It has now reached the public’s consciousness that the NHS is broken — as we GPs have been saying for ages.

No longer is it possible to blame poor care on healthcare staff: it is obvious that the whole system is overworked, understaffed, inefficient, and poorly guided by a DH which is clearly out of touch with reality.

Read more on Rebuilding the NHS by making general practice more attractive…

Last week Custodes once again headed to Liverpool for the annual conference of the NHS Confederation.

There were some really interesting topics discussed both in the sessions and outside. The one that may seem least interesting to front line general practice is the speculation about who will replace Old Nick as chief exec of NHS England when he steps down.

Read more on Who will be the next NHS chief exec and why GPs should care…

I read yesterday’s newspaper and noticed health minister Anna Soubry’s attack on part-time women GPs. Next week I have to sit examinations in Latin as part of my classics OU degree. I thought perhaps Aristotelian logic might help the current batch of health ministers find their way.

Read more on Aristotle, health ministers and the burden of women GPs…

The events of the last two weeks have left health secretary Jeremy Hunt with a bloody nose.

His statement about a huge rise in A&E attendances since 2004, and the implicit assumption that it is all the GPs’ fault, has got him into hot water. As the King’s Fund revealed a few days later, the apparent increase is simply due to a different method of counting, which now includes attendances at walk-in centres. The DH has been made to look silly: clearly its statistics cannot be trusted.

Read more on GPs have upper hand in out-of-hours row…

One of the consequences of falling incomes for GP partners is the reduction in the discrepancy between partners and salaried GPs.

This week I have spoken to three practices which have decided to take on a new partner, and a partner who has decided to go back to being a GP. The premises can cause some interesting complications.

Read more on Partnership changes and GP premises complications…

There is a point beyond which I stop being amazed and simply despair. A recent poll by the Medical Protection Society has found that 40% of patients think they should be able to amend their medical records without their doctor’s approval, and – wait for it! – three quarters of patients believe their records should be written in simple language, avoiding medical jargon and terminology.

Read more on Whose record is it, anyway?…

What have Earth, Vulcan, Tellar, Andoria, and Alpha Centauri got in common?

Right now there are two kinds of people reading this – the ones who will die a slow painful death trying to look for a connection, stars? moons? book characters?- and the ones who will reach old age and grow rich because they know the answer.

Read more on Can federations help GPs to live long and prosper?…

In my time I’ve done my fair share of out-of-hours work. I still do a bit when the registrars need experience. It is without doubt one of the most challenging facets of general practice.

Read more on Who is to blame for this NHS 111 out-of-hours nightmare?…

The Guardian reported a leaked document this week which disclosed that HM Revenue and Customs (HMRC) was paid £4.5bn from four ‘sweetheart deals’.

These are arrangements that HMRC comes to with taxpayers. Now that sounds like a lot of money to you and me, but as Margaret Hodge, chairwoman of the Public Accounts Committee asked: ‘How much did they not get?’

Read more on HMRC, ‘sweetheart deals’ and GP car insurance…

Whenever an ultra-successful Roman general was awarded a ‘triumph’ – a procession through Rome with captives and booty – he had in the back of his chariot a slave whose sole job was to repeat, time and again, ‘Remember — you are only a man’.

Read more on Returning out-of-hours responsibility to GPs would be ridiculous…

I’m open to what’s-his-name being a substitute. Lets face it, the Silver Fox was the real health secretary, but he didn’t get to the promised land. Even so, as a substitute he’s gone a bit Louis Suarez and then some.

Read more on Jeremy Hunt takes a Suarez-shaped bite out of GPs…

I have had a number of GP clients who have taken over or merged with other practices, some have done well, and others fared worse.

The reasons are complex, but to put it into a simple sentence, the success stories are where the more successful practice gets involved with the less successful.

Read more on GP practice mergers and is bigger better?…

I was speaking to a GP client this morning, discussing the current state of general practice and the depressingly familiar view of the future when an email message popped up on my screen: ‘Hunt wrong to scapegoat GPs for pressure on A&E’.

Read more on Hunt misses point when blaming GPs for pressure on A&Es…

‘What’s my motivation here?’ is apparently a phrase which actors use to ‘explore their characters’.

It’s an interesting concept, perhaps one we might think about applying to our medical practices. All those parents who thought I was jabbing their little prince or princess out of pecuniary interest should look at the storm of activity in Swansea to realise that sometimes as GPs we work for a higher cause than money.

Read more on Don Berwick and how can GPs become capable of the transformation required?…