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Ed Turnham Profile picture
Ed Turnham
@EdTurnham
GP partner. Clinical Advisor for Digital Strategy, Norfolk & Waveney ICB. A lucky husband and father. Views are my own.
Jan 15, 2023 • 25 tweets • 8 min read
A thread on this week's other GP controversy.

Here's why more specialist services should be accessible without a GP referral, and why we should stop thinking of GPs as 'gatekeepers'.

@TomPMarshall @mancunianmedic @BenAllenGP @doctor_katie @ClareGerada @dave_dlt @MinalBakhai Expanding direct access is in the latest NHSE guidance, but we should seek to go much further.

england.nhs.uk/wp-content/upl…
Jan 7, 2023 • 21 tweets • 9 min read
There is one strong argument in favour of moving to large-scale salaried General Practice.

Even so, this is a very risky approach that could throw away most of what is good about GP. A thread:

@wesstreeting
Here's the argument in favour.

Most of the economy is far ahead of healthcare in the use of technology and automation.

I can take out a credit card or an insurance policy with no need for intervention by another human.
Oct 31, 2022 • 21 tweets • 10 min read
Plans to automatically give all adults online access to their full GP record are failing - for the third time.

Let's look at what's wrong with this project, and what it tells us about the problems with NHS IT and management.🧵:

bma.org.uk/news-and-opini… The go-live date was pushed back from Dec 2021 to Apr 2022, then to 1st November. Now half of our duopoly of electronic record suppliers say they won't go ahead, and many practices are refusing their consent. @EMISHealth
Oct 14, 2021 • 10 tweets • 4 min read
Early thoughts on today's @NHSEngland guidance on GP access: a short thread🧵
england.nhs.uk/coronavirus/wp… The guidance assumes that it is inappropriate for less than 20% of GP appts to be F2F (face-to-face).

I'd be fascinated to see the evidence that shows this is inappropriate. Unfortunately there is no reference to such evidence in this document.
May 30, 2021 • 26 tweets • 9 min read
New data suggests GP Online Triage/Consultations do NOT lead to increased patient demand: THREAD @MinalBakhai @HelenRSalisbury @mgtmccartney @keithgrimes @MartinRCGP @murrayellender @fhussain73 @bcdelaney1 @ClareGerada @prof_tweet @jacobnhaddad @dave_dlt @sib313 @DrLindaDykes Three Norfolk @NHSNWCCG practices have used Total Online Triage since 2019. All patient requests for clinical help are entered into the online system, either by patient or receptionist.
May 11, 2021 • 19 tweets • 8 min read
Why that @prof_tweet modelling paper does NOT show that online triage increases GP workload, and what we can learn from it. THREAD⬇️
@MinalBakhai @HelenRSalisbury @padsbigsis @mgtmccartney @keithgrimes @MartinRCGP @murrayellender @fhussain73 @bcdelaney1 @BenXGowland @ClareGerada I preface this by saying @prof_tweet is great and his 2018 Mackenzie lecture profoundly influenced my thoughts on general practice.
spcr.nihr.ac.uk/news/james-mac…
Apr 1, 2021 • 25 tweets • 6 min read
Lots of debate recently about triage in GP. Here's a thread with a detailed argument:

@MinalBakhai @SteveLaitner @dave_dlt @dr_musgrave @sib313 @stevekellGP @HelenRSalisbury @H_Atherton @jacobnhaddad @SiliconPractice The short version:
- there's no such thing as no-triage General Practice
- it's reasonable to argue that traditional model beats current model, for some practices, but:
- tech improvements will make a triage model far superior to traditional model.
Apr 1, 2021 • 17 tweets • 3 min read
(section 2 of mega-thread)
Part 4. There is no good evidence that patients want everything to be done face-to-face. In fact there is strong evidence to the contrary. Obviously, will vary between patients and according to the nature of the problem.

It's OK to defend the 8am telephone scramble, the 4 weeks waits, and forcing patients to take half a day off work for a straightforward problem. But be in no doubt that this does no favours for some of our most vulnerable patients.
Dec 31, 2020 • 7 tweets • 3 min read
GPs about to hit a perfect storm:
⬆️Covid-induced demand
⬆️demand from 2ry care delays
💉nurse/HCA clinic time lost to vaccinations

GPs urgently need specific guidance empowering us to suspend a large proportion of routine work.

THREAD to explain why this is needed ⬇️ @FSRH_UK has probably been the best at giving pragmatic guidance for GPs, e.g.
- leave in a contraceptive implant for a 4th year
- leave in a mirena for a 6th year
- reduced requirement for BP monitoring for contraceptive pill

But in most clinical areas such guidance is lacking.
Nov 20, 2020 • 12 tweets • 3 min read
THREAD: An example of how tech could save time++ & improve care in General Practice.

It will sound like a pipe dream to GPs, including me. But in other industries this level of automation is standard. It doesn't require AI or anything flashy.

Key:
=❌impossible currently A man's Hypertension review is due. He needs a BP check and blood test.

With no human intervention, the IT system sends him a notification via SMS/email/app. ❌

He does not respond. A week later, he is automatically sent another notification. ❌