Saturday, 11 April 2015

Look how little it costs for you to get general practice in the UK.

If you were to ask the average patient in the UK how much their healthcare cost them the answer would probably be “Nothing” for as far as they are concerned it is completely free at the point of abuse.

The total NHS budget is c. £ 100 billion and only 8.4% of this is spent on primary care and general practice deals with c. 90% of medical consults in the UK. The GP magazine called Pulse has done some calculations which you can read here.

If you want to see how much the NHS pays to your own individual practice then there is a link here.

Please be aware before you start jumping up and down and saying my GP gets X million pounds a year that a GP’s income will be this figure MINUS

what it costs to run the practice in terms of staff wages (c. 70% of expenses), heat, light, telephones, repairs etc. etc. which results in something called profit

which when tax, national insurance etc. is deducted from this profit will be divided between partners to give your GP their own individual income and this is decreasing year on year. The figures in the article per patient are considerably less in many parts of the UK almost half in some cases.

So the average figure is £ 136 a year or £ 2.62 a week or 37p a day. Now the average patient consults 6 times a year which means that the cost of the average consultation is about £ 22.67 but remember dear reader this is the cost to the Party the cost to the patient is exactly £ 0 everytime, however many times they consult and the amount paid to a GP for each consultation will be even less (see above).

Now some might think I never ever see my GP, in the same way that no one ever has a home visit, so they are getting paid for nothing as far as I am concerned but we are sure no GP practice in the land has any patients who will consult 3 times a week every week of the year so it is a case of swings and roundabouts here comrades but if you never see a GP never fear for the service is still there free at the point of abuse should you ever need it.

The article does make a distinction between the different types of practice. The lowest cost per patient is for those practices that have a (n)GMS (new GeneralMedical Services) contract which on average receive £ 131.45 a patient.

The Party also has practices with PMS (Personal Medical Service) contracts where the practice can negociate with the local health authority or equivalent a set of specific services and receive more gelt for doing so at £ 140.52 a patient.

The third type of contract is the APMS (Alternative Provider Medical Services) contract often referred to as ones with the private sector which are more generously funded at £ 192.85 per patient which is the result of a political bung to encourage private interest in general practice and a reflection of the fact they tend to have fewer patients.

Most general practice is provided by self employed contracters so in fact most, if not all, general practice in the UK is provided by private enterprises. However the difference in funding in some areas leads to resentment between practices who may be treating patients who live in the same area but receive different amounts of payment per patient for doing so.

You will be pleased to know that the Party is working to correct this imbalance which may result in winners and losers and a possible lack of interest from the private sector that might result in workload “gains” to certain practices in areas so affected. APMS contracters will be able to take the money and leave the work while remaining GPs with other contracts will be dumped upon with extra work and expected to cope with the same workload for less money than the APMS contractors received before they left.

The article goes on to give examples of what £ 136 a year won’t buy you and here are a few others:

A colour TV licence which costs £ 145.50 a year.

A single NHS outpatient appointment with a consultant (allegedly) under the NHS Soviet tariff payment system (2014-5) unless it is for a colorectal surgery first attendance multidisciplinary attendance comrades at £ 118, an upper gastrointestinal surgery at £ 134, trauma and orthopaedics at £ 124, ENT or paediatric ENT at £ 136, ophthalmology at £ 106, plastic surgery at £ 124, anaesthetics at £ 125, paediatric dermatology at £ 133 or gynaecology at £ 131 a punt.

3 weeks of average expenditure on food by a person (patient) in the UK £ 160.20. 

12 weeks of average expenditure for alcoholic drinks, tobacco and narcotics. 

The cost of gym membership c. £ 300 a year as told to us by our medical students.

An initial single private medical consultation at £ 200 with follow ups at £ 125 a time. 

The cost of an hour of a solicitor with four years post qualification experience time in 2010 (GPs have a minimum of 5 years post qualification experience now).

Praise be to the Party for valuing each patient in the UK so generously for the bulk of their health care and then slagging off GPs for not being able to meet demand for the cost of less than a TV licence per patient. Anyone slagged the BBC off for providing television for more than the cost of a GP per year?

Saturday, 28 March 2015

Psychics.

One of the most important qualifications to be a GP is the ability to be psychic. Take some of the following examples of consults provided by our doctors:

GP: What is the problem? 

Punter: I don’t know you tell me. YOU are the doctor? Boom, boom!

The vet is trained to deal with dumb animals which as a doctors we cannot legally treat, next.

GP: What drugs did the hospital/out of ours service/your friend give you in this morning’s early hours? 

Punter: I don’t know it is on you system . . . 

GP: We have no record of this. 

Punter: . . . er they were from my previous GP 

GP: Who was that? 

Punter: I don’t know is it not on your system? 

And so on examples of the NHS total brainectomy that is performed the minute a patient walks into any GP’s surgery which is instantly reversed when the patient leaves and suddenly suffers Total Recall after they light their first fag after the unbearable agony imposed by the Party of not being able to smoke in public buildings.

The second thing they do after their relief, and getting their brain back from the NHS, is answer their friend who phoned them as they sat down in the consultation to ask “what has the doctor said?” They then tell their friend that “the doctor was crap because they knew nuffink about me even though I told them all about what was wrong with me and what drugs I were taking. They didn’t listen to a word that I told them . . .”

Now that is your average punter but there are others that are even worse take the insurance industry.

The insurance industry, unlike the NHS, exists to make money and in order to do so employs intelligent people to try and predict using historical data and complex maths the likelihood of a Russian Mig 15 dropping on a shed in Slough stuffed full of mustard gas kept by great granddad from WW1 just in case Napolean invades England while he was on the toilet and then estimate how much this likely event would cost them.

They use this information to calculate premiums which must generate a profit and cover the cost of any potential claims. Despite this fiscal accuracy when it comes to helping themselves to your money they too expect GPs to be psychics.

They provide forms with questions similar to these time and time again:

At the time that the insurance was purchased what was the state of health of your patient?

At the time that the holiday was booked what was the state of health of your patient?

This is like asking a GP when did your patient last have a dump? Clearly you average Northernshire GP would have been in the patient’s bathroom at the time and most importantly documented this fact contemporaneously for each and every patient such is their interest in their patients’ well being and dedication. Others might view such dedication in a slightly different light which is why most GPs don’t keep such tabs on their patients to this extent.

Clearly most if not all GPs missed the lecture at medical school which said that as part of taking a medical history IT IS MANDATORY that you must always ask of a patient:

When did they last purchase holiday insurance?

and 

When did they last book a holiday? 

Can anyone guess what the patient’s answer will be to the insurance industry’s questions?

Praise be to the Party for creating holiday insurance an industry which knows the answers to some of the questions on the forms they send out to GPs but presumably for reasons of confidentiality or data protection don’t put the answers on these forms.

So if they get an answer on their forms saying “don’t know it’s on your system” you will now know why. GPs are not psychic and deal with plenty of other time wasters every day.

Saturday, 7 March 2015

The idiots just don’t get it do they?

One of the doctor’s magazines here in the UK are reporting the next great idea from the UK’s National Respository for Morons known as National Health Service England (NHS England or NHSE) that all GP practices should open on Easter Saturday as part of NHSE’s “resilience” plans otherwise known as jokes.

For those who like to read twaddle here is the letter in full but you will need a dictionary of NHS management speak to fully appreciate it and keep a straight face while doing so.

Now which ever genius thought this up will never have ever worked in healthcare. Prior to the 2004 new General Medical Services (nGMS) contract general practice used to open on Saturday mornings and do you think that this meant that Saturday morning surgeries were:

a) packed to the gunnels with patients wanting to be seen with acute life threatening illness that could not be dealt with during the working week

or

b) were most people in the UK after a hard Friday night at it recouperating at home and letting their livers take the strain?

Were these surgeries busier or quieter on Bank Holiday weekends? Go on have a guess.

You do not have to be a rocket scienctist to work out which of the above two options the Great British public were doing for they used to be long quiet mornings spent doing paperwork sometimes puncturated by 2 or 3 patients coming for repeat prescriptions to break the monotony.

We have even heard of some recent initiatives that tried the same idea to try and ease A&E pressures over the winter with the same result. Surgeries were empty and A&E was full.

And further down the article (or the letter) it suggests “NHS 111 staffing increases to cope with potential surges in demand”.

DoH?

So NHS England suggests increasing NHS 111 staff to cope with potential surges in demand which will result in an increase of referrals to A&E and out of hours GPs? Would it not be better to give them the Bank Holiday off (and the rest of the millenium) to allow ambulance trusts, emergency departments and GP out of hours a breather?

Praise be to the Party for ensuring that no-one is too thick to be unemployed in the United Kingdom for there is always a job for you at NHS England. No experience of anything and no common sense is also useful.

Sunday, 1 March 2015

NHS productivity exceeds all targets for the better of patients.

All good Soviet run institutions like targets and just like the former USSR in the late 1970s used to boast of exceeding all grain production targets while conviently ignoring the fact that the USSR had to import grain from Canada and the USA to feed their population while fighting a war they lost in Afganistan the NHS is no different.

All NHS targets are of course met by the hard work of the politicians who define them and all those targets not met are by the failings of those who actually treat patients those idle people on the front line if you believe Party organs like the Daily Mail. 

Take NHS 111 (Dumb, Dumb, Dumb) a “service” which alone has contributed to a massive increase in tractor production of some 192% in its referrals to emergency departments from January to October 2013 when it was a mere 374,506 to January to October 2014 when its production of 3 wheeled tractors increased to 1,092,967 against a total number of A&E attendacnes of 21.7 million a massive 5% productivity gain comrades for a speciality that is struggling to recruit doctors and failing to meet its politically defined target. 

Furthermore comrades the efficiency gains of the great political idea of NHS Dumb, Dumb, Dumb are also reflected in a massive 186% increase in its referrals to primary and community care from a mere 2,844,452 to 8,138,863 in less than year against a mere 330 million a year GP consultations. 

The idle overpaid GPs will have no problems coping with a mere 2.5% increase in workload from just one source of retarded “technicians” with a mere 6 weeks training on a computer system whose output is like tossing a coin either see a GP or go to A&E. 

Further more comrades NHS Dumb, Dumb, Dumb have increased their turfing rate for in 2012 they managed to use self care for 48% of calls while in 2013/4 this was down to just 15%. NHS redirect only turfed 1 in 3 calls to GPs and A&E when it was around so a turf rate of 85% just shows how NHS efficiency gains are working so well.

Add to that a politically determined decrease in GP work force availability by politicians who have not a clue deciding to waste hours of GP and their staff’s time producing tractors that do not work called care plans, risk stratification and admission advoidance all of which has done sweet FA and meant that GPs and their staff do not see patients which has been as useful as a vicar standing up in Hiorshima saying God is Love as the first atomic bomb fell (other faiths and politicians are available to achieve the same end result).

Ask any GP or their staff today in practice how they would describe their workload today and they would probably use a very naughty grunt word like sh*t.

The Daily Mail says GPs are sh*t and have launched a do you wait more that 4 weeksfor an appointment hot line?

Of course in the same way that a decrease in GPs numbers and funding against an increase in demand is not news and neither is an increase in NHS Dumb, Dumb, Dumb referals to General Practices or A&E departments across the land the fact that the Swinton surgery once had 9 GPs but has dropped to 5 and cannot recruit replacements is not news and this is for one reason only.

In order to understand why a decrease in GPs while the number of patients remains the same could lead to an increase waiting time you might have to be able to do complex maffs called share bys.

Jounalists and NHS managers don’t do sums which is why those at NHS England say there was only an 86% rise in calls refered to GPs by NHS Dumb, Dumb, Dumb.  That was probably the number of fingers or cloven hooves present in the meeting on a Friday afternoon when they discussed this while trying to find someone who could switch on their abacus.

Praise be to the Party and its organs for highlighting the problem and completely missing the cause of it. Anyone got a mirror or more importantly know how to use it?

Saturday, 21 February 2015

NICE now to reward bad medical practice.

NICE (National Institute for Health and Clinical Excellence) is becoming increasingly desparate to try and dictate by diktat how NHS doctors should practice medicine. In any first world nation it would be a joke a despotic commissariat under the delusion it is doing something useful other than lick something political but under socialized medicine doctors are told to follow NICE guidance or else. However the worms may be starting to turn and not just doctors. 

A variety of sources reported on this story which we first saw here. Others took more rational slants which you can read here (greedy GPs) or here (dob a doc). 

Now socialized medicine in the UK is becoming very similar to socialized education. In socialized education the better you do academically the less input you receive from the Party. This is the principle that all pupils are equally dumb and as such all pupils are treated equally dumbly but some pupils are more equally dumb than others.

The reverse is also true in socialized education/medicine for if you are a disruptive failure then you went into class sizes of maybe 2 or 3 pupils to a teacher in contrast to if you were good you would be rewarded with class sizes of 30-40. If you were good and turned up that was just expected. 

If you were bad and turned up say 4 days out of five or more you got a star for each day you decided to grace skool with your prescence and when you hit five stars you got a prize, every week if you got all your stars comrade. If you did well and turned up every day you got nothing for doing so (although some might argue that as a result you may have done better in life as a result of being ignored by the Party apparatus and in doing so are allowed to contribute hugh sums to the Party for the privilege). 

So applying NICE’s retarded thinking and recent Party policy to some recent ideas can you see how this approach might work in medical practice? Take the great Westminister Hunt’s £ 55 per dement bung.

We know of a few local practices that did this work off their own backs a good while before Hunt even had his great idea and increased their dementia diagnosis rates for whatever that is worth in terms of outcomes (zero?) and then comes along a great Hunt who knows best.

When the practices who had already done this work asked if they too were to be rewarded for this they were told “Oh no comrade the work you did was counter revolutionary and such acts of terrorism against the Party will be severely punished as it was not ordered by the great leader and so was of no benefit to the Party. Hale Ming! Sorry comrade we meant Jeremy we have just watched a study video all this week.” 

So while the media reports an increase in dementia diagnosis what it is acutually reporting is that people who were not doing medicine that well are now being paid for what they should have been doing anyway but did not do so until they were given the great Hunt dement bung.

Ditto antibiotics. Will practices that have low rates of antibiotic prescribing be rewarded for doing well in terms of good medical practice or those delinquent practices receive huge bungs for reducing their antibiotic prescribing? In other words will poor medical performance be rewarded for doing better while consistent good medical practice gets nothing just like at school?

Praise be to the Party for once again rewarding duff medical practice by NICE and not rewarding good practice.

PS Please Sir shood NICE be spelked NIHCE?