Sunday, 28 September 2014

Fools and their ideas are soon parted.

Fools and their ideas are soon parted in politics and this week’s speeches by Ed Miliband and that by Gordon Brown during the Scottish referendum illustrate this. 

Ed has promised 8000 extra GPs by the end of the next parliament while Gordon emphasised how he and Scotland had built the NHS while conveniently ignoring his and his fellow Scot Tony Blair’s plans to privatise it. Presumably those who some in a satirical magazine refer to as Milibean will become nice Jack in the Jack and the Beanstalk fairy tale whereby Ed sows some magic beans that magically grow some 8000 GPs out of nowhere if he is elected as the next Prime Minister? 

Perhaps as we are in the silly season that is Party conference time we ought to revisit the Emperor’s New Clothes fairy tale and consider Ed’s fictitious promise. 

The total number of medical graduates trained in the UK is around 8000 a year so if by some incredible turn of fate Milibean persuaded all of them to become GPs in his first year as PM and these would have to be all the F2 doctors in a single year then he would deliver his target by the end of year 3 of his premiership. 

He could try a slightly different tack and say just get half of all medical graduates in the UK 4000 in year one and then another 4000 in year 2 could be trained to be GPs in which case he could using the above arguments deliver 4000 newly trained GPs by the end of year 3 and another 4000 by the end of year 4 and so on.

Assuming for the sake of argument each of these GPs was paid an average of £ 100,000 a year this would only cost the country some £ 800,000,000 extra in wages. The current spend on GP services is 8.4 % of the budget provide by 65,294 GPs so add another 8,000 GPs and this might lead to a 1% rise in the NHS budget and no doubt there will be no increases in taxes as this is a politician who is talking.

Now clearly no-one in Ed’s Party has told him how stark b*llock (sorry for the naughty grunt word) naked his promises are for no-one has told him that general practice is not popular with new medical graduates. Perhaps because politicians tell everyone that GPs are idle, overpaid, golf playing idiots and politicians increase their work load year on year and decrease their pay as well as the funding for it while increasing demand. Did we also mention that currently GP training places are not full? You have to admire Emperor Ed’s new clothes.

So how is Ed going to deliver on his promise? Increase the number of medical students by 8000 but naked Emperor Ed probably doesn’t realize it takes 10 years to train a GP from entry to medical school? Perhaps naked Emperor Ed will introduce NHS Choice to fee paying medical students and introduce conscription for all F2s by getting the appropriate percentage per year to draw a black ball out of a bag which means they have to train as GPs? Easily done using the current lottery that is selection for medical training. 

No doubt Ed would assume that newly qualified highly trained, intelligent doctors would never dare to ask for more if forced to be GPs and might actually vote with their feet if they wanted to be surgeons, physicians, psychiatrists etc. and go abroad?

Praise be to the Party for making the NHS so easy to fix. Politicians have years of experience of this for they are the ones who constantly break it in the first place and Emperor Ed is just another politician clad in empty promises wondering why no-one believes or likes him. 

Just look at the track record of those who have preceded him recently.

Tuesday, 5 August 2014

It’s free so why not?

One of the great things about socialized medicine in the United Kingdom is how it has gone from treating patients’ needs for treatment of acute illness to treating patients’ wants and more recently, and most importantly, the ill-informed wants of the politicians and the Party. You will note that all three big Parties in the UK are mutually inclusive regarding healthcare policy as they all believe private profit good, NHS bad, sod the patient.

The patient can wait for treatment for acute illness, the Party tick box (QOF) cannot wait to be ticked for illness is in the UK now defined by the Party not the patient. Tick box medicine = Party control of physicians’ profits and cares only for the diseases that the Party defines - not the patient for any non Party prescribed disease. 

Take last week’s typical instant access surgeries for politician’s wants for patients to be seen within 48 hours not for acute illnesses but for whatever (crap) the patient wants. So on one week’s Party Generation Game conveyer belt of want that your average highly trained GP primary care team has to deal with in order to pander to the pathetic (Scottish) politicians’ wants we have had the following: 

“I am paying an absolute fortune for paracetamol”. (Not in Scotland, Northern Irleand or Wales only England we are after all a “National” Health Service). 

Paracetamol is a painkiller for mild/moderate pain available from most supermarkets, local shops and even chemists without a prescription for about 1p a tablet so I want a prescription for it as I don’t have to pay. (GPs get the same for dental problems where patients pay to see a dentist for a prescription for antibiotics but same day GP appointments are free a resounding Party policy success is UK NHS dentistry). 

Can I have a month’s worth as I am off to the caravan? 

(For those not from Northenshire a caravan is a trailer usually parked by a coast in a so called park where there are rows upon rows of such trailers, sorry caravans, which are often state funded where many NHS patients decamp to at weekends and during the summer in order to partake of the benefits of the sea air. A trip there is always an emergency same day appointment especially before a weekend break when a drug resupply and a sick note are required to fund their extended sea air break). 

The smart phone chucked on the desk with their car keys was worth at least £ 300 or a minimum £ 40 a month contract hire and yet a month’s worth of paracetamol or 224 tablets at 1p a time comes to £ 2.24. The Range Rover Sport keys on the desk cost a lot more.

Cheap compared with the cost of a GP appointment let us say £ 20 and a dispensing fee for the freebie of say £ 5.00 a shot for £ 2.24 of drugs a month.

The next one on the conveyer belt of want was the same.

I am pregnant . . .

Pregnancy is in the UK is a supercharged NHS AmEx gold platinum card that will do nicely card which means together with multiple tattoos and kids trashing the surgery toys means I want and I want it now, IT’S AN EMERGENCY, I’M PREGNANT.

The punter went to A&E yesterday but because they had to wait more than 20 nanoseconds (I am pregnant you know) the punter took their own discharge (it was doing my head in there were loads of drunk tossers and wasters there . . .)

Taking ones own discharge when pregnant is clearly a near fatal act of potentially catastrophic proportions akin to falling on your own sword and disemboweling yourself designed to evoke unremitting sympathy from a GP when added to the now wounded (pregnant did you know that Dr?) patient crawling unaided to a taxi to get home from A&E and then with their kids in tow (and trashing the waiting room toys) crawling the next day to an urgent same day GP appointment.

The punter continued for they alleged they had had piles which during their stupendous 20 nanosecond wait before leaving A&E had mysteriously got better but as they aren’t causing me a problem (now) my midwife (allegedly) said I ought to see a doctor (immediately) and that was 3 weeks ago so “can I have a prescription for somemit just in case it happens again as I am off to the caravan”? 

(The alternatives to the above are “I am running low” or “I have just run out” all acute medical emergencies requiring same day urgent appointments not a degree of common sense or a small amount of thought or planning which would cost the patient more than a free NHS same day appointment the cost being having a brain). 

Emergency department attendance, same day “emergency” GP appointment totaling close to £ 100 for a minor pharmacist treatable problem. Except that Pharmacy First schemes don’t do problems, or diagnosis, especially in the pregnant or children just what they can peddle for a fee to “reduce” GP workload (not) and there are around 813,000 births a year in the UK.

When it comes to the healthcare game of Top Trumps there is a clear cascade of winning cards that patients play for free daily and it is as follows:

Hospital consultant > hospital doctor (A&E) > GP (one time hospital Dr.) > nurse (opening gambit for getting a better card the nurse said I should . . .) > paramedic (they have blue flashing lights impressing the neighbours when called to your trailer) > pharmacist (they have a degree but there is a 1 in 10 chance they might cost so best avoided) > NHS 111 (DoH? Call an ambulance or see a GP within an hour which is a top trumper waste of everyones’ time but the last resort to try for a better card).

All cost nothing at the point of abuse but patients always want to play the top trump card and for free. If they don’t get the top trump card they want they will simply play another card. 

Next on this weeks’ conveyor belt of want was: 

The extra on top of the 15 alleged emergencies that HAD to be seen that day for a test result.

The punter already knew what the problem was 10 years ago when they had been offered treatment and in their infinite retardation knew better and so demanded a same day appointment after 10 years because their condition had got worse (totally predictable). They were sent for a test the result of which was already known (10 years ago) - but it is free.

So although told to come back after a few days to allow for the transfer of results and for these results to be triaged as doctors have done for years into what needs to be seen now (life threatening/urgent but rare), what needs to be soon (a few) and what can wait to be seen (most) a complete waste of space but the punter knew better and they HAD TO BE SEEN NOW.

When challenged about their free at the point of abuse misuse of the NHS they got nasty and said it was an emergency because they were going on holiday in a few days’ time (can you guess where?) and couldn’t wait (for another 10 years). 

And to complete the week’s conveyer belt of NHS misusers’ wants the last emergency surgery free at the point of abuse and more importantly completely free of any real urgent illness (thank you Tony Blair and Gordon Brown) of the week the Friday afternoon “something for the weekend” surgery (before the caravan) saw Thick attending with Thicker to complain that they had lost a job just seconds before.

Thick and Thicker repeated their story 10 times between them just in case the first world educated doctor hadn’t got the fact that this was nothing medical and when Thick and Thicker were advised this was nothing medical they retorted but we “HAD to DO something and see someone” as they didn’t know where else to go (for free). 

The crux of Thick and Thicker’s attendance was a legal matter not a medical one but then you usually have to pay to see a lawyer but seeing a GP on the same day within seconds of something non medical happening is our right and free at the point of abuse.

Thick and Thicker were told this and when they heard the words "no win, no fee" were out of the surgery like a shot and even stopped playing the cracked record as it went round for the 11th time (just in case the GP hadn’t heard why they needed a same day appointment for nothing medical). 

Praise be to the Party for providing the NHS with public school educated Scots and allowing them to reform the NHS for the better for they see what doctors cannot see namely WMD and saving the world from a financial crisis they created.

Unfortunately some of us live in and see the real world daily and it is not big and it is not clever especially at holiday times. So if you can't see a doctor when you are ill you now know why.