Tuesday, 15 April 2014

Extended hours.

So the BBC have broadcast that the pilots for extended hours have been announced even though earlier the health secretary announced their results. The BBC also proclaims that these will ease the pressure on A&E. 

Well you do not have to be a rocket scientist to realize that these will make not a tad of a difference to A&E attendances in the same way that a former Scottish prime minister thought that extending the standard 10.5 hour GP working day would allow all those busy commuting pensioners and toddlers to be seen when they were not busy at nursery or the Darby and Joan club. That worked so well now children didn’t it?

A few observations from the doctors at ND Central are being reported on here. From experience when you have a lot of doctors available surgeries do not always get full and there are sometimes free spaces especially if that coincides with periods of low demand like work shut down periods (when the former PCT was on holiday).

Under such (rare) circumstances someone ringing up with an urgent emergency, all general practice consults are for precisely this, for example an itchy scrot of 6 months duration, then receptionists are able to say: NHS free at the point of need and abuse sir/madam? That will do nicely I can fit you in straight away.

Now the converse also applies for example during school holidays when doctors who do not see much of their families during the politically determined minimum 10.5 hour day plus extended hours might want to spend some time with their children and so there is a shortage of surgery slots.

As a result there are rarely gaps in surgeries and so when the above emergency, extremely urgent MUST be seen NOW that day case rings up and is told we have no spare slots today we can fit you in tomorrow, next week or you can play Blair appointment roulette and see if you get a lucky on the day appointment what does the punter do?

They use NHS Choice and after a torrent of abuse to the receptionist (abuse is always free at the point of care on the NHS) and how they pay their taxes they march off to A&E comfortable in the knowledge that there is no come back for abuse or wasting an Accident and Emergency department’s time for something that is rarely if ever an accident and even less so an emergency. Increasing A&E is a general practice service with x-ray for those who cannot get what they want, when they want it and it is always NOW – regardless of true (medical) need.

Now using the above experience at a surgery level can anyone see a possible way of improving things? Will a few extra appointments for a few extra hours in a few locations with no extra doctors make any difference?

The issue here is the number of doctors that are available and the politicians are ignoring the elephant in the room and the fact that this elephant is getting bigger year on year. However, they conveniently ignore this and try to stretch a very thin film of puncture repair material over an increasingly large puncture hole they have created at the same time that they are increasing the pressure of demand in the tyre they are trying to fix.

Anyone who has been a cyclist will know what will happen under these circumstances. Do any of the politicians who cycle know this or can work out what is wrong?

Praise be to the Party who whenever they do not provide enough always blame the workforce for not working hard enough. There are 2 one day bank holidays in May this year can you guess how many days the politicians won’t be working in May? No wonder you can never see a politician when you are ill.

Wednesday, 2 April 2014

Care.data oops the Party did it again.

Care.data. It sounds like a fluffy high tech Party cuddle hug by the NHS of its patients (aaah) until you dissect it in a bit of detail. It is nothing more than shameless exploitation and shafting of your average patients’ and their GPs’ and hospitals’ (personal) medical records for private gain.

Now you can read the Party’s propaganda here and you may also have listened to a Radio 4 item recently saying that only a third of people they surveyed had had a leaflet re care.data in January. At ND Central the figure is much, much, much lower but then all those who live up North are thick and will have missed any care.data leaflet as they were busy eating their fish and chips and mushy peas out of it.

Having said that for some reason the number of patients asking to be excluded from Party.shaft.your.care.data.to.the private.sector.com is far greater than those who asked to be excluded from the Party’s Summary Care Record. Perhaps a reflection of the public’s ethos that the NHS is not there for private gain? 

You have to be careful here for if you opt out from care.data it does NOT mean that your personal medical records will be immune from being accessed by over a million NHS Smart card users without your consent. Indeed certain suppliers of NHS GP software on their Party peddled wears advertise the fact that your patient, has given their implied consent to their medical records being uploaded to the Summary Care Record (SCR).

Not that there is any true NHS Choice here as this information is hidden from any patient looking at the standard GP screen, comrades, and the patient will not have been asked about this issue at any point by a politician or an NHS administrator or their GP. 2 out of the later 3 occupations have had plenty of time to do so but have chosen not to do so.

This means that if you opt out from cuddled care.data the Party has another bite at your records via the Summary Care Record which you have to opt out from separately if you choose to do so. If you don’t your data is there for any data miner the Party allows (to pay for) your data to be accessed using a red, amber and green system of how identifiable you are to the purchaser.


As someone put it a few years ago, “I have been with this doctors since the NHS began and my family trust you far more than the politicians to keep our records confidential”. But if the Party does not tell anyone they can acquire all your data by stealth that is of course all right?

There have been a few bits of note re the cuddly fluff that is care.data in the news recently.

Certain GPs of principle have quite rightly decided to opt their patients out using the GMC (Party organ) principles of informed patient consent (something the Party does not believe in nor does its organ) which the Party has conveniently and ultimately overruled using the Health and Social Care Act 2011.

By then NHS England, decided that their bully boy (or girl other genders are available if preferred) tactics were a “misunderstanding”. This is akin to the SA/SS going back after kristallnacht and saying please Sir can we have our balls back it was all a terrible isunderstanding . . .

Further the NHS’ elite remedials who have blown billions on an IT system that has not yet put a single Summary Care Record on the moon let alone on a nationally accessible NHS database have said that they are suspending care.data for a few months in order to “build understand” of (its) benefits.

That really shows the level of ability of NHS managers. Come up with an idea, spend billions on its failure and then go back to better understand the millions they have wasted on it most recently.

Bit like saying we will build a plane and put no wings on it and then wonder why it does not fl? But these morons do this every day and get paid more than nurses and some GPs to do so. Think of the scene from Plant of the Apes (1968) where Charlton Heston makes a paper plane and it flies. The person who crushes the paper plane represents the ability of those in charge of NHS IT. Why fly when you can crawl like a slug? Anyone used C&B today?

Praise be to the Party for creating NHS England and care.data a national repository of uselessness for all those in the bottom third of your average Northernshire comprehensive school who would be unemployed if they had to work rather than something else beginning with w and ending in king for a living.

Unbelievably useless but highly paid uselessness with no principles.



Sunday, 2 February 2014

Tales from the pharmacy 001.

A trip to the chemist to collect our relative’s prescriptions led one of the medical team we are now forced to report on to note the following.

A patient in the pharmacy who had been to their own doctor was unhappy that they had not been prescribed for free what they had wanted namely a linctus for a cough. They had instead been diagnosed quite correctly from the history given so freely to all those in the chemist’s shop with a simple but very common at this time of the year viral Upper Respiratory Tract Infection (viral URTI = dry, painful, cough and a sore throat = painful windpipe, voice change and fever) which requires no treatment.

Please remember when visiting your GP to add really, really, really, really bad before all of the above bog standard symptoms that our GPs see each day and even come to work at this time of year with all of them at once and no treatment.

What followed was interrogation of the thick by the thick and gullible for the sole benefit of private gain. This was not by the degree educated pharmacist but by their (relatively) untrained dispensing staff. The team recall a few years ago reading a piece in a much missed medical blog saying that pharmacists’ accuracy of diagnosis is about 50% the same as tossing a coin. We do not know if there are any figures for dispensing staff diagnostic accuracy.

The punter, sorry patient, was asked to describe their cough. Was it chesty, dry, tickly, or mucus? Was it a cold or flu? Was it bronchial?

A quick scan round the medicines on display for purchase revealed that all these words correspond to the stacked items available for purchase by patients as they waited for their real but mostly free dispensed rather than sold medicines. No different to sweeties at the supermarket checkouts with free tissues for any purchase of any “flu” remedies as well.

For our doctors the questions they ask about diseases of the chest are limited to the following:

Shortness of breath
Haemoptysis (coughing up of blood) 

None of these were asked at the chemists but none of these were on the bottles of what is little more than legally peddled snake oil or Dr Feelgood which tastes very, very nice as did Southern Comfort which was once popular at grunt school and frequently referred to as “cough medicine” because of its taste. Drink too much too quickly and you coughed but useless for a cough as it did medically very little or nothing as did the stacked bottles of Dr. Feelgood cough medicines. It did however taste very nice but at a cost just like the cough medicines on display all those years ago and with a secret recipe. 

The patient got what they wanted, for a price, but they had paid for something they didn’t need and will do them sweet FA.

Amazing what you learn in a chemist’s shop.

And can anyone can tell us the exact definition of what a “chesty cough” is for those ignorant idle over paid GPs with more than 2 centuries of medical experience between them would be very gratefu if you could?

Pharmacists and doctors 2 peoples separated by a common language. And look where the big Society wants the over 75s to go first. Linctus you know it makes sense - to big business.

Praise be to the Party for dumbing down on the cheap while ensuring that the private sector benefits from the ignorance of patients and politicians and profits from such ignorance.