Quote of the day

“George Harrison once said to me, ‘If we’d known we were going to be the Beatles, we would have tried harder,’ ” (Eric) Idle writes. “I think the same could be said of Monty Python.”

The Monday Morning Quote #502

“Everything that is not forbidden by laws of nature is achievable given the right knowledge”

David Deutsch, quoted in “Enlightenment Now

A Builder’s Lesson.

How shall I a habit break?
As you did that habit make.
As you gathered, you must lose;
As you yielded, now refuse.
Thread by thread the strands we twist
Till they bind us, neck and wrist.
Thread by thread the patient hand
Must untwine, ere free we stand.
As we builded, stone by stone,
We must toil, unhelped, alone,
Till the wall is overthrown.


Julian Tudor-Hart RIP

I was sad to hear of the death of Julian Tudor-Hart recently. I quote from his obituaries:

A visionary general practitioner (GP) who spent his career practising what he preached, Julian Tudor Hart is best known as the author of the inverse care law: “The availability of good medical care tends to vary inversely with the need for it in the population served.” Like Karl Marx, his guiding inspiration, Tudor Hart believed that it was not enough to interpret the world in various ways; the point was to change it.

“He was the first GP to measure the blood pressure of all his patients”, “At the time, hypertension was often thought of as a condition that had to be managed by hospital specialists”. “Julian was a major force in ensuring that it became embedded in primary care.” “When in 1990 he published the results of 25 years of what he’d been doing compared to a neighbouring practice, he showed that mortality was down by about 30%”. This, Watt (Professor Graham Watt, Honorary Senior Research Fellow in Glasgow University’s Institute of Health & Wellbeing) believes, was attributable to a number of interventions besides blood pressure measurements. “The main thing, I think, was that he was providing unconditional personalised continuity of care for all his patients

Writing in “A New Kind of Doctor” in 1988 he described what he called “Anticipatory Care” as “Professionally, the most satisfying and exciting things have been the events that have not happened: no strokes, no coronary heart attacks, no complications or diabetes, no kidney failure with dialysis or transplant. This is the real stuff of primary medical care.”

Obituaries HERE, HERE & HERE

HPV vaccination – still too slow

I have written before about HPV vaccination HERE, HERE, HERE, & HERE. I thought all was going well however this article in the Lancet has made me realise there’s a way to go.

Data from Public Health England highlight how the UK’s national cervical cancer vaccination programme has greatly reduced the prevalence of human papillomavirus (HPV) in young women, providing encouragement for a future reduction in cervical cancer mortality. HPV, however, is implicated in other cancers in both sexes (eg, oropharyngeal and anal cancer), and HPV infection also causes genital warts in both sexes. HPV-related oropharyngeal cancer is the cancer with the fastest growing incidence in the UK, and is soon to become more common than cervical cancer in the USA. Given the results of the Public Health England study, a gender-neutral vaccination programme would provide substantial protection for the overall UK population.
Boys and girls are vaccinated as part of a universal strategy in an increasing number of countries, which now includes Australia, Austria, Bermuda, Brazil, Canada, Croatia, Germany, Israel, Italy, Lichtenstein, New Zealand, Serbia, and the USA. However, despite mounting evidence and support from clinical, scientific, and patient advocacy communities, the UK has been slow to move towards universal HPV vaccination. The Joint Committee on Vaccination and Immunisation (JCVI) has been considering the merit of a universal vaccination strategy since 2013, but issues such as putative herd immunity and cost-effectiveness were cited as reasons to postpone vaccination of adolescent boys.
Herd immunity for boys will only occur in areas where rates of female vaccination are high (≥80%). Substantial reductions in female vaccination rates have occurred in Denmark, Japan, and, most recently, Ireland (51% uptake), although a high-profile government campaign led to vaccination rates in Ireland increasing to more than 60%. Uptake in the UK varies substantially by region (eg, a 48% uptake in Stockton-on-Tees compared with a UK average of 83%). Herd protection will not protect men who have sex abroad or with older unvaccinated women.
Our findings and those of others have indicated that universal vaccination can deliver substantial health economic benefits. An analysis also indicates that the mathematical modelling studies underpinning policy recommendations regarding universal HPV vaccination might have been flawed. The additional cost of vaccinating boys in the UK would be £20–22 million annually at most (<0·02% of the UK National Health Service’s annual budget). However, this cost is offset by the annual costs of treating genital warts (about £58·5 million), HPV-related oropharyngeal cancer (>£21 million), and anal cancer (about £7 million). Wider economic benefits (increased productivity and earnings, enhanced tax revenue) would also ensue. Thus, universal vaccination can save lives and yield economic savings for our health-care system.
The mounting evidence has led to the JCVI finally recommending a universal HPV vaccination strategy. Although the Departments of Health in England, Scotland, and Wales have now indicated their willingness to vaccinate boys and girls on the basis of the JCVI recommendation, the Department of Health in Northern Ireland has been disappointingly silent on the issue to date. It is crucial that this decision is implemented rapidly and equitably across the UK to spare the approximately 400 000 adolescent boys each year who are left unprotected against the serious life-threatening and health-debilitating diseases that result from HPV infection.

HMRC and the evolving status of associates.

HMRC & the changing status of associates.

First published in dentistry.co.uk HERE

The BDA has emailed their members working in General Practice to tell them that HMRC are reviewing the status of associate dentists. This is no surprise to many observers but to some in the profession it will be another cause for outrage. In a career spanning nearly four decades I have observed the late adopters and laggards chant their mantra of, “They wouldn’t dare do that to us” through several new NHS contracts, compulsory VT, CPD & audit, the imposition of the CQC and the rise of the spiteful creature the GDC has become.

Their next question is, “What’s the BDA doing to stop it?” Particularly vocal are the non-BDA members. Over the past 15 years the BDA has repeatedly advised individual dentists to be wary of relying entirely on NHS income. Reading between the lines the advice is, “get out of it, the system is failing”.

The BDA can do very little if a government decides that they are going to change a policy. Especially if that policy will:

  1. give them more control over a group or profession,
  2. bring more money into the exchequer and, possibly in this case,
  3. shift the pension contribution obligations to a third party.

The advice to all parties is to ensure that you routinely work with an accountant who understands the employment status of associates NHS and private, hygienists and therapists. Be clear on the contract that you have and insist that there is documentary proof of claimed employment status.

I still visit practices where DCPs are clearly employees but treated as self-employed because of convenience. Observing work patterns of many NHS associates I struggle to justify their status as truly self-employed.

An unintended consequence of 2006, a step to control dentistry further or just evolution? Time will tell.


PS There’s a fact sheet from CIPD with links to a questionnaire from HMRC to determine status (you will probably have to register with CIPD to access – no worries it’s free). I suggest that you have a play with the links and make your own mind up. Link to the fact sheet HERE.




The Monday Morning Quote #484

“Appreciation is a wonderful thing: It makes what is excellent in others belong to us as well.”



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