Episodes
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Welcome to 2024! Dr David Cooper, @davidcooper1975, co-chair of SNUG and GP in Old Machar Practice in Aberdeen, discusses the progress of GPIT Re-provisioning, challenges faced, especially by EMIS practices, and the broader landscape which includes a number of upcoming projects and technological advancements expected over the next 12 months. David hopes for efficiency savings through smarter use of IT, including DACS systems, AI, Power Automate, Microsoft Forms, and the new SharePoint environment.
No new year would be complete without meeting up with Dr Chris Weatherburn, @ChrisWeatherbu1, to discuss his reading recommendations for the new year. We also, unexpectedly, tap into some of the wisdom of Arnold Schwarzenegger.
Unstoppable by Dave Anderson. Dealing with changes in life is inevitable, and we have to be ready for both wins and losses. You have the power to change your own attitudes and how you respond to challenges.
Chris Weatherburn review on YouTube.
How to find a black cat in a dark room by Jacob Burak. Will power is a finite resource – use it wisely and focus on intention rather than outcome for personal goals and projects.
Chris Weatherburn review on YouTube.
Be useful – seven tools for life by Arnold Schwarzenegger. There is nothing more energizing than chasing a vision. Make sure others know about your dream and act as if it had already happened. However, rest is not just for babies and relaxation is not just for retired people!
Arnold Schwarzenegger discusses origin of “Be Useful” book title on YouTube.
SNUG is holding a Migrations Training Day on Wednesday 24th of April 2023 in the Westerwood Hotel Cumbernauld. Contact [email protected] for more details.
Microsoft Power Automate
Cegedim Vision demo videos.
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Could video consultations have the potential to be a game changer in medical education? In this SNUG podcast interview, Dr. Richard Darnton @DrDarnton discusses his role in running the GP part of the Medical course at the University of Cambridge, and his role as director of the GP Education Group (GPEG), focusing on the emphasis on hands-on experience for medical students in general practice. He highlights the topic of video consultations in medical education, particularly in general practice. Dr. Darnton discusses the challenges faced by GPs in adopting video consultations, including issues of complexity, logistics, and the perception of limited benefits. He suggests the use of structured video clinics in general practice, and explores the benefits of video consultations for medical education, such as overcoming space constraints and providing valuable insights into patients' environments.
We discuss the experiences of students during the pandemic, where remote consultations became more prevalent. Study findings indicate that non-face-to-face consultations, including telephone and video, provide unique learning opportunities for students, improving their consultation skills and clinical reasoning.
We consider the infrastructure challenges of implementing video consultations in medical education, including the need for waiting rooms, access to patient notes, and integrated consent functionalities. Dr. Darnton expresses optimism about the potential for innovative platforms to address these challenges and enhance medical education. He encourages a shift in mindset and embracing technology for the benefit of both education and clinical care.
Any feedback or comments are welcome via email: [email protected] or [email protected].
Why do GPs rarely do video consultations? Qualitative study in UK general practice BJGP paper
Primary care placements in the post-COVID era: A qualitative evaluation of a final year undergraduate clerkship
Medical students consulting from home: A qualitative evaluation of a tool for maintaining student exposure to patients during lockdown
Medical students remote consulting from home and from the health centre: A survey of prevalence and supervisor perspectives
Let’s face the music and dance!
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Missing episodes?
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GPs in England and Scotland are trying to do a broadly similar job - they both work within the NHS, yet they have different contracts, different organisational and digital infrastructures and different GP clinical systems. They both face similar challenges in terms of workload, prescribing, sustainability and increased demand. Additional team members like pharmacists, physiotherapists, mental health nurses and ANPs are reshaping the way we organise care. The digital health and social care strategies in both countries are broadly similar with a focus on digital transformation and giving patients increased access to their own records. Today we discuss all of this and more with the Digital and Tech GP Dr Gandalf @drgandalf52 who gives us some advice on meeting all of these challenges and how to use some new tech tools which can help us work more efficiently, like a new tool called Nabla co-pilot which can transcribe and summarise consultations! Don’t miss it.
Any feedback or comments are welcome via email: [email protected] or [email protected].
What is the NHS Spine? The NHS app
What is eGPlearning? eGPlearning website Youtube eGPlearning site
Video consultations in General Practice
SCA essential tech tips to pass
Quick clinician notes in healthcare with AI by Nabla Copilot
Nabla copilot website
You are not a frog
Agenda and Registration for November 29 SNUG Conference at Westerwood Hotel, Cumbernauld
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The National Digital Platform (NDP) is an open technology platform developed by NES (NHS Education for Scotland) in collaboration with multiple partners from across health and social care. It aims to make it simpler to deliver technology that improves the care and well-being of people in Scotland. The platform brings together cloud-based digital components and services to provide technology solutions for the public sector in Scotland. It offers a range of technology services, including an identity management service, application programming interfaces (APIs), and an application development framework.
In this episode, we find out more from Dr Paul Miller, who is the Clinical Informatics Lead at NHS Education for Scotland Technology Service, a working GP, and also the Co-chair of the openEHR Clinical Program Board. Paul has been a long-term member of the National Vision Users’ group and Primary Care Informatics / SCIMP, before working for the NES Technology Service. We discuss the changes in general practice, the concept and development of the National Digital Platform (NDP), the electronic ReSPECT application, what the migration challenges are, the need for coexistence with commercial systems, and the importance of incremental change in transforming healthcare systems. The shift toward separating data from applications and adopting digital health platforms will be a long-term, iterative process and require strong clinical leadership.
The ultimate goal is to design services around patients rather than around healthcare systems, allowing patients to access and manage their own data.
Any feedback or comments are welcome via email: [email protected] or [email protected] . Paul Miller on X/Twitter: @docpaulmiller.
National Digital Platform - The open technology platform for Scotland
Video explainer on the Digital Platform from Digifest 2022
ReSPECT and Open EHR video from Digifest 2022
The ReSPECT process
Scotland’s Digital Health and Care Strategy
SNUG Annual Conference and AGM November 2023
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We are delighted to welcome Professor Bob Wachter in this episode of the SNUG podcast.
He is Professor and Chair of the Department of Medicine at the University of California, San Francisco (UCSF), a highly influential voice in the worlds of medicine and Health IT, renowned for his book "The Digital Doctor"and the 2016 Wachter Report on NHS digitalization. He joins us to discuss a wide range of current topics, including the future prospects for healthcare, with a particular focus on the impact of digitalization, consumer expectations, and the balance between technology and human interaction in medicine.
We discuss the trends in both US and UK in terms of digitalisation, increasing demand for health care, and the impact of technology on doctor-patient interactions, as well as the rapid advancements in AI, and how healthcare delivery may be reshaped in the future.
We look at issues of trust, bias, and the potential consequences of over-reliance on machines, including “automation complacency”. And finally, we explore the dynamic use of social media, particularly X/Twitter, in combating misinformation during the COVID-19 pandemic. Professor Wachter discusses his social media journey, emphasizing the role of trusted voices in providing reliable information during crises.
Any feedback or comments are welcome via email: [email protected] or [email protected]
You can subscribe to the SNUG podcast on the following platforms:
SNUG podcast on Apple podcasts SNUG podcast on Google podcasts SNUG podcast on Spotify
NHS Digital Academy
Robert Wachter on The Digital Doctor
Bob Wachter's Viral Tweet and Thoughts on AI in Medicine
A Fireside Chat with Eric Topol
ChatGPT: Will It Transform the World of Health Care?
UCSF Department of medicine videos on Youtube
In the Bubble podcast - The Doctor Can't See You Now (with Dr. Christine Sinsky)
Prof Bob Wachter on X /Twitter @Bob_Wachter SNUG on X /Twitter @SNUsersGroup
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In this episode, we return to the world of Digital Asynchronous Consulting Systems (DACS) and ponder how digital changes might be implemented in general practice during a time of chaos for the NHS, as it has its 75th Anniversary.
We get a fake 5-year old’s opinion on DACS systems, before hearing from Michael Wong and Sandeep Singh from Engage Health Systems, who have developed a system called Engage Consult, a digital asynchronous consultation system (DACS), which is already in use in England but is new to Scotland. We covered the following ground in the conversation:
Why is Engage Consult a configurable digital asynchronous consultation system (DACS) that can be tailored to meet the specific needs of healthcare practices?How is collaboration with other services facilitated?How can implementation vary based on organizational structure, such as Primary Care Networks (PCNs) in England or a more practice-level focus in Scotland?What are the automation features for intelligent routing and assignment of patient requests?What is the integration with Vision and EMIS PC?How much will the system cost?How are implementation and support approached?Video demonstrating the Engage Consult system from the SNUG Members Day 2023 (log in needed)
Engage Health website
Technology Enabled Care explainer on DACS systems
The birth of the NHS
Summertime Blues – the Who
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In this episode, we delve into the fascinating world of some of the new AI tools and their impact on healthcare and innovation. We explore the advancements in large language models like ChatGPT and the potential they hold for transforming the way we access medical information and provide care. We discuss the experiences of Dr Keith Grimes, an expert in digital health and innovation, as he shares his insights from working at Babylon and his own consultancy.
We unravel the main points, such as the importance of detailed instructions and questions for obtaining accurate results from language models. We touch upon the challenges and benefits associated with relying on AI for medical information, emphasizing the need for critical thinking and background understanding of medical concepts. Privacy considerations and the global access disparity in healthcare are also explored.
Join us as we navigate the promises and concerns surrounding language-based tools, shedding light on their potential to revolutionize healthcare while navigating the ethical and practical considerations. Get ready to expand your knowledge and gain insights into the future of healthcare in the age of AI.
Dr Gandalf and Keith Grimes discuss and demonstrate ChatGPT video: ChatGPT in healthcare
UCSF debate on Chat GPT in healthcare chaired by Bob Wachter video: ChatGPT: Will It Transform the World of Health Care?
The Wachter Report: Making IT Work: Harnessing the Power of Health Information Technology to Improve Care in England
GreatAIprompts.com
The AI Revolution in Medicine: GPT-4 and Beyond
Dr Keith Grimes contacts: www.curistica.comLinkedin: https://www.linkedin.com/in/drkeithgrimes/
Twitter: https://twitter.com/keithgrimes
Register for the SNUG Member’s Day May 2023
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High risk medicines are defined as medicines that have a high risk of causing injury or harm if they are misused or used in error. Error rates with these medications are not necessarily higher than with any other medicines, but when problems occur, the consequences can be more significant. A number of high risk prescribing safety indicators have been identified.
We talk to Dr Ann Wales, @Ann_Wales who is the Programme Director for Knowledge and Decision Support at the Digital Health & Care Innovation Centre, and she manages the National Decision Support Programme and its Right Decision Service.
We also hear from Dr Scott Jamieson, @DocScott82 a GP in Tayside and member of RCGP Scottish Council, who is one of the most enthusiastic GPs in Scotland and has an interest in Quality Improvement, among many other things. He has tried out the Right Decision Support tool which alerts prescribers to potentially harmful combinations of medications, using algorithms triggered by specific conditions, patient age, and values like blood pressure and renal function. All the GPs who have tried out the tool so far want to keep it!
Anyone who is a prescriber will be interested to hear more about this useful new tool, which will be made available across Scotland soon.
The DQIP study
Scottish Polypharmacy guidance
Right Decision App library
BJGP paper with high risk prescribing indicators (table 2)
Sign up for new Bing powered by ChatGPT
The Bing who loved me – NY Times Hard Fork podcast
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How can we best measure the activity in general practice and measure how busy we really are?
The In-Hours GP Activity project is a collaboration between National Services Scotland (NSS), Public Health Scotland (PHS) and the Scottish Government to access, understand and improve the availability and consistency of activity data from in-hours general practice. A pilot was held during the autumn of 2022 to try out guidance to practices on encounter recording, collect data and try out a dashboard at practice level.
Numbers of “encounters” as recorded in the practice clinical systems and the corresponding “healthcare professional role” responsible for the encounter are made available as a by-product of documenting routine clinical care. Recording behaviour varies across and within practices, and to extend the project to cover all practices will require more work following feedback gained during the pilot. In this episode we have an interview with Dr Keith Moffat and Billy Davidson of NSS, who discuss the encouraging progress so far and planned next steps.
We hear from our friend of the podcast, Dr Chris Weatherburn, for his annual dose of inspiration and book recommendations. This year it’s all about Resilience, how to create new and sustainable habits, and being surrounded by idiots!
And finally at the end of a bumper episode, we note the emergence of a new level of “smarter” AI Chat GPT (Generative Pre-Trained Transformer), which uses deep learning algorithms to analyse and generate text, with some amazing results. We discuss it rather briefly but do manage to create a poem about a famous doctor from Dundee, and a limerick about SNUG!
Primary Care - In-hours General Practice Activity Visualisation
Dr Chris Weatherburn video review of Resilient by Rick Hanson and Surrounded by idiots
https://chrisweatherburn.com/smart-change-five-tools-to-create-new-and-sustainable-habits-in-yourself-and-others-by-art-markman/
ChatGPT DALL-E2
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Our recent SNUG annual conference on the 30th November, was held face to face for the first time in over 3 years, at the Westerwood hotel in Cumbernauld. In this episode we get a taste of the atmosphere at the conference and say hello to some of the attendees. The main focus for many people was the forthcoming GP system change, with every practice now planning a move to Vision over the couple of years.
We have edited highlights of a workshop which was really useful in setting out what practices will need to think about before they embark on the task of changing systems, especially important for EMIS practices, who will have to move to a brand-new system, requiring much preparation and re-training.
We hear hints and tips on what to do from Robin Cupples, and Dawn Ellis, GP IT facilitation managers with the NSS Re-provisioning team, and Dr Jim Campbell, former GP and clinical advisor to the national team.
What you can do now? Deal with your patients that are registered for patient access; register for the Cegedim elearning; find and replace any local codes; tidy up your user list; think about what third party tools you need to use; and consider data cleansing.
Plan ahead for the migration period: appointment books, data entry and Word / mailmerge templates and searches don't migrate, so those will need to be rebuilt in the new clinical system. Data validation and data mapping will be needed for the first cut of migrated data.
Plan for the Read- only period: let the patients know at a suitable time; plan for how clinical notes and prescriptions issued during downtime will be recorded; consider how will you manage when lab results and screen messages are switched off (just before the final cut of your data is taken).
Plan for Post migration: there will be training days and webinars. Clinical data will need to be re-entered, including allergies.
And we hear from Alex De Franco, the SNUG Business Manger on how she thought the conference went.
Contact the Re-provisioning team at: [email protected]
See the latest migration news at http://gpit.scot.nhs.uk (NHS net only)
Register for the Cegedim elearning Zone for videos and demos of Vision
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And then there was one….
EMIS Health shared the disappointing news this week that they are unable to meet the timelines of the Scottish Framework for GP IT Re-provisioning, and as a result, have made the decision to withdraw.
This will leave Vision as the only accredited GP system for Scotland.
A Frequently Asked Questions (FAQ) document regarding EMIS’ exit from the Framework has been created and issued to health boards. The NSS GP IT website (NHS net only) will also be updated to reflect the changes announced. If you have a specific question about EMIS, please contact your local Facilitator Lead or eHealth team, or contact the programme team at [email protected].
In this edition of the SNUG podcast, Drs Andrew McElhinney and Neil Kelly discuss the implications of the news for Scottish GP practices, and manage to come to a reasonably positive conclusion, while accepting that it will take a massive amount of work by boards and practices to manage a system migration for more than half of Scottish GP IT Users over the next couple of years.
If you aren’t already a SNUG member, see our website below for more information about SNUG, its support for GP practices in Scotland and the forthcoming November conference.
https://www.snughealth.org.uk/snug-conference-and-agm-2022-november/
SNUG conference registration page
Mindtools: coping with change
The End by the Doors
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Docman is an electronic document management system and is used by general practices across Scotland. It was integral in the move to paper light practice and provides a workflow functionality, as well as rapid transfer of discharge and clinic letters and results from hospitals via the Docman hub and electronic document transfer (EDT). Using electronic document interchange between practices, the GP2GP process has been developed to transfer patient records rapidly when they change GP practices.
We hear from Sharon Wishart, who is the lead facilitator at the Primary Care Mentor team in Fife, and we discussed her experiences with Docman over the years, as well as dealing with a recent national problem with mysteriously disappearing documents. We also have highlights from a workshop on Docman 10 at the recent SNUG Members' Day given by Sean Foster, Philp Austin and Lesley Thorpe from the supplier company, OneAdvanced, when they outlined some of the benefits of Docman 10 over Docman 7. Docman 7 relies on local servers, but Docman 10 is run on a web browser as the data is stored in the cloud. Backups and updates will be handled in the data Centre, no down time is needed by practices and speed will be consistently better even at branch sites. Remote working will be easier, and also federated working.
SNUG members asked the team questions regarding coding of documents, system speed, SCI Gateway integration, timescale for rollout, direct printing to Docman, joint folders, updating the National folder structure, and emailing documents from Docman.
Oneadvanced Docman 10X
Docman - Electronic Document Management for healthcare video 2011
History of Docman
National Docman Conferences 2016 highlights
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Scotland’s Digital health and care strategy was published in October 2021: https://www.gov.scot/publications/scotlands-digital-health-care-strategy/
What are we going to do with citizens data, with the management information that is collected, how do we address the challenges of devices and new sources of data that are coming in, how do we build trust?
In this episode, we hear highlights from a plenary from the May 2022 SNUG conference given by Jonathan Cameron, Director of Digital Health and Care at the Scottish Government.
There are three strategic aims:
Citizens to have access to, and greater control over, their own health and care dataHealth and care services to be built on people-centred, safe, secure and ethical digital foundationsHealth and care planners, researchers and innovators to have secure access to the data they need.Jonathan explained how these aims are being taken forward, with an emphasis on how they apply to Primary Care and general practice in Scotland.
Views are also sought on the new Data strategy which is out for public consultation until August 12th.
Data Strategy for health and social care
Contact via email: [email protected]
TURAS learning site: Digital Health and Care - Supporting development of a digitally skilled workforce
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Professor George Crooks is the Chief Executive Officer of the Digital Health & Care Innovation Centre. He was a GP in Aberdeen for many years and understands the challenges facing Primary Care, as we move forward in a Digital age. At the recent SNUG Members’ day, he gave a plenary entitled: “Back to the Future! How can we use next generation digital solutions to deliver safe effective and sustainable services?” in which he posed the following questions:
What does person centred data sharing look like?How good - and complete - is the data that we use to make decisions for our patients and their families? How much do we currently listen to our patients, and understand what their expectations are for the health care we provide?“All we have to do is understand that our health and wellbeing is down to us as individuals, and we have to look at better ways of empowering individuals to take more responsibility, not simply for making better health and wellbeing choices, but also delivering more of their health care themselves...”
We have a condensed version of his talk on this episode – the full version with slides is available for SNUG members on our website – see link below.
Your comments and queries are welcome – you can email us at [email protected]
Digital health & Care Innovation Centre
Professor George Crooks on Twitter
SNUG members Day 2022 programme and videos (for SNUG members)
Back to the future theme
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Dr Jamie Hartmann-Boyce is associate professor at the Nuffield Department of Primary Care Health Sciences, and her team published a paper at the start of the Covid-19 pandemic predicting how care for patients with conditions like diabetes might worsen during national emergencies like the Covid pandemic.
She also had a paper in Diabetes care looking at the evidence that patients with diabetes were at increased risk of more severe Covid-19, and has also looked at whether Covid-19 infection may itself lead to a higher risk of developing diabetes.
There is now some evidence starting to emerge that a significant number of patients with diabetes may have been lost to follow up during the pandemic, and others may now have poorer control, although there is some variation within different subgroups. We discussed what this might mean for the care of patients with diabetes, and other long term conditions, and how we might now start to address this problem.
Listen to the end to hear whether e-cigarettes are a good thing, and what our favourite film trilogies are!
The Centre for Evidence-Based medicine
Oxford COVID-19 Evidence Service
SNUG Members Day 2022
The Godfather theme song
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The Practitioner Services Division of National Services Scotland (NSS) supports GP practices across Scotland in a number of important ways. In this episode, we speak to their Business Change manager Annie McDonnell ([email protected]) who describes a project to digitize new patient records coming into practices who have already backscanned their old patient records. We discussed how may practices in Scotland are participating in the project, how quality assurance works, and when the paper records may be safely destroyed. We also reflect a little on what life was like as a GP with nothing but paper patient records, and discover a film depicting life as a Highland doctor in the 1940s.
PSD Area offices details are listed below:
Grampian: [email protected]: [email protected]: [email protected] & Clyde:[email protected] & Arran:[email protected] & Galloway:[email protected]:[email protected] Isles:[email protected]Primary Care Informatics/SCIMP advice for practices on backscanning records
Scottish Government Digital health and care strategy
The Highland Dr film
Nimrod by Elgar
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We have another episode looking at the care of patients with long term conditions, today we are joined by Dr Lorenz Kemper of Medlink Solutions. This is a system for carrying out online clinical reviews and can be used for reviews of conditions like asthma and diabetes, as well as a variety of other uses like medications reviews, submitting blood pressure readings, or reviews of patients on HRT or the contraceptive pill. Lorenz discusses how Medlink started up, how it provides practices with more options for reviewing patients and can prompt an overhaul for the entire approach to review of chronic conditions.
NHS England is supporting Primary Care to move towards a Digital First approach, where patients can easily access the advice, support and treatment they need using digital and online tools.
In Scotland, the Technology Enabled Care (TEC) programme is looking at a number of Remote Health pathways, including a national DACS solution.
What is Medlink? video
Technology Enabled health Care GP DACS updates.
Barbara Fredrickson: Positive Emotions Transform Us
SNUG podcast on Apple podcasts
SNUG podcast on Google podcasts
SNUG podcast on Spotify
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Scotland’s House of Care is based on the Year of Care Programme and as this BMJ article explains, is all about delivering person centred care in long term conditions.
In this episode of our podcast, we discuss how we can offer Care and Support Planning to patients with long term conditions, as we speak to Dr Graham Kramer @KramerGraham and Lindsay Oliver @lindsayeoliver, two of the leading figures in promoting this approach both in England and Scotland over the past few years. We also hear from Alison Fox, the Practice Manager of St Triduana’ s practice in Edinburgh, who have found that Care and support planning really works well for them, and how this has continued to be useful throughout the pandemic.
Angela Coulter video: evidence for care and support planning.
Cochrane Database review of evidence supporting Care and Support Planning.
Many conditions, one life
RCGP Person centred Toolkit
Alliance video: Patient Reps from Greater Glasgow and Clyde Health and Social Care Partnership explain their experiences with the House of Care and having care and support planning conversations with health professionals.
You can contact SNUG by emailing [email protected]
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Dr Bill Martin is a former co-chair of SNUG and has recently moved on after a long spell in general practice, during which he experienced progressive computerization of all aspects of general practice. We discussed why he still thinks general practice is a great career choice, why he thinks many of the changes which have happened during the pandemic will stick, and why we will have to be careful about “opening up” surgeries again. He reflects on impending GP systems changes, having been through it all before, and recommends lots of planning as many systems are replaced over the next few years. He decides how he might spend a billion pounds on improving GP IT in Scotland, and we discussed whether general practice might benefit from having a spin doctor at the moment!
We also got on to debating whether he might want to consider running for prime minister and, of course, whether Scotland might beat Ireland at rugby?
Email Alex De Franco [email protected] with any comments on this or other SNUG podcasts.
SNUG regional meetings
BBC News article on face to face GP consultations on Scotland.
Downing Street parties: How many wine bottles fit in a suitcase, and other questions
Summary of The Machine Stops
Read The Machine Stops here.
Neil Young: Rockin’ in the free world
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Dr Rob Hamilton is a GP in Snug Medical Centre in Snug, a small town on the South coast of Tasmania. We say hello to Rob and hear a little about what life there is like at the moment, as the border with new South Wales is about to open and they may start to experience Covid-19 for the first time. We also reflect on a hectic 2021 with SNUG co-chair Dr Neil Kelly who gives us some ideas for new year’s resolutions, including a digital detox, or at the very least, switching off notifications on your phone. And of course, we have some book reviews from Dr Chris Weatherburn, who describes SCIMP’s mutation into Primary Care Informatics and gives us plenty of enthusiastic tips on maintaining positivity as the new year beckons.
BMJ Talk Medicine Podcast: Wellbeing – feeling addicted to your phone?
Today FM Christmas Covid Handicap Hurdle
Chris Weatherburn’s book reviews
Positivity – Chris’s Barbara Fredrickson summary Youtube video
See and subscribe to Chris’s newsletters here!
Airplane: re-inflating the autopilot
Have yourselves a merry little Christmas
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