GP TechLead

In a pivotal move that could reshape the landscape of primary care in the UK, Local Medical Committee (LMC) leaders are poised to vote on a highly contentious motion concerning the role of Physician Associates (PAs) in General Practitioner (GP) practices. The motion, which has sparked intense debate among healthcare professionals, seeks to "condemn" the utilization of PAs for any tasks beyond "administrative or simple procedural duties."

In a resounding vote of no confidence, GPs in England have overwhelmingly rejected the proposed contract changes for 2024/25. The British Medical Association (BMA) held a referendum, with a turnout of over 61% and a staggering 99.2% of participating GPs voting "no" to the contract. 

The recent unveiling of the revised GP contract by NHS England has sent shockwaves through the healthcare community, igniting a fierce debate. While some elements of the contract have garnered cautious acceptance, the British Medical Association's General Practitioners Committee (BMA GPC) has expressed strong disapproval of several key points, raising concerns about the potential impact on patient care, workload management, and the overall sustainability of primary care.

The Type 2 NHS Pension Scheme Self-Assessment Form is a critical document for salaried GPs, solo practitioners, and locum providers to accurately report their earnings and contributions to the NHS pension scheme. The 2022-2023 form deadline is upcoming, so I thought a guide might be useful for those struggling to complete it.

The ever-evolving landscape of primary care finds itself at a crossroads when it comes to the role of Physician Associates (PAs). While some hail them as indispensable allies in tackling the physician shortage and improving access to care, others express concerns about potential compromises to quality and the dilution of the doctor-patient relationship. Examining both sides of this debate reveals a complex picture, demanding nuanced solutions rather than simplistic pronouncements.

The proposed 1.9% uplift to the GMS contract in England has ignited concerns within the general practice community, raising critical questions about its impact on both financial sustainability and patient care. Examining the details of this offer and its potential ramifications reveals a complex scenario with far-reaching consequences. 

Beneath the apparent calm of the UK's National Health Service, a low rumble of discontent vibrates between two pillars of primary care: general practitioners (GPs) and the wave of new roles funded by the Additional Roles Reimbursement Scheme (ARRS). While both share the noble goal of serving patients, they find themselves on opposing sides of an evolving landscape, where questions of territory, training, and the very definition of "good care" spark ongoing skirmishes.

Working as a General Practitioner with a Special Interest in Vasectomies  Vasectomy is a surgical procedure that sterilizes a man by blocking the vas deferens, the tubes that carry sperm from the testicles to the urethra. It is a permanent form of contraception and is one of the most common surgical procedures performed on men. General practitioners (GPs) with a special interest in vasectomies have additional training and experience in performing this procedure. They can provide patients with information about the procedure, answer their questions, and perform the vasectomy safely and effectively. 

The recent announcement of a substantial increase in the minimum wage (up to £11.44 from £10.42) has sent shockwaves through the healthcare sector, particularly among GP partners. While this move aims to uplift the lives of low-income workers, it could inadvertently jeopardize the financial stability of general practices, threatening the very foundation of primary care in the United Kingdom.

Working as a General Practitioner with a Special Interest in Sports Medicine  General practitioners (GPs) with a special interest in sports medicine are doctors who have additional training and experience in treating and preventing sports-related injuries and illnesses. They work with athletes of all ages and abilities, from recreational weekend warriors to professional athletes. GPs with a special interest in sports medicine have a broad range of skills and knowledge. They can diagnose and treat a wide range of sports-related injuries, including muscle strains and sprains, ligament tears, bone fractures, and concussions. They can also provide advice on preventing injuries, improving performance, and recovering from injuries. In addition to their clinical work, many GPs with a special interest in sports medicine are also involved in teaching and research. They may work as part of a sports medicine team at a university or professional sports organization. They may also conduct resear

Working as a General Practitioner with a Special Interest in Aesthetic Medicine  Aesthetic medicine is a branch of medicine that focuses on improving the appearance of the skin and body. General practitioners (GPs) with a special interest in aesthetic medicine have additional training and experience in performing non-invasive and minimally invasive aesthetic procedures. They can help patients to achieve their aesthetic goals, while also ensuring that their safety and well-being are paramount. 

The global sum for GP practices in England has been increased from £102.28 to £104.73 per patient, in order to finance a 6% staff uplift. This is roughly a 2.4% increase. Negotiations between the Department of Health and Social Care and the British Medical Association (BMA) concluded last week, and the BMA's GP Committee said they had done so 'satisfactorily'. The global sum is a fixed amount of money that GP practices receive per patient registered with them. It makes up the majority of a practice's income, and is used to fund all aspects of primary care, including staff costs, premises, and equipment.

On the GP social media, locum GPs are angry that they are unable to find jobs because other allied healthcare professionals are undercutting them. Locum GPs are fully qualified GPs who work on a temporary basis, and they are often used to fill gaps in the workforce when a GP is on leave or sick. However, in recent months, there has been a growing trend of allied healthcare professionals, such as nurse practitioners, paramedics and physician assistants, taking on GP roles.

Has the season of strikes ended? In the news, many professions have now ceased their strike action. Teachers have now accepted a 6.5% pay deal meaning they will not strike anymore. Nurses, paramedics and 999 call handlers accepted a 5% pay increase as well as a one off payment to end the strikes. The nurses were actually in favour of continuing to strike but the turn out for their ballot was too low to legally allow more striking. Firefighters didn't strike but they accepted a 7% backdated pay increase and 5% pay increase this year. 

Aging can cause normal things to look seemingly abnormal, and can make even experienced healthcare professionals fluster and worry, even those that see older people on a daily basis. The care home rounds are one of my highlights of the week, it breaks up the normal week and allows for the continuity of care that is sorely missing in primary care these days. We start with a morning coffee, or in my case Mocha, and I run though the list of patients to see with the nurse in charge. One of the patients was an elderly lady whom the nurses had noticed a lump on the right side of her groin. They wash and dress her and apparently had not seen it before. Wasn't causing her any issues but the carers seemed worried about a hernia. 

Lots of interesting news came for doctors this week in the form of the Budget and also an announcement from NHS England. Jeremy Hunt, the current chancellor of the Exchequer who is control of the countries finances, was previously the infamous health secretary who battled the junior doctors back in 2016. Since then though, he has claimed that he more sympathetic to doctors and has claimed that he will solve the NHS pension issue for high-earning doctors. Well in this announcement on the 15th March has gone some way to solving it.

With the whole NHS seemingly crumbling, it wouldn't be a stretch to say that primary care was valiantly holding up a failing system. Emergency departments with long waiting times, paramedics, physiotherapists and nurses striking, junior doctors likely going to strike, waiting times for elective procedures at all time highs - there is only so much this system can take. 

The healthcare system in the UK is under immense strain. Hospitals are full, emergency departments are facing 12 hour waits and GP practices are closing. The ones remaining are facing huge workload pressures, of patient's demanding appointments from a dwindling numbers of doctors. A browse of GP facebook groups more recently have been discussions on how to manage this workload, from allowing unlimited emergency slots, to triaging carefully once all the appointments of the day are used up so only certain demographics are allowed an urgent slot (children, end of life, etc.), to just closing the list totally and directing all calls to 111. Which one to choose is very individual to the practice, a balance on providing what you can to your patient demographic to protecting your doctors from burnout. 

Money is seemingly what is forever talked about in the news. We're constantly told we're in the cost of living crisis and that we're only steps away from the breadline. There are a few reasons for this, the war in Ukraine, the Covid pandemic and the period of relative boom with historical low interest rates. Those used to super low mortgage rates of less than 1% are now shocked that they are coming back to 'normal' interest rates of 5-6%. However it's not just mortgages that are now more expensive, it's everything such as milk and eggs. This has lead the inflation rate for this month to top 11.1%, the highest its been for 41 years. This makes it hard for us to afford everyday items as our wage has definitely not gone up by that amount. This disparity has led to the many strikes that have happened this year (trains, royal mail) and may lead to more in the next few months (nurses, doctors). 

On Disney+, there is currently a great dramatisation of the opiate epidemic that started in America called Dopesick. It explains the unscrupulous methods that this pharmaceutical company used to market their drug Oxycontin to physicians: nice meals out, filling up their fuel tanks, trips to Florida to listen to pain lectures. It shows the devastation that uncontrolled opiate prescribing can do to patients and seemingly to those around them. In this country, we do get drug reps around here but they don't seem to have as much power to do that sort of thing here. When in hospital, I remember the makers of Vesicare took the urology team out for a curry one evening, and our consultant gave us a talk on the drug. It clearly had an effect, as I remember it clearly and it is front of mind for overactive bladder. In primary care, its more limited to 'educational lunches', the big companies bring M&S and waitrose food, smaller companies bring in tesco meal deals - definitely not

 Doing a weekly ward round at a nursing home is interesting that you get to see people in their home and you get to see them very regularly. You tend to remember the patients a lot better and generally build a better relationship because of it. Because of that, you can tend to talk to the residents a lot less formally than you may do a regular patient. I had a elderly man who had a long term catheter whom i was seeing regularly for his skin ailments on his legs. The catheter was due to him not being able to pass urine freely, so it wasn't going anywhere. It normally was getting changed 6-7 weeks by the district nurses but more recently it was needed to be changed several times a week. The nurses at the home had an idea what was causing it however they felt they couldn't broach it with the patient. Every day after lunch, the patient was given 'alone' time with himself and his iPad and then following that, the nurses noticed cloudy sediment within the tubing and bag of t

Buying a house is generally a big step for most people, a step into adulthood with all the responsibility it entails. First-time buyers have it relatively easy as most sellers love first-time buyers, they don't have the dreaded 'chain', they are potentially naive in regards in what to look for and usually quite keen. But what if you already have a house and you need to sell to get a new place. This is the predicament I found myself in, the dreaded chain. Whilst we haven't found a new place to purchase yet, our current place has been sold so below is some things I've learn about the process along the way.

Everyone is striking these days. The train drivers are always doing it. The posties are doing it this month. There are barristers and firemen talking about striking. More interesting in our case is doctors. The government has reccommended a 4.5% pay increase to doctors. However, not to all doctors. GP partners and doctors in training are not included in this deal. 

For most NHS workers, especially doctors, there may be less consideration for financial planning for retirement. There may be a thought that the NHS pension will be enough and actually with annual allowance considerations for high earners, further contributions will be not tax efficient. However there is another savings vehicle that could be used that seems to be often ignored for retirement, that is the Lifetime ISA (LISA).

Ever tried to get your NHS pension statement from the total rewards statement website? It's a total lottery if it will work. One day it will give an error and say the website is down, rarely you manage to get in (but then the numbers are wrong) and sometimes you get a funny error like below. Not helpful to those that are self-employed.... Very useful total rewards statement website. No reply back, been 2 weeks now. Very efficient system...

I was having a discussion recently about what can those not relying on an NHS pension can do for retirement. Workplaces are legally required by law to give a pension, and though most of the time you should definitely take it (it's effectively extra income if your employer will add to it), it may not be invested in the appropriate funds or might be charging high fees. The two main methods most talked about are Stocks and Shares ISAs (Individual Savings Account) and SIPPS (Self-Invested Private Pensions). They effectively are tax wrappers that shield the growth of the equities within them from tax. Below Are my takes on the pros and cons of each of these products, and when they may be appropriate for some.

Work in GP land seems to be ramping up in intensity and days seem more draining than ever. Every day seems to be full and every day seems to go onto the urgent lists. I wanted to see what my normal day (roughly 8-6) would be like, not on duty or late (12-8), to see where my time seems to go in the day. It was totally random day, so I couldn't cherry pick a particular quiet or busy day.

Primary care is getting busier and busier post-covid, the floodgates of people waiting to see their doctors have been open and staff have been wiped out with sickness, not least more covid. There has been a bit less GP bashing in the media which is a change, though I'm sure its coming soon. The new GP contract states that there will be Saturday 9-5 opening from October onwards - though how this will be staff will be very interesting indeed. I imagine this may be contracted out, and locums will have a good time if they don't mind giving up a Saturday.

Been busy with life so not posted for a while, so much has happened in the world since I last posted. Putin has gone true megalomaniac and invaded Ukraine, and if reports are true, they are doing a valiant job holding him back. Things were already very expensive prior to the war due to Covid but with sanctions flying from the western nations to Russia, it has made things like petrol very expensive. Certain foods are also set to rise, with the bulk of sunflower oil and wheat coming from these two countries, things like bread and livestock which need as feed, will become more expensive. Drivers have already noticed, with petrol prices through the roof, I'm sure we're a few weeks away from 200p / litre. Rishi Sunak tried to stem this tide with his announcement today, increasing the NI limit and taking 5p off fuel duty. Covid seems like a long lost friend...

Previously I discussed the proposals to change the amount of that employees contribute to the NHS pension. Those on lower incomes will be contributing more and those on higher incomes will contribute less. This was meant to be rolled in this April 2022, but this is now going to be started from October 2022 with the final changes to the employee contributions in April 2023.

The annual allowance allowance calculation for the NHS pension is confusing. I wrote about it here but I still have to go back to refresh my knowledge about it. The hard bit about working it out for tax purposes is to think that it's not the monetary amount you contribute, but its the annual growth of the your pension pot. The maths involved makes my head hurt. 

Sometimes face to face is much needed to get a better idea of what is going on with a patient. Usually there are obvious reasons to bring a patient in for a face to face consultation: young children, chest pain, abdominal pain, shortness of breath and more. However the hard part of this age of remote consulting is deciding on when someone needs to come down. It could be the ambiguous history or the story that doesn't quite make sense - sometimes it's better to bring them down. However there is the constant thought of not creating too much covid-19 risk in your practice or putting too much pressure on your clinic.   One lady called in complaining of a weird smell from her armpits, she was smelling onions there. It wasn't just her though, her husband had also been smelling it. It was causing understandable anxiety and also meant they had to sleep in separate bedrooms, which was causing issues in their relationship. She had tried all manner of body washes and deodorants but t

As I write this, I'm stuck awaiting a PCR test for a cough that has come about suddenly. I'm sure it's not Covid but got to make sure, the numerous lateral flows are all negative. It does mean that I'm away from any family this Xmas as PCR test results are taking the maximum 72 hours to come back; previously it was no more than 24 hours. Must be a combination of the extra testing this time of year, the increase cases due to Omicron and possibly less people working in the labs this holiday season. Omicron cases hit over 120,000 cases a day which is mind-blowing, no doubt some form of lock down will happen post-xmas. 

Prostate - a gland surrounding the neck of the bladder in male mammals and releasing a fluid component of semen. Prost r ate - lying stretched out on the ground with one's face downwards. Men's prostates inevitably get bigger as they older and inevitably most men would probably need their prostate's checked. I got one such man in my clinic. He had somewhat managed to avoid anything like that until he got to 90, but time finally caught up with him.

Whenever you go to get a X-ray at the hospital as a patient, you may be able to see the image if you ask the radiographer. However it definitely is not the norm and some radiographers may say it's best to wait for a doctor to review it and tell you the results. That's generally because whilst radiographers can identify some pathology on a scan, their role is not to interpret the scan and they may not be able to tell you what is on the scan. Also patients may see something they may not like on a scan and they will unduly worry themselves with what could be a normal scan.

If you do joint injections, then having a template in EMIS can help speed things up, as well as give useful prompts on what to mention regarding informed consent and recovery. There may be already one on your system but it may not be appropriate to your practice or may not include what you want it to include. Below I'll show you how to create your own Joint Injection template on EMIS which you can customise to how you want it. 

GP Practices have had a few financial obstacles put in its way this year. Firstly there was the 3% pay rise for staff which I have covered before. But more recently, there was an increase in National Insurance (NI) contributions and in the budget last week, an increase to the minimum wage to £9.50 an hour. Financial experts feel the NI changes alone will mean an average loss of £15,000 a year  to the average GP surgery. I feel NI is a very confusing tax to understand compared to income tax, so I thought I'd try to break it down as easily as I can.

Being a GP at the moment is not a popular profession. The perceived impression with the public is that we aren't doing any work and that we're just hiding in our surgeries. Media bashing and Daily Mail articles such as this  are fueling the hatred toward the profession at the moment. The government don't help - their new 'support package' aims to force face-to-face consults and demonise the bottom 20% of practices that don't see patients face to face. GP leaders have told practices to boycott this package and not give NHS England the information to vilify them. I imagine this won't be the last we hear about this package as several urgent BMA meetings are taking place regarding it's implementation.

Going back to my previous introductory  NHS pension post , employee contribution to the NHS pension was tiered dependant on your earnings. Below was the previous banding and employee contribution rates. 

You may have heard in the news that GPs are going to be getting a large money boost in the form of £250 million to help with the winter pressures. This hasn't been received very well by GPs and the BMA as they feel it's not enough and doesn't really solve one of the main issues in this, lack of doctors. I had a quick read through of the plan released by NHS England, and found some interesting points. You can have a full read of the plan here .

During the Covid-19 lockdown, the NHS was doing some big deals. One such deal was with Microsoft to provide all their staff with Office 365. This includes their email services but also 1TB cloud storage, video-conferencing software and importantly their suite of Office programs. This includes their well known MS Word, Excel, PowerPoint and more. This was agreed from the 15th June 2020 and will last until April 2023, though hopefully longer.  Those who have used these suite of programs recently may already know, but if you want to use the latest edition of Word, Excel or PowerPoint, you will now need an ongoing subscription. There is no longer a yearly release of these programs that you would purchase as a one-off, now you purchase a Microsoft 365 subscription that will allow you to download the newest edition of these programs. This allows you to use the online, desktop or mobile office apps. Personal subscriptions start at £59.99/year but with this NHS collaboration with Microsoft,

Previous I discussed the principles of Financial Independence, Retire Early (FIRE) but there is more than one type of FIRE. There is a no one size fits all when it comes to financial independence. 

What is the point of saving? For some it is to buy a house, for others its to buy a nice car or a big holiday. But once you're settled in your living arrangement or there is nothing material to save for, what else should you do with your money? Do you live to work or do you work to live? These deep questions may make you think about the purpose of work and what we really do with our money.

Altcoins in relation to cryptocurrency are any other coins that aren't bitcoin. The biggest one of these is Ether, the coin of the Ethereum network. Sometimes said to be the Silver to Bitcoin's Gold, that is actually a poor analogy. Ether is more of a currency that Bitcoin is, but it's capabilities are almost endless. The technology that the Ethereum network utilizes is far more advanced than bitcoin. Things you can do on the Ethereum network are smart contracts, creation of new tokens and NFTs.

The new to partnership scheme has an attached £3,000 bursary attached to it for new partners. It's meant to teach new partners the non-clinical skills that should serve them well in their new role. It requires you to pay for the course, and then NHS England will pay your practice back on your 1 year anniversary of being a partner. There are several options available that I'm aware of, listed below.

I don't read the Daily Mail regularly but occasionally I get sent a interesting news articles by friends and colleagues. This time, I got sent the annual GP bashing article as the annual pay report is released, titled Rise of the £100k GPs . The actual financial report is published here . 

I briefly mentioned the proposed 1% pay rise for NHS workers in the maternity pay post but now the government has actually come out that there will be a 3% rise for NHS workers  in England. This will include consultants, dentists, nurses, paramedics and salaried GPs. This will not include doctors in training or GP partners however. This is actually more than I thought it would be, but for some, they want more. Consultants are being balloted to see if strike action is warranted as they didn't get the 5% they were looking for. Nurses will get roughly £1000 extra annually on average but they wanted 12.5% (which would be £4000 extra) and may strike as well. Other union NHS staff may also stage a strike if they don't get the pay rise they want.  Seems a bit ungrateful this sign A lot of their arguments are that it's still a below inflation pay rise (which is predicted to go reach near  4% this year ) and wont make up for the years of below inflation or non-existent pay rises.

Before the Euro 2020 final, the whole country was excited, people had forgotten about Covid for the time-being (in a good way), there was talk about a bank holiday being held in August if England won; Boris Johnson had advised employers to allow their employees to rock up to work the next day a little late. I had been asking all my patient's whether "it's coming home" as a light ending to my consultations. I think people appreciated it. People were in a good mood.    However we all know how the story ends. 3 penalty misses later and England came crashing back to reality. No extra bank holiday and still in Covid lockdown, people were in sour moods again. The next day, I was doing a duty session at my practice, urgent call comes on the list. Mental health issues. Call up this young woman in her 20's in tears. Turns out she got a tattoo on her forearm with the words "It's coming home, Euro 2020" and the England flag the day before the final. She was n

As a member of the BMA, I occasionally get promotional emails from them and their partners. One such partner is Chase de Vere, an independent financial advisor. They send out regular notices of their free webinars talking about retirement planning, wealth building and investment advice, which can be be quite interesting to watch. However one such email invited me to get a free 'financial health check' - this seemed too good to pass up! I thought I'd go through what happened during this health check, and to remind you that no company gives you something of value that is truly free. 

Sometimes in the course of the day as a GP, you may have occasional need to edit a drug chart (like palliative care drug doses) or change a document on EMIS. If you have printed out a drug chart then you could just write on the chart with pen, but you leave no auditable electronic trail. You could recreate the document but that may take up more time, and still may leave the wrong document up on the system. What I think is better is to edit a saved Word document on EMIS, which will leave a audit trail on the patients notes and hopefully minimise wasted time. Below is the process on how to edit a saved MS Word document on the patient notes on EMIS.  Have the patient consultation screen open and click on their documents tab.  On the document / drug chart you need to edit, right click to open up the menu and left click 'Edit'.  On the MS Word screen, do the edits that you need to.  Then click on the File button in the top left of the screen, and click 'Save As'. On the nex

One of the ways to become financially independent is to generate income whilst you sleep, passive income. The idea is that you invest either some time or money into a certain idea or thing, and that will generate income for you without any further time or effort. This is how generally the super rich, got super rich. People only have a finite time in which to earn (governed by how much you stay awake) so if you can earn whilst you sleep or do something else, that is the dream of many people I'm sure.

Since the pandemic, GP's have been under fire in the media for supposedly not seeing our patient's face to face, not understanding that most of the changes have come under direction of the higher authorities who requested we try other methods of primary care consulting given the covid pandemic. I can't speak for other practices, but in my area, face to face consultations were still going on if there was a clinical need following a telephone triage or online e-consult. E-consult is an online triage tool that many practices have used to increase access to primary care, there are many but e-consult is the one I am most familiar with. Patient's who complain may have likely forgotten pre-pandemic waiting times for a GP face to face appointment, which could sometimes be up to 3-4 weeks. In this current system, people can get a phone appointment on the day and have their issue resolved, or get a face to face consult within a few days of that if needed. The main difficulties h

Cryptocurrency is the new financial trend at the moment. One month ago, it was at new record highs, with Bitcoin and Ethereum each having peak market caps of $1.1 trillion and $470 billion respectively. However in the last 7 days, a crash occurred which wiped 50% off their respective market caps. This volatility is part and parcel of cryptocurrency and I don't see this ending any time soon. But I do see some cryptocurrencies breaking out and sticking around for the long term, it will all depend on their fundamentals, institutional adoption, governmental regulation and ease of use. One of these is Bitcoin (BTC), and below I'll go over why I think it could possibly stick around for the future, and possible reasons why it wont.  The blockchain If you transfer some cash such as £100 from one bank account to another, a bank or financial institution is doing all the back-end work. It has to check a private ledger of your account; to make sure you have £100 then possibly contact the

 We had a new resident this week at the care home, a 90 year old man who seemed pleasant enough but with quite advanced dementia. Hadn't met him before but was on the round for an initial meetup to see what his baseline was and to go over a few housekeeping things. Due to covid, we have to gown up, face visor and glove up for every resident, which I normally I find very laborious but in this instance, I was glad got the extra use of PPE.

So in NHS pension news, there has been talk about the McCloud judgement. This relates to two different cases made against the government by a judge and firefighters in regards to public service pensions. They won their case against the government on age-discrimination basis and therefore the government will be forced to act. Here is the very simplified break down of this ruling.

Maternity pay is something I have found quite confusing, especially in the NHS. With a spate of new pregnancies in my friendship group, I thought it'd be something I'd revisit. I find it easier to think of it as weeks in the pregnancy so you will notice the fractions, which mean the week of the pregnancy (10th week of pregnancy is equal to 10/40) - hope that makes sense. Also bare in mind this is the standard NHS / BMA maternity leave, if you are employed by a GP surgery then depending on your contract, it may differ from what is down below. 

As a GP Trainee, I took a call from a middle-aged lady from Eastern Europe who had some problems urinating for several days, associated with some lower abdominal pain and back pain. She spoke very little English so she had made her young teenage daughter call in and translate over the phone. This is one of the issues of phone consultations, how can things like this be kept confidential? GPs don't have an easy way to get translation services for phone consults, and not one that would be quick to get. Asking about vaginal discharge is bad enough for a male GP, let alone getting a young daughter to ask her mum. 

As a parent, there are several topical parenting questions. One such popular question is “Will you give your child a smartphone?”. When I was young the old Nokias that could play snake was very popular, but I never got a phone until I was in 6 th form (and it was not a snazzy Nokia). I guess parents back then did not have the dilemma they have now.

Headaches are a common symptom in GP land. They ironically can be a bit of a headache for a GP to manage. There are a number serious headaches that need proper attention and during this remote consulting era, it takes a lot of clinical confidence to manage them over the phone only. 

Due to the chat about 1% pay rises for NHS staff, a discussion amongst friends brought up the NHS pension again. One thing not mentioned previously, was the illness and death benefits that it brings. This document outlines a lot about the 2015 pension scheme and also talks about what would happen if you were too ill to work. This is only applicable to the 2015 scheme; given the recent McCloud judgement, I am unsure if we have all reverted back to the legacy schemes. However, come April 2022, everyone should be on the career-average 2015 (maybe renamed to 2022) NHS pension scheme so hopefully this should still be applicable then. 

The UK has been through a tough economic year, given people have lost jobs, people have been been put on furlough and there has been massive government spending. There has been a lot of money being pumped into the (successful) vaccination drive that will hopefully kick-start our recovery. A lot has been talked about the 'national debt' but given this is a fiat currency, this will always be the case... (possibly discussed at a later date). Rishi Sunak was given the unenviable job of creating a budget plan to try help the recovery which he reveal 2 days ago. Below are what I feel are the biggest changes in the coming tax years.

Like most primary care doctors around the country now, we're all working towards the vaccine effort of vaccinating our local populations. Some are actively giving out the vaccinations, some in a supervising role, some doing the very important task of organising everyone and everything. Uptake of the vaccine has been good with most people very keen on receiving it in with many others who are not eligible yet, calling up wondering when they will get it. One is the hard parts has been calling patients up to consent and inform them about the vaccine. The cohort of patients currently that area being called in are over 80, and may have issues with hearing that can make phone calls hard. Most of these patients have been done now, and we're moving down the age groups. People who cannot leave their home in my area have been able to get free transport to the vaccine hubs which will greatly improved uptake.

Last post I discussed the intricacies of the annual allowance, how earning above a certain amount or being stung by changing CPI's can cause you to be foul of the annual allowance. This post I will go over the lifetime allowance and how it applies to the 2015 scheme.

In my first post I explained how the NHS pension is calculated and it's more obvious benefits - I suggest reading that first otherwise it this may not make too much sense. The main reason I actually wanted to look into it was to calculate the annual allowance and to see if it was worth topping up a personal allowance. What I found was, that it was very complicated so hopefully I will be able to break it down for you in a easy to follow manner. Again, I am only talking about the 2015 NHS pension.

Covid has really been tough for older people, being constantly reminded that this disease is a death sentence for them and having to isolate at home. What has been even tougher is older people in the care homes. They've heard through out the pandemic that Covid has been racing through the homes and a lot of the deaths have been in them. In the care home I help look after, the social isolation has really been getting to a lot of the residents. 

The NHS pension is often a mis-understood financial benefit that many employees generally just forget about. They know a lot of money gets taken from their payslips with the assumption they'll get it back later when they retire. I recently decided to look into it further so I thought it'd be useful for me to break it down as easily as I can. First this to say is that the NHS pension is a defined-benefit (DB) scheme, not a defined-contribution (DC) scheme. What you pay in is not added to some pot of money; it's better thinking of it as a membership fee. There are two NHS pension schemes, the old 1995 final salary scheme and the newer 2015 Career Average Revalued Earnings scheme (CARE). I'll go over the 2015 scheme as it is applicable to most people now (and what I am mostly in). The NHS pension is a guaranteed income for life upon retirement. It is index-linked, meaning that it will increase with inflation (Consumer Price Inflation) every year. This sort of scheme is r