Thursday, 21 May 2015

Paracetamol 001.

Paracetamol is a cheap drug in the United Kingdom which has a licence for mild to moderate pain and is an antipyretic (used to reduce a temperatue). It is readily available in supermarkets and pharmacies for a few pence.

Many years ago as junior grunts one of the team at ND Central was asked by a senior grunt why did older patients repeatedly say they take paracetamol as a sleeping tablet?

None of the junior grunts knew and neither did the senior grunt who posed the question. Sometimes time gives one the answer and one of the team at ND Central thinks they may finally have the answer.

As one gets older people develop wear and tear arthritis (osteoarthritis) and this can affect the neck and is often known as cervical spondylosis when it affects the neck.

Spondylosis is virtually universal and is part of the triad of patheticness that many GPs hear as an opening gambit of any consultation “I have spondylosis, irritable bowel and fibromyalga” to try and gain sympathy from GPs before the average punter has even thought of creating a symptom for any new disease (and prior to the can I just have a repeat prescription and a sick note?).

Recently one of the more senior members at ND Central noticed that they kept waking up with neck pain at about 03.00 at night. Instead of dialing 999 or asking for an urgent consult with NHS dumb, dumb, dumb they took some paracetamol and after an hour they were able to go back to sleep.

As this happened repeatedly for several days they employed logic, rather than ring NHS dumb, dumb, dumb, or demand an urgent consult with their GP, or ask for a home visit, or go to A&E because I couldn’t sleep for a night and it was doing my head in, and thought if one was to take paracetamol before one got the pain one might not wake up at 03.00?

And they did and they slept.

So perhaps the answer to the question proposed many years ago was finally answered?

Paracetamol is not a sleeping pill but a painkiller and if pain does not disturb sleep then you sleep.

Perhaps this is why many elderly patients refer to Paracetamol as a sleeping tablet? Maybe some of the elderly worked this out themselves before the politicians invented instant access to NHS healthcare?

Praise be to the Party for denying common sense and providing NHS dumb, dumb, dumb in its place and mandating its use for all. If you notice that when you reverse the car your neck doesn’t quite twist as much as it did before then this will come to you at some point – if you love long enough.

Tuesday, 5 May 2015

‘twas the night before Christmas sorry an election.

Regular readers of our humble blog will have noticed a slight deficiet in our posts of late. Some may have attributed this to a group of highly dedicated GPs being out on the election campaign trail that is gripping (not) the UK at present. Instead it is down to the relentless grind of socialized medicine that all political Parties are promising more of.

The its an EMERGENCY = 6 months of chronic gut ache due to eating crisps as a stable diet, he/she is not eating anything and has lost weight but is 2 stone heavier than when last seen 6 weeks ago, I booked this appointment a week ago and am better now but I thought I would come just in case . . . and so on this is at present UK general practice. Here are a few more examples.

And all have to be seen straight away. Demand is currently inversely proportional to illness and is increasing.

So tomorrow we have an election and a potential change of government.

Oh joy.

Praise be to the Party for general elections a chance for the UK population as a whole to decide who they wish to govern them. This year it is a case of not who is best to govern us but a case of who is the least worse to do so and what is in it for me them.

And for those in healthcare at whatever level once the Parties have finished celebrating bickering the result will be that all in healthcare will have a hangover headache that will last far longer than any politicians’ post election booze fuelled headaches as they start meddling again.

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.