GP TechLead

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 Micros...

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 rise...

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 ...

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...

Never expected big numbers with my first app, its quite a niche market and I've done no advertising for it. I haven't put it on the App Store on iOS (no point for £99 a year) but eventually I will. There is a separate app called play developer console which gives you some analytics about the app. It's been roughly 3 months on the Google Play Store, below are the numbers.

Thus ends this short journey. I still have one to do, but isn't quite a matched bet, more of a money-back gamble. In the end it was too time-consuming for me for not enough pay off and it always was quite boring to do. In total I made £957.67 tax free which ain't bad. 

Must admit, the grind of this is getting long and boring. Profit is down as I'm finishing the sign up offers and just relying on reload ones. I learnt how to do ACCA bets this month, but doing it is long... I think I will stop after my subscription ends this month, time spent is not worth the pay off... Here are the stats for this month.

Out of hours is a service that provides primary care when the normal GPs have closed, so is usually available after 18:30 on weekdays and all the weekends. It is also available on bank holidays if the GP surgeries are closed (which is most of the time but during Covid, GP surgeries have had to stay open for 2 of the bank holidays). Ideally issues that are dealt with are ones that are more urgent that can't wait until  you see your regular GP, not a long term issue that requires investigations or referrals. 

So one month in part-time Matched betting, I feel I've made an alright profit. It did take a bit of time near the start but I sped up nearer the end of the month, so it takes much less time making bets. I barely think about it now which does worry me that I'll make a mistake but I've only had a few slip ups (!) - these have actually been me not really reading the terms & conditions of the promotion, and not an issue of placing the bet. I've signed up to the monthly profit accumulator website which has a very useful oddsmatching tool which greatly speeds up finding the deals and finding the odds. You can sign up here  (referral link - both get £20 if you sign up!). 

After introducing this new scheme , there have been problems with new partners getting their payments. Hurdles that were put in the way had been that the probationary period of fixed-profit that a lot of practices put in place when a new partner joins. This period has new partners paid a fixed salary rather than a share of the profits for a short amount of time. When these partners have gone to apply to the scheme, they've been told that they are no eligible for the payment, as they are not profit sharing and also because when do become profit sharing after their probation then they will still not be eligible as they wont be 'new partners'. 

I created an app, very basic and first one on Flutter. I hope to develop more slick versions but it was said to just get your first one out so you know the process of creating, uploading and publishing an app to the App stores. I have only published it to the Google Play store as I don't plan on paying £99 a year just for the privilage of uploading to the Apple App store but if I do create another app, I likely will. It has very basic functions but I find it useful as a reference tool to see what are the current guidelines for cancer referrals in primary care. Give it a download and give it a review if you think its good! Please click here to check out the app!

Matched betting is a system of getting guaranteed profit from bookmakers. It’s been around for years but I’ve never got round to doing it as I thought it was too complicated and it would take too much of my time. Now we can't do much due to Covid, I thought I'd give it a go and will document my journey through this. Profits are likely low compared to time spent but it’s risk free, stress-free and tax-free.

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...