GP TechLead

The government and NHS have released their new Covid-19 app. After their disastrous trial on the Isle of Wight, it can be assumed that things have been ironed out enough to roll out for general release. It works via Apple's/Googles Covid-19 API which allows phones to handshake each other over Bluetooth. This API is only provided to healthcare authorities so other app developers aren't able to exploit it to make other apps. It takes the much talked about de-centralised approach to contact tracing, meaning that in theory, the app developer/government wont know which users have been in contact. Countries trying to do the centralised approach have been struggling as Apple refused to let app developers meddle with the Bluetooth settings so have had to adopt this de-centralised approach. Below is the rough blueprint of the two systems.

Flu season starting and people are calling up to try get them done. Normal winters, most people can't be bothered but with Covid as well floating around, people are desperate to get it (in fear that they'll be a shortage). Nursing home residents usually get top priority as just like any transmittable disease, it can spread like wild fire in an enclosed space like a home. It usually is a given that most residents will get it but one relative of a resident did not want his dad to have it.

I recently published my first Flutter app, and one of the hard parts as a newbie was signing and  creating the app bundle from Android studio. There is a good link here walking you through it but it didn't help with the details if you were having any issues. Here is my walkthrough on how to do create your app bundle and what to do if you had issues like me. This walkthrough is applicable to Windows. Once you're happy with your app and created a nice app icon, you're ready to sign it.  Copy and paste this command into the terminal, replacing USER_NAME with your particular username. This will create a key file. You do not need to store the key in that particular folder but just for ease of use and for finding it later. keytool -genkey -v -keystore c:\Users\USER_NAME\key.jks -storetype JKS -keyalg RSA -keysize 2048 -validity 10000 -alias key   Now for me, when I input that command, it did not recognise keytool as a command. The way I fixed it was to download the new...

I had a young man come to see me face to face, he was worried about his testicles. He as worried they were too big. He hadn't noticed any changes recently, no previous medical issues. After examining his testicles, they were large but not abnormal. I asked what made him feel this way. It came out that at his work in the warehouse, there was a bit of a competition amongst his male colleagues. They had decided to see who had the biggest testicles and had decided to whip them out in the back office. My patient had been the winner but was left with undue anxiety of being the biggest testicles at work.

Details have come out about a new fellowship scheme which will be available to all newly qualified GPs (and nurses) working in Primary Care. It will be offered to all newly qualified GPs in a fellowship scheme which will provide at least 1 hour of mentor-ship every 4 weeks and at least 6 sessions of coaching over the 2 years. Locums cannot apply, it is aimed for salaried GPs though partners can apply. It is also offered to nurses interested in primary care but I will not cover that here. You would sign up to a 2 year scheme   and participants receive funded mentor-ship and funded CPD opportunities of one session per week (pro rata), and rotational placements within or across PCNs to develop experience and support transition into the workforce. To allow this to happen, the NHS will pay £10,200 to the practice to release their GP fellow out for a session a week for their CPD and also mentor-ship. Over the 2 years, it will form a sort of curriculum which I assume will mak...

Doctors have to make difficult decisions. GPs generally don’t have to do so as much but occasionally a hard one comes our way. On my ward round at the nursing home, an old 110 year old man was nearing the end of his life. He lived a storied and interesting life, in the army, seen the wars and was an actual rocket scientist. He had seen better days however. He had many comorbidities and had a poor quality of life for several months now. We were treating him for a chest infection, and he had 4 days worth of his second course of antibiotics. His daughter, herself an elderly woman, was concerned about his well-being, he looked unwell, barely conscious and breathless. She asked what we should do once the antibiotic course was finished. I explained that we could either try a third course of antibiotics which may clear up his chest or we could decide that antibiotics aren’t working for this infection and let nature take its course.

Part of being a GP is unfortunately thinking of the bigger picture. We get guidance and directives from our big brother NICE, who make sure we give the most effective therapies clinically but also from a cost-effective point of view. Sadly this occasionally conflicts with the patient’s agenda and can lead to disagreements between doctors and patients. One such disagreement occurred when I had a telephone consult with a newly diagnosed type 2 diabetic lady. Diabetes is a condition where the body can’t control the sugar levels in the blood, and it becomes too high. There are two types of diabetes; type 1 where the body doesn’t produce enough insulin and type 2 where your body doesn’t respond well to insulin. Insulin is the hormone that lowers the sugars in your blood. We treat it with a combination of diet, medication and sometimes synthetic insulin. However the problem with the treatments are that they can flip the blood sugars the wrong way, and you end up going too ...

Part of my duties is doing rounds of a local nursing home. I do it weekly and I enjoy the continuity I get with the patients. The nursing home gives me a list of patients whom they want reviewed and I spend a morning going round the home seeing everyone. I therefore get to know most of them well, but I see one resident a lot more. Dear old Marge is a very anxious lady who is relatively healthy, bar some mild cognitive deficits. She is put on my list almost every week due to her health anxiety, she always feels something is going wrong with her, and every time we check her over and examine her, nothing can ever be found. She is always grateful to be checked over though, so I never mind seeing her. This time though, we get an odd note on our list – “Pill in the poo?”. Saying hello, she tells me that her antidepressant she is on, has magicked its way through her digestive system intact and come out whole the other side. I have my doubts but lo and behold, upon looking in h...

GPs can earn extra money through many different means. One of the most popular ways is to work in Out Of Hours (OOH) or UCC in your local area. These are usually run by groups of GPs or private healthcare companies (Care UK). Most new GP trainees will have done an OOH shift when training but here I'll try breakdown what working life is like for OOH/UCC. OOH is operational when the GP surgeries close (usually 1830) until they reopen again on 08:00 on a weekday. Over the weekend that is 18:30 Friday until 08:00 Monday. Patient's call 111 and if they get triaged for a GP call, they will put onto a central list on the GP's computer screen. They are then called back by the GP who will then try manage the patient - either on the phone, bring them down for face-to-face consultation, schedule a home visit or refer them to A+E. The GP may be the one who is doing the face-to-face consultation or do the home visit. GPs working OOH may be done in a section of a hospital or a...

When GP's qualify, they have a possible decision to make. Do I try find a salaried post or do I locum (work ad hoc)? Nowadays with Covid19, a lot of GP work has shriveled up and there is a shortage of locum and salaried jobs, with news that some have had to go on benefits ... however in this discussion I'll be assuming a pre-covid time when locum jobs were abundant and there was a shortage of GPs. I'll be mainly looking at these roles from a financial stand point in a GP surgery, there are numerous other pros and cons to these roles which are outside the scope of just the money however.

Part of creating this website was to document my forage into making an app, and publishing it to the Android Play store or Apple App Store. I have never programmed and know no coding language. The idea came from a random youtube video, where it was talking about programming, and it talked about Flutter, the new coding language from Google. It supports cross platform meaning I can code it once and it should work on both Android, Apple and even Windows.

There is a useful shortcut to allow you to prepare pieces of text in advance when writing consultations. This can speed up typing up your notes, especially if you normally usually repeat the same information to the patient. In the consultation tab, go to CR config button found above.  Select the 'Quick codes and text' tab on the menu that pops up. Press the 'Add..' button.

Inside EMIS there are very basic macro functions you can do to help speed things up. I'll go through a very basic one which may help you speed up certain tasks and procedures. First of all, go to the top right-hand corner of EMIS where you can find the menu button. Click on the EMIS logo and go to Configuration -> Template Manager.

Following on from my guide on how to install EMIS at home , here is a short guide on how to install other useful programs on your home computer. Best to be on the VPN when installing and running these programs. AccuRx Download and  Install AccuRx installer from here . Log in with normal password, should just work as normal.If not, you can follow the guide here . You will need to open it when you have EMIS open for it to sync with your selected patient. Alternatively you can use the standalone web site which has all the features in the browser - Fleming . However if is a bit more time consuming and it also doesn't save into the notes automatically nor automatically select the correct patient.