The NHS Brand or Ronald McBrown on corporate identity.

Fellow bloggers and readers while doing some research for a post one of us stumbled across the NHS Brand Guidelines website.

Being good scientists and scholars we did study this website and if you have no surgeries or anything else constructive to do for the next week then we respectfully suggest that you trawl this website to see where tax payers’ money is being spent (on healthcare).

Go to the Homepage. Look to see what is in the centre: a section for dentists. Are we thick up North but when did anyone in this affluent area get access to a NHS dentist especially as an emergency?

Look at the rotating images and see how clean everything in the NHS is. We all know that actors and film, or photographers’, studios rarely see the number of patients in a day that real healthcare professionals and institutions do. Notice the subtle ethnic “diversity” and images of children being cared for by the benign “NHS brand” team of website designers as opposed to real healthcare professionals. Don’t the patients look so well and the staff so relaxed and rested?

Check out the About the NHS brand to learn that “this website is a central resource for all those involved in developing NHS communications”. Hmmh clearly no-one there talks to patients or to us on the frontline.

It finishes with the sentence “whether you are a communications professional working within the NHS, or an external supplier providing design or print services, our guidelines will show you how to use the NHS brand properly and effectively”.

Nice to know that the frontline staff in the NHS are being provided with all this vital information to help them treat patients. Next time we access an NHS print service as part of our families healthcare we will be greatly reassured.

Back to the Home page. There are 21 options in the drop down menu in the blue Welcome box. Being thick enough to be GPs we went straight to the last one “unsure?”

Reading this we found the following sentence:

“If you're not sure where to fing the information you're looking for, . . .”

Clearly Vicki Pollard is now working for the NHS as a website designer and doing nothfing, whatever. But getting paid for it no doubt handsomely.

There is even a telephone number possibly a “NHS Identity Helpline” call centre? For the paranoid perhaps?

Try checking out the section we think might apply to us we think it is General Practice.

There is even a a 4.2Mb pdf document with a warning large file size (think steaming pile of cow dung) underneath it. It is 103 pages long and we suspect that a quick skip read of the first few pages will make the idea of hammering nails into your feet a more rewarding experience than reading the rest of the document. Go on give it a try. If you are not a GP there are loads of other such documents to download too some even bigger than ours!

Try reading the first page and see what it says, remember we found this site by accident:

“This need has come from:

GP surgeries and primary care trusts (PCTs) asking us how to use the NHS brand within their surgeries.”

Of course we have been we have been banging on their doors for years asking how to use the NHS brand and we suspect that every other GP and medical blogger in the UK has been doing the same too.

Look at the bewildering array of options on the GP site which we have looked at and after an hour of research at the Café Michelle have barely scratched the surface of this hidden gem of NHS excellence in wasting tax payers’ money.

On the web page there are 3 GP categories. Unfortunately we fall into the D or Delta fraternity here at ND Central as we do not use the NHS brand on any of our Practice correspondence so no doubt there will be a visit soon from the NHS Brand Stasi for a spot of political reeducation or is that rebranding?

If you are still breathing after being underwhelmed by this marvellous website of Party speak (deep breaths, dear reader, think calming thoughts of steaming dung heap to counter any negative thoughts or emotions) then navigate to the Useful Links and click on the bottom link Tone of voice: Words and written communication.

Start reading this section and image the text being read by Telly Savalas as Ernst Stavros Blofeld in the James Bond film On Her Majesty’s Secret Service in a darkened room.

Read the section Respect, understanding and accessibility and see how communication should be. Anyone ever hear a PCT manager speak “free of jargon, free of acronyms and free of overly technical language”?

Clearly even the PCTs are not on message so we GPs have no hope but carry on listening to Mr Savalas’s dulcet tones in your imagination as you progress to bits that might just be relevant to GPs’ daily lives the “One-to-one communication with patients and the public”.

“Every time you communicate with a patient or a member of the public, you are acting as an ambassador for the NHS. You are projecting the NHS identity. Remember, first impressions count, and what you say and how you say it will impact on that person’s confidence (positively or negatively) in our ability to do a good job.”

Now why were none of us told this in medical school? All those lectures, booklets and sessions on communication skills and we were not told that we were not doctors but were in fact ambassadors for the NHS constantly apologising for its inefficiences and difficiences. We did not realize we were projecting the NHS identity we thought we were being doctors.

How could we have got it all so wrong?

Praise be to the Party for enlightening our darkness as to what we are actually doing with patients – projecting the NHS identity. So much better than treating them and making them better. And this will not have cost the taxpayer a penny.

This is the polite version the grunt speak version is as follows: what a load of paired dangling male sexual organs contained in a sack. Money to burn anyone?

Grief

The last few days have been crap days for a number of reasons for us here at ND Central but what caught our collective attention was the recent out pouring of apparent public grief in the UK.

Commentators at the annual Remembrance Day Ceremony at the Cenotaph said there were more crowds than usual. This week we watched scenes that evoked memories of the funeral of Diana, Princess of Wales when hearses with coffins inside this time with the bodies of fallen serviceman, were covered with flowers as they passed through a normally quiet English village of Wootton Bassett.

This got us thinking about grief and peoples’ reaction to death. One of our forebears lost 5 of their siblings and a father in one year. A few short years later more of their family were lost in the First World War albeit just within the last one hundred years. Infant mortality was high then and deaths in the First World War were in the tens of thousands in a day alone.

One death is a tragedy, a million is a statistic said the “great” Soviet leader Joseph Stalin well known for his humanitarian views and influence on current Party thinking especially freedom of expression.

But perhaps there may just be a point?

When infant mortality is high then losing a child is as upsetting to parents in these times as it is today. Emotions do not change but circumstances do.

If those around you lose their children to disease and in large numbers perhaps there is a degree of desensitization that sets in as a means of evolutionary self preservation?

Similarly if you lose a loved one in war, especially if you believe it to be unnecessary, this is not good but if tens of thousands do the same does it alter one’s perception of loss?

One person’s death or a few people’s deaths versus tens of thousands? Which is the greater grief?

Which is the greater absolute “loss” versus the greater Media interest?

For any human being the death of a loved one is distressing. It takes time to come to terms with and usually involves the support of one’s friends, or family although increasingly there always seems to be the all wise watcher of the UK Soap opera called Eastenders whose perception is that you always “you need to go and see your doctor.”

It devolves any responsibility for our own disquiet with death or disease and it is free in the UK. Grief then becomes an “illness” not an uncomfortable unpleasant emotional state.

So often within 24 hours of a death we will see relatives who have been sent always by someone else as an “emergency” and usually expecting the magic grief prevention pill which they have been told we have by whoever refers them to see us.

They usually get nothing other than a bit of time spent explaining that grief is a normal but unpleasant experience and what they are experiencing is normal.

Yes, you will be crying. Yes, you cannot sleep and yes, you will be thinking of him or her all the time but this is normal. Yes you may feel disbelieve, anger, guilt or any other emotion but this is normal. You will get better but it will take time.

Time is a great healer but unfortunately works slowly. Time spent explaining usually works better than the quick fix usually expected pill based alternative.

Disasters create Media induced grief. Would the tens of thousands slaughtered on the first day of the Somme have been reported in the same way that a servicemen’s death is reported today? Would Wootton Bassett have stood still for a 20,000 long cortege in the same way that the Public honoured those fallen in the last few days?

Same loss of an individual to the individuals concerned, same emotions but different circumstances and more importantly numbers.

Grief is an immensely personal thing. It is also a highly collectively hijackable thing via the Media but still, at whatever level one thinks of it, it boils down to the relationship between the individual, those around them and the deceased. It also now boils down to how we as Society, via the Media, view death.

The support provided in the UK usually also boils down to that between the individual and those they deal with. Often that is the principly the local undertaker followed by a local GP or in the military medical officer or members of whichever faith the family subscribe to. Before free healthcare the family would shoulder a lot of this as would local ministers of religion. It is a deeply personal relationship and always takes time to resolve.

While we here at ND Central do not have any qualms about public outpourings of grief we know that behind all the pomp and ceremony there will be a few individuals working locally to help bereaved individuals in all manner of different capacities.

We are relatively lucky in this day and age that the widespread losses that even 2 or 3 generations ago wiped out huge parts of families have been reduced to the point that death is a relatively rare occurrence in most peoples' lives although one that we will all with certainty experience on a very personal basis.

Thinking back just a hundred years ago to our forebears’ experience of losing several children to disease then losing several young adults a few years later to war must have been awful.

The human emotions were the same then as they are now, the circumstances were different. Grief is grief is grief but society changes and not always for the better.

Our thoughts go out to anyone who has experienced the loss of a loved one however it was caused. It is never easy whatever the circumstances.

Who knows whether one of us here at ND Central will have to break the news of a death to someone today, go out and confirm a death, or see a relative who has been bereaved. For some of us more than others it is a regular occurrence and has to be handled with sensitivity and tact.

Death always has the upper hand and always plays the game by his rules. We just follow.

It does not get any easier the more you do you just get more used to it. It is however part of the job and we will get on with it as always, however hard.

The same can be said for the military and the relatives of those killed in action for we feel war will always be with us.

Praise be to the Party for all their support for our servicemen and servicewomen.

Fortunately the Services have their own methods of support evolved over years to help those with loss. They may not be perfect but they have stood the test of time certainly longer than the NHS.

We await the centrally Party approved NICE guidelines on how to deal with grief (military personnel) but a lot of us have already learnt the hard way. We are but grunts on the ground and cope accordingly - without guidelines, on a one to one, very personal level with no cameras in sight.

More NHS Choice, Swine Flu and Immunization.

One of the advantages of being involved in medical education is that every now and again you go to meetings and talk to different doctors at different stages of training outside of your own Practice. A few days ago one of us did just that and came back with a rather worrying story.

It would appear that one of the many local hospitals is “encouraging” their staff to have the swine flu immunization.

Obviously an excellent idea of the benevolent Party looking after its own as it says, in one of its briefings for managers, that if you are sick with the dreaded Swine flu then you cannot be allowed to work and look after patients.

How caring is the Party? It is so concerned for the well being of the comrade workers on the frontline that, in order to enable them to continue to care for their fellow comrade patients, it is offering them a free flu jab ahead of all others.

The carrot.

What is more worrying is that staff are being told that, if they do not have the Swine flu jab, and then they dare to be ill with Swine flu, they will face "disciplinary action" for not having had the “voluntary” swine flu shot. If they have the shot and get Swine flu they will not. Same illness, two different outcomes?

The doctor in training from whom we got this little gem in passing also said that managers were prowling the wards at night in the small hours to immunize their staff after these threats. Good stasi tactics there comrade managers.

The stick.

Now we may be old fashioned here at ND Central but we still, as far as we know, have the concept of informed choice in healthcare.

Unless the Law has changed as a result of us here in the UK “democratically” accepting the Lisbon Treaty after the "promised" referendum, a patient has the right, if they are compos mentis, to decline treatment even if it may harm them (assuming no other conflicting law for example the Suicide Act).

Now if any lawyers are reading perhaps we could suggest that rather than sniffing round A&E departments there may be rich pickings to be had here.

Employment Law, European Law, Human Rights Laws surely are being breached here as well as basic medical and nursing ethics and codes of conduct?

What if a patient who is coerced to have a shot gets Guillain-Barre syndrome? A lawyer’s Christmas present in one convenient bundle perchance?

And at what cost then to a local hospital or more importantly to the NHS for the incompentent local managers’ zeal in the face of basic medical ethics and human rights?

Come the New Year we may start to know the success or failure of the Swine Flu pan(dem)ic vaccination program in terms of Guillain-Barre syndrome. We are normally great advocates of vaccination when the science is there but given the fact that a few days ago the local Politburo came to immunize priority staff and less than a third of the doctors took it up does that tell you something?

Praise be the Party for we know it to be all wise.

We hope it rewards these managers with the prize that they will surely richly deserve a one way ticket to their spiritual homeland:

North Korea.

Halloween some Odds and Sods

A few little bits have caught our collective eyes as we here at ND Central go through the 100+ letters we each get a week.

We are always keen to “embrace” new treatment options and the suggestion by one of our local eye consultants for us to arrange “dermatological relief” for a patient was interesting.

It reminded one of us a line from a UK gangster film, we think it was The Squeeze 1977, where a cop was asked if they wanted “special relief”?

Another new therapy we observed for treatment of a fracture from an orthopaedic clinic was to try “vibration massage therapy”.

Long gone are the simple days of plaster of Paris, metalwork and the odd antibiotic as core orthopaedic treatments.

As none of us knew what these actually meant we felt we have either been out of hospital medicine too long, watch the wrong kind of films or have an odd sense of humour?

We could also just be plain pig ignorant. Still it gave us a few giggles.

The Walk In Centres continue to provide us with lots of evidence of rain forest deforestation but not much evidence of useful work.

One punter, sorry patient, there is of course no real market in the NHS, had been 5 times in 4 weeks and the history and treatment was the same on all 10 sheets of A4 paper produced.

The same history, examination and conclusion = “viral infection”, all 4 lines of it, in the 2 sheets of A4 per attendance repeated 5 times was as relevant to us as GPs as a used piece of toilet paper in a sewer.

Unfortunately one question had been consistently missed and had it been asked, 2 weeks ago, would have given the diagnosis in 2 minutes not the 5 times 20 minute consultations.

We asked the relevant question and the patient got better with the right treatment.

Someone has said that 85% of diagnoses in General Practice you can get on the history alone.

All of our consultants at medical school said that a good history was vital and only after a few decades of multiple history taking and seeing lots of patients and doing sometimes many unnecessary tests do you realise that this is true as a result of experience not a short course.

Until you observe those in training (medical students, F2 trainees, registrars and even nurse practitioners the new Vim of medical healthcare on the cheap) and how they fail to listen though inexperience, not inability, you do not realise that taking a good history from a patient is an art that takes a long time to do well.

That is if you can remember your own short comings, which we feel is vital in teaching, for if you forget how bad you were once, you become intolerant of ignorance which we should be correcting via education not humiliation.

These skills cannot be learnt in a few short weeks or, even less now, as “education” has improved so much under ZaNu Labour’s rule, that in 3 hours of Party sponsored “how to (mis)diagnose swine flu” courses anyone can play doctor and get away with murder.

We are situated close to several largish conurbations and we have noticed a number of different formats of walk in consultation printouts (mostly rain forest and knowledge unfriendly) but one we had not seen until now had the following code sitting in amongst the crap printed on them:

Mobility: WALKING

We shall be looking out for any variations on this one given that these are “Walk In” centres.

Would one get treated if you “hopped in”, “roller bladed in” or were “carried in”? Would that alter the mobility code?

Surely given their name, all mobility codes should be “Walking”?

Heaven forbid someone from a local military base might abseil in from a helicopter but we are sure there must be a code for that, comrades? Or would they be denied treatment as they did not walk in?

Finally we asked each other how many cases of genuine swine flu we have seen?

Answer none. Lots of Tamiflu positive patients but no genuine confirmed cases. There are rumours that the Health Protection Agency have been swabbing patients and finding large number of people have had swine flu but with little or no symptoms. These are just rumours which will no doubt be suppressed as if this got out there would be nothing left to panic the population with and the benevolent vaccination program might not be of any use.

Still our patients know better than as all of them are convinced they have “flu” but they have managed to drive in, park their cars after taking their kids to school, on their way into work and then walk in to see us to tell us they have “flu”.

These acts themselves tell us they do not have real “flu” most of them just have minor upper respiratory infections as do the rest of their families, schools and work places which is usual at this time of the year. We are still waiting for our first proven real bacon butty case of flu.

It is of course Halloween so no doubt the Department of Health will be allowed out to play out unchecked for one night of the year in contrast to the rest of the year when it inflicts all manner of horrors on patients via their “initiatives”. This morning’s patients at one of their bright ideas, the Gordon surgery for busy commuting pensioners, at one of our less affluent branch surgeries more than surpassed the local supermarket’s Halloween horrors and that was in daylight.

Praise be to the Party and all its new health reforms.

We wonder which one of them was responsible for the new “reliefs” and “therapies”? Sir Liam or possibly Dame Christine or maybe it was a joint effort?

No doubt NICE approved all of them as part of evidence based politico-economic medicine if only we could recover their rainforest depleting missives from our shredder to read the relevant ones . . .

Has science finally disappeared from good medical practice or are we just taking the proverbial?

You decide dear reader we just live this daily. Beware the ghouls and beasties tonight for if they do not get you the DoH will!

Beware Greeks bearing gifts.

Being in the “market”, a real market not the management structure called the “NHS market”, for a new partner a few of us saw our eyes drawn to an article in the GP rag called Pulse magazine.

Now anyone here in the UK looking to recruit a new partner as an established GP practice would look upon £225,000 (over 3 years) as a god send to boost income as virtually all GP Practices have, and will see, a drop in income as a reward for fulfilling their side of the new GP contract which has displeased our political masters so much.

The exception being the “private” contractors, some of whom will also be local GPs, supplying the Darzhole centres who we reckon will, for providing less than half the services that we do at ND Central, will be raking in as much in PROFIT as our whole Practice TURNOVER. These will be generously funded to ensure their success as they are political structures provided by “private” providers rather than things that are actually needed.

In English this means a million quid for an 8 doctor practice which includes the doctors pay versus 2 million quid for a 3 doctor practice but here the profit is the same as our turnover. Private is clearly best, comrades, it costs so much less than Publicly funded general practice.

This is why we say onto thee, dear reader, beware of Greeks bearing gifts.

The Trojan Horse is the fact that any Practice(s) greedy enough to take the comrade Commissar’s schilling will in effect be losing any independence they have as they will be expected to sign up for a PMS (Personal Medical Services) contract.

Historically PMS contracts for GPs in the UK have been financially better paid (although that is changing) but the downside is that you lose your medical independence as the Party seeks to control how you “practise” medicine via the PMS contract it negotiates with you.

Although there is an alleged” National Health Service” in the UK it is in fact a multi national health service with each local Politburo or Soviet (PCT) dictating the local supreme idiot commissar’s (Chief Executive) policy for local healthcare loosely based on the supreme Soviet’s (Department of Health) view of the current Party’s (Government) healthcare policy.

If, and this is a huge if, the local commissar has a brain this might result in some degree of local improvement.

However, the NHS’s “socialized medicine” means that this is nothing more than an attempt to cut costs via imposing a PMS contract = more local idiot Party commissar’s control.

For any US, and indeed UK readers’, you have to realize that all NHS commissars have at least 3 degrees from either Harvard or Yale or, in some cases from the lesser universities of Oxford or Cambridge as historically the brightest of the United Kingdom’s graduates go into NHS management in contrast to those who struggle to make it into medical school (not!).

This is why NHS managers struggle to improve healthcare in the UK as they are always hampered in their efforts by the less intelligent medical profession. This then angers the Party, who being true Socialists, hate the bourgeoisie called medicine as the Party represent the “workers” of the private sector and will happily trouser anything forthcoming from them.

So while we would like to replace a partner there are no local Party bungs unless we sell our souls to the dark side of “socialized medicine” = total Party control. Although we would like to be as intelligent as the local commissars we know we would struggle to keep up so we shall decline their gift of a horse even if it means a few more years of siege.

But still like the Trojans, after almost as many years of siege by Za Nu Labour, sorry the Greeks, there will be those in the Resistance who may take Gordon’s commissar’s schilling and sell out.

We here at ND would urge caution for having invited the Greeks in, you may find that far from bearing gifts, they will in fact raid your family silver for years to come which you will have to pay for year on year.

Praise be the Party for free healthcare and for encouraging GP Partnerships in these austere times. They are all wise and as good socialists they want even.

As someone is said to have said (sometimes Lenin and Stalin are quoted as originators of this phrase) and we have checked our sources:

“The [capitalists] will sell us the ropes with which to hang them”.

So will they now “pay us” for new GP Partners?

Job Clubs in the ‘80s recession, now in the Noughties, welcome the Leg Club.

While trawling the web, in yet another busy surgery waiting for work, we decided to have a look at The Comic and found an interesting article here that caught our eye.

Those of us old enough to remember the 1980s were reminded of “Job Clubs” where unemployed people were meant to meet up, exchange ideas and get advice to try and help them to find work (when there was actually very little or no work to be found).

We remember them well. We walked past people with no jobs in groups, usually of men, smoking lurking around the Job Club doors spilling out on to the street and looking like a posse you would try to avoid at all costs often funded by local councils.

We thought given, our memories of the former Job Clubs of the Eighties, we would have a look at the Comic’s “Resource Centre” where there is a new form of club, the Leg Club.

In summary it is “social model to manage treatment such as ulcer care”.

Sounds a little vague. Leg Clubs: a social model to manage treatment such as ulcer care? Can a “social model” manage other “treatments” such as coronary artery bypass surgery in a CABS Club?

We read on.

It tells us that leg ulcers affect people mostly over 65. Well nothing there new to your average Northernshire GP, district or practice nurse. “Evidence” shows this is expensive with slow healing rates and a high incidence of recurrence”.

Never?

Does “evidence” reflect the team here at ND Central’s experience that it is usually little old ladies whose only source of social contact is their ulcer?

If they complied with treatment their ulcer would get better but instead they remove dressings, develop multiple allergies to all known dressings and let their favourite pussy rub up against their festering ulcers and then complain it never seems to get better. And they sit with their leg down to “improve” circulation and “facilitate” healing and still they never get better.

OK rant over that description was just our own Grandparents over whom we had a degree of control and who mimicked every other geriatric leg ulcer patient we see. Patients, however, are more manipulative. For example ringing nurses after they have just put a new dressing on to tell them it has “fallen off” with no patient helping hands whatsoever honest guv.

Yes, ulcers heal slowly, and they do recur but if your ulcer is your only source of social intercourse then there is no incentive to get better.

It is also usually a pre morbid condition caused mostly by poor circulation which gets worse as you get older but we digress. These were just some thoughts from those on the frontline based on years of experience.

We were only on paragraph 2 just wait for paragraph 3 and its little “QUIP” and being “referenced” whatever that means by the Department of Health. So it already is doomed to failure or care on the crap sorry cheap.

The Leg Club idea was apparently developed by a former nurse of the year who goes on to say that “Collabrative working (comrade) is the bedrock of each Leg Club”.

Fourth paragraph and a good Party phrase or two already mentioned for the comrades in NHS management to absorb in their working week off.

The next two paragraphs, with lots of Partyspeak (if you want more of this check out this inpiring link on Leg Clubs) describe how they work which to our slightly cynical eyes at ND Central sound very like the current dressing clinics and tissue viability clinics held at local surgeries and dermatology clinics.

Further on GP involvement is kept to a “minimum”.

Excellent idea! Keep the idle educated GPs away from patients.

Next paragraph starts to shed a little light on where this might be coming from as:

“Established and run by volunteers in partnership (excellent Party word!), they are self funding (cheap), with patients finding ways of raising the money for the rent and equipment (remember care free at the point of need?). The cost to the Commissioner (ah ha the important one in the equation the new force of Darkness in NHS management) is in the nursing time and dressings.

True Party Central Utopia no cost!

Hmmm. Could we perhaps re write that paragraph to describe the current system as such:

“Established and run by district nurse, practice nurse and GPs they are cost neutral to the patients as the care is delivered in their own homes. The cost to the Commissioner is the nursing time and dressings. There may also, unfortunately, be GP and dermatologist involvement but at no extra cost to the commissars.”

Have they forgotten the additional costs for genuinely housebound patients like “Vera”, the case study, who will no doubt be volunteering to self fund taxi services to mosey on down to her local Leg Club shin dig in the same way that Vera does not now come to surgery so no cost there comrade commissar in you needing to provide transport to the Leg Clubs via the ambulance (free taxi for OAPs) service.

Read on dear reader for things are getting worse.

It turns out that clubs are supported by the Lindsay Leg Club Foundation which presumably is the new version of the Rotary Club devoted to charitable good causes?

Now it really starts to get interesting.

Click on the Leg Club Foundation link > Useful documents link and download the Leg Club brochure.

Just look at how a “Leg Club” will transform your patients.

Take Mavis Thistlewaite, 30 stone, five foot nothing, 60 a day lifetime smoker and a bottle a day of Scotch for good measure in her farmhouse high on a moor some 10 miles = 25 minutes drive to any social centre, with ulcers for 10 years as she watches day time TV with her legs massaged regularly by her 5 cats surrounded by their droppings and see how she will be transformed into a Leg Club brochure babe of the month.

Patients (sorry well looking geriatric models not real patients) wading in the sea, worshipping the Leg Club, practising martial art manoeuvres, smiling holding hands and not an ulcer or bandage in sight. Please look and see how Leg Clubs have been so successful.

Instead of just looking at the pictures of ulcers “transformed” try reading and see what the bottom line is. If you are just a tad cynical and bored by now just read the “Setting Up a Leg Club” section on page 8. Is this a possible Third way model for funding ulcer care?

Oh Lordy we are reading this and seeing our patients transformed by this new Messiah. Like St. Paul we now see the light and will start following the guide word for word. Tell us how do we get the handbook? Will there perhaps be a small donation to the Leg Club’s Messiah’s charity? (We couldn’t find that bit).

Still Resistance work at the café Michelle is hard. So after another trip to the Quartermaster for some top up rations we sat down for some more self directed learning from their website.

We looked at the “Corporate Partners” a few names we recognised and we are sure none would have any vested interests in this particular field of medical and nursing care except the one which had “wound care” in its name. Still 1 out of 16 may just be allowable.

This can’t be a public private initiative via a charity? We can’t be that cynical given our recent religious conversion to the “Leg Club” creed? But it is “referenced” by the Department of Health which we know likes care on the cheap and lots of private sector involvement to save money ( = pay more for less) a good Prudent “socialized medicine” policy (we do like that phrase here at ND Central it sounds so much better than incompetence).

But then we noticed, after more rations, and this Resistance meeting was after an early and a late Gordon shi*t for some of us, the link “Information for Motorcyclists”.

Pause.

Think.

Well you can imagine the imagery that came to our collective minds at this stage in the evening.

Poor old housebound Mavis Thistlewaite on the back of a Harley being whisked to get over to her Leg Club by the local Hell’s Angels Chapter perhaps? A Community Partnership?

Will there now be a Northernshire Chapter of the Angels called the Leg Club Ulcer Seniors, the LCrUS Seniors for short, using a “social model” to help their leg ulcers? Nora Batty on a motorbike anyone?

We fell apart laughing at this point it had been a long day.

(For our overseas readers Nora Batty is a comic character from a long running gentle humoured comedy called Last of the Summer Wine set in southern Northernshire who was the love interest of a rough geriatric scruff who yearned after her wrinkled stockings. The picture here is not too dissimilar from your average Northernshire leg ulcer patient although Nora was a lot more mobile even on motorbikes).

A few more mouse clicks and we found a picture. Could this possibly be of the new “Messiah” mounted astride a Hog?

Well you can imagine that any more serious critique had long since evaporated at that point.

We do not know if Leg Clubs work. The nearest one to us in Northernshire would be about an hours flying time to reach such is their obvious success up North and we here at ND Central certainly have no axe to grind with Ms Lindsay but we do thank her and the Comic for inspiring this irreverent piece.

After a long hard day at the coal face and a few top up rations you do need a bit of light relief. It will take a while to get the imagery out of heads.

We really must get back to 5 minute appointments it will stop us trawling the Net in our downtime but the Party has decreed 10 minutes good = pay but 5 minutes bad = no pay.

Bored minds do mischief make. And we ain’t teenagers on a street corner.

Praise be to the Party and NHS Innovation. Heath Robinson’s ideas seem workable in comparison with some of theirs.

Those of us old enough to remember grants and UB40 cards as medical students here in the UK will be off to the Leg Clubs in the same way that we went to Job Clubs in the eighties. They were such a good idea. Some Job Clubs may still be here today? None locally but GPs and district nurses are still here so are the leg ulcers.

A meeting with the Party in General Practice.

In business in the UK a lunch break is at least an hour, according to friends in the City. Sometimes hosted at a gentlemen’s club with a couple of bottles of wine per attendee. Then back to work.

Lunch in GP land is usually a ten minute meal grabbed on the move between surgeries, clinics, telephone calls, prescriptions, correspondence and visits.

Once again this alleged lunch “hour” that people in the UK are meant to have, but certainly in General Practice never have, was hijacked by a the local Party for a “meeting” to explain a new “improved” service from on high.

Meetings in the NHS General Practice workplace are where GPs are forced to listen to people from the local Politburo with about as much ability as your average permanently excluded child with ADAH in today’s schools who live in an exclusion unit if they ever turn up that is.

They are usually rehashed NHS corporate laptop presentations about something “new” = reinventing the wheel to ensure that it is square that the Department of Health and its local Politburos thinks will improve things above and beyond any of their previous “ideas” that have gone before and failed miserably.

Beware any new ideas from the Department of Health. They usually mean more work to deliver less and take longer to do than it ever used to.

Just think Choose and Book and then mentally conjuror up the image of a £ 12,000,000,000 smoking dung heap.

Most UK GPs and their poor frustrated secretaries/receptionists will know what we mean by this complete failure of NHS “progress”. They who have to use it, not that it is use is voluntary as it has been “mandated” to ensure people use it because it is so crap, are so grateful for the extra work it has generated and how little it cost patients or tax payers or delivers to them as customers (we almost forgot the non existent “market” there dear reader how silly of us to do that).

Good constructive meetings are usually short, with a fixed purpose, to achieve an objective, properly chaired and hopefully deliver an outcome. The Party does not do good meetings but they do lots of meetings similar to this one.

It started in the usual way when someone large and fat, they always are, (did we mention thick as well?), turned up late and waddled in clutching their badge of office a laptop. They then said they were waiting for someone else important from another commissariat who was also late.

Obviously these people are all very busy people (they are never there on a Friday afternoon)but it is all right to keep lazy idle GPs, nurses and reception staff all of whom actually deal with patients waiting as they have nothing else to do (in contrast to NHS managers who do what exactly?).

In true Party fashion when they eventually arrived 15 minutes late, with a room full of bored nurses, receptionists and doctors all of whom could be doing something useful if otherwise not engaged with local Party commissars.

It took the two local Party Commissars about 20 minutes to wire up a laptop to a projector and then wait for the valves to warm up to the point where they could finally display a Party produced presentation. The smell of ozone was over powering and the generators were struggling to cope supplying the gigawatts of power needed to get the meeting off the ground.

There then followed a 20 minute praising and presentation of a pilot and “research” work (think dung heap) and the thoughts of Chairman Gordon, comrade Andy Burnham which had worked so well somewhere elsewhere that the local Northernshire Politburo (Praise be) had been specially “selected” to roll out this most “excellent” idea across the whole of the local Soviet.

Given the huge affluence and intellectual prowess of Northenshire PCT, they in their infinite thickness, think this is truly a great honour being bestowed on the local Politburo and a great honour as they are truly worthy but those of us who dare to think realize it is because Party Central wanted someone dumb enough to do it.

Hence Northernshire PCT was chosen because it is in the top twenty “world-class commissioning PCTs” which means if anything will fail it will fail here first on a “sink PCT”, sorry the correct term is a “spearhead” PCT, a lot of which are in the top 20 world class commissioning PCTs. Gross incompetence and inability under Za Nu Labour = success.

The body from the other commissariat was then allowed their 10 minutes of fame to explain that they would (without consent) extract data about patients to make the pilot “work”. This was interesting as the same department had not made a NHS clinical system work in over 3 years of trying but they have been well paid for their incompetence.

So at the end of this 30 minute presentation (after 20 minute set up time and 15 minutes waiting) for what we were told would be no more than an hour there then followed a Party stooge presenting the local Chief Commissar’s thoughts on what the financial situation would be over the next few years and how there would have to be clinical staff cuts but no management cuts as employing more Commissars was the way forward to save money.

Right. This took another 45 minutes and then the question and answer session followed.

After the 5 minutes waiting for the commissars most people found the ceiling to be slightly more interesting and motivating viewing than the presentation and it remained so throughout the meeting.

At the 2 hour stage (remember it was only meant to be an hour of our valuable time as the Party think GPs and their staff actually do not do anything useful) people started leaving for surgeries, clinics etc but not the commissars as they were still busy on the front line of healthcare sitting in a GP practice and clearly working very, very hard at doing nothing.

This meeting was a complete waste of time. It involves a “pilot” of a system to help patients use the NHS following a Department of Health initiative which means it is doomed for failure before it starts.

It appears to be a complete work avoidance program for nurses being trialled in Northernshire. It will involve them manning a phone line, sound familiar? A possible refinement or reworking of NHS reDirect?

After the meeting a few of the Resistance met up and discussed it before going on to do real work with real patients. All of us knew how to save money. It was so blinding obviously that only the Chief Commissar at the local Politburo could not see it.

But the Chief Commissar thought this “pilot” was the way forward but they were blinded by the incompetence that is NHS management which is a classic example of the Peter Principle.

Another successful Party sponsored meeting in General Practice. Lots of doctors and their staff’s time wasted, work disrupted all for absolutely nothing useful.

Praise be to the Party and all its wise local Chief Commissars for they see what we cannot see and believe it works. This is frighteningly worrying but they do at least have the Department of Health to guide them.

No wonder the Americans are worried re socialized medicine.

Why have quality care when you can replace it with crap? Thank God for a genuine world-class education to protect patients from incompetence. It is, however, very hard working daily in the face of gross institutionalized incompetence.

Can’t wait for the next one . . .