NASGP | The art of GP locuming

In this informative session, clinical psychologists Dr Jess Gough and Dr Alesia Moulton-Perkins from Neurodiverse Online (https://neurodiverseonline.com/) provide a comprehensive overview of ADHD and autism diagnosis, treatment, and patient care. They discuss the current healthcare landscape, highlighting the rising demand for neurodevelopmental assessments and the challenges in diagnosis, particularly for women, girls, and older adults. Also available as a YouTube video https://youtu.be/HLEY7BQrjMEThe presentation covers key topics including:Prevalence and comorbidities of ADHD and autismDiagnostic criteria and screening toolsTreatment options (medication and non-pharmacological interventions)Health outcomes and importance of early interventionPractical advice for healthcare professionals on supporting neurodivergent patientsThe speakers emphasize the need for personalized, holistic approaches to diagnosis and treatment, with practical recommendations for creating more inclusive and supportive healthcare environments.

Join us for a insightful conversation with Dr Kalindi Tumurogoti, who explores his remarkable career path as an international medical graduate turned GP. Discover the supportive work of BAPIO, the challenges facing sessional GPs, and the critical role of local medical committees. Dr Tumurugoti shares personal experiences of transitioning from hospital medicine to general practice, emphasizing the unique aspects of GP work like patient continuity and holistic care. Learn about the professional support networks for international medical graduates and the current landscape of general practice in the UK.

Experienced nurse Claire Coughlan, clinical lead for Bowel Cancer UK, presents the NASGP's second webinar given at 1pm on Thursday 6 February.The main aims of the talk were to give an overview of:-Bowel cancer and the red flag symptoms.-Use of qFIT in symptomatic patients.-The bowel cancer screening programme.-The diagnostic pathway.-Lynch Syndrome.-Bowel Cancer UK support services for GPs and patients.Claire Coughlan is a consultant nurse in colorectal cancer with expertise in bowel cancer follow-up, genetics and symptom assessment. Claire is currently undertaking a PhD in the priorities for bowel cancer follow up care across diverse communities.#TeamGP #BowelCancer #PrimaryCare

Tori Ferguson answers questions on taxes, expenses, national insurance, NHS and private pensions from experienced and new GP locums as well as GPs and GP registrars who are thinking of locuming for the first time in 2025.Also available on YouTube https://youtu.be/r0xu5p1PbWUAs healthcare professionals, we understand the day-to-day challenges you face, which is why we founded NASGP. We are a supportive membership body for GP locums, and we are also home to LocumDeck – the award-winning workforce management platform for GP locums and practices: nasgp.org.ukVictoria (Tori) Ferguson BA Hons, ATT CTA: After working for the NHS Tori joined Honey Barrett in October 2016 as part of the tax team. In addition to dealing with personal tax clients, Tori forms part of the specialist medical team where she deals primarily with tax and pension-tax matters for our doctor clients, as well as assisting with GP practice accounts.The information contained in this podcast is for guidance only, and does not constitute advice given by Tori Ferguson or Honey Barrett. No responsibility can or will be accepted for loss occasioned to any person or entity as a result of action taken or refrained from in consequence of the contents of this article. Professional advice should be obtained before acting on any information contained herein, from your own accountant, or by contacting Tori for a free initial consultation.

This podcast features Dr Sarah Smith, a GP and member of the @leukaemiacare advisory panel, discussing the importance of early diagnosis of acute leukaemia. Learn how: Leukaemia is often diagnosed late, with 37% of cases first identified in A&E, leading to poorer outcomes.  Common leukaemia symptoms include fatigue, repeated infections, bruising, and bleeding.  Symptoms like shortness of breath, fever, night sweats, and bone/joint pain can also be indicators of leukaemia.GPs are advised to have a low threshold for ordering full blood counts if leukaemia is suspected, and to act quickly to get results.The emotional impact of a leukaemia diagnosis is significant, so GPs must communicate sensitively when raising concerns.#Leukaemia #EarlyDiagnosis #GPEducation #BloodCancer #MedicalEducation

In this informative podcast, hosted by NASGP, consultant ophthalmologist Nigel Davies from St Thomas' Hospital shares practical insights on diagnosing and managing common eye conditions in general practice. Nigel offers a structured approach to assessing eye problems, focusing on symptoms and signs, not just diagnoses. The session also covers practical tips on red eye cases, the importance of pupil reactions, and key considerations for conditions like conjunctivitis, retinal detachment, and glaucoma. Perfect for GPs looking to enhance their ophthalmology skills in everyday practice. See YouTube video https://youtu.be/LNklfZ50Joo

In this informative session hosted by the National Association of Sessional GPs (NASGP), Victoria (Tori) Ferguson, a tax manager at Honey Barrett, shares essential advice for GP locums on managing their finances, tax obligations, and pensions. Tori, a chartered tax advisor, offers a comprehensive guide tailored to GPs who are new to locuming or those seeking a refresher on best financial practices.For further advice on these topics, NASGP members can access more resources and guidance on the NASGP website: https://nasgp.org.ukDuring the talk, Tori covers 10 key points to help locum GPs successfully manage their self-employment status. She explains the importance of setting up a personal tax account, notifying HMRC of self-employment, and staying on top of record-keeping and software tools like LocumDeck. Other essential topics include navigating the NHS pension scheme, understanding expenses for tax deductions, and planning ahead for tax payments, especially with looming changes such as Making Tax Digital.The session also delves into the nuances of claiming allowable business expenses, the significance of maintaining separate bank accounts, and the critical need for GPs to view themselves as both a doctor and a business. Tori emphasises the importance of investing in financial education to stay up-to-date with ever-changing tax laws, whether through self-learning or hiring a specialised accountant.The Q&A session further explores real-world concerns, such as handling fraudulent use of unique taxpayer references (UTRs) and dealing with the complexities of IR35 and employment status, highlighting Tori's expertise in resolving practical issues GPs may face.Intro 00:00Topics covered: 1. Setting up a personal tax account. 02:41 2. Informing HMRC about self-employment. 03:38 3. Importance of bookkeeping software. 05:23 4. Record-keeping essentials for locums. 06:25 5. Navigating expenses and the trading allowance. 08:30 6. Pension contributions and time limits. 12:00 7. Managing a separate business account. 15:15 8. Saving for taxes and avoiding pitfalls. 16:53 9. Viewing yourself as a business owner. 20:21 10. Investing in financial education. 21:52Q&A 25:41Highlights: • HMRC UTR fraud cases and how to handle them. 27:46 • Employment status and IR35 for locum GPs. 38:07For further advice on these topics, NASGP members can access more resources and guidance on the NASGP website: https://nasgp.org.uk#GPs #LocumTax #Pensions #NASGP #HoneyBarrett #SelfEmployment #TaxAdvice #GPFinance #MedicalAccountants #MakingTaxDigital #IR35 #LocumDeck

This webinar from Dr. Eloise Elphinstone provides an update on managing unscheduled bleeding in postmenopausal women on hormone replacement therapy (HRT). Key points include new guidance on assessing bleeding risk factors and adjusting HRT regimens. Case studies demonstrate approaches to controlling bleeding through modifying estrogen and progesterone doses or alternatives like the Mirena coil. Guidance is also given on ultrasound results and referral pathways. Options for complex cases involving progesterone intolerance or premature ovarian insufficiency are explored. The talk aims to help GPs confidently manage common menopause issues and determine when specialist referral is appropriate. YouTube of this podcast available here https://youtu.be/2dYJiv8-IIQ

Join Dr Richard Fieldhouse as he talks with Dr Jennie Ferrie, a seasoned GP with a rich international background, now practicing as a locum in New Zealand. In this episode, Dr Ferrie shares her journey from the UK to New Zealand, detailing the nuances of locum work in rural areas, the challenges and rewards of adapting to a different healthcare system, and the lifestyle benefits of living in New Zealand. This enlightening conversation offers a deep dive into the life and career shifts that come with international locuming, providing valuable insights for GPs considering a similar path.

Join Dr Andrew Whittamore, jobbing GP and clinical lead for Asthma+Lung UK, as he delves into the latest strategies and treatments for managing asthma effectively. In this informative session, we explore the essentials of asthma, principles of treatment, and how to support patients towards achieving better asthma control. From understanding asthma triggers to discussing the impact of inhaler choices on the environment, this webinar covers it all.View presentation slidesUseful links:See this talk on YouTubeAsthma and Lung UKInhaler Technique VideosAsthma Action PlansTreating Asthma with AIRFollow on TwitterJoin the Facebook community: Asthma and Lung UK If you're a healthcare professional, this webinar provides valuable insights into optimising asthma care.

In this informative episode of our dermatology-focused podcast, Dr George Moncrief, a retired GP with a profound interest and extensive experience in dermatology, delves into common dermatological conditions, offering his insights into their diagnosis, management, and treatment. Dr Moncrief shares his journey from practising as a GP to specialising in dermatology, reflecting on the challenges and learning experiences he encountered along the way.Throughout the discussion, Dr Moncrief emphasises the importance of accurate diagnosis, highlighting cases where misdiagnoses led to ineffective treatments. He provides practical advice on the use of topical steroids, advocating for their cautious application and the preference for ointments over creams to avoid sensitivities and ensure better treatment outcomes.Dr Moncrief also addresses several skin conditions in detail, including tinea incognito, discoid eczema, superficial BCC (Basal Cell Carcinoma), and perioral dermatitis. He stresses the significance of considering the patient's history and presenting symptoms to avoid common pitfalls in diagnosis.Particularly noteworthy is his discussion on the management of perioral dermatitis and rosacea, where he advises against the indiscriminate use of steroids and highlights alternative treatments that can provide relief without the adverse effects associated with steroids.Additionally, Dr Moncrief touches upon the psychological impact of skin conditions on patients and the necessity of integrating empathetic care with clinical treatment. He concludes the session by answering questions from the audience, further enriching the conversation with practical tips and clarifications.This episode is a must-listen for healthcare professionals seeking to deepen their understanding of dermatology and for anyone interested in learning about the complexities of diagnosing and treating skin conditions effectively.

Join Richard Fieldhouse and Tori Ferguson as they delve into the world of tax advice for GP locums in this episode of the Art of GP Locuming podcast. Tori, a Tax Advisor for Honey Barrett, shares her expert insights on a range of topics including tax returns, pension statements, and the value of using a tax adviser. She also provides practical tips on how to handle your tax affairs effectively and efficiently. Don't miss out on this informative episode, perfect for any GP locum looking to better understand their tax obligations.

Join Dr Sam Merriel, an experienced GP and NIHR academic clinical lecturer from the University of Manchester, as he shares his insights on prostate cancer diagnosis in primary care. In this informative session, Dr Merriel discusses the risk factors, recent changes in the diagnostic pathway, and the importance of PSA blood testing. Discover how these advancements can help improve early cancer detection and address inequalities in prostate cancer diagnosis and treatment.

Join Dr Eloise Elphinstone, a GP with a special interest in women's health, as she provides an insightful update on ovarian cancer, focusing on its implications for general practice. In this webinar, Dr Elphinstone, who works in SW London and has extensive experience in menopause and postnatal health, delves into the complexities of diagnosing and managing ovarian cancer from a GP's perspective.Link to slidesThis session covers:The latest statistics and survival rates of ovarian cancer.Risk factors and symptomatology.Challenges in screening and diagnosis.Case studies illustrating practical scenarios in GP practice.NICE guidelines and primary care tips.Dr Elphinstone also shares her experiences working with the Target Ovarian Cancer organization and the Family Planning Association.Connect with Dr. Eloise ElphinstoneInstagramUseful LinksMenopause Care ClinicTarget Ovarian CancerFamily Planning Association:#OvarianCancer #GPUpdate #WomensHealth #GeneralPractice #NASGP #MedicalWebinar #EloiseElphinstone

In this enlightening talk, hosted by the National Association of Sessional GPs (NASGP), we delve into the critical role of primary care in the cancer pathway. The discussion covers early diagnosis challenges, personalised cancer care (PCC), effective referral processes, support during and post-treatment, and the importance of integrated care. This talk is a valuable resource for primary care professionals seeking to enhance cancer care.* Download PDF or presentation* Watch on YouTube Useful links* Macmillan Support Line Services Referral Form - Email to supportlinereferrals@macmillan.org.uk* Macmillan Cancer Support - Learning and Development Hub * Cancer Care Map - Find Local Cancer Support Services

Welcome to our latest episode, where we dive into the inspiring world of Dr Amy Small. A GP locum with a rich tapestry of experiences, Amy has navigated her career through various roles, from a GP partner in Scotland to a salaried GP in London and a locum in Sheffield. Her journey doesn't stop there; as a passionate advocate in medical politics, she's been a driving force in local medical committees and the BMA. Overcoming the personal challenge of long Covid, Amy has become an advocate for people living with long covid and works for a charity supporting people with the condition, showcasing her tenacity and commitment to health activism. Join us as we explore her story, her unyielding spirit, and her knack for making things happen. Get ready to be inspired by a GP who truly speaks her mind and leads by example. Dr Amy Small on social media TwitterLinkedInLink to this video on YouTubeUseful links Subscribe to NASGP podcastLong Covid - Chest Heart & Stroke Scotland The Cameron Fund

Dr Andy Whittamore has been a GP Partner in the Portsmouth area for 17 years. In that time he has developed an interest in respiratory medicine and gone on to hold a number of regional and national roles. Over the last 7 years he has spent 2 days per week as Clinical Lead for Asthma and Lung UK and has recently worked as NHS England's Clinical Champion for FeNO.The talk was the penultimate NASGP monthly clinical webinar this year, and you can view the slides here: https://www.nasgp.org.uk/resource/slides-asthma-and-feno-testing-in-general-practice/YouTube00:00 Intro00:50 Talk33:33 Further reading34:00 Q&AConnect with Andy:LinkedIn | Twitter

Nick Pollard and Dr Elizabeth McNaught of Family Mental Wealth CIC explain the work they do, provide advice for GPs and answer audience questions at NASGP's September 2023 webinar. Get 50% off e-learning at familymentalwealth.com by logging into your NASGP members offers section for a discount code.Get an invite to our next free event at https://nasgp.org.uk.Eating Disorders (Oxford Specialist Handbooks in Psychiatry)

Terry Bentley-Darby BA (Hons) is a Senior Tax Manager at Randall & Payne, members of the Association of Independent Specialist Medical Accountants (AISMA). He works for a portfolio of clients particularly in the medical sector. Terry answered questions around VAT, slef-employed vs limited company, NHS pensions and much more.

GPs can learn more about oesophageal cancer by listening to this podcast, or watching a recording of our June 2023 event on YouTube https://youtu.be/dRg2i1WXebkProfessor Rebecca Fitzgerald of Heartburn Cancer UK led ‘Oesophageal cancer: what GPs need to know', NASGP's clinical lunchtime webinar for June.

Inflammatory Bowel Disease with Dr Charlie Andrews from Crohn's & Colitis UK.Also view on YouTube GP resources: https://crohnsandcolitis.org.uk/our-work/healthcare-professionals/community-healthcare-professionals

On 01 September 2022 we were delighted to host Dr Helen Garr, Medical Director from Practitioner Health, to our regular monthly educational webinar.What are the signs and symptoms, and what can you do about it? You can also watch this talk as a YouTube video here https://youtu.be/M1uSNNjgRC8

Welcome to this recording of June 2022's NASGP monthly lunchtime webinar, where we are joined by Dr Tony Downs for a talk on the management of actinic keratosis.As well as hosting as live events, we also publish these as a YouTube video and a podcast, and include a link to the slides in each episode's show notes.Look out for your Monday morning emails from us with details about the next talk, which in July will be on bowel cancer.Thanks for listening or watching, and hope you enjoy the talk.To view slides https://www.nasgp.org.uk/wp-content/uploads/Diagnosis-and-management-of-actinic-keratosis-by-Dr-Tony-Downs.pdf

Dr Tina Peers joins us from The Menopause Consultancy in a talk to 40 NASGP members, followed by a Q&A. View Tina's slides, or view on YouTube.

Judith Harvey speaks to Richard Fieldhouse about the seventh age of man and her latest article on the NASGP website https://www.nasgp.org.uk/resource/judith-harvey-netflixs-my-love-is-an-uplifting-watch-for-us-gps

How many New Year Resolutions have you kept? If I don't get around to clearing out the box room, no-one is going to hold me to account and it isn't the end of the world. How many countries fulfil their undertakings to cut carbon emissions? If the nations of the world fail to cut carbon emissions, the world may indeed end. If it ends, who would hold them to account? What if we had a single measurement for the nation's health? Judith Harvey outline's the need for the new Health Index, currently being compiled by the ONS. https://www.nasgp.org.uk/resource/the-health-of-the-nation-whos-keeping-score

Judith Harvey speaks to Dr Richard Fieldhouse about her article on the critically acclaimed documentary '76 days', shot during the very first days of the pandemic.

Dr Leila Saeed is a GP in Buckinghamshire, and talks to NASGP chairman Dr Richard Fieldhouse about approaching difficult consultations with patients. Original article.

https://youtu.be/u4wdyASH0UI In our 114th edition, Claire shares some flowers with us; Victoria is sceptical about the rollout of remote consultations, and Richard has similar feelings about locum banks; Rachel has advice about the coming winter and Liz debunks some mythts about 'overtime'. Judith has some questions about masks, and Louise has an update on anaemia in pregnancy. Scroll down to hear the podcast, or subscribe to it in your usual podcast app. Click to view the magazine

https://youtu.be/u4wdyASH0UI - In our 114th edition, Claire shares some flowers with us; Victoria is sceptical about the rollout of remote consultations, and Richard has similar feelings about locum banks; Rachel has advice about the coming winter and...

https://youtu.be/gsLTy0Wr2gA In our 113th edition, Claire has painted another beautiful cover picture, Isobel has been looking at locums as GP tutors; Judith doesn't want us going backwards, and Louise has an update on AAA; Nigel has an update both on DIS and some childcare help; Liz has an SEISS update and Rachel has some good advice for when we're in a rush. Scroll down to hear the podcast. Click to view the magazine

In our 113th edition, Claire has painted another beautiful cover picture, Isobel has been looking at locums as GP tutors; Judith doesn't want us going backwards, and Louise has an update on AAA; Nigel has an update both on DIS and some childcare help; Liz has an SEISS update and Rachel has some good advice for when we're in a Continue Reading The post Podcast | The Sessional GP Magazine June 2020 appeared first on NASGP.

Richard Fieldhouse reviews the latest edition of the Sessional GP magazine. In our 112th edition, Liz has summarised the government's advice about financial support for locums; Rachel from MPS has advice on how to practise in these times; Judith's been keeping a diary; Louise has reviewed the latest guidance on leg ulcer management and Nigel's looking after your financial health. Scroll down to hear the podcast. Click to view the magazine

Richard Fieldhouse reviews the latest edition of the Sessional GP magazine. In our 112th edition, Liz has summarised the government's advice about financial support for locums; Rachel from MPS has advice on how to practise in these times; Judith's been keeping a diary; Louise has reviewed the latest guidance on leg ulcer management and Nigel's looking after your financial health. Continue Reading The post Podcast | The Sessional GP Magazine April 2020 appeared first on NASGP.

In our 111th edition, Louise provides a roundup of Nice's clinical guideline on management of thyroid disease, Liz gives some more advice on returning to work after maternity leave, Rachel goes through some scenarios when locums give feedback to practices, and Judith takes a look at antibiotic resistance. Scroll down to hear the podcast. Click to view the magazine

In our 111th edition, Louise provides a roundup of Nice's clinical guideline on management of thyroid disease, Liz gives some more advice on returning to work after maternity leave, Rachel goes through some scenarios when locums give feedback to practices, and Judith takes a look at antibiotic resistance. Scroll down to hear the podcast. Click to view the magazine The post Podcast | The Sessional GP Magazine February 2020 appeared first on NASGP.

Richard Fieldhouse reviews the latest edition of The Sessional GP magazine. In our 110th edition, Rachel has some seasonal advice, Tina loves LocumDeck, Claire has some warming paintings for us, Judith unmasks a ruthless dictator, Louise gives a comprehensive rundown of hypertension in pregnancy and Liz has some great tips if you're in the process of making babies. Scroll down to hear the podcast. Click to view the magazine

Richard Fieldhouse reviews the latest edition of The Sessional GP magazine. In our 110th edition, Rachel has some seasonal advice, Tina loves LocumDeck, Claire has some warming paintings for us, Judith unmasks a ruthless dictator, Louise gives a comprehensive rundown of hypertension in pregnancy and Liz has some great tips if you're in the process of making babies. Scroll down Continue Reading The post Podcast | The Sessional GP Magazine December 2019 appeared first on NASGP.

A partner in a North London practice was feeling burned out. The crushing target-chasing workload was no longer offset by the reward of helping patients. The BNF had no remedy for the distresses of modern life which patients were bringing into her consulting room. She, like her patients, was ground down. Casting about for a way of reviving the sense of hope and enthusiasm that had led her into medicine, she contacted the local Transition Group. Three years later a bleak courtyard next to the practice has transformed into The Listening Space – a therapeutic garden where patients and staff get together. They have pitched in to create a beautiful and productive green space. People who no longer have gardens of their own share their expertise, patients help with planting and harvesting, and they cook for seasonal parties. Immigrants are delighted to share their traditional dishes. Patients and staff demonstrate their music talents, and everyone chats. The ‘Crafternoons’ in the waiting room were slow to take off, but gradually patients plucked up the courage to join in, and now it’s a flourishing social group. Lonely patients in the waiting room are encouraged to participate. While members embroidered ‘welcome’ onto fabrics in their native languages, an old man sat on the edge of the group staring at his hands. Suddenly he perked up, saying “You haven’t got my language ”. Offered blue thread, he insisted on red, gold and green, the colours of his birth nation’s flag. He’s now a regular, and for the first time, staff say, he’s smiling. Hollowed-out social infrastructures have left us all less connected, and the most vulnerable people easily fall through the holes in the net. They crave worthwhile activities to occupy the long empty hours, to distract them from insoluble problems, to make them feel useful again. But people who are treading water need someone to help them onto firm ground. Medical prescribing for medical problems, social prescribing – referral to a range of local, non-clinical services – for social problems. It makes sense. In Somerset, Frome was once a busy market town, but over the decades its life-blood drained away. By 2013 the town was flat-lining. The residents were depressed. The GPs and their staff were disheartened and stressed because they couldn’t solve health problems that were essentially social in origin. Again, a GP took the initiative. She worked with the town council and the local Compassionate Communities health group to identify unmet social needs. Now GPs can refer patients to professional ‘health connectors’ who bridge the gap between patients and community resources. As well as practical advice, innovations include ‘talking cafes’, and - so isolated old men can potter in company - ‘men’s sheds’. Six years on, the people of Frome, their town, the practice - all exude confidence. Patients feel they have choices and are in more control of their lives and health. The attendance figures demonstrate the benefits for the NHS. GP appointments are down 28% and A&E attendances 24%, while in Somerset towns comparable to Frome, demands on the NHS continue to rise. There’s nothing like a walk, the wilder the better, to blow away brooding thoughts. Studies show that two hours a week in the fresh air is enough for people to feel better, more self-assertive. In the Shetlands, it was the RSPB’s outreach officer who suggested ‘nature prescriptions’. Now Shetland GPs ‘prescribe’ walks, with tips about what to look out for and do en route. Patients are more active, many lose weight, and their physical and mental health improves. Talking groups, walking groups, reading, drawing, sewing groups, gardening, cooking, singing: for almost any activity there will be someone out there who is anxious to share their enthusiasm with other people. Even the housebound can join a world-wide virtual choir. They sing their part and upload it onto the internet where it is combined with...

A partner in a North London practice was feeling burned out. The crushing target-chasing workload was no longer offset by the reward of helping patients. The BNF had no remedy for the distresses of modern life which patients were bringing into her consulting room. She, like her patients, was ground down. Casting about for a way of reviving the sense Continue Reading The post Podcast | Social prescribing – I’ve seen the future of 
general practice… appeared first on NASGP.

In our 109th edition, Alacoque describes a legal case where a locum's tax status was different to their legal status, Rachel's being a Good Samaritan, Judith's been looking at therapeutic spaces, Louise has summarised the Nice hypertension guidelines for us, plus much more. Scroll down to hear the podcast. Click to view the magazine

In our 109th edition, Alacoque describes a legal case where a locum's tax status was different to their legal status, Rachel's being a Good Samaritan, Judith's been looking at therapeutic spaces, Louise has summarised the Nice hypertension guidelines for us, plus much more. Scroll down to hear the podcast. Click to view the magazine The post Podcast | October 2019 magazine out now appeared first on NASGP.

The Royal Opera House orchestra was rehearsing Die Walküre. For more than three hours violist Chris Goldscheider sat in front of twenty brass players belting out Wagner at 90dB. His hearing was permanently damaged. The Opera House argued that artistic standards took precedence over the risk of acoustic shock, but the courts thought otherwise and awarded Goldscheider substantial damages. A musician’s job is to create sound. Rock musicians ramp up the amplifiers and often lose their hearing temporarily after a particularly loud concert. Many don’t acknowledge the warning. Over time, even violinists can lose 6dB of hearing in their left ear. Many publicans and restaurateurs foster sound. They rip out partitions, strip out soft furnishings and turn up the music. Chatter turns to shouting and then to screaming, and by the time the sound level is 90dB – that’s the same as a pneumatic drill – they have created the vibe they think their clientele enjoy. At least that’s what many of them told Action on Hearing Loss. I wonder. You can’t pour your heart out, or even chat to your mates, against a wall of sound. When a bartender brings a legal case for acoustic damage, publicans may think again. "Noise affects patient care. If staff are distracted or unable to clearly hear information or instructions, lives are at risk." Silence is elusive. Over four days, walking along the Thames path from its source to Oxford, we were out of the sound of traffic for just half an hour. Military jets scream over the remote Highlands and police helicopters clatter over secluded corners of Regents Park. Libraries now entertain kids singing nursery rhymes, art galleries display video installations, and the espresso machine thumps and grinds in cafes where people go to read and work. Who cares Hospital calm? Gone are the days! Machines, phones, bleeps, call bells (left unanswered because they’re short-staffed), crashing trolleys, long visiting hours with noisy families . . . the noise level in ITU can be over 100dB. Noise affects patients. A Swedish study found that loud environments triggered more re-admissions. More hypnotics are prescribed. Patients self-discharge to get a good night’s sleep. Noise affects patient care. If staff are distracted or unable to clearly hear information or instructions, lives are at risk. Noise affects us all. Raised blood pressure, increased risk of cardiovascular problems, poor sleep and its attendant consequences, low birth-weight, obesity, diabetes and cognitive impairment . . . these are some of the consequences. My worst experience of noise was in Santiago de Cuba. The ancient, grinding engines of trucks and buses which had long lost their exhaust silencers woke us at dawn and deafened us until nightfall. We found relief at a cliff-top café. There was a pervasive smell of drains but, like most people, we could put up with pollution better than noise. Nearly 2000 years ago Juvenal listed noise as one of the seven plagues of Rome (along with high rents and fashionistas). Victorians were assailed by the hawkers’ cries, wooden clogs on the cobbles, clattering carts – rubber tyres were a late 19th century innovation. Now, noise has been weaponised. In Guantanamo it’s been used as an instrument of torture. Holed up in the Vatican nunciature, Panamanian leader General Noriega didn’t surrender until the CIA blared rock music into the building. (You can hear it on YouTube). In contrast, shopping malls broadcast Beethoven to see off hooligan loiterers. Our valuation of noise is very subjective and poorly related to the damage it does, which is determined by its acoustic intensity and how long we are exposed to it. The decibel scale is logarithmic, so a 70dB sound is ten times more intense than 60dB. The safe exposure time for a 90dB lawnmower is two hours; for 1...

The Royal Opera House orchestra was rehearsing Die Walküre. For more than three hours violist Chris Goldscheider sat in front of twenty brass players belting out Wagner at 90dB. His hearing was permanently damaged. The Opera House argued that artistic standards took precedence over the risk of acoustic shock, but the courts thought otherwise and awarded Goldscheider substantial damages. A Continue Reading The post Podcast | Quiet please appeared first on NASGP.

In our 108th edition, Judith makes a noise about being quiet, Liz summarises everything a newly qualified GP needs to know about getting their tax in order, Nigel helps us plan for when our offspring go off to university, Louise has been making sense of LFTs and Rachel has something to teach us about learning. Scroll down to hear the podcast. Click to view the magazine

In our 108th edition, Judith makes a noise about being quiet, Liz summarises everything a newly qualified GP needs to know about getting their tax in order, Nigel helps us plan for when our offspring go off to university, Louise has been making sense of LFTs and Rachel has something to teach us about learning. Scroll down to hear the Continue Reading The post Podcast | The Sessional GP magazine August 2019 appeared first on NASGP.

In post-war Italy TB was still rife and notices in buses commanded “No Spitting”. In Britain in 1946 the message “Coughs and sneezes spread diseases” promoted the use of handkerchiefs to catch the germ-laden droplets. Presumably a reasonably successful public health campaign, although if you are trapped like a sardine in a rush-hour tube train, you may have no alternative but to sneeze into the shoulder of the person jammed in front of you. Reducing droplet spread is a great step forward, but rhinoviruses are also transferred from noses to hands and so to any surface we touch. They survive there for several hours for the next person grabbing the handrail or turning on the tap to pick up. So do more dangerous infective agents from other sources. Hence the slogan I recall from my childhood “Now wash your hands”. So, a century after Semmelweis published his paper on reducing the spread of infection in maternity wards, his advice had reached the Department of Health. If followed today, it could cut gastrointestinal upsets by a third, reduce sickness absence from school and work, and save the UK economy more than £1 billion every year. But the E coli counts on peanuts set out for grabs on pub bars demonstrate that the general public still isn’t heeding the message. A surgical scrub isn’t necessary, but the more thorough the wash, the better. The NHS recommends washing with soap (antibacterial not helpful) for as long as it takes to sing ‘Happy Birthday to You’. Twice. Though as most of the pathogens are on the fingertips, even waving the fingers under a dribbling tap may be better than nothing. Wet hands still pass on a lot of pathogens, but effective drying removes almost all the bugs. Dryers in public toilets are a relatively recent introduction – the researchers of the 1965 Good Loo Guide found that less than five percent of public toilets had hot air dryers, though they probably had roller towels. Paper towels came later. Jet dryers (OK, Dyson Airblades ®) are a 21st century invention. Which works best? Cloth towels are quick and effective, though try finding a clean area on a jammed roller towel. Studies comparing the effectiveness of paper and jet dryers are limited, and the results tend to support the product of the industry which sponsored them. It does seem clear that jet dryers are more economical than paper towels, which have to be sourced, delivered, stocked, cleared away, and disposed of in landfill. Add in the cost of calling the plumber to unblock the loos and the fire service to put out fires in waste baskets. But on the road to reduction of infection, cost isn’t even a surrogate end point, it’s just a station on a by-line for institutions that are counting the pennies, not the pathogens. The paper industry claims that jet dryers blast bugs into the air. The jet dryer industry claims more effectiveness and less mess. The only independent study, a literature search by the Mayo clinic in 2012, found (in a 2009 survey) that most members of the US public preferred paper towels, and recommended that single-use paper towels be used in health care settings. The bottom line is, do people use whatever drying method is provided? And do they use it effectively? Time is one hurdle. Traditional hot air dryers are too slow. Jet dryers are quick, but not that quick, and if there is a queue and the curtain is about to go up on the final act, you probably shake your hands and rush to your seat. Paper towels are quicker. But paper towels dissolving to pulp on a wet floor don’t encourage users to spend time doing even a cursory wash. Poorly maintained facilities may make users feel they need to clean themselves of the grot, but probably make it more difficult to do so. Fastidious users don’t like the idea of contaminating themselves with other people’s germs,

In post-war Italy TB was still rife and notices in buses commanded “No Spitting”. In Britain in 1946 the message “Coughs and sneezes spread diseases” promoted the use of handkerchiefs to catch the germ-laden droplets. Presumably a reasonably successful public health campaign, although if you are trapped like a sardine in a rush-hour tube train, you may have no alternative Continue Reading The post Podcast | Now wash your hands appeared first on NASGP.

NASGP chairman Richard Fieldhouse reviews the latest edition of The Sessional GP magazine. In our 107th edition, Louise has not one but two COPD-related e-learning articles; Judith has been washing her hands, Liz has been answering your tax questions, Rachel has some advice about medical hierarchy, and Kate has been making stress her friend, all with some more beautiful paintings by Claire. Scroll down to hear the podcast. Click to view the magazine

NASGP chairman Richard Fieldhouse reviews the latest edition of The Sessional GP magazine. In our 107th edition, Louise has not one but two COPD-related e-learning articles; Judith has been washing her hands, Liz has been answering your tax questions, Rachel has some advice about medical hierarchy, and Kate has been making stress her friend, all with some more beautiful paintings Continue Reading The post Podcast | June 2019 ‘The Sessional GP’ magazine appeared first on NASGP.

London’s Wigmore Hall is a temple of high culture. The audience is packed with musicians. Sometimes I feel I’m the only person who couldn’t be up there performing the work. But recently I joined forty people, some able, some less able, in mind and body, for a ‘Big Sing’. Everyone seemed to feel at home. In the morning we learned to sing simple songs in four parts, and in the afternoon we went up on stage and sang them. I’m no singer but the opportunity was fun and boosted my morale. So how much more it must have done for the participants with dementia. Everyone, everywhere, responds to music. We hear it in the womb, it accompanies the important events in our lives, it modulates our emotions. Hearing is the last sense we lose as we die. People with advanced dementia who haven’t spoken for months may perk up when they hear Vera Lynn singing The White Cliffs of Dover. They may even venture into a solo, or go to the piano and play with an ability no-one knew they had. Thinking skills may have atrophied, but musical skills remain. Given the right stimulus, they surface from the depths of a failing brain. * CPD | Management of dementia There is currently no prospect of effective medication for dementia. Reluctantly, we prescribe agitated patients chemical coshes. But does music sooth agitation – and more? Neuroimaging shows that, unlike speech, music lights up lots of different areas of the brain. It finds a back door into even a ramshackle brain. Music may even help to keep neural pathways in the brain open. So far, studies of the effect of music on people with dementia, though small and short-term, are encouraging. But research projects are seeking robust evidence. Can biochemical changes be linked to our responses to music? What psychological measures can be used to assess benefit? How can music most effectively be used? What opportunities does it offer for carers, care homes, musicians and institutions? Music therapy is a well established profession, although few care homes can afford a therapist. But graduate courses in using performance arts to help people with brain failure are burgeoning, and charities, local authorities, music schools, music groups, orchestras, arts and religious venues are trying out different interventions. With phone calls and a few visits, I discovered how much there is on offer. "Through music, families can glimpse the individual their relative once was: the loving partner, the caring parent, the delightful aunt, the indulgent gran. Once again they can share pleasant experiences." Residents of care homes respond when amateur choirs come to sing. They may join in, although perhaps not singing the same song as the performers. They may rattle a teaspoon throughout the concert, or stand behind the conductor waving their arms. The benefits are fleeting, but any enrichment of barren lives, however temporary, is worthwhile. Repetition helps. And not surprisingly, participation increases the benefits, too. So a musician, squatting down in front of a wheelchair to encourage someone to make simple music, singing or playing instruments may stir her from apathy for longer. She may start chatting. And so change the atmosphere of the home. For people with dementia still living in the community there are ‘relaxed concerts’ where no-one minds if you are restless. Other events encourage people to take part. Alzheimer’s Society’s Singing for the Brain is a model: experienced singing leaders run weekly sessions. Volunteer helpers ensure that carers also have some fun and a break – a crucial benefit of community events. There’s a welcome, action songs, familiar numbers and new ones, opportunities to shake a tambourine,