“Extended hours saved my life.” Exclusive Not!

An interesting article on the front page of one of the GP rags this week. Clearly a total vindication of Mr Clarkson’s intellectually impaired Caledonian premier’s extended hours Policy for no extra money known as a pay cut. However, we are in hard times, and so comrades these policies are necessary for the war effort.

Whose life has been saved by the all wise Caledonian gentleman’s omnipotent wisdom?

None other than the:

NHS Director-General for Commissioning and System Management

who is one of the officials responsible for extended GP opening hours.

A good Comrade Commissar at a senior level check out his importance here in the Comic.

Our staff are incredibly grateful to him for their lost weekends, early starts and late finishes but then they are not paid as much as he is and so that is all right, comrade.

Now a man of this importance you would expect to be able to organize his life as well as destroy the NHS healthcare system.

He would after all, if he were buying a house, be unable to see a solicitor or an estate agent due to the fact that he “often works 12 hour days”, as he is clearly an important person and for some reason has not mandated extended hours for any other profession. We like the word “often” it can hide many things like “never”.

Time off from being NHS Director-General for Commissioning and System Management to see a GP would clearly lead to disastrous National Consequences.

Something might happen (for the better) comrade.
.
So a disorganised part timer then thinks that a crap policy has saved his pathetic life?
(There are plenty of time management courses available to you full of useful tips like “write things down to remember them”. You might even get a MBA from the NHS University.)

A senior NHS official who would have “brushed concerns about his own health aside had he not been able to make an evening appointment”. No self preservation?

Clearly a true hero of the Soviet Union beyond all others in the Great Patriotic War! A true Comrade Worker!

Clearly a man who cannot look after himself other than on a political whim is the ideal person to be in charge of everyone elses’ healthcare being destroyed by the escalating mushroom cloud of management know as (de)commissioning.

Surely if he started work as a GP at 08.00 hrs and did a 12 hour day he could easily have made a 19.00hrs appointment? However he probably starts his twelve hour days at 06.00hrs so having late opening makes sense if you can believe this Party propaganda.

He made some interesting comments re “the primary and secondary care interface” (sorry re jargon his words) and how he couldn’t get any incontinence pads from his district nurse.

Management bullsh*t (sorry re grunt speak but this is manna from heaven!) is a particularly offensive and smelly discharge especially if you are a patient who experiences its results so this would have been a huge problem for him every time he opened his mouth.

Now for those that work in Northernshire who have “world class commissioning” this would have never have happened.

In Northernshire there are no longer any district nurses or health visitors as the idiot Commissioning Mangers have decided that these are not required in GP practices. If there was a problem with the District Nursing services we as GPs could leave a message on an answer machine and hope something might happen. This is commissioning, sorry world class commissioning, in action as this manager has seen himself.

Following his treatment he has agreed to take part in a “scheme piloting patient reported outcome measures” which will surely mean that the NHS he is destroying will turn out to be even more excellent? After all “manager patients” advising managers how good the NHS is can only lead to one thing?

'Our doctors and nurses are fantastic,' he said.

Yes they are. And if left on their own could do so much more to improve things.

'But we need a new generation of clinical leads who are less tolerant of failure and want to bear down on poor performance.'

More incompetant managers or “world class commissioning”? No "clinical engagement here then"?

If this manager has a problem with any of the services he experienced then he has only one person to blame.

Himself.

Praise be to the Party and its world class decommissioning of anything useful that works. Things will only get worse comrades, ever worse, as now the Comrade Commissar patient has been born. More managers coming our way.

The Northernshire Ku Klux Klan

In the last couple of weeks we at ND Central have noticed a slight hardening of attitudes in reception towards foreign nationals.

ND Central is in an interesting part of Northernshire in that until the Party decided to disperse immigrants and asylum seekers away from the coastal ports it had a 99+% Caucasian population and a very high percentage of the population claiming to be Christian something our medical students found hard to understand when they did practice population audits. They have worked elsewhere in Northernshire where there were high immigrant and deprived populations.

Now granted that if you go abroad you expect free healthcare.

It is after all one of the inalienable British “rights” such as the one whereby all foreigners must speak English albeit never actually in any law.

Of course, now we are part of the EU, there are now European “rights” to free health care albeit actually in law.

This is why all of our patients will go abroad, drink themselves senseless on their holidays (which they have paid for) and ignore any illness they have for 2 weeks until the plane touches down on UK soil.

Their first abusive phone call will be to get an “emergency” appointment with their GP, or they will drop into a local A&E department as an “emergency”.

Both of these services will have been available overseas (but for a price) for the illness that they have had for the whole 2 weeks they have been on holiday.

But hit the UK and IT IS AN EMERGENCY.

The same now applies to many foreign nationals.

They too may have years of illness and will tell UK GPs that there is nothing wrong with them but walk out with a prescription for 5 items for free as they are over 60 and they don’t now have to pay for it.

Same problems overseas, no prescription as it costs.

Free healthcare = prescription.

This sea change is not inspired here by us at ND Central where we have noticed a huge amount of p*** taking by people of all nations in terms of getting free healthcare something that anyone who is not a politician or NHS manager will realize does not occur anywhere else in the world.

Anywhere else in the world if you can’t pay, you don’t get treated.

Simple.

Bit like food.

No money no food but that is alright isn’t it?

Healthcare is a service while food is a necessity to life.

One you have to pay for the other is free in the United Kingdom.

However, if you can pay you may get better treatment which is why some of our more affluent patients go abroad for treatment in the first world, the USA, and even the less affluent have been known to fly to India for dental treatment while on holiday as the total costs involved (holiday and treatment) are less than getting the same treatment from the local NHS, sorry, private dentist.

And it is better and quicker.

It would appear that that the bean counters that are the local Thickerazzi have discovered this new (to them) healthcare tourism and are now instigating institutionalized racism in the same way that they support institutionalized incompetence.

A comrade graph manager has noticed an influx of the same patients coming from Europe who are getting health care and drugs in blocks of 3 months according to the local Politburo’s under graph manager for registrations (EU Nationals) Eastern European sub commissariat division’s latest graph which is at variance form the DoH’s under graph manager for registrations (EU Nationals) Eastern European sub commissariat division’s latest graph.

This is not allowed.

Why?

We can register EU residents for 3 months as temporary patients and they are entitled to free health care without any additional paperwork. Drugs they have to pay for overseas are cheaper on a prescription here. So come over here to work, register as a temporary resident for 3 months, go back home for a week and then re register.

Free healthcare, free prescriptions no questions, no paperwork. Bring the family too.

We now have, from the Party, several pages of paper (paper not patients) which says who can, or cannot, have healthcare based on their nationality and what paperwork they have to produce in order to be registered at a GP Practice in Northernshire.

We at ND Central are now the new UK Border Guards for NHS Healthcare plc.

Unarmed, on patrol, while the Thickerazzi struggle with this new problem.

It is after all upsetting a comrade under graph manager and costing money. The Thickerazzi are monitoring us as they are asking us which (local) patients at 101 are still alive at what address, their nationality and have we seen their passport, and a host of documents, utility bills and that is just for the local population?

This is a ripple effect from the local Supreme Thickerazzi Central (Northernshire) which has only just noticed this as someone said “Spasiba” to one of their number after treatment at a GP Practice rather than at the local Politburo meeting. As a result the Stasi are on the case as the whole of NHS Northernshire is troubled with the problem of overseas nationals getting free NHS care without the correct paperwork.

Where have they been for the last few years to realize what is going? Certainly not working in General Practice.

Praise be to the Party for its provision of free healthcare to those that have never paid for it. Such compassion acts as a beacon to all and creates conflict on the frontline. Try getting free healthcare abroad.

Can you?

Are we treating our own?

Check the cancer clock it is still ticking.

Value for money?

Politicians love to appear to save money. Our current Party has constantly boasted about how much of our money as taxpayers it has prudently (trousered), sorry, spent on itself, sorry, us.

After all the NHS is awash with money benefiting patients now we have slowly caught up with what the rest of what Europe spends on is residents’ healthcare.

We have even slipped down the league tables in catching up with the former Communist countries.

The medical blogosphere has produced some interesting figures in the last week.

We at ND Central, being thick and up North, can’t work out what the following figures mean as to how much money is actually being spent on health care and, given how much we GPs trouser, if we represent value for money?
Perhaps some one could help us with these figures here?

NHS Management Costs £ 12, 600, 000, 000 note 1

General Practice £ 7, 000, 000, 000

PCT HQ costs £ 2, 128, 000, 000 note 2

Midwifery £ 1, 800, 000, 000

NHS Dentistry costs £ 1, 800, 000, 000

Accident and Emergency £ 1, 700, 000, 000

% increase in managers last year 9%
% increase in nurses last year 2%

Note 1: This figure is just the Department of Health, Strategic Health Authorities and quango costs.

Note 2: taken from a local PCT summary accounts and multiplied by 152 PCTs to give a guestimate probably on low side.

Sources are here and here (last one is a slow loading link).

How many patients have used any of the services above?

Average GP consultations per person are 4 per year rising to 7 a year for children aged 0-5 years and adults aged over 75.

Remember no one ever sees their GP which is why we are expensive to run. They always run straight to their NHS manager for free healthcare.

A&E attendances for 2006-7 in England were just under
19, 000, 000
versus
250, 000, 000 for GPs a year in the United Kingdom.

If you want to see the problems a shortage of nurses has check out the Militant Medical Nurses blog here. We hear the same from our patients so it is not just one voice saying we need more frontline nursing staff not bureaucrats.

Praise be to the Party as we never realized how frugal it is in squandering our cash on the important areas of healthcare in a recession. NHS management value for money as every patient who sees them knows.

PS there is a rumour that £ 15 billion might be saved in the forthcoming budget. We was not good oop North at mafs sums you ner adds, take aways, times and share by sums but is £ 12.6 billion + £ 2.1 billion almost £ 15 billion?

We live in hope.

Anniversaries 20 years on

Here in Northernshire several of us have noticed that the media have been concentrating on an event that 20 years ago resulted in the loss of 96 lives in a matter of minutes at what should have been a sporting event.

While any unnecessary loss of life should be avoided, it got some of the team who were there, or trained, in the cities involved to think how people cope with such events. Here are some of our collective recollections of these events from 20 years ago:

One remembered a former Professor of Forensic Medicine who argued strongly when building a new Coroner’s centre that there was a need for a 100 “bed” fridge in the new morgue. He thought it might be needed in case of a mid air collision.

He was right. It was needed in his lifetime but was wrong as to the circumstances when it would be first used. Any manager that bright?

On the afternoon at the sporting event there were many doctors present some officially as a “jolly” others unofficially in the crowd. Many of these we have subsequently worked with. There would have also been nurses, physios etc all of whom will have their own story. These rarely appear in any official enquiry.

One of ND’s team had a GP trainer who had been there and recalled the event several years later when they attended a suicide whose chosen means of demise recalled what they had seen in the many dead at the stadium.

Another recalled a patient who loved football and used to work on one of the turnstiles and remembers the relief they felt when the Police eased the pressure on the turnstile he and his son were working in when they let the fans into the ground.

The brick walls were moving under the weight of the fans who had arrived late pushing to try to get into the ground before the kick off. Both he had his son were so relieved when the pressure was eased as they feared they would be crushed by the fans and the wall if it gave way as they had no way out.

Only later did they realize that their “relief” had such an impact on others’ lives. That elation of apparent survival of he and his son was later followed by despair, grief and guilt at having survived when others had not. He was a father and went to his grave with this.

There were also Police officers there some of whom were at school with ND team members and some of whom went on to sue their employers for their inability to cope on the day.

Same school, same city, different jobs and different reactions to the same event.

There were those who although off that weekend heard the news but went into work after hearing the disinformation that is the media to help with the 8 operating theatres working (as far as we are aware there were none).

When we arrived the whole of the medical speciality team with whom we were working (consultants X2, senior registrar, registrar, senior house officers X2 and the 2 house officers) were all there waiting and prepared to help. The 2 nursing sisters and several off duty nurses had also come in as well and that was just on one ward in a large teaching hospital.

No one had called them (there was a major incident plan) they had just heard and came in of their own volition.

Over the next few days the wards where we all worked were on national TV daily something that most doctors avoided but unfortunately the show of a blue uniform is always good for the media even though it meant that nursing care suffered as the media is more important than patients.

We remember the feeding frenzy that was the media scrum of piranhas biting at any meaty titbit that might be a newsworthy story.

One of us recalls going on major incident exercises with the military and recalls being told that the biggest problems to be contained are the Press and the relatives as there is a huge demand for information which hampers any attempt at organized relief efforts. Remember no mobile phones then and this grunt training has been right on so many occasions since.

20 years on what is our collective memory of this event? Part of it is for the unnecessary loss of lives due to a football match but mainly for the fact that so many uninvolved directly came in voluntarily and gave over what was ever required of them during the disaster and its sequelae. This is the best part of the human spirit and was heavily diluted by the blame culture which followed and that has been evolving every since humanity realized there is a potential right and wrong.

Oh yes we also remember a nurse manager wandering around with a clipboard and suit in a corridor (yes, they were around 20 years ago too!) saying “Are you are right?” to any one in a nursing uniform or white coat as she avoided drunken fans hassling nurses for information as they tried to work.

Also:

Two days later the whole of the A&E team in casualty falling around in laughter when at 22.30 hours the night nurse manager announced that some unknown "counsellor" would be offering their services if any one “needed” them?

“Where was the idle (expletives not printable) and you when we needed help?” is the phrase we remember being shouted back in amongst the laughter at the manager as they beat a hasty retreat.

It was another day at the office in a small Northernshire town remote from Westminster albeit just a bit busier on that day.

The grunts on the ground did their job and coped as best as they could.

Some things never change in the NHS. The problems keep coming and we deal with them. Occasionally it is recognised. Anyone remember Bradford?

Praise be to the Party and their managers whose major incident plan worked “so” well as they always do (if you believe them and don’t see major incident plans in action).

Would that esprit de cours be there today?

Despite all the crap that those who work in healthcare endure we suspect the answer would be a quiet Yes.

And someone with a clipboard will be there too.

Queues GPs

We had a discussion today about an item on a BBC local news station about queues forming at a GPs surgery in one of the more Southern reaches of Northernshire that one of the team here at ND Central had spotted and past around.

The video can be seen on this link but what was interesting was the fact that several members of the team were worried as the TV program concerned had asked viewers to email in their experiences and they were worried that someone might grass us up even though we do not have this situation, as yet, on our own home turf.

We got thinking as to how this situation had arisen and how the news item had someone from the local BMA towing the Party line.

If you can bear with us and follow this through we hope we can explain how such a situation has arisen as a result of the new Soviet style NHS system of Big Gordon knows best.

Prior to the introduction of the 2004 New General Medical Services (nGMS) contract there was no specified minimum consultation time. Practices had adapted consultation times and availability to best cope with local demand.

In areas of well ordered and well informed patients you would probably have had longish consultation slots with extra spare slots to fit in genuine emergencies. In areas that differ from this you may have had a drop in and wait system in the morning to accommodate high numbers of minor but quick to deal with problems e.g. the urgent sick note, 2 minutes in and out.

There were all sorts of different ways of seeing and dealing with patients that local practice’s had evolved to deal with local demand and refined and adapted according to changes.

But then came along Comrades Tony and Gordon who given their collective experience of healthcare came up with the nGMS contract. They thought that 10 minutes was the correct Soviet length of time for a consultation and that all patients should be able to see a GP within 48 hours.

If GPs did not tick these 2 boxes then they would be heavily penalized financially. So in well over doctored, affluent areas this was not a problem as they were probably doing this anyway.

However, in less affluent areas that were under doctored areas, this caused a problem. As most of what presents here is relatively simple it does not need 10 minutes to deal with and so you cope with high numbers by short consultation times.

One of us at ND did a stint as a locum GP and remembers seeing 50 patients in an inner city deprived area on a drop in basis when there would have normally been 2 GPs on their own and spending 5 hours to do so or 6 minutes per patient.

At ten minutes per patient that would have been 8 hours 20 minutes followed by visits and paperwork and that was just the morning surgery.

Now Gordon and Tony, who are both holier than all others bar Mugabe, were not pleased following the introduction of the nGMS contract that GPs did honour by doing all that was required so costing them dear which they had not allowed for.

So Gord and Tony did then start reducing how much they paid GPs and as a result some GPs incomes went down from the alleged £ 250,000 a year we all earn (but not as a pension).

This happened at ND Central where we resisted the 10 minute appointment scam until we realized that the only way we could preserve Practice income, which is used to pay our staff, run the Practice as well as pay ourselves the £250,000 that we don’t get was that we had to introduce 10 minute appointments.

So after 2 years of the nGMS contract we introduced a 10 minute appointment system for the second time as the first time it failed disastrously as we tried to keep existing appointment numbers up and found we were doing nothing but appointments. The second time we reduced the number of appointments to enable us to do other things in the day. The well establish Dr Crippen seems to be going through the same process and his thoughts are here post "Things can only get better ,comrade" and we like the graphic 3 April 2009.

The system we employed was that any patient could ring at 08.30 or 12.00hrs to get a same day appointment for any problem (urgent or not) to ensure that Gord and Tony were happy we have 48 hour access. These same day appointments disappear within 4 minutes sometimes as little as 2. We have 10 minute appointments (where we used to have 5 minutes) but we have less appointments than we had before. Previously only emergencies were allowed to book same day appointments now anyone can book with anything.

So what happens? Certain patients with non urgent conditions and nothing else to do with their disorganised lives realize that that they can access a GP the same day and so they book appointments for trivial non urgent conditions and block the same day slots from those with more urgent problems.

Sometimes we as GPs see patients that need review after a day or two to see the evolution of an illness to check it is not our worse case scenario and as a result we ask people to book into a same day appointment but tell them to come to the surgery (and not ring) just before 08.30/12.00hrs to guarantee an appointment.

This is what happens in relatively affluent areas but the same will happen in less affluent areas. People will discover that, rather than ring the surgery and get the engaged tone because they were a millisecond too late hitting the last key on the phone, they are more likely to be seen on the same day if they go in person and ask for an appointment so stopping a receptionist answering the phone.

Now the BBC and the Government do not realize that patients are not always directed by the Big Brother screen in their home much to the disappointment of the Party who seek to control people but they also speak to each other. So if someone finds a way to get seen quicker they tell their mates who tell their mates and so on.

Next thing you know is that people desperate for an appointment will start to queue, rather than phone, and know that the earlier you get there the more likely you are to get an appointment. Remember appointment numbers are likely to have gone down in order to meet the 10 minute target.

Then disgusted of Dinnington using her mobile phone steps in and it is highly likely that disgusted of Dinnington voted Labour but it is of course the GP’s fault as he was merely following Party diktat.

So a simple “it is disgusting story” has a relatively simple explanation and an equally unaccountable group of idiots that are responsible for its creation.

Praise be to the Party for their “if it isn’t bust, break it” healthcare policies. They work so well to make things better?

Safeguarding Adults Training: the Thickerrazi training the bright

The local Politburo have “mandated” (remember that all members of the local Thickerazzi are duly “elected” based on their incompetence to PCT posts) that all those to whom they subcontract should now have to undergo under pain of death “Safeguarding Adults Training”.

Now we thought that this might be how we protect our staff and our limited thoughts on this new management buzzword were great! Flak jackets, side arms and M16s but no.

Party speak means, that Safeguarding Adults Training means protecting those with “learning disabilities”.

Are we allowed to use the term “learning disabilities” or should it be less able to protect themselves? That was the initial term but then, in a slot scheduled for an hour (because this is important Politburo “re education”), we had half of our practice cramped into a small room listening to an incredibly important seconded district nurse reading from a Party prepared (Praise be) presentation on a laptop delivered in 15 minutes flat.

It was delivered thus because although we had been told to allocate an hour to this “important” and more educated (than us) speaker they arrived late (because they were vitally important and busy) to a room full of staff (who could have been doing something useful) doing nothing.

Such is the importance of Party dummkopfs employed to “re educate” us to the Party line that they can disable half of a practice’s work force for one tenth of the Practice’s working day to listen to something that could have been put on a couple of sheets of A4 read and binned in 2 minutes.

What was interesting to any cynic, not that we are here at ND, was the following:

That all the measures outlined as being now “mandatory” in the training were meant to have been in place in 2007 based on Acts of Parliament from 2000.

We were given a copy of the procedures (2007) to be followed (in 2009) a huge resource of rainforest destruction surely destined for landfill end use.

We were informed that as a result of these changes there were now only 32 “safeguarding managers” in post to be “referred” to. This number of managers is only a few less than the number of additional GPs we should have locally in the ever over affluent Northenshire to bring us back up to the low levels of the national average of GPs per number of patients.

Given the 15 minute presentation (that should have been an hour) the examples of abuse illustrated would all have applied to the Baby P, Staffordshire hospitals, Iraqi US military prisons and Guantanamo Bay all of which could have been used as examples of abuse in the “Safe Guarding Adults” training NHS corporate laptop presentation.

They were not. But we hadn’t had our training and so we all would have missed these examples of abuse.

A busy district nurse who was “safe guarding adults” did the presentation clearly an efficient use of this resource? We are short of “working” district nurses following a disastrous reorganization of the service which saw 80% leave.

We were told that if,

after, a referral to a “safeguarding manager”,

there was felt to be a “case of abuse” then a local committee of dummkopfs would be appointed and if they then felt there was any evidence of criminality that they would refer it to the Police. Bright boys then on such a committee and they would stop any further “investigation” before resuming their “investigations” when the Police had finished theirs.

Clearly the Party and its Politburo’s investigations are more thorough than those presented to the Courts that they use merely as an information gathering service.

Are we missing something here dear reader?

So a case of a child abused reported to “a line manager” who then reports to a “safeguarding manager” will now result in the convening of a “committee” of social workers, nurses, doctors etc. all within the statuary 10 days.

If the “Committee” then decides there may be a criminal act they will then refer to the Police.

So continuity of evidence is not as important as following Politburo procedure “to protect” a vulnerable individual? While the Committee is being formed what happens?

Nothing?

Apart from possible further abuse?

Every member of staff said the same thing: “waste of time and what did they tell us that we did not already know?”

(The words “what a load of sh*t” was the most common descriptive word to describe the presentation and that was just the practice nurses).

Only one person in a room of twenty did not know what they were doing and that was the speaker who will continue peddling like any drug dealer their gear but to no market. The market is already saturated with knowledge of this subject.

Praise be to the Party and its every excellent local Politburo managers for telling us as much as they know about this issue = nothing.

They are ticking boxes and we already dealing with the problems they have only just discovered and feel they should share with us.

(We apologise to any chimpanzee readers as given recent research into primates there is a move to reclassify their species as Homo as in Homo sapiens. Unfortunately no one seems to regard the classification of NHS managers and politicians into H.thickus or H.incompetans as important. At least chimpanzees can think and adapt).

Honest MP’s expenses versus GP’s expenses a few musings

While busily waiting for patients, most of whom were in and out in 2 minutes, we were at ND Central (following Party orders and offering 10 minute appointments) reading a non medical blog and came across some MP’s expenses on the web and so we dared look up the local MPs in this prosperous part of Northenshire.

Being of the landed gentry stock we were amazed to discover how much our elected representatives were claiming given their affluent backgrounds.

The source of this information came from the scurrilous political blog Guido Fawkes and to look up what your MP claimed in the year April 2007- March 2008 go here .

We got our finance wizard to look at the figures and see if we could compare our expenses as evil overpaid under worked GP scum who are destroying the health services against those honest, hard working MPs led by the ever honest and prudent Gordon Brown MP who are trying to reform our health service for the common good of the Party (Praise be).

Oh yes and for the electorate we forgot about them but so did the Party so that is all right but we are GPs and the cause of all UK healthcare problems as we are paid too much.

Comparing like for like expenses where possible we present in Technicolor:

The costs of running one Northernshire MP full time (excluding summer and other breaks as a pooled average of our 3 local MPs) in red

vs

The costs of running one full time (normal holidays) Northernshire GP in blue:



Total Expenses: MP £ 110,934 GP £ 88,356


Staff costs: MP £ 75,818 GP £ 45,656


Stationary and postage costs: MP £ 1,107 GP £ 1,145


Number of surgeries: MP 2.3 per month GP 8 per week

Hours of surgery time: MP 4.3 per month GP 19.75 per week


Constitunency/practice population: MP 74,000 GP 10,000

(The expenses figure for GPs is all practice expenses while the figure for MPs is just those items gleaned from the link above.)

Remember this is Northernshire where first world healthcare is the norm, there are no waiting lists, no MRSA or Clostridium infections and where all patients are driven to their appointments in chauffer driven Rolls Royces after they disembark from their helicopter.

Right.

Praise be to the Party for keeping the pockets of the essential health care workers called MPs full while depriving the masses of what they need. Frontline healthcare.

Dare you! Check out your MP’s expenses wad and remember they get paid on top of their expenses.