products that help them

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Is it the end of GP Appraisal?

Apparently we need cuts to NHS England and ICBs. Not just personnel but budgets too. GP Appraisals would be high on my list to chop. Originally brought in post Shipman to “catch” bad GPs - has it ever delivered on that? Watered down repeatedly to a nice chat. Its not internal to an organisation - it has almost no performance data in it - basically its a chat about, how it’s going, what training you have done to keep up to date and what your next years plan is (almost impossible to state given how quickly the NHS changes).

Now I’m not saying some people don’t enjoy it. You get a session out of surgery. Appraisers get reasonably well paid and no doubt some individuals find value in it, but there are alternatives - many training hubs have mentoring and coaching schemes that would give better advice. You can replace almost all of it with a website - upload your training certificates and press a few buttons on are you healthy and attest you are legal. Or make it a requirement that practices do internal appraisals? CQC (who might also be for the chop) spend an inordinate amount of time checking everyone’s been on their training and all policies and procedures are in place - why do you need an appraisal with an outsider who has not access to any of that as well?

Please defend appraisals, but as stated if it was me - they’d be gone - a few million saved - tick!

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Lexacom's Ambient AI

I’m loving Lexacoms ambient AI and I’m starting to get where the productivity gain is going to come from.

Did a longish consultation with mother and her child with a range of issues. She had a list of concerns. They wanted referring back to a specialist they’d seen before but had sort of been discharged from. They named her and the hospital in the conversation.

The AI - summarised the consultation - correctly identified all her issues/concerns and what I planned to do. It then suggested the text of the referral letter - in a much nicer way than I would have put it! I pasted one into the record (full EMIS integration is coming soon) and sent the letter to the sec to send.

The next step will be for the software to do that without bothering the secretary by perhaps linking to Accendas Gateway software or eRS directly.

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How long have I been a GP!?

Yesterday I was seeing a 31 year old chap who I see every now and again, enough that he knows I’m his doctor and I recognise him but not enough that I know his whole life story. He had waited to see me though. He had a cough and wheeze and I asked him about whether he’d ever had an inhaler before or if anyone had wondered if he had asthma. “Think so - when I was a kid” was the reply.

I had a flick through his notes and sure enough I’d given him an inhaler when he was 6! Suddenly feeling old.

It made me reflect on the current turnover of salaried GPs and registrars we have and the drive to online consulting and whether old fashioned general practice isn’t what we should be aiming for?

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If you are a primary care clinician of any sort GP/ANP/Nurse/Pharmacist/PA etc or in…

If you are a primary care clinician of any sort GP/ANP/Nurse/Pharmacist/PA etc or in training to be one and you live or work near/around south Cheshire (Nantwich is where the meetings are held) we are restarting our evening education meetings we have:“ “Evening of Thursday 27th March - CKD and Hot Topics in Renal Medicine for GPs” “Given by “ “Dr Menon” “Consultant in Renal Medicine” “UHNM - Stoke” “  “ “Evening of Thursday 1st May - GUM medicine for GPs” “Given by” “Dr Noel Connolly” “Consultant in GUM Medicine - Liverpool” “ “These are free to attend for HCPs. They are supported by pharma sponsorship (we follow the ABPI regs and the companies have no involvement in the topics speakers or content) “ “Food (a nice curry) is provided.” “Let me know if you are interested in coming or if you would like to join our mailing list.

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Using Lexacom's AI Product in Surgery

Did my first day using Lexacom’s ambient AI product live in a real surgery yesterday - does it need a name? (what about Amber? - lol)
Previously I’d largely demo’d it. This was raw and in the wild.

First thoughts - the basic speech recognition without the ambient AI has improved massively - I actually didn’t find it making a mistake. It also cut out come of my mumbling and corrected my grammar!

The ambient AI is almost unreal to behold and I’ve been playing with things like chatGPt for a while now. It listened to numerous 10-15mins conversations and summaries them really well.

Was it perfect - no… but then as I’m being paid to help improve the product I would say that else I’m out of a job but wow… I normally write perhaps too short a consultation record and this not only better recorded the patients presenting complaint and history it did a really good job of working out what my differential diagnosis was and what my action plan was.

My initial comment from doing it live - you perhaps do need to know its listening and speak out your exam findings and work out a way to make this sound natural. For example listening to a chest - it cant hear what you can.. maybe one day! but either say to the patient im just telling the computer my findings or tell the patient your findings.

I can also see that for those that write massive consultations it could really speed up their work.

I also found it useful to summarise to the patient at the end - which I kind of do anyway - something like “so I think you have X, and our plan is to do….” but this isn’t essential. I had one patient with about 5 issues and it got all of them and what I was doing with each.

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The last meeting had great feedback - join us on tuesday!

The last meeting had great feedback - join us on tuesday! All Free!

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Some are saying that LLM AIs are running out of training materials and that AI won't keep…

Some are saying that LLM AIs are running out of training materials and that AI won’t keep getting better because of this - however think about the wealth of data that coding every consultation every day across the whole country linked to outcomes and test results combined with a wealth of wearable data could provide - we may have only touched the surface of AI insights into health - should we be collecting as much data as possible at every contact and tracking its relevance. ive heard of 2MP cameras that can read heart rate - sao2, bp, temperature. when big companies decided to photo every road of the country we initially thought they were mad now we all use streetview.. should we be flooding the population with wearables (more than we are at the moment and concentrating on the ?over 45s?)

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An interesting podcast about how most people who think they are penicillin allergic…

An interesting podcast about how most people who think they are penicillin allergic actually aren’t and the cost of not challenging this in terms of more expensive antibiotics, resistant infections and potentially worse outcomes for patients. IT DOES MATTER! “ “https://lnkd.in/eHZZuNTX” “

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Is the writing on the wall for companies providing services to PCNs with remote ARRS…

Is the writing on the wall for companies providing services to PCNs with remote ARRS staff. The latest guidance loosening the rules effectively means that practices can move all of their internally employed staff over to ARRS over time. KBS from GPC advising that PCNs just split the money by practice and each practice directly employ what they need.

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What's in the latest contract

If you read my posts, a lot of what I’ve been talking about has turned up in the latest contract.

A concentration on CVD as a way to reduce health inequalities and deliver rapid health outcome gains - tick - UCLPartners and others are leading on this. Also see PocDocs POCT testing.

Risk strat’ing patients to ID those that need a care plan/Continuity of Care approach - tick.

Increased pressure to deliver the modernising GP approach to access - tick.

Talk of reducing paperwork - but little detail on the how.

Move towards the direct reimbursement of clinical staff - but without any guidance on activity levels or staffing levels.

What we don’t have is any clarity on how we are going to deliver the integrated teams approach to healthcare. With GPs and the wider primary care teams under separate contracts with separate pots of money - how are they going to deliver together? In fact despite saying they want to deal with PCNs rather than practices - there is actually very little detail on what PCNs role is going to be other than some form of communications channel. they appear to have watered down the idea of peer command and control.

It’s clear despite some new money - the pressure is on - and the workforce is still stressed - I’m not hearing anyone loving this new contract - a lack of hate isn’t the same thing. We still need new ways of working - productivity savings - efficient IT tools. we need to see what things like AI. ML. RPA. AR. POCT. WAS. can really do.

Change management skills and the onboarding of new tech and the maximisation of its benefits is key - so many practices only scratch the surface of tech capabilities.

Do we need new contractual routes? LLPs? LTDs?
There are lots of inequalities in funding - that haven’t been worked out. there are lots of unwarranted variations in service - that needs QI projects.

We are still in interesting times.

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IMHO Augmented reality is perhaps one of the next big technologies that haven't quite…

IMHO Augmented reality is perhaps one of the next big technologies that haven’t quite made it yet but just needs the right use case

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Thanks Andrew Whiteley!'

Thanks Andrew Whiteley!“ “I’ve long liked and used Lexacom software but was starting to think digital dictation was getting old school. When Andrew showed me their ambient AI and some of the things it could do and his roadmap/vision, I knew they had hit it out of the park and were at the cutting edge. It will be a game changer for GPs and Clinicians working in primary care and I’m honoured and pleased that Lexacom have asked me to be involved in advising them on products and the current primary care landscape. “ “ “For clarity I remain a 4 session a week jobbing GP (25 years now!) with PCN and GP federation responsibilities and will bring this experience and knowledge to the team. I will be delivering this support through Howbeck Howbeck Healthcare Limited with help from the team. Lexacom adds to the list of amazing med-tech companies Howbeck supports.

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Im going to be helping develop this product and am convinced its a game changer!

Im going to be helping develop this product and am convinced its a game changer!

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Once again I'm jealous of Raza's skills and knowledge and range of interests.

Once again I’m jealous of Raza’s skills and knowledge and range of interests. Very interesting blog on ML/AI - well worth a read. “ “ “Raza Toosy fancy coming up for my AI conference to present your predictive work?

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In the post below I talk about the need to have a richer more nuanced coding system.

In the post below I talk about the need to have a richer more nuanced coding system. In yesterday’s announcement about the new GP contract there was a push to expand GP connect and have more people have access to a patients record.“ “ “While this is a good thing - IG puts an onerous on us not only to share but not to over share. Take the example of a person attending a podiatrist - seems more than reasonable to have access to the fact their are diabetic and on treatment for neuropathy but does the podiatrist need to know about their depression history or the fact they’ve had a STD or TOP? (ok these are extreme examples but im not sure patients realise how much information is in their record)” “ “Now there will be a cohort who say - leave it up to the patient to choose and Im sure the intelligent motivated patient will perhaps sit down with their app and perhaps go through a process of vetting their own records and choosing what to share with whom but many wont understand or be capable of doing this and they have rights to privacy and confidentiality as well.” “ “Do we need some form of role based access to a shared summary record? Can AI or RPA help here by automating the process of tidying up the record and choosing what to share with whom?

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One of our team recently started working with me on delivering clinical trials here are…

One of our team recently started working with me on delivering clinical trials here are her thoughts

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The amazing team have been busy

The amazing team have been busy

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My Latest EMIS Request

My latest EMIS request - A Button that temporary switches the script destination to the chemist outside out front door.
Don’t get me wrong I’m a huge fan of EPS and choice. Many pts choose a whole range of pharmacies for their repeat medication and this is great. However almost all of mine want to get their acute scripts from the chemist situated outside out front door. up to 30 times a day if I’m on call - I have to click on eps. click on change one off destination find the chemist downstairs which isn’t always on the screen as its arranged by postcode and some pts don’t live near here… it can take 1-2 minutes per consultation. Just give me a button that as a one off lets me choose that chemist - make it on the screen that I issue the scripts from… save me up to half an hour just clicking…

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Interesting conversation that is quite explanatory to those not understanding how we are…

Interesting conversation that is quite explanatory to those not understanding how we are funded

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If you are running a PCN have you thought of getting some support?

If you are running a PCN have you thought of getting some support?

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Gus is delivering a good product here which deserves more publicity - nice to see nhs app…

Gus is delivering a good product here which deserves more publicity - nice to see nhs app integration happening and personally like the look and feel of- the nhs branding of hero i think works - pts often“ “Tell me they get confused by so many “non nhs” look and feels

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Benefits of API to ICE

I’ve been looking at RPA and AI products (partly ahead of our conference) and it appears that a lot of people would benefit from a proper API to Clinisys ICE.

So many use cases to automate test ordering especially associated with repeat prescriptions and DMARDs but every surgery seems stuck manually loading a patient and then manually ticking what boxes are needed. Some form of API would be amazing - even the ability to upload a CSV file of pts nhs ids and the tests they need would be good.

Has anyone got API access to ICE? are Clinisys on here? You’re hold back primary care :-)

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Was just speaking to my bank and they sent me a notification through their app to prove…

Was just speaking to my bank and they sent me a notification through their app to prove they were who they said they were and to prove to them who I was (using Face ID) - what a cool feature - nhs messaging apps could learn from this!

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Early news - Howbeck Healthcare Limited will be delivering a conference on AI in primary…

Early news - Howbeck Healthcare Limited will be delivering a conference on AI in primary care in conjunction with C&M ICB (thanks John Llewellyn) with me chairing! Date and venue to be announced soon (hint in the next quarter) “ “We are really interested in speaking to inteerestung speakers especially with actual case studies so do get in touch!

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Had a great meeting with Andrew Whiteley from Lexacom yesterday having a sneak peak at…

Had a great meeting with Andrew Whiteley from Lexacom yesterday having a sneak peak at their upcoming new products/services - moving away from digital dictation into the whole productivity space. Was blown away by the possibilities and cant wait to try it myself. Existing customers are going to be really happy!

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Standardising Referrals

With all the talk of elective recovery and standardising referrals (in Pulse today) and indeed referral management in general, it’s not clear why more people aren’t talking to Accenda about their tested and mature Gateway product which frontends eRS and has a range of great features including ability to publish standardised templates for referrals (but also have their auto build from coded data).

My only CofI is some of the practices in my PCN are on a free trial - it’s really good so far and main lesson is you have to have local system buy in for smooth deployment - speak to Ian Cooper whom I’m sure is happy to take your call!

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Time for GP Provider Collaboratives?

Is it time for private equity to join up with GPs? I was asked to create a BHAG! (look it up) so here it is!
Seen a lot of talk about GP provider collaboratives working at scale across 200-500K population. These have huge potential but lots of issues.

There is a lot of work to be done - the whole “shift left” - effectively with the government wanting to cut elective waits - there is a huge opportunity - the traditional way is to hire private consultants - and pay them a fortune - and perhaps for a hip replacement - there is no alternative but for a lot of stuff - the intermediate level stuff - so called GPwSIs GPs with Special interest/knowledge/skills could be the answer.

Private hospitals aren’t known for high volume efficiency - they are known for high priced luxury they aren’t set up like old style treatment centres.

There are lot of GPs out there with advanced training in dermatology, medicine, ENT, gynae, MSK etc and a lot of what gets referred into secondary care could be done in extended primary care and a lot is by some though its variable and as its not funded and the demands on GP time are for other things its increasingly being done less however with estates, organisation and funding a new primary care provider at scale could be the solution. A lot of about to retire GPs might be more than willing to work in their area of interest without the hassle of general general practice.

However leadership and organisation and perhaps funding arent there. GPs are perhaps not used to investing - being trapped in a partnership model trains them not to be and while running small businesses they arent used to setting them up from scratch. GP Provider collabs will get trapped in governance and role and TOR and models unless they have support and funding.

The right combination of business acumen and funding might attract a lot of GPs to do the work - you would need some consultants to provide some clinical governance and you would need some commissioners to take a punt on buying this - but perhaps the time is right?

Now of course some acute trusts might be thinking the same thing - lets employ a load of GPSIs..and do this work - they went for PAs big time so GPs might be there next step, however unlike PE they wont consider a profit share/equity stake which might be what tips the balance for some to join.

Is it time to create a slide deck for an investment round for a new company to take on the left shift?

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Have you seen my post on why doctors need to be replaced by AI?

Have you seen my post on why doctors need to be replaced by AI?

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Secondary Care Follow-ups

I try very hard not to bash my secondary care colleagues. We are all on the same side - we all have issues - we perhaps don’t understand the pressures we are each under however yesterday I had a bit of a laugh.

We recently had a paper from our Sec State Health suggesting that a major priority for the NHS is reducing unnecessary follow up appointments - and how we can use the NHS App/AI/PROMS etc to help here.
I was reading the post weekend discharge summaries and came across an 82 year old lady whom I knew reasonably well who had about 5 co-morbid conditions who had been in for a minor stroke. She was on all the right meds and was doing well - or at least was stable. She was discharged with a comment for GP to monitor her.. like we were going to ignore her.. and a comment that they would see her in a year in out-patients for a follow up. I couldn’t work out if this was a mistake or a rather optimistic assessment of my care of her that id keep her going that long. Made me smile. I suspect when they get to a year - it will be delayed :-)
Perhaps they need to start with reviewing who they are following up and why?

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Puzzled by the focus on AI?

Puzzled by the focus on AI? I was too until I read Noise by Daniel Kahneman Affiliate link: https://amzn.to/4fX8l1v“ “ “While not about AI per se the book discusses in length a topic I find fascinating which is the variability in decision making especially professional decision making. “ “ “The book clearly points out there is a difference between bias and what they term noise. There are indeed different types of noise - some is between people some is between the same person at different times though there are other types.” “ “The book looks at a lot of legal cases - presumably as they are in the public domain and can be analysed but it also looks at diagnosis and prescribing decisions. “ “ “Which when analysed are often very noisy. For example Doctors tend to prescribe more codeine to patients at the end of the day. Hunger and tiredness make huge differences on performance. “ “ “In some ways we aren’t surprised by this and perhaps accept it but should we? Should the tests you get or the diagnosis depend on whether your doctor had time for lunch? Shouldn’t we be aiming for consistency and efficiency?” “ “The book in one of its sections looks at how algorithms can out perform humans. Even quite simple algorithms, but it also looks at multi-variant regression analysis and also Machine Learning - ie AI - which goes what - often wins over humans.” “ “Humans interestingly often believe there is something special about the case they are seeing when actually it isn’t special and it’s in the algorithm. Although perhaps paradoxically the book points out the real role for humans is knowing when the algorithm doesn’t apply.” “ “So AI - reliable - unbiased (if trained properly) - consistent, efficient, more accurate. This is why people think its the future.” “ “What we need to understand and perhaps train people on is what should we be doing? If the AI is better at decision making than us - what is our role? “ “ “Clearly knowing when the AI training isnt right - this is harder than it sounds..” “Perhaps in communicating the outputs of the AI?” “ “What should the doctor of the future be learning now if AI is going to take over and probably do a better job!

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Should be a good session.

Should be a good session. We have TPP talking about their roadmap and plans and me doing an introduction to patient segmentation and what we are doing in my area. If you have any questions and or experience in your area that you would like to share - get in touch.

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Ive been flattered into resharing this!

Ive been flattered into resharing this! it certainly looks worthwhile!

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Should be an interesting session - come join us!

Should be an interesting session - come join us!

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Is it time to change QOF?

Is it time to change QOF similar DES/LES contracts and stop spending effort on patient groups that have little to gain and aren’t a productive use of resource?

We know there is little hope of new money. We therefore must do more with what we have. Given everyone is working hard we need to stop doing some things. This week we have had acknowledged by the government/NHS E that a lot of follow up outpatient activity is a waste of time. I could have told you that 30 years ago when I got told off by a consultant I worked for as a registrar when I discharged all his patients and gave him the shortest new waiting list meaning clinics got busy! A neighbour who is semi-retired paediatrician has been for the last year working in a local hospital just discharging children from follow up - so it’s still happening.

However as a Primary Care physician I know over 80% of contacts happen in primary care and we need to do the same thing as we are full to capacity too. We need to find contacts we don’t need or perhaps concentrate on those that add value to the system and in passing do the best to an individual’s health.

Hence what we need are tools to help us with Impact-ability modelling.

To give an easy example:- knowing which patient has the highest risk is one thing. I can risk stratify my PCN list and rank patients by risk quite easily. One option might be to stop seeing patients for annual reviews by say month of birth (which a lot do) and see those at highest risk first - working down the list. You could argue you are seeing those that have the most need first this way. But that’s not necessarily true.

Some of these patients will be high risk because of age or stage of disease. Many may be being seen all the time and on maximal therapy.

What we really need to do is identify those who have the most to gain from an intervention.

Who isn’t on maximal therapy - who isn’t being treated to target. who has the most to gain in terms of mortality / morbidity improvement. Often these might be your more deprived patients and one potential benefit of a “prioritise gain” approach is it might help reduce inequalities.

Of course we need to understand how much each intervention benefits a person - an interesting article this week seems to suggest NICE doesn’t always get it right. and the person needs to engage. As a GP I will say a patients idea concerns and expectations need to be taken into account and these aren’t always what the text book says.

However we need more tools - keen to hear your experiences/thoughts.

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