Part of Who I am

A powerful message about our own personal stories


This blog was first published on the NHS Vale Royal CCG website in September 2015.

A scene familiar to doctors and nurses. An urgent call in the middle of the night followed by a rapid fumbling with clothes and shoes as you shake the too little sleep out of your head. The run through the quiet and empty corridors of the hospital before bursting onto the ward, your destination immediately made obvious by the busyness and urgency around one patient. As you approach you see resuscitation already underway, someone doing chest compressions and someone else ventilating.
Many of you reading this will relate to the scene. Two things make this memory different for me. Firstly, the patient is not an elderly person potentially coming to the end of a life well-lived,but is only 17 months old. Secondly, the patient is my son.
Over 11 years ago, this scene brought to…

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A letter to Theresa May via my MP

Please feel free to copy and paste this in an email to your own MP, sign a petition, do anything. You can find your MP by using this link

Dear Prime Minister,

I was dismayed at your inability to directy condemn the US president’s vindication of the use of torture and also your frankly lacklustre and tardy repsonse to his latest exectuive order about immigration controls into his country. Whilst I cannot know what goes on behind closed doors between you I believe you have a duty to outwardly show your own country that you serve, that you do not condone such actions at all, and not just when they affect British citizens (it is already, by the way).

I would politely ask you to cancel the State visit of President Trump until such moment as his Executive Order over immigration is revoked. If you are not able to do this immediately then I expect nothing more than a full and frank explanation as to why not. Please feel free to write to me directly, or make a public announcement.

I look forward to hearing from you

Yours Faithfully


The GP 5 Year Forward View, the importance of inequality and the Deep End

Great blog by Greg Fell about inequality and how it affects general practice

Sheffield DPH

So we are all doing responses to the GP 5 Year Forward view
Who knows whether there’s any REAL investment fund. Meanwhile the world keeps revolving.

General Practice, you know the bit that everyone says is the jewel in the NHS crown, gets ever more fragile.

The point re General Practice in the most disadvantaged parts of our communities, you know the bit of the narrative everyone manages to forget, isn’t going away anytime soon.

The amazing Deep End group keep shining a light on it.

Here are some thoughts as we finalise where we are re the GP5yFV.

Regular readers will recognise rehashed material (sorry, but got to say the same thing again and again)


The slice of the NHS £ going to primary care and in particular General Practice

GP funding seems like it’s going down not up

General practice funding has fallen to 8% of…

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What many doctors think is happening

London, United Kingdom - April 27, 2016: The Second Day of the Strike By Junior Doctors. The junior doctors resolve is strong on the second day of the all out strike over working conditions.A slimy man is at a very large desk. He is speaking into a phone.

“Don’t worry Richard, sorry, yes, Sir Richard. Don’t worry Sir Richard. Look we have talked about how we were going to have to break it a little bit before…sorry…yes, I know, well look it is  just a little bit. No, no, no it’s not a basket case like the East Coast mainline.”

There is a buzzing sound from a red telephone on his desk, “Look, hang on a minute, I have an important call on the other line.”

He mutes the mobile phone, puts it down on the desk and lifts the old-fashioned red telephone to his ear, “Hello, Rupert,” he listens for a minute or two, “Well that is very kind of you to offer. This week, let’s do nurses, followed by consultants the week after, with a dash of immigrants. If the comments sections seem a bit tame then why not go after the hospital executives and managers, you know publish a few salaries, significant events, patients complaints – you know the sort of thing?”

He listens for a few moments, “Yes quite, I completely agree, ungrateful sods. Speak to you soon,” he replaces the handset and picks up the mobile phone again.

“Sorry Richard, Sir Richard, where were we?” he checks his fingernails and holds the phone away from his ear to protect his eardrum from the shouting, “Look, Rich… SIr Richard, I promise you I will not completely break it. It just needs to be a little bit broken, you know, for us to be able to seal the deal, splash the cash, bring home the bacon… No, no I haven’t been smoking.”

He sits forward in his chair, “Listen, when have we ever let you down? Tell me, eh? Leave this to me and I’ll make sure it will all work out fine for us. Even if they suspect, there won’t be anything they can do about it. Everyone will be panicking about bloody Brexit for a start… Yes, I know… Can’t believe we have been so lucky to have such a massive distraction from our plan land straight into our laps. They always vote with their wallets as you know.”

A woman walks into the office. He cups his hand over the mobile phone and mouths, “Who are you?!”

“Your new specialist advisor, sir.”

“But I’ve already got three, what does her up the road think she’s playing at? No Sir Richard, not you!”

He glances angrily at the woman, “Look, I have got to go. Need to figure out how to make sure Number 11 keep their coffers shut. Speak to you soon.”

He turns to face the woman as the mobile phone is silenced, “And what, pray tell, are you going to advise me about?”

The perfect storm to distract us from a crisis

Paris, FRANCE - JULY 21, 2016 : The Prime Minister of United Kingdom Theresa May arriving at the Elysee Palace at Paris for a work visit.All over social media today there has been wailing and gnashing of teeth, by GPs, such as myself, at suggestions that the opening hours of general practice are in some way to blame for the crisis being seen in hospitals up and down the country. A single paper initially led with the story that the Prime Minister was going tell GPs that they had to be open from 8 until 8, 7 days a week, according to local need. This is nothing new. This is old news. This is the part of the plan set out in the GP Forward View, with the finer details being laid out in NHS operational planning guidance (see page 53).

Fortuitously for the government the National Audit Office has recently released a report into GP opening times. This shows that, currently, GP practices are not open 8 until 8, and in fact some surgeries will have a half day, neglecting to point out that many surgeries will compensate for this by opening during unsociable early or late hours on other days of the week.

Certain aspects of three reports have simply been juxtaposed, within a right wing newspaper and set alongside the context of the bed crisis in the NHS. The ridiculous inference is that the crisis seen in hospitals is down to GP surgery opening times. However, he Prime Minister hasn’t even made an official statement, speech or given a press release about this – all that is reported is that she is going to remind GPs of the details of the GP Forward View.

As always, the politicians, their advisors and journalists have cherry picked from the reports linked above, in order to create a distracting media storm. Better to have irate GPs, and their supporters, on the TV and social media, than pictures of patients in corridors and stories of deaths on trolleys. The spin doctors have done a perfect job and we have all fallen for it. The Prime Minister doesn’t even have to retract a statement she hasn’t made.

As for the cherry-picking – well the GP Forward View and the accompanying operational guidance make it clear that not every practice will have to work from 8 until 8, 7 days a week. Practices will be able to work together. The National Audit Office report does talk about the current state of affairs, but the real headline from it is that every unsociable hour that a GP surgery opens will cost 50% more than regular office hours. It is also worth pointing out that we’re in Year One of the GP Forward View, which is underpinned by the Five Year Forward View. The clue is in the name of the latter. GPs are not expected to provide these extended hours services until 2021, so no wonder current opening hours are much less.

Organisations that have been quick to jump into the media to decry a statement that has been reported will be made, are the very organisations that support the GP Forward View; namely the British Medical Association and the Royal College of General Practitioners. They think it will be the only way that general practice will get the funding it needs.

The argument over whether the GP Forward View makes economic or clinical sense is one that needs to be had. The real debate for the moment, however, is about the crisis in the NHS as a whole due to a combination of funding, workforce and demand issues. All three have to be tackled at the same time to have any hope in hell of providing the public with standard of care they need.

I am a GP partner in Birmingham, Board Member of Our Health Partnership and co-clinical director of QCAPS for Northfield Alliance Ltd. The views expressed here are my own and don’t necessarily represent that of any organisation I work for.

My New Battle

A brave blog

Ivel Explorer

About 8 weeks ago I had reffed a rugby match and came home feeling good and went for a wee later in the evening. I noticed  quite a bit of blood in my wee. I was scared and worried. The blood stopped and my wee became normal after that. I went to see my GP on the following Monday who tested my wee and said there was a spot of blood in the wee. I was referred to Hospital and had a meeting with my Consultant who did an examination and said that that he would like to to a Cystoscopy and examination of the bladder.

I attended Hospital a week later and following the procedure the  tumour was found inside the bladder it was around the size of a 1p  . I was initially told most are superficial and pretty much like a wart and can be removed and…

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I wrote to the Department of Health about the imposition of the junior doctor contract

They wrote back:

Dear Dr Dawlatly,

Thank you for your recent email to the
Department of Health about junior doctors’ contracts.  I have been asked to reply.

doctors work incredibly hard across seven days.  Ministers value the huge
contribution they make to the NHS and agree that they deserve a fair,
professional contract that supports patient care.  Patient safety is the
absolute priority for the Secretary of State for Health.  He wants to
ensure that we have the safest healthcare system in the world by moving away
from a culture of long, unsafe hours and by ensuring that consultants are
available to make vital decisions about patient care across seven days.

consultants and junior doctors are crucial to ensuring patients receive the
high-quality care they need every day of the week.  The British Medical
Association (BMA) – the doctors’ union – called for reform of the junior
doctors’ contract in 2008.  The proposals
put forward for reforming the junior doctors’ contract and the consultants’
contract are designed to protect the safety of junior doctors and patients as
well as rewarding junior doctors more fairly and ensuring more consultant availability
over weekends to support the training of junior doctors.

Department has been making every effort, in good faith, to work with the BMA to
introduce a new contract for junior doctors that supports these principles
while maintaining average pay and ensuring no doctor is required to work longer
or unsafe hours.  After the BMA walked away from negotiations with NHS
Employers in 2014, the Department and NHS Employers accepted the
recommendations of the independent Review Body on Doctors’ and Dentists’
Remuneration in July 2015 and sought a return to negotiations.  The BMA refused to negotiate, rejected an
offer published and sent to junior doctors on 4 November, and balloted for
industrial action.

November the BMA, NHS Employers and the Department agreed to talks under the
auspices of the Advisory, Conciliation and Arbitration Service (ACAS) and this led
to negotiations involving ACAS beginning in December.  The Secretary of State appointed Sir David
Dalton, a respected trust chief executive, to take those negotiations forward
on behalf of the NHS and the Department.  Initial talks led to a revised
offer on 4 January, which the BMA refused to discuss, instead announcing that
industrial action would commence on 12 January.
Talks continued during that action with the BMA suspending further
action that had been planned for 26-28 January.

1 February Sir David wrote to the Secretary of State to advise him of the
progress of negotiations (see  At the same time, the BMA announced
industrial action for 10 February – with junior doctors providing emergency
cover only, rather than the full withdrawal of labour that had previously been
announced.  Ministers believe this action
was regrettable and unnecessary, given that Sir David’s letter showed that the
parties had reached agreement on many issues, most notably on safety, education
and training and on many elements of a new pay structure.

detail on the safety, training and pay aspects of the 4 January revised offer
is set out at:

Sir David’s request, a letter was sent to all junior doctors in England, with
details of the revised offer.  It was
published at

door remained open to the BMA to discuss the remaining issue of pay for
unsocial hours, as it agreed to do in the joint agreement at ACAS in
November.  Sir David made a further offer
to the BMA on 9 February, which was rejected.
Sir David wrote to the Secretary of State on 10 February.  He said that:

Despite the most recent progress and substantial
agreement on many elements of the contract, the BMA has refused to compromise
on its insistence that the whole of Saturday must be paid at a premium rate. In
contrast Employers’ position has moved several times, on each occasion offering
more hours attracting premium pay. Regardless of these changes no agreement has
been possible.

with other senior NHS leaders and supported by NHS Employers, NHS England, NHS
Improvement, the NHS Confederation and NHS Providers, Sir David asked the
Health Secretary to end the uncertainty for the service.  Sir David and his colleagues consider the new
contract both safer for patients and fair and reasonable for junior doctors.

11 February the Secretary of State announced that a new contract will be
introduced.  He also announced a review
into some wider and more deep-seated
issues relating to junior doctors’
morale, wellbeing and quality of life, which will be led by Professor Dame Sue
Bailey, President of the Academy of Medical Royal Colleges.  Further details will be set out shortly.

Government and junior doctors want to do the same thing by improving patient
care at weekends.  Ministers believe a
contract that is safer for patients as well as fair and reasonable for junior
doctors is a step towards that.
Ministers believe the further strike action announced by the BMA on 23
February is completely unnecessary as it will mean tens of thousands more
patients face cancelled operations, over a contract that was 90 per cent agreed
with the BMA and which senior NHS leaders have endorsed as fair and safe.  Ministers urge junior doctors to look at the
detail of the contract and the clear benefits it will bring, for them and for

With regard to MPs’ pay, this
is set by the Independent Parliamentary Standards Authority (IPSA).  IPSA is entirely independent of the
Government.  Therefore, you may wish to
contact IPSA direct for further information.
You can do so by writing to:

Independent Parliamentary Standards Authority

4th Floor

30 Millbank

London SW1P 4DU

I hope this reply is helpful.

Yours sincerely,


Ministerial Correspondence and Public

Department of Health