Northern Doc

Strange when the boot is on the other foot.

2012-02-14T22:49:00.000-08:00

If you as a GP work in a part of the world with a local press you will be aware of the fact that most of what it reports is wrong. If you are involved as a doctor with a murder for example or a suicide you may attend the same event as the local press reports and think you had gone to the wrong scene when you read the press version later. Our staff regularly read the local rags to see what Johnnie and Joanna Scrot have been up to, who has died (or sometimes not!), or has been born and the odd kindly thank you for care to patients usually deceased.

A lot of what the local press reports seems to have been trickle fed to them by the local constabulary, Coroner’s and criminal courts. The local Northernshire press seems to delight in local doctor and hospital stories and alot of local doctor and hospital bashing.

Stories are usually along the lines of local doctor missed one in 300 million tumour diagnosis which was finally diagnosed by a Brownie with a first aid badge when the family were at Center Parks on a holiday. A relative is usually so stunned at the Brownie’s ability to do what the doctors did not that they are quoted to have dropped their chips in amazement.

Doctors reported to the GMC are always hot topics but when they are found completely innocent of their alleged injustices while presumed guilty by the Press in headlines leaping out from the pages their acquittal is reported if you can find it towards the back of the paper as a microdot.

Innocence in such circumstances is a bittersweet victory for the damage done by the Press’s reporting lives on in peoples’ minds for a long time and can impact on any doctors so affected lives for a long, long time after.

So while driving home from work in the Ferrari we heard first on the radio and then later on the TV news the assistant editor of the Sun protesting about a witch hunt. Having dealt with colleagues who too had felt the same we felt he may finally understand what it is like to be on the receiving end. We feel this is a bit rich for yes freedom of the press is vital for the provision of information to a wider public be it of good or of ill as long as that information is ACCURATE.

The provision of a free press does not allow it to act as judge, jury and executioner and if anything good comes out of any inquiry at present ongoing it should be that if a newspaper publishes a headline like doctor death killed my relative by stamping on their head when the cause of death was different and involved no medical negligence or culpability that the paper concerned should publish an equally prominent retraction and apology to any individual so wronged. This would be in stark contrast to current press "good" practice of lets assassinate a character and if we get it wrong walk away whistling with our hands in our pockets heads looking skywards as if nothing has happened.

The problem with the British press is that they have got away with so much for so long that they do not like to finally experience what their victims have endured for so long namely the feeling of victimization with little or no redress. Now they are on the receiving end they are able to protest far more and far more loudly than their victims were ever able to do so. For they have friends in high media places. Their victims do not.

Praise be the Party for increasing regulation of doctors within a free society while allowing a free press. Should the same clinical freedom of doctors to act now be extended in the same way by regulation of the Press via the benevolence of the Party?

A General Press Council, annual appraisal and revalidation of “professional” journalists to maintain good press care? Go on you know regulation of professionals makes such good sense . . .

Perhaps the head of a new GPC could be someone who knows a lot about the press like a doctor who has read a newspaper once (the Sun or Daily Star of course) or once watched John Craven's Newsround . . .?

Lansley slips one under.

2012-02-11T01:09:00.000-08:00

Regular readers of our blog will know that we have featured the PFI initiative a few times in the past. This is part of the Tripartite policy on healthcare that NHS bad, private good.

This indeed is the crux of the Health and Social Care Bill which is not about health or social care only the denial of both unless provided for by the private sector which is perceived to be more efficient except that cost is not negotiable only quality. And you only need to think breast implants to see how cost is fixed and quality service is dumped in favour of profit only, care not, by some private providers. So look what Andrew is trying to slip one under the radar, always a good game at an English public school on a naïve new boy or members of the public.

A £ 1.5 billion PFI rescue fund. Who could have thought that the super efficient private sector modeled NHS foundation trust or a world class commissioning PCT which funds them would need a rescue fund? After all if you have PIP breast implants the private or any willing providers are queuing up to help you after they have relieved your wallets dearly and you have paid tax too for an NHS that won’t deliver?

Now this £ 1.5 billion is for seven trusts only and there are 103 PFIs. Here are some statistics.

£ 1.5 billion shared by 7 averages £ 214 million per trust. Sounds a lot but this is to be spread over 25 years.

Each PFI agreement will have been negotiated by a few senior NHS managers overseen possibly by a Chief Executive and maybe some at the Department of Health some of whom might be able to read or count and may just have been in the bottom third of a Northernshire comprehensive school when younger.

NHS management attracts the rejects of the UK comprehensive school system while the private sector does slightly better. So it is not surprising that some parts of the NHS are needing a bailout. Looks like some NHS managers are doing a banker and getting a stealth bailout for their and the politicians’ cock ups.

Given that there is a need for £ 20 billion savings in the NHS is there any reason why £ 1.5 billion is being paid to bail out NHS management incompetence? At an average of £ 214 million for each NHS PFI contract failure that is a hell of a reward for a few individuals’ failings.

Remind us Dr Andrew private good NHS bad? Oh yes and don’t forget to blame Labour but who invented PFI? See second paragraph of history here together with some interesting quotes from some of those involved over the years.

Praise be to the Party for ensuring that only in NHS management and banking is incompetence rewarded with government bailouts to the tune of billions and no doubt with promotion as well.

Big Brother’s members continues to get bigger.

2012-01-30T23:39:00.000-08:00

We here at ND Central apologize for using smutty innuendo in our title but a piece from the GP magazine caught out eye and a lot of it we found quite offensive for it is showing how clearly the bottom up liberation of the NHS is more of a monster top down command and control exercise. We took offense to the classification of cataract surgery and knee replacement surgery as low clinical value treatment that must only be restricted on the basis of strict evidence based criteria.

Well if these are procedures of low clinical value then we are sure that some alkaline substance sprayed into the eyes of the dumbkopf that thought this was a low clinical value treatment followed by a knee capping might make them realize the high clinical value that both of these procedures have to patients. Not being able to see or to walk comfortably are not fun and correction of these has a very high clinical value to the NHS customer aka our patients.

However it is not the patient who is in charge of the NHS it is the Party. Remember "no decision about me without me"? These are seemingly become more and more meaningless words with each day of ~~top down reform~~ bottom up liberation that passes.

You haven’t yet seen another layer of top down control via bureaucracy coming to control bottom up GP commissioning decisions via the Quality, Innovation, Productivity and Prevention Right Care Team? Not heard of this quango? Give it a Google (ooh no misses!) and you might land up here.

You might want to checkout a Right Care “bespoke” Health Investment Pack (HIP weren’t they formerly another bureaucractic nightmare called Home Information Packs once?) for your area. Go on give it a go for your PCT and look at all the pretty, pretty colours on all of the graphs.

You might want to look at About QIPP Right care and its 3 bullet points

Improved clinical involvement in commissioning.

Is that the same as we are telling you what to do?

Stronger patient involvement through shared decision making.

Is that the same as we are telling you what your only choice (if any) is?

Supporting commissioners with knowledge, information and coaching to consider the legitimacy of variation and thus whether the level of variation.

Is that the same as we are telling what to do in order to make sure you meet our ~~targets~~ outcomes?

And this is all to be “evidence” based? You can even have a HIP Guide for GPs if you choose to register something we think we shall decline.

Seems the more the war of liberation goes on the more the top down reform of healthcare goes on so that GP Commissioning Groups are going to be told what they can and cannot do by all those HIP Right On Care guys and gals at the new and rapidly evolving mushroom cloud that is the NCB.

You know all this makes perfect sense and you can find what all this is really about in the sentence:

"QIPP is working at a national, regional and local level to support clinical teams and NHS organizations to improve the quality of care they deliver while making efficiency savings that can be reinvested in the service and deliver year on year quality improvements."

That is a polite way of saying we will command and control you to reduce services and save money.

Praise be to the Party for its transparency of opacity when it comes to giving the troops on the ground what they need. More diktats and stats Herr Doktors?

At this rate we will soon be ready for another quick QraP.

QOF and squeegee gangs.

2012-01-26T22:34:00.000-08:00

We wonder how many patients may have had at this time of year letters along the following lines (we have put our real thoughts in brackets):

The doctor/nurse/adminstrator in charge of your (insert name of a Party determined illness) has noticed that you have not had the following:

blood test/blood pressure/asthma test/cholesterol test/(your head shoved down a toilet test for no reason other than QOF says we should do so test).

As part of the practice’s commitment to your health and well being (that’s a pack of lies we want to get paid if we tell the truth) we invite you to make an appointment for this with a doctor/nurse/healthcare assistant.

It is vital that you have this test to ensure your continued good health (if you don’t all your sexual organs will shrival and drop off or some other implied threat inserted here)

Please ring on the above number to arrange for this test.

Signed

Doctor/Nurse/Another.

Now we bet no GP will have ever have sent such a letter or asked staff to ring certain patients and “invite” them to come in for some “tests”.

The annual GP QOFing season is on so if you are a patient look out for numerous invites to perform tests to ensure that your Party approved illness is well “managed” by the medical process of ticking a box determined by some dullard in Whitehall the sole purpose of which is to try and reduce payment to your evil overpaid GP. Any real illness can be treated usually without all these mostly unnecessary extra tests done for no medical benefit other than doctors’ pay reduction.

A simple example would be if you have a mental illness do you need your cholesterol checked every year if you are well? Would your identical twin without any mental or other illness get the same intensive “treatment” as you? No discrimination here comrades as all patients are equal in the NHS and we are all in it together . . .

We think that as a patient with a long term condition being QOFed is a bit like being squeegeed at the traffic lights. Your windscreen is clean as you are well and so you get from your doctor a totally unnecessary load of soap and old flannel packaged to make it look like it is something useful to you when you don’t actually need it to make someone a fast buck.

Soap and old flannel will we are sure appeal to anyone who went to a public school especially if administered in the showers by a matron in a uniform but to anyone else it will be a load of froth on your windscreen - completely pointless and very annoying.

Praise be to the Party for ensuring that year on year GPs and their staff are spending more time squeeging windscreens than doing real medicine. Don’t worry if you can’t see your GP with real illness. If their QOF points are squeegee clean then they are Party approved excellent GPs for ticking all the Party boxes while ignoring your real healthcare needs. QOF you know it makes sense medicine.

Not.

The new word on the block.

2012-01-23T05:56:00.000-08:00

There appears to be a new word on the block in GP land and it is called integration. Now those of us in GP land who have a scientific background know this as a very powerful tool used in mathematics that can produce useful results.

The new tool sorry word on the block seems to have come from the Future forum which is neither the future nor a forum as it is a government appointed quango to lubricate the Health and Social Care Bill up the arses of the unsuspecting British public via a sham consultation and its leader gives us a math’s lesson here. If you want a read you can learn about Mrs Crabtree here someone that no GP will ever have seen or encountered in their professional lives.

Now integration is a word we have seen here before in healthcare in the guise of several previous buzzwords take for example integrated nursing teams.

At the time this buzzword was doing the rounds we had then, pre TCS (Transforming Community Services), our own attached district nursing team based in the surgery with whom we worked with for the benefit of our patients but for some reason they were not integrated. The nurses were employed by the local Soviet but resided in our premises and we played on the same side as they did namely that of the patient and this arrangement seemed fairly well integrated to we who are simple grunts in the field.

However integrated nursing teams were not what it sounded like on the tin. It was in fact the local Soviet asking us as GPs to take on the budget, albeit less than the then current cost, for the nurses and manage it for them hence the term integrated nursing teams. So professionals working together are not integrated you only become integrated when you manage the budget not the patients.

Now in Shiteton in the run up to NHS privatization we have TCS district nurses the location of whom is a top secret for they are now deployed in secret central barracks to ensure greater integration with their medical colleagues and to ensure complete work avoidance and unaccountability. Is the new integration in fact differentiation?

So what of now and the new integration? What is it? Some examples taken from the GP rags say that this involves the overhaul of the GP contract to promote “integration” of practices. What exactly does this mean? New super large health centres 1960’s style or a rebranding of Darzi centres anyone? May be the forced mergers of local practices for efficiency gains?

Clinical commissioning groups must show ability to integrate during authorization process. Haven’t a clue what any of that means but might it be the top down bit of the bottom up liberation of the NHS via the National Commissioning Board (NCB)?

Integration may mean to explore ways to pool health and social care budgets. Is that the same as to save money but not improve care a bit like integrated nursing teams?

When you have been in medicine for a while you hear the same ideas repackaged with new buzz words. It is said that every generation of surgeons who goes to war makes the same mistake and tries to close contaminated wounds rather than leave them open to heal. Just as new surgeons make the same mistakes and do not learn from their predecessors so does every new Party not learn from the mistakes of the previous ones.

Praise be the Party for reintroducing calculus into the medical syllabus. We suspect that those talking of integration missed out at school on how useful real integration can be and are merely using the word as something to paper over a large series of budgetary cracks.

Anybody notice the similarity between the new NCB and the former NCB (National Coal Board) in terms of integrated efficiency on a mammoth scale?

Less is the new more. Practical QraPing vs patient care.

2012-01-17T23:52:00.000-08:00

In contrast to politicians who litter their speeches with their constant encounters with the vox populi your average Ferrari owning GP living in their baronial mansion house who daily is on the golf course would never see a patient in their life, if you believed the politicians. Hence their constant need to bugger up things that work via reform (the politicians that is).

We bet if one such GP said that patients would prefer to see their GPs in a surgery rather than have their GPs sitting in meetings looking at pretty, pretty graphs the politician would tell them where to get off and set a once a week GP on a future forum to put such a devient GP in their place.

A recent meeting and a series of conversations with GPs from other practices shows how central Party control is taking more GPs further away from patient care in order to direct them towards tri Party care aka commissioning. We return once again to the QraP (QP indicators = Quality and Productivity) indicators of the useless QOF (Quality and Outcomes Framework) of the nGMS (new Genral Medical Services) contract.

QraP is nothing more than Party approved love ins and huge group hugs to ensure that all GPs are equally dumb, Party dumb, deny patients care dumb to save managers money by not treating patients dumb. We have posted before on this but the slow onset of terminal buttock ischaemia from sitting on our arses in (medically) useless meetings is starting to affect our sanitity.

We return to the QraP indicators and will concentrate on QraP indicator 6 which can be found with the rest here. Once again GPs who are trained to work as professionals on an autonomous basis are now being subjected to an increasing collective centralized censure to ensure that all referrals are now collective decisions, not individual decisions made by an autonomous trained professional, leading to socialized medicine which to our limited minds smacks of the former communist model so loved in the former Easten Bloc (deceased) and still practised in the North Korea with its obvious benefits to patients there.

A recent meeting in order to achieve the net outcome of this process, a series of pro formas filled in and sent back to the local Soviet for them to approve, tick the box and authorize payment for GPs not to treat patients was an eye opener as to how low Brown/Blair/Cameron/Clegg/Lansley Party control has become in denying our patients real medical care.

Remember all of the above are fully trained medical professionals, public school educated, extremely privilaged people who have never worked in the NHS and so can speak with the same authority as a brothel owner on the benefits of virginity in increasing sexually transmitted disease and the birth rate via the private sector.

The QraP 6 indicator is as follows:

The practice meets internally to review the data on secondary care outpatient referrals provided by the PCO (Primary Care Organization aka local Soviet).

(italics are our counter revolutionary ones must stop watching Dr Zhivago).

Well for starters the information provided by the local Soviet was worse than useless. Lots and lots of pretty, pretty graphs and numbers in all sorts of colours they had found while pretending to understand Excel. If they had had to try and draw and label any of these graphs by hand on graph paper by themselves for their teacher at school they would have put them in detention for not producing anything readable. Oodles and oodles of pretty, pretty piles of paper going to a landfill site at the detriment of real patient care and in doing so achieving nothing towards real patient care.

When we had deciphered, or thought we had we had to guess what all the initials meant, we then followed the PCO’s pro fromas as to what we had to do and fill in. People who had failed in everything they did at school continue to do so as more and more of the data turned out to be at complete variance with the practice’s more accurate computer data. We found referrals we had made which we hadn’t and referrals we had that hadn’t resulted in patient care until the second or third request that had generated hospital income at the expense of real patient care.

We reviewed our referrals and collectively (see we are actually “team” players) agreed all were appropriate. We have done this pointless exercise numerous times before for NHS managers who are all better doctors than we are for some of them can count but only up to the number of fingers on their hands that they are not sucking in their mouths or stuck up some other dark orifice doing nothing useful.

Each time we have found that we could not prevent referrals and each time the concensus is that with hindsight we should have referred to a more expensive service to better serve our patients’ healthcare needs which is at odds with this exercise which is to save the muppets in PCO land money.

At the end of this completely useless exercise several pieces of paper were filled in and a grand total of 8 days of GP time had been wasted to achieve what?

16 pages of A4 paper pro fromas filled in to achieve 6 QOF points at £130.51 per point for an average practice. This income would not even cover the cost of a locum to replace the lost doctor boots on the ground treating real patient in real time. It certainly did not replace the 8 full days of appointments lost for patient care and this is set to get worse under the Tripartite health policies being persued at present.

Praise be to the Party for giving us QraP 6 to deny patients’ care by removing doctors from treating them. QraP 7 is even better socialized medicine. How many more surgeries will have to be disabled to ensure that QuaP 7 succeeds?

Has anyone noticed the subtle subtext that QraPing is grooming GPs to become fundholders sorry clinical commissioners via clinical commissioning groups?

It is not big it is not clever and doctors should be using their time to treat patients. Not prop up a hugely flawed and failed idea called commisioning. When will the politicians wake up and see that they all are providing everyone with is less and costing more to do so?

And it came to pass . . . eventually.

2012-01-14T06:46:00.000-08:00

Sometimes recent events can trigger long forgotten memories of previous lives. Recently at ND Central one such event occurred.

Many many years ago in place that practised first world medicine a junior grunt in the middle of the night pushed an ill patient for an urgent CT scan. There were porters at this great centre of learning and nurses were not meant to push patients but as the porters earnt more per hour for a night shift than junior doctors they were allowed an uninterruptable hour for their midnight lunch and this was sacrosanct. Bugger illness we need our snap and are part of t’union.

So a junior grunt (the cheapest employee on the pay roll earning less than a 40 hour a week police office at the time for working a 100+ hour week) and a junior nurse (leaving a busy ward on take understaffed) pushed the ill patient several hundred yards and several floors up and down in lifts to the CT scanner.

In those days CT scanners cost about £ 500,000 to buy and another half million a year to run. Scans took sometimes half an hour per patient in contrast to the minutes they take to do today.

The hospital had very good radiologists and the junior grunt sat and spoke with the on call radiologist as the scanner warmed up and during the scan. Obviously a lot of the conversation was about the images we were seeing as they were slowly produced on the screen and we cannot recall the outcome of the scan but we do recall the radiologist’s comments as the scan progressed.

They told us about the costs above and said that the scanner “tubes” had a life expectancy of about 3 years (this was early CT scan days) and that given the costs to get best value they should be used 24 hours a day. Now knowing that the junior grunt was the lowest paid member of staff per hour in the hospital at night and, in those days radiologists did very little out of hours work and so were not that highly paid among consultants, the grunt asked why did they not do this?

The radiologist replied that they thought most patients would be prepared to come in in the evening in order to get scans done quicker but went onto say that they had looked into this and the consultant radiologists were prepared to do this so that they could offer a better service and reduce their waiting times for the one CT scanner they had.

The only thing stopping it being a cost efficient service was the cost of the overtime for the radiographers. The figure quoted was that they wanted 2-3 times their normal hourly rate for out of hours (17.00 - 09.00) during the week and more at weekends especially for nights. The huge cost involved on this one item of expenditure meant it was not possible.

Both of the grunts in the scan room looked at each other at this point as they could see the logic of using expensive equipment efficiently for the benefit of patients being scarificed on the absurdity of an institutionized selfish stumbling block.

Now at that time most places in Northernshire had not any CT scanners and were only dreaming of such magic but if we fast forward through the mists of time and memory to a Northernshire that now has CT scanners and even MRI scanners we come to the present and the event that triggered our little musing.

One of the team answered a family member’s phone and it was a hospital radiology department asking to speak to the family member. They left a message and asked if the family member would be prepared to come in for their scan 10 minutes earlier than their appointment.

And the time of their new appointment? 07.30 Zulu.

It has only taken over a quarter of a century to get to this stage that we had discussed in the scan room all those years ago. Who knows in a another 25 years time GPs in Northernshire may be able to request a MRI scan of a back after the lumbar spine x-ray is confined to the dustbin of history for investigation of back pain.

Now we heard someone wise in the ways of radiology talk about that idea in the same scan room how many years ago now . . . ?

Praise be to the Party for ensuring that when it comes to progress the NHS is designed to inhibit it at every turn. Come up with a good idea in the NHS and it will out committee you at every turn.

And still does.

Private good NHS crap - unless it is breast implants.

2012-01-08T00:51:00.000-08:00

As there is no real news in the UK the media have been having a feeding frenzy over the decision of a former historical enemy of the UK now a “partner” in Europe called the French to remove a certain type of breast implant. Already at the end of the week one of the team who was on call listened to a receptionist say as they put a call on hold “I have been waited for this one all week my first boob job panicker what do I tell them?”

The breast implant scare is a classic example of private versus NHS care. When people want something they initially try the NHS for it is free. Often genuine medical treatments are free and usually no problems. If something goes wrong usually the NHS will pick up the pieces in terms of medical care although not necessarily compensation. If they can’t get something then Mr or Mrs Disgusted go private and moan to their GPs about the NHS and their taxes.

The figures we hear are that only 5% of the defective implants were done on the NHS and these patients will be offered the relevant corrective treatment for free at least as far as the patient is concerned. The remaining 95% of punters are expected to go back to their private consultants.

The great thing about NHS care is that the private sector always has a bail out option. We would ask our fellow bloggers how many of you have not admitted a case from a private hospital where an NHS consultant treating a private patient had to admit their patient for bail out care when the operation went wrong or there were life threatening consequences?

Examples being haemorrhage, septicaemia, cardiac arrest and heart failure which the private hospital with no intensive care could not treat and it interfered with the consultant’s extra currciular activities.

At present there is always an NHS bail out facility. What will really p*ss off the private sector “I’ll pay for the cheaper option to increase profit” is that quality costs and that in theory their mistake should cost them dear. On this occasion it might cost them or their patients unless the private sector, some bits of which seem to be no longer in business, do the honourable thing. Patients won’t like that.

Mr Lansley in his naivety expects that the private sector will do the honourable thing and perform the corrective surgery for free. Question is, in the free market is honour a cost worth paying? Or will the private clinics who can’t be arsed to do anything that will cost them do the dump and run on the NHS thing?

Praise be to the Party for always providing the private sector with a rip cord. When it comes to private boob boos will the Party allow all those in the private sector who have fail to act honourably the opportunity to pull the NHS rip cord? Or as someone who flew in world war two without a prachute said to us many years ago if you don’t pull the string it don’t mean a thing.

NHS parachute or private crash and burn? Which do you think most NHS patients and private clinics will choose? And who will pay and who has profited?

Some thoughts on the year 2011 from up North.

2011-12-31T04:58:00.000-08:00

Traditionally at the year’s end people reflect backward on what has been and think about what they hope will be. Most humans are optimistic but as one ages in general practice one becomes more pessimistic with each change of Government or “new idea” that comes out of the Department of Health or local PCT.

As GPs we should treat patients. We are trained and able to do so and by and large we do. We are not so dumb that we believe that all those in jails or politicians are saints but overall most people in medicine care and try to do their best to the best of their abilities, their training and knowledge which we know varies from individual to individual and from place to place.

In 2010 the great Marshals NC/DC launched a war of liberation of the NHS something we haven’t quite got yet. It was sold as a “bottom up” liberation as opposed to a “top down” reorganization which has become even before the relevant legislation is passed a bureaucratic quagmire going nowhere fast.

Every GP is in this quagmire to some extent treading water and wasting time and money away from patient care to deliver Marshals NC/DC dream of liberation which increasingly looks like the Red Army’s advance into Eastern Europe at the end of World War 2 looked to those dreaming of democracy in countries occupied by the Nazis.

The “bottom up” reorganization with the clinician in the consulting room being in charge is prevented from doing anything useful by the (non) top down reorganization dictating the rules of engagement (ROE) while the real ROE are still being thought up on the hoof and modified on a daily basis. And that is before its codification into legislation and thereby enforceable diktat.

As a result the real net reform of NHS to date is business as usual at the frontline. A centrally, politically controlled Sovietized medicine of tick boxes that deliver piss poor patient care by ensuring that your GP gets paid to tick patient useless boxes at the expense of treating patients.

Preventative medicine is easier to control and reward. Life saving medicine is acute real time and unrewarded.

As a GP if you resuscitate a 3 month old child successfully from a cardio-respiratory arrest in your surgery or a patient of 45 who walks in feeling unwell who has a VF arrest using a defibrillator you purchased yourself because you thought it was a good idea to have one this is all available to the government for no charge. No box ticked but a clear benefit for the patient.

Do a cholesterol on a stable diabetic/angina patient or a patient with mental illness every year which is normal and requires no treatment and you are rewarded for doing so. One intervention makes a clear difference the other intervention’s benefit is of debatable benefit but rewarded.

Patients want care especially when ill and this is what most of us are trained to do. Increasing they are getting care not for acute illness which is unpredictable and therefore not Party controllable but for Party determined “illness” in the form of boxes to be ticked.

The need for boxes to be ticked to generate income, for we all need money to live, has led to more and more of our surgery time being filled by reviews of well patients and of us seeing less and less illness. Party determined “illness” is taking priority over real acute illness.

This is not medicine it is a retarded bureaucracy of medicine determined by politicians’ needs and not by patients’ real illnesses. It is said if you want to learn surgery go to war. If you want to learn bureaucracy go into general practice.

Praise be to the Party for pursuing policies of reform which are nothing more than command and control of patient care by politicians at the expense of real hands care of patients and their actual illnesses. Commissioning is not about getting good care it is about controlling costs and will be centrally controlled.

A Happy 2012 to you all and to use an expression from one of the teams’ previous lives - stay frosty. We suspect this year in United Kingdom general practice will be a bleak one with every more expected for ever less and even more interference from on high that will not benefit patients - only politicians and their friends.

Helf and safety and a few erratic Christmas musings.

2011-12-23T04:42:00.000-08:00

For those of us here at ND Central old enough to remember the use of candles with which we used to do our homework in the 1970s powercuts is nothing new. What is new is what we found atop a candle bought from a local shopping establishment which beggars believe (see above).

This is similar to our doctors in training who are now asking us 2 years after they qualified to certify the fact that they can put IV cannulas in something which we in General Practice do once in a blue moon. Apparantly in hospitals only registrar grades, which apparantly now includes GP Principals, can do this because under the new eportfolio fellow doctors in training in the same year as they were are certifying their peers in training making a mockery of the new online e-retardation portfolio as a means of proving competence.

If you have not seen a doctor in training do a IV cannulation how can you in all honesty say they are competant? By implication having done a year’s plus worth of house jobs, sorry comrades foundation year 1 (F1 jobs), they should be but I suspect Mrs Jones the vicar’s wife would be a bit miffed if we asked her to allow our F2 doctors to cannulate her when she merely comes in for a repeat hormone replacement prescription so we can sign them up.

Still their fellow juniors can and no doubt such probity issues will be swooped upon at their next appraisals (not). The GMC and Deaneries can’t have F2 doctors signed up for cannulation skills in hospitals when they will be doing it many times a day it would make a mockery of revalidation. We'll do it instead in GP placements.

So we will have to consider whether we can at ND Central light a candle for Yuletide in our own homes for we must surely have to conduct a risk assessment and ensure all the proper safety equipment is in place? Fire proof gloves, eye goggles, fire retardant clothing, a selection of fire extinguishers, a first aider, a fire safety officer, a fenced off exclusion zone, a fire access and assembly point all for one little decorative candle on top of a Christmas cake.

We are so thankful to all our patients who at one surgery have bought Yuletide joy to all of us by nicking from the surgery the empty cardboard boxes wrapped up to replicate presents under an illuminated (risk assessed) Xmas tree now mercifully free of its once proud baubles to bring some festive joy which no doubt have found a new alternative happy home for Xmas.

Given last year’s zero attendance at a Xmas Eve surgery we are sure that our ever appreciative patients’ health will be being looked by caring publicans as they engage in healthy self care by getting rat faced before smashing up our Police officers’ in the spirit of universal love and joy that is Christmas in some parts of Northernshire.

On Christmas Day we are sure they we partake of the 8000 calorie Xmas workout and that is just the chocolate in their kids’ Christmas’ stockings. Spare a thought for their little canine chums who no doubt will pig out on the copious quantites of uneaten and wasted food. Our veterinary colleagues tell us that pancreatitis due to over ingestion of fatty food by middle aged dogs goes up at Christmas big time.

We hope that all of you who have been kind enough to read our little thoughts from Northernshire this year have enjoyed some of them and we thank those of you kind enough to have spared the time to post a comment or two. We hope that you will all enjoy a happy safe and healthy festive Christmas and the same in the New Year.

Contrary to popular belief the NHS and GPs are still open and availible for business day and night something that many patients found surprising today when told of this by King Herod their GP as they bought their little cherubs in for a pre Xmas check to ensure they would not interupt their Mummie’s or Daddie’s own 8000 calorie Xmasfest by being ill. We are sure they are plenty of in laws that can do that without any angelic little helpers.

Enjoy and be careful out there!

Praise be to the Party for creating Christmas and all its trimmings. Can’t wait for the sales rush on the 26th and our on little post festive rush on the 28th. Watch those candles carefully and remember to follow all the instructions on them to the letter.

NHS Global™ goes globally nowhere.

2011-12-18T04:59:00.000-08:00

Blogging is quite a good way of recording ones thoughts at a particular time and sometimes when you read something you wrote a while ago it shows that sometimes we have a healthy degree of cynacism here at ND Central.

We wrote a piece in April 2010 and poured a lot of scorn on the idea then and a piece in the Pulse magazine has revealed that the net income earned by NHS Global™ is a massive zero. In fact it will have made a net loss to date after all the expentiture to generate nothing.

We particularly like the bit in Pulse where a former big man in the NHS, none other than the former director general of commissioning at the Department of Health Mark Bittnell, was predicting last month that NHS Global would deliver £ 50 billion for the NHS. Good start then thus far and we all know how much income commissioning has ~~generated~~ cost the NHS. No wonder the world is queuing up to buy NHS ideas and innovation.

Praise be to the Party for yet another good idea to generate income that has cost us all.

What will they think of next?

Tonsillitis.

2011-12-13T08:37:00.000-08:00

A teacher once said that you have no bigger group of idle malevoent gossipers with nothing better to do and no purpose in life whatsoever than parents at the school gate. The teacher said that they could create a serial sex offender axe murderer out of a new born if they wanted to by the sheer power of disinformation. In the recent past we may have seen this in action.

Recently lots and lots of parents have been presenting their precious little Tarquins and Chantelles in their droves not with the usual “really” sore throat or being “really” poorly as they trash the toys in a wrestling match to subdue and destroy the defenceless toy but with what they think their child has namely tonsillitis.

Really Mrs Slob your years of non attendance at any educational establishment let alone a medical school do you proud as does your 20 stone 5 foot 2 physique reeking of cigerette smoke although we know you only ever smoke outside to protect Tarquin’s and Chantelle’s delicate collective 80 pack year lungs from anyone coughing close to them in case they catch summit really serious.

Now being doctors we do not usually accept patient diagnosis as gospel for if we did we would have seen over a thousand cases of Lassa fever this month alone we instead do the grunt school honoured thing of taking a history.

The history shows that when Tarquin and Chantelle are asked to point to their “really” sore throat due to tonsillitis they point to their lower neck to a structure called the trachea (windpipe) many inches below the tonsils and their pointing finger even extends further down to the bottom of their breastbone.

The history also revels the prescence of a clear discharge from a snotty nose, a painful dry cough and if one listens to Tarquin/Chantelle telling Tarquin/Chantelle to f***ing give me that f**king toy a very hoarse voice. Observation shows a non coughing child and examination reveals a normal set of tonsils and a completely normal sounding chest.

Sorry to disappoint you Mrs Slob you cannot have some antibiotics to send Tarquin or Chantelle back to school with their “tonsillitis” so you can watch Jeremy Kyle and go Christmas shopping with your healthy friend Rothman. You will have to look after them yourself.

And thank you for noticing that we too have “tonsillitis” in the form of a dry painful cough, hoarse voice, cold and temperature of 40 degrees centigrade which is why you found it difficult to hear us above you shouting at Tarquin and Chantelle to f**king shut up as you were at the doctors while on your mobile ordering your five a day pepperoni pizza and chips for tea.

Praise be to the Party for ensuring that every Yuletide they try it on and on and on. Could this be an NHS Abba special? Sound quality is as good as listening to the mobile phone conversation described above!

More QraP - care pathways.

2011-12-06T23:32:00.000-08:00

All three political parties in the UK regard the National Health Service (NHS) not as a service to patients but as a political toy that they can use as the Roman emperors used bread and circuses to placate the populus whom all politicians despise as did their Roman predecessors.

Your average Secretary of State for Health uses the NHS more like they do a toilet. They sit on it, crap on it and then move on to something else leaving all those who work in the NHS covered in smelly brown stuff that we then have to spend years sorting out while they disappear after a huge unproductive dump.

One of the things that strikes us repeatedly at ND Central is when children in often very deprived parts of the world are interviewed and asked what they would want to be it is usually a doctor, a nurse or a teacher all of whom should be professionals and by and large are trusted by most people apart from politicians who fear them. This is the perception in the third world where access to such professionals is less than it is in the UK and where professionals still have a degree of respect even if you cannot access them as freely as you can here both in terms of cost and distance.

Historically this fear of the professions has been so in any political persuasion from the far left (Pol Pot, Mao et al) to the far right (Hitler) and our current politicians are no different.

One of the most sinister manifestations of the theory of creep proposed by the medical blogger the Witch Doctor is we believe is that of the care pathway. What a care pathway is a mystery to those of us who actually treat patients but here are a few possible definitions here, or here or try here. We lost the will to live when we read the word tool for while we will happily here at ND Central to use a hammer as a real world tool anything branded a care pathway is merely a tool.

The care pathway is the creep of socialized medicine using the principal that all doctors are crap and the only people who can really treat patients are those who could only get into a medical school as a corpse to be dissected namely politicians and NHS administrators. This is why if you read the QraP indicators, Quality and Productivity comrades, you will see indicators Qrap 8 and Qrap 11 aka “Delivery of improvement along the care pathways.”

Over the last few months, and perhaps it is because it is autumn when nature starts to deposit and then digest all the detritus we have had increasing piles of detritus called care pathways for our consideration. Most are full of what might be best described as bovine excrement with frequent references to NICE manure and alternative manure treatments but packed full of the absence of any scientifically proven treatments.

What NHS care pathway would empower the professional to do to help the patient in the following instances?

NHS Care Pathway Apollo 13: Land on Moon and return to earth.
NHS Care pathway British Airways Flight 38: land on runway with all engines working normally
NHS Care pathway US Airway Flight 1549: take off do not hit any birds do not pass go and land as normal.

The answer is none of them for life is never as straight forward as a written diktat and sometimes deviation from the protocol is for the better as in all three of the above examples.

Fortunately in some areas of life a few professionals are allowed to make their own judgement but not in the new increasingly Sovietized NHS. Deviate from the Care Pathway comrade and even though you may save a spacecraft or land an airplane and all of its passengers safely you will fall foul of the Stasi and although you may save a life you may as a result not get paid for missing a quick Qrap.

Indeed every care pathway has been about restricting and denying care rather than allowing or improving access to care or the quality of care provided.

This is very worrying. For it is another nail in professional freedom for the Party are telling us what not to do now in order not to treat patients via Qrap. For there is now a target to reduce care see our last post and now insidiously via the Qrap above to reduce care further. So can you see where Qrap is going – reduce asthma care and then if asthma related admissions go up - introduce a new “care pathway” to reduce asthma admissions. Is this now the emergence of a Tripartite intergrated care pathway?

Deny NHS care via QOF micromanagement and allow the emergence of a better any willing provider?

What is worse is the fact that these so called pathways are determined by those doctors who believe that treating patients is best done in a meeting rather than in the consulting room. By avoiding patients this makes them better able to determine care for they will see not first hand the results of their mistakes, their little Qraps on their colleagues, for they are so busy castigating those who actually treat the patients to maintain the quality of care that they do not provide at all. Some may even be well hard once a week men.

Now for simple grunts in the field care of real pathways that patients can actually use involves such things as the application of a bit of Agent Orange to suppress weeds, a bit of gravel and tarmac here and there to ensure a smooth passage to the surgery or to repair a garden path in your average GPs baronial mansion’s garden not about the restriction of care via the local Soviet and its retards. Looking after paths is one thing looking after patients is a much bigger ball game.

When quack medicine, unproven treatments, and where and to whom you can refer for excellent treatment are denied by care pathways enforced upon GPs by the Thickerazzi of the average NHS committee does it not feel that the Eastern Bloc is back and back for good?

Praise be to the Party for progressive freedom in the form of ever restricted choice and centralized control.

We like bottom up reorganization of the health service it works so well as Orwell predicted many years ago. There may even be some new non top down, non targets called outcomes coming our way today – all 60 of them - whoppee!

Did Christmas come early to Northernshire?

2011-11-30T23:36:00.000-08:00

Today (30 November 2011) those of us that are average Northernshire Ferrari owning GPs noticed something different as we began our long descent into the great metropolis. It was like a scene from one of those post apocalyptic holocaust films where someone wakes up and finds a car to drive only to find no people or other vehicles on the streets completely unaware of what was going on.

There was literally no traffic on the roads and it was similar to, but better than, going into work early on a Christmas Day morning. Many of our staff said the same that the drive was a pleasure and why was it not like this every day and our doctors in training commuting from other nearby conurbations arrived light years earlier than usual.

Now this is Shiteton an incredibly affluent area of Northernshire so we do wonder how others got on on the day of action over Party proposed reforms to pensions? The late news was ambivalent as to whether the day had been a success for the unions or a damp squib. In general practice at ND Central it was full on - no lunch or drink for the on call doctor until they got home well after 19.30hrs but some colleagues at the local tractor plant reported boredom as normally busy units were quiet.

Tomorrow will no doubt be back to commuting hell as usual and although our sympathies are with the strikers whose pensions are being well and truly shafted as they are an easy target for cash strapped governments (think Maxwell) whether it will make any difference will be a judgement to be made later as is often the case.

The news was full of gloom when we got home and partook of a refreshing glass of a fizzy fruit juice consumed faster than normal due to thirst and the news that we now have just ten days to save the Euro. Anyone remember 24 hours to save the NHS?

Question is as was the case then what are we actually saving, saving from whom or what and who does this salvation actually benefit? The Party or the people?

Still the sun will come up tomorrow and it will be business as usual as it was today at ND Central. Shame the drive to and from work won’t be as good as it was today.

Praise be to the Party for allowing us drivers the odd day to enjoy the roads they charge us so much to drive on at the expense of so many whom they allegedly serve.

I am a patient . . .

2011-11-29T23:13:00.000-08:00

For more than 3 score and ten years we have lived in the United Kingdom and have seen many changes. We recall the early days of the NHS and of being able to go to a school based on ability not on the ability to pay. As a result of our education we were able enough although not rich enough to go onto a real University for our fees and grants were paid for by the state via our parents and others’ taxes.

Through our own efforts and the foresight of our forebears we have advanced ourselves free from the shackles of institutionalized prejudice based on the bonds of class and wealth and by opportunities based on ability and education we have prospered both in terms of health and financially.

We have bought forth two generations of our children and grandchildren and hope that we may live to see a generation of great grandchildren all of whom have benefited from our hard work but principally from education and as a result they have all gone further than our own parents could ever have expected or dreamt of.

However such progress is seemingly being darkened by a dark cloud passing over all by politicians who have benefited as we have from state funded healthcare and education but who now regardless of race, creed, colour or political persuasion wish to deny our children’s children that which they themselves have had so freely and as a result so richly profited from.

Nowhere is this more so than in healthcare.

I am a patient and I have a dream that one day the NHS will return to being a service based on medical need alone not on politically driven priorities.

I am a patient and I have a dream that all those who are trained to work in healthcare learn to care and treat patients first above and beyond any slavish desire for useless tick box bureaucracy that serves not the patient.

I am a patient and I have a dream that my treatment will be dictated by a doctor that I know and trust not by a PCT diktat, a NICE guideline or centrally dictated target for I want a trained professional to treat me as an individual for my medical condition for I remember the Cold War and have seen how deprived those who lived in the Eastern Bloc were as a result of centralized state control with no accountability.

I am a patient and I have a dream that when I see my doctor he or she will treat me for my illness alone and not waste hours of my time asking me to go for patient useless tests every year that treat me not.

I am a patient and I have a dream that when I develop a potentially life threatening and/or a life limiting conditions and I see my doctor I get prompt treatment for the illness that is not delayed by bureaucrats telling my doctors to treat a waiting list target before a true medical need.

I am a patient and I have a dream that those who abuse the health service and prevent those with genuine need from accessing it are penalized for doing so rather than repeatedly rewarded for their abuse at my and many other patients’ expense.

I am a patient and I have a dream that when I go into a hospital I am cared for by highly trained professionals whose sole purpose is my healthcare, my well being and my recovery who are not distracted from my care by the need to complete endless paperwork while neglecting patients like me.

I am a patient and I have a dream about the NHS free at the point of care, available to all based on need not ability to pay that is not destroyed by those who know nothing about me or about my illnesses or about healthcare.

I am a patient and I have a dream that when I have a life threatening illness I do not have to repeatedly use my private health insurance to maintain my quality of life for I have paid and still pay my taxes for together with the National Insurance that I have paid over my whole working life.

I am a patient and I have a dream that the doctor treating me will be able to do so to the best of their ability based on the latest scientific research and that they can give me the best care available regardless of any politically doctored or dictated evidence for I am a patient in need of care from and by a professional not by a protocol.

I am a patient and I have a dream that the NHS might one day return to being a being a high quality state funded service providing care for patients who have paid for it delivered by healthcare professionals not a money consuming bureaucracy that provides no hands on care for patients.

I am a patient and I have a dream that when I become too old and infirmed and my family can no longer manage to care for me that the promise of care from the cradle to the grave will be there and still honoured when I am most vulnerable and in need but may not be able to represent myself as I can now.

I am a patient and I have a dream that what I have enjoyed in my lifetime from the NHS will be passed onto and available to my children as a beacon of how a civilized society treats its people and meets their healthcare needs in an equal and fair way based on medical need alone.

I am a patient and I have a dream that I and my family will be able to live that dream paid for by all of our taxes but equally provided for those who are less fortunate than us who may be unable to pay but hopefully still be able to receive that which we do and that those less able to pay will not be denied the same healthcare should they need it.

Mr. Cameron, Mr. Clegg and Mr. Milliband do any of you still have or share the same dream as your parents and grandparents may have once had?

Praise be to the Party and its NHS reforms and reformers and to some of our more senior patients and our parents and grandparents for their indirect inputs into this piece over the years.

We cannot ever better the original speech but can draw inspiration from the sentiments expressed in it and try as did the original orator to right injustice and inequality wherever it is be found even it is to be found in healthcare.

C-sections and NICE twaddle.

2011-11-23T23:21:00.000-08:00

Like all GPs in the UK the team at ND Central own Ferraris and commute along Northernshire’s high moorland roads and through its forests from their baronial mansion houses daily to serve their patients. During this arduous chore a few of us listen to the radio. Several of the team this morning heard an interview on the BBC’s radio Four news which can best be summed up as like watching a couple of pensioners trying to emulate a world championship heavy weight boxing contest.

The link to this is here and it illustrates what our fellow GP blogger said in their piece here.

We don’t know how long the link will last so here is the moron’s take on it. The interview is very long (10.21 minutes) by UK media standards and the twaddle is produced by a Dr Gillian Leng NICE’s deputy chief executive who has loads of obstetric experience if you read here and who says:

“We think that the rate of Caesarean section is likely to decline as a consequence.”

Really? A few choice grunt words came to mind as we heard this pontification for over the years of doing medicine we have heard repeatedly from our colleagues in midwifery over and over again that there has been an increased demand for Caesarian sections that are medically unnecessary.

This is akin to NICE recommended compulsory castration to prevent testicular cancer, the removal of all skin defects to prevent melanoma, and the removal of all subcutaneous fat to prevent obesity. All medically unnecessary, but available, treatments if you so wanted.

Unfortunately we suspect that NICE is doing what it is paid to do to review “alleged” evidence and pander to the politicians to justify their interference in matters medical.

Of course those NICE people do not understand the NHS “meerkat” of NICE cuddly toys held up by politicians to tempt patients, sorry punters their way. Who could resist a NICE cuddly “meerkat” when it is always free when know your NICE rights?

If you were too posh to push and you used to have to pay for it and your local supermarket now gives it away for free where do you think the stampede would be that would crush you?

If the NHS offered euthanasia (or any other medical treatment) for free that is not currently available we bet you that the euthanasia rate (or other treatment) would go up, not down, regardless of need.

Anyone fancy a bet on whether C-section rates will go up or down? After all a NICE lady doctor has told you what will happen and we bet you trust all that is NICE?

Don’t you?

Praise be to the Party and its all wise idiots at NICE who have already increased obstetric costs in a time of increased poverty of resources but for what medical gain? We look forward to next year's drop in the C-section rate and to our trouserring a few pounds from our friends at the local bookies.

The law of intended consequences - patient safety and more radical pharmacism.

2011-11-22T23:09:00.000-08:00

There is something new in the Quality and Outcome (QOF) framework which is neither Quality or Outcome based medicine just a set of tick boxes to see if GPs are doing any work and to begrudgingly pay them for doing so. QOF is not a fixed set of “quality” goalposts related to any first world quality medicine.

QOF is merely a football kicked by the Party to control cost and a profession. Whenever GPs achieve a “quality” target and have to get paid the Party shifts the “quality” goalposts to ensure less payment or worse even dumber medicine something our American cousins fear for they call it socialized medicine.

Part of the new QOF is something referred to as the QP indicators that stand for Quality and Productivity. We call them QraP points for short because we have problems pronouncing our r s.

Read the indicators and see how a GP once a professional qualified to work independently has to all of a sudden engage in “quality” loveins with the PCT (morons) and “external peer review” (Party stooges) to judge such things as prescribing and referrals. If this process continues unabated patients will not be able to get into the consulting rooms for the number of committees of unrelated “professionals” sitting in there to ensure “quality” Party medicine.

Now one such piece of QraP devised over a campfire by the Al-Qaeda school of radical pharmacists is that GPs prescribe too many drugs that enable their comrade patients to breath.

Such a fact presented to your average NHS manager will ring alarm bells for they will think high expenditure equals crap care as a number on their pretty, pretty spreadsheet is flashing red for a target is being missed albeit at the expense of well treated patients.

Unable to calculate, or explain the difference between what doctors do they will employ a "consultant" (pharmacist) to help them usually a radical who will allay their fears and reinforce their limited belief that all that is wrong with the health service is the GPs.

When you go through grunt school you engage in many alien processes that NHS managers and their Al-Qaeda radical pharmacist colleagues have never done. The first is that you learn a bit of science and then you progress to treat patients.

Such things take more than 3 years to do. In general practice a few years ago it would have taken a minimum of 9 years more like 10 to become a GP now in contrast to NHS managers and their Al-Qaeda friends who can achieve in 3 years or less what a doctor can in 10.

Take for example heart failure and the use of diuretics (water tablets) to treat it. If someone comes in with mild heart failure you might say start with a once a day dose of a diuretic (water) tablet of say 20mg of furosemide (frusemide). If that that does not work you would gradually increase it until symptom control and hopefully a well and functioning patient was achieved. You may even add in other drugs and titrate them according to the effect on the patient.

This is called medicine and the average pharmacist and NHS commissar manager have never had to determine (diagnose) an illness, or think about its possible causes or then go on to treat it and be responsible for their actions. Neither of them has ever had to titrate treatment against its response both on the disease and on the patient. As a result the pharmacist and NHS commissar think QraP is all wise.

The above is the care of the individual by a doctor not a pharmacist or a NHS manager nor the protocol or spreadsheet. None of them aims or shoots the rifle they just ration the ammunition (think of the scene in Zulu Dawn where ammunition is rationed in the face of overwhelming need).

Heart failure can present dramatically and suddenly with a patient waking up in the middle of the night unable to breath and pouring fluid out of their mouths as they drown in their own fluid. At such times those who dictate QraP rationing of care would be asleep and as much use as a chocolate jock strap in a hot oven to prevent facial burns. At which point a highly trained grunt would give many times more than any QraP dictated dose to save lives again something alien to a pharmacist or NHS commissar.

So let us look at a QraP idea thought of those by those in the bottom third of the UK comprehensive system and their buddies in the Al-Qaeda school of radical pharmacists.

Let us look at a group of stable asthmatics and reduce their treatment to save money for GPs never see patients and therefore cost the local PCT money via its drug budget but do remember that GPs, as doctors, are well used to increasing drug doses (mild heart failure versus life threatening heart failure) but equally they also REDUCE drug doses. For example patients with low sodium or potassium due to drug treatment. It is called optimizing treatment for an individual patient not treating a pretty, pretty flashing spreadsheet number.

Al-Qaeda pharmacists or NHS managers do neither of these things instead using socialized medicine, “contract” driven for enhanced “performance” they do “quality” via blanket reductions in asthma drug treatments using pharmacists. Pharmacists who take the trouble never to consult patients unless it is to do a totally unnecessary drug review (DRUM (dispensing review of use of medicines) or medicines use review et al) for which they get paid more than a GP consultation to do so but pharmacist good, GP bad.

Like the Darzi centres pharmacists workloads on such reviews are limited via contracts while NHS GPs are expected to see everything and anything for a fixed cost regardless of numbers so no piecework for GPs. Such pharmacist reviews usually have no change needed to treatment as their conclusion or try this drug instead we did and it did nothing so usually contribute nothing to patient care other than more pieces of paper and a longer stay at the chemist to increase someone’s income.

The reduction of doses of asthma treatment increases as per the local Soviets’ commissars’ and radical pharmacists’ plan which instantly reduce costs and so ticks all the QraP boxes which results in much vodka drinking and fellow Soviet body hugs as those in the bottom third of the United Kingdom education system fail to notice the law of intended consequences for they have done the same with step down dosage of ulcer healing drugs and delayed antibiotic prescriptions.

GPs for some unexplainable reason notice increased attendances of previously stable asthmatic patients with shortness of breath. These then require treatment with steroids (cannot prescribe those for they are too expensive and “evidence” shows enteric coated steroids is too expensive as well) and often hospital admissions when patients cannot breath.

So when we are told that £ 10,000 has been saved in a quarter on asthma inhalers as a result of Al-Qaeda socialized medicine and we are doing well and yet the extra 10 admissions for an acute exacerbation of asthma at around £ 3,000 a shot means we now have to reduce our unplanned admission rates. Are we the only ones to see through the fog of QraP and the law of fully predictable consequences?

QraP is any ongoing process so we have to meet in the near future to discuss ongoing “progress”. No doubt the increased admissions due to poor asthma control will be a non issue? If untreated asthmatics die then that is the ultimate “quality” in the “productive” new world of the market driven NHS?

For dead patients are cost neutral.

Praise be to the Party for allowing the thick to increase costs and NHS workload for a negative financial gain. Those who deliver such outstanding service for the NHS could only be better deployed in Afghanistan in the neutralization of IEDs - they are wasted in healthcare.

More QraP to come comrade patients . . .

You cannot be serious?

2011-11-14T06:55:00.000-08:00

Our friends at Pulse have provided a little gem as to how little use some bits of NHS management are. You can read what we believe is the original document here.

Now for those of us who work in real medicine this will not be an issue. If you are off for less than seven days any patient who wants a sick note for such a period will not get one. They will be told about self certification whatever their little Führur of a manager (NHS or otherwise) says.

If you take strike action that is your NHS Choice and you should accept the consequences. We would not expect our taxes as GPs and the tax paid by our staff to subsidize your withdrawal of labour. If your employer wants to argue the toss let them do so at an employment tribunal but please do not waste your GPs’ time at their behest.

We really do wonder what some NHS managers do with their time but if anyone is looking for some quick NHS efficiency savings we have a pretty good idea where to find some.

But lo as GP entrepreneurs we see a little glint of goodness in amongst these dark tidings of NHS management woe for cash strapped practices.

Read note 2 on page 1 of the original document. We will be happy to provide such certificates to any reasonable employer at say £ 100 a shot?

Game on anyone? Let the specialist commissioning of such a service commence should be ready to roll by Christmas 2027.

Praise be to the Party for ensuring that all comrade workers can have their cake and eat it possibly at everyone elses’ expense? They cannot be serious, can they?

A trip to the attic and some thoughts on NHS computing.

2011-11-08T21:48:00.000-08:00

There are certain things that as an oppressed minority in general practice you can only do when the memsahib is away and one of the team did just this at the weekend.

They went up to the attic (disgusting) to retrieve a computer from almost 20 years ago. The dust on all the components coated their fingers and as they pulled the pieces from the attic they saw many things that were once the workhorse of their general practice and which still held useful information which was the purpose of this quest to answer a patient’s query.

The computer was reassembled without a single USB or PCT IT technician (delta grade triple star the NHS’s IT elite able to connect a monitor to a computer in less than 3 days and disable a practice as a result) but with lots of screwing (disgusting) of old fashion cable connections. When fired up the screen only displayed the message on the massive Cathode Ray Tube (CRT) screen of no video input with associated muscle ache from carrying it downstairs.

Disaster no flat screen light weight flat screen here but another trip to the attic found an even smaller CRT screen (bigger than the local Soviet allows their doctors to watch today) and on connecting and with a bit of experimenting and remembering the correct firing sequence for the cylinders of this particular piece of electronics the screen lit up.

The screen boasted of its massive 16 000 kb of RAM, its 90 MHz processor combined with a stonking 500Mb hard drive. Cutting edge in its time this brute of a machine ran a business for more than 5 years. The data required was extracted over a couple of hours and transferred to a more modern machine but what struck us was how easy it was to access this aged computer.

There was no password to gain access to the windows program for this computer ran using the DOS program (not the useless D(r)OS of Choose and Book) and you had the C: \ prompt which you followed with the hallowed secure password “win”. Access was almost instant.

No Smartcard, only one password for the most secure of files and the whole box that contained the PC weighed less than one of our current laptops. And what is more the whole boot process took less than 2 minutes which was like warp speed compared with today. All you needed to run a GP practice was still there and functioning.

Would we here at ND Central be able to access our current PCs in 5 years time? What about 20 years? Clinical systems demand regular password changes every 2 months. NHS Smart (Dumb arse) cards we believe automatically exclude users after 2 years until their local Soviet redefines them as suitable users of the clinical data that they create and record to enable them to treat patients.

The centralization of medical data although by some may have been seen as a relief to GP Practices but increasingly we see it as part of the control of the medical profession. In order to do your job as a doctor you need access to medical records. No access to medical records = can’t do job.

The NHS Smartcard is there not to keep people out of the medical records you create but to control which doctors are allowed in and hence able to work. We no longer have control over our access to the records that we create in the same way we had with paper or practice hosted computer systems even though the paper records were technically the property of the Secretary of State.

The data we required was easily extracted and most of the time spent doing this was with getting the hardware up and running from the attic. The same would be so of paper records.

Could you as a GP answer a complaint from 20+ years ago when the records may be on a computer? Can you remember your passwords or even your PINs from 20 years ago? Could you if you had ever assembled/built a computer yourself remember how to do so and get it to work?

Where do you your computer’s hard drives go to when replaced (Africa perhaps?) and given that now the Party has so generously relieved GPs of their financial responsibility for computers who defends GPs in the event of complaints? No records we believe means no defence. Are the centrally held server records so beloved of the Party still going to be there in 5, 10 or 20 years? Our old hard drives from various clinical systems still are.

Do you know where your hard drives from 20 years ago are? Can you access them? Can you remember the passwords?

Of course the benevolence of the Party is such that this will all have been thought of but issues of different coding of information from system to system means that data accurately recorded once may be inaccurately transferred over several years of changes of clinical systems which may well haunt us as GPs for years to come.

Paper records although bulky are easy to read (subject to doctor’s writing), are very personal and they need no electricity, no password, no dumb arse card and it is most satisfying to be able to answer a patient’s query about something that happened to them 50 years ago without going into the attic (disgusting) for the information was available from that time and was accessible to anyone able to read which would rule out most who work for local NHS IT.

Can today’s doctors say the same about what happened to someone in 50 years time? Paper has stood the test of time will NHS IT do the same?

Praise be to the Party for ensuring that a trip to the attic (disgusting) means we have experienced more advanced and secure IT on a desk 20 years ago than we do at work today for there was no internet or Party attempted centralization of records via a central summary care record which holds information as securely as a sieve holds water.

Furthermore these were “our” records and we as professionals knew where to find them and controlled access to them. This is no longer the responsibility of doctor but we are sure that other professions like lawyers and accountants will not have Smartcards or a national network of lawyer or accountant records to share with the world wide web as doctors are forced to do.

You have been warned.

Anyone done the maffs?

2011-11-01T23:28:00.000-07:00

We have been informed that a Caesarian section will now be a right rather than a medical necessity. A few thoughts occurred to the team. Let us suppose that you work at a hospital that does 12 deliveries a day and that all the women opt for a Caesarian section rather than a natural childbirth.

Let us assume that each Caesarian takes half an hour of operating time then any hospital operating new NHS C-choice™ would have to find a mere 6 hours minimum of theatre time a day above what is provided now. Operating time is not the only thing that would have to be found there would need to be found additional anaesthetic and associated personnel time, surgeon and assistant time, midwife time, paediatrician time as well as porters et al and of course those most essential for true patient care the NHS commissars to prepare the bills that allow the NHS to work independently of all of the aforementioned non essential personnel.

The hospital would also have to find 12 beds a day as well as recovery staff time and ward nursing staff time and that is assuming that these are all done as general anaesthetics rather than epidurals which take longer to work and all were done as day cases.

Indeed our recollection of elective Caesarian sections done under regional anaesthesia which you can bet will be the norm for those too posh to push so they could see their darling little Tarquin or Chantelle-Detritus-Leah (it's exotic!) born and post the event on YouTube was that 2 maybe 3 could be done in a half day session.

So 6 hours of operating time is being optimistic it is more likely to be 2 or possibly 3 theatres operating for a full day plus the increased number of staff. In order to work this would need to be available for 365 days a year as well as facilities for any emergency C-sections.

Obviously as this would be C-choice there would be peaks and troughs for Tarquin’s and Chantelle-Detritus-Leah’s planned arrival into the world. For example I couldn’t deliver at Christmas as I would miss my turkey and heaven forbid any obstetrician says to a woman the only slot we have for an elective C-section is on the night of an X-factor final, FA cup final, or a Big Brother eviction. How would Wayne Trotter the father cope? You can bet that he and Sharon will know their rights then.

The article quotes a figure saying that a one percentage point reduction in C-section rate saves £ 5.6 million. Does that mean that if 100% of births were done by C-section up from the current 25% the NHS would have to find £ 420 million a year for a procedure that some would argue is not being done for a medical reason?

And in order to double check the maffs if one takes the figure of 708, 708 births in 2008 take 75% of these and multiple by the quoted £ 800 extra per birth you get a figure of £ 425 million. Not a small chunk out of £20 billion NHS efficiency savings over five years in the midst of a recession.

Then there is the morbidity and mortality to add in. Yes deaths from anaesthetic complications have decreased in pregnant women over the years but if more women have abdominopelvic surgery then DVTs will increase. We believe that 60 in 100,000 women who are pregnant will have DVTs which is an old figure presumably based on a 25% C-section rate. If that rate increases will DVTs and PEs and their 1% mortality go up as well as general morbidity for example wound infections to match the increase in numbers done? More operations means more chance of misadventure so what would happen to NHS indemnity bills and defense society charges?

Now we are simple GPs here at ND Central and while doing home visits one of the team heard an interesting point being made on a popular TV show as they listened to the normal chest of the infirmed but “too idle to come to surgery”, the ancestor of the "too posh to push" generation. This urgently infirmed geriatric had wanted to be sure they were well enough to go to their granddaughter’s Halloween Party and outdoor barbeque – presumably as the evil looking witch with nicotine stained nails, eau d’cigarette body odour and scary brown hag dentures – followed by trick or treating with Jemima-Louise.

The point was made on the programme that NICE stood for National Institute of Clinical “Excellence” (not) – got us listening – and that Marshall DC’s poll rating with female voters is low. Could this be the answer to another medical blogger’s posed question?

We await the final publication of any NICE guidance and their reasons for suggesting their policy. We hope that following on from this that all cosmetic procedures will now be available on the NHS for surely if everyone is now too posh to push then no-one is too poor to be ugly?

Praise be to the Party and its NICE organs who evaluate “evidence” rather than science and come to some fairly doubtful “best” ~~political~~ practice ideas.

Dark nights and darker thoughts.

2011-10-29T02:26:00.000-07:00

For those of us who live North of the Thames the inevitable move towards autumn and winter leads to a rapid shortening of the daylight hours. Now darkness is good for members of the Resistance based at the infamous Café Michelle for it allows more covert activity and as the temperatures drop the thought of a night with good company and a few fermented fruit beverages is very appealing.

At one recent such meeting we were discussing the state of the current health and social care bill and what had been said at various meetings and events that members of the team go to. We are a very broad church here up North in terms of our interests and associations and as a result encounter a wide range of opinions and thoughts on matters political and practical. After a few fruit juices the thought processes sometimes deviate from true logic and what follows is one such deviation.

For those of you not lucky enough to live in the Shiteton PCT’s area of enlightenment you will not see the results of early GP led commissioning. Here GP commissioners have many fruitful meetings and are reshaping local healthcare by the minute as all our Harvard and Yale educated MBA PCT commissioners always start the meetings with the words:

“How can we help you master/mistress? We are here to serve your every whim for the betterment of your patients all praise to Andrew the great prophet and liberator of the NHS.”

We are so lucky but not many leagues away we are aware of the complete opposite where local Soviets are dictating the rules of who can commission what and on what terms and as a result nothing is happening. Equally we know of other Soviets and GP commissioning groups that are in between these extremes.

Historically Government does not like resistance and certainly the old Party did not like GPs for they did what the Party asked but the Party did not like having to pay for that. It is uncertain at present what the current Party’s true thoughts are regarding GPs but it is clearly engaged in a campaign of lies, sorry spin, about how much “support” there is for their reforms in all sectors of the medical profession.

Commissioning has failed expensively over the last 20 years but is being reborn and re-branded but this time with GPs nominally in charge of much larger scale commissioning by GPs than ever before. Previous attempts at commissioning failed in times of plenty while this time we are in a time of recession.

We are told that this will be no top down reorganization but it is clear that local initiative is set to be stifled by the new financial politburo call Monitor and clinically via the new uber super quango the NHS Commissioning Board and its regional under boards.

So if GPs get to play commissioning how many of their ideas will be allowed by the bureaucrats who failed to make commissioning work in its previous guises? The Party can fight any Clinical Commissioning Group (CCG) on two separate fronts to prevent successful GP commissioning. One front is via Monitor using financial constraints and if that does not work they can fail an idea on clinical, quality or outcome grounds with support from other limp organs like NICE via the NHS Commissioning Board.

Add in a recession and reduced funds by virtue of inflation combined with a hugely flawed process and GPs are now fighting on three fronts with no ammunition or weapons centrally provided and still having to do their day job as well.

It is possible that despite “best” intent we GPs may all be looking into the large toothed jaws of possible global failure except that this time the Secretary of State may be able to wipe their hands of their enforced failure for they can blame the GPs instead. Failing that a change of Party might do the same job and blame the GPs as well. Is the strangling of local initiative by centralized Party control part of the Liberation process? And from whom is the NHS to be liberated from?

So in the dark corners of a Northernshire cellar in front of a blazing fire we got to “the what if” stage and dark thoughts loomed large. If GP commissioning fails perhaps the benevolent Party would have to step in and take over via the (its) Commissioning Board and Monitor and maybe a few other central organs of control? The Press would have a field day and say GPs “couldn’t” and therefore “shouldn’t” run the health service.

Completely understandable if you have to fight a boxing match with both hands tied behind your back, wearing a blindfold to outfox your opponent who can see where things are going, with lead boots from local NHS management to facilitate your forward progression and the complete absence of any seconds.

The next step might be to rein in GPs autonomy and perhaps enforce a salaried service in order to control any clinical dissidents and at the same time reduce costs and recoup all the excesses of the failed CCGs. A new leader might be required to sort things out and take charge perhaps a more powerful than now Secretary of State?

The new leader might then be free to bring in the private providers to run things better and then employ them via corporate entities? We won’t mention the words dentist in our discussions on these dark matters for it has happened there already.

Could it be that the Tripartite healthcare policy has one aim and that is to reduce GP control over and involvement in healthcare? For if GPs cannot successfully commission can you successfully refer or treat patients as independent “self employed contractors”? The system would clearly then need “reform”. The thought processes got darker and darker as the evening wore on until someone said some time honoured magic words to rid us of our demons.

“Time please ladies and gentlemen of the Resistance haven’t you got nice surgeries to go to tomorrow morning?” Yes we have but dark thoughts will be with us as we see our first commuting toddlers and pensioners at seven thirty hours tomorrow as true beneficiaries of previous “market” reforms.

Then the alarm went off and it was time to get up and go once again. At least this weekend we get an extra hour and the next early morning might not be as dark, for a while longer.

Praise be the Party for always needing to reform things even if they work. Let us hope our dark thoughts were merely a bad dream.

Why?

2011-10-25T23:31:00.000-07:00

Why is it that patients who buy home monitoring blood pressure measuring machines, who record it 5 or more times a day on a spreadsheet that they give to you, who also attend nurse clinics where their blood pressure is taken sometimes the day before you see them always ask if you would “just” take their blood pressure?

Surely this is pandering to the pathetic worried well? Just in case one of the following:

their one Campbell de Morgan spot
their verruca
their paracetamol relieved headache of seconds duration
their self inflicted Gaviscon eased indigestion
their coital avoiding headache
their red face
their feeling dizzy
their not feeling right or myself
their I went to the gym and the instructor felt that a blood pressure of 110/80 at age 97 was a bit high/low

is a sign of high blood pressure?

Patients always know when their blood pressure is high for they can feel it is so when it never is. Could this be a huge revenue earner for the health service?

If you buy a television, even a computer capable of watching TV be it broadcast or via the internet, a DVD/video recorder or mobile phone that can receive TV in the UK you are asked to provide your name rank and serial number and address to the retailer which is then sent off to the TV licensing authorities who check if you have a TV licence.

Perhaps we should have a scheme whereby if you buy a blood pressure machine your details including NHS number are sent off to the new commissioning board who would automatically disqualify you from ever having your blood pressure taken again for you have opted for private healthcare? Given the state of NHS IT when you next see your GP a huge flashing screen would say to any nurse/doctor/healthcare assistant ineligible for NHS BP care and smack a £20 charge if patient asks for their BP to be “just” checked.

Sound familiar? The pandering to the pathetic well is a growth industry and should be ripe for Government picking? Instant deficit reducer. Instant pandering to the pathetic well reducer of unnecessary surgery attendances for many of these patients always opt to be seen within 48 hours or as an “emergency”.

Praise be to the Party for encouraging people to pay for their cake and eat it and then to come back for seconds they don’t need or pay for.

PS we at ND Central do not have a problem with BP monitoring and some of us have in the past regularly done 5 minutely BP readings for when you are bleeding to death from a knife wound it is then useful. When you are a bleeding heart forget it.

The 0845 number debacle.

2011-10-19T23:25:00.000-07:00

One of the great successes of Za Nu Labour’s running of the National Health Service was its use of a system of government that used to be common in Eastern Europe. It was called communism whereby everything was dictated from the central offices of the all wise Party under the guidance of the supreme leaders the Laurel and Hardy of modern healthcare Mr Blair and Mr Brown all for the benefit of the people.

The former ex great leader was famously handbagged by a patient who asked him about his health reforms and to explain why she could not get an appointment under all of his improved access targets. Under Comrade Blair’s preferred model such dissent would have resulted in a quick trip up to a gulag for a period of re-education but under what remains of democracy and public scrutiny in this country his lack of knowledge of matters healthcare was on view for and enjoyed by all.

Following along from his enlightened leadership one of the reforms that the new General Medical Services (nGMS) contract ushered in was the need for a single phone call to enable instant access to your GP or more importantly the out of hours service.

Now in theory this would seem at first to be a good idea. You dial one number and can access your, or a, GP 24 hours a day. True market reform for the good comrade patients’ benefit no evil private sector backhanders here. The non paying customer, we call them patients, gets instant self centred medical gratification a bit like certain politicians and their DVDs but then these cost the taxpayer via the MPs expenses.

Prior to this at ND Central we had a single telephone number which when the working day used to finish at 18.00hrs would switch on to an answer machine which gave the contact details for the out of hours or deputizing service that we as GPs paid for to cover our patients after hours to allow us some sleep.

Now the blessed Tony, a true socialist conservative Anglican Catholic, who believed in comprehensive education for all, bar his own children, in the NHS for all, except when he was ill, and who can now do no wrong, he only has to confess not to be responsible, thought let us supply the out of hours care using the private sector for private medicine good, socialised medicine bad and costs rose astronomically for a worse service.

Back to the phone call side of things this two phone call issue was clearly a huge problem to the likes of Tony and Gordon for they were all wise and so the nGMS contract gave prizes for a single call. Being true socialists and wishing to share this great idea of a single call for all ills an 0845 HEALTH (we purposely omit the W at the start of ealth) was suggested and PCTs, government sponsored enforcers “encouraged” GPs to sign up for deals with 0845 numbers. If you don’t you won’t get paid for you will fail to provide a Sovietly acceptable one phone call to tick the “quality” box.

Remember dear readers that PCTs are staffed by those who at best were in your remedial class in any Northernshire comprehensive school a few of whom could read and count. So GPs were “encouraged” using the “free” market model so loved by Tony and Gordon to sign up to Party deals for GPs were given the same true NHS Choice offered to patients via the market which is none.

Move forward and although the Party dictated and approved idea is good a few people noticed that some pigs are more equal than others (Hewitt - excuse us we just sneezed) when it comes to profiting from telecommunications and a few dissenters in need of political re-education noticed that if they ring on a mobile, which after all is only the preserve of the politician and drug dealers, not a pensioner on a limited income, they were disadvantaged. For the 0845 number is not a local charge number it has many different costs depending where you ring from to access it.

So the Party does a massive U-turn on its equitable access policy and tells GPs you can’t have a 0845 number. You can look here for who hasn’t by PCT and compare them with the sink estate PCTs, sorry comrades, spearhead PCTs and see which PCTs have the best in remedial NHS management. This does seem to be a recurring association dear reader that we have noticed by chance during our researches over the past few years.

Now this is the history what are the practicalities to current GPs given that the true socialists Brown and Blair have peed over the NHS and retired to pastures newer, richer and more idle lifestyles that befit all true socialist Party members?

Well the first is that local Soviets are asking us (= demanding) that we GPs get them out of the brown stuff they insisting on putting us in. We now have to change our numbers or else.

This is excellent for the remedials who agreed the contracts but could not read all those big words in them for all they saw were the flashy teeth of the nice salesperson who flattered them and told them what a good deal this until they signed. When the X was one the bottom of the contract in the managers' best crayon the salesperson said "Thank you for signing and so long sucker” and disappeared in a puff of fairy dust never to be seen again.

And those signing such “deals” are the “world-class” commissioners of old trumpeted as such by the Laurel and Hardy of UK plc healthcare now joined by their new bum chums the Charlie Chaplain of healthcare (Lansley) with the help of hop(e)along Clegg.

So the get out clauses for GPs for contracts enforced on us are now as follows:

1) you can revert to your original single line with an answer machine and lose money for not providing a single point of access. Not a problem to us comrade GP we merely follow orders.

2) you can keep your current 0845 number and we will shaft you for doing so. Not a problem to us comrade GP we merely follow orders.

3) you can ask your current 0845 provider to change to another number that will be dialled when the patient dials 0845. Your current 0845 number then provides a call switching “service” which would involve no cost to the PCT morons who thought of this but scratch deeper and you find that once the call is switched from the 0845 number to your out of hours provider you the GP then pays for the patients call. So a patient's call to a surgery costs the patient but the patient's diverted call to out of hours costs the GP. Another great buy one pay for two value for NHS money idea like PFI. Not a problem to us comrade GP we merely follow orders.

4) you could consider doing the same using another provider and get stung in the same way. Not a problem to us comrade GP we merely follow orders.

5) you can pay a fortune for reprogramming your current phone system to divert calls which once again you have to pay dearly. Not a problem to us comrade GP we merely follow orders.

Best still we hear that some local Soviets are insisting that practices write to all their patients to tell them of the Practice new number change policy which would mean a net loss to correct "their" folly.

It is said that in any society there are rights and responsibilities. Increasingly in the NHS the rights of the politicians are that they have no responsibility and the same is so in NHS management. Until these groups acquire some responsibilities GPs and all involved in healthcare will continue to spend time not treating patients but mopping up political and management collateral damage inflicted on them via continuous "reform" and incompetence.

In the same way that these “world-class” commissioning managers have screwed up the Darzhole centres they have also screwed up the 0845 numbers and once again someone other than them will be paying for it.

Now if you were a betting man who would you back to win in Mr Lansley’s, new NHS market? The NHS’s commissioning managers, the patient or the private sector? Go on have a flutter it has to be a dead cert . . .

Praise be to the Party for allowing the least able in our society to bugger up the NHS time and time again. Bloody comedians only they ain’t that funny when you're the ones sorting out their fine messes once again.

Flu clinics and zombie movies.

2011-10-13T07:31:00.000-07:00

A few years ago the zombie movie was quite popular and it is a film genre that has been around for decades perhaps the best known of recent British movies is Shaun of the Dead (2004). In virtually all such films there is a scene where lines of the living dead zombies march forward apparently unstoppable towards the heroes or heroines.

There is also the nursery rhyme if you go down the woods today you’ll be sure of a big surprise. Well as a public service announcement we would advise you that if you go down to your surgery at this time of the year you may also be sure of a big surprise. Yes go to your doctor’s surgery at the wrong time and you will see the annual zombie gathering that is a flu clinic.

Watch in amazement as line after line of the living dead hobble in waves towards the surgery seemingly unstoppable. Some can just walk on their own, some use a variety of walking aids that double as lethal weapons to those who are as yet not of the undead be it the form of walking sticks, Zimmer frames, wheelchairs and electric buggies. Others are helped by their relatives or carers and they have been prised out of their pre tombs for the annual march to the surgery for the life preserving anti zombie serum the annual flu jab.

In order to counter the waves of the undead surgeries have developed efficient methods of processing them. The undead are discouraged from regarding these flu clinics as drop in and moan clinics but the undead do not hear well at the best of times. The undead are processed brutally by the heroes and heroines of the annual general practice zombie flick the reception staff who ask them for name rank and serial number, tell zombie 6491 to expose your left (or right arm if left missing having been hacked off by one of the other undeads’ walking aids) and lurch forward to serum room X. NEXT!

At serum room X a nurse, doctor or other trained health care worker will plunge the life giving anti zombie serum into the exposed arm and utter the protective words “NEXT zombie to room X” and dispatch their current zombie before they can open their mouths and utter the well known zombie mantra of “While I am here . . .” NO NEXT!

They will have already tried that at the chemists before they got here as they can’t get their prescription which they forgot to collect the day before from today's zombie, sorry flu, clinic and will run out of tablets before the next surgery which would mean they would join the true undead. “You must help me doctor/nurse/receptionist” they whine with outstretched hands, pleading eyes, gasping their last . . . Wield the chainsaw and blast them with NEXT!

And so in at the front, report to reception no talking or moaning, jab and then out through the back the zombies lurch side to side slowly ever forward until they get back to the zombie mobile parking area. To those of us who are still alive this is as terrifying a place to be as is watching the waves of zombies walking in and through the surgery and out again.

Line upon line of white haired, hunched, swollen ankled, slowly moving from side to side faster than they move forward just defying gravity, spectacle wearing, false teeth clad sufferers of chronic diseases and well rehearsed self pitying regurgitated stories of woe kept going, i.e. just alive but not enjoying it. For we are living longer but not enjoying it, and they are here believing that the anti zombie serum will dent the Reaper’s scythe which it may well but it still keeps hacking away at their general health year on year with an ever worsening decline.

For in the limited space of a surgery the lurching zombie mode of walking is dangerous to most other than lawyers, indeed most of them in a major shipping lane could hit and damage something major usually a floor or failing that a supertanker but worse still is the spectacle of zombie parking wars. Here usually in small cars sometimes with one but sometimes with up to 4 zombies a vehicle they play dodgems and compete to park using the ancient way that headless zombies park using the touch park technique.

Leave your own vehicle here at your peril, walk here at your peril. Our staff park several miles away surrounded by anti terrorism concrete blocks just to be extra sure for whilst parking is a tactile experience for most zombies driving is more of a Braille reading exercise of straddling the white line and feeling for the cat’s eyes to know where to go and avoid bumping the kerbs which they frequently drive over and complain of the worsening potholes. Surgery walls frequently take damage on anti zombie serum days as zombies seek to avoid other stationary zombie mobiles in the car park entrance by giving them at least 3 times the width of the surgery car park as clearance.

Given that zombies are the second most dangerous group of drivers on the road the collection of large numbers of the living dead on a small area of road is lethal. Many of our medical students know them for they are usually the 40 mph in 30mph zone drivers and 40mph anywhere else for they are pushing the envelope of geriatric speed endurance.

The combination of a heater on full, steamed up car windows combined with cataract ridden eyes, out of date glasses wrapped up in fifteen layers of 1950s duffel coats and driving gloves with protective flat cap head wear, unstable bladders desperate to pee somewhere and reaction times 10 times slower than normal means that a right signal means I have priority and I am turning into a car park regardless of on coming traffic as another zombie pulls out unable to see the other vehicles 12 foot in front of them BANG! Left turners fare little better KPOW! CRUNCH!

After several hours of zombie carnage the surgery building and car park go quiet as the living dead have been dispatched with enough anti zombie serum to keep them going for another year. However the living dead leave behind them several things. The odd walking stick, limb prosthesis, glasses, scarves, gloves, hats, car keys, false teeth, mobile phones, handbags, wallets and hacked off body part have all been recovered but the worst bit and this is true of any battle is the smell. Unwashed clothing with the subtle industrial strength eau d’urine being the most easy way to describe the smell of the living dead after their annual visit and it lasts for hours sometimes days even after the use of Agent Orange strength air freshener.

This is not an end to general practice zombie wars for within 3 days of the first wave of zombies receiving their anti zombie serum they start to come back complaining that having had their anti zombie serum they have now become real zombies by virtue of having contracted the flu from their flu jab.

Is the annual zombie movie of the average GP flu clinic all worth it? To a general practice it might generate a few hundred pounds of extra income but that is not without costs in terms of staff time and discomfort. Our understanding is, and we are welcome to be corrected if we are wrong, that it does not reduce hospital admissions one bit. Yes it may protect you against flu but there are plenty of other viral infections in the winter months that will accelerate our proto zombie population into full zombiedom and hence hospital admission.

Praise be to the Party for providing the zombies with their life restoring serum every year. We hope it is worth for you all.

Until next year? Anybody watch the march of the Lords into their bespoke ~~zombie~~ debating chamber . . . ?

The internal market, NHS “competition” and a Yorkshire practice.

2011-10-09T04:21:00.000-07:00

A few bloggers have posted on a practice in Yorkshire offering to do certain operations for their patients for a fee. It seems from this link that health minister Paul Burstow does not think this is on as he and his Party seek to make this more the norm than the exception. How could this come about given the NHS internal market and competition?

Well perhaps it is the result of the true free market as opposed to the NHS Soviet style market? We have commented before on how the only part of the Party’s fixed NHS tariff, the only bit of which you can compete on is quality, not cost, that can be negotiated is the price a PCT can pay a GP to do a job cheaper than a hospital can. This means if a GP refers a patient to see a dermatologist with a mole then the cost of seeing the dermatologist is the same anywhere in the fixed price but competitive internal market that is the NHS Tariff zone. So the Party fixes cost but you can haggle all you like on quality with a hospital only GPs can undercut the hospital tariff price system.

So in general practice you get used to get the situation where NHS managers deep in their bunkers notice that as people become more vain they want moles removing a few of which may be cancerous which are the only ones that NHS commissar managers think really need removing. So being some of the brightest remedial class graduates they think did not GPs used to do that once and more cheaply?

We will give GPs a few farthings to do something that the hospital would do for a couple of hundred sovs and that should save us pounds. So the local Soviet commissars do this and go into the playground to play commissioning games and using the NHS Soviet free market model they restrict the number of cases GPs can do to save even more farthings.

If any of them spoke to GPs instead of dictating to them they would realize that minor skin abnormalities are very common and NHS consumers aka patients pay bugger all for anything so they will use the system as much as they like. NHS consumers, sorry service users, are well used to the concept of the free market especially when it comes to health.

Furthermore if you agree for example that a practice can only do say 30 excisions a quarter and the practice can do that in 4 weeks then where do the others go? Local GPs say that they could do more for cheaper but targets are targets so there is no extra money for doing more work so referrals to hospital continue to go up.

Now if you have been in a remedial class for all of your life and are allowed to play at being God in a PCT then the idea that you can stop your betters having something really appeals to you and so NHS commissars fix the market a little more. Not only do they restrict the number of procedures GPs can do cheaper than the hospital they stop the patients going to a hospital as well. The supply of dermatological surgery in the NHS free market has now been capped by your local PCT but the demand has not and it is not being met.

So you tell all the boffs in your class at school that you used to throw paper balls and other things at to stop being doctors and operating and you also tell them to stop being doctors by referring patients because we are not going to pay you so there! We are so big and clever with it!

Result if doctors cannot treat patient themselves or refer them to hospital because the local Soviet says you can’t how do doctors get round the not being able to treat their patients?

Well this is where the NHS “free” market comes in for it will allow any willing provider to set up shop. GPs are mostly small businesses and if you spot a way to make more money and provide a service being denied by the NHS then this is where the free market can help. You are not allowed as a GP to charge your patient for any NHS care but if the NHS does not provide the care you could set up as a private company and offer a service to patients for a fee. So the “free” market using innovation comes up with a solution to the problem created by the Soviet style NHS internal and centrally regulated market.

Simples. And we are sure that there will be plenty more such innovation as the money becomes tighter like the noose of central regulation of healthcare reform and it is probably an entirely intended consequence that has sneaked out a little too early for political comfort. Not all such any willing providers will be GPs but anyone who can see a way to exploit shortcomings in current and forthcoming NHS provision.

We here at ND Central wonder what will be the next any willing GP or provider opportunity? The way the NHS “market” works means there will be some and if you have the money you can always get better and quicker treatment when the NHS fails to provide.

Praise be to the Party of continuing reform using the current tripartite vision for NHS provided healthcare of expensive market good, cheap socialized medicine bad.

Do not shoot the entrepreneurs for they are just playing by the rules of the game and some of them may well win and win well. Their wins will probably be at the loss of the as of now non-paying consumer our patients and their future healthcare and wealth and all the result of a highly flawed centrally imposed market that has failed for 20 years.

And it continues to do so. Reform of a bad idea does not make it a better idea and even the politicians don’t like the result of their endeavours.

The results are in and . . .

2011-10-08T00:58:00.000-07:00

We posted about the GMC consulting on whether it should regulate doctors’ lives outside of medicine and the results are in and can be read here together with some GMC thoughts on the issue.

In summary in answer to the question do you think the GMC should regulate doctors’ live outside of medicine the results were:

No              1100          94%
Yes                54            5%
Not sure       13            1%
Total         1167

If you look at the percentages if you were a politician you would regard this as a landslide result of a mandate saying that the GMC SHOULD NOT regulate doctors’ lives outside medicine.

However dear reader read further down and see that the amount of column inches given to the comments of the Yes voters is proportionally greater than that given to the No voters as is that given to the Not sure voters.

Read further and see that:

“Given the very large response to this question, we have decided to ask a specific question about doctors lives outside medicine when formal consultation starts later this month.”

Interesting words those for they remind us of the “ratification” of the treaty of Lisbon whereby if the politicians did not like the result of a referendum they wanted they have another one or the old joke that if the British ever solve the Irish question the Irish will change the question.

We are sure an elite team of (Daily Mail?) journalists will be at work drafting the question so as to get the right answer. Here is our crude attempt:

Should the GMC have the power to regulate the personal lives of all doctors if they are paedophiles?

Should result in more Yes votes than the previous question comrades shouldn’t it?

As someone once said on 10 July 1790:

“The condition upon which God hath given liberty to man is eternal vigilance; which condition if he break, servitude is at once the consequence of his crime, and the punishment of his guilt.”

John Philpot Curran Irish judge to which we would add a term some of us heard from modern(ish) military circles in Iraq:

“Stay frosty gents”.

We await the publication of the specific question with interest and whether the formal consultation will be along the lines of the Future Forum consultation on the NHS reforms.

Praise be to the Party for giving us the illusion of democracy within an increasingly Party controlled “free” state.

Darzhole centres costing more, delivering less, we mean nothing.

2011-10-04T09:03:00.000-07:00

We have been waiting for this story to break and had even toyed with the idea of suggesting it to the medical press but it seems our friends at Pulse have worked it out for themselves. Now what is interesting is the lack of detail as to whether payments have been made for early closure and more importantly how much. These details are “confidential”.

Now given that this is public money that is being spent why should these figures be confidential?

There are one or two reasons for this. The first is the tax paying public would not like to know how much money has been squandered on flights of fancy by those with whom they went to school especially when they realize that these “world-class” commissioners of expensive white elephants were those who were close to the top of their remedial classes at school.

These “world-class” commissioners who negotiated the contracts probably thought they was wicked because they had big numbers involved (more than all their fingers and toes combined at once) and had words printed in a big book with many pages that someone would read to them and they would have put their X at the bottom with their best crayons and thought they were well hard.

The problem was that the commercial sector did an even better job and provided very poor value for money and rubbed their hands with joy at how easy it was to get their hands on taxpayers' money for doing sweet FA but then they knew they were dealing with the “world-class” remedials who were, and still currently are, NHS Commissioners/managers.

We heard rumour, after one of the team’s recent trip South of Watford Gap in July, that the pay-offs are of around twice the annual cost of running a Darzhole practice which was estimated at around £ 1.1 million a year.

If this is the case then not only did “world-class” commissioners get suckered into paying an absolute fortune for contracts that when the targets agreed were met the providers just stopped working but still got paid and do remember 2 patients a day is a lot of fingers to count up and write down in a contract at the same time but best of all is the fact that taxpayers' money is being used to pay off contracts that will be delivering bugger all healthcare for their buck.

This is a scandalous waste of taxpayers’ money paying private firms or PCT stooges to deliver nothing. Of course the real losers apart from the taxpayers will be the local GPs. Now in areas like the Isle of Wight with its one registered patient there probably won’t be much of a capacity issue but look at our post from 2009 and read about spearhead PCTs which are those that cannot provide enough GPs for their population.

Look at those in the top twenty or so of the “world-class” commissioning league table and look at the names at the end of this week's Pulse article. We count 7 out of the 9 on Pulse articles list are in the “top” of the league table but have a look at this list of the spearhead PCTs and see how many of the list of 9 in Pulse are spearhead PCTs we counted 5.

Now spearhead sounds like an elite military unit until you realize that spearhead is actually pronounced as sink in front of the word PCT in a similar way that the word sink is applied before the word estate to describe areas where most politicians would choose to live if they were that lucky to earn so little in order to be able to do so.

So in areas that are under-doctored “world-class” commissioners are paying private firms public money to shut down white elephants that these “world-class” commissioners (morons) agreed contracts for and best of all are paying people NOT to deliver any healthcare to under-doctored PCTs. So much for "equitable access" comrade commissars. The comparison between certain Southern African dictatorships and Za Nu Labour cannot be more relevant (with thanks to Guido Fawkes blog for this little gem).

Will anybody be looking into the true costs involved and investigating the “commissioning” activities of those "world-class" commissioning managers involved?

Somehow we doubt it but we know who will pick up their failures and that will be whatever remains of the local NHS but it won’t involve any extra work for the “world-class” commissioners will it comrades?

More vodka and caviar to celebrate another successful private/public sector misadventure? No doubt many more will follow.

Praise be to the “world-class” commissioners who could not organize the proverbial in a brewery when they were flush with money and were given instructions on how to do so. No doubt their expertise will be available to the newly formed GP commissioning groups who will have to make do with less and will be welcomed like a handful of molten metal.

The future is truly bright for when the private sector fails and "scores", the public sector and the taxpayer will have to pick up the pieces. Time and time again but no doubt efficiency savings will make good all of these “world-class” commissioned losses of hard earned taxpayers' money.

Won't you comrade workers?

Meeting creep.

2011-10-03T00:27:00.000-07:00

We here at ND Central used to once have proper Practice meetings. These meetings were when we the GP partners in the Practice met together with our practice managers and other staff (if required) at least once a month to discuss the Practice’s “business” which is providing healthcare for our patients.

For non-UK readers and for most in the UK who think that most GPs are employees of the state most GPs are “self employed contractors”. We are like self employed plumbers or builders albeit contracted to provide services to the middleman of the state called the PCT (Primary Care Trust) soon to be abolished with whom some of us hold a nationally agreed contract.

This means we have to provide certain core services but as professionals we have a greater degree of control and therefore freedom as to how we run our Practice (our business). This can result in innovation and excellence as some Practices adapt their services to suit their local population and its needs but the downside is that it can allow some Practices to slide if high professional standards are not maintained

In the old days practice meetings could last as little as two hours and were often held after hours which meant when the working day once finished at 18.00 Zulu we might get home at 21.00 Zulu after a full working day as well. Complex matters like what colour paint should we have for the window frames or when can we take leave during the school holidays were discussed or how many emergency surgeries do we need/want to provide.

During our training it was always said that GP Practices which had regular Practice meetings were the better practices as there was communication and hopefully Partner participation in the business especially if each Partner had a vote i.e. a democracy as opposed to Practices where the Senior Partner dictated everything. Such meetings were once business meetings and were short(ish) and to the point.

Under Za Nu Labour’s centralized Sovietization of the NHS coupled with their “command and control” policies of the (medical) professions, the team at ND Central have seen meetings increased in both in length, and in number, by imposition of so quality “targets” to tick local retards’ boxes and deliver bugger all health care.

We repeat deliver bugger all healthcare but increase medical arse time on seat doing sweet FA to tick someone’s box.

The military use the term “mission creep” for increased involvement in matters hopeless at the behest of interfering ignorant politicians and we would suggest the term “meeting creep” for something similar in GP land.

Lets us look at some examples of meeting creep that have been imposed from the local Soviet and discuss whether they achieve anything other than a box ticked. Bear (sounds like a Soviet bomber?) in mind these are just of few of the many add-ons imposed by local commissars over the last 13 years.

Let us start with the perceived need by local NHS retards, managers, sorry commissars, who feel that quality involves discussing every new diagnosis of cancer as a “critical incident”.

We feel, as simple grunts on the ground, the need for a huge Homer Simpson “D” word here and may unfortunately have to use a few choice grunt words in what follows for which we apologise.

Listen up f**kwit NHS retard managers sh*t happens every day in medicine but never in your offices for you never see patients.

Grunt rant over and apologies for the extremely rude grunt words. A few facts for your average NHS commissar/manager follow to compensate for our slight impoliteness but then you never deal with real patients just spreadsheets.

Cancer happens. It is not a critical incident unless you are one of those NHS managers who only look out a window on a Friday afternoon?

Why? Because if you didn’t do this on Friday you would have nothing else to do for the rest of the week. (Old medical joke re NHS administrators). Remember what do you call two NHS managers holding hands? A synapse.

Cancer happens it is unfortunately part of life and will kill up to a third of us. If it is missed, through negligence, then that is an INCIDENT but if just happens that is life.

So discussing whether John Doe who has smoked 60 a day for sixty years has got lung cancer will achieve what?

Nothing.

Now the tw*ts that think that this sh*te is important will think that this will make a difference. So Mavis 54 who does not smoke or drink has had 2.4 children who develops breast cancer because she is a woman who has a 1 in 9 chance of developing breast cancer is now a “critical incident” that we have to “discuss”.

Why? What does it achieve? Should we discuss gravity as a critical incident at each meeting because things fall off desks in NHS mangers’ retard offices and patients fall over and break bones? Gravity must be a tsunami of a mission “critical” incident to be discussed at each meeting in future.

Retardation extends even further in the NHS Soviet command and control structure as we now have to discuss as “critical incidents” something that never ever happens in life but is deemed “critical” to NHS managers’ existence the fact that patients do things beyond their limited comprehension and control and they eventually die. Death is now a “critical” incident.

Get the smelling salts out for Whilhelmina Bristlecombe who died peacefully in her sleep at 105 years of age and was subject to a post mortum by the coroner as the last GP to have seen her had done so 3 months earlier when she had been playing baseball and ran a homer with her great grandchildren and didn’t know why her doctor of 40 years was there.

Amazingly the post mortum showed she died of nothing more sinister than “Old Age” but this totally natural death is now a “critical” incident because at age 105 she died.

Why? What does it achieve? Should we discuss the weather as a “critical incident” at our next meeting because it rained?

The worst of all meeting creep add-ons are the imposition of attendance at practice meetings by members of the radical Al Qaeda school of pharmacy the pharmacists employed by the PCT. In the same way that a nurse can now do a doctor’s job on the cheap and people with no qualifications can play at being nurse’s PCT retards feel that a radical pharmacist can now educate doctors and make them perform better.

So many hours are wasted as these Al Qaeda trained pharmacists invite themselves to meetings and demonstrate how much work they do by displaying graphs from laptops for hours at a time. This is not about quality it is about saving the local Soviet money so they can employ more managers. The most recent innovation from the local Soviet who quote words like QUIPP but we think Jonathon Ross would pronounce it more accurately as CRAP is to substitute one non steroidal anti inflammatory drug (NSAID) for a cheaper alternative.

Now the idiots that have thought of this idea clearly only have memory in their computers for the more expensive NSAID appeared in the late 1980s and it became popular because it was much more effective that the one now being promoted by the radical pharmacists who are too young to remember the less effective older drug (they would have been in diapers and probably still are given what comes out of their mouths) and as they do not ever follow up patients for years will have no idea what works and what doesn’t but will happily dispense any sh*t (sorry another grunt word) for profit.

Still they are getting paid to waste doctor’s time by hijacking what should be business meetings about providing healthcare not saving money by the use of less effective drugs.

The increasing layers of retardation coming to GP land are like an atomic bomb. A small explosion in central government leads to a huge, expanding mushroom cloud of retardation that will engulf all in general practice for years to come.

This mushroom cloud of NHS retardation and meeting creep continues to expand, despite the new NHS reforms, and please do remember Marshal DC’s quote "We are not reorganizing the bureaucracy of the NHS, we are abolishing the bureaucracy of the NHS". We suspect that the mushroom cloud of NHS management, albeit in different guises, will spread NHS management to new, and as yet unseen, levels of meeting creep.

For surely we will have to now have commissioning meetings, budget meetings, referral target meetings, feedback from consortia meetings et al on at least a monthly basis and more so towards the end of the financial year when the money starts to run out?

Remember fundholding? No extra work involved in that policy, comrades was there ever? Anyone remember having practice meetings and then additional fundholding meetings. We all know that history never repeats itself.

Praise be to the Party for inventing Practice meetings that will result in GPs treating patients so much better by being in meetings all day. More meetings and longer meetings clearly means more, and better, hands on patient care.

The minutes will prove this for if you die when your GP was in a meeting your GP’s attendance at a meeting means you had true quality care for the meeting minutes will show this to be true. The “evidence” will show this to be true.

Quality healthcare is as we all know delivered by sitting on ones’ arse for longer and longer in meetings and avoiding patients. Just look at nurse managers.

Dear GMC,

2011-09-24T03:30:00.000-07:00

I am an average British GP.

I am Caucasian/Afro-Caribbean/Indian/Chinese/Australasian /mixed race.

I am male/female.

I am a Christian/Muslim/Jewish/Sikh/Buddhist as well as agnostic/atheist and part time Satanist.

I am heterosexual/bisexual/gay/celibate.

I am a member of the Conservative/Labour/Liberal Democrat Parties together with being a Communist and a Fascist and many other political parties too.

I read The Times/The Guardian/The Daily Telegraph/The Daily Mail/The Daily Express/The Mirror/The Sun/Daily Star as well as Pravda and the Morning Star and many other journals including Railway Modeller and those in our native languages including occasionally English.

I shop at Sainsburys/Tesco/Waitrose/Aldi/Morrisons/Marks and Spencers/Lidi and a local corner shop amongst a host of others.

I watch BBC1/BBC2/ITV/Channel 4/Channel 5 and subscribe to Sky but never watch any late night pay to view channels honest.

I drink alcohol, smoke tobacco and eat far too much and sometimes far too little and may even be teetotal or vegetarian.

I drive a car, ride a bike or a motorbike, fly planes, sail and sometimes walk and race lawnmowers.

I enjoy sailing/shooting/horseriding/unarmedombat but sometimes flower arranging/needlework/reading/my family/exercise/reading and loads of other legal sports, hobbies and activities including work with religious and youth organizations.

I go to a church/mosque/temple/synagogue and the odd covern.

I am a member of the Territorial Army/British Red Cross/Medicins san Frontiers/Cafod/Unicef and a host of other organizations and charities to whom I give my time for free or for payment.

I have killed, maimed, seriously injured and broken the bones of my fellow human beings sometimes in war, sometimes in peace and many times on the sport’s field.

I have suffered illness sometimes self inflicted, sometimes acquired and worse still have prescribed for others who are not registered patients in time of emergency.

I read and write blogs.

All of the above statements apply to the some of the many doctors’ life experiences that we here at ND Central have learned of while working with them over our collective lifetime in medicine.

So why GMC are we writing to you?

It appears that you at the GMC are undertaking a sham consultation as to whether you should regulate our “personal” lives as doctors. We all know that consultations of this kind are merely precursors to a done deal.

Perhaps you should put on your consultation what an ideal doctor should be? Dr Finlay? Dr Kildare? Dr Frankenstein? Dr Watson? Dr Shipman? Dr Mengele? Dr Forest? Dr Donaldson?

And who will decide who is racially and socially pure enough to have a private life free from GMC regulation?

We do not have a problem with professional regulation but when we are not at work that time is ours, not yours, it is called freedom. If what we do with it is legal and does not abuse anyone what is it to you?

This increasing regulatory approach reminds us of some other regulators from history some of whom you probably admire with first names like Adolf, Joseph and Mao. Will you be advising us next on an appropriate dress style for use in our free time? Perhaps a black uniform with matching red armbands and long black boots or will it be a tweed jacket and brown brogues?

By way of conclusion and we know you are above the law remember the Human Rights Act 1998 and the European Convention on Human Rights article 8 which we reproduce for you in the hope that someone can read, and more importantly, understand it:

ARTICLE 8

1. Everyone has the right to respect for his private and family life, his home and his correspondence.

2. There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.

And if we may be allowed to use a quote from a religious book:

"You hypocrite, cast out first the beam out of your own eye, and then shall you see to cast out the mote out of your brother's eye".

The Bible, The New Testament, Matthew 7:5.

And on a lighter note there is the old religious joke whereby Jesus says “Let he who is without sin cast the first stone” which is followed by the punch line “Put that stone down mother!”

Is the modern version now to be “Put that stone down Niall!”?

Is the standard for doctors’ personal lives to be those high ones that are currently abroad in today’s journalistic profession?

If you want to comment you may do so here.

Praise be to the Party for this highly hidden gem of consultation as they all are. You know they make sense. No doubt all those who dare to express an opinion will be monitored for any deviation from the future Party line.

Computer “games” and the current "state" that is NHS IT.

2011-09-20T22:24:00.000-07:00

Not all of us at ND Central are of an artistic streak although most of us are when at the infamous Café Michelle watering hole. One of the team who is really sad is a scientist by training. A week ago for reasons best known only to the deviant scientific mind they decided to try and play an old computer strategy game.

You would think that as the software was already on their computer that it would be a case of pop a DVD into a disc drive and the game should work as it did a few years ago a bit like if you as a doctor had a holiday and came back and expected your NHS computer to work as it did before. It rarely does but it is always your fault.

Of course this was not the case. The game demanded that the user downloads many megabytes of software from a remote server which is all well and good if you live in the first world of internet communications but here in Northernshire this takes many hours. Please remember that what takes many hours on a private individual’s internet connection this amount of data would take days via NHS broadband.

After several attempts at downloading the compulsory patches the game did not work but all the right patches were there. After a lot of headbanging our Practice techie got the game to work by disconnecting from the internet and going back to basics.

The basics in this instance was to install the software on a computer but forego the added enhancement of the game being only playable via connection to a remote server by disconnecting from the internet. Problem solved game worked, hours of unnecessary and unworkable downloads avoided and the game worked.

This is similar to the way in which doctors used to use computers. Each Practice had its own set of data called patient records which it could access locally usually from a hard drive within the practice itself. Now the good comrades from the Za Nu Labour Party thought this was not a good idea for while politicians are allowed security you as patients are not your medical records should be in the hands of the all powerful Party.

Now there may also be some shrewd business movers here as there has been a move away from information created locally being used and held locally to having GP practice records hosted remotely on servers owned by the private sector, and this is worrying, paid for by the Party via its PCT lackeys. Business has used similar successful methods as these to great success for example transferring call centres to the Indian subcontinent.

As a great grandparent a patient said to one of the team a few years ago "My family and I have been with your practice for more than 50 years and have always trusted you and the doctors that work here over the years with our medical records. We’re not trusting any Government with ours so we opt out and want paper records with you only".

This is not too dissimilar to our scientist colleague’s dilemma. They had purchased a game that they were once able to play (access) and were now denied access to what they had bought. This is like doctors creating medical records the prime purpose of which is to allow them and other doctors the ability to see what has happened and is being planned for the patients they care for.

When we were at grunt school we were told that the medical record should be such that if another doctor who has never seen the patient picks them up and reads them they should then be able to follow on even if the original doctor is no longer there. It is like a lot of medical information it is primarily there for people treating patients and they are the ones who can use it and should have unfettered access to it.

In essence the purpose of the medical record is to be a record for medics and as such access should be primarily for medics in the same way that if you buy a game you should be able to play it at home on your computer without any 3rd party involvement.

We are aware that there is piracy with games and can to a point understand the games industry trying to preserve their copyrighted products but when they prevent you using what you have purchased they are denying you what you allegedly own.

The Party is no different for it to is potentially the biggest pirate of medical and personal information. It is increasingly trying to restrict access for doctors to medical information that doctors need and have indeed created. The Party wants remotely hosted medical information and if you do not know how vulnerable this system currently is look at this recent story and you can bet they said the same about the Titanic and our practice Titanic has already sunk many more times than once losing days of work as a result. We bet also that any GP practice regardless of which system it uses has had its own DOS (Denial of Service) story.

The Party want all healthcare workers to have Smartcards which is nothing to do with protecting patient data, for if this was a major concern then the national patient summary care record would be a non starter, it is nothing more than a command and control device which anyone dumb enough to use a “Smart” card will have experienced when all of a sudden you cannot log on.

Doctors no longer have control over the information that they created and need to use in order to do their jobs and this is becoming an increasing problem with the Party approved extended hours. We have commented on this before but if a computer goes down outside of normal NHS IT working hours 10.00-15.00hrs you are left in the dark that is assuming you can get through to a local PCT IT “help” desk who say its not our problem please ring someone else.

Bit like the computer game. What once worked now does not despite the improvements in technology allegedly improving things. The same has happened not just to computer medical records but to laboratory results access to x-rays all things that used to be easily accessed which are incredibly useful to doctors but increasingly denied by centralization of IT control usually by idiots whose terminally inability enables them to be intellectually unable to use the data they now control.

This minor handicap does not prevent them exercising their terminal inability to prevent those who can use the information they control doing so and in doing so seriously compromise patient care. This NHS underclass of IT technicians seek to deny to doctors information by increasing layers of bureaucratic retardation but then they could never spell the I or the T bit of IT for they were very, very big words. Hint the I in IT stands for in-form-a-tion and it helps doc-tors do their job if they can see it.

So if you get frustrated by your inability to play a computer game because of the need for remote access even if your computer is up to the game imagine how your doctor feels when they cannot access what used to be their records, hosted on their computers now only available from remote locations. It is not just doctors it is nurses, receptionists and secretaries who cannot play what used to be a simple game called the written record or locally hosted computer record.

All because the Party wants control of UK medical records. Why should that be so important and costly? Just let us do our jobs, easily. Give us our records back we do know how to look after them honest. More importantly we know how to use them too.

Praise be to the Party whose idea of NHS IT will means that in contrast to the concept of the world wide web surviving a nuclear strike the NHS IT revolution cannot even survive a power cut.

Those of us old enough to remember power cuts can remember eating and reading via candlelight paper documents. Could we do the same with medical records in general practice now? More importantly could we practice?

NHS IT making it easier to take down a health service than ever before and denying those who need the information to do their jobs via institutionalized incompetence. And they keep getting better at doing it with each upgrade.

Wasteful class commissioning.

2011-09-13T05:06:00.000-07:00

One of the terms we have not heard banded about for a while is world class commissioning (WCC). What is that you may ask and how does it affect my healthcare? A good question and the answer is it was a buzzword used by those who might have been close to the top of your school’s remedial classes in order to make them sound clever.

You would have thought that such intellectuals who were destined to run PCTs would have used their WCC skills to ensure that public money was well spent and maximize tax payers’ investment. Unfortunately they were not at the top of your average Northernshire comprehensive school’s remedial classes for those brighter than them will either be guests of her Majesty or rubbing their hands with greed for they could spell two 6 letter words a week, instead of the one 5 letter word a week needed to be a world class commissioner of healthcare, and they went into the private sector.

A small piece shows how well the WCC remedials have done in out foxing the private sector. If you cannot sleep well at night we suggest you download the full accounts from here but we do warn you if you are on a NHS N3 connection the massive size of the download (10Mb) could cripple your practice computer system for days.

Just look at the costs on these world class commissioned projects and in particular the weaselly words that describe world class crap. They are under the heading of 31 Losses and Special Payments and other Accounting notes p133 using Adobe reader (128 using account page numbers) and subdivided into the following headings:

Claims abandoned.

The National Decontamination Programme (was that ethnic cleansing or some other form of NHS cleansing for example ward cleaning does anyone know what it actually is?) has written off £ 1,125,841 on two schemes as neither was able to complete its procurement due to insolvency on the part of the preferred bidder.

Excellent even those just retarded enough to be involved in WCC don’t have enough fingers to work out the difference between positive and negative. No doubt their betters in their remedial class will know where the £ 1.25 million has gone or the money needed to run a 10000+ patient GP practice for a year has just gone puff the magic dragon into thin air.

Store losses.

Emergency Preparedness Stockpiles which we are sure that all GPs and hospital doctors will have ready access to in the event of “accidental or malicious release of chemical, biological, radiological or nuclear agents.” This is an understandable mere £ 30,948,109. Anyone know where the current stock is kept just in case we need it?

Pandemic Flu Countermeasures Stockpile The department wrote-off £59 million in relation to counter measures held for the pan(ic)demic flu preparedness (another one for the bingo card) that have now passed their shelf life. An interesting phrase which could be translated as completely useless products.

Fruitless losses.

£ 8 million pay off to a private firm to terminate an ISTC contract. Seems a lot when the cost of ammunition to terminate international terrorist leaders is pence. Still someone will be laughing at the taxpayers’ expense and be assured that as this was at the request of NHS London which was responsible for the management of the contract there will have been plenty of WCC to account for this loss but not to make it good.

Constructive losses

E-learning for healthcare. Bet you knew nothing about this one but following a review of capital projects a decision was made not to allocate further capital to E-learning projects and 20 were cancelled at a loss of £ 6.1 million which cannot be recovered. We can think of plenty of other E-something projects that could do with going the same way.

Look at the recovery of loss recorded in 2009-10. A loss of £ 79.2 million in 2009-10 was reduced by £ 13.7 million because someone found the paperwork. Given that WCC is nothing more than paperwork how could someone not have the relevant paperwork for storage of anti flu drugs to the tune of £ 65.5 million?

There are plenty of other little bits to delight you in this 154 page document try p22(18) and see how much per head your region costs the tax payer, how much cars cost for certain senior doctors and managers p51(47), how much certain senior doctors and nurses got as salaries p53(49) and in pensions and lump sums p54(50) together with DoH expenditure to organizations which certain individuals have connections with p135(131).

Look at the end of the article to see how little politicians understand the health service that they, and they predecessors, have created and seek to improve using the Tripartite market model. The person quoted here is none other than health minister Simon Burns the italics are our additions:

“All these payments relate to contracts signed under Labour (we will do it so much better), who gave the private sector preferential treatment in the NHS (so we won’t of course do that just any willing provider). The contracts were overpriced and the delivery often inadequate.

Our Health and Social Care Bill introduces safeguards that will stop (encourage) this, whilst ensuring that patients are given the best (most expensive) choice of a wide (more limited) range of (privately provided) services (completely similar to the ISTC contracts but with different names).”

Praise be to the Party for ensuring that in the United Kingdom no-one is too thick to fail as there is always NHS management. You cannot fail there either for gross incompetence is always rewarded with success albeit it at the penalty of a sideward promotion and a healthy pension.

And there is more of the same coming our way very soon.

Medicine north of the wall.

2011-09-08T21:44:00.000-07:00

One of the team recounted a conversation they had had with a relative who lives way up North in some of the now darker reaches of Northernshire. As any GP knows whenever you talk to a family member or friend they immediately think that you want to hear about their latest brush with illness or the NHS. This conversation was no different and it went something like this:

"I went to the doctor who was really good. They were English. They started by talking to me and asking questions about my illness. When they had finished they examined me and then told me what they thought was wrong before giving me some treatment. Not like the other (local) GPs."

An interesting observation which got us thinking how else does one do general practice? Clearly our relative had noticed a difference in their part of Northernshire large enough to comment on it.

Perhaps this is why 2 previous Prime Ministers hate GPs so much for they have never done it the English way before?

Praise be to the Party for giving us a National Health Service of 4 nation’s health services. Is there any St Patrick out there that can explain the current 4 leaved sham(rock) that is the NHS to us simple believers? Will it be any simpler (better) after the “reforms"?

Mystic Darzi foretells the future of the NHS.

2011-09-04T02:26:00.000-07:00

One of the few advantages of being a GP is that when you have found the right patch you are a bit like a good copper and you get to know your manor or beat.

You get to know:

the patients (some of whom are villains most are just punters taking a free ride a few are actually ill),

the local hospitals (the local CID and CSI when you are stuck),

your staff (hopefully a highly trained professional team who will back you in a firefight),

the Harvard and Yale MBA commissars at your local PCT (the local Russian Mafia when it comes to shafting patients and their healthcare)

and there evolves over time a status quo with some of the players competing with others to provide first world medicine while others wish to bash such hopes on the rocks of incompetence which usually succeed at the expense of patients. You also start to see the impact of international crime on your patch illegal drugs in the case of the Police but NHS privitisation in the case of the GP.

Of course not all are so lucky to live in enlightened Northernshire and if, under current training arrangements, you start as a newly qualified GP you will have left school at 18 and be just under thirty before you can practise as a GP principal. If you are lucky and find your niche you may then be there for up to 35 years – longer if current pension reforms continue the way they are – although most GPs have had enough (of NHS bureaucracy) and tend to retire, if they can, at age 60.

Politicians, unless you are a certain Colonel G in North Africa, are never there that long in one job or place but amazingly if you listen to them they listen far more than your average GP. They even have listening "exercises" and no doubt a few personal "trainers" to help them benefit from "exercise" and ensure that they are “fit” to govern.

Which is why some (now) very rich (allegedly socialist) former Za Nu Labour politicians thought who better to consult on reforming NHS General Practice than Mystic (Lord) Darzi a man whose days in general practice could be counted on the remaining fingers of Abu Hamza’s hands

This consultation process was no different to the politicians of old consulting oracles or basing decisions on the entrails of sacrificed animals prior to going out to wage war (Iraq) or spend huge amounts of money on follies (NHS IT, commissioning).

Their consultation of a high priest all wise in General Practice who is an Armenian born Irish trained surgeon would be like the Americans consulting the oracle of Pol Pot about the Apollo space programme and who best should they employ to make the rocket take off as opposed to hit ground zero something all three political parties seem to regard as the end result of the space race that is current NHS “reform”.

Well it appears that Mystic Darzi is turning out to be on a par with mystic Meg as an accurate foreteller of healthcare to come. He may just by chance, rather than ability in his chosen field of general practice, been consulted but his oracle like predictions and advice to the Party are showing us what may happen with the current round of entrail driven NHS reforms.

All three Parties are no different for all three are busily typing away like monkeys at random hoping to produce Shakespeare not realizing that all that has past has failed but each is still hoping that maybe one of them will get lucky and healthcare right if they change a few words here and there.

You can have quality healthcare, you can have universal healthcare and you can have cheap healthcare. You can however only ever have 2 out of the 3.

We hear that the Darzi centres and their drive for equitable access are about to be ditched in some parts despite all the “world-class commissioning” of their contracts which in some cases have failed spectacularly. Costs are far greater than normal general practices and they deliver less and cost more.

So what will happen if Darzi centres slowly fold? You would have thought that under the great war of liberation of the current NHS there would be hundreds of any willing providers queuing up to say “Yes we can” do it better and cheaper than they anyone else in the "free" NHS market where price is not negotiable only “quality” which is the new “choice” word which is strange as all Darzi centres were put out to a competitive tender process run by the Soviet run PCTs.

So there will be no worries regarding where patients will go for the remaining PCTs, under the supervision of their PCT clusters, the result of reduced NHS bureaucracy, will be busy commissioning any willing providers to fill the gap. We hear rumours from colleagues down South that they have already found many cost efficient (un)willing providers to mop up the Darzi centre patients as the local Soviets start to shut them down.

And who do you think these any (un)willing providers cost efficient providers will be? None other than the existing hugely inefficient local GPs that Darzi centres were meant to replace. Of course under the NHS Choice agenda those who did choose to run Darzi centres (for profit) could choose to do so while those who have to pick up the pieces of their expensive failure are given true NHS choice which is none.

It is not difficult to see the same thing happening using Mystic Darzi’s model in a few years time. GP commissioning groups will reinvent the Darzhole centre or its then political equivalent and when the Party changes have to find another (un)willing provider to replace it when people realize how much things cost and how little they deliver.

Who will have seen this process come and go for decades and realise that history often repeats itself? Those who at best last a decade in politics or those that provide consistent healthcare for families for decades?

There has been a listening exercise recently but no-one has listened for politicians never listen. GPs listen to the failings of the politically driven NHS bureaucracy they are called patients but we cannot spend all our time fighting it. If we did we would cease to see patients so we have to ask them to do so. Politicians spend so much time listening to patients who they sprinkle like spices into their speeches to show that they care (for you) but spend far more time ignoring them when it comes to their political actions when they are caring for those that they truly love.

Praise be to the Party who forever quote from history but rarely learn from it. Any guesses who will be mopping up the next load of politically driven expensive private failures? Whatever then remains of the non private NHS.

GPs perhaps? It has started already and Mystic Darzi has shown us the way.

Appraisal made simple.

2011-08-29T04:27:00.000-07:00

Once a year as a doctor in the UK one has to reach an intellectual low point the ultimate test of medical retardation called appraisal. This we suspect to most doctors is like pulling your own teeth out with a mole wrench while being told you will look better for doing so and it won’t hurt a bit. It is like the “What I did in my summer holidays” essay at school when you were the only kid in the class who hadn’t been to Disneyland it is so painful and like the essay a complete waste of time and effort achieving nothing but happens each year.

Appraisal, although officially denied by those who missed Harold H. Shipman the multiple mass murdering GP in the UK, was introduced by the GMC as part of licensing and revalidation all of which are tools to curtail professional freedom and ensure that all doctors are dumb ar*ed Party organs. Harold H. could at least objectively quantify his achievements something that the gentlemen’s club cannot but Harold H. was of course not the GMC’s fault. How could it ever be? It is a bureaucracy that costs doctors who actually do real work dear each year.

Check the GMC website here and see how easy it is to identify a crap doctor. Can you find a dodgy doctors’ list here?

We have on several occasions identified dodgy doctors and checked the helpful GMC website and their details have been wrong. We have then informed the GMC and it takes at least two attempts per doctor to change things. Some examples of dodgy doctoring we have come across in our collective careers include such minor infringements of high professional standards like accessing highly dodgy porn while allegedly working or giving false qualifications. The initial phone calls were ignored as was a subsequent letter sent recorded delivery until someone who could read found it by chance.

We follow the individuals concerned with interest in the hope that concerns reported do not result, a quarter of century later, in the next Harold H. Shipman. We have discharged our duty as doctors in the field but has the GMC done its protecting patients bit?

The great thing about the GMC is that although it now provides licenses (not the ones we would really like) called licenses to practice if you resign from the gentlemen’s club then they have no sanction against you. We have seen this locally too and the only sanction relatives have is the legal one and so a protective GMC is a totally toothless tiger when protecting patients in contrast to its full set of armour plated nashers when savaging the profession. It has failed to protect and anyone who has failed in any NHS managerial capacity gets away with it and just carries on.

Enough of the grunts’ rants. If the officers are incompetent then the grunts will fail. Not a problem in war you just die but when patients are harmed someone may just get sued and more importantly patients get hurt due to incompetence. Hurting patients is not on but still the regulators blame and penalize all the doctors for their regulatory failings.

There are a variety of other medical bloggers who have realized the self same things about appraisal, revalidation, licensing and those in charge. Have a look here, here and here for a selective snap shot but type GMC into their blog search engines and there is plenty more to read. Remember power corrupts and absolute power (with no accountability) corrupts absolutely.

Although officially denied on its web site (Q. 8) that “appraisal”, which is part of “revalidation”, is in response Harold H. Shipman can you see anywhere a reference to Harold H. on its timeline? Neither can we but that must be because some of us haven’t yet had our annual appraisal and so will be nearing the end of the boosting charge to doctor performance that is the annual appraisal. Appraisal is that impo(r)tent to making us perform better as doctors after it just like the summer holiday essay turned us into budding Shakepeares.

You can imagine how appraisal was “thought” of as any doctor married to a nurse in the UK will have had this, or a similar, conversation in the last 10-20 years prior to doctor appraisal being brought in.

Picture the scene thus:

The Gary Grant like doctor, a member of the GMC, is cuddling up to Doris Day his wife, a caring nurse manager, in full body pyjamas in their separate single beds after they had both had their full days “work” in their respective “managerial” but hands off patient caring roles. If Gary and Doris don’t do it for you imagine the former Chief Medical officer Sir Liam Donaldson and the former Chief Nursing Officer Dame Christine Beasley instead who brought all this in. The sick bags are located in the seat in front of you if needed.

GC: Darling, the GMC have asked me to come up with something cracking to check that all doctors in the UK are all damned good chaps.

DD: Really darling? Why would they need to do that? You are all such good sports and pay for my swimming pool, Porsche and all I have to do is to lie here on my back and think of England. I get paid as well for doing absolutely nothing at one’s splendid hospital as a modern matron.

GC: Oh darling do not be so gay with these matters. I haven’t got a clue what to do but need an answer by tomorrow, my dear love.

DD: But darling that is why you work for the GMC? Oodles and oodles of money for doing absolutely nothing worthwhile!

GC: You are right as always darling, I forgot about that, but you are such a top hole sport can you help?

DD: I think I might just be able to help you. We nurses have a completely useless system called appraisal. Nobody likes it, it achieves absolutely nothing but piles of paperwork and the killers get away with it all the time. What do you think?

GC: Splendid idea Doris! I can feel one of those jiffy moments coming on and will present this as an original idea tomorrow at the GMC. Should be easy to get though as I pull a string and everyone votes yes. I am sure it will work as well as the crystal set I put into my car although the radio does go on and off over every bump but someone has to try “new” ideas despite the ups and downs.

And so appraisal may have been born for the medical profession after it had failed elsewhere and continues to do so.

If you think appraisal for GPs is quality tough stuff check out this link.

Have a read of the forms and remember all a doctor has to do is write something in the boxes. Nowhere is the care given by that doctor actually assessed. Not once in all the years that appraisal has been running have we been ever asked to show even one set of patient records. Just the filled in appraisal forms. Convinced this will ensure good quality doctors? Read on.

Check out this link for “minimum appraisal standards” here. Think Harold Shipman as you do so and substitute the word worthless for limitless in the first sentence.

We believe that he met all the then current educational “standards” and had to provide certificates of attendance at courses to qualify for educational payments called Post Graduate Educational Allowance (PGEA). That’s right to qualify for payment not to check quality of care.

We will say the word again payments so no conflict of professional interests, or of professionals maintaining their own professional standards because they think it is the right thing to do.

In summary before the more rigorous system of appraisal if you sat on your ar*e at any educational meeting and got enough certificates you were deemed a “good” or Shipman equivalent doctor. Collect your PGEA money, pay your GMC fee, no questions asked so carry on killing doctor.

Given the fact that a lot of “educational meetings” were sponsored at posh restaurants and hotels by drug companies you can rest assured that all doctors with a full PGEA payment were uninfluenced by commercial organizations only by their “love” for (money) professional advancement (and good food) which some of us have always done for nothing using the time honoured method of reading original research and doing something verboten in the current NHS thinking what is best for the individual patient not following a Party (or drug company sponsored) diktat.

We regard this as part of the job if you are a “professional” and we do this for free and do not collect “trophies” for doing so. Others however feel that keeping up to date should be paid for and rewarded with little baubles.

Check this site for it provides the “minimum” paperwork you need to comply with appraisal paperwork. You can fill it all in less than half hour. Have a read of a structured reflective template and see if you can fill them all in with something you made up that might appear real.

If you are struggling then an episode of the BBC’s Doctors soap will be more than you will need to do so. The soap is a fictional work but patient care is non fiction. Appraisal in minutes, we have done this in 20 minutes and the best bit of it was nobody read any of it but we completed our appraisal. We found this by chance (just read post #16) doing our research so it appears that others do even less than this. See how long the Party and its organs feel you spend (top of second page) on your “What I did in my summer holiday” essay here.

So current GP appraisal consists of telling a local colleague how wonderful you are in 2 hours while your colleague gets a bung of about 500 quid to sit and listen to you after a 2 day training course to become an appraiser and identify any proto Harold H.. They may even have read the sh*te you wrote on the forms but often don’t. They are getting so bored with the process, probably because no-one likes doing it and rightly so for appraisees (notice the subservient term aka trainees) are giving the Quislings a hard time so now that the whole thing takes just over an hour.

Appraisal is meant to be part of revalidation for doctors a process that is so straight forward an idea that the other great medical gentlemen’s club the RCGP have published 5 versions of the RCGP Guide to Revalidation of General Practitioners. Not over many years but between April 2009 and December 2010 so no-one is making things up as they go along are they?

Praise be to the Party for ensuring that Harold got away with murder and was educationally up to date and got paid for it. Thank God the Party and its stooges have realized this and tightened things so much up that what Harold could do in hours of education you can now do in less than 30 minutes of downloads and a 2 hour (or less) chat called appraisal.

In order to practice as a GP you have to have been appraised but before you can fail as a GP in the eyes of the GMC you have to have passed appraisal. Makes sense doesn’t it? Protecting patients guiding doctors?

Government to finally consult over IT matters?

2011-08-24T23:27:00.000-07:00

A small piece in this week’s GP online caught our eye. Have a read and ask yourself is this a true government engagement with the profession (unlikely) or another variant of an alleged listening exercise now on “listening” (to cronies) exercise 2 the sequel? There is a bit more information here (even an app blog!) and here on Party websites that give a bit more spin. Can you spot the subtle play on words?

We could think of a few apps for any health minister to put on their smart phone in our attempt to improve the NHS and of course improve patient (and staff) well being the first is the:

Scrap Cab app.

If pressed this would stop all Choose and Book systems dead thus enabling referrals to make it to their intended targets and give patients real choice via the power of paper.

Health secretary Andrew Lansley said the campaign to develop new apps ~~was a political gimmick to divert people’s attention away from something else~~ is part of a drive to give patients better access to information that ‘will put them in control of their health’.

As well as submitting ideas for new health apps, professionals are also being asked to name their favourite exciting health application.

Perhaps if Mr Lansley asks his nice secretary when they have switched his computer on and before he plays his favourite computer game NHS Battleships to point out the Google app on it he will discover the app most patients already know about and use regularly that “put them in control of their health”.

We are sure there could be other apps that could benefit the NHS like:

The Waynetta Dullard app

will automatically block any 999 call for a broken nail and divert them to the emergency on call beautician.

The Holiday Emergency app

would automatically block any call to a GP from within 30 miles of an international airport when the caller says “I have just got back from holiday and need an emergency . . .”

The Find My Dealer app

Simply place your drug dealer’s mobile number into this and it will display a map showing their current location. If their phone is switched off or is located in any of Her Majesty’s prisons or police stations it will automatically look for any other willing provider or failing that your nearest GPs’ surgery or NHS Walk In centre.

The Are you alright? app.

Vital to ensure that you are always a worried well in peak shape this handy app asks you at least once a day (other options available you can’t be too careful) if you feel alright. If you answer yes nothing will happen but any other answer will randomly dial either NHS 911, NHS Direct, your GP or 999 to ensure that you get instant gratification for not feeling right.

iBoob Checker

This app will enable anyone worried about breast disease to consult instantly with a trained ~~pervert~~ professional who can in real time review images that might suggest disease. If need be a real time video consultation can be arranged and advise you how best to examine yourself via your phone’s camera. Images may be recorded and used for training or security purposes. (Other iCheckers are in development).

We really must start doing some real work but we are sure there are plenty of other ideas out there so you know where to send them. Click the link at the bottom left of this page to see what other "hot ideas" have been rolled out so far.

Praise be to the Party for once again thinking that technology is the answer and completely missing the point about what real healthcare is.

The rise in NHS bureaucracy even stops you dying at your anointed time.

2011-08-23T23:11:00.000-07:00

We are sure that a few of our fellow GPs and district nursing colleagues will have noticed the emergence of the DNR form. DNR form? Well it stands for Do Not Resuscitate form which has made its appearance as an additional passport now needed by the dying patient from NHS bureaucrats to speed up their navigation on their final NHS journey.

Imagine as the on call doctor in your average NHS GP’s consulting room you are happily practising a few putts on your golf simulator with your three 96 inch plasma screen 3Ds displays and surround sound when there is a knock on your door that distracts you from winning the last US Masters with your expert putt after years of practice while on call.

In walks 37 stone of experienced cream cake eating and work avoiding district nurse commissar Kristina Brinklocova whose proud boast is that she always puts paperwork first. This former Eastern European chocolate putter then thrusts a DNR form in front of your face and drawing herself up to her full 4 foot 6 inches of honed work avoiding lard while making her once every 3 monthly appearance at ND Central as a new modern matron of remotely hosted district nursing service says sign this.

Not that we are easily intimidated here at ND Central but when your only defence between being crushed to death is a golf putter then discretion is sometimes the better part of valour (thanks Dr Z).

You then read the mountain of paperwork that is a DNR form and see that Ernest Thistlewaite age 65 who your friendly local oncologist has given odds of he will not last to the end of the month as most of his lungs and body organs have been replaced by small cell lung cancer and was, and is still, a 60 a day smoker whose sole nutritional support is alcohol is, until you sign otherwise, to be resuscitated in the event of any preterminal cardio-respiratory arrest.

He is being given the privileged of going AWOL from death and avoiding CPR even though death is seriously on his case despite the nurse commissar whose response time in the event of a code blue would be hours, just to assume a vertical posture from lying down.

The DNR is yet another sign of the paperwork generating NHS for unless one is signed, given to the district nurses, relatives of the patient, Police, Ambulance and Fire services, local boy scouts and local girl guides together with the local Women’s Institutes then anyone unfortunate enough to be on a very short haul flight to meet the Grim Reaper may have their stay in the departure lounge extended by all of the above jumping up and down on their chest for no useful purpose other than protocol.

Not so long ago GPs and district nurses worked together. They knew and discussed patients together and with their relatives and if a patient was about to die we discussed the issue of dying and CPR and if appropriate we agreed when we would/would not. The out of hours services were also informed so instead of dispatching life saving paramedics a death confirming doctor would be sent.

We would call this death with dignity. No unnecessary heroics just an unassuming passage into the after life with minimal bureaucracy in the here and now.

For reasons better known to those with less experience than us it appears that all punters are for resuscitation at all costs unless a DNR is signed. An interesting point that isn’t it? Patients have by implication given their consent to CPR even if they are dying from incurable diseases and have NEVER been asked? Remember "no descision about me without me"?

Who is worthy of resuscitation? Well as all comrades are equal in the NHS then obviously everyone is regardless of their physical condition even Ernest whose body is being painfully eaten away by a cancer that no-one can do anything for. If Ernest stops breathing or loses a pulse should all the stops be pulled out to resuscitate Ernest back to life so that he can continue to live out his remaining life in pain with no hope of remission unless the parole board give him a DNR?

Well over the years we have worked with doctors who would happily gone into a graveyard to dig up corpses to practice resuscitation on. This is an example where common sense used to prevail but not now the bureaucrats have taken over. It is now “policy” dictated by “protocol” that means that regardless of any patient’s medical condition being assessed individually people should be resuscitated by NHS corporate policy. You cannot die with NHS care although you may often die because of it.

The thought that the application of military triage principles be applied clearly frightens some. After all who would be able in today’s NHS to fathom out those who will not survive, those that will survive with treatment and those that need no immediate treatment? An article in this week’s BMJ highlighted the default position being that of resuscitate without any thought except in certain instances such as “rigor mortis, decapitation, decomposition or dependant lividity”.

We like that last one how many UK sixth formers doing General Studies A level grade U or E- or below soon to be next week’s elite NHS managers would know what “dependant lividity” meant? Is it an Excel Word or on Facebook thingy? Perhaps some others like doubly incontinent, demented, not moved for years after multiple stokes with pressure sores or dying of something incurable should be added to the list? And can it get worse?

Yes it can! For any DNR order now has a review date, an excellent increase in totally pointless bureaucracy and multiple form signing.

So let us return to Ernest whose life has got even shorter since we last mentioned his name by a disease over which we have no power to defeat. If you were a thinking person and were asked to complete the DNR for him you would think that the review date is postponed indefinitely but oh no Matron will not allow more than a few days grace in case something changes. If it does and he gets cured we promise we will ring the Pope but a review date get real?

At this point anyone with intelligence will have lost the will to live or be suffering a cerebral haemorrhage of some description as a result of repeated banging of a head against a wall. Can it get worse? Yes it can for before these worthless pieces of paper came along we were sent letters saying how much “effort” had gone into devising these pieces of soiled lavatory paper. Lots of words like “consultation”, “partners” “co-operation” “inter agency working” but how come no-one told, or asked, the grunts on the ground?

Praise be the Party whose concern to provide first world medicine for patients is always trumped by its desire to add more paperwork in order to evidence its patient centred activity. When Ernest dies there will not just be a death certificate and a hopefully dignified pain free death to justify his well taxed self abusing life style there will also be a DNR audit and quality care paper trial available to justify Matron’s huge girth.

Why make things simple that work when you can have NHS care? The morons are well and truly in charge. We must away to read the next protocol and avoid patient care as a result.

And no doubt Matron will get through some chockys and cake while doing more essential DNR forms and ignoring the morphine. One involves meaningless paperwork the other involves hands on patient care. Which is most important?

NHS IT and accurate information.

2011-08-21T07:37:00.000-07:00

After a particularly hard night of resistance work at the infamous Café Michelle some of the team decided to check the NHS Choices website for a laugh. You know how it is when you are waiting for the liver to do its job and the Sunday morning bacon buttie to get digested. We have visited it before and commented on its value for money.

Well we started by putting in our postcode and looking at our empire. We looked at how many doctors there were at each surgery site and none of the figures were correct for the same number of doctors are present at each site and the same sex ratio applied but not on the NHS Choices website that gave you several Party approved “NHS Choices” none of which actually applied.

What amazed us more was that the distances from the postcode we put into NHS Choices to many local neighbouring surgeries were at complete odds with our regular commutes and the figures on our milometer. Our most rural surgery was closer in distance to our main surgery than another surgery site in the same small rural conurbation according to NHS Choices. Clearly something strange is distorting the space-time continuum in Northershire and we will need either Doctor Who or Mr Spock to explain how a journey of many miles over high moors has been reduced to a few tenths of a mile.

This could be interesting as neither Dr Who or Mr Spock would be qualified to work in NHS IT but we are sure a sonic screwdriver or a translator device would help them “crack” this NHS Choices conundrum.

If you click on the map it shows the correct locations of the surgeries and shows the same distances but if you look at the scale bar on the map then the distances quoted by NHS Choices are clearly wrong. Can't be Google's fault can it?

We did this for a few other locations we knew well and the same errors were there too for distances quoted. Indeed 2 surgeries at approximately the same true (map) distance were quoted as being 0.3 and 0.9 miles from the postcode entered.

One of the reasons we did this was to see if any comments had been posted since we last visited and the website showed that we had scored one hit. Salivating at the thought that someone might actually like us enough to post a comment on the NHS Choices website which surely would reward us with untold riches due to a surge in patients wishing to register we clicked the link and were invited to be the first to post a comment.

Strange we thought could there be a programming error so we used our provisional number of comments =number quoted minus 1 formula and tried one of our neighbouring surgeries which confirmed the formula worked for they had 2 comments but only one was visible.

Being on an Einsteinian mathematical roll we went to the local dross practice which was sporting a massive 0 out of 2 comments recommending the practice so we thought we would be in for a laugh and see maybe one comment but there were in fact 3 one in favour two against.

There was lots of other similar information available like the fact that we opened at weekends which was news to us as was the fact that we offered extended hours at times which we did not. We found this by clicking our surgery name.

Extending our search we found degrees that we have never been awarded but it is good to know that we have doctorates in subjects we have never studied while lacking even a basic medical degree.

All in all an interesting website if you have nothing else to do other than work off a hang over and fancy a laugh. Reminds us of reading the Sunday Sport to get real news.

Go on try it for your own and local surgeries. If it is as accurate as it is for Northernshire surgeries and places where we trained then you will be “recommending” it to your friends. More likely you will ignore it as most people do when choosing a doctor and go on personal recommendation.

Praise be to the Party for spending millions on crap websites to provide factually incorrect information. Once again the NHS is leading the world backwards in provision of IT services for patients.

And spending millions in doing so which could be better spent on treating real patients rather than providing useless but expensive websites.

The taxman sayeth sorry?

2011-08-17T07:15:00.000-07:00

How GPs get paid is a mystery to most of our patients as they can see highly trained professionals for free in contrast to their lawyers, plumbers, builders and dentists for whom a small honorarium is usually required from our patients in order for them to avail themselves of these professionals’ services. In the same way that anything provided for free should not be paid for which is the view of government the way in which GPs are taxed is a mystery to most including GPs.

Most GPs are self-employed and to put it simply we pay tax twice a year on the 31 January and 31 July. This is in contrast to most employed people who have tax taken from them on their monthly earnings.

The Inland Revenue are not normally viewed as the kindest of people but those of us who live in a civilized society and like roads upon which to drive our Ferraris, as all UK GPs do, realize that tax is a necessary evil in order to provide public services.

So each month that we work we GPs here at ND Central put aside enough money to pay the taxman (or woman) must show we understand “diversity” for we know our place in January and July each year.

Now because the country needs money it is important that Her Majesty’s Revenue and Customs (HMRC) run a smooth well oiled ship but this year several of the team at ND Central did not receive the paying in slips that HMRC send out twice a year before the 31 July deadline.

If you as a taxpayer miss the Party’s deadlines then a fine and interest are slapped on you and you have to still pay the tax. So the non receipt of the paying in slips caused a bit of bother but fortunately our accountants who, you will be pleased to know operate on the same charitable status that our patients can see us, were ahead of the game and advised us how much to pay to keep the HMRC wolf away from our doors.

So imagine our surprise to receive on the 17 August our paying in slip dated 3 July 2011. Now can you imagine the self righteousness of any individual’s indignation if they were to complain to the Revenue about this late arrival and their non payment as a result of this error for the benevolent HMRC suspends the innocent until proven guilty principle of common law and replaces it with you are guilty until you can prove you are whiter than white and we mean Snow White with no hint of even one of the seven dwarfs within a hundred miles of her in terms of pure innocence.

After a hefty dose of sodium nitroprusside IV to control the understandable rise in blood pressure we read the accompanying paperwork and found the form at the start of this piece but despite trying the official website we could not find it for you.

Still it is a first we think. Who knows if HMRC can start saying sorry maybe politicians who have buggered up the NHS will do the same next . . .?

Praise be to the Party for allowing us the privilege of free healthcare and of 70%+ taxation (if you include National Insurance in its various guises) in order for us to pay for what we deliver. Still for once we as GPs are not in the wrong . . .

Riots – a thought.

2011-08-14T05:21:00.000-07:00

One of the great things about the NHS is that whatever you do as a patient it is never your fault. Take for example the following:

I am fat (nothing to do with you being greedy)

I smoke (nothing to do with choice and will power)

I am a drug addict (nothing to do with you choosing to do so)

I am in debt (nothing to do with you over reaching yourself)

I beat my wife and children (nothing to do with you being a self centred bully)

and so on.

All of the above are examples of the no blame culture that exists in the UK at present especially in healthcare. All of the above are examples of the crap that UK GPs see on a daily basis where it is never the patients’ fault but it is always the doctor’s responsibility to put right.

And you can bet your bottom dollar that someone who has rioted, been arrested and charged will want a doctor’s letter to tell the courts that their limp meant they had to carry a plasma TV to help them walk more evenly while wearing a hood to protect their photosensitive skin from the sun (at night).

We wonder which GP will be the lucky one to be the first to receive such a request for after all it is never their fault it will all be because they have an “illness” or a "medical problem"? And they do know their rights . . .

Praise be to the Party for allowing choice of action via rights. When responsibility does not enter into the equation rights become meaningless - just ask the victims of the riots for they too had rights that were violated by the mob.

Both groups be be seeing doctors in the next few days and we are lucky as doctors in the UK that we will not be prosecuted for seeing one of these groups although we still have to treat them.

GP led commissioning?

2011-08-06T01:08:00.000-07:00

The great work of fantasy fiction the novel called Liberating the NHS was supposed to give GP’s the chance to commission services for their patients. Remember such words as these:

“The headquarters of the NHS will not be the in the Department of Health or in the new NHS Commissioning Board but instead, power will be given to the front-line clinicians and patients.

The headquarters will be in the consulting room and the clinic.”

A piece in this weekend’s press shows how much of a fantasy this was. Have a look at the diagram and see where GPs fit in. Look at the mountain of beaurocracy that has been created something that we felt was self evident in the great liberation war. It looks like the headquaters has not moved to the consulting room and the clinic but has dug itself deeper into existing layers of beaurocracy and entrenched themselves more firmly than ever merely changing their names.

Although some of these new and increased layers of bureaucracy are set to disappear (cluster PCTs/SHAs, PCTs/SHAs) you can bet that the manpower will not and will continue to function as command and control organs rather than liberators.

It makes the Soviet style control of healthcare even more powerful than under Za Nu Labour and as anyone at the coalface knows the names may have changed but the same idiots are still in control.

So much for Marshal DC’s claim that

'We are not reorganising the bureaucracy of the NHS, we are abolishing the bureaucracy of the NHS.'

Really?

As the song of all governments goes Things can only get better . . .

Praise be to the Party for our liberation. The chains get heavier with each day that passes . . .

Emergency 911.

2011-08-04T22:31:00.000-07:00

One of the great ideas to improve healthcare of recent times is that politicians think that if you have a “problem” then in order to solve it you must dumb down and create a call centre. One only needs to think of the success of NHS (re)Direct which continues to send GPs unadulterated crap as emergency must see GP immediately who are usually sent away with no treatment whatsoever and who are also told that NHS (re)Direct always tell patients this.

This is usually after the patient apologizes for wasting our time after being told it will get better on its own. There are possibly moves a foot to abolish this expensive redirection non healthcare service and replace it with a new dumber and call centre based service called 111. We still can’t think why 111 was chosen despite watching American medical dramas to keep us in touch with First World medicine.

One of the coalition’s NHS War of Liberation ideas was to replace efficiency savings with efficiency gains and we are sure in the Kremlin Marshals NC/DC will be having a vodka, sorry comrades a Pimms or two it is after all the British summer, over some news we spotted in this medical magazine.

Their new “service” has beaten all previous production targets of turfing a third of all calls to NHS Direct to see either a GP or to A&E and managed to redirect 42 per cent of calls to GPs (it does not say how “urgently” these turfs would be) and beat this comrades 5% will land up in A&E.

Praise be to the Party for great healthcare ideas that could be reproduced more cheaply by tossing a coin. Something to put in ones home first aid kit on top of the old NHS (re)Direct number to remind you of its replacement's improved efficiency and save you having to make a call.

Benzo Wars.

2011-08-02T10:45:00.000-07:00

Our fellow blogger (respect JD) did a piece on benzodiazepines following hearing a piece on this programme. What JD said is true but perhaps the “experts” in the ivory towers of academia and alongside the Thames ought to spend some time in the field.

At the infamous Café Michelle home of the Northernshire resistance a couple of us tuned our crystal sets to listen to the original piece (BBC Radio 4 Face the “Facts” 27/07/11) and would take issue with some of the points raised.

The alleged GP fuelled epidemic of benzo addiction is due to the “power of the pharmaceutical industry.” Interesting point GP bashing BBC reporter dude for is prescribing of benzos in a practice where no GP sees pharmaceutical representatives an illustration of your point? Or perhaps if you are a scientist might there be other hypotheses to consider, analyse and prove or disprove? Something we are sure you did at journalism school in your lecture entitled fact, science and sensationalism.

According to our local psychiatric colleagues who deal with addiction are the BBC and Government GP bashers aware that the biggest problem they are facing is a huge rise in illegal benzo imports from the Indian subcontinent and Far East?

Heroin addicts need several grams of alleged heroin a day to fuel an addiction but our local scrot population of illegal users seem to get by on 40-80mg a day of benzos usually Diazepam. For BBC journalists a gram is the same as 1000mg so if you do the share bys you might just see the points we are making.

Trafficing heroin carrys serious bird if caught and involves quantities of weight almost a 100 times greater than benzos. Given that the NHS run by politicians believes in a fixed price "free" market for healthcare can anyone see where the true (illegal) free market will head?

Current street prices for legit benzos are about £1-10 a tablet for drug addicts depending on supply and prescribed benzos get a mark up. This is about the same as a less than legit “gram” of heroin/talc/brickdust etc. We believe that 3mg Warfarin tablets have the same size and shape as certain benzos something we are more than happy to prescribe for those with a legit use.

If you are a drug dealer which substance might be most profitable and less risky?

The BBC programme said that the cost of a prescription for benzos for a month was less than 2 pounds. Lets say a pound fifty for one 5 mg tablet of diazepam a night for a month 28 in total.

Get a free prescription in the United Kingdom, unless you are one of the unlucky 10% who live in England and have to pay, and if you don’t actually need your benzos but tell your caring GP, who has no way of checking that you do, then your monthly prescription becomes a State funded up to £280 a month additional tax free income.

Is it any wonder that some of our benzo users regularly lose prescriptions to the point where if they see other doctors at other practices and the out of hours services they can obtain 500+ tablets in a 3 week period. That is a massive 5 grand for 3 weeks blagging and all state and taxpayer sponsored and legal.

Now some would argue why do GPs give in? Well going back a few decades when informed medical opinion tried reducing benzos in the same way as they did alcohol and heroin there were a few little problems like fitting. A few patients admitting fitting in the absence of the guidance now available does tend to make GPs cautious.

The addicts in the BBC programme cite a lack of support for the reason they could not come of. In our humble experience they need a lot of support sometimes for 2 years before they become clean. They also need a very cynical degree of supervision for some will lose their grandmother 24 times in a year, have problems with their children all 14 of them at least twice a week and as for the canine morbidity and mortality well we have exhausted our tissue boxes dealing with these excuses not to reduce but to increase their benzo use under such times of domestic "stress".

The BBC programme said that in 1988 a warning was issued. The oldest copy of a current BNF we have is from 1984 and it issues warnings of addiction and those of us young enough to have read this edition of the BNF were warned big time about the risks of addiction with benzos by our seniors then. A copy of the 1976-78 edition page 79 makes the observation that "Hypnotics are overprescribed and patients are kept on them for years". The following page makes this observation "There is no justification for using them for long periods".

Temazepam and Paracetamol were routinely prescribed by house officers as “prn” (as required drugs) to prevent being awakened because a patient could not sleep in hospital or had a headache and sometimes would be prescribed as a take home drug. We regularly used to stop these drugs being prescribed as take home medication but we know many other doctors did not.

Another problem locally is that local substance misuse services seem to regard benzos as the cure for opiate addiction and try to substitute them for heroin. We would suggest this is like trying to cure an alcoholic of drinking by saying stop the scotch and will we will prescribe you beer instead.

As a result a large number of benzo prescriptions are initiated by consultants that then get carried on by GPs who wish not to deviate from consultant led “shared care arrangements” = Party approved we will not pay for specialists whose price is fixed to look after difficult patients we will pay for “quality” and price reduction by sub contracting specialist services to GPs the only negotiable part of the new NHS market.

As a result GPs are seeing many multiply addicted patients using heroin, cannabis, methadone, alcohol, benzos, crack all of whom feel they are not supported but whenever they feel, sorry re grunt word, sh*t, see their GP for a panacea to “get them through”. After all 28 benzos = 28 wraps or £280 pounds for a Party approved ten minute consultation = £1680 an hour for something costing less than couple of quid.

There is a simple solution to this problem. Put benzos on the same prescribing status as anti malarial drugs and ensure that the only way patients can get them is on a private prescription. The NHS “market” would then decide.

If GPs were over prescribing them this should in theory lead to a reduction in demand as GP over supply would lead to a reduction in consumer demand as market costs apply. If it is in effect a patient led demand then benzo prescriptions would soar especially in young people who are buying them because they are so cheap. Perhaps the government could help with a benzo added tax (BAT) on such private services as a deficiet reduction scheme?

Obviously there would have to be a period whereby addicts could come off if they wished but we wonder where NHS market forces would lead?

Simples. No more BBC programmes regarding crap GPs and health ministers telling us that we need retraining.

Praise be to the Party for waking up at least a quarter of a century too late to benzos.

We here at ND Central need more training for this week we had to deal with the dog ate my benzos, my children put my benzos in the bin/washing machine/shredder/customs ceased my benzos, I am out of prison and on a self run heroin detox can I have some benzos, my benzos were on a window sill and the window was open because it was hot and they have melted . . . can I have another prescription?

How much more training do we need?

The answer to all of the above replacement requests will be no until we actually get a request to replace their lost paracetamol. Several decade’s collective experience totalling over a century in practice we have never had one of these requests ever. Wonder why? Perhaps the BBC should investigate the failure of GPs to replace lost paracetamol prescriptions “Millions of Britains are suffering unnecessary pain due to the failure of GPs to . . . ?

Navigation.

2011-07-28T22:08:00.000-07:00

There are certain things that we here up in Northshire regard as essential skills. One of these is navigation for home visits can sometimes involve trips into the wilderness with few road signs in the dark and in adverse weather conditions which in Westminster would be any shower requiring an umbrella as to opposed to a Force 9 easterly and a couple of feet of snow.

A recent trip down South from ND Central to a previously unvisited location and a straw poll of our hosts there revealed that about 50% of our contemporaries and their spouses use Sat Nav to work their way from A to B. The other 50% use a map and compass and other navigational aids such as the trusted sextant and nautical almanac to work our way around the globe.

Navigation has proved over the years to be a problem for some of our doctors in training who despite being extremely able medically would spend many minutes being briefed by our staff on how to find a visit location using the time honoured method of reference points that they knew and instructions to their visit location from these familiar land marks.

This time consuming process was both fascinating and painful to watch at the same time for if one receptionist did not list familiar landmarks another would be tried until a crude idea of location was eventually obtained. The concept of a map was beyond our doctor in training and they were not confident that they could master Sat Nav despite being otherwise very able.

However one navigates occasionally you have to enquire of a local where is such and such?

This weekend we did enquire of locals where is such and such for our maps and compasses suggested together with a noon sextant fix that we were where we should have been. The roadsigns and locals said otherwise.

For once our readings were spot on, we had hit the target but the maps and locals were out of date. Even our hosts did not know of the changes in local road topography.

How accurately can you navigate using the Internet? Some of our doctors in training cannot but we could and did so using basic skills. Perhaps there will be an NHS Nav App to help staff get from A to B? Perhaps its name will be 1592 Map App with up to the last millennium maps to match? Perhaps the technology is already with us in a covert form known as Choose and Book?

If AA Route Planner can get bits so wrong after years of being spot on how well will any NHS Map App do?

Come to think of it how well has any NHS produced software done?

So back to the old fashion history, examination and special investigation routine which will compromise the patient by foregoing the excellence of a clinical dashboard, a referral management centre and a clinical alogorithm and protocol.

Basic grunt navigation works and gets one to ones destination.

Is that a journey?

And guess what we got back too using the mark one human being and without any NHS (re)Direct assist. How did we as a doctor do that?

Praise be to the Party for inventing satellite navigation and ensuring that all who use their software can never screw it up. Thank goodness for grunt training and the fact that not all maps are accurate - even 20 years after inaccuracies are pointed out.

When will the politicians listen? And more importantly can they remember where they went wrong like the maps – 20 or so years ago?

“Quality” and money grabbing bast*rds.

2011-07-25T04:55:00.000-07:00

The word “quality” as defined by the Shorter Oxford English Dictionary has many meanings. It can relate to both people and things but we shall use the meanings of excellence or superiority as in a “quality newspaper” as our benchmark for this little ramble. We appreciate that “quality also can be used sarcastically but we are simple folk up here in Northernshire and will stick with the excellence and superiority definitions in their literal sense.

Most, if not all, GPs we suspect are sick of hearing the word “quality” spouted by NHS mandarins for whenever it precedes anything medical it usually means that something which is really poor, time consuming and completely useless to anyone called a patient is coming our way to increase workload in order to tick someones’ box when a steel toe capped boot would do better placed in the same manager’s/politician’s “quality” box.

When used by anything NHS “quality” usually has the same meaning as the Late Modern English word “crap” or, in grunt speak, a word from a Mid Low German origin, and we are sorry for a couple of very naughty grunt expressions “sh*t” or its derivatives pile of s. or croak of s. both of which can be used with the c. word.

You can very quickly think of things with the Q word in the NHS just think QOF (Quality and Outcomes Framework) which is so excellent and superior that it isn’t working.

We are sure many readers will have their own little local Q word initiatives which like the Q-ships in WW1 were thought of as being a good idea at the time but which were superceded by better things than anyone at an average PCT could think of on a good day on a down hill run with wind assist ditto politicians.

Na Zu Labour’s endless persuit of Soviet style bureaucracy for the NHS led to the formation of the Care Quality Commission which like the Q-ships of old appears to be an innocent vessel striving to save others from harm and charged with maintaining standards but in fact like any poorly built tramp steamer is struggling to do its job and already cannot meet its own deadlines such is the quality behind it in terms of thinking and personnel.

Now where do the money grabbing bast*rds come in?

Well the CQC being a benevolent caring organization existing purely to serve the patient will happily relieve any GP practice (and others too) of £ 1500+ to be registered with it for you have no NHS “Choice”. Not registered can’t work, fail inspection cannot work well shafted whatever the outcome of any inspection cough up or else.

So this Q-ship is not charged with preventing harm it is in fact a source of harm and will no doubt shoot and hole many practices below the water line not with a ship terminating Exocet but with something far more deadly like you didn’t have gerbil wipes in your washroom (CQC “quality standard 57.997.47.1101.gerbil.9/11). Bear in mind that the captain of this Q-ship has much experience of being a U-boat, sorry hunting U-boats . . .

One of the members of the alleged listening exercise a once a week man aka part time GP called Professor Field has clearly embraced the market so much that he has given GPs the opportunity (to lose a few grand) to improve “Quality” via something called the Quality Practice Award (QPA).

Notice the little Q word at the front? Impressed are we?

Try googling “quality practice award” as we did as part of our research and see what, and who, else runs “Q” word practice awards and like the Royal College of GPs there are some excellent and superior organizations which put Northernshire’s Harvard and Yale MBAs to shame for not having put forward a Shiteton QPA of intergalactic quality.

We digress for the CQC are prepared to relieve practices of a mere £1500 (a year we believe) for registrartion and inspection by inspectors who we are sure will be our “equals” or betters in terms of qualifications and abilty for something which is a legal necessity and a nice little deficient balancer to boot for any Government in power. Can you imagine Pol Pot inspecting Harvard and Yale medical schools and what the outcome would be but remember we are talking NHS “quality”.

If you look in the small print of the Royal College’s Qboll*cks page, sorry about the offensive grunt speak the Q word slipped out by accident, here you will find out how much Professor Field and his back slapping government stooges would like to relieve their fellow hard working GPs actually on the real frontline, on a full time basis, as consultable GPs a few of whom are not members of the Royal Gentlemen’s club but do exactly the same work.

Have a look at the little red words on the first page (the italics are ours) which say that evidence obtained for certain QPA/mQPA (Version 14) may help providers demonstrate complainace with the Care Quality Commissions essential standards.

Have a look at how much quality has gone into the preparation of the web page and how “quality” means that the word United Kingdom is severely displaced by “quality” and the quality of the logo which looks like it was drawn by a nine year old. Or perhaps someone drunk hit the enter key more than needed? And note version 14 – does that mean someone got the quality not quite right 13 times before this one? We hear rumours that even version 14 is being redone.

We know of some commissioning groups (RCGP mafiosos) that are taking “may” to mean “will” meet CQC registration and thinking of imposing it on practices but the old expression caveat emptor applies. But if you are MRCGP you don’t do Latin or Windows when in collegiate mode for this usually involves real general practice avoidance aka commissioning.

For there is not just one RCGP QPA that might just get you QPC registration scam there are in fact two. Did you notice the subtle mQPA that you can take longer to get? And can you guess who devised this?

So yet another set of different Q words from different organizations but they all have two things in common. No quality and money grabbing bastards. One is the Party's the others are just advising them.

Praise be to the Party for using the Q word as freely as tinpot dictators award themselves medals and charging the punters for the privilege of wearing their baubles as well.

Now will those commissioning groups wanting the RCGP bauble be able to justify to their patients why they spent more than £ 3,900 on a Q word when £ 1500 was all that was legally required especially if the CQC don’t accept it and they still have to pay the government’s income generating lackey as well?

It appears that certain Royal colleges and their members don’t just shaft their trainees they are more than prepared to Qrap on their colleagues too.

We think the ladies protest too much . . .

2011-07-12T23:10:00.000-07:00

As we drove one of our many practice Ferraris home from ND Central this evening across the high moorland and forest covered hills of rural Northernshire we were listening to the bleatings of a poor Northernshire citizen an alleged victim of the current cause celebre in the UK the phone hackings by the Press of certain peoples’ private data.

In medicine we would call this a breach of confidentiality which is a serious charge against a doctor and yet the loudest of the little bleaters was not one of the numerous maturing lambs we drove past on our way home but one of the biggest advocates of weapons of mass disclosure in our history none other than Gordon Brown something MP, sometime unelected Prime Minister and “saviour” of the World from the destruction of his own making.

On the Radio 4 news programme this evening he said as follows and if there are any factual typographical errors in this transcription it is because we are not audio/touch typists (our press officers had gone to get a late appointment but they were delayed due to leaves on the line):

“. . . if I with all the protection and all the defenses and all of the security that a chancellor of the exchequer or a Prime minister, am is so vulnerable to unscrupulous tactics, to unlawful tactics methods that have been used in the way we have found, what about the ordinary citizen?"

Yes what about the ordinary citizen Mr Brown? It is reckoned that perhaps 4000 peoples’ mobile phones in a population of 60 million have been hacked but you were, in your ignorance and while in power, more than happy to rush through a process to allow 60 million UK residents’ personal medical records to be uploaded without their active consent on to an inherently insecure government sponsored database with at least a million plus users?

Try doing something you have never done in your life called thinking. Which network is most likely to be hacked? Which network has the most holes?

If you are outraged by the disclosure of your family’s records to a select few journalists via dubious means how do you think an “ordinary citizen” will feel when their medical records are hacked for £ 20 of smack to a receptionist dismissed for drug misuse whose smartcard has not been cancelled? That is how easy it is to hack the Summary Care Record.

That is your creation, it is flawed and useless and if you feel that the disclosure of your childrens’ medical records is a problem then perhaps you ought to start thinking instead of bleating with your political colleagues like a Northernshire lamb.

Praise be to the Party for all of their leaders’ concerns about the confidentiality of the privileged. It would seem that they are all biting the hand that feeds them but what will happen when the hand slaps back?

More importantly when will they finally realise the inherent dangers of centralization of patient’s confidential medical information?

Would you believe it?

2011-07-07T22:10:00.000-07:00

Upon opening one of the GP rags this morning a headline screamed out at us here at ND Central.

“Patients shun ‘wasteful’ Darzi centres” it read and yet only a short time before another GP rag said “NHS Choices ranks Darzi centres top”. Surely a slight difference of opinion here but look a little deeper at the first story. The GP magazine contacted 95 PCTs (out of 152 in England) and found some interesting facts about how many patients these Darzhole practices had registered.

Remember these practices are organs of the fromer Party Za Nu Labour’s muppet Lord Darzi, the Iraq born Armenian, Irish trained surgeon who, based on his vast ignorance of general practice, was asked to advise Messrs Brown and Blair on how to reform it. He pulled from his black hole of knowledge of general practice the idea of the Darzhole practice which led to their ~~imposition~~ creation.

We have commented before how they fit into the Soviet market model that is today’s tripartite political model for healthcare but let us now present the findings. Remember too that the Orwellian porcine principle was applied to all PCTs so that all PCT porkies were considered equal and got the same number of Darzhole centres regardless of whether they were over- or under-doctored. (We love true political equality here at ND Central).

The figures are as follows:

12 % have no registered patients

26% have less than 500 patients

35% have less than 1000 patients.

The most damning figure was that on average the cost per practice per year is £ 1.1 million.

Now we can only go on local experience but a practice with a turnover of about £ 1-1.3 million a year normally has a list size of between 10000 - 12500 patients not none, nil points, zero patients on its list.

We will let you do the maths as to cost per registered patient but look in the article about NHS Isle of Wight which has just one registered patient. £ 1.1 million to spend on one patient they are going to live forever!

This might explain the second headline bearing in mind that virtually no-one uses NHS Choices for choosing anything so for them to claim Darzhole centres are ranked top is to be viewed with deep suspicion but just think if you are the only patient would you ever have a problem getting the phone answered, an appointment when you needed it or to see the doctor of your (NHS) choice?

Your call would be highly valued by a Darzi centre and would be jumped upon by staff with nothing to do in contrast to the real world of general practice where 10000+ patients all want the phone answering NOW.

Perhaps we could make a helpful suggestion.

Given that these highly expensive and underused centres are public money going to waste, perhaps every GPs’ surgery in England could give a list of their top one hundred time wasting heartsink patients to their local PCTs with a view to utilizing under utilized Darzhole centres with patients whose needs are clearly not being met by overstretched underfunded normal GP practices.

Such patients could be told that there is a surgery that will see them at any time and they would never wait for an appointment. If they are quick they could in fact be the only patient at that practice but it might mean a bit of a trip but we are sure that given private sector involvement their every need would be catered for and the PCT would pay for their trip to the Isle of Wight (“we could even have a holiday as well as see the doctor!”).

Just a thought for any new commissioning group keen to utilize underused local GP services efficiently and mop up any inefficient capacity issues within the global corporate structure . . .

Priase be to the Party for giving us Lord Darzi and for the way he has transformed general practice (not), improved access to GP services (for a few) and for all of his and the Party’s financial prudence in doing so. Clearly such good value for money and increased equitable access for all patients especially the one on the Isle of Wight?

We dare anyone to say he was wrong . . .

Health tourism.

2011-07-05T06:00:00.000-07:00

In the UK the phrase health tourism is taken by your average reader of the UK’s government’s attack chiuaua newspaper the Daily Mail (DM) to mean the swarm of people from non caucasian countries who fly into the UK to take advantage of free medical care. A lot of these people are from former countries of the British Empire and are actually entitled to free healthcare but DM journalists won’t know that.

Disgusting, say most hard working Joes and Joannas, and their non tax paying friends of the Daily Mail readership the benefit claiming non working Wayne and Waynetta Slobs for health tourism clearly explains to them all why they can never get an appointment with their GP.

There is a far more incidious version of health tourism which largely involves the elderly who have a migratory lifestyle. When it is cold, in winter, many of them swarm South to take advantage of the summer, or warmer temperatures, there but as temperatures drop down south they return to the motherland.

When it comes comes to fraud, dishonesty, lying, cheating and shafting the NHS (and the benefits system) in the UK they put the likes of Wayne and Waynetta Slob to shame because they are zen masters at it.

A few examples of health tourists and their abuse of the NHS are presented below. These are not isolated one offs for most are repeat offences time and time again albeit by different patients.

NHS shaft #1

I am going to live in country X in my villa/with my relatives for six months and need all my medication.

The DoH recommends only 3 months supply and technically you should be removed from our lists after 3 months.

You won’t do that will you doctor? I have been with you for years (abroad) . . .

Yes we would and no we won’t give you more than 3 months.

NHS shaft #2

I am just back from 6 months in my villa in a country where healthcare is not free and I am only back here for a month.

I would like a hip replacement, cardiac bypass, varicose vein surgery, a stairlift fitting and my council tax reduction form signing and someone to wheel my wheelie bin on account of my “disability”. Can I have all of them now?

And what do you reckon your chances are? Did you say that you have just flown back unaided from Australia for the 2nd time this year and driven from the airport yourself despite your “disability” in an unmodified car and were on your way to a round of golf?

NHS shaft #3

I have lived abroad for 5 years and before I went away I was referred to see a surgeon. Now I am back I MUST go to the top of the waiting list because I haven’t heard from them after 5 years.

The reason you haven’t heard from them was not that your GP hadn’t referred you, as you claimed, it was the fact that you took advantage of another foreign healthcare system and did not attend your appointment in the UK despite it being sent to and a second follow up one as well.

5 years ago.

Although you are “entitled” to these services you are more than happy to abuse them because they are free and as such you get the special priviledge of going to the bottom of the waiting list.

NHS shaft #4

I am in wherever and I am ringing you at huge personal cost on my mobile and have a medical problem. Can you send a prescription to my relative at home for my acute illness based on my own diagnosis with Google assist but I cannot find a doctor anywhere here (for free).

My relative will cash the prescription for free in my name and send me the drugs.

No if you are not in the UK, and are in central Berlin, the responsilibity for your healthcare is that of the country you are resident in.

This may unfortunately involve a charge and a degree of responsibility on your part to prove that you are actually ill, which you don’t have to in the UK when you see a doctor.

Although a prescription is a freebie to most people (85%+) in the UK it can prove very expensive to any doctor who prescribes on the above basis for they have not seen the patient but they are responsible for any prescription that they sign.

NHS shaft #5

I have decided that the NHS is crap and am paying to go to abroad to have surgery there for my condition. In order to save money I would like you to perform all the preoperative bloods, a chest x-ray and an ECG and declare me fit for an anaesthetic in 3 months time.

We are GPs not anaesthetists and the responsilility for declaring you fit for anaesthesia in 3 months time is not ours now it will be one of our anaesthesiology colleagues then who pay an arm and a leg for medical protection insurance so we would suggest you pay the going rate and not misuse the NHS which you think is carp.

The recent spate of bank holidays and school holidays has led to other forms of health tourism other than the silver shafters for they have educated their ill begat spawn on health tourism these being some of the most common:

I am going on holiday tomorrow this is an EMERGENCY. I need to be better before I go on holiday.

So I MUST have an urgent appointment for a seriously trivial self limiting illness that MIGHT ruin my holiday something that I have paid for and is valuable to me unlike your time.

The corollary of this “serious” case of health tourism is this:

I have had this while on holiday but once healthcare is free I need an urgent consult for this rash I have had for 3 months while in Thailand and I have only just landed after my 16 hour flight. Is this painless ulcer on my genitals of any consequence but I am not worried regarding this?

We are more worried about those you have abused to get these symptoms you disgusting overweight smelly middle aged individual resplenant in unwashed T-shirt, shorts, flip flops and socks. We can treat such sex pats as you for your syphilis for free but who is going to treat those you have abused to get you Thai red chilli rash and painless genital ulcer?

No doubt you will be going again later this year?

I was ill overseas and had to pay for healthcare there (never?). This form needs filling in URGENTLY for it cost me $15000 in the USA which made me better and I had a GP consultation followed by full hospital care and investigation including full blood tests/x-rays/CT scan/MRI all within 6 hours.

And you actually had to pay for healthcare something you can claim back on insurance that would have taken 6 months in the UK to tell you there was nothing wrong just a minor infection?

Of course cost is always urgent while complete investigation is always essential if not needed but unfortunately expensive especially when the individual who receives all of this medical excellence and no treatment realizes how much healthcare ACTUALLY costs for then cost is an EMERGENCY for the first time in their adult life after years of them and their family abusing their GP.

Whilst it may be URGENT to you the more you tell us it is URGENT to fill in your form the longer it will take. We have patients to see who are not better unlike you but unlike the special ones like you who have actually had to pay for healthcare those that we see in the UK do not.

But you are importantly different aren’t you?

I need an urgent appointment because I am going on holiday and want to enjoy it so I thought I would see if you have my scan result from yesterday and they told me the result would be back in a week have you got it?

No.

So this was an urgent consult, so you could selfishly enjoy your holiday, deny someone who might be ill an appointment even though you were told how long it would take?

Let us advise you how this scan and the lack of a result will increase your travel insurance premium and reduce your insurance cover . . .

We wonder whether Brits abroad must be the biggest pains in the proverbial a*se (sorry a grunt word slipped out there) of any healthcare organisation overseas for they fail to realize that healthcare is a very expensive thing.

Healthcare is not the same as buying a pack of fags from a corner shop where you have to pay money up front to someone who serves you who could proberly be trained to do this in a day or two but the average Brit values their fags and booze more highly than healthcare when abroad as they are cheaper (than local healthcare) and so using a “market” model must be consumed with extreme prejudice.

We recall in our naïve years in the UK remembering a scene in a movie where someone asks a patient before they are treated if they are Blue Cross or Blue Shield in terms of insurance before they can get treated. At that stage we thought the NHS was great for patients did not have to get asked this in order to get treated they just were. When you work in healthcare in the UK you realize how little it is valued because it is free. The last Party trivialised healthcare to the point where you can see a highly qualified healthcare professional on the basis of (political) WANT not on the basis of (true) medical NEED within 48 hours.

So if you cannot get an appointment when YOU WANT it, rather than you actually NEED it, remember others may be blocking your access based on their selfish WANT and not wanting to pay for anything else than their holiday. In the recent past this selfish group has been up a third of all “emergency” consultations.

And they think the young are disrespectful idle benefit defrauding scum. The young here in the UK have such excellent role models when it comes to swinging the lead.

Praise be to the Party for the winter fuel allowance which in Barbados must be good for a good few duty free G&Ts rather than a few extra peat briquettes in the burner. GP practices and A&E departments near to airports will know what we mean.

A speech for all reasons.

2011-06-30T22:25:00.000-07:00

Now being an overpaid underworked GP in Northernshire means that at the end of the working day one hands over the keys of ones Farrari to ones manservant and goes to dress for dinner.

As one does so one may watch the news on that most modern of appliances called the television usually a 7 inch monochrome device for only people who need home visits have 90 inch colour ones, 5 cars in their driveways and cannot come to surgery as Wayne is doing a “deal” and on the sick with a bad back.

We really must get more au fait with the use of elephant doses of Diazepam in the management of back pain and remember the really dark opaque glasses to shield our eyes from plasma TV glare and industrial ear muffs to protect us from the surround sound system on such home visits for acute emergencies such as itchy scrot that is doing his head in but he has gone out - sorry doctor.

Meanwhile back on track and at the usual GPs baronial mansion house, whilst being served our G&T and while the memsahib was away at her toilet preparing for dinner, we watched an item on the British Broadcasting Corporation’s evening news.

We heard this and thought this was a slight case of déjà vu and spot the difference between the Parties for all three seem to be rolling out similar speeches about any (still) vaguely useful and cheap public service they are meddling with the one difference being that one and a half of them are in power.

The link to what we listened to is here and we reproduce the text with a few thoughts which if you cut and paste summarize the current attitude politique to healthcare/education/anything that might help you advance yourself or make you better.

So here goes:

The White Paper therefore proposes unconstrained recruitment of the roughly 65,000 high-achieving students, scoring the equivalent of AAB grades or above at A-level.

We will bail out the organization using private sector funding paid for over many years and increase service provision as a result of a public sector/private sector engagement.

Quotas for those students will be abolished and funding will go to whichever university offers them a place they accept. In addition, we will create a flexible margin of about 20,000 places to reward universities and colleges that combine good quality with value for money and with average tuition charges, after waivers, at or below £7,500 per year. That adds up to around 85,000 student places—roughly one in four places for new entrants contestable between institutions in 2012-13. We aim to expand this further year after year.

We will introduce competition via a market of sorts with additional capacity provided by any willing provider but wouldn't dream of centrally fixing prices.

We will also extend the scope for employers and charities to offer sponsorship of extra places, provided that they do not create a cost liability for the Government, and provided, of course, that there is fair access for all applicants, regardless of ability to pay, and no sacrifice of academic standards.

We ain’t going to pay for nuffink the Big Society will and everyone will have“equal” access if they can pay for me bitches.

The reforms put students in the driving seat, but if they are to use that power to best effect, more than a liberalising of the quotas regime will be needed.

No decision about me without me and in order to put you in charge there will have to be some reform and you will have to pay more to get less.

Prospective students also need to know far more about the academic experience on offer. We will therefore transform the information available to them about individual courses at individual institutions. Each institution will make available key items of information, such as contact hours and job prospects. Information will also be available to outside bodies, such as Which?, so that they can produce their own comparisons. That will lead universities to match their excellence in research with a high-quality academic experience.

More league tables and expensive websites anyone?

We listened to this little less than 2 minute speech on the video link and thought of a word relating to something bovine for has not much similar been said about the NHS by all Parties? Give the people and the professionals the illusion of control but only if they can afford it?

For reasons of brevity we have confined our comments to the BBC piece. You can, if you are a cowpat afficionado, read the whole speech here. We think all 3 Parties are doing an excellent job recycling these cowpats for different public services.

Praise be to the Party for allowing all of the many, who paid for the education that benefited the few now in charge, to have the privilege of paying for what they gave the few for free.

Welcome to NHS Reform and the Market movie coming to a child, a mature student or university near you soon in its follow on Education – the sequal to NHS reform.

More "reform" anyone? We’ll ask Kato to get you some more . . .

E-portfolios.

2011-06-27T01:47:00.000-07:00

It would appear that some other counter revolutionaries at a despotic meeting of seriously ill informed and well time expired minds are suggesting that the flagship of the Scottish Silicon Glen IT revolution called NHS Education for Scotland, the all powerful e-portfolio is a waste of time. No.

Nothing new to those grunts on the ground for all our junior doctors have said the same for years but if those most out of touch at LMC level have heard of it then Apollo 13 must be hot news there as well as the recent launch of Sputnik.

Now we here at ND Central use many computers for a variety of things usefully like timing our microwaves, setting our DVD recorders, operating our washing machines, digital photography, car engine management systems, flying planes all simple uses of high technology which actually do something useful that NHS IT does not.

They work (more of the time than NHS IT) for we rarely if ever ring the “help” desk to get a job number for something that never gets better like NHS IT.

We do not use an e-portfolio to determine whether an individual can qualify as a doctor for those dangerous enough to be bad doctors get round this flawed system easily. Only a seriously brain damaged retarded educationalist dean dude high on some unnatural herbal substance would use this Braindead E-Retarded Portfolio (BERP) software to determine how good a doctor actually is.

Think about any other things that have crawled out of (NHS) Scotland and screwed up the NHS. Think Brown and Blair, think NHS “reform” and think computing (Choose and Book, Summary Care Record et al and their creators) and can you start a common theme re new ideas and their origin and how useful they are especially when it relates to high quality education and computing for the NHS?

Which is curious for once Scotland produced most of the world’s ships that usually carried people on real journies all be it at a high price in terms of some of our forebears’ health but then there was no NHS Education for Scotland so that must be why.

Those educated in Scotland for some reason see things that most people do not see. Weapons of mass destruction and an end to boom and bust are but 2 examples and as such they are deemed fit enough to screw up the United Kingdom’s medical education via Scottish IT. Even the opening screen cannot fit automatically onto your computer’s screen. This tells you how “good” those programming it are or how desperate they are to hide? Look which bit is cut off here.

The great thing about the e-portfolio is that none of the, excuse the very rude grunt word, sh*ts that devised this pile of retardation ever seemed to have used computers when they trained as doctors. Certainly no-one thought about security for doctors in training could at one time do their own assessments all they needed was an email address and anyone can find an NHS email address.

Our medical students, our F2 trainees and our GP registrars are increasingly troubled by the need to be groomed to complete their BERPs which is worrying as BERPing is seemingly occurring at an ever earlier age in medical training.

This is driven by a bunch of pillocks at deanery level and reinforced by their rubber hose beating stasi boys and girls who insist that doing a BERP is a good, not retarded thing because “it is er a good thing” but they are “only following orders” and having so much fun by setting increasingly tighter deadlines for completion of the BERP especially towards the end of GP training.

Our intelligent junior doctors and medical students see this for what it is a completely useless unproductive waste of their time. They want to learn from patients in the time honoured way of treating patients (remember patients dean dudes?) with good clinical supervision not BERPing in isolation with a computer hairy palms and poor eyesight being the sole result of this process.

Of course this might be the end result for those inflicting BERPing on their poor doctors in training. Give them hairy palms, short sight and a computer and a good BERP and that will make them all most excellent consultants or GPs?

Dream on dudes.

We are not computer phobic by any means here at ND Central. Indeed we are the complete opposite but when it comes to delivering care in the field a protocol on a computer or a good BERP are about as useful as a pacifist who does not know how to resolve a deadman’s click in a fire fight or someone unable to intubate and cannulate at a paediatric cardiac arrest when it comes to hands on clinical care.

Did doctors who did not BERP compromise patient care by being on wards looking after patients for hours longer than our current doctors in training spend tapping on keyboards? Instead of BERPing to prove how good doctors were did they instead spent time on the wards, talking and learning from their patients and seniors. This information was retained in their heads for years to come for future reference rather than sitting and entering meaningless, useless data on a hard drive to gather electronic dust and tick boxes?

Most excellent if the quality of patient care is now determined by a good BERP rather than the treatment a patient receives from a doctor. MMC will have succeeded despite its critics. And patients?

Is a doctor without a BERP better or worse than a newly trained well BERPed up doctor? As a patient should doctors be BERPing or treating?

We at ND Central think all junior doctors deserve a good burp after a good night out in the mess as part of R&R after some serious clinical work. We think that getting junior doctors to engage in seriously unproductive BERPing is a waste of their time (and ours) and totally unproductive unless electronic boxing ticking is the new way of medical/nuring/social service/anything training for the better? Believe us BERPing involves lots and lots of box ticking but sod all patient care.

Praise be to the Party and we await the day when the BERP will treat you now. Until then we hope to train a trained doctor who will do so without impolitely and wastefully BERPing.

After all those writing this piece did not BERP once during their training and succeeded despite this handicap of not being modern doctors trained by ticking boxes rather than treating patients which is the antithesis of BERPing.

History is said to repeat itself but we doubt any of our intelligent academic colleagues would make the same mistake twice with unworkable software . . .

All change?

2011-06-22T02:15:00.000-07:00

When the great war of NHS liberation was declared we were told that this would not be a top down reorganization. A certain Mr Cameron even said 'We are not reorganising the bureaucracy of the NHS, we are abolishing the bureaucracy of the NHS.'

Which bit did we miss about the non top down reorganization of the health service combined with the abolishing the bureraucracy of the NHS?

True a few managers have been made redundant locally but not nearly enough and those most incompetant survive to continue to wreak havoc and do remember this is one of the few local Soviets where all local NHS Commissars have either a Harvard or Yale MBA in contrast to those who failed in the too thick to fail comprehensive school system who as a result are found in most PCTs.

A small piece in the GP journal Pulse shows us how far the lack of top down reorganization is progressing. It says that cluster PCTs which do certain bits of NHS bureaucracy for the remains of the real PCTs who are still supervised by the Strategic Health Aurthority are now to be "outposts" of the new super uber quango the NHS Commissioning Board.

So the old system of

SHA > PCT > GPs

is now

NHS Commissioning Board in parallel with the SHAs > cluster PCTs now NHS Commissioning Board outposts > PCTs > GP commissioning consortia > GPs.

So much simpler now don’t you think?

(If you want a laugh read the article in the link and you might even find a new word or more for the buzz word bingo card. Anyone know what commentarit means? Or is it misspelling of commissariat?)

Admittedly some bits will disappear at some point but we suspect in order for the Party not to maintain its top down control that most of the “change” or “reform” will consist of merely rebranding the same groups of incompetant bureaucrats but essentially keeping the same structures with different names.

Commissioning and the concept of an internal market is merely a bureaucracy based on a failed Soviet style state price fixed model of a market. All GP led commissioning is at present is rearranging the deck chairs on the Titanic while all the time the space being left to rearrange the deckchairs gets smaller and smaller as more top down reform via the new state organ the NHS Commissioning Board and its new “outposts” is implemented.

If the price is centrally fixed and all commissioning activity is to be controlled by the NHS Commissioning Board and its new "outposts" what role do GPs have in the commissioning process as the Party tightens its grip?

We almost forgot what our role is that of the fall guys. For who do you blame when GP “led” non top down reorganzation all goes horribly wrong?

The GPs of course but now with added consultant and nurse members.

Praise be to the Party for continuing to support the lack of a top down reorganization and for continuing to abolish NHS bureaucracy. Aren’t they doing well?

The Spruce Goose theory of healthcare.

2011-06-20T05:50:00.000-07:00

There have been many theories about flying and most of those that get off the ground do actually work. Some do not and they cost lives. The same applies to healthcare and theories that relate to it.

Politicians love to grandstand and while they cannot control such popular favourites as Manchester United they can tinker with the NHS and, with no experience of it except perhaps as patients, bugger it up some more every five or so years via the process called reform. You would think that with all the political reform the NHS would be something akin to a SR-71 or Concorde both planes developed in the 1960s but not bettered even today. They even flew and cost less than the huge failure that is the non-functioning NHS IT system.

For most people the NHS is a workhorse like the Boeing 747. Not exactly what all those who expect 5 star hotel service would want but it gets most people to their destination for example to Florida and back for less than we pay a GP a week.

The advantage of political power is that with it comes wealth albeit in the form of the taxpayers’ hard earned pounds. In the same way that Howard Hughes had wealth and therefore power he could build a monsterous aircraft called the Spruce Goose which flew only once. Politicians feel they can do the same without the benefit of a pilot’s licence or a mandate for their new reforms.

For the last 20 years politicians of all Parties have been building the Spruce Goose of NHS healthcare aka commissioning and the internal market. It is a monsterous beasty (beaurocracy) that will not fly (or deliver healthcare any better or cheaper) but because all of the political pilots think it is a good idea it must be capable of flying for it is a basic concept of aviation that that the more lift (spin) you have the higher you will fly?

Politicians deal with grand ideas while the aviation industry usually tries to get an aircraft from A to B in one piece at an affordable cost and with a close on a 100% success rate. Doctors usually try to do something similar with patients. We in medicine accept that we do not have a 100% cure rate. In politics anything less than a 100% record is clearly the result of “inefficiencies” that only politicians see hence the need for “reform”.

The NHS has traditionally used the 747 approach cheap reasonably comfortable but consistant unlike the Freddie Laker approach to healthcare that politicians of all persuasions seem to favour at present.

The analogy of aviation may be wasted on some but why after 20 years of costly failure are the 3 main main political parties in alphabetical order the Con Dems and Za Nu Labour trying to shaft the British public into a Spruce Goose as opposed to maintaining a tried and tested 747?

The Spuce Goose only just flew once. Most of the electorate have surpassed that limited expensive triumph via the 747 of healthcare. The same basic model has been updated by Boeing over the years in the same way that medicine updates itself but from the passengers the outside looks essentially the same and it still flies. There are a few changes that some might note like new engines or TV screens in the back of seats rather than cinema style screens but what the patient sees is the NHS 747. They are not looking for Spruce Gooses when they look for healthcare.

How come the politicians of 3 supposedly independent parties are trying to lift the long dead Goose out of the water as opposed to getting a reasonably priced 747 bird to continue to fly? One is expensive and wasteful folly the other just keeps on going with minimal cheap maintence. How come all three political parties are trying to be Howard Hughes in a time of recession?

Praise be the the Party for realizing what we do not that one Spruce Goose with one flight of fancy will care for so many more patients than 40+ years of 747s which fly daily.

The NHS works – without politicians – keep them out of the cockpit and keep the 747s flying. They get you there without the commissioning and internal market crap. The new revised revised revised revised Spruce Goose of healthcare which has just recovered from a near fatal stall is still trying to lift off, for how much longer will it continue to do so before it is confined to history?

Many a true word spoken in jest . . .

2011-06-15T23:21:00.000-07:00

Last week while one of the team was acting as officier of the day and patrolling the practice perimeters all right then signing a few prescriptions they overheard a conversation between some of the reception staff. One of them had managed to get some tickets to see the now middle aged boy band Take That in concert and was clearly loving the attention of and jealousy of her co-workers who would have given their right arms for such tickets.

Now, given the ages of the staff, who would have been pre teens and teenagers when the Osmonds were the hot ticket in town, age had not mellowed their adulation of their rock gods or their individual lusts after their favourate band members. They were no longer pre teens and were mostly mothers with teenage kids and the team member, one the minority sex at ND Central, knew that when these staff members went out socially there was usually a large amount of fermented fruit juices consumed.

The team member made an off the cuff remark that the local Police must be dreading the coming of a Take That concert to their patch for dealing with a football riot would be easier than policing a load of hormonally challenged, booze sozzled middle aged ladies lusting over a boy band only a few years younger than themselves. This did not go down too well with the boy band droolers who quickly oppressed the minority and told them to get back to work. Some of us know our place at ND Central and did just that.

We did not think much of it until someone told us about a news item on this morning’s news bulletin. Can you guess what it might have been about?

Have a look here if you can’t.

Praise be to the Party for hell hath no fury worse than . . .

a drunken group of Northernshire women lusting after that which they can never have. Don’t try stopping them . . . ever!
You have been warned!

Independent media and “independent” reviews.

2011-06-13T06:08:00.000-07:00

After the reveille bugle had sound this morning, one of the team’s early birds tuned into the ITV 05.30hrs morning news bulletin where the headline was that of the publication of an “independent” review (? by government stooges) to be published later today.

The BBC news at 06.00 we are fairly sure, but are prepared to be corrected if wrong, mentioned also a review but not an independent one. Surely a small reporting error we thought after some discussion. However the BBC one o’clock news also reported “an independent review”.

We would say we were waiting with baited breath to see how many seconds or minutes of a degree the “independent” navigators of the current SS NHS Titanic of reform for the better recommend that its course be changed.

Praise be to the Party for more unnecessary reform but at least this time it will have been “independently” scurtinized at least by the media.

Privatization by stealth?

2011-06-06T23:36:00.000-07:00

We wonder if anyone else in GP land has noticed subtle changes to their practice based staff and not realized that what seem to be small and incredibliy awkward changes were in fact part of a possibly more sinister plan?

Many many moons ago we used to have district nurses and health visitors attached to ND Central and they had their own part of the ND bunker as offices. This arrangement worked very well for it meant that we had regular communication and if things were not done it was easy to chase up who was responsible.

Now the Party does not like professions to fratanize for if this occurs then counter revolutionary ideas might be born and a cohesive resistance to its benolvance might develop so a few years ago it removed our attached district nurses and health visitors away to new Party controlled central barracks.

Communication went from being face to face on a daily basis to such advanced methods as message books which were read “whenever” someone happened to be passing or leaving phone messages on an answer machine or via a Party controlled call centre with the inevitable dilutation and censorship of information.

Needless to say the local Soviet will have held a public holiday and drank lots of vodka to celebrate its success in improving local services. Those on the gound saw once good services destroyed and a two way exchange of information destroyed too. The health visitors were particularly missed as it gave local paedophiles a free reign but this was Party approved for we were repeatly told that this new model for health visiting was the highly successful Doncaster/Haringay model. So no chance of a baby Peter or a Victoria C here in Northernshire.

This at first seemed to be local Soviet incompetance but scratch a little deeper and this was not immediately apparent but it was in fact part of a process called TCS (Transforming Community Services).

Did you, or more importantly, do you know what this is? Try googling it and see how easy it is to work out what it actually is. You could try the FAQs here for starters. We did not until a recent lecture presented by a midget ex nurse, one of the snide evil idle kind who have spent all of their (very) limited time with patients doing bugger all hands on nursing before moving into nurse management and then onto NHS management.

At each level such snide evil idle kinds do less and less work but generate more and more for those few nurses that do what they used to be trained for namely to look after and care for patients rather than print off loads and loads of care plans to show patients were looked after as they died of dehydration.

This midget both of body and mind told their audience about how successful the TCS programme had been. Unfortunately Party stooges do not take kindly when their audience of frontline healthcare workers start standing up and asking midget mind why things are so bad and worse than before despite the midget’s Party spin.

Midget mind had to get the Stasi in to quell the disgruntled audience. No doubt when they went back to report to their commissars about their propaganda trip they would have told them that the sun was shining, wheat production was at its highest ever level and all was good in the world of NHS management cream teas and cakes.

What we learnt from midget mind was that the withdrawal of district nurses from the frontline and health visitors was all part of the TCS programme – whatever that is try googling this. Now consider the wider picture.

With the advent of commissioning one of the first things local GPs here in Northernshire wanted was the return of district nurses and health visiters to practices. Midget mind had told us that the first TCS contracts were up for renewal and with this information local GPs were keen to restore the status quo for the better.

Unfortunately this is not an option for a far more insidious parallel plan has been running. The parts of the local Soviet PCTs that were once “responsible” for the district nurses and health visitors were farmed off into little separate “corporate” entities initially part of the PCTs and then completely “separate”.

These little entities are now “independent” of the local PCT Soviets, have there own crap computer system (System One) that cannot (or will not be allowed to talk to any others despite SHA sponsorship) and have all been Party sponsored.

This division of a once more joined up service between GPs, health visitors and district nurses has been politically destroyed with the active involvement of the relevant professions at a senior (more lardy) level.

Locally resistence has been huge but of course ignored for when the sh*te hits the fan it will be those that knew better that go down the pan even if they dared to complain and resisted the policy not those who implimented it.

No doubt the TCS programme creates little entities that come whichever version of alleged “GP led” commissioning crawls out of the political slime will be sellable commodities and GP commissioners will have to purchase their services from former PCT bodies.

As simple grunts on the ground the “improvements” produced by TCS namely no district nursing or health visitor communications, less accountable care, delays in communication all have had a positive impact on patient care which is that of the negative for all are worse off especially locally regarding child protection.

Praise be to the Party for ensuring that when it comes to the provision of healthcare this will always be compromised by political expediecny at the expense of excellent healthcare.

This has all been done by stealth and unless there is a massive mind shift in UK healthcare policy whereby

Conservative healthcare policy = Labour health care policy = Lib Dem healthcare policy

ceases then there will be more to come. All of it of course for the better, comrade.

As directed.

2011-06-01T07:01:00.000-07:00

Writing a prescription is a relatively simple exercise provided one knows a bit about drugs, can read and write and most importantly can do it safely. There are lots of short essays on how to do so and if you haven’t already done so, and believe us many doctors have never done so, the British National Forumlary is a good place to start. A few years ago the Medical Protection Society published a booklet on prescribing.

These were full of common sense things like don’t use Latin initials for example t.d.s. instead write it in English as “three times a day”. A lot of doctors still use the Latin abbreviations which are useful as a form of medical shorthand but can cause confusion in certain situations.

Another top tip was to only use the abbreviation mg (milligrams) and not use the abbreviation μg for micrograms which the article showed various ways that handwriting could convert the symbol μ into the letter m. Not to dissimilar to look at but a thousand fold variation in a dose that with some drugs could be very lethal so this was a good one to avoid.

For many years these simple principles have kept us going but in the recent past two organizations, both non medical ones, have decided like all impudent and ignorant children that they know better and would learn us doctors to do proper like what they does.

The first shot across the bows of HMS Smooth Prescribing was from the Al Quaeda school of radical pharmacists. On one of their many visits to educate those more knowledgable than they, they had decreed a jihad after issuing a fatwa against the term “as directed” (a.d. to use its Latin short hand) appearing on prescriptions.

This simple term had become verboten in radical pharmacist circles and as such was now the source of a witch hunt as all true religious and science based zealots do embark on after reading holy scrolls from a Midlands “University” famed for the production of many social service graduates and media studies types all highly useful in healthcare.

The zealots persevered but those of us with memory and experience played them at their own game. What about patients on insulin who may need to daily change their insulin based on current blood sugars?

No “as directed” is not acceptable the scripture says so. So we will need to write a prescription with a specific dose for each insulin injection 4 times a day for every diabetic on insulin every day when we do not know their blood sugar readings?

Yes the prophet Keele is most precise on the interpretation of the holy scriptures for “as directed” is now heresy and the prophet is all wise. OK lets play the prophet’s game and guess what?

Eventually when it became unworkable the radical pharmacists accepted that the term “as directed” might just be useful. For thing like insulin and warfarin and bum cream and a whole load of other things where regular doseage is not required, cannot be predetermined and is dependant on variable feedback from blood tests and worse still the needs of a patient according to their lifestyle.

Patients involved in selfcare prescribing using their own judgement who needs them went the zealots of radical pharmacy all that is required is that the label is written as per the prophet’s will. We do not involve patients in “academic” pharmacy.

Unfortunatley we do involve patients for it is their symptoms that often determine when a drug needs to be used and unlike “academic” pharmacists we do not have the luxury of being able to sit next to each and everyone of our patients so that if they develop an itch, or rash or a pain we can instantly write a prescription dictating when, where and how often to apply a medicine. This is why the term “as directed” is useful and if a patient is sensible, rational and understands what the drug is used for there is rarely a problem.

Scratch one revolution. The revolutionary zealots crawled back into their tents in a far desert and we thought sense had prevailed until this week when the fedayeen branch of radical pharmacy reared it increasing ugly and gorgan like head when a colleague in a neighbouring practice, while the on call doctor, was requested to visit 27 patients to do urgent medication reviews at a residential home.

Could this be that a chance inspection of 27 inmates in one the Grim Reaper’s departure lounges had noticed that 27 of their residents had stopped breathing 3 weeks ago and there was a needle and syringe and an empty ampoule of 100mg of Diamorphine by the side of each decaying corpse? Were the last doctors to have visited none other than Dr H Shipman and Dr Ubani?

Of course not it was far more serious than your average day in GP land. Apparantly the home concerned had had an inspection by the Blair Quality Commission C(B)QC and someone had been upset by the fact that a few patients dared to have the blasphemous words “as directed” on their medication.

Now pharmacists and C(B)QC employees live in a magical world of excellence where nothing wrong ever happens. This is why we need more and more inspections by the local villages idiots who have failed throughout their lives to do anything useful and no-one liked at school.

We have seen the local parmaceutal advisers at work locally now their fellow zealots are at work with the C(B)QC. Worse still the zealots had affixed parts of their holy scriptures to the offending prescriptions saying that there were no directions as to how often to administer the medicines or even to which part of the body.

The first few of the presriptions so purified and freed from mortal sin by the zealots’ inspection were for creams. One was for a patient with widespread eczema which varied on a day to day basis both in terms of location and intensity and was treated with a mixture of steroids and moisturizers. The patient had had eczema since childhood and although physically infirmed was mentally able to dictate how to use the creams for best effect.

A disease that is variable in time, location and severity requiring differing amounts of medication at different times and locations cannot be prescribed for on every single occurrence in today’s NHS but despite this self evident truth attached to the offending prescriptions was the holy scriptures dictating that as directed should be removed and precise locations and timings be written instead.

Several other creams had been similarly cleansed by the zealots and all were conditions that varied as above.

So what did our professional colleague do in the face of the terror of the new Spanish Inquistion? Well they considered their professional responsibilities remembering that they were responsible for any prescriptions they signed. Those who did the inspection had long since galloped off and their faces were hidden under pointed hats with only their eyes visible and so there was no idea what qualifications (if any) they had.

The prescriptions had all be written correctly from a medical point of view, the staff at the home knew what they were doing and so did the patients and so passive resistance was employed.

Praise be to the Party for ensuring that no-one is too thick to fail and if you do you can always inspect something and take full no responsibility for your inactions. If you prescribe and make an error it comes back to haunt you. The ability to prescribe is hard won and carries with it responsibility.

The ability to prescribe responsibily to meet the needs of patients not those of protocols must come first for it is they that we as doctors are there to serve and protect. Of course if you want doctors to spend all day writing prescriptions and not seeing you just dial CQC PHARMACY for instant help.

Muppets.

Bank holidays, dogs, dentists and the coming of CQC.

2011-05-28T07:39:00.000-07:00

The recent spate of bank holidays has given a few of us the chance to travel to places new and talk to others involved in medicine. One of our travels involved a chat with a dentist.

Dentists deal with mouths and teeth and have done very well out of NHS dental reforms. This have resulted in most dentists earning far more by doing less and have created the phrase of “doing a dentist” which if GPs did the same as a result of market led NHS reform would lead to very long queues outside those GPs who could afford to work for very little for the NHS as per the NHS dentists. A clear victory for NHS market led reform in increasing provision of dental care to those best able to afford it at the expense of those who need it most. Still toothache = see NHS GP.

We chatted to this dentist who asked of us how we GPs were affected by the Care Quality Commission (CQC). The overwhelming impression we got was that this was bureaucracy gone mental. In 20 minutes of a quite in depth discussion, for dentists are ahead of GPs here, one of us was reminded of an expression that one of the team who used to help out in remedial classes recalled being shouted out loud when one of the class couldn’t spell a word one of their peers thought was easy to spell.

The word was “retard”. As we spoke it became apparant that a lot of general practice time will be spent on matters of retardation rather than anything to do with medical care. Remember retard and retardation were words used to insult those who could only just spell 5 letter words better than their fellow pupils in a remedial class. Old words were revisited in the context of what crap, nay in grunt speak sh*t, is about to be inflicted on professionals by the Care (Blair) Quality Commission C(B)QC.

As we spoke more to this dentist about the C(B)QC process the word retard got louder and louder in our brains until we were told about the section dealing with dogs when an atomic explosion of retardation gone mentally ballistic occured.

Now forgive us for being thick at ND Central but when did dentists do dogs? Err perhaps we ought to rephrase that as to when did dogs become big issues in your average dentist’s clinical practice other than blind or support dogs? But we forgot there is a war on terror and as a result in the search for weapons of mass destruction as a large government “organ” the C(B)QC may be ahead of the game.

Maybe as part of the defence of the realm all dental practices are the new Home Guard and therefore have to have a policy on provision of rest rooms for bomb disposal dogs (Armed Forces Dogs section A), enemy combatant sniffer dogs (Police Dogs section B) as well as substance misuse sniffing dogs (Drug Enforcement Dogs section C). All essential for your average dentist’s quick look in your mouth, scale and polish and charge you service.

Maybe as part of the “patient experience”, a new C(B)QC retard buzz word for the buzz word bingo card, there has to be a policy on provision of crèches for dogs at dental surgeries?

With sub sections on provision by dental surgeries for dogs’ urinary excretion needs (quality care for clients’ dogs section 1.1.a), dogs’ faecal excretion (quality care for clients’ dogs section 1.2.1a), needs with special reference to disabled dogs excretory needs (quality care for clients’ dogs section dogs 1.2.1b), and special provision for dogs with Zimmer frame needs(quality care for clients’ care for clients’ dogs section 4)?

All essential layers of retardation for the provision of “care” and “quality” assured dental services (perhaps with a little red lion mark too?) at your average general dental practioner’s surgery. Ditto the same to come for GPs?

Now GPs are not immune to the layers of retardation that have come the dentists’ way for we have already seen the 6 inches thick of ring binders full of paper that needs to be completed. We can take comfort from the fact that if all those at CQC piled their brains up we would still be able to see these ring files from space with a magnifying glass for there would be no meaningful obstruction to the passage of light as that usually travels in a straight line unless it encounters a large quantity of dense matter called a black hole in which case the light might curve and render it invisible. (In our dreams).

It would only take 4 GP’s brains to hide them from view. If the C(B)QC lost their brains they would still be able to function unhindered and deliver world-class retardation and zero patient care but completing this monster pile of retardation gone wild sh*te will lead to many GPs losing their minds in the cesspit of alleded quality and care that is C(B)QC.

No doubt for general practice the C(B)QC will be more “rigorous” and “robust” and the layers of retardation will extend to cover other areas of Linnaeian classification so no doubt hamster and gerbil policies will be de rigor to ensure a “good patient experience” and maintain alleged “quality” and “care” as per the new Soviet style commissariat?

Figures we have seen suggest that 90 hours of work will be required to complete this monsterous pile of rain forest deforestation and intellectual retardation. If you are a single handed GP that equates to almost 3 weeks less medical care in order to demonstrate “care” and “quality”. Do patients want to see a completed C(B)QC folder or a doctor when ill?

Heaven forbid if a spot CQC inspection found that little Joanna’s visit to their doctor with a minor self limiting illness was compromised because the practice did not provide gerbil wipes for little Misha their pet gerbil who happened to do a whoopse in their travel cage in their 4X4 wally wagon parked in the practice car park and poor Joanna were to be distressed as a result of the lack of provision of a rodent rest room at the practice with gerbil friendly changing facilities (red gerbil mark anyone?).

They will be in therapy for years unless the C(B)QC and it fully retarded personnel are there to maintain high “quality” medical “care” standards via the important task of completing a tick box and devising “action plans” for the provision of rodent rest rooms and all things C(B)QC led improvement.

Now the dentists seem have got their act together in contrast to the Government stooges called the BMA and are helping their members (in contrast to the BMA). The Blair Quality Commission has powers without ability (sounds familiar) but is coming our way as GPs.

It is retardation gone wild and enables all of those who failed in the UK education system to get their own back on those who were bright. For there are not enough qualified people to inspect all those even more well qualified people who provide healthcare without compromising the provision of healthcare itself.

Instead it will be the job of those who have failed. Only those who are expert in providing layers of retardation can do this and there will be plenty of people made redundant from PCTs and SHAs who will be up to the mark and they will do so to the best of their exceptionally limited abilities but at least your gerbil will be well cared for as a result. Your grandparents will die as a result as their current leader is well qualified in not registering multiple deaths on their radar.

The CQC is not about care, it is not about quality, it is merely another layer of retarded bureaucracy and in having to fill in its mind destroying paperwork it will distract those who actually provide quality care from doing just that.

For if we, in healthcare do not fill it in “properly” to retard levels of “quality” and to retard “care” levels the retards can and will shut down the asylum and be totally unaccountable but at least we can take comfort from the fact that the gerbils will be well looked after as a result of the moron generated retarded enforcement notices and action plans if you pass.

Praise be to the Party of free enterprise for ensuring that with each Party the layers of retardation increase year on year despite their increasing promises of red tape reduction.

If it carries on at this rate the weight of the (gerbil friendly) protocols and bureaucracy will crush your average GP’s practice under their weight more efficiently than any Japanese tsunami and aircraft will never fly for the weight of pilot ticked retardation will be greater than the ability of the plane to take off.

And if the plane never takes off and the patient is never treated then no-one comes to any harm but rest assured all the boxes are ticked and all the policies are there to prevent harm (or treatment?).

Now that is important, isn’t it?

(We know we missed a doggie i before you start!)

It’s not working. Never?

2011-05-17T23:29:00.000-07:00

Being early birds (well most of us are) we awoke to see the electronic care records scheme as the first item on the BBC news this morning. Nothing new to anyone who works in frontline medicine but either there was little else to report, like the Queen visiting Southern Ireland for the first time or people are slowing realizing that there is a project haemorrhaging money away and delivering nothing.

One of the biggest problems is that the people employed in local Politbeau IT departments are some of the thickest in the country. They can only be employed in NHS IT according to one of our friends from the first world from many years ago who works at the opposite end of the IT evolutionary scale who had the misfortune to dabble in NHS IT many years ago. They commented that anyone who is any good at IT goes into the private sector for the rewards are better. Perhaps that is why a few years ago parts of the private sector pulled out of the NHS IT project?

The BBC news item showed pictures of doctors looking at x-rays on their desktop. We used to have that service as a trial a few years ago and we posted on how the special groups of decerebrate vermin that inhabit the swamp of mediocracy that is your average PCT IT department can, using age old excuses, deny intelligent people use of data that they have control over but do not have the abilty to use.

We used to be able to see pictures but all of a sudden a few months ago they disappeared from our screens. No explanation, no consultation just disappeared overnight.

Now swamps are difficult places in which to navigate and so it took us several weeks speaking to many IT morons who were just able to stay out of the water for a few minutes of work before they had to return there to breathe again. Eventually we got a name and found the reason which must have been dreamt up by some form of IT department low life who had been out of their pond for so long there was little oxygen reaching their few functioning neurones.

So we at ND Central took a few small steps forward and NHS IT has sent us back to where we were on the whim of a decerebrate invertebrate. This was the same problem our first world friend had with NHS IT and its morons many years ago when we were junior grunts and still is today. The technology is there but the intellectual ability is not. Hence while we can see and treat patients, read and interpret x-rays those who cannot do any of the aforementioned deny us access to information that is useful for our jobs and is known as IT. It is meant to help clinicians but we are kept away from it and its development.

This is apparently the third report by the National Audit Office and what it says is a reflection of what we troops on the ground see and deal with daily. We however knew that. Thank you Auntie for just realizing that.

Praise be to the Party for giving us the IT equivalent of the Apollo space programme. Some of us know you can get to the moon and back but whilst the Americans used the best available the British just use those who failed to find work in world-class organizations like McDonalds.

No wonder we are so good.

Watching the consultants.

2011-05-14T05:02:00.000-07:00

If you are a GP in the UK for anything more than a couple of years you notice certain growth areas in healthcare provision most of which are sponsored by those in the bottom third of the UK educational system bright enough to work in UK healthcare management and deliver sweet FA to patients. You also notice that things are essentially the same but change their names often.

For example Shiteton Health Authority becomes the Shiteton Primary Care Group (Nor’ Nor’ West) which merges to become Shiteton (Nor’ West) Primary Care Group which then becomes Shiteton (North Western) Primary Care Trust. Same group of retards rearranging deck chairs on the Titanic awaiting the next ineveitable iceberg of NHS reform striving to finally sink the big ship NHS.

In doing so patient centred care is enhanced by the huge amounts of money spent on NHS letterheads and on NHS corporate provided sign painters all produced to the same high standards of the NHS Brand. This growth industry must be loving the current NHS reforms at the expense of hands on patient care.

For those GPs who read letters we are doing something more active than admiring the changing logos on a weekly basis. We are watching the rise and fall of local NHS hospital departments. This is something most managers will not see for they do not have to ability to retain information but they do have the inability needed to destroy via alleged reform or is it “service” redesign?

Some departments have more than doubled in consultant numbers while our local patient numbers have stayed the same. This is picked up by thick GPs reading the ever changing names of the list of consultants on this week’s new letterhead.

As a stable GP practice we have not seen any similar increase in GP numbers. Despite the increased consultant capacity we are as GPs told by managers that we are over referring to the increased number of consultants.

Another department once had several brilliant consultants and provided excellent medical care in a high demand service. NHS targetization meant that half of them left as they were not allowed to screen or prioritise Choose and Book referrals and now we have a p*ss poor locum service where the locums change on a weekly basis and the remaining consultants struggle to cope with NHS management demands.

We suspect that they will not stay much longer and will follow those who have left for better working lives. We know that the reason they left to pastures new and happier was management interference in clinical care.

This same unit was targeted by local management retards for the fact that the evil overpaid GP scum were over referring to this unit. The consultants treated all those who were referred but this was not good.

It was pointed out to the local retard managers that the same service was once provided more cheaply by local GPs and had been cancelled by them on “quality” grounds and as a result we HAD to refer certain cases once done in general practice to the hospital.

NHS mangers are not bright and they can pretend to read, and understand, spreadsheets (pretty pretty!) and once costs started to rise they thought there was a major problem but they could not see or remember who had caused it.

Referral management schemes were introduced and consultants and GPs hounded over patient “care” = referral numbers, not illness by managers too thick to understand the concept of intended consequences of an action until the (pretty, pretty!) colours on their spreadsheet change. There were inevietably casualties of this seesawing of retard managers’ changes to working practices.

All patients suffered – poorer service longer waits- but these do not appear on the pretty coloured spreadsheets for quality is difficult to measure by retards. Patient seen =yes/no patient better/worse = a Homer positive doeh.

So why should we as humble Northernshire GPs be concerned with hospital foundation trust and PCT moron managers and the games they play and the effects they have on our consultant colleagues? Because it affects our patients.

If 100 new cases of surgery are seen and generate NHS income of 100 Soviet socialised medical units then that is good. The manager is happy. Patient treated job done.

The GP sees otherwise. If comrade consultant Mr Botch Jobb FRCS (eastern bloc) surgeon sees 100 cases and 98 of them are botched then 98 will need to be referred on for corrective surgery. The consultant may not see their botchalisms for they no longer see follow up post op cases for hospital follow up in the NHS internal market is expensive and has been outlawed by the managers.

GPs are cheap and so they now see the follow ups that junior surgeons used to see. This improves consultant training by them not seeing the results of their handiwork and managers are happy for any complications need a new referral (=more income) after the patient is discharged. Consultants and managers don’t see the complications but a good GP will and they will stop referring to Mr Botch Jobb et al.

The NHS manager will not see the 98 problems for they will have seen the 100 cases completed. The complications of surgery will not appear on their spreadsheet and will not be linked to the initial cause. The manager will however see an over referring GP as the problem and this must be terminated for the referral target has been exceeded.

So we GPs continue to watch the consultants come and go. We are often aware of problems for we talk to patients who work and are treated at the local tractor plant. We talk to junior doctors and medical students who have been there too, we talk to our GP colleagues and on odd occasions when we are let out to play we sometimes talk to the consultants. Some of them we see as patients and vice versa.

The question is how many managers watch the consultants? Answer is none they just count the beans whatever the quality (pretty, pretty colours!).

It is responsible GPs who count the patients and their complications despite the NHS managers trying to tell us where to refer and to whom based on cost and their self determined “quality” standards. When we complain we are told to shut up until those who don’t realise there is a problem twig that there is usually after a few years. At which point something brown and smelly spills out of its pit where it usually lurks and covers everyone else in it.

After which the self same self righteous determinators of healthcare move on and crawl back into another cesspit of incomptencae and we loose the more able consultants as a result of witch hunts. There are then inevitable casualties but unfortunately not always the right ones.

Quality in healthcare is a difficult concept to measure, the new NHS reforms emphasis quality as the new competition not price. Will the new breed of GP commissioners do any better for in theory we can now watch and act unlike before?

Praise be to the Party for ensuring that signwriters and letterheads provide us all with high quality healthcare via “sign posting” and logos. Pretty, pretty things however do not good medicine make.

In the same way that the price of freedom is said to be eternal vigilance ensuring good quality healthcare is achieved by the same method. However it helps if you know what you are looking for. So we will keep on watching the consultants most of whom do not need to be watched but a few do.

We will hopefully by doing this save our patients from harm and guide them towards the best treatment which is not always the nearest. Knowledge of who provides what is one of the strengths of British General Practice for healthcare is not a simple as buying a tin of beans although a lot of politicians think it is.

Screening programme a “political” project, surely not?

2011-05-08T05:34:00.000-07:00

While once again busily waiting for patients one of us stumbled across a headline from Pulse 27 April 2011 which screamed out “Vascular screening was a ‘political’ project admits DH official” although you will notice that the electronic version of Pulse magazine has a different headline.

Great headline but what about the reality? Now we assume that “vascular screening” was one of the former Party’s great ideas was that too many people were dying from aortic annerysms bursting. Ergo a huge expensive screening program will save countless lives and of course there is the usual expensive but totally useless website which tells you (little) about it here.

The medical stats are if you have a ruptured abdominal aortic anneruysm (AAA or triple A) and get to hospital you have a 1 in 3 chance of survivial but if, your enlarged aortic anneysm is picked up routinely and referred for elective surgery you have a 95% chance of survival.

So for the great health gurus Tony and Gordon, whose years on the frontline of medical care mean that their knowledge of everything transcends all that any who are medically educated like a health care assistant, this means that this has to be a NHS priority, for they are holy beyond all others than Mugabe. For Tony and Gordon are well known for seeing what mere medically trained mortals cannot see for example WMD and the end to boom and bust.

Now we would not suggest that this little idea of screening would be of benefit to the private sector for we all know that there is such a huge surplus of radiological provison of ultrasound scanners in the UK so screening for triple A for a few thousand would clearly never impact on routine provision of ultrasound scans for ill people nor would subsequent repeated annual follow up.

A lot of column inches have been devoted as to how GPs could provide the screening service (for a fee) and the private sector would also be rubbing their hands with glee as many patients have come to surgery clutching leaflets pushed through their mail boxes offering them life saving scans for triple A and numerous other “preventable” diseases for a small charitable donation to ask is it worth it?

Look at this site here, read the propanganda and see the costs which we reckon are more than to see a consultant privately in Northernshire or google private ultrasound uk for more such charitable lifesaving healthcare providers.

Now the curious thing is that there is already a national screening program for aneurysms it is called your GP. Most GPs will pick up anerusyms far more cheaply using a very nontechnical method called examination of the patient using a pair of hands. Now Tony and Gordon will have listened to a sound bite and realised that GPs do nothing and so a national programme was essential.

Hands up any GP who has never found an undetected triple A in 10 years? Of course being GPs we would never have referred them for follow up to a vascular surgeon or checked their blood pressure, cholesterol, or indeed done anything for GPs are not blessed with Gordon or Tony’s medical experience and are therefore thick.

Heaven forbid that a GP on finding a pulsatile lump in a patient’s abdomen and, daring to suspect an aneurysm, would send their patient for an ultrasound which of course proved the GP wrong for the aneurysm was in fact an undiagnosed abdominal tumour which the patient survived despite their GP’s pathetic application of non Party approved medical knowledge.

Returning to the article look what was said to the prestigous gentlemen’s club called the Royal Society of Medicine who have invited most of us at ND Central to become fellows based on our huge contribution to medicine for a small fee (charitable donation).

Someone called Heather White, deputy branch head of the DH vascular programme, is quoted as claiming that the roll-out had been based on a “convincing model but said that the scheme was launched after pressure from the then Labour government”.

She went onto say that “We maybe should have tested and had pilots, but the Government was clear that it believed the information and was happy with the evidence. Preventive programmes were high on the political agenda.”

And furthermore she went on when asked about why the model was not peered reviewed to say “The model was consulted on.” and “If everything had been peer reviewed and we’d done randomised testing it would have been delayed for years.”

Interesting point that political expediancy versus hard science. Or is that how numerous healthcare reforms have been devised and delivered over the years and dumped on the NHS for no benefit. We are absolutely sure here at ND Central that things like that will not be going on now will they?

Praise be to the Party who allow politicians to think up ideas on a whim and implement them with no testing. If drug companies did the same wonder which drug they would come up with? Why bother testing ideas when you can just roll them out as political projects?

It would be funny but it is too close to the truth?

2011-05-05T06:26:00.000-07:00

Just a quick one. While busy doing nothing other than waiting for patients who were struggling to fill the whole of the Party approved 10 minute appointments with any real illness, or even struggling to turn up at all (must be the heat?), one of the team espied this little piece of news.

Anyone who has worked in the health service of late will realize that this piece of "news" is rather too close to reality. We wonder if any politicians reforming the NHS could see the satirical humour or would they just see it as someone criticising their best efforts?

Praise be to the Party for giving us free broadband internet access to fill out our time while we meet their targets. It is so very useful to us for medical matters and money well spent.

We now earn £ 600,000 plus a bit of sense for a change.

2011-05-03T10:16:00.000-07:00

Well we idle over paid GPs have had another sun drenched 4 days off work in the form of a Royal Wedding Bank holiday and a May Day Bank holiday (comrades) in contrast to all those hard working PCT managers who felt that we should not have the same as they are entitled to. This gave the team the chance to do some reading of everyones favourite GP bashing newspaper The Mail on Sunday (MoS).

Now how could anyone ignore this headline that your “average” (sarcasm) family GP is on £ 665,000 a year for doing bugger all?

This is up a massive £ 165,000 in just a year according to the MoS yet only a year earlier they were earning on “average” £ 380,000 a year and getting £ 200 an hour for work they used to do for free!

So in less than 2 years your “average” GP has seen their income rise from £ 380,000 in December 2009 to a massive £ 665,000 now. No wonder new medical graduates sleep rough in our car park and pester us as we walk from our Ferraris as our staff hold umbrellas above our heads to shade us from the sun as we are carried in our sedan chairs into our large offices to await the great unwashed unwell who frequent our humble abodes and pay us so much to do so little.

Who would not beg to be a GP Registrar if you knew that according to the Mail on Sunday your income would increase by just under £ 16,000 a month, month on month in just 18 months? No wonder the government of hypocrites sees fit to relieve of us about 70% of every illgotten tax pound we earn. Digusting it shouldn’t be allowed.

But a more in depth trawl of the MoS publication led us to find this little gem.

Now if you have been reading UK medico-political blogs over the last 3 years this is nothing new but this little gem that should be shining out much more brightly was hidden in the Review section of the MoS. Reviews are normally about about opera, theatre and the finer things in life for some who read what are popularly known as the broadsheets. Regular readers of the Stoat Tickler's Gazette, our favourite rural read here at ND Cnetral, can't even spell review.

On the day before the death of Osama Bin Laden is reported the MoS has finally realized that there are people in the UK who have done more to terrorize the frail and vulnerable in our society than any terrorist or maverick GP has.

Terrorists usually target the fit and healthy. NHS managers get to target the opposite and it is these people who need the NHS the most and are most frequently let down by NHS managers. We call this institionalized incompetence and the 2 individuals in the MoS articles are masters of it and if the article is to be believed totally unapologetic in one case.

Now Bin Laden is no longer the world’s most wanted person, that title will undoubtably pass to the man, or the woman, who got the head shot, will the UK’s government turn its attention to those mass murderers who continue in the NHS?

Probably not for if every hospital is to become an NHS Foundation Trust the Party will need more of them.

Praise be to the Party for rewarding incompetence with promotion. For if a NHS manager screws up they are moved sideways into a new career.

Shipman did the honourable thing, Bin Laden was taken out and what will Nicholson et al do? They will just carry on and ~~kill~~ create more Foundatin Trusts as per Party orders and get away with it for NHS managers are never wrong and there is no GMC for NHS managers.

Only promotions and honours.

The market, university education and the NHS.

2011-04-23T04:53:00.000-07:00

This week it was announced on one of the evening news bulletins that most universities will be charging the maximum allowed by the Party for university tuition fees of £ 9,000 per year. According to the figures in this piece 75% of universities will be charging the maximum.

This is interesting as one minister said that the higher figure would only be charged in “exceptional circumstances”. Another one thought that about £ 7,000 would be the norm with maybe only the Oxbridge universities would be the exceptions.

It is always nice to see politicians come unstuck with their policies and certainly there was outrage in a bit of southern Northernshire when shortly after Oxbridge announced they would be charging the maximum for a mediocre education a former polytechnic now promoted to a university announced that it too would be charging the maximum for something far superior.

This is not too dissimilar to what is going on in the health service which is being reformed by the same politicians who have overseen the university fee changes. They too have set a maximum fee for medical treatment but in this case there is less leeway for there is only one price so patients will not have to haggle over cost for healthcare will be “free”.

Instead the only “market” choice in healthcare for the “consumer”, an alien word to those us that still treat patients, will be the place of treatment and its quality.

Now if the price is the same, as it will be for most universities and healthcare providers, then the “choice” of place of learning/healthcare might be a factor in “consumer” choice.

For most people who want a serious education you would want the best university for your chosen subject or child so Oxbridge would probably be high on ones wish list certainly way above a former Northernshire polytechnic. This will not always be the case (in education) for some universities/polytechnics provide very specialised specific courses which others do not.

Now admission to a given university is usually via an admission procedure and based on academic criteria and interview and of course will not be based on ability to pay. You can apply to any university as long as you can afford the tuition fees and to live.

You will not be able to “apply” to a hospital in the same way that you as an individual would apply to a university but in both cases the cost of your “care” has been fixed by the Party.

So if “choice” of location is going to be consortia decided, overseen by the NHS Commissioning Board et al, and the price is fixed then the only real thing the NHS customer is going to get to choose via NHS “Choice” is “quality”.

So if say you do a history degree at Oxbridge for £ 9,000 will the quality of the education/healthcare provider you get there be the same as a history degree at a former Northernshire polytechnic/healthcare provider that also charges almost £ 9,000?

In other words will the fixing of price in education/healthcare lead to similar outcomes between say Oxbridge and the former Northenshire polytechnic? If it was your child who was going to have to find the £ 9,000 per year of fees as an investment where would you rather they get their education?

Ask now the same of your healthcare.

If the price is fixed, your NHS “Choice” consortia limited and your only choice is “quality” then where do you get the best healthcare and can you, or will you, be able to do so?

The market has worked well in education with the consumer paying more so will a similar fixed price market improve access, quality and drive down costs as per education?

Given that prices for education and healthcare are fixed then if education and healthcare are meant to make a profit how can a fixed price market generate a profit whilst maintaining quality?

Something will have to give. Price (fixed), location (fixed) and quality (variable).

Can you guess what will change for the better?

Praise be to the Party for pushing on with reforms whilst listening. It seems that in education the market has not listened to the politicians. Will it do the same in healthcare?

After all education has become “more” available and “affordable” to more people as a result of these reforms, hasn’t it?

NHS theorems for beginners.

2011-04-13T06:41:00.000-07:00

The British patient does not like paying for anything.

The National Health Service is free.

Ergo the British patient is happy.

QED.

The British patient believes they have the best health service in the world.

The British patient is ignorant but believes this because their healthcare is free.

Ergo the British patient is happy.

QED

The British public understand the market.

If it is cheap at a supermarket they will buy it even if they don’t need it.

If healthcare is free at the point of delivery the British public will use it even if they don’t need it.

The British public understand the NHS market.

Ergo the market works for politicians.

QED.

Politicians believe that the National Health Service is the best in the world.

The British patient is ignorant but believes this because their healthcare is free.

The Politicians know better for it is too expensive.

Ergo reform is essential.

QED

Politicians know nothing about healthcare.

They are therefore best placed to deliver healthcare.

They believe reform is essential and believe it works.

Ergo more reform is always essential.

QED.

For those of us in healthcare what is QED?

Quite Extensive Destruction by those who know nothing about healthcare.

The patient gets healthcare for free but the healthcare worker gets shafted by each successive group of politicians. Absolute power corrupts absolutely therefore politicians can succeed with numerous reforms which deliver what?

Quite Extensive Destruction of that which works at the expense of public service to service pockets' politic at the expense of the taxpayer for management costs rise while health service provision falls.

Praise be to the Party for all of their misguided politically driven reforms. Imagine if these idiots ran a Formula 1 team. Where do you think that team DoH would be after all the miriad of changes? The best team in the world or driving in different directions for each race they enter while still trying to win something?

Are we having a pit stop now?

More Orwellian porcine equality.

2011-04-08T00:15:00.000-07:00

One of the old Party’s great white elephants that it has bequeathed to the British public that is neither use nor ornament is the idea of the national Summary Care Record (SCR). The idea is that there would be a huge but “secure” summary of everyone’s medical record available to a selected few million plus (bureaucrats) at the touch of a button to preserve patient confidentiality.

If you were unlucky enough to have a cardiac arrest in some unknown ‘hood in the UK then while you were lying unconscious and rapidly approaching the reaper’s scythe, the caring medical team would find your wallet and immediately find some form of ID. Those caring for you (robbing you?) would have achieved basic cardiopulmonary resuscitation (CPR) at this stage and then they would then proceed with no delay to advanced Party CPR.

They would reach for their own personal life saving NHS Smartcard and rapidly log on to the computer by your side in the street where you happened to have collapsed and (in a mere matter of minutes) find your SCR.

Having found out all about your past medical history, drugs, allergies, address and telephone number all of which are essential before any medical professional could access the how to do CPR protocol on the same street side computer (what a marvel NHS IT is when saving lives) and only then could any Smartcard enabled individual start to do something useful such as save your life.

Given that our staff frequently cannot access anything Smartcard enabled service for hours at a time let us return to the real world. Fortunately not all of us live in Holby City, or work in the BBC Doctor GP practice, and if you were to have a cardiac arrest at ND Central you would not be treated by accessing a protocol or your SCR but by people who were trained and knew what to do without the “benefit” of either. They also know where to place a Smartcard for maximum patient benefit in such a situation.

The benevolence of the Party extends to applying the well known Orwellian pig principle to all who were to be allowed to opt out of the SCR and we were told that important people like Tony Blair would not have their records accessible to Jo or Josephine GP or a drug addicted clerk in a PCT typing pool. A little article shows that the new Party has had a little rethink and you can read about it here. The comments underneath are quite good too.

It would appear that a new super race are to be extended the politician’s porcine privilege of being SCR invisible. Now who might you ask are these? MI5 and 6 operatives? Undercover police officers? Other people whose work places them in life threatening and dangerous situations which might lead to them being targeted by international terrorists or criminal gangs? Teachers? Magistrates? High Court Judges?

Well according to the article only a mere 2000 people are currently considered Blairly important enough to be “flagged” but that number might soon increase for the new super race are none other than . . .

Celebrities.

Thank God that Jedward will be afforded the same security as the blessed Tony Blair while poor Professor Hawking’s medical record will be on public display.

The comment at the end by a GP that

“The need for politicians and celebrities to opt out of the care record demonstrates that it remains the chocolate firewall of NHS IT.”

is we think understated for a bar of chocolate would hold more water than the security of the NHS SCR sieve with its million plus holes.

Praise be to the Party for once again demonstrating its commitment to extending porcine equality to all pigs it serves and for value for money in procuring white elephants.

The Americans said they would put a man on the moon (and bring him back too!) within a decade and did. How long has the NHS computer system been in the delivering nothing useful stages and at what cost? Recession anyone and possible savings?

Unfair taxes and the myth of a “National” Health Service.

2011-04-05T23:35:00.000-07:00

For most people in the UK there is the myth of a National Health Service when in fact there are 4 nation’s worth of health services. This subtlety is wasted on Jo Public for as long as they get to see a doctor for free they cannot be bothered (ar*sed) by the politics.

One of the first NHS charges to be introduced was the prescription charge and one of the team who is quite old remembers hearing a doctor talk about the early days of the NHS when everything was free saying that doctors would actively conclude with patient’s requests for medicines because no-one had to pay for anything then. The story we recall was someone asking for a bandage for a limb injury and then because this was a common injury could they have 9 more just in case and the doctor said they used to give in.

An item on the BBC News reminded us of the fact that English prescription charges will go up to £ 7.40 per item from the 1st April this year while in the other 3 nation health services you do not pay the tax.

However how many people actually pay the tax? The BBC report says that 90% of prescriptions are dispensed for free anyway and from memory this has in one of our professional lifetimes increased from 80% to 85% so 90% was an eye opener.

So who doesn’t pay? Well the 19% of the population under sixteen and the 16% per cent over 65 (should be 60 and over) eliminates at one fell swoop at least 35% of the population. Add in those on low incomes, those on benefits of various types, those between 16-18 in full time education, those with certain medical conditions and pregnant do not and the number available to tax falls very rapidly indeed.

It is a very fair tax as the full time GP writing this is exempt from the tax while the medical students with us with huge debts in their final year are paying it. No tax is fair but clearly some taxes are fairer than others based on the ability to be charged not on the ability to pay or on clinical need. We are sure this was one of the NHS founding principles.

We are currently being governed by a Party committed to a “market” of some description in healthcare but do those who pay the prescription charge get a free market choice?

The answer is an emphatic No you don’t for two good reasons.

One you get no choice as to where you can get your NHS prescriptions dispensed. You can take it to any NHS pharmacy pay your tax to the Government tax collector, the pharmacist, who then pays the Government and you get your drugs.

Reason two is because this is a State monopoly the price is fixed. We are grateful for some colleagues who work in a dispensing practice for the following prices which we have rounded up to the nearest 10s of pence.

Suppose you have a chest infection and are given a prescription for an antibiotic called Amoxycillin for a week you now pay £ 7.40 for your treatment. The pharmacist can buy the drug for £ 0.40 wholesale.

Now let us say the chemist could do as used to be done add 100% mark up and a £ 2.00 dispensing fee to cover the costs of bottles, labelling, staff etc. you could push the cost up to a hefty £ 2.80 as a commercial transaction but for the Party this is a steal at a mere £ 7.40.

Supposing you have a heart condition and are on the following drugs: Aspirin, Amlodipine and Simvastatin the wholesale cost of all 3 would be about £ 1.80 but the Party will be screwing you for £ 23.20 a month although you would if you have more than 2 items per month be better off with the prepayment option which comes from this website site euphemistically called NHS Business Services Authority or should it be the State Servicing its own Business Authority?

Many years ago doctors in some parts of the UK used to write private prescriptions for their patients so that they could get the same drugs cheaper than the then prescription charge. Now no Party, however benevolent it is to its tax payers, likes losing revenue currently about half a billion creamed off the 10% of prescription charge taxpayers (like our medical students) and they made it so that if you as a doctor treat a patient under the NHS you have to issue them with a NHS prescription regardless of the cost of the drug.

So GPs who know the cost of drugs (look at your doctors prescribing screen where wholesale costs may pop up) are actually issuing patients with expensive prescriptions for a few pence worth of drugs. We like the NHS free market here at ND Central it is so fair and free just like the NHS Internal Market.

Jo Stalin’s boys in all political parties have kept the red flag and Soviet market system going in all its glory for the benefit of those 10% in England allowed to pay this tax.

So if next time you pay for your NHS prescription why not ask your pharmacist how much the drugs actually cost to buy and then ask your MP to explain the “market” within the NHS. Go on have a laugh there could even be a competition for the best MP’s explanation.

If any of them understood it in the first place.

Praise be to the Party for unfair taxes, the truth about the “National” Health Service and “free” market economics. They are all so good at all three.

A letter from a Party organ and maybe the future?

2011-04-04T05:58:00.000-07:00

In amongst the 1500+ letters we get a week here at ND Central one of the team noticed a missive from one of the few ISTC (Independent Sector Treatment Centres) in our neck of the woods. For those who have missed it, these are private hospitals which provide elective surgery for uncomplicated NHS cases and consume huge amounts of public money, are underused and have higher complication rates than normal NHS hospitals. You can read about them here in their own words or another view is here.

It was concerning the “Aftercare Service”. This “service” was currently provided by nurses who did 3 home visits after certain types of surgery to remove stitches and change dressings. The missive said that the Party organ had found that this was no longer cost effective.

Let us read on further into the Party organ’s edict for it reads that to make the “service” more “efficient” and “cost effective” those treated at the ISTC will now be “invited” to attend a clinic at the ISTC which is many miles away from ND Central to have their stitches removed and dressings changed. As a Brucie bonus if those so invited attended they will be rewarded with some dressings to change using a self care protocol.

In the extremely unlikely event that some comrade patients feel that a 60 mile round trip is too far then the punters (sorry patient or is it clients now?) MAY be offered transport (cost effective?) or a (cost effective?) home visit MAY be arranged and (can you see what is coming yet?) in an exceptionally rare and highly unlikely scenario the punters may be asked to travel the few hundred yards to their GP surgery.

Wonder which one of these options most non paying patients will take? 60 miles of petrol versus a few hundred yards surely “market forces” will determine patient “choice”?

Private sector dumping on the NHS to maximise profits surely not? Or possibly the start of the thin end of a very long wedge whereby those in the private sector already cherry picking patients are now also discharging their clinical responsibility in the interests of a “more efficient and cost effective service”.

Praise be to the Party for providing GPs with a level playing field which whenever there is extra work to be dumped always leans towards the GPs’ and their staffs’ direction. The White Paper we are sure will put an end to such practices won’t it? In the same way that these world-class commissioned ISTCs won’t be able to weedle out of their robustly commissioned contracts.