Friday, 27 February 2009

NHS Rangers leading the way - the War on MRSA #5

Our source from a centre of intellectual excellence (not) tells us that all the new modern Matrons at their local hospital barracks were involved in an important new anti MRSA offensive called b*ll*cking staff leaving the hospital in their uniforms.


How does this stop MRSA getting into the hospital?

Staff may wear their uniforms with pride but more likely are wearing them because they are not provided with any secure areas where they can change and if they want a clean uniform the next day they have to take them home and wash them themselves. If they rely on the communal hospital laundry it will give them a uniform 2-3 sizes bigger or smaller than they are and certainly not less than 2 weeks after it is handed in for cleaning. Staff used to be provided with coats to cover up uniforms but due to costs this has stopped.

So the elite of the NHS Ranger corps, the Modern Matron, is deployed as a surprise tactic to prevent MRSA creeping into the secure MRSA free zones called hospitals.

Post these elite Rangers outside the building and MRSA will not dare cross the new Maginot line of Modern Matrons. The Maginot line tactic was used successfully by the French against the Germans in World War 2 and any public school boy knows the power of Matron on middle aged or elderly politicians’ fantasies. It therefore cannot fail.

Rangers lead on. Victory by the clipboard carriers is ours for the taking!

Praise be to the Party for Modern Matrons who are leading the way on the war against MRSA by avoiding any patient contact as they lurk outside the hospital and care for patients there. Perhaps the best place for them?

Thursday, 26 February 2009

I couldn’t care less which GP I see . . .

The politicians who decide health policy are those who usually are least aware of how it actually works. Very few if any are medically trained. Given their vast inexperience is that why they can come out with comments like “I couldn’t care less which GP I see”?

Is that because, Alan, I shall use this as a hypothetical name, you have no involvement in childcare from several marriages and so never take children to see a doctor yourself? So as long as the brat is quiet I am OK and so quality of care for your various offspring is of no consequence to you?

Is it because, Alan, you have never been pregnant and will never know the value of good consistent midwife based care?

Anyone will do?

Is it because, Alan, you have never dealt with good health visitors that can support and help young parents during their new experience of childcare?

Anyone will do?

Is it because, Alan, you have never had a cancer or a long term medical condition that requires any degree of consistent and quality care?

Anyone will do?

Is it because, Alan, you have never had a demented parent and experienced the living hell that caring for them can bring?

Anyone will do?

Is it because Alan you are lucky enough to have never been ill?

As, Alan, you clearly have never had any commitments to anyone of any importance other than yourself do you value healthcare as worthless? You may even want to abandon it to the private sector?

You probably, Alan, have company health care from BUPA so will never worry about waiting lists? You will probably have an exclusive dining room open all hours so you won’t even have to go to a supermarket to feed yourself?

Why not move to the USA where they reward people with talent and experience like you and there is quality healthcare but at a price? You never need it so you will be quids in?

On the other hand you can stay here and see whatever crap whenever you want as you couldn’t care less who you see?

You could go and see Sir Liam McDonaldson’s healthcare at your local Darzhole centre? You might even get to see a nurse!

They are so much better and cleverer than doctors as they are cheaper and you get more of them per pound. You could ring NHS (Re)direct when you get rectal bleeding and be told it is piles or “go and see a doctor” but you would be happy with this when you die from the missed rectal cancer because you couldn’t care less?

If, Alan, you ever need to see a doctor we could give you a list of those to avoid as just with any profession there are good and bad people in medicine but you wouldn’t read it because you couldn’t care less?

Praise be to the Party and all the many Alans in the world who couldn’t care less. They are in government for that reason.

Wednesday, 25 February 2009

Odds and Sods

Couple of things. First if you have not read the PCT list: New Labour’s NHS legacy part 2 posted 2 February on the Ferret Fancier's blog then it is an excellent list of the dead wood that are the Thickerazzi at any PCT. Ask yourself how many of them treat patients? The picture above shows the list printed out and our staff have read it and cannot believe some of the jobs on it. They can however relate to the level of ability of those likely to be one the list and the fact that they are getting paid more to do less than those on the front line.

Compare that list with a list of staff we employ to treat 10,000 patients:

Practice nurses
Health Care assistants
Practice manager
Assistant practice manager

Even if you multiply the above list by 10 to treat 100,000 patients the size of the local PCT you still do not get a list as long as the Ferrets. Remember it is your taxes that are paying for that list and the impressive do nothing titles on it.

The other thing that the Ferret Fancier has posted, 6 February, is regarding PCTs being branded “incapable and useless”. If you look at the original document Health Committee-First Report NHS Next Stage Review on the section on PCTs and read paragraphs 38-40 you can see that MPs have realized what ND and team realized well over a year ago that Practice Based Commissioning is going nowhere fast.

It is the Titanic going dead slow ahead towards the inevitable iceberg of oblivion under the command of the many Captain Thicks all trying to turn the rudder in different directions that are PCT commissioning departments. Your money wasted by idiots chasing their own tails. We have written about this and think the image posted at the time still applies now link.
Dr Crippen More Stealth Cuts in Health Care February 18 publishes an interesting piece on District Nursing that got our blood boiling given the state of play with district nursing here in Northernshire. We had an excellent and stable group of 7 nurses attached to our practice until the Thickerazzi ordered them back to the local Soviet barracks to “improve” the service.

Of the original team only one remains and the nurses are “too busy” now (sorry not enough of them) to cover our patients. Presumably they are doing their “metrics” and “currencies” rather than caring for patients?

A piece in the healthcare republic also caught our eye whereby David Cameron was criticised by Comrade Alan “Postman Pat” Johnson for sticking up for GPs.

Comrade Alan is quoted as saying of David Cameron:

'He believes in primary care access being for the convenience of the practice, not the patient.’

Surely he meant to say:

'He believes in primary care access being for the convenience of the Party, not the patient.’

This we believe is the correct and original version of the quote being about our incumbant cerebrally challenged (according to a Mr Clarkson from southern Northernshire) Prime Minister’s thoughts on extended (unpaid) hours for GPs and their staff.

Did you notice we said a couple of things at the start of this post but actually covered four things? Just like patients who start with a “couple of things” and land up talking about seven things. We can’t count rite well oop here in t’ North neither can our patients or their politicians.

Praise be to the Party for continually making things better.

Monday, 23 February 2009

NHS cancer care an update

A while ago ND posted a piece on NHS scanning versus the rest of the world. Well the relative concerned got a MRI scan within days as opposed to the same day in the rest of the (non NHS) world but the promised CT scan did not materialize until 18/02/09 as the CT scanner had bust at the local Politburo tractor plant (but we bet it was exceeding all production targets according to the local commissars).

So the local Thickerazzi that deal daily with patients got a portable scanner (the one that was idle in the last post) to replace it.

When ND was a very junior grunt we loved going to see CT scans as medical students. This was high tech and brought anatomy alive. The scans took 20+ minutes. Over the years they have improved to being a matter of minutes for those now senior grunts have seen this wondrous technology in action.

The imported CT scan can apparently only do 5 scans a day probably why it was idle when we walked past it. There were probably not enough 10p pieces to put in the electric meter or the 10p put into the meter manager had not yet been fully trained.

In the time since the last post ND has seen another patient who collapsed in a third world country. The same day they had all the usual tests you would get here but what stood out was the fact that they also got a MRI scan on the same day.

The flag of the country is next to that of ours. Yes it will have cost their health insurance but then the relative concerned has paid “National Insurance”.

The news was not good. Further treatment is needed. When we saw the consultant we were told what would have happened in the first world namely the USA as one of their junior staff had been on a research fellowship there that they had won against international competition. Unfortunately we are in the NHS world not the first world. More waiting with the cancer clock ticking relentlessly on while the NHS marks time.

We will keep you posted.

Praise be to the Party for bringing down medicine in the UK to some of the lowest medical standards in the civilised world and for spending so much to do so and meeting all the low targets they set for patient care.

Tuesday, 17 February 2009

Welcome Back

The team at ND wish to welcome the return of the Grand Daddy of medical bloggers (as far are we are concerned) a certain Dr Rant.

It was his website that via its links inspired us to think about medical matters and ultimately led us to blog.

Much respect.

While we do not endorse the use of excessive grunt language the sentiments expressed are an accurate reflection of frontline NHS medicine in the UK.

If you have not read it we would suggest that you have a look. A lot of the links to other blogs are out of date and could do with a trawl. Follow them and broaden your perspective of matters medical.

Nonetheless it has served us well in the Nether Regions of the NHS in Northernshire.

There is no Praise be to the Party on this one for this is the antithesis of the Party.

Sunday, 15 February 2009

More choice and respect for medical confidentiality in Northernshire

Once again it has come to the attention of the Resistance that the Party are continuing its Choice agenda by refusing to take no from patients who say they want to opt out (of the summary care record.)

According to an article in Pulse the local Politburo thickerazzi want the under comrade GPs to hand over patients who want to opt out to the local commissars so they “can be invited to the surgery (Gulag?) to discuss it further (for re-education?)”.

The idiot thickerazzi comrade commissar managers ever proud of their 5 year plans and popularity with the comrade patients are planning to put on their invites for re education the surgery details “as if from the practice”.

Now those in the Resistance quoted point out that for GPs to do so would breach patient confidentiality.

A rather more sinister quote goes on to say that under comrade GPs had been asked "to report (inform) on patients (comrades) who wanted to opt out to reduce the administrative burden on the practice” and so their “wishes could be respected" ?

Excuse us if we are thicker than the NHS thickerazzi here but does the compiling lists of patients who want to opt out and inviting them for re-education increase or decrease administration?

The end of the article goes onto to say that so proud is the Party of its Policy that good under comrade GPs who fully uploaded their records will receive payments of £2,000. We would be deeply suspicious of any practice that achieves one hundred percent in the same way if a politician got 100% in a general election.

Praise be the Party and its ever wise choice agenda giving Hobson’s choice to the masses via the Party who always knows best. Some of them may even be able to write their own names with an X in crayon.

P.S. Since we penned this it would appear that the Politburo who issued this has seen the error of its ways? Again the source is Pulse.
For the time being?

Saturday, 14 February 2009

Hoping to stay online

The team at ND Central will lose its primary email on Blogger this weekend. We hope to keep posting but may not be able to do so if our plans go pear shape.

If any fellow medical bloggers have been there, done that and got the T-shirt we would value any input as we are still relative newbies.

Thanks and respect for keeping freedom of ideas and expression alive against the wishes of the Party.

Praise be to the Party.

The shape of things to come?

So the news media reported that various people are unhappy about a NHS computer in a London hospital link to BBC article.

No real surprise there for those of us who deal with NHS computing on a daily basis and yearn for the days when dial up was standard as it was so much faster than the N3 network. A few facts caught our eyes about this failure and these are as follows:

“technical glitches had caused more work for staff and meant out-patient bookings were taking four times as long.”

“ . . the hospital has had to employ another 40 administrative staff to handle the extra workload . . “

“The faulty system had also prevented the hospital from billing other parts of the NHS for treatment.”

Now that is the really important bit of any NHS computing project bean counting.

“Many of the medical staff are incredibly disappointed with what we have got.”

No surprise there as the system is not meant to be used by doctors-they just get in the way of its prime function and complain.

“the hospital has spent an extra £4m to get the system working. On top of this, Mr Way estimates the Royal Free has lost £6m because of fewer patients . . .”

Excellent! Fewer patients means less cost and obviously better health as they are not being treated and are therefore not ill. Another box ticked.

“Nigel Edwards, of the NHS Confederation, which represents most health service organisations, said: "This isn't the first hospital to have very significant problems with implementation.”

You mean there are more because it is so good?

“A Department of Health spokesman said: "Many elements of the programme are complete, and patients and clinicians are now beginning to see the benefits these systems bring to improve patient care.”

What benefits are patients and clinicians seeing?

And finally a word from a mentally impaired Caledonian gentleman if you believe a certain Jeremy Clarkson from Rotherham.

He said: "For all the problems that a huge project like that has created, you cannot say that that is not an advance."

Fewer patients, more administrators, more expenditure, four times longer to do things and that is an advance? Will this gentleman be swapping a Jumbo next time he goes abroad for a bicycle as that is an advance?

A former comrade at arms of the ND team who works in computing said that the idea of computers was to reduce work and make life easier for those using it. If it doesn’t it should be scrapped and you look elsewhere for something better.

You have been warned. If this expansion of duff computing continues we will all be worse off. All the software we use on our home PCs gets better with upgrades in contrast to anything NHS which does the reverse. However, read any Party website on Choose and Book, Connecting for Health etc. and you will see the good comrade workers singing its praises and record tractor output. The Party does not hear the daily torrent of abuse that we do in Northernshire but may be it doesn’t work as well up North?

Praise be to the Party and all the “advances” they have bought to healthcare. We now have a headache so we will go and see the skull bone borer for some “advanced” headache relief.

Tuesday, 10 February 2009

Another letter, this time from Sir Liam

In amongst the remaining letters that we read at ND Central several of us discovered a letter from the great and the good of medicine in this country the chief medical officer Sir Liam Donaldson. Each addressed to us by name.

Sir Liam being Chief medical honcho clearly did not go to a real medical school as the advice in the letter relates to how important he feels it is ask patients about their smoking and to tell patients to stop smoking. The little mnemonic AAA Ask Advise Act is to be “heavily promoted” although we thought triple A was something you shot at aircraft?

Clearly as a man who went to what one of the team refer to as a university for “Oxbridge rejects” he now has discovered that smoking is harmful for health and feels the need to share his newly acquired knowledge at public expense (a few tens of thousands we guess for a mass male shot to GPs) with his medical colleagues. We should even be giving patients advice on the need to stop smoking.

Granted he qualified in the early 1970s and would have been a student in the sixties when smoking of tobacco and other herbal things would have been more common but why has the Chief Medical Officer taken until now to tell us what we have known and imparted to medical students and junior doctors for years? We have even advised our patients to smoke smoking. We even refer them to Stop Smoking services. Are we doing something wrong or old fashioned?

Praise be to the Party for telling us that smoking is harmful to health while reaping the rewards from taxing it. And to a Chief Medical Officer for spending thousands to tell GPs how to suck eggs.

Grunt Humour, drug research and NHS staff dedication

As there has been a lot of serious things written in the last few days we at ND Central thought we would share a light hearted moment with you out there in the bloggosphere. One of the Team was reading the 70 or so letters we receive per partner per day at ND Central and noted in their correspondence a letter from a drug company promoting a product.

We at ND Central do not usually see drug reps so reading these letters is a way of learning about new products that if you are not interested in the product is very quick and easy to throw away and move onto something else in contrast to drug reps.

The member who read this letter highlighted a paragraph that amused them and passed it onto the admin team who have a good grunt sense of humour. The paragraphs that amused this team member is reproduced below minus the name of the drug:

“ . . . is licensed for the treatment of erectile dysfunction and is the only PDE5i that can deliver efficacy all day, every day allowing suitable patients to respond any time they are sexually stimulated.”

(efficacy for the non medical reader is the power or capacity to produce effects.)

A further quote from this letter says that the drug is:

“. . . suitable for (those) who anticipate frequent sex (i.e. more than once a week) . . "

The effect on the staff at ND Central was amazing. Within minutes the building was alive with people volunteering (5 in less than 10 minutes) to do research into whether this drug did as it said on the tin for no cost to the NHS none of whom were the intended direct user of the drug.

We cannot recall there ever being so much interest in a new drug product among our staff and so much enthusiasm to volunteer for research. This indeed is a reflection of the selflessness of those who work in General Practice and a measure of their desire to increase our knowledge about medicine.

Praise be to the Party and their NICE attitude towards drugs. Is there a Ph.D. in this or might that be too much hard work? (Could not reproduce all the other comments regarding this there were too many and many were too rude.)

Sunday, 8 February 2009

Measles and the Media

The BBC has reported this weekend an increase in measles in the UK. Not really any surprise to anyone with a bit of medical knowledge. It is an interesting example of the power of media to influence the population for the worse.

Mrs ND’s favourite morning TV is Gormless Moron TV otherwise known as GMTV and as we share the same house one has over the many years we have been together had the misfortune to have seen bits of it. One thing that struck ND, apart from Dr Hilary’s claims that meningitis was a virus (yes that is one of the many causes but he was referring to the bacterial serious kind at the time), was the disproportionate way in which scare stories about MMR are always in the first 1-3 items of a news bulletin whereas any study showing it to be safe was almost always left until the last but one item on the news.

Such is the accuracy of GMTV that they report 3 cases of meningitis in the whole of the UK as an “epidemic” when in the same week ND as a junior grunt did diagnose 3 cases of meningitis in one part of Northernshire which was never reported by the responsible, but not wishing to scaremonger press, that is GMTV. ND is not a journalist but 3 cases in the whole of a population of 60 millions an "epidemic" versus 3 cases in a population of 100.000. That must just be a blip?

If ever a gong is awarded for disservices to medicine via the media it should go to St Fiona who over the years has wallowed in presenting scare stories and then a few months ago presented an item saying how “GMTV had predicted a rise in measles” cases in the early 1990s many years earlier the implication being that she alone knew better than anyone else that this would be the case. Not exactly difficult given how much time she had spent frightening people.

A few seconds of bad journalism can damage public health and undo many years of work done by doctors, health visitors and nurses in promoting immunization which will then take more years of persuasion to put right.

While that is happening people will catch the disease and suffer unnecessary and preventable harm. Thank you St Fiona you have wasted more medical time than anyone other than Government and earned in the process more per year for doing so than a GP. You are truly a Saint and worthy of something.

The message has to be to immunize your children not only for their protection but also that of others. Smallpox was eliminated from the world and in theory so could measles via mass immunization.

There are risks with any medical treatment but all the research to date shows that the risk from vaccination is less than the risks of being killed on the roads but most parents will happily put their child into a car and drive them to school or the supermarket or the GPs surgery. Some will not immunize their children.

Over the years ND and the team has been promoting MMR to worried parents something that takes a lot of time and we are relatively well protected in our part of Northernshire a credit to our nurses, health visitors and rarely mentioned public health doctors who have tirelessly worked to spread the correct message. We also have very low rates of confirmed measles (all cases being in the unvaccinated traveller community rather than the home population or imported via unvaccinated children from abroad).

It never ceases to amaze us that “measles” is frequently diagnosed by teachers who, more likely than not, have never seen a genuine case of measles. They inform school nurses who panic and issue pieces of paper to parents that say there is “measles” in the school with no confirmation of the diseases and guess what happens?

Loads of GP consultations based on the ignorance of a teacher. All such cases in the last 10 years have been due to slapped cheek syndrome a relatively mild illness.

Except if it occurs in a school where any rash in a well child is inevitably due to the Bubonic plague if you are a teacher. And rumours about the Plague spread fast at the school gates.

How do we know it is not measles?

Because we talk to public health doctors and ask them about any confirmed measles cases and notify the “measles" cases to them who then test the children and the tests are negative.

There are many arguments for immunization but the one ND thinks is most powerful is the one that goes is MMR banned in the USA?

Surely if it was as dangerous as it is claimed then someone would have successfully sued, made millions and drug companies would have dropped the product like a stone?

Has anyone done so?

Based on current evidence we rest our case. (We are always prepared to be wrong if some can prove it).

Praise be to the Party and its openness about which of its senior members immunize their children. Yes we respect medical confidentiality but lead by example not by ignorance. Once again the UK is top of the league in Europe in matters of health.

N.B. it would appear that there may now allegedly be a new “Saint” on the block that is Mediasville according to the Witch Doctor - many thanks for your kind mentions in the recent past - hope the cold air is not affecting your flying and spell casting! (and others including Dr Grumble).
Respect to you all.
Not as yet had a chance to view the source so the last bit the N.B. is to be regarded as heresay but occurred as a pure coincidence after viewing the news re measles this weekend.

Saturday, 7 February 2009

Doctor’s Dilemmas

In the GP magazine there was an interesting piece in their diary section (sorry cannot link to it) about a standoff about Christmas Eve working in a part of Northernshire. It went something along the lines of local Politburo tell a GP they can’t close on Christmas Eve afternoon so GP says OK we will ring local commissars every hour to see that they too are working. GP then allowed to close.

At our regular end of week meeting of the Resistance at the well know watering hole the café Michelle we were faced with a doctors’ dilemma.

No one had booked into the extra Saturday Brown shift (remember the silent f). That is right no one despite the huge numbers of commuting pensioners and children that live in the leafy suburbs of Northenshire needed an urgent consult with a doc on a Saturday. No one. Not one single patient.

Presumably most of ND’s patients would be in bed on a Saturday morning metabolizing their efforts from the night before or taking their ever affluent kids to the likes of ballet, horse riding etc although those at the coalface suspect they would be most likely letting their livers take the strain and letting their kids watch satellite TV on 6 foot plasma screens.

The dilemma the Resistance faced was to open or not to open on Saturday. A lot of debate took place. What if the Stasi sent round a patrol? Would we all be put into detention?

The extra Brown shifts are only for booked appointments. We do not see emergencies unless they literally walk in and die on us and we do not do home visits. We do not take phone calls as these are directed to the out of hours service. The surgery is not open as we are protected by a remotely operated locking mechanism we installed to protect our receptionists on the late nights as part of an Elf and Safety review.

So the question was do we inconvenience everyone’s family lives and come in for 2 hours and do nothing? This was decided by the precedent quoted above and the Resistance’s decision was based on we thought NHS mangers would do on a Saturday morning when they have no work to do.


Difference between doctors in the NHS and the thickerazzi that is the MHS (Management Health Service) is that one group work most of the week the other have a week of weekends.

Praise be to the Party and to Gordon’s little Brown shifts (remember the f) that are so loved by both the GPs (and their families) and more importantly by their receptionists, and their families, who frequently curse his wisdom for improving their family and weekend lives. Thank you Gordon for your little Brown ones.

Thursday, 5 February 2009

NHS Rangers lead the Way Confidentialiy #2 -> 20 years on.

Fast forward 20 years to another galaxy closer to Northernshire. A good mate of ND invited ND down South to show how you could see X-rays, CT scans and MRI scans taken at the local hospital on a GPs’ desktop computer. Given the far North where ND works and distances involved this was a wonderful invention and could be of so much use until ND asked was it available to all?

ND was disappointed to hear that a few pilot practices had got this system with obvious benefits e.g. GPs seeing fractures on patients requesting home visits after A&E attendances that had been missed by more junior A&E Drs and even incorrect radiology reports being corrected because of the ability of a local GP to actually see x-rays with the patient at the same time.

ND’s former comrade at arms told him how a patient had seen them and as a result he had saved the local Politburo a few grand because the x-ray report was wrong from the radiologist but ND’s friend had years of experience at looking at this type of x-ray and so correctly treated the patient purely because of the ability to see the incorrectly reported x-ray and the patient at the same time. If he had relied on the type written report several tens of thousands of pounds of compensation would ultimately have been paid out.

(Aside: in medicine the ideal is that you see the patient and the x-ray together. In some of Northernshire patients were sent for x-ray by their GPs and the reports came back from overseas some 3 months later due to a shortage of radiologists in the UK. Another reason why this could be useful but we digress dear reader.)

However the good comrade commissar idiot managers at the local Politburo had decided to restrict its roll out to further practices while encouraging and forcing the use of Choose and Book, Connecting for Health and Summary Care Records against the wishes of local GPs and most informed patients.

The reason?

“Patient confidentiality”.

Déjà vu or what?

The local Politburo felt that a roll out of the ability of a few 10s of local GPs to see a few 10s of thousands of patients’ X-rays from the local hospital serving a 100,000 patients would breach “patient confidentiality” while the roll out of the ability to see 60 million records by over a million unaccountable users would not.

NHS Rangers lead the way onto victory.

Praise be to the Party for they see what ND and other GPs cannot. Patient confidentiality. And they don’t treat patients.