Ooooooooh, entropy.

The 20k limit is in total per year.

I don’t know about tax I’m afraid.

If you’ve not earned any money this tax year then a pension may not be the correct investment for you as I think that you won’t get the tax relief.

Simon Clarke and FOREST are industry shills.

So if you want, I believe that you can and (unless you need the money in the next 5-10 years) should transfer your money from the Cash Isas to a stocks and shares Isa.

There are two basic types of managed funds, active and passive. Active are where the fund managers make active decisions to try and beat the market (spoiler alert: they mostly don’t) and charge you extra for doing this. Passive are where they use a set of index trackers, but automatically rebalance for you on a regular basis – these are better.

It’s easy to get analysis paralysis and have that stop you doing anything for fear of getting it “wrong” however actually the worst mistake is to delay starting. If I knew back then what I know now, I wouldn’t have started in the way that I did, but I’m still glad that I started anyway.

@mattyfez – what are your ISA’s invested in?

WRT Vanguard, an easy fund to start with is one of their Target Retirement funds, it’s all managed for you.

Then it depends how far down the rabbit hole you want to go?

I’d probably leave £10k in the Premium Bonds for an emergency fund and feed the other 40k into a pension in the most tax efficient way, but I am not a financial advisor.

Tom and Jerry and Battle of the Planets.

Although it was only a few years ago that I found out that Battle of the Planets was actually hyperviolent Japanese Manga, and they just cut all the violence out which is why the plotlines never made much sense.

Yeah I’m not interested in individual shares, just efficient investing in trackers etc.

 it’s an exercise in moving problems around.

Unfortunately very true. It’s also not specific to the NHS.

This week I’ve had a letter from a private consultant about an incidental finding on a scan on a patient, that the radiologist quite clearly states just needs a follow up scan in one year.

However the consultant says because it’s not his area of expertise the patient needs a referral to another specialist, please can I organise?

Well first of all, as is clearly stated in the scan that he commissioned, a referral isn’t warranted.

And second of all, if he wants to make a crap referral and waste everyone’s time, then he should make it himself, rather than fobbing the patient off by sending them to see me and putting pressure on me to make the crap referral, which is actually his responsibility.

I’ve also had two patients this week where the specialists are suggesting random referrals to other specialties even though the patient and their symptoms fall squarely within their own remit.

@roverpig

Most patients view all doctors (except those who are obviously private) as working for the same NHS.

Indeed, in fact many erroneously believe that we are junior to the hospital.

Would your depiction of hospital doctors as lazy, workshy and ignorant survive contact with reality?

The difference between GPs and hospital doctors is that all GPs have worked in hospitals, very few of our hospital colleagues have any experience at all of General Practice, and even fewer a working understanding of what it is that we actually do.

But yes, I’ve had direct contact with my hospital colleagues, and whilst there’s always been a few who aren’t very good, IME they’re getting more common. It’s not so much laziness and being workshy, it’s the arrogance without the competence to back it up. And my friends who are senior hospital clinicians have commented on the same phenomenon.

 Patients need to be advised that PALS are their point of contact for any hospital issues they can’t resolve through first attempts eg calling the secretary.

PALS are no help at our local hospital either unfortunately.

@thecaptain

My guess (and very much an outside look) is that they are just all flat-out firefighting and can’t afford the time to do anything other than the bare minimum for whatever happens to be the top of their heap at that moment in time.

I used to think that, but it’s actually gone beyond that now, and it doesn’t explain the poor attitude when we make them aware of the issue. I’m going to post later about some actual things that have happened, where it’s gone past firefighting into the realms of incompetence.

@martinhutch

My recent experience of the system is that none of you buggers communicate with each other or the patients/clients, whether it’s GPs, secondary care, social services…

I’m sorry to hear that.

Somewhere in hospitaltrackworld, docs are probably complaining about GPs and the quality of their referrals.

Interestingly, in my 20 year career as a GP, every so often a hospital doctor gets a bee in their bonnet about that, and decides to come and audit/educate us about appropriate referrals. Every time they’ve stopped within a day or two because they’ve realised just how much we actually deal with ourselves and the level of clinical risk that we carry on a daily basis.

The last consultant I worked with in the community told me that “basically you do eighty percent of what I do, in twenty percent of the time” which I think is a fundamental truth of being a GP.

Ok, apologies for the delay, it’s going to be a longish post so I wanted to wait until I had some time to write it.

As a few of you have already guessed, this isn’t a singular colleague, but actually repeated behaviours by a group of colleagues.

That group of colleagues are hospitals and secondary care services (services that we as GPs refer our patients into for further care). For succinctness I’m going to use “hospitals” to describe this group from now on, as they make up the majority.

It is doctors (senior and junior, NHS and private), nurses and other therapists.

What started as isolated incidents are now becoming commonplace. Not only is it causing massive problems for us as GPs, it’s causing issues for you as patients. After all if your GP surgery is busy doing the hospitals work for it, then there’s less time and resources to spend on seeing patients, which is our actual contracted job.

Some of the inappropriate things that hospitals are asking us to do are:

• Deal with their abnormal test results.

Apart from the fact that they are paid to deal with their own results, a large part of dealing with abnormal results depends on the context in which they were done, or speaking directly to another specialist to see whether any further action is needed. Both of those are better achieved within the hospital than by dumping them into the GPs lap.

• Providing sick notes for conditions that they’re treating.

Hospitals have been able to do this for decades. Part of the reason that they have is to free up appointments with GPs. Even so it is amazing how many of them refuse to do so, or if they do do them, provide them for a ridiculously short period of time and then when the patient asks for an extension refuse to issue one and fob them off by telling the patient that it’s the GP’s job.

• Make onward referrals for the patient.

Again this is part of the job that they’re contracted to do, it is not part of a GPs job, and it takes a huge amount of our time and effort. Also when a referral is made, ideally it should be to answer a specific question, so it is best coming directly from the clinician who wants the question answered who is also best placed to forward the relevant information. More and more we’re seeing this as a tactic for hospital doctors and their teams to avoid taking clinical responsibility for their patients.

• Follow up their patients appropriately.

Again it’s part of what hospitals are contracted to do, and they’re not doing it, instead telling patients to come to us for follow up. Once again this is not generally part of our job, and actually takes us away from seeing our own patients who are ill.

• Arrange their own tests and investigations

I’m starting to sound like a broken record here, but hospitals are paid to arrange their own tests and investigations, and deal with the results. In most cases GPs are not. However hospitals often don’t, using the excuse of patient convenience as to why not. This is not credible as it’s perfectly possible for most hospitals to use the same test services that we do for our patients, they just choose not to. Tests are better arranged directly by the person who wants them done, so that they can make sure the correct test is ordered (and avoid the Chinese whispers effect) and get the result directly back to them, rather than rely on a chain to pass them on (through the GP) with the associated potential points of failure.

• Looking for spurious reasons to refuse referrals

More and more we’re seeing referrals being rejected for arbitrary and nonsensical reasons. Often to be reversed when we query it. We can only imagine that this an attempt to avoid their contracted workload.

I am going to write a further post with some examples of all these points.

What makes all this even more egregious is that when we politely raise this with our hospital colleagues we are routinely met worth BS excuses, denial and obfuscation.

Interestingly it’s not just me. Two of my good friends who are senior hospital doctors have seen the same trends of their less senior colleagues doing everything they can to avoid taking clinical responsibility for patients and so creating unnecessary workload for their colleagues.

I’ll be honest, there has always been a tendency amongst a proportion of our hospital colleagues to be arrogant, especially to their (perceived as) lowly GP colleagues, but at least in the past we used to have confidence that (mostly) they were competent. Now I’m not so sure.

I agree that dogs are completely feckless with very little sense of responsibility, especially if they think no one is watching, but unfortunately this isn’t one of our dogs.

@eddiebaby

Yes, and the big reveal is going to be just as disappointing.

@gordimhor

Make my own now and then too but it’s a faff

Me too. But worth it. Great with corned beef hash and a runny egg on top.

I’m home from work and tired and so don’t have time tonight to write the update, but I promise I will reveal all tomorrow.

After a tip on here, Branston.

Cheaper, more beans, tastier.

What’s the dynamic here, are you their manager, are they a contractor, are they a third party supplier?

They’re a fellow professional, with contractor status with professional obligations.

I’d cancel the order if they weren’t willing to pass on the reduction.

bodmin has a trail centre

Lanhydrock also has some trails. Neither of them are places that I’d go out of my way to ride.

I wouldn’t say it’s brilliant for MTB, the vertical drop tends to be a bit small.

The Camel Trail is a beautiful multi use trail, but in Summer I’m told it’s pretty much nose to tail traffic.

One of the things for me was believing for a long time that I didn’t have to pay a price to change my situation. In the end I realised that actually, whatever the price was, I had to pay it.

It sounds like your friend is stuck in the denial phase.

I had an appraisal where I became award of what was going on with myself and how toxic it was.

The advice given to me was to work out where my line in the sand (boundary) was of what I was prepared to accept for myself.

I gave in my notice a few days later. As soon as I did I started to feel better.

However I was in a position as a GP that work was easy to find, so I didn’t have that to face. Having said that it has still significantly set my career back compared to where I would have been.

In the long run I’m stronger for it though.

Good pork pies in Pateley Bridge too.

The reviews I’ve read of them have all been pretty mediocre.

Rule 5 definitely applies too.

Don’t smoke. Eat a balanced diet with adequate calcium. Don’t try and do too much on it too soon.

@TheArtistFormerlyKnownAsSTR – it sounds like your Kenevo is too small for you. I had the same problem with my last full sus bike. At the time I bought it, it was bigger than my previous bike and felt more confidence inspiring, however as I started to ride more challenging stuff on it, it had a tendency to throw me OTB.

A longer stem may help the ergonomics of your arm and elbow position and allow you to better resist pitching moment, but it isn’t going to change the weight distribution which is the fundamental problem IMV.

Now having two bikes that fit me, both a full sus and a hardtail, it’s amazing how much more confidence inspiring they are.

Don’t Muc-off do a refillable one?

So, we’re planning on doing it self-supported/flashpacking so staying in hostels and hotels. It would just be a shame to get to Durness and then not be able to make it to Cape Wrath.

@the_kenburg if you message me your email address I can send you a GPX of the route we did from Staylittle which was all ok as far as I remember.

Thanks, that’s what I thought.

I’m just planning logistics for the Great North Trail, and it would be a shame to get almost all the way there and then not be able to make it to the final bit because the ferry wasn’t running.

I don’t know about Android, but on iPhone the steps to do it are as follows:

1. Download the GPX file
2. Open it from within downloads
3. It’ll open as a text file with a list of lattitude and longitudes
4. Press the share/export button (arrow going vertically put of the top of the square
5. Choose the Garmin Connect app from the pop up menu

I’m sure the Android process will be similar.

@pondo I’m no particular fan of hers, but to report her to social services based on her son going on holiday with his mates is both petty and shows a complete disrespect for social service’s time.

Based on what?

Based on the fact that it’s an absolutely ridiculous thing to report to social services.

I’ve only ever seen a guided group up there once, and they’d come as a group, with the guide from elsewhere, but I can’t remember where exactly.

To be honest, the Peaks aren’t particularly remote compared to other mountain biking destinations.

Yes, social services have to investigate everything that’s brought to them, but I strongly suspect that this complaint is from self-righteous social media user who’s got a chip on their shoulder about something mildly controversial that Kirsty Allsop has said in the past.

If so the complainant needs to take a long hard look at themselves IMV.

Ignore her.

She’s a provocateur just like the rest of the grifters.