Wasting medical time and a Happy New Year to all in Accident and Emergency this evening

There is a crime of wasting police time but not one of wasting NHS time. NHS time is free as is Police time but waste Police time and you could do time.

If you drink 8 pints and fall over and fall asleep in a corner and are disturbed by the Police, who are concerned for your welfare, and proceed to hit out at one of them you will be arrested, fined or even jailed.

However, if you drink the same 8 pints and fall over spraining your ankle and, after walking 2 miles home, go to sleep and then awake the next morning and decide that your ankle hurts you can then dial 999. You are then taken free to an A&E department and get an x-ray and are told there is nothing wrong with you even though you “thought you had broken your ankle” which you walked on for 2 miles under the influence the night before.

You can even assault the staff and probably get away with it due to the “zero tolerance” of the NHS as you were “poorly”, “under the influence” or “stressed” due to your (self inflicted) “illness” with a good lawyer provided by the legal aid scheme.

You can then demand an “emergency appointment” within 48 hours to ask for a sick note because “you were ill” = pissed and can’t work because you can’t walk on your sprained, but not broken, ankle for at least 3 weeks. And can I have some painkillers “ ’cos it really hurts”?

And this is all free.

This is not made up it is a genuine and frequently repeated scenario in frontline NHS care and this story is from 20 years ago and no different today.

8 pints at £2.40 a pint = £ 19.20.

Ambulance at £ 167.00 a shout.

A&E at £ 79.00 a time.

GP appointment for a sick note at £20.00. Painkillers around £ 7.00 a shout.

Costs to employer and benefits agency don’t know these costs with any degree of authority.

A cheap night out? Unless you are a taxpayer.

Is there not a case of if you drive under the influence of alcohol and get caught you get fined but if you drink and misuse the NHS you get away free?

Given the increasing taxation the Party is exerting why not have a “if you are over the drink drive limit you get charged for all your NHS treatment” policy?

Simple and cheap to administer. Like speed cameras it could deliver millions apart from the fact the NHS is free but drive a car and it is not free unless you are a joy rider. The NHS has millions of joy riders. They are called drunken patients.

ND as a junior grunt well remembers counting how many ill patients they saw in a busy city centre A&E on a Saturday night single handed and out of 30 patients only 3 were not due to alcohol. One had an unexplained painful blood clot in their mouth, one had a stroke and the other almost drowned due to heart failure. These were the ill ones out of the thirty.

The rest were just pissed but hey they had paid their taxes on their booze and fags but complained bitterly when ND had to treat genuine illness in between the drunks that were waiting (to go onto a night club with their drunken and abusive mates). This applies equally to the Police, Fire and Ambulance services at this time of year and most Friday and Saturday nights.

We at ND would like to wish our readers a happy New Year and know full well that whatever we say people will continue to abuse the health service because it is free.

Remember that those in the NHS whom you abuse so freely would also like to enjoy the New Year but a lot of them will not.

Because of you the patient and the Party all of whom will be on call this New Year as politicians are every year picking up the puke, the abuse and the ill and doing nothing about it while they enjoy themselves.

Happy New Year to most NHS workers you deserve it. The time wasters deserve a good financial kick up the proverbial backside.

Praise be to the Party and the NHS for 60 years of treating drunken abusive b*****ds free at the point of delivery of care. Nye Bevin would have been proud.

Now we all have to be NICE?

What inspired this piece is an article in the GP magazine Pulse:

http://www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4121395

where a Party organ has said that doctors must now follow NICE guidelines or face prosecution. An interesting phrase “guidelines” as the Shorter Oxford English Dictionary defines them as “a directing or standardizing principle laid down as a guide to procedure policy etc”. It would appear that if the Pulse article is correct that guidelines have now become a Party diktat.

A lot of doctors ignore NICE as they feel they are politically and economically driven rather than scientifically driven. In Northernshire they are opened, the front cover scanned and then binned by and large and reference made to a variety of other sources journals, books and colleagues opinions before deciding on a particular treatment.

This is called being a doctor. As a doctor, rather than a Party organ, one considers the various options and applying what one thinks is best for a particular patient and their condition. However the Party knows best and if this idea is followed through patients will have any “choice” of treatment as long as it is black and NICE.

An example from the ND’s past experience may illustrate how this ill conceived idea would work in practice.

When ND was in the military, ND was stationed at a hospital that took part in the ISIS2 trial looking at clot busting drugs for heart attack patients. The trial was stopped early because the use of clot busting drugs was so much better than the existing treatments.

The senior medical officers at the base read the results of the trial and decided that it might be a good idea to stop the trial and treat all heart attack patients with the clot busting drugs. They went to see the commanding office at the hospital who was also a doctor, not a manager, and presented their view that the hospital should change treatments and he agreed after a short meeting and a review of all the evidence.

Thus within days of a major scientific trial being published this particular military hospital was one of the first in the State to use clot busting drugs long before many other neighbouring civilian hospitals did. This treatment has been is use now for almost 20 years throughout the world.

This is an example of doctors acting independently, considering the research and coming to a considered opinion before changing treatment for the better.

Now let us look at what would happen if NICE was the only treatment. We know that NICE considers things at a pace slower than a crushed slug can move so it would take months or years for them even to consider new research. Even if it did consider new research it would look at the economics probably have a political slant all of which could mean that something that worked might not be approved because of cost or Party interference.

So the result would be that the Party would approve and ration drugs even more than at present and medical innovation would be stifled by the fear of prosecution.

The Party and its comrade commissar managers rarely learn from history. Someone has not told them that the Berlin Wall has come down, the Cold War has ended and Communism in Europe is virtually non existent. Someone hasn’t told them that once centralized Party driven control was removed from the Eastern Bloc then countries with some of the worst health care systems in the world have risen up the league tables while the increasing centralisation of the NHS is one reason that it has slipped down health care leagues to be almost bottom.

We implore anyone reading this to think carefully about what the effect of Nicentralization would be on the NHS’s ability to offer cutting edge health care. We suspect it would end it and set back NHS care years at a single political stroke.

Let us hope that our faith in democracy and reason will over come the Party’s ill thought out centrally dictated policies that will ultimately harm patients and deny them “choice”.

Praise be to the Party for Gordon’s Little Green Book knows best.

Seasons Greetings

To any one who has read this blog we thank you for taking the trouble.

We wish everyone regardless of race, creed, country, color and gender a Happy Festive season. Illness and death do not discriminate neither do we.

ND and the team.

Respect.

Branson states the bleeding obvious

BBC News has reported that Sir Richard Branson has told the government how to cure the MRSA crisis. Once again it is the staff who are the sole source of this infection and they should be screened and if found to be carriers be treated although not sent home.

Funny how 20 years ago we used to do that and send people home until they were clear but then that became too expensive.

What can one say but stating the bloody obvious is now headline news. And it has taken how long for this to surface? Perhaps Sir Richard has a degree of medical knowledge closer to him then those at the Department of Health?

Praise be to the Party and its manager for winning the war on MRSA.

NHS Rangers lead the Way # 3 MRSA to be defeated in Scotland

In the far North of Northernshire there is a minor province that thinks it is a country. It has the right to determine certain aspects of its own fate and also the god given right to screw up the rest of the UK’s fate as its MPs are allowed to vote on English issues but the reverse does not apply. It has also given us Gord the Holy (beyond all others than Mugabe) a fine product of their limited education system.

While out driving ND did hear that staff in this minor province are to face the sack for not washing their hands.

Praise be to the Party for this. We now know that Scotland will be free of hospital acquired infection for the Party there have realized that the only source of hospital acquired infection is the staff. Not the patients or their bowels or their skin. Not their clothing or their coughs or noses or faeces or urine. Not the visitors and anything brought in from outside. No the root cause of ALL hospital infection is the staff.

This is clearly the state of knowledge at both Party Central UK and Party Central Scotland.

Given that 60% of men and 40% of women do not wash their hands after going to the toilet then sacking staff for not washing their hands will surely rid hospitals of all infection. Remember that all of those non handwashers will touch a door handle or something else while visiting a hospital that you as a patient or visitor may then touch. You will have nothing to fear from these people as they are free from disease it is only hospital staff that carry disease.

According to the BBC, whom some do regard as a Party organ, a spokesman for the Scottish Health Secretary said “The Scottish Government is to introduce a “zero tolerance” regime on hand hygiene for hospital staff in January”.

Does that mean that Scotland will be the first place in the United Kingdom to ban hand washing completely?

The link is hereif you are interested:

http://news.bbc.co.uk/1/hi/scotland/7794479.stm

Once again the NHS Ranger Corps (Scotland) show us how to lead onto victory. By concentrating on the minor skirmishes which will achieve nothing bar a sound bite they miss what should be the main thrust on the war on hospital acquired infections, the root cause – themselves and their policies.

Praise be to the Northern Rangers.

So Gord has saved the World did he in doing so forget the NHS?

So Gord the Holy made a fluff of his lines when he claimed to have saved the world by spending billions of tax payers money on propping up a banking system that had failed while on his watch as Chancellor and more latterly as Prime Minister.

Does anyone recall the famous phrase used by Gord’s friend Tony about 11 and half years ago the famous you have “24 hours to save the NHS”?

Anyone else see the similarities between the two scenarios? Both the NHS and banking system have been set up by or supervised in the recent past by the current ruling Party and its organs. Both have required billions of extra funding paid for by the taxpayer in order to keep them going and possibly to improve them?

I cannot answer the question as to whether this money has been used efficiently and improved things but I am sure 60 million of the British public will have their view as to whether this money has been well spent as they will be paying for it for years to come regardless of which party is in power.

So Gord has saved the World but seems to have forgotten the NHS. He has “saved” the world in weeks but what has he, and his Party, done in the past 11.5 years to the NHS?

You know you have a Broadband problem when:

ND although artistic by nature still appreciates the use of broadband technology and we are lucky enough to be able to avoid it for most of our working lives for example when in surgery.

ND is equally unlucky enough to use NHS broadband whose speeds rarely exceed dial up connections but then this must be because ND is in the North and miles from London where the NHS exchange is and we all know the further from the exchange you are the slower the speed is (according to the multitude of engineers who cannot fix the problem of speed but are getting paid to do nothing at our expense).

Whilst Patricia Hewitt and many other Party members are profiting from the crap NHS broadband system ND uses it daily to tell us when there is a problem at home. It is one of NDs’ laws:

It states that when your home broadband is slower than your NHS N3 connection speed you have a major problem.

Praise be to the Party and their ever wise and profitable excursion into IT. By providing so much to so few at huge costs to everyone bar themselves they have denied most to those that might be able to use it.

NHS Dentistry the Government reacts

After several years in power and changing NHS dentistry contracts it has been announced that there will be a review of NHS dentistry.

We at ND wonder how long this will take and what its conclusions will be?

Surely the truth as to who has created this mess is self evident to all apart from those ordering the review?

We await its august findings (next spring) with interest but doubt it will decrease our increased dental workload in general practice or in A&E. We do note that the review is being lead by a dentist. Surely that is a mistake? Would not a physiotherapist be better qualified in the same way that a surgeon can reform general practice?

NHS Rangers lead the Way - the War on MRSA #2

Another great tactic in the war on MRSA is copied from the Royal Navy but applied in disguise.

Grog was a mixture of rum and water issued on a daily basis to the Royal Navy for many years in order to improve sailors’ health and wellbeing.

For some unknown reason for centuries NHS staff have never washed their hands especially those who walk from the dissecting rooms and into the New Labour ward and so in an effort to encourage them to do so the NHS Ranger corps has placed Grog bottles at the bottom of every bed and at the entrances to wards and even attached them to nursing staff in devices called hip flasks.

This contains an alcoholic mixture of up to 20 % by volume which some patients find a very good source of free alcohol especially if you can get a 350ml bottle. Patients do not see the hygiene advantages of Grog but due to a trick of hospital fluorescent light will often see the 3 bottles of Grog on the left as something else (the 3 bottles on the right) in the above picture.

Grog is often placed in dispensers at the entrance to wards called optics (pictured bottom left) commonly seen behind bars in pubs (pictured bottom right for non UK readers) where the public avidly approach them to obtain relief from their worldly worries but in hospitals they are frequently ignored by visitors or empty due to theft as they do not look the same as the ones in pubs.

Grog - winning the war on MRSA and a lot more expensive than soap and water and hand washing.

Lead on NHS Rangers.

PS if you see the 3 bottles on the left the same as the ones on the right you may need help so please ring NHS Direct for urgent assistance but they cannot provide Grog (or medical care).

A public health message for our reader from the NHS Ranger corps.

NHS Treatment of Patients: the Shotgun approach (Drs) vs the finely honed NHS Manager Sniper. Your life in their hands.

Patient: I am bleeding from my arse I think I have piles . . .

Doctor: You may have piles but after examining you I am concerned you may have cancer. I would like to arrange some more tests to make sure that you haven’t . . .

Manager: you do not have cancer as it costs too much to investigate so we will send you to a complimentary therapist who is an expert in colonic irrigation and can decide if you have a cancer as they have never seen it or operated on one but they are cheap.

NorthernDoc’s scientific team had the misfortune to go to a meeting with certain paid up members of the Party. These were all less qualified and experienced in the field under discussion than NorthernDoc but as a result have power.

One of them repeatedly claimed to be a “clinician” which is defined by the Shorter Oxford Dictionary as “a clinical investigator; now, a doctor having direct contact with and responsibility for patients”.

The alleged “clinician” was in fact a jumped up alternative or complimentary therapist with the title “consultant” which can be obtained faster in non medical professions than a doctor can qualify as it is a cheap meaningless title and used to be termed a “senior” complimentary therapist which is more accurate.

This was to “sell” the local Politburo idea that Drs are expensive and quality health care is cheap especially if the managers organise it. The upshot was that the local comrade commissar managers had seen a statistic and decided to bugger up loads of peoples’ lives based on the bottom line (cost).

Why?

When you start in medicine you feel that you know everything and believe that what you are told in medical school for example bleeding from the back passage is something serious. As you get more experience you realise that yes it might well be and you should investigate it thoroughly for you cannot tell that it isn’t something nasty until you have done so.

Medicine is not a snipers rifle it is more often than not a shotgun. As a good doctor you should refer to a specialist in order to exclude this small but life curtailing possibility. This may seem like shooting a shotgun and potentially hitting nothing but you have to fire the gun (refer) in order to chance hitting a target but know that more often than not that you will miss.

Doctors unfortunately (or fortunately?) miss more often than they hit but then that is because they try to be safe. If you do not look then you will not find.

Unfortunately NHS mangers eye sight and general health and ability would disqualify them from any active military or otherwise useful service to the country.

They assume that if out of a 100% of people referred to say a surgeon only 25% need an operation then 75% of the 100% do not need to see (an expensive) surgeon or even be referred in the first place. They need to see an alternative practitioner who based on their less extensive and much cheaper experience (which involves no assessment as to who might, or might not, need an operation as they cannot operate) can save money (but not lives).

NHS managers are therefore the elite snipers of the NHS.

For they “see” what the thick overpaid doctors “miss” namely the result of medical investigation not the clinical suspicion. They are so much better at treating patients as they failed to get anywhere near a medical school. They see that 75% of referrals need no (expensive) treatment and therefore are a waste of time and more importantly money.

Unfortunately like a sniper they miss what is going on outside the snipers sight (the 100% who might just possibly be ill) that some of the patients are actually ill and will be missed by complimentary therapists who have never dealt with ill patients who need surgery.

If you therefore work on the management assumption that 75% of GP referrals are crap then it makes sense to refer all GP (100%) referrals to see the “alternative therapists” as they are cheaper but unfortunately and unbeknown to managers are thicker than themselves and would miss the 25% that need surgery.

Why? Because the alternative therapists have only ever seen the 75% that DON’T need surgery but they have never seen the 25% of people THAT DO NEED SURGERY.

Therefore a thick manager can decide that a patient who has seen a doctor who has decided that there may be a chance (1 in 4) of something nasty that needs to be excluded then the manager who has not seen the person can exclude the 1in 4 possibility of something serious by using the Party Centrals means of control called Choose and Book.

Because all referrals are mandated to be sent via Choose and Book instead of the referral letters being screened by consultants they are now screened by complimentary therapists a few of whom are “consultants”. In other words when a GP in Northernshire asks for a more qualified and experienced opinion (which we used to get when real consultants read the letters) we now get a complimentary therapists’ opinion who has less experience than the referring GP.

Result? Patients who are ill and need surgery are subjected to unnecessary and painful complimentary therapy while getting worse until usually after weeks the therapist realizes there is something wrong and asks for a surgeon to see them which the GP already had done several weeks earlier, or the patient is so peed off that he comes back and asks for a referral to a real consultant (which we had asked for in the first place).

Ergo management thinks that the scum known as GPs refer 100% of patients in order to only get 25% operated on and so complimentary therapy (which is cheap and thick) is the way forward.

If you are in pain and there is a lasting solution that may be achieved by surgery I suspect that most people in pain would consider the option of surgery.

But this costs and requires an opinion of a surgeon who may be able to help you IF there is an option. Managers who are all wise as organs of the Party know better and so you are denied this option (unless you have private insurance as do those who work for Connecting for Health.)

Once again Praise be to the Party for they are all wise. And NorthenDocs are thick.

Eh up luv is tha doing a Gordon surgery or somemit else?

One of the team read with interest the Jobbing Doctor’s blog of their posse’s description of the extra hours for no pay that Gord the Holy, beyond all others than Mugabe, feels must be inflicted on GPs as penance for their sin of doing the contract.

Knowing that the next day NDs’ artistic member was due to do a “Gordon surgery” in a PCT building with no heating after a long and sub zero drive to work in the frozen North starting at 07.30hrs with 3 unfilled appointments at 10 minutes each then do a day on call until 18.30hrs with no heating this team member did say that they would be doing “an extra Brown shift that f**king day for no extra f**king cash but paying a f**king fortune for extra childcare”.

While we at ND do not condone the use of expletives we do note that the phrase “extra Brown shift” could, with the removal of a letter or the use of a silent f, become a phrase that could summarize a lot of current health policy being dumped on general practice.

Praise be to the Party and the ever changing English language.

Practice Based Commissioning (PBC) and Practice Based Commissioning (PBC)

Many of NDs’ team have wasted hours over PBC and were heartened to read that the Kings Fund have decided that PBC is not working. We had realized that after a month of meetings but then we are only Drs not the Party who are all knowing and wise in healthcare matters. We therefore present this explanation as to why PBC has failed:

One of our glorious leaders great ideas was to reintroduce the flawed idea of fund holding introduced by the Conservatives a few years ago. This was basically the idea that you give each practice a budget to spend on their patients and hopefully reduce costs. Fund holding didn’t work because it costs loads to administer and hospitals fixed prices. Unlike supermarkets that can reduce costs simply because if you don’t shop there they don’t earn money the NHS is free at the point of purchase.

In other words if the punter don’t pay they don’t care what sh*te they buy = NHS as it is free. Go to a free drinks promotion or where someone pays for the bar and you will see what I mean - needless consumption of things you might not otherwise consume. Look at a suddenly empty shelf in a supermarket and ask why it has suddenly emptied since last time – hint look at the price reduction or 2 for 1 promotion compared with last time. So competition can never work in the NHS as there is no market as punters turn up knowing they can waste professionals time for free but politicians think otherwise as they are intellectuals.
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However because of New Labour who, as true socialists believes that the consumer, not the Party, is king we now have PBC as the New Labour answer to health care inequalities but suffers from one fundamental flaw. What is it?

We know it is not fund holding because the Party tell us that it is not and do not give practices money to spend but they have to earn it by saving the Party money. However there is PBC and PBC. What is the difference?

PBC 1 (the 1 will help us at ND who are thick to work out which PBC is PBC) is where the local Politburo wants GPs to do extra work in order to save money by asking them to do the local hospital’s work. So if a GP does a hip replacement at his surgery the PCT will pay him under £20 (under the local Politburo PBC plans) and save the £5305 it would pay the hospital.

This is where the local Politburo “commissions” = PBCs the GP to do the work to save them money. We all know this will work because GPs are spending too much time on the golf course and not enough time banging in hips or doing triple bypasses all of which they learnt to do in their 3 years of what is now called “specialist training”.

The second version of PBC, PBC 2, is the idea where groups of GPs come together and try to improve the services that the Politburo and its’ wise managers have designed for their patients. Now this in theory might be a good idea as GPs will know which patients are waiting longer for what procedure as their patients moan on to them (not managers). They also know the good and bad hospital doctors and what needs to be done to improve the current systems. In this case the GPs would “commission” = PBC the service on behalf of the patients and hopefully influence its design.

However this idea has many failures the main one being that it would cost the local Politburos’ to run it as anyone knows that quality costs which is at odds with the core current NHS philosophy that the NHS is “care on the cheap”. It is therefore doomed to failure as the Party will not give money to people who might do things better than the comrade commissar managers who have so successfully run the health service for so long.

PBC 1 = secondary care decommissioning or dump it on the GPs to save costs which is after all the whole point of PBC.

PBC 2 could mean GPs in touch with what their patients’ need being able to purchase and even improve things for their patients. This however is not allowed as the Party and its managers know best and have done so for years. So PBC 1 is the only version of PBC that is allowed and so if you look at the force diagram above you can see that PBC is going nowhere fast as doctors and managers are looking at the same problem from different directions.

Confused? So are GPs in Northernshire who have spent hours sitting on their arses listening to fat managers giving presentations from NHS plc Party Central corporate laptops on PBC 1 while asking GPs how they should be saving the NHS money (or doing PBC 2) but not wanting to pay anything to “facilitate the process”.

Here are two examples from one part of the world of Northernshire of PBC 1 at work:

PBC 1 wants to reduce GPs orthopaedic referrals by 25%.

The Party and the local Politburo have increased orthopaedic consultant numbers by 200% as well as purchasing extra, but underused (because it is crap), orthopaedic capacity from the white elephant called ISTC (Independent Sector Treatment Centres) but GP levels are unchanged over 10 years in the one of the most under doctored areas in the country.

So having spent a fortune to increase capacity joined up NHS thinking says lets not use it but increase work for those already under resourced.

Another example is that despite there being “choice” offered where there was none by the Party the local Politburo commissar managers think (oxymoron we thinks there) that too many patients are going to A&E and feel that if GPs have a word with their patients this would stop the flow of (expensive) patients to A&E.

We know that will work don’t we? “I think I am having a heart attack but my GP said I shouldn’t go to A&E as it is too expensive so I will die instead”.

Where do they get the managers to think up this crap from?

PBC another great Party failure going nowhere fast but it will soon be “worldclass commissioning”.

Whatever that is.
Praise be to the Party.

NHS Announces the Biggest email spam experiment in the history of the Internet - Behold the “Communicator”.

"Its email Jim but not as we know it"

One of NDs’ number has been off for a trip across the pond and indulged in some fine R&R events like putting a few rounds into pictures of NHS administrators and returned to find in their in tray an article on the latest NHS improvement to NHS GP access. The source is the Pulse magazine link is here:

http://www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4121138

Of course none of the idiots that run the NHS realize that the basic problem with access is that we don’t have enough Drs (because they cost) but ideas are cheap so they are full of them along with certain brown smelly stuff that does not help patients and is best sent down to the local sewerage works which does more for public health than any NHS manager can ever do.

The NHS communicator is another wonderful idea from the Connecting for Health team who clearly are building on the other “successes” of the NHS IT system. A lot of the ND team gave up using NHS email over 18 months ago when following an “upgrade” the whole local system crashed and needed to be reconfigured for those sad enough to use it. The team has managed without NHS email for this long because it has acted as a huge spam magnet.

Now this is not the spam of various individuals offering cut price Viagra or counterfeiters or fraudsters it was the spam of NHS management. No longer do we have to log on and wait for up to 5 minutes a day to access the system before having to then down load spam city Arizona of crap like “Matron X will not be into work as she is having her legs waxed but will be available tomorrow but in the mean time contact her 15 deputies” all of whom then send messages saying that they will not be available and so contact the following. All of these messages were carbon copied (cc) to the deputies and then sent to everyone on Northernshire Politburo’s address book -sometimes 5 times. One of NDs’ new team members was given a new NHS email account and had 2500 messages on it immediately and this was all just from NHS staff.

So the new communicator will allow greater access to GPs on a “voluntary” basis. Any one out there bright enough to see where this might be leading?

As it is “voluntary” it will be included in “access targets” and GPs trying to avoid crap will lose money.

Those who use it will be opening the biggest Pandora’s box of spam they have ever encountered as patients will be less selective in their abuse of email than managers.

Still there may be some restrictions on this as the local Politburo imposed a 1Mb file attachment size on their email system due to “abuse” of sending pictures so at least we might be spared 20 13Mb photographs from Tony on the dole in Thailand asking his Dr in the UK what this strange tropical rash might be after sleeping one night in a strange bed because he can’t be bothered to pay a local doctor to look at it but would also like an urgent appointment the minute his plane touches down in 4 weeks time. Taken on his Canon D1 camera and sent from his iPhone and while I am on line can I order a repeat prescription, get some free condoms sent over, sick note for the next 6 months etc etc.

Now fellow resistance fighters the Party have started the biggest government sponsored spamming exercise in history. And it is coming your way soon. Let those who have no drug reps, financial advisers or other shady dealers on their lists sleep soundly. Otherwise be prepared for the tsunami of spam slowly building in an ocean near your communicator inbox.

Praise be to the Party and their stupid ideas that will deny healthcare through misguided attempts at technology that they do not understand but do profit handsomely by. 60% increase in IT budget to improve connections by BT anyone? Could this be the reason?

NHS Efficiency

ND’s team is getting increasingly bored in surgery which is in part why the team have taken to blogging after many hours of reading other more established bloggers. But hang on we hear you say, how come you have so much time to do these things after all the health service “reforms” and “efficiency savings” that have been achieved?

A recent statistic shows that each year the NHS becomes 2% less efficient. Someone put it that if the Party spends £1 this year on the NHS then next year that £1 is worth 98p in terms of what it buys from the NHS and so on year on year.

Why is this so?

Well let us look at some of the reforms that the new General Medical Services contract has inflicted on one of the two front lines of the NHS = General Practice. Let us look at GP appointments and access.

Our last glorious Party leader Tony, currently struggling through the economic crises on a true socialist income of £12,000,000 a year lecturing to Americans wanted people to have access to a GP in 48 hours as all good but, paying, Americans do have?

Remember the famous “why can’t I see my GP with a booked appointment?” incident?

This hand bagging of a Prime Minister who is happy to inflict his policies on his people without knowing its impact on the front line is so typical of NHS reform and a direct result of a centrally imposed target driven culture driven by people who have never worked in healthcare. In order to get everyone seen within 48 hours some surgeries had to scrap booked appointments because of demand or lose money.

At ND Central we used to have a mix of pre booked appointments and a daily “emergency” surgery where patients were given a card and told that this was for acute illness not for things like sick notes, medication reviews, follow ups, getting results etc. We had a degree of control over what an “emergency” was.

ND Central after a couple of years also introduced ten minute appointments for purely financial reasons as despite Party Central hype income was falling. Under the rules patients could come in with any crap not with acute illness just ring up and get an appointment no questions asked. Therefore there was no control on demand. And the effect of this was?

A direct reduction in General Practice efficiency due to Party Central. Why?

The Party “working day” for a GP is 10.5 hours from 08.00hrs -18.30hrs = 52.5 hours for a five day week vs the European working time directive that the Party has signed up to of 48 hours per week.

Suppose that you could see 24 patients in 3 hours under the old system. This would give you a morning and evening surgery of 3 hours each with a gap in between of some 4.5 hours where you could fit in visits, paperwork, meetings, clinics, sign several 100 prescriptions, read hospital consultant letters, answer phone calls, supervise trainee doctors etc.

Apply ten minutes appointment to 24 patients and you get two 4 hour surgeries a day and a gap in the middle of 2.5 hours. So in order to meet the Party target you have increased the time to see the same number of patients and decreased the time available for other GP jobs unless of course you increase your working day by 2 hours (and your week to 62.5 hours) that you would not get paid for. (However Government is holy and does not believe in contracts and feels that increasing GPs' working hours without pay is an OK thing to do.)

Now doctors are human. They have families and outside interests and like a little R&R. They also get bored sitting down for 4 hours and this increases the risks of DVT by doing a trans Atlantic flight every day of the week. So after much discussion the ND team decided that 3 hours was the most it could stand and so we reduced the numbers seen to fit two 3 hour slots and not reduce the other minor things that GPs do in between surgeries that do not count towards Party tick boxes.

(Numbers used are for example not actual before the local Politburo Stasis’ start sniffing and to make the mathematics easier for any innumerate Stasi snoops reading).

Thus we are spending more time and meeting a target but doing less work as a result. If someone comes in for a simple sick note this might take 2-3 minutes leaving 7 minutes spare per appointment. If this is repeated several times a surgery then there is a hell of a lot of (unpredictable) spare time but not time that can be applied to complex tasks.

A good example of this was the first extended hours surgery the ND team did which was 4 hours long and of that 1 hour and 55 minutes was spent waiting for patients. Last extended hours surgery was 3 hrs 40 minutes of “booked” appointments with only 1 hr 46 minutes working. So a GP was waiting, not working, the best part of 2 hours on a political whim.

This is what happens when the Party Central imposes targets that have to be met so Doctors and their staff get paid. Local flexibility and doctors’ knowledge are over ridden by the superior knowledge of the Party. The end result?

A decrease in efficiency.

ND suspects that they must be using British Leyland as their model for running the health service efficiently. Maxi or Micra anyone?

So if you can’t get a GP appointment do not blame the receptionist blame the Party for they set the rules. GPs only play by them.

Praise be to the Party.

NHS Rangers leading the way - the War on MRSA #1.

NothernDoc starts with this earth sh*ttering idea from one of the most renown leading “teaching hospitals foundation trusts” in Northshire.

To stop MRSA it is simple . . . .

Get your staff, all 3000 of them, to sign for the fact that “they can wash their hands”.

Brilliant Simple Cheap Ineffective almost scientific who needs Einstein just a Modern Matron, a few managers and an infection control committee.

Imagine if as a consultant surgeon (old school of training) you have done 5 years of medical school, a year as a house officer, up to 4 years as a senior house officer, 4 years as a registrar, 4 years as a senior registrar possibly a post graduate degree as well as passing the Fellow College of Royal Surgeons (FRCS) exam and oh yes during this minimum of 18 years of training you might just have had to scrub up at least once to go into an operating theatre on the odd occasion.

What a brilliant idea! MRSA cured in a stroke.

Some more pieces of revolutionary health care coming soon in the NHS management drive for more paper not patient initiatives (paper is after all cheaper than patients):

I can wipe my own bottom
I can do my own bra strap/fly up
I can print X for my signature
I can flush a toilet

5 simple cheap ideas at 3000 pieces of paper per idea = MRSA defeated with 30 reams of paper in one Trust alone.

Rangers lead on to victory.

Education, Education, Education unless you can’t afford the co-payment

ND is still a grunt. ND has worked his way up through the ranks and is proud that ND has done so. ND is now in the privileged position of being able to teach medical students and junior doctors at various stages of their training. ND enjoys this as it is a rewarding two way process. ND teaches them and they teach ND in the new ways of medicine.

Over the many years ND has seen many students from many different backgrounds from many different nationalities and all have been bright and enthusiastic. ND did not come from a privileged background and managed through hard work and ingenuity to break even at the end of medical school. Statistically ND should not have got where ND did. ND relates to the students who say that “I am the first of my family to get to University” or “I am from a working class family”.

One of the biggest complaints from NDs’ students is that of money. Our new Drs are leaving medical school with thousands of pounds of debt before they start to earn. Anyone in general practice knows what debt does to people. It is not nice. NDs’ team are sympathetic and will often allow students a little lea way from a 10 hour day to catch trains early so that they can get back to jobs to fund their education. This is very much the American way but not the traditional UK method of medical training.

Education, Education, Education was a catch phrase of our former Prime Minister and is entirely justified and a noble aspiration. ND believes that a meritocracy where the best, regardless of background, are trained to achieve the best in whatever they are good at is a noble ideal. This should, ideally, be provided for by the State in order to help the State, and its people, further as those that benefit from it will ultimately repay the State via taxation.

The previous Labour administration had maintenance grants which were abolished under subsequent administrations. Now students have a variety of sources of funding to help them on their way. Medical education is now very expensive for students and their families.

ND was not pleased to hear on the radio as ND drove through the dark wilds of Northernshire that the Party are reducing student funding due to their miscalculation. This will only have one effect.

It will reduce the variety of people applying to do medicine. Those who are able, but not affluent, will be put off. This will increase the selection of those going to medical school and further limit medicine to the able and affluent and thus reduce the variety of characters becoming Drs and deny opportunity to talented but not affluent people.

A few days ago a former deputy Prime Minister was bemoaning the fact that 7% of the population who go through private education get 80% of the top jobs because of money. I am sure that he will be pleased that those who go onto higher education particularly medical school will now have to be increasingly affluent rather than able.

ND does not think this is a good move and it would seem easier to get to and through medical school a few years ago coming from a less affluent background than it is now. This is not progress it is a slow return to an old world that was not necessarily a better one in terms of fostering talent and advancing people through education. ND and family all benefited from educational opportunity but looking at today’s times and opportunities doubt that they could have achieved what they did in the past today.

That is not progress it is preservation of the ancien regime by the Party many of whose children will be in the 7% going through private education. George Orwell was right about matters porcine and these things many years ago.

How little have we progressed and how far backward are we going?

NHS Direct and Walk In centres.

NorthernDoc has seen figures saying that it costs £20 for a GP consultation £25 for a NHS Direct phone call and £34 for a Walk In centre consultation.

What do you get for £25 from NHS Direct “consultation”?

Below is a standard NHS Direct consultation - top secret - because if you dare to criticise one of the comrade nurse commissar’s actions (or rather inaction) then it is covered by “confidentially”.

“We can’t tell you what the comrade nurse commissar said as that would breach patient confidentiality”. NHS Direct is therefore perfect as a Party organ as it is completely unaccountable.

Caller: I have a problem.

Nurse commissar: Greetings comrade patient I will ask you a series of questions regarding your problem . . . .

20 minutes later and with lots of boxes ticked on the computer screen (so justifying Party and NHS Direct efficiency).

Nurse commissar: Thank you comrade patient caller. I do not know what is wrong with you so go and see your GP or local A&E department within 4 hours as it is clearly urgent even if you have had for 5 weeks and it is getting better because the comrade computer says yes so.

(The same process occurs at NHS Walk In centres.)

Caller: Thank you I feel so much better. I do not know what is wrong with me (or my child/grandma/other relative) so I will go and be abusive to my GP’s receptionist/A&E receptionist and demand an urgent appointment because the Nurse commissar at NHS Direct or Walk In centre has told me to do so.

Patients get wise to this and use NHS Direct or Walk In centres to get, or attempt to get appointments or visits, using NHS Direct as an American Express card to access health care “that’ll do nicely you can have an appointment/visit because a nurse ‘pratitioner’ on a telephone said so”.

Anybody done the maths as to which is the cheapest?

GP consultation £20 Problem sorted or referred on (appropriately)

NHS Direct £25 + £20 for follow up GP consultation
or + £73 A&E attendance.

Walk In centre £34 + £20 for follow up GP consultation
or + £73 A&E attendance.

Another great use of NHS money and resources?

Dare NorthernDoc say Not?

Taking nursing staff away from front line nursing to man NHS Direct wastes patient and nurse time to achieve nothing and adds to GPs’ or Accident and Emergency Departments’ workload.

NorthernDoc gave NHS Direct’s software the symptoms of a simple viral infection that affects a quarter of us per year and needs no treatment. 2 minutes for a GP 15 minutes on the computer and guess what?

Told to see GP urgently within 4 hours.

Jobs a good un comrades.

NHS Direct = Direct to GP or A&E

NHS Wa*k In centres = Walk into A&E or GPs.

Do what they say they but completely and utterly devoid of medicine. Use if you are thick and at your peril.

Praise be to the Party for they are all wise regarding quality healthcare.

PS I notice that the Witch Doctor has highlighted this issue in her post in the recent past. Sorry for the duplication but had been working on this one for a bit so thought would chuck into the ring. The more the merrier.

Consultant Nurses

Nurse consultants. What a great idea give a nurse a degree in 3 years that used to be a RGN qualification and then call them a consultant because you can use them to follow up patients cheaper than a real medical consultant can.

ND’s most recent encounter with an alleged (nurse) consultant came after reading the idiot consultant commissar’s letter advising us what to do and a subsequent visit request by the patient as the nurse consultant said this should happen as she was a consultant. This resulted in a phone call to the comrade nurse consultant which went something like this:

Consultant nurse commissar: I think this patient needs to be on digoxin for their heart failure.

ND: Why?

CNC: They have an irregular pulse

ND: Which they have had for years and seen several consultant cardiologists who have been happy with the patient’s treatment so why do they need this drug?

CNC: It is in the protocol

ND: Is that the same protocol that all the consultants have used but based on their experience have decided not to use this drug? Any reason why we should start it now? Has the patient changed?

CNC: It is in the protocol

ND: Has the patients conditioned worsened (no it is the same)? Have you done a recent ECG (no it was 2 years ago) a recent echocardiogram (no it was 2 years ago) have you checked their kidney function and potassium (no it was 2 years) and you want to start Digoxin without any of these tests? So why does the patient need Digoxin?

CNC: It is in the protocol

You can see where that conversation went = nowhere. Even our unqualified medical students could have done better.

If Northern Doc had done what this alleged (nurse) consultant had done and not done the basic tests above as a junior Dr in the UK ND would have been killed. Done that in the USA ND would be an invisible corpse in a swamp.

Outcome? No change in the patient’s treatment but loads and loads and loads of unnecessary work for already over stretched (doctor) consultants and GPs. But not nurse consultants who can probably count their patients on a three fingered hand and those they make a difference to on a digit less hand.

Praise be to the Party and the new dumbed down “consultants” who make sod all difference to patients but generate lots of unnecessary work for other professionals.

NHS Rangers leading the way

With apologies to any colleagues in the US and UK armed forces for using this analogy and terminology but ND feels that certain aspects of the current NHS way on healthcare need to be drawn to the public’s attention as examples of excellence to be promoted through the health care community.

ND has decided that certain “beacon” health care projects and initiatives will now be highlighted by the “NHS Rangers lead the Way” tag on subsequent posts.

This may be a regular or episodic series depending on the ability of those involved and how much of their excellence filters through to us at ND given that most it is carried on in secret due to its highly technical nature.

Remember that words are cheap but quality healthcare costs.

NHS Rangers lead on to the way to excellence.

P.S. NHS Northern “Ranger units” are all the managers and modern matrons and their various management meetings that aim to win the war on whatever the war is against this week.

They are all highly trained, fit and use all the highest tech means available to this elite unit of the NHS - the Rangers. They are heavily supported by teams of sign painters, printers, badge makers and creative consultants. Not normally photographed on active service they have allowed ND an exclusive photograph of some of their number on exercise. Their idents with few exceptions are top secret.

Some of their ideas are cutting edge killing machines and must be regarded as highly classified.

You have been warned soldiers now eat 10 chocolate digestives finish those 2 chocolate eclairs and drink that coffee double time. Hit the dirt, pick up that heavy laptop, grab the power point presentation and memory stick and move out we have another meeting to go to.

NHS Computing and the 12 rules of NHS management a case study

If you read the above and have an IQ greater than the Party then you will see a pattern here with health policies. Let us use Choose and Book (C&B) as an example.

Rule 1) If there is no problem make one

There has never problem with GPs referring to anywhere until Comrades Gordon and Tony (G&T) decided that there was a problem = no choice. Anyone who has worked in the NHS for all the years that comrades Blair and Brown have done would know that there has always been a choice but G&T based on their vast experience of healthcare decided they had to introduce choice to replace that which was there in the first place.

The only restrictor of choice was, and still is, NHS management and government not NHS doctors. So Choose and Book was a solution to a problem that was never ever there for either patients or doctors. It therefore fulfils the first rule par excellence.

Rule 2) If it is simple make it complicated

In the before G&T “Choice” days GPs used to send letters to their consultant colleagues with what was wrong with their patients and which consultant they as GPs felt their patients should see. The consultants read the letter decided if the referral was appropriate and then arranged for a letter to be sent out to the patient with an appointment or sent the letter to the correct consultant.

Now this simple process has been made complicated. Instead of a secretary typing a letter putting in an envelope and sending to a consultant for their consideration the following extra “enhanced service” has been produced.

Letter goes to a “referral management centre” RMC where, instead of referring up to a more specialized and qualified individual (a consultant), it is passed to a clerk or alternative therapist. The patient, instead of receiving a letter with an appointment, now gets a letter with an appointment to ring a call centre to be told what “choice” they have. This “choice” is determined by the local Politburo who use RMCs to restrict choice. Instead of one letter it is now one letter, a phone call and maybe many, many more of both (this is an abridged a summary of 3 pages of A4 as to what can happen for a simple Choose and Book referral).

For the elderly this is extremely confusing. C&B is now a choke for if there are no appointments on the C&B system (because of the 18 week rule) then patients are told to ring again to a call centre (several times) before being told to ask for another referral from their GP. If you don’t get an appointment you don’t appear on a waiting list and so the 18 week rule is achieved using Choose and Book.

Rule 3) If you can’t find a solution have another meeting

Choose and Book = meetings meetings meetings meetings meetings and over time the Gods of C&B cease to talk to those that identify the many problems. This leads to more meetings to find out why no one talks to those having meetings from which they are excluded.

And so the cycle repeats and achieves nothing but more meetings.

Rule 4) If other meetings don’t work employ more managers

More managers have to be employed to sort this simple problem out. Rule 4 is simple it is the way of the health service and a growth industry with zero return.

Rule 5) Do not involve anyone with ability as they might come up with the solution and put you out of a job

Drs used to get asked for their opinions but do not now go to meetings unless they are brain dead or like to avoid patients. Even the people who the C&B system was designed for Drs, the secretaries in surgeries and clerks in out patients, have not been invited to meetings for months as they dared to criticise and interrupt the local C&B commissars pre written answers to their questions which they were not allowed to ask.

So the managers who never use C&B for they never see patients drive C&B forward. Ever onward and downward.

Rule 6) If you fail you will be promoted. If you are not, set up a consultancy (see 7)

Many idiots who have failed to deliver even basic working IT systems at a local level have been promoted due to their failures. Bit like a pilot who crashes their paper dart being allowed to fly the space shuttle. NHS IT is full of failed rocket scientists who the private sector would not touch with a barge pole. Makes sense and explains a lot does it not?

Rule 7) If 1-6 do not work employ management consultants (not consultants see rule 5).

Due to the fact that NHS managers are thick this has to happen. Who do they employ who knows anything about the NHS problem they have created? They employ their thick friends indirectly. The thick failures set up as management consultants and tout their “alleged” experience in the NHS to the private sector who use them to milk the political gravy train. Commercial and successful companies pull out. We get the dross.

Rule 8) All new policies must generate extra work for all involved to achieve the same goal or ideally less.

Anybody using Choose and Book seen their workload reduced? Just ask how many doctors use it because it saves them so much time? Ask their secretaries which was easiest to use the old paper based system or the new system?

Ask hospital consultants how it has doubled their workload in some departments because the wrong patients turn up at the wrong clinic and how much extra paper work has been generated at the hospital end for clerks?

If you can’t refer to a particular department you now send a letter (even ‘though all referrals must go electronically) with a covering letter saying why you are sending a letter because the electronic system did not work. If you don’t send the second letter the referral will bounce because it has not been sent electronically.

Rule 9) If a change is unpopular tell them you are re-applying for your job or change your job title and tell them it’s someone else’s department.

Can anyone complain about Choose and Book? If you do who do you complain to? No one answers or gets back to you or it is someone elses’ department and you never hear from them. You have to sort it out yourself or use something that works called paper.

Rule 10) If you cock up have a listening exercise. Hear and change nothing.

Choose and Book managers no longer talk to the users’ of Choose and Book as all they get is abuse it is so bad. If you do not talk to the end user there can never be a problem and you can report this back to Party Central and get a promotion (see rule 6).

Lots of listening but nothing has changed. It has just got worse and worse and worse. A previous simple and flexible system made worse on a political whim and flight of fancy.

Rule 11) You have power and are unaccountable.

Many Politburos’ Chief Commissars have imposed unilateral “every one must use Choose and Book” policies in order to be awarded their Order of Postman Pat 1st class unless of course it is one of the 575 exclusions where C&B does not work and you MUST use paper. Managers have imposed a failed system and by using rule 10 they are completely unaccountable. The Party and C&B move on like a glacier with all using it waiting and praying for global warming in order to stop its progress.

Rule 12) Reinventing the wheel is called innovation just make sure that the new wheel is a square one.

A system that worked has been replaced by a very expensive failure. Just ask a politician how many countries have bought Choose and Book? Compare that with other IT systems like Windows.

People pay to use commercial software e.g. Windows because it is useful. Choose and Book has to bribe people to use it because it is crap.

Rule 13) Managers can’t be expected to count.

The Bottom Line guys. What was meant to cost £ 6 billion is now forecast to cost up to £ 50 billion with the clock ticking constantly. Peanuts considering all the banking bale outs but remember the US moon race is reckoned to have cost $ 100 billion to put a man on the moon in a decade. You do the maths.

If any journos want a story on sleaze ask yourselves how many politicians from our last Prime Minister’s administration were/are directors or advisers to companies supplying the NHS IT disaster? This is one waiting to be reported.

Possibly the biggest IT white elephant of all time? Probably. A large bean counter by any other name certainly something of no use to any one involved in health care . . .

Other than Managers and the Party.

Praise be to them both.

The 12 Rules of NHS Management (aka Politicians and NHS Managers reforming the health service)

1) If there is no problem make one
2) If it is simple make it complicated
3) If you can’t find a solution have another meeting
4) If other meetings don’t work employ more managers
5) Do not involve anyone with ability as they might come up with the solution and put you out of a job
6) If you fail you will be promoted. If you are not, set up a consultancy (see 7)
7) If 1-6 do not work employ management consultants (not consultants see rule 5).
8) All new policies must generate extra work for all involved to achieve the same goal or ideally less and cost more.
9) If a change is unpopular tell them you are re-applying for your job or change your job title and tell them it’s someone else’s department.
10) If you have cocked up have a listening exercise. Hear and change nothing.
11) You have power and are unaccountable.
12) Reinventing the wheel is called innovation. Remember to make sure that the new wheel is a square one.
13) Managers can’t be expected to count.


Northern Doc wishes to add that NHS management is the pauper of UK management. Anyone with ability and management skills works for the private sector because they are rewarded for their skills.

So if you wish to tell some war veteran or a young mother who is a cancer suffer they can’t have treatment become a NHS manager You need no ability, no knowledge or understanding of science or medicine and no compassion. You don’t have to talk to patients just make their lives miserable and the Nuremberg “I was only following orders” excuse will work every time as per rules 6 & 11 as you are untouchable. You can make all the intelligent people lives you knew when you were bottom of the class at school, hell.

And get paid for it.

Power to the Party (and its ever wise managers).

NHS Co-Payment

Following a couple of pieces on the BBC regarding cancer drugs “co-payment”, some of NDs team have been expressing a little sympathy for our beleaguered politicians as they try to sort out the banks and thought they might help the benevolent comrade Postman Pat in his campaign to stop people who pay for extra healthcare not provided by the NHS having free NHS care.

Here are some ideas of other forms of “co-payment” which the ND team feels will help save the NHS money in these troubled financial times:

1) If a parent buys Calpol from a chemist or supermarket for their child then their child should cease to have any NHS treatment ever.
2) If a patient seeing a private dentist attends a NHS GP with toothache then they should be denied any NHS care.
3) If a patient pays to park at a hospital car park then this is co payment for the treatment episode and so NHS treatment should be denied.
4) If a patient rings NHS Direct they have paid for the phone call and so should pay for all subsequent healthcare.
5) If a drunk falls over and pays for a taxi to get them to A&E for further treatment they should be denied NHS care as they should have dialed 999 and gone there for free to entitle them for free NHS care.
6) If an old lady falls over and pays for some plaster to put over a wound that subsequently needs treatment she should pay for this subsequent treatment due to her earlier co-payment for treatment.
7) If a patient who is worried he has something serious but pays to see a consultant privately they too should cease to have further NHS care even though a lot of people do this because of waiting times.
8) All people who have private health insurance should automatically be excluded as they are paying taxes and private health insurance is for everything so they don’t need the NHS.
9) Any patient returning from abroad with an illness that was treated overseas on their holiday insurance should also be denied NHS treatment on their return due to their prior co-payment.
10) Any patient who returns from overseas and develops malaria and has paid for anti malarial prophylaxis should have to pay for their treatment. If you don’t pay for malarial prophylaxis your treatment will of course be free.

Much respect to those resistance fighters trying to help end this awful scheme of co-payment as featured on the BBC hopefully they will not be penalized for doing so although placing a patient before the Party is a sackable offence without trial.

We at ND hope this will be of some help to the good comrade Postman Pat but the ND team feel that there will be plenty of other money saving tips out there for the good Postman and his Party Comrades?

Please send any other top tips for co-payment scams to:

http://www.alanjohnson.org/contact.aspx

The new GP contract (nGMS contract) and Overpaid GPs a theological perspective

Northern Doc did in one of their more spiritual moments consult with Bishop Northern who is a man used to luxury limos and not too far from government about our concerns regarding the lack of truth regarding the people who deliver 90+% of the health care to the British public the humble GP and their staff and mentioned that no-one Northern Doc knew in the over affluent North earned as much as comrades Gordon and Postman Pat.

After much reflection we present his thoughts in the hope that some enlightenment may be made available to the Party:

"My dear brethren, about 4 years ago, mindful of the fact that GPs were unhappy our glorious leaders, the Blair /Brown axis, for they are blessed and holy negotiated a new contract with the GPs. They thought that this was a good deal. The BMA too thought it was a good deal but then they had tasted so much of the cream cakes and teas and avoided real work for so long at Whitehall that they would have said yes to anything.

Granted the BMA had managed to sacrifice the out of hours’ element for the princely sum of £6000 for each GP. Clearly New Labour is unaware of the minimum wage it introduced as 365 days X 13.5 hours = 4927.5 hours. Divided £6000 by 4927.5 and
£1.22 is what Tony and Gord thought a GP out of hours is worth per GP per hour. £ 16.47 for a 13.5 hours night less than one NHS Direct consultation.

And so the Government were happy as they had allocated 1050 quality points @ £75 a point and did fully expected GPs to fail to get any more than 600-700 out of the 1050.

Unfortunately doctors are in the top 1% of the population in terms of intelligence and when presented with a seemingly impossible contract did apply themselves diligently to solving the problem they had been set by Blair/Brown and achieved an average of 1000 points out of 1050. They did thus alleviate the suffering of the NHS comrade patients and improve their healthcare as the Party had hoped.

However, Tony and Gordon were not happy, for the doctors had not failed as was expected but had worked to the Contract and achieved all, and more, of what was asked of them. This was not good as it cost the Government.

For true comrades of our Government of lawyers know that if you achieve a contract then this must be paid for but not if you are Government for they are holy and can refuse payment based on a majority.

In the second year of the contract GPs did even better and were paid at an increased rate per point of £120. These were the Happy Years and GPs caught up with solicitors, accountants, plumbers, builders, MPs and government ministers and they were happy and felt blessed that at last extra work meant extra money.

But then Gord and Tony ceased to be happy. For although the scum of the earth that they had agreed the contract with had done all that was asked they thought that this was not good and the GPs were to blame for they were evil. But Gord the Blessed was not daft and changed the extra tax known as superannuation so that GPs, unlike the comrade workers that Tony and Gord did represent, now had to pay their employee share as well as their employers' share.

This was good as now the evil scum known as GPs were paying 55% of their earnings which they did exploit from the comrade workers by doing their jobs as per the contract that Tony and Gord had agreed.

Costs for out of hours care had risen because doctors had heard of the minimum wage and standards had fallen as doctors were no longer available for they dared to ask for more money to work anti social hours than Tony and Gord, true working class heroes, had agreed. The evil scum were asking for more than the minimum wage which is truly ungodly behaviour.

So Gord and Tony decided that they would not honour their contract, for they were Government and good, and decided to reduce points and forget how much extra they had agreed to pay for their quality healthcare service in the third year of their covenant with the evil scum they call GPs. For it is sacrilege for those who work as GPs to dare to aspire to earn that which true socialists like Cherie Blair earn as they are not lawyers who like Government are holy too.

Then Tony did leave and Gord took over.

Gord, being a true man of the working people, and spawn of their loins decided that despite there being a European Working Time directive on working hours that the groups of people already working more hours than most were not working hard enough, for they were professionals and to be despised, unlike the true working class man that he is.

So Gord the Holy decided based on a divine sample of punters marginally more than that on which he was elected, to impose extra hours on GPs (and their staff) and in doing so he did ignore a much larger sample of people in a survey he had paid for who were happy with their evil scum GPs for he is divine and therefore right.

Furthermore the blessed Gord, for he is holy beyond all other than Mugabe, decided to impose this but with no extra funding for GPs. He decided that if GPs wished to earn as much as they did the year before they must do extra hours for the same pay.

This, my dearly beloved, is known as a pay cut but, if you are holy beyond all other than Mugabe, it is for the benefit of the comrade workers. Furthermore, my dearly beloved, if as a believer of the great goddess Prudence you add a further increase in penance on those sinners’ earnings then Gord the Holy is now taxing the evil over paid GPs at 60% of their earnings then you are a true working class hero. For no true working class hero would dream of doing such a thing to the lowest paid by abolishing the 10% tax rate.

At this point dearly beloved I must end this lesson for the rest is yet to be written. I hope it explains what has happened to those overpaid GPs, scum that they be, and why they are so hated by Gord and Government for they have dared to do what Government asked them to do namely honour a contract which is heresy to Government. They must therefore be punished for they are evil.

Praise be to the Party and Gord the Holy of Holies."

Two Tier Cancer Care whose fault? You’ve guessed it . . .

Cancer is not a nice disease and most people once they get it will want to try anything to try and halt its progress. This is human nature and entirely understandable. Unfortunately the Party as represented by its organ Alan Johnson (aka Postman Pat given his huge life time of knowledge of healthcare) knows best and has denied NHS treatment to anyone who tops up their treatment in the fight for life by decreeing that anyone who does this basic survival instinict which it calls co-payment is to be denied NHS treatment.

This is bad enough but what is worse is what the Party is doing to patients already receiving treatment for cancer. Not only do people suffering cancer lose economically by losing time off work (oh yes they also suffer physically but this does not cost the Party) but the Party adds insult to injury by charging patients who suffer from breast cancer almost seven times the wholesale cost of the drug Tamoxifen if they pay the prescription charge. That is right seven times the wholesale cost of a drug that these patients will need to be on for 13 prescriptions per year for 5 years if you pay the prescription charge and follow Party prescribing guidance.

So if you have breast cancer and want to pay seven times what a drug is worth you can and still get NHS treatment. Comrade Commissar Alan says he wishes to prevent a two tier health care system by banning health care “co-payments”. But has he not already created a two tier healthcare system as if you are one of the 80+ % people who do not not pay for prescriptions you are getting something for nothing while your fellow cancer suffers are being shafted by the Party?

Interestingly Gordon has decided that now patients who have cancer will at some point not have to pay for their treatment. And people with age related macular degenration can now get treatment?

Is NorthernDoc’s team cynical or is there a by election coming?

When will anyone in the Party realize that they have created a two or more tier health care system in this country as we do not have a National Health Service more of a Multi National Health service sometimes known as a Post Code lottery? You can have the Party health care system = care on the cheap or crap care, or you can try to do better and pay more but then lose all basic health care.

Clearly if you try to do better then the Party it will try to bring you down. New Labour does not try to bring people up (to the higher standards in other European countires) it tries to push you down especially when you have cancer.

Praise be to the Party and its benevolence for none of the Party will pay for private education for their children in order to better themselves in the same way that they deny NHS care for those who try to do better against the odds that cancer imposes. They are happy to allow a two tier system in education but not in health?

On behalf of cancer suffers and other people in England (but not in Scotland or Wales) who pay prescription charges of £7.10 for drugs worth less than a pound, NorthenDoc asks why?

Is it a case of all Pigs are equal but some are more equal than others?

Worldclass P**s take?

Another NorthernDoc, a fellow vet of Nam, has told me that one of the more Southern outposts of Northernshire has decided that it will create for the first time ever in the history of the UK, or the world, a “world class” general practice service for their comrade patients.

A “world class” service in Northenshire?

Is that the equivalent of :

1) the Austin Allegro
2) the Sinclair C5
3) The Trabant
4) The AK47?

Sorry one of those is actually a true world class instrument of death and destruction and on a par with NHS administrators delivering equitable health care as it kills regardless of sex, race, creed, or colour and does so very well and cheaply with no losses to those that use it.

And this is allegedly being delivered by a “world class” management team the Chief Comrade Commissar of which comes from an area of the world that is better known for producing sheep for the Middle East housed in conditions better than they allow their comrade NHS patients to endure.

It used to be the case that if you suffered from delusions = a belief in the absence of reality you were treated for mental illness.

Now it seems that under care in the community you get to be the Chief Executive of a Primary Care Trust.

Anyone wonder why the health service is so bad with the lunatics running the asylum?

If you need “world class” health care then either move to America and pay

or

Google “world class” and “GP” and see what you get.

You can check out the results of years of mismanagement by the Soviet concerned on which the sound foundations of this “world class” service are to be built here:

www.yhpho.org.uk/download.aspx?urlid=424&urlt=1


It will take a few seconds to load as NorthernDoc discovered when doing the research into this NHS Utopia as it is a Party website.

With thanks to HP for the inspiration for this piece. HP keep the faith and the 50 cal close to hand they may be coming for you soon.

Appraisal: Deans Billious’s and Tedious’s guide to this worthless piece of ***** sorry paperwork.

Northernshire’s resident most excellent post graduate deans, Bill and Ted discuss appraisal:

Bill: Yo dudes NorthernDoc has just had their appraisal so that must mean they are one cool happening doctor dude and may continue to practice medicine in the Northernshire deanery?

Ted: Most excellent Bill I am so glad as NorthenDoc is my caring happening family GP. So hey what is appraisal dude? Is NorthernDoc now cool?

Large pause.

Bill: Wish I knew Ted.

Ted: Well my good Dr Billious appraisal is a happenin’ dude thing where you hang with your homeys called other Doctor dudes for a couple of hours and achieve nothing unless you are the appraiser dude where you get a wad of money for doing nothing. Wey can anyone do appraisal?

Bill: Way to go Dr Tedious appraiser dude respect (and money). I am interested man.

Ted: (Strut air guitar) And this is to stop another Harold H Shipman?

Bill: Not! He would have walked his appraisal.

Ted: Well then Billious what is appraisal dude?

Bill (now a GMC homey): Well Ted. You sit on your arse and do a ground hog day with the homey dude called an appraiser and fill in the same forms each year in order to make you a better doctor and produce a Personal Retard Plan (a PR Plan).

Ted: Sorry Bill, I think that was a Personal Development Plan not a PR plan which I am sure you are aware is a non PC medical in joke which involves a glove and KY jelly available at pharmacies without prescription.

Bill: So appraisal is a process where I say what I have I done different (not) for the last year and then say what will I do different (not) for the next year even though nothing has changed?

Ted: Yes. You answer the same questions what stops you dude and give the same answers year after year as guess what? Nothing changes. And this makes you a more excellent doctor dude.

Bill: So appraisal is most excellent as it makes you a more excellent doctor dude as it achieves nothing by doing more arse sitting?

Bill: Excellent! I understand now why some GMC guy copied it from the nurses. More work for nothing = safer practice. Excellent!

Ted: Party on dude can I become an appraiser as I need a new guitar?

Bill: Most certainly as you are over qualified . . .

Bill and Ted (in unison) Appraise on dudes and be excellent to each other.

NHS Shortage of Cash?

Watched Alistair Darling the other day saying that they have pumped £100 billion into the banking system.

The NHS is forecast to have a £1 billion surplus.

And we still cannot fund basic healthcare.

Cancer suffers are denied drugs that given the sums involved would cost peanuts.

Prop up a Bank aka a Government (to prevent it failing or is that falling?) but remember to shaft the people paying to prop up the Bank.

They are called voters known to us as patients.

Praise be to the Party and its managers for they are omnipotent and all caring (for themselves?).

(Dr) Neil Bacon and IWantGreatCare.org - the next stage?

Fellow resistance fighters (and bloggers) a lot has been written by you on this subject and I feel that the time has come for the worms to turn.

I do not know if this idea has been posted before but I am proposing that someone sets up a IWantCrapCare.org website and invite NHS managers to post their best cost saving ideas and rate themselves in their cost saving effectiveness.

This would enable the public to be protected from incompetent management as the greater the healthcare savings reported by the managers who would be self reporting, self auditing and unaccountable as they are in real life the worse the patient care would be.

Furthermore this would provide the Government with an “independent” sample as does Neil Bacon. We can thus Protect Patients and Guide Doctors to the best health care and provide an “unbiased” sample that the Party could use to influence and reform healthcare?

Anyone game for a laugh comrades?

If we worked in a democracy it might work.

Praise be to the Party.