Monday, 21 November 2016

Frail Elderly.

Ah the NHS is struggling and it is not the fault of under investment, under manpower it is the increasing demands of an aging population who are now the frail elderly. What a complete load of crap spread by the appeaseniks of the BMA, RCGP et al most of whose august members are not on the front line for more than a session a week.
When we started many decades ago in Northernshire if you went to a busy Friday once a week branch surgery you might get between 3-7 patients. Now they are always full. Most people came in then with just one acute illness problem and if they had 3 separate problems that was commented upon then.
Yet people are now healthier, live longer and yet consult more up 24% more between 1998 and 2014 an increase of 1.5% per annum offset by a decrease in NHS funding for primary care from 11% some 5 years ago to less than 8% now. Ignore the GP Forward View funding that does not even restore the status quo 5 years ago.
The increased demand in the NHS is similar to the if you build more roads to relieve congestion people drive more just think Darzhole centres and NHS Dumb, Dumb, Dumb.
Roads are free and so is the health service and so are extended hours, 7 day working all of which result in the same increased demand for want but rarely if ever true medical need.
Take a typical “emergency” appointment which have become more and more common over the last 2-3 years:
1) I think I have a chest infection for I have been coughing for 15 minutes. No you don’t you have a minor viral upper respiratory tract infection that will get better in 3 weeks just like all those other family members that you told us about who had the same symptoms and got better after they consulted their GP, had no treatment so what is different about you other than this is a freebie? (3 minutes).
2) Oh, clear disappointment here at not having blagged an antibiotic, so then comes the while I am here can I collect my blood tests I had done because I was worried I was ill 6 months ago? (Actually 2 years ago but thanks for the disinformation and wasting our time searching for them).
Until now when I didn’t get what I wanted. All normal. I thought so because no one had bothered to contact me (no patient responsibility or self care agenda here). (3 minutes).
3) Clearly disappointed so on to the next old chestnut end of consultation favourite my partner/seventh cousin twice removed/employer said I ought to get this completely unchanging skin lesions of 20 years duration checked. And why did they suggest you do this because they had noticed a change? No because they told me to.
If you want a “check” for non-illness see your bank manager but those who do others bidding without thinking won’t get that. (3 minutes).
4) I think I might be stressed, I have a busy job, I work 24/7 and never stop can I have a sick note for I hate my job?
If you have time to think you are stressed then you are not. I am a doctor the fact that you hate your job is not my problem it is your life style choice and as such yours to fix.
Hating your job is not an illness in the same way that you don’t like your spouse, mother in law, house you live in etc. But please feel free to waste your doctor’s time discussing something we can do absolutely nothing about other than give you a sick note which you are not going to get because you are actually medically fit to work. (7 minutes).
5) While I am here can I collect my repeat prescription and also my children’s, and their children’s prescriptions it will save me so much time (but waste the most expensive part of general practices’ time but your time is precious see 4) above (3 minutes but an additional 45 seconds for each prescription to print using advanced NHS IT).
6) When I got up this morning I had a twinge in my knee when I put it to the floor. It was really painful for a fraction of a second and has not bothered me since and I went for my usual 3 mile fell run without any problems this morning. Can you tell me what that was it was so painful? No. (2 minutes).
7) I am planning a trip in a few months’ time what immunizations do I need? Am I at risk of the Zika virus in the Antarctic? (Ah the emergency I am going on a holiday which I have paid for appointment but this is a freebie). (2 minutes).
Well thank you for squeezing me in as an emergency. I don’t come here very often so I thought I would save them all up to save you busy doctors’ time (usual idiot NHS freeloader’s grin here) and a typical Friday afternoon something for the weekend crap emergency appointment. You can’t be too careful at 18:10 on a Friday when demanding an emergency appointment for all of the above as there are after all no doctors whatsoever for a whole weekend in the whole of the UK until late on Monday morning.
Repeat such retarded crap across a nation and then wonder why you as a patient cannot get to see a GP and patients usually spend the first 2 minutes of their appointment whining about this fact. It is not the frail elderly it is the retarded well whose only port of call when they have acute case of non copitis and are feeling pathetic and no-one wants to listen to them is to see their GP. True illness is conspicuous by its absence.
Praise be to the Party for ensuring that via socialized medicine no one with anything wrong with them will be denied access to a GP unless they are actually ill. GPs did once used to see illness now most of their workload is social and educational inadequacy that they cannot fix.
The NHS is increasingly the convenience store for those who don’t want to pay for coping and all Party’s sponsor this message but don’t fund it.

Tuesday, 25 October 2016

What is this man on?

One of the few things some of the team remember from grunt school psychiatry is that a delusion is a belief in the absence of reality and can be a sign of mental illness. So bearing this in mind what is a rational person to make of the great Hunto’s latest Pontification?
Clearly a man who reads learned texts like the Daily Mail for he believes that there are more than enough GPs in the UK all of whom struggle to fill their days with work and so he feels that he can help than do this by dumping yet more work onto them.
Just look at his arguments and implied facts:
1) The outpatient budget is about the same as the entire GP budget. GPs do 90% of healthcare in the UK for c. 8% of the budget c. 340 million consults a year compared with 85.6 million outpatient appointments. So the great Hunto expects a mere 25% increase in workload from a workforce struggling to cope with the day job?
2) The total cost if any to a patient for potentially a year’s worth of free access to a general practioner is £ 136 while the cheapest outpatient appointment is £ 69 for a one off follow up in dermatology. The most expensive single appointment is £ 324 for a first attendance at an infectious diseases clinic.
Will the money therefore follow the patient into general practice as a result? Clearly the day job won’t be so financially attractive and outpatient work will displace the day job so something has to give. The doctor won’t see you now for just over £ 20 for a normal GP appointment they have an urgent dermatology rash that has got better to see for £ 69. Curious number 69?
3) Hospitals are allowed to run at a £ 2 billion deficit but if GPs do so they go out of business in contrast to hospitals which are supported in their failings by the Party.
4) Hospitals get money per patient per attendance via the NHS Tariff which if GPs did would mean a very happy workforce for the harder they worked the richer they get but this system does not apply to GPs only hospitals. So Jeremy like every other Secretary of State before him thinks lets dump extra work on GPs for they are on block contracts and as such we just change their contract and don’t pay them anything else extra.
Remember comrades the concept of money following the patient within the NHS Internal Meerkat is strictly one way.
5) If work moves out of hospitals then so does money which could make deficits even worse although of course you could make the redundant hospital medical staff redundant as they would be left with nothing to do except that NHS employment is very well protected in terms of employment rights and this would not be cheap.
Once again the current Secretary of State has cracked the NHS nut with world-class efficiency savings (sorry comrades "gains) based on his limited view of the world via Oxford University’s political degree called PPE which is useless elsewhere in the real world.
Praise be to the Party for once again ensuring that the only qualification you need to run the NHS in the UK is no knowledge of the NHS at all.

Saturday, 15 October 2016

Now the Muppets really have taken Manhatten.

You have to admire a Royal College that lacks both ability, leadership and academic kudos for just look at this august body’s (corpse’s) latest wizzo wheeze. A College without a clue has produced “A wellbeing pack”. 
An initiative directed at GP trainee members of the college (sorry RCGP should that be “registrars” in your Chair of Associates in Training Committee’s quote in the article?), all of whom are bright enough to see through Royal College sh*te or chaff(ing) crap called reflection, e-retardfolios and probably are bright enough to realize that chocolate coins, teabags et al are mere baubles, beads and trinkets that are once again there to convince the muppets in charge that they know best (or more accurately know nothing). 
You have to admire a bunch of appeaseniks who have screwed up medical training for years for having come up with this outstanding idea for only they could think that teabags, a chocolate coin and a reflective colouring book would bring an end to the problems in general practice at present. 
The idea of a “gratitude journal” is beyond measure for it will probably be shorter than other such masterpieces read by those on high and in charge in their formative years such as One Exciting Thing to do in Inverness on a Dull Rainy Winter Solstice Day.
We suspect the only thing most frontline GPs will put in their “gratitude journal” is the weekends, holidays, time off sick and retirement as the shortage of GPs struggles to cope with an increasingly aggressive demand for urgent appointments for trivia which cannot be met at present.
Still as someone once said every little bit helps.
Yeah, right.
Praise be to the Party for giving us the RCGP whose contribution to educating and supporting GPs is beyond measure in their own humble retarded opinion. Ideas like this would have ended the Second World War long before those slightly brighter at Bletchley Park solved the Enigma code.




Saturday, 10 September 2016

Greedy bastards.


The Party is as ever all wise and believes in a fair day’s pay for a fair day’s work in all commercial organizations like the Houses' of Parliament, banks, stock brokers and the like and applies its free market principle to all and sundry with one notable exception which is the NHS.
A small piece of non news caught our eyes as it shows once again how greedy bastards are getting paid extra to do extra work something that would not happen in any other industry. Can you imagine asking a builder to work on a Saturday or a Sunday to finish a job on time because they were behind schedule? We are sure the conversation would go something like this:
“Comrade customer I am so very and truly sorry that we have not been able to finish the job on time but I will forego taking my children to the seaside this weekend and my summer holiday and I will work 168 hours a week to finish the job as agreed on time. It is a privilege and honour to work for you comrade customer and I shall not ask for any tea and biscuits or even money in case the need for food and drink and the toilet interferes with me working non stop”.
Now imagine a hard pressed comrade hospital commissar manager asking an idle hospital consultant who never works weekends if you believe a certain Jeremy Hunt to do the same.
The hard pressed consultant brushes their hair back and pulls a half smoked cigarette from behind an ear before taking a few stressed puffs from it after lighting up while looking worried and concerned at the comrade commissar’s request and shaking their head from side to side, tutting and tapping the ash from their cigarette before saying:
“That’s not gonna be cheap mate. It’s gonna cost you time and some mate. I can just about squeeze you in which ain’t gonna be easy because I’ve got more jobs on at the moment than I have comrades to work them and we are in a recession you know . . .”
So once again the press point out that market forces using the supply and demand curve mean that if there is a shortage of supply but increased demand then costs usually rise but this is verboten in the NHS “free” meerkat. Costs comrades should be zero regardless of demand for all who work in the NHS.
If you put the £ 350 million overtime into context with the overall spend and these are approximate figures from various sources then this represents about 16% of total consultant pay but remember comrades compare that with estimates of the total cost paid to all locum staff say £ 3.3 billion and for those on medical top dollar salaries £ 350 million is a small percentage of total agency spend (10.6%). And curiously the same cost of the alleged weekly benefit to the NHS from brexit so why is the BBC unhappy?

It means that full trained staff can be used to plug the gaps today rather than waiting for the Party to increase supply which will take at least 15 years if they recruited extra medical students today as demand on the NHS increases unabated. Or take the chance of possibly dodgy locum cover? (Before you start we are aware that locum staff have the same good, the bad and the ugly just as regular staff do). 

And did we also say that it costs 25 times more to fill locum posts than it does to have full time posts? Clearly the meerkat is working for the meerkat not the comrade patient.

And remember some highly trained professionals choose to work as locums for the following reasons:
1) better pay
2) choice of hours to suit family commitments
3) post retirement to top up pensions and do a job of pure clinical medicine they enjoyed without the Party add on of retardocracy that they hated and resented that went with the day job.
Still there is a solution and Jeremy knows how to do this. He will just change the contract. Perhaps the consultants will agree to the same contract as the BMA got for GPs in 2004 whereby the Party only has to “consult” about changing the “contract” each year and does not even to bother doing this now knowing that they can in true Soviet style enforce it. Maybe a consultant QOF too to make bugger all difference to patients’ healthcare other than “inviting” them back to consults for nothing more than to tick a retadocrat’s QOF box.?
We are sure the Party will want any extra consultant hours to be done for a no extra pay for extra hours clause in any new contract just like they did with GPs, junior doctors, lawyers, bankers, plumbers, builders and so on for comrades when it comes to exploitation of the NHS workforce in the NHS “meerkat” we are all in it together.
And Jeremy understands a contract as a voluntary agreement between two parties enforceable by law as a contract by Jeremy and for Jeremy take it or leave it using the concept of Party NHS “Choice”.
And interestingly the same news organization has no qualms about highly skilled operatives in a different profession that people pay for when they use it being paid a mere £ 220,000 a week after tax in contrast to the salaries commanded by consultants and GPs in healthcare.

That is the equivalent per week of the total annual earnings of 2 above average paid GPs per year total income BEFORE they have to paid their tax and after they have paid their staff and expenses.
Praise be to the Party for again once explaining to those in the NHS that extra work is to be done for no extra pay for they understand this for builders, footballers et al they pay for but the NHS is completely free at the point of abuse and should cost nothing extra for politicians to misuse it even more. Seven day working anyone?
You know it makes financial sense, simples?