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Peter Reynolds

The life and times of Peter Reynolds

Posts Tagged ‘GP

Top Jersey Doctor Misinforms and Misleads On Medicinal Cannabis.

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Dr Nigel Minihane

Dr Nigel Minihane

Dr Nigel Minihane is the head of Jersey Primary Care Trust which represents all GPs on the island.  Recently he contributed supposedly ‘expert opinion’ to an article in the Jersey Evening Post about someone who had been juicing raw cannabis for therapeutic reasons.  His comments demonstrate an ignorance and lack of knowledge which is unacceptable in a doctor in such a senior position.  In conjunction with CLEAR members in Jersey, we have submitted a formal complaint.

JEP PCT 1

JEP PCT 2

Jersey Evening Post, 13th February 2016

Dear Sirs,

On behalf of our members in Jersey, we wish to bring a complaint of misconduct against Dr. Nigel Minihane concerning comments attributed to him and published in the Jersey Evening Post on 13th February 2016.

The article in question is attached to this email. The passage we are concerned about is at the very end of the article where Dr Minihane gives false information about a recent drug trial in France which resulted in one death and several people suffered brain damage.

The trial to which Dr Minhane refers was not “of a cannabinoid substance”, it was of an FAAH inhibitor, known as BIA 10-2474. This drug is designed to inhibit the natural degradation of endocannabinoids, leading, it was hoped, to pain relief through modulation of the CB receptor network. It was therefore neither a cannabinoid substance nor cannabis. See: http://www.nature.com/news/scientists-in-the-dark-after-french-clinical-trial-proves-fatal-1.19189

Dr Minihane’s words were therefore inaccurate and misleading and contribute to the prejudice and misunderstanding around the use of cannabis and cannabinoids as medicine. Dr Minihane is, of course, entitled to his opinion but based on his other comments in the article he is clearly very poorly informed on the subject. There is a vast amount of peer reviewed, published evidence which supports the safety and efficacy of cannabis and cannabinoids as medicine. See attached paper ‘Medicinal Cannabis: The Evidence’. Furthermore, it is well established in the evidence that cannabis is physically addictive, with about 9% of regular users developing dependence which is characterised by physical withdrawal symptoms including insomnia, lack of appetite and headache.

We understand that Dr Minihane is head of the Jersey Primary Care Trust and the Jersey Evening Post will have asked him to provide an expert opinion. The information he provided was inaccurate, misleading and reckless. In our view it falls well below the professional standard that one is entitled to expect from any doctor. It is woefully inadequate in the case of a doctor in such a senior position who holds himself out as an expert yet communicates false information to the public through the media.

We would be grateful if you would consider this complaint at your earliest opportunity. We are able to provide oral evidence in support and to suggest witnesses resident in Jersey who endure unnecessary pain and suffering due to medicinal conditions that coud be treated by cannabis if the PCT was properly assessing and considering the evidence.

Yours faithfully

Peter Reynolds
President

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Written by Peter Reynolds

February 25, 2016 at 10:25 am

Back To The Future Of The NHS

with 12 comments

I have grave concerns about the government’s NHS reforms.  I feel like it’s Groundhog  Day.

I was deeply involved in the last major health service reforms back in the 1990s.  I am hearing exactly the same ideas, phrases and promises as we heard then.  Haven’t we done this all before?

When the “internal market” was introduced and the first NHS Trusts were “founded”, the idea of  marketing was introduced to the NHS for the first time.  I saw the opportunity, organised a conference at the QEII conference centre and built a nice business, thank you very much, for several years as an expert in the field.    I was an advisor to several health authorities and a number of the new NHS trusts.  I undertook marketing and communications audits, ran training courses and I made something of a specialty of designing, writing and producing annual reports.   I learned a lot and I felt I contributed a lot.  Why is it all being done again?

Marketing is a perfect description of the way the health service should work.  It is the management process responsible for anticipating, identifying and satisfying customer needs efficiently.  The 1990s NHS model was that  “purchasers”, health authorities and GP fundholders, would buy services from “providers”, hospitals and community health services.  “Purchasing” was later renamed “commissioning” to reflect how complex the task is. It’s about understanding what services are required and making complex choices as well as actually contracting for them.

Strategic Health Authorities (SHAs) were always a redundant tier of bureaucracy in my view.  District Health Authorities (DHAs) were to be the principal commissioners but the plan was that GP fundholders would eventually take over most of it with DHAs becoming centres of expertise rather than administration.  Then there was a rather messy fudge between GPs and community health services and we ended up with Primary Care Trusts (PCTs).

There is a huge amount of expertise required in commissioning.  The complexity of the tasks involved – understanding, assessing, testing, planning, choosing, contracting and much more, is enormous.  GPs will have to buy in that expertise which will build a bureaucracy which we will call – what?  We will have gone round in a circle.

One of the biggest mistakes made about the NHS is the endless stream of attacks on managers.  Almost all the problems that the NHS has and that people complain about are management problems.  NHS managers have a hugely demanding and thankless task for which they are regularly pilloried and censured.  They are, actually, crucial to an effective NHS, just as much as the clinicians.

So now we are to have “Foundation Trusts” and GP commissioning.  It is the same thing, yet again, under a slightly different name.  The NHS is not broken. It is, in fact, greatly improved.  It doesn’t need fixing.

We do not need more reform.  We need some adjustments.  There have been great achievements on waiting times.   Now, we need to shift the emphasis towards outcomes.  We need targets on quality rather than quantity.  It’s a tweak rather than a revolution.

Under Pressure

with 2 comments

About four months ago I embarked on a course of medication for high blood pressure.  For some time I’d been warned that I was marginal with a reading of 140/90 so I decided it was time to start looking after myself.  I was a heavy smoker and drinker.  My only redeeming factor was that I walk with my dogs every day for about an hour – and that’s vigorous walking, up and down steep hills.

I was started on a calcium antagonist and within a few days I had virtually lost the will to live.  I had no energy at all.  I’d lost all motivation.  In the most degrading epsiode of all, one morning I found myself prostrate on the sofa watching “Homes Under the Hammer”.  That’s when I knew it was serious.

I took myself straight off that poison and went back to see my GP.   My blood pressure reading was now 168/100.  He advised a change to a thiazide diuretic.  Being the not so patient patient that I am, I insisted on a full explanation as far as my “O” level science was capable of understanding.

This time it was more subtle.  My energy, motivation and enthusiasm was sapped gradually.  As my positive life signs went down my thirst rocketed to absurd proportions.  After a month or so I was regularly up six times a night with a raging thirst and a full bladder.  When I cleaned out the space behind the passenger seat in my car I had two carrier bags full of empty drink bottles.

In the meantime, I gave up smoking.  I give the pharmaceutical industry credit for this.  A month of patches and a nicotine inhaler weaned me off the evil weed easily.  About this I am both pleased and proud.  I have at least one  “cigarette moment” every day but I am not going back to it.  Although I can recognise no physiological benefit at all (if anything I seem to get more breathless now), I am much richer and everything around me is cleaner as a result.

The next visit to my GP saw my pressure reduced to 150/95.  Better but not good enough.  He advised me to start taking an ACE inhibitor as well as the diuretic.

I researched ACE inhibitors and was horrified at the range of side effects and contraindications.  Then, suddenly, coming fast up behind and undertaking me before I knew what was happening (forgive my blushes) I discovered I was impotent.  One embarrassing date and then a dawning realisation that nothing was happening, even involuntarily.  No more waking up with a big itch!

I’m not ready to give up my sex life just yet.  The one and only criticism I have of my GP is that he never warned me of this side effect.  I have also cut my drinking by a huge proportion.  From a half bottle of whisky upwards a day I am now comfortable with a single glass of wine or a small beer.  In the last few weeks my motivation has gone again.  I can’t be bothered with long walks with the dogs anymore.  Just half an hour out in the mornings and I’m exhausted.  I’m not interested in anything.   My occasional lunchtime nap has become a necessity.  Sometimes, even before midday I feel so exhausted, I just can’t wait to go back to bed.

Four days ago I stopped the diuretic and yesterday I felt like I had got my life back.  I have so much more energy.  I’m enthusiastic as I can’t remember for months.  I fair romped up the hill with the dogs this morning.  My thirst is calming down and I was only up twice last night.  My mojo isn’t back yet but I can feel a little twitch developing.  Come Christmas time I advise you to lock up your daughters once again.

The punch line? My blood pressure is now 170/110.  I may be heading for a massive stroke or heart attack any minute but at least I’ll die happy.  Despite giving up smoking and decimating my alcohol consumption, my blood pressure is much worse than when I started.  So what does that tell me?

I have no idea at all but at least now I have a smile on my face!