Matt Thomas

GP & TPD in the South West. I produce open-access pharmacology CPD for primary care clinicians. Interests in better prescribing, polypharmacy and frailty

[Matt Thomas @DrMattThomas]

@ShaunLintern If Labour want to improve staff productivity then toxic/hostile NHS culture must be conquered.

[Matt Thomas @DrMattThomas]

@ShaunLintern When things go wrong why not first independently review whole situation to identify where the system can improve rather than jumping to target the closest staff member?

[Matt Thomas @DrMattThomas]

@jabberwock951 You can get access to BMJ best practice with an NHS Athens account. It’s not UTD but it’s better than dynamed

[Matt Thomas @DrMattThomas]

@JDF_Keswick @NHSEngland @RCEMpresident Is there is any evidence I missed would be keen to see!

[Matt Thomas @DrMattThomas]

@JDF_Keswick @NHSEngland @RCEMpresident Researched this a while back and couldn’t find any evidence to support asymptomatic BP screening in the general population.

From GP perspective a pain as well - single high BP then needs 7d monitoring which is usually normal. Generating work for little gain.

[Matt Thomas @DrMattThomas]

@timricketts_ Aspirin
Ticagrelor
Atorvastatin
Ezetimibe
Bisoprolol
Entresto (counting this as two!)
Dapagliozin
Eplerenone
Bumetanide
Metformin
Gliclazide
Ozempic
Amlodipine
Doxazosin
Allopurinol
Paracetamol
Mirtazapine
Lansoprazole

[Matt Thomas @DrMattThomas]

@timricketts_ Trying to come up with a hypothetical common long drug list all with good indications. Managed 18 - imagine metabolic syndrome pt: HTN, dysplipaemia, T2DM, obesity, gout, OA, recent MI with secondary HFrEF:

[Matt Thomas @DrMattThomas]

@drlauraforrest @DeanEggitt Depends on who your local wholesaler is - near me it all seems to come from one (Alliance Direct) but I think other areas have several. Ask a local pharmacist they should know

[Matt Thomas @DrMattThomas]

@Dr_DeanS In this case if you wrote saying sorry we’re trying to refer but being told no I would also do one to make sure patient not lost in the noise.

The aim is to make as much work as possible for the admin people who reject the referral - if it slides they’ll just do it again

[Matt Thomas @DrMattThomas]

@Dr_DeanS In that case you should be able to refer - assuming congenital issue needing their attention so therefore related to initial presentation (delivery)! You can bounce back and quote this guidance at them.

[Matt Thomas @DrMattThomas]

@OpinionCovid @Dr_DeanS More up to date guidelines from Cheshire here, nationally endorsed by RCGP, message is the same: https://t.co/Rj12TrhnMd

[Matt Thomas @DrMattThomas]

@Dr_DeanS If completely unrelated then it’s reasonable to come back to us GPs, often we can deal with the issue ourselves rather than referring to secondary care.

[Matt Thomas @DrMattThomas]

@Dr_DeanS Depends what the referral was for - see here: https://t.co/rB0pbFQOHn

If related to the original presentation or an emergency then they can’t refuse - bounce back and quote this guidance at them.

[Matt Thomas @DrMattThomas]

@dr_shai All came down to spidey sense from ANP that was not a normal child with constipation. Would have been a lot sicker had diagnosis been delayed. Nothing substitutes for those years of experience.

[Matt Thomas @DrMattThomas]

@dr_shai One year old seen by (very experienced) ANP with constipation. Asked me to see as duty doctor as something ‘not quite right’. Further questioning: weight loss, nappies overflowing at night. BGL was 30, DKA. Early diagnosis with rapid recovery in hospital.

[Matt Thomas @DrMattThomas]

@emmavardy2 @DrSandyThomson @dementiaunited Thank you, from primary care perspective this is important. Occasionally will have pts discharged with non-specific dementia diagnosis, shortly after will approach us enquiring about meds. Then needs whole work up from scratch which can take best part of a year.

[Matt Thomas @DrMattThomas]

@DrLKVaughan @Adam_Skeen I do a lot of pharmacology teaching for GP trainees - lots of feedback asking for more as neglected area throughout medical training. I was lucky to have excellent clin pharm teachers at med school - taught us how dangerous inappropriate prescribing can be

[Matt Thomas @DrMattThomas]

@DrLKVaughan @Adam_Skeen Couldn’t agree more.

Has become too formulaic (if diagnosis X, give them Y). This leads to inappropriate prescribing and iatrogenic harm. Understanding the pharmacology massively improves prescribing ability and confidence.