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.