Go to main NASGP website
The only independent representative organisation for locum and salaried GPs
Thanks for looking at the NASGP Blog. With over 100 postings and links to both the NASGP website and a host of other websites relevant to Salaried GPs and GP Locums, this is by far the largest resource for Sessional GPs anywhere on the internet. If you like what you see, we’d love you to join, and you can do this very simply for only £8, and remain a member for as long as you like.
I make no apologies for taking a look at another article by Atul Gawande, the Boston doctor who writes common sense. In a recent edition of the New Yorker he asked why doctors don’t have coaches. read more »
Welcome to our 62nd edition, just in time for Christmas. Linda is trying to make sure locums are ready for revalidation, Lucy explains sub-clinical hypo-thyroidism, Judith reckons a lot of Sessional GPs may benefit from coaching, Liz explains inheritance tax, Jason thinks hygiene guidelines have gone too far, Sonia has more careers, Sarah talks about being more open and lots of news from Sessional GP Groups from around the UK.
Inheritance tax is in general only payable on substantial gifts into Trusts or on death. The current rate is 40%. Lifetime gifts are normally PETs (potentially exempt transfers).
If you, or your parents, are looking to reduce eventual inheritance tax liabilities there are various simple opportunities available: read more »
After a serious case of writer’s cramp some years ago, we dispensed with our annual Christmas cards to our Sessional GP Group leaders and instead opted for a gift from NASGP to those around the world who need some support with life’s basics. So this year, on your behalf, we’ve bought safe water supplies for 160 people somewhere in the developing world. This will add to other donations from you over the years that have included goats, some emergency tents and a couple of toilets.
The current edition of GMC’s Good Medical Practice was born 5 years ago this November – and the GMC want to know if it still cuts the mustard. They want to make it more patient centered, and want to make sure it’s relevant to how we work as doctors, and of course are asking for the opinion of Sessional GPs as part of this.
You have until the end of January to give your opinions (they have a very well laid out online Q&A questionnaire, so no enormous documents to read).
Already NASGP members are debating some issues raised in the consultation about working as a locum GP, and members can view the discussion here and are encouraged to join in.
Continuing Professional Development for doctors is like motherhood and apple pie. Yet it is consistently one of the things that our profession has been unable to get to grips with for us Sessional GPs. Back in 2004 the GMC issued guidance on CPD for doctors, and now wants to update this in light of all that’s changed (or more likely what’s not changed!) over the last 7 years.
The GMC has asked the NASGP for its advice on its new guidance, and has started a consultation here (look for The Review of Continuing Professional Development Consultation 17/10/2011 to 27/1/2012).
This is particularly important for both salaried and locum GPs who will be facing a BIG challenge once the revalidation process begins at the end of next year – the issue for us is not going to be revalidation itself, but providing the evidence that supports revalidation. So by ensuring the GMC’s guidance fully reflects the difficulties that Sessional GPs face, we stand a much better chance of making revalidation a much easier process for us all.
Sometimes, being open with patients when things go wrong is not as easy as you may think, particularly if you are a sessional, says MPS writer Sarah Whitehouse.
Following an adverse event, being open and admitting something has gone wrong is essential to maintain a patient’s trust. Encouragingly, in a recent survey 92% of MPS members said that they felt they are open and honest with patients.1 read more »
As a biochemistry student many of the experiments I studied started with a culture of HeLa cells. Why HeLa, I wondered – was it Greek?
Some years afterwards, I read that the cell line came from a patient called Helen Lane. But it turns out that wasn’t her name. The Immortal Life of Henrietta Lacks is a fascinating portrait of a woman and her time and place, a scientific investigation, and a moral tale.
Henrietta Lacks was born in Virginia, the great-granddaughter of slaves on a tobacco plantation. Her education was cut short when she became pregnant by her cousin at the age of 14. In 1951, aged 31, with five children and syphilis, she felt a “knot” in her stomach. She went to Johns Hopkins, the only good hospital in Baltimore open to black patients. She had cervical cancer.
A tissue sample was taken before she started radium treatment. But the cells proved uniquely aggressive, both in vivo and in vitro. Even before Henrietta died nine months later, overwhelmed by metastatic cancer, the immortal cell line which bears her name was being used in labs around the world. HeLa cultures made it possible to test Salk vaccine and within a year to launch mass immunisation against polio.
Her family knew nothing of this until 1973. When they found out about the cells, they thought that in some way she was still alive. They struggled to make sense of it. The barrier between the family and the scientific community was great, the distrust deep. It took the author of the book, an educated white woman, years to gain their trust, and to help them try to come to terms with what seemed to them yet another exploitation.
They had good reason to be suspicious. In 1932 the US Public Health Service had enrolled poor black sharecroppers from Tuskegee, Alabama in a research study, in exchange for free medical care and food. The study was the natural history of untreated syphilis. Participants were not told that, and even after the discovery of penicillin they weren’t offered treatment. By the time someone blew the whistle in 1972, many had tertiary syphilis, wives had been infected and children born with hereditary syphilis, all preventable since 1947. No surprise that many black US citizens still distrust medical research and are leery of preventive medicine.
Are things different now? The Nuremberg code, drawn up in 1947 to prevent anyone using fellow human beings for experiments the way the Nazis had, didn’t stop Tuskegee. And how much research is exported to poor countries where ethical codes are looser?
Henrietta’s treatment was standard for 1951. Then, doctors did what doctors wanted to do and patients didn’t question. As late as 1973 a postdoctoral research fellow was instructed to phone Henrietta’s widower David to ask permission to take blood samples from Henrietta’s relatives. The researcher – recently arrived from China – explained in poor English that they wanted to look for genetic markers. David spoke equally non-standard English. She thought he understood. He said yes because that was what you did when a doctor asked you something. The family thought they were being tested to see if they had cancer, and they waited anxiously for results which never came. The genetic marker study was published, with the family’s names, but no-one thought of contacting them.
Are things different now? We know informed consent is important, but how well do we check that our patients really have understood us, and we them?
Henrietta’s daughter Deborah never ceased to be troubled by the thought that her mother was still suffering somehow when her cells were blasted into space, or irradiated, or injected into prisoners, or fused with non-human cells – to Deborah ‘cloning’ meant making replicas of her mother.
Henrietta lived in a society where racial segregation was legal. Education, health services and prospects were limited and criminality, violence and sexual exploitation were common for those on the wrong side of the colour bar.
Are things different now? Henrietta’s descendants have received no financial benefit from HeLa (and indeed cannot afford health insurance), but they are inching their way out of deprivation. And HeLa may have played a part. Traditional gospel ‘soul cleansing’ helped Deborah bear the burden of her mother’s perceived suffering, but she realised that to understand HeLa, she needed some education. And through education Henrietta’s family have come to feel proud of what HeLa has made possible – including treating the disease from which Henrietta died. Henrietta’s great-granddaughter is the first Lacks to go to university.
Still, Henrietta’s family remain distressed that the cells were taken and used without her knowledge.
Are things different now? It is not just in the Deep South of the 1950s that there is a gap between professionals and the public on medical ethics. Doctors at Alder Hey didn’t feel that it was necessary to ask permission to remove organs at post-mortem, or even live organs if they were considered to have no value to the owner. (The thymus glands of children undergoing heart surgery were removed and sold to a pharmaceutical company.) When these practices came to light in 1999, it was clear the public felt very differently, and the result was the Human Tissue Act of 2004 and the creation of the Human Tissue Authority. Consent is now required for the removal of human tissues and their use is legally controlled. But the removal of Henrietta’s cells would still be legal in the USA, and in the UK samples taken for biopsy can subsequently be stored without further consent. Maybe, in 50 years time, we will look askance at the cavalier way we now treat the ownership of patients’ cells.
The Immortal Life of Henrietta Lacks, Rebecca Skloot, Macmillan (2010) ISBN-10: 9780230748699
P.S. In 1972, when HeLa came to the notice of the general public, Henrietta’s name was not revealed. Who was HeLa? The popular press speculated. The film star, Hedy Lamarr, perhaps? They settled on ‘Helen Lane’.
The 61st edition of the NASGP Newsletter is out now. We loved the NASGP conference, hosted by GP newspaper. Judith was there, and has a great piece for us on Henrietta Lacks. Sara has been out of hours, and Liz answers your tax FAQs. Jason is back with Twinn Speaks, and Lucy from GP Update explains some of the reasoning behind the new BP guidelines. Sonja has some career advice, and there’s a roundup from our Sessional GP Groups.
I have been talking to a lot of new locums recently and thought it would be useful to set out some of the questions I’ve been asked, which may be of interest to both new locums and salaried GPs. I’d be happy to answer further questions in a future article – just email me at the address below.
I’ve been on PAYE up to now, so there’s no need to look at anything before I start self employment
Unfortunately PAYE does not always deduct the right amount of tax. Doctors in training rotations are always at risk of their P45 not following them properly, or having overlapping employments – which can give rise to material under and overpayments of tax. read more »
