Tuesday, 28 July 2009

Salve Medice. Latin a dead language? Long live Latin!

We at ND are quite proud of our collective life experiences in various parts of the medical, social and wider world(s) which we share with each other.

We believe we have a “skill mix” to “support and foster” the “primary health care team” and “its diversity” so lead us to a “gold standard general practice” with “equitable access” in Northernshire and hence provide “world class commissioned services” that involve the patient at every “key decision” on their “patient journey” to “empower” them to make the right “ NHS choice” for them and their family.

OK let us cut the bull and come to the point we do after all live in the real world of NHS General Practice.

One of the old fart school of medicine among our team went to a Northern state school where they were taught Latin by a teacher called Big John. This was a few decades ago and while Latin, like any language has different forms, for example medieval and ancient our team member had not used it since pre grunt training.

Imagine our collective response when this “well” educated member from the Northernshire state school told us that they had been presented with an MRI scan by a patient from an Eastern European country formally part of the Soviet Union. The patient had in broken English said:

“I have this report which you will be able to read . . .”

They then presented the MRI scans and the report to our team member. The scans we could have a guess at given our training.

The x-ray report, however, was typed in Latin in an Eastern European type font!

Titter ye not, it's wicked to mock the afflicted! Well it might be one of your own!

A first in Northernshire for the team!

Anybody else know better?

Praise be to the Party for Latin x-ray reports?

Thanks to teacher Big John all those years ago for allowing us to translate it and for our team member who had worked in an area of the world that had MRI scans many years before “world class” commissioning PCTs thought these might be useful for doctors. They were able to interpret both the scan and the report without using a language line.

The Party continue to use a modern variant of Latin and teach it to their managers which is why few understand a word they say. Bit like the Catholic Church in the Middle Ages before the Reformation? Use an incomprehensible language to confuse the peasants and maintain power via fear and ignorance?

Therefore it is back to the books: Grumio est in culina . . .

Sunday, 26 July 2009

A Present from the Party, the success of the Swine Flu line and Things can only get better 003

Another day at the front and we each had on our desks a gift from the local Party commissars. Our own personal flu protection mask this time with not just one set of filters (2 per mask) but 2 X 2 filters.

Clearly this will be a long campaign for front line doctors to be protected against the hazards of interior decorating namely paint spraying and sanding which these masks are designed to protect against but our staff just have to manage without any protection. The learned local commissars feel that nurses and receptionists do not need any protection.

You can see what these masks are designed to protect their wearer against in the following paragraph taken from this link look for the section regarding the filter 2138 the ones issued to us to see how it protects us against swine flu. In fact are any of the filters designed for swine flu?

Some more research on the effectiveness of the filters is found here.

This gives the following information about the supplied filters:

“The 2138 filter has been classified as a GP3 particulate filter, and is thus able to be used for protection from mechanically and/or thermally generated particulates i.e. it provides protection against dusts, mists, fumes & ozone as well as for toxic materials like beryllium. It is also suitable for use against low vapour pressure chemicals (V.P. <1.3 Pa or 0.01 mm Hg at 25 deg C) up to ten times the Exposure Standard and also offers relief from nuisance* levels of organic vapours and acid gases such as chlorine & sulphur dioxide.

NOTE: The 3M™ Disc Filter 2138 provides GP3 protection only with full facepiece
respirator. Provides GP2 protection with half facepiece respirator.”

You will see that a lot of thought has gone into supplying us with filters that specifically stop the transmission of the flu virus as outlined above. At £ 15.00 + a mask and filters on top clearly public money well spent on something that offers no apparent protection against viral particles but scares patients.

The commissars are clearly worried as they realise even though they have their own masks and Tamiflu they cannot run the health service when even minor illness strikes. Clearly there is fear and panic in issuing these masks to personnel less important than themselves as this goes against Party policy of GPs = under worked overpaid scum on golf course.

The NHS Flu Pandemic line has been a great success that demonstrates the years of planning (panic) that has gone into the best prepared country in the worlds planning for this crisis.

Sir Liam was on G(ormless) M(oron) TV saying that the best prepared country’s plans had only estimated 25,000 calls per day not the 9.3 million calls (estimated) in the first hour. A mere miscalculation of some 2 orders of magnitude which I am sure is allowed for in emergency planning in the same way that inches versus centimetres helps land Mars missions successfully.

Add to that a late start and it is all coming together that the UK is the best prepared country in the world for swine flu. We are so well prepared that we have to export ill patients to Sweden for life saving treatment.

Today we have had patients who have dutifully followed the Party’s advice to ring NHS Swine Flu (Porky Pie) line only to be unable to understand their operatives English. “They speak too fast” and “I can’t understand them” were comments relayed to us. So where do they go?

To their GP.

Another patient was given a Tamiflu prescription authorisation code but the chemist did not recognize it so where did the patient go?

To their GP to get a correctly written prescription.

Another success in relieving GP workload. Yes less phone calls but more work sorting out problems generated by the Flu Line which is so different to other great Party successes like NHS reDirect.

Patients from a nearby town were forced to travel 20 miles to get their prescription as they were given a code that was only valid at a Tamiflu distribution point (TamDP) 20 miles from where they lived.

We thought this was just local to us but it was on the evening local news from a region far south of us that other places in Northernshire had the same problem. See this link.

You will notice in this link how the flu buddy aka the patient is sent to collect the Tamiflu in person to minimise the risk to the admin staff now issuing and dispensing drugs. Clearly another sign of the plan's success in action.

The official way of getting Tamiflu in the far south of Northenshire we found here and in case you think the TamDPs are secret as per the clip try this link to find yours.

No contradictory advice here then?

Clearly the best prepared country in the world?

Like the lager, probably not in the slightest.

Also we have predicted the black market for Tamiflu. There is a rumour going round that a delivery truck to a TamDP was knocked off and the only drug taken was the magical Tamiflu.

And we are being told not to panic by none other than the new health minister himself. Seems that there may be a slightly critical report about the flu preparation coming this week. Surely this cannot be a problem for the Government of the best prepared country in the world? Probably a lot of problems given how we and other bloggers have seen this preparation in action.

Praise be to the Party and their prudent panicking, sorry planning.

Wednesday, 22 July 2009

Some More from the Front

Dear Mom,

The surge of swine flu has been relentless and we in the trenches are beginning to crack.

Today we had to prescribe for a five year old whose brother was so severely affected by the disease that within 4 hours of his first dose of Tamiflu he was better.

Unfortunately his brother, a year younger, could not have the liquid Tamiflu. Despite us being in the best prepared country in the world, of the one hundred and fifty rounds of Tamiflu delivered to our local TamDP, only one was in liquid form. That one round of liquid Tamiflu was reserved, like the last bullet, for the under ones.

Gulp, Ma that is hard to swallow.

Imagine my distress, at having to tell a 5 year old with a non life threatening illness, that despite his brother having the same non life threatening illness and surviving, despite treatment that made no difference, he too would have to have capsules broken up in order to save his life.

That was really hard Ma and the parents were disgusted even though the treatment you pay for is free here.

They were used to children in this Third world country called England, having any medicine they want as a liquid but we think they were selling the Tamiflu on the black market.

The War in Northernshire is tough. Beer is in short supply - we could only muster 24 pints a man for a Friday lunchtime educational meeting and then had to do a Friday surgery without pork scratchings. This war sucks Mom is really does. No Scratchings on Friday? What are the Brass doing?

It is heartbreaking Mom. We are seeing so many flu like illnesses that used to stay at home and get better on their own but now they ring us all the time. They just keep coming at us and don’t stop.

We have no phones (they are always engaged), no Tamiflu and most importantly no illness.

Still we are comforted in our trenches by the Gordonels and Donalols telling us that there is nothing to worry about as we are in the best prepared country in the worlds and the fact that soon huge call centres full of untrained soldiers with no medical knowledge will be on our side to defeat the evil non enemy called flu like illness.

Sorry Mom, my sergeant said as this letter will be censored, the evil swine flu disease.

We saw those poor raw recruits queuing to sign up for the call centers (or were they job centers?) and thought what are they letting themselves in for?

They will in 2 days have no training, let alone a basic medical degree or any medical experience and will be exposed to the pathetic worried well of the UK? They will not know how to shoot Tamiflu and so they will squander ammunition like a drunken soldier pees after 2 bottles of Jack Daniels. But rumour has it that there is so much duff Tamiflu that the Brass want shot of it any which way.

We are here in the trenches a little short of information so we hope the brass know what they are doing.

Hope you and the new born calves are well and Jim Bob is helping out? As he is 11 will he be joining the Flu centres? I hope so as ever little bit helps here in Northern Kansasshire in these hard times.

Your loving son,

Captain “Doc” Northern MD
US Flu Com (advanced recon patrol in the UK somewhere in Northernshire)

Monday, 20 July 2009

The NHS Flu Pandemic Plan vs reality 003 May the Surge be with you

We here at ND Central may had been a little critical about local arrangements for the Swine Flu Pandemic so we thought we ought to look at those in charge’s perception of the “crisis”. We are, as is the whole country, in the hands of the legions of faceless mandarins who for years, possibly since 1919 but, unlikely, as they don’t have that many fingers to count with, have “planned” for the flu pandemic in the background with no thanks what so ever for doing nothing.

We have posted on the results of this foresight and ever wise planning but thought we would, for balance, consult their views on how Northernshire, sorry the whole NHS is prepared, for the impending Swine Flu problem.

We therefore consulted the Comic, aka the Health Services Journal, and attach a few links for you to realize how Swine Flu is just about imposing on their ever busy existence and how well they are coping.

It would appear that PCTs’ swine flu pans are being tested by real life. A real shock to your average NHS manager as that might mean that a real person, or a patient, a totally alien concept to them, is ill (and importantly costs money).

We particularly liked the comment of a certain Professor towards the end of the article:

Where flu starts to hit one particular area it is important PCT chief executives are visible to GPs.”

Why? What good will they do? They won’t see or treat a single patient. Unless he means visible in the crosshairs to GPs . . . ?

In the 10+ years we have worked in Northernshie we have only ever seen a Chief exec once and could not understand a word they said.

We are also relieved that a national director for “social care flu resilence” has been appointed.

We here at ND Central have been losing sleep over this gap in our "advanced" flu planning. Thank goodness the all wise managers have created such a post. We can now sleep soundly in our beds knowning that there is a national director for social care flu resilience - what ever that is? It will no doubt make our jobs so much easier.

Lots and lots of tough words from the flu czar here.

He wants PCTs to review their “surge" plans. Don’t know what these are but we bet it won’t be anything like the American surge in Iraq but we know where the word was copied from. Perhaps it is how quickly a PCT can evacuate its headquarters when large public gatherings are banned if real flu takes a hold with the exceptions of GP surgeries and hospitals which will have to remain open regardless?

“PCTs must “give a very high priority” to making sure GPs have the capacity to look after all patients, regardless of how widely the disease spreads”, he said (as all GPs and Hospital doctors and nurses will be spared the flu).

Think he might find that virtually impossible as they can’t even look after all patients in the absence of a flu pandemic so another highly paid NHS commissar living in Never Never Land with Micheal J and getting paid to do so. But isn’t Michael now brain dead?

Hospitals will be expected to make sure they can “surge” their critical care capacity for several months if necessary. And human resources advice produced by NHS Employers recommends skills audits and plans to redeploy staff to areas of need.

The “surge” word again obviously a popular word for managers at present. We have already mentioned one plan that is probably in place to redeploy staff to areas of need (their homes) but a skills audit? Can you see Chief Executives asking their HR departments “how many GPs do we actually have?” for the first time ever?

Asked whether discussions were taking place over how the system might respond to financial pressures such as a “surge” (it is there again) in accident and emergency admissions, Mr Dalton said: “Our job is to ensure any impact is managed properly.”

More “surging” or managers coming our way?

Interesting how the system might respond when it has already 100% bed occupancy and struggles to cope with the current state of play so if there is a nasty flu pandemic we will be pleased that the shortage of resources already in place will be “managed properly” when the brown stuff hits the fan.

He also said the Department of Health is still planning to launch its national flu line in October. Really? Looks like that has been “surged” forward a bit something we are sure was foreseen in all of those advanced flu plans.

Listen up the flu is here now, the Chief Medical Officer has said 100,000 cases per day in August and you were planning to respond in October but now it is in 3 days time?

Surely no panic here as it was all in the plan? Can we have your job? Sitting on your hands and being paid big bucks we like that idea of work. Try dealing with the "surge" in phone calls your advice to patients has generated in the real world to pander to the pathetic.

There is also an article about GPs getting unclear advice on dealing with swine flu.

Surely not? Just look at our previous posts to see what is happening in one of the top World Class Commissioning PCTs to see that this is not happening.

A few intersting comments at the bottom. So we at ND Central are not alone?

And finally a little piece about what might happen to NHS managers if their flu plans don’t succeed.

Some PCTs will get it right, others will be lucky. Those who get it wrong and are unlucky will be exposed to the full force of public anger. The exemplary performance of the best PCTs will be used as a stick with which to beat the worst.

Local managers should be in no doubt about what they will endure if they fail. After five years of preparation, millions of pounds of investment, months of warning over swine flu and endless declarations that the country is ready, the public and local and national media will lynch you

So if your PCT has a higher death rate due to your flu plan the public will lynch you as they did in Staffordshire? Looks like a lot of NHS managers will be getting some hefty promotions if a flu pandemic strikes. How many more NHS Chief Executives can the country afford to fund to reward high flu death rates?

Praise be to the Party and all its wise managers and their flu plans.

What would we do without all of their work?


Perhaps? On our own, as always?

Friday, 17 July 2009

Things can only get better 002

Following our last post things have improved further. All of yesterday’s Swine (flu) phone calls were nothing like flu. Our on call doctor noted, as we did the day before, that there was a “surge” (more on this in a later post) of calls towards the end of the working day.

Another trend we have noted is that a lot of people were ringing from work:

“I can’t come down to see you in case it is something else, I’m at WORK!”

Are people starting to take the proverbial pee? They could after all ring NHS (re)Direct but they already have and what do they get?

NHS (re)Direct is telling patients they can’t do anything (nothing new there and a huge waste of money in the process) go and see your GP. Yes we had that yesterday afternoon as well.

Of course the swine flu hysteria has become a skivers’ charter. You ring your GP and get Tamiflu and go into work with it. What happens?

The boss either sends you straight home relieved to get the evil flu away from them or your co-workers on seeing the box panic and evacuate the building (faster than if someone had chucked tear gas in) to go home and get Tamiflu for themselves after exposure to a “confirmed” case. Easy week off either way.

While doctors can often diagnose over the phone simple things our biggest concern is children.

If Shaza rings and says Tarquin has “flu” can she have some Tamiflu and omits to tell you about the rapidly spreading rash that she hasn’t noticed, due to booze and watching Home and Away while having her lunchtime 20 Rothmans, Shaza will be so forgiving when Tarquin’s meningococcal septicaemia fails to respond to your Tamiflu.

We here at ND Central are confident that Sir Liam et al will be indemnifying us especially as they don’t pay for this. Will the “I was only following Party orders” be an acceptable defence?

After all, Shaza will be upset for not telling her GP about the rash that she will do penance at her local no win, no fee solicitor. And who will lose if we follow the Party’s advice? Tarquin and you?

So kids will be coming to surgery regardless of what we are told. We suspect so will adults as telephone consultations take so much longer than face to face ones. Will the “I’m at WORK” crowd then come down? We shall see.

The “world’s best prepared country to counter flu plan” is working so well. One prescription for Tamiflu was issued yesterday and the patient’s flu “buddy” came down to collect it.

The “flu buddy” was none other than the patient themselves.

And of course we know we can be confident about our diagnoses as we are no longer able to do swabs to confirm the disease. Given that only about 1 in 4 of swabs done so far were actually positive for swine flu it is likely that a lot of anti virals will be given for something that isn’t swine flu. The more anti virals used the quicker resistance will develop. Guess work is a poor substitute for accurate laboratory diagnosis. But our odds of getting it right are higher than losing at Russian roulette.

We suspect it is only a matter of time before drug addicts realize that Tamiflu is a marketable product and start feigning “flu like” symptoms. A packet of Tamiflu with a suitably endorsed prescription to prove it is the real McCoy could provide the next few fixes for a few minutes of blagging.

Praise be to the Party and its plans. Things can only get better?

We await the "who will get the flu vaccines" announcement from yesterday afternoon's high level meeting with interest. We think the list will be Gordon, Sir Liam, Lord Mandelson, Sir Humphrey . . .

Wednesday, 15 July 2009

Things can only get better.

Well another Northernshire Blogger’s practice has posted on the “best prepared” country in the world’s flu plans and its impact on workload before anything serious, like real virulent flu, has happened. Jobbing Doctor post 13 July 2009.

We are constantly being told here that we are the best prepared country in the world to tackle flu. This is by people who retired from real medicine years ago or good honest politicians whose every word can be believed. The front line is struggling already and we are still in the phoney war stage. The enemy is not virulent yet but it is spreading

Now children let us do this very simply.

One flu sufferer coughs and sneezes and so infects another passer by. This becomes 2 flu suffers who then become 4 then 8 and so one and hence the Flu intellectualazzi are proved right. We might have 100,000 people with flu a day by August. Simple mathematics.
Unfortunately although “we are the world’s best prepared country” have any of them thought of another malignant virus that could cripple health care before “real” flu even arrives?

The exponential Shaza effect (ESE)?

It works like this:

“Wotcha Shaza just watched GMTV and when yer texted us that your Tarquin has a cough, sore throat and a temperature I fort he might have swine flu.

As yer Tarquin was at nursery with mine I have texted all 400 of me mates on me mobile to let ‘em know he has swine flu and that you are ringing the doctor just in case. I’ve also e-mailed my 600 clients just to let them know as a qualified beautician they may all have SWINE FLU as our Chantelle were in Mexico 9 week ago.

She is OK but woz getting her nails done here 4 weeks ago and her cousin’s kids woz with Tarquin 2 weeks ago at MacDonalds for a birthday party. I told them at school about Tarquin’s swine flu and they are sending notices out. Any road I’m ringing my GP just in case can’t be too careful - it says so on t’news.

It is so stressful it is doing my head in . . . I tried to ring NHS Direct but gave up after 2 rings and even me GP ain’t answering as its always engaged. I’m off to A&E.”

Has Sir Liam any idea how many people get a temperature, sore throat and cough each day?

Of course not. Sir Liam has not practised real medicine for years although he has more initials after his name than all the doctors here in Northernshire who are dealing with this kind of crap. And it is getting rapidly worse.

We had in one hour yesterday 8 phone calls all demanding to speak to the on call doctor because they thought they had swine flu. And that was while we were trying to see patients in a surgery which Gordon and the Party ration to 6 per hour so 8+6 in an hour is without a Party target. That was just in one hour up from 4 calls for the whole of the day before and the hour before that after lunch.

Some had had it for days and were getting better but they rang “just in case”. Some had been to a NHS walk in centres in cities 60 miles away and had been sent home to ring the GP. Others were ringing from work 30 miles away about patients who they would not allow us to speak to as they were asleep but could we have some Tamiflu just in case? None of them had rung of their own accord other people had told them they had swine flu and to ring just in case.

Welcome Sir Liam to General Practice in the UK. Depending which figure you believe here in Northernshire there is no spare capacity. We cannot deliver first world medicine (US standard) to our patients in the absence of a flu problem.

There are 250 million GP consultations a year. If everyone gets 2 sore throats a year then that is 120 million potential slots lost to sore throats alone. If every child suffers one illness a month AND sees their GP for each of these then that is 120 million consultations per year. Ball park figures these but these 2 conditions alone have all but swamped the NHS GP system.

Not all patients see their GPs or take their children to see GPs with these conditions but these are just 2 conditions and there are many more conditions as well. However the fact that certainly here in Northernshire we have very few slots free on any day in the year means that the NHS is one of the best prepared countries in the world to handle any extra swine flu workload.

We have so much spare capacity we could export it to the third World! Not.

We are having to deal with more crap that is accelerating due to the exponential Shaza effect as a result of ill informed media scare mongering. One only needs to see the effect of one idiot declaring that measles is in a school on workload to see how panic and ignorance grips a small population. Apply the power of media and Government to the whole population and you can guess the rest.

Thanks for the facemask and its 2 filters. That really reassures us on the front lines. Will you be sending soldiers to deal with the Taliban with tissue paper as a weapon? Must have been going cheap at Wickes builder’s merchants if you read the spec here to see how this will protect us against air bourn viruses. For anyone unfamiliar with this type of kit there is even a training video that shows why you need two filters which we provide as a public service for educational purposes.

Praise be to the Party how can we ever fail given their all seeing wisdom and forward planning? Patients are already complaining they can’t get through to NHS Direct due to the pandering to the pathetic and the Flu centres will be opening in October.

The genie is well and truly out of the bottle and keeping the bottle at home isn’t going to stop the genie spreading. It has already spread worldwide and we all breathe the same air.

So why tell people to stay at home and ring their GP if they “think” they have flu but still allow sporting events? Will that contain the genie?

Wednesday, 8 July 2009

The NHS Flu Pandemic Plan vs reality 002

Listen up soldiers, in order to help fellow grunts stuck in the trenches we here at ND Central thought we would share some of our experiences thus far of the real world swine flu pandemic.

Today we stumbled into a meeting of the practice COBRA committee - alright then we exaggerate a bit - some reception staff, our practice manager and nurses were trying to work out what they should do if someone rings in and thinks they have swine flu (the terms are usually mutually exclusive at this stage of the game).

This may seem simple given that the Party’s advice. Stay at home and a doctor will ring you. However, one eminent medical blogger has pointed out the dangers of the simplistic advice given out by the Party. His well written piece points out (and saves us having to do so, respect Dr C) and illustrates the pit falls of telephone diagnosis and treatment.

The full article is here at Dr Crippen's well respected blog and we reproduce this section :

"In the meantime, though, other illnesses continue as normal. Children still get meningitis, and may well present with high temperatures, tummy ache, headaches and a dry cough. Children still get bacterial pneumonia and may well present with high temperatures, tummy ache, headaches and a dry cough. Children still get pyelonephritis (kidney infections) and may well present with high temperatures, tummy ache, headaches and a dry cough. Children still get acute appendicitis and may well present with high temperatures, tummy ache, headaches and a dry cough. Children still get acute leukaemia and may well present with high temperatures, tummy ache, headaches and a dry cough."

While we may get medical indemnity in a flu pandemic this will not spare a doctor a hard time if they don’t see a patient who subsequently dies of meningitis even though they were being a Party stooge and prescribed Tamiflu for high temperatures, tummy ache, headaches and a dry cough. Real world medicine is not a checklist and swine flu is not the only illness GPs see.

After all any patient with a checklist could land a plane in the Hudsen as the checklist would say put the plane down on an airfield. Just ring NHS (re)Direct they use check lists and land planes every day in GP’s surgeries and A&E departments. Look at their Swine Flu check list here.

During the course of the COBRA meeting we looked at the multiple and often contradictory emails from the local Politburo who, safe in their Party bunker and clutching their personalized packs of Tamiflu, spout forth rainforest after rainforest of cows manure for us to tread in, sorry, for us to read carefully and consider their words of collective wisdom and follow in order to treat our patients to the best of our (not their) ability.

We found out that our local chemist, who a week ago could not dispense Tamiflu, as the Politburo Tamiflu Guardian Committee had blocked them from doing so and more importantly because they hadn’t got any, is now an official TamDP (Tamiflu Distribution Point).

We rang the newly established TamDP and asked them if they had got it (they had) and asked them how did we go about prescribing it? They did not know as someone senior from a pharmaceutical giant was coming down to see them that afternoon. We found that interesting as we read in our email that Tamiflu can now be issued on a standard GP prescription form a FP10.

However, in order to make the magic Tamiflu work, a special spell has to be written across the top of the FP10. We will not give the exact words of the spell for this is highly classified stuff but it is something a kin to “soft and ready to use toilet tissue” and must be written on the FP10 to activate the magic of Tamiflu here in the UK.

We asked our pharmcist if they knew these magic words and they knew nothing about it. This was most interesting as the last sentence in that email from the Politburo’s Coms centre said “that all TamDP chemist’s would have been notified of the master plan”.

Another email told us that each local GP Practice would be issued with one face mask ventilator. Now given that ND Central composes of over 40 personnel over 3 sites we immediately worked out if we formed a circle and each took a breath through the ventilator, did not exhale and passed it one to the next man taking no more than a second to do so we would all be protected against ever inhaling the swine flu virus.

Of course if you have to hold your breath for 40 seconds before your next breath you won’t be able to do anything else but you won’t get the dreaded Swine Flu. A circle is well known in Western movies as a good defensive position so that should further deter the evil Swine (Flu) from attacking us as as all airbourne virus detest a defensive circle.

But we are just simple grunts on the ground.

There is no replacement filter so that won’t last too long but nonetheless each Northernshire practice will shortly have one such mask and 30 disposible face masks to protect their staff.

A colleague recounted their experience of ringing for authorization for Tamiflu as per another previous hour’s Swine Flu Plan and they were repeatedly asked by the call centre operative “Are you sure it is not just seasonal flu doctor”?

Well we can’t be sure because we are no longer allowed to test for it as we now have to use our clinical judgement. So if you as a doctor are ringing the Flu line is it because we have nothing better to do or might it be because we suspect someone might actually have it and want to follow Party Central advice and treat it?

You may recall in our last post that we were waiting for a swine flu swab result.

This took 10 days to come back (and was unsurprisingly negative) which isn’t bad when we are told the disease usually only lasts a week and treatment is best given in the first 48 hours. So when the swab was taken we couldn’t treat with Tamiflu without a proven index case? When the swab result came back the patient was better.

Is someone trying to protect Tamiflu at all costs or is their a conspiracy afoot like there is not enough to go round? (Cue X-files theme music).

A further Politburo email dicktates (small mistake possibly?) that each practice should appoint a responsible GP as a swine flu co-ordinater and the Practice had to email who that responsible GP is back to the local Politburo Public Health Co-ordinator by the end of that working day by 13.00 Zulu or 14.00hrs local.

Their duties would be to read all Party email mountain re swine flu on a daily basis so it would have to be a retired GP with no brain or will to live to do this job. Needless to say as most people don’t read NHS email spam there was no shortage of volunteers running away from the Coms centre here at ND Central.

Anyway like all high powered COBRA meetings nothing much was decided but a lot of merriment was had. We await the next batch of rainforest destruction with baited breath as we are still using the respirator while it lasts. We don’t want it to go to waste do we?

Local NHS planning is akin to the state of British readiness at the start of the second world war. We have a few time expired generals posturing, a jaw jaw rather than war war situation and the combined might of the NHS is the equivalent of the Local Defence Volunteer Force led by several Captain Mainwarings but with no General Eisenhower anywhere on the horizon.

And the War has not even begun yet.

Praise be to the Party for claiming we are one of the best prepared countires in the world. All those telling us this from comfortable media bunkers while the troops in the trenches muddle through. One soldier gets an empty gun, the next a bullet and so on . . . onward to victory?

Sunday, 5 July 2009

A Tale of Two Worlds

A previously healthy woman notices some shooting pains down her arm and thinks nothing of this as she has had them intermittently before and they have gone off after a few days. One morning she gets up and find that her arm is not working properly in that she cannot lift her shoulder up or move her elbow but can move her wrist, hand and fingers.

Thinking that something is wrong she rings her family physician, Doc Northern MD, and is seen that afternoon. She consults with her family physician who talks to her, performs an exam and suspects that she may have a disc in her neck pushing on the nerves to her arm.

Doc Northern rings the local neurosurgeon who sees the lady the same afternoon and arranges a whole series of tests including a MRI scan of her neck. The scan reveals no disc problem but further tests on her nerves reveals that she has a condition called mononeuritis or inflammation of a nerve that affects its function. It should recover given time and help from a physiotherapist. The neurosurgeon passes his patients care on to a neurologist whom she sees the next day and he then arranges further follow up and treatment.

This is a tale from one world. Let us though the wonders of imagination now travel to another world and start the story again.

A previously healthy woman notices some shooting pains down her arm and thinks nothing of this as she has had them intermittently before and they have gone off after a few days. One morning she gets up and find that her shoulder is not working properly in that she cannot lift her shoulder up or move her elbow but can move her wrist, hand and fingers.

Thinking that something is wrong she rings her GP, Northern Doc, to ask for an “emergency” appointment but there are none. All the emergency appointments are now “open access” and not limited to emergency only consultations and so are taken by people needing contract review appointments to ensure that their GPs will get paid.

She then attends the local A&E department, something she shouldn’t do as it costs too much according to the local commissars, where she is seen by a junior doctor who tells her to go and see her GP as there is no neurosurgeon at this hospital. The A&E doctors cannot refer direct to a neurosurgeon as it is not an emergency and therefore the neurosurgeon would not get paid under Payment by Results as it is a consultant to consultant referral (rather than a GP to consultant referral which will lead to payment).

A few days later she gets to see her GP “as an emergency” (something she was loathed to do as she does not wish to abuse the health service) who talks to her, examines her and suspects that she may have a disc problem in her neck. Her GP, Northern Doc, knows she has been to A&E and not been referred to a neurosurgeon because of funding issues.

Northern Doc could refer her by Choose and Book but the local neurosurgeons do not use this system. They like to screen referrals to prioritise referrals themselves rather than see non urgent cases first if they are booked by Choose and Book. Any paper referral would take days or weeks and the only other option would be a possible emergency admission to a far distant neurosurgical centre which the patient does not want because of family commitments.

Therefore, the doctor and patient decide to go for a private referral direct to a consultant neurosurgeon a couple of days later to ensure a prompt review by an appropriate specialist and circumvent the management structure that delays health care called World Class Commissioning.

The neurosurgeon admits the patient straight away and does all the tests over a couple of days that reveal inflammation of the nerves or mononeuritis as the cause of the lady’s problems.

He refers on her onto a neurologist who tells her what the problem is that she will need follow up including specialist neurophysiotherapy which he then asks her GP to arrange (to ensure that funding for this specialist service is preserved) as his referral was from a consultant not a GP.

She is discharged and goes to see Northern Doc to ask for the physiotherapy.

Northern Doc asks his secretary (for GPs in the UK rarely have enough time to use the snail like computer system that is Choose and Book) to try and arrange a neurophysiotherapy appointment.

Northern Doc’s secretary hunts high and low but can not find the hospital where the patient was treated on the Choose and Book system as the local Choose and Book Commissars will not allow this service on their local Politburo controlled Choose and Book system.

They do allow several local tractor plants which claim to offer neurophysiotherapy but the GP knows that these physios at the tractor plant know nothing about neurology. They cannot recognize worsening paralysis in patients they treat for bad backs, in place of real orthopaedic surgeons, who are too expensive for local management commissars to allow local GPs and their patients to use them.

After a long time trying to use the new and improved Choose and Book system, which just shows what is available, not its quality, the dedicated secretary rings the hospital where the patient has been discharged from to ask if they know where to refer the patient to?

She speaks to several people who know the department exists and is eventually told to send a paper referral to the physiotherapy department who will sort it.

After 2 weeks the department phone and say because the patient does not live in the same town as the hospital they cannot have this service even though they have been treated at the same hospital and there is an alleged National Health Service.

This is the tale of two worlds. The first 3 paragraphs detail what would happen to the patient in any first world country and it does as our patients tell us their tales of illness abroad or how their (and our) relatives get treated overseas.

The susequent paragraphs (14) relate the second world's story of the "patient journey" (=management speak for treatment why use one word when 2 meaningless ones will do?) in the wonderful world that is local NHS World Class Commissioning one of the (alleged) best in the country.

If your arm did not work one morning which world would you like to live in?

Praise be to the Party for the wonderful world of World Class Commissioning the 21st century equivalent of the Youth Opportunity Program (YOP) from the 1980s. Jobs for the otherwise unemployable and an artifical bureaucracy serving no useful purpose than preserving its own existence.

Welcome to the fourth world that is medical care under the current NHS in Northernshire and this is not a made up story. We really wish that it was but it isn’t.

The patient is still waiting and getting worse with each day of World Class Commissioning in action. Perhaps they should go private but then is that not what the Party wants?

Can they afford to? No, so they continue to worsen despite paying their taxes.

And our heads are sore from banging them against the brick walls of institutionalised management incompetence.

Friday, 3 July 2009

The NHS Flu Pandemic Plan vs reality

Anyone who watched Sir Liam Donaldson and the new health minister, Andy Burnham, yesterday afternoon would have been “impressed” at how far on the United Kingdom is in its preparation to counter swine flu (according to them).

GPs will now diagnose swine flu using a checklist and there will be Tamiflu distribution points (TamDPs in grunt speak? Sounds a bit like damned MPs?). We await with (no) interest further details as the medical press are saying that Primary Care Trusts or the local Politburos will take over in a military style command structure to direct GPs in the event of a pandemic.

Excellent idea! Appoint people who cannot provide decent health care to a population that is predominantly well to a position of a General to command an army in the midst of a crisis?

Vicky Pollard does D-day ? Whatever.

But we digress. This post is about the reality on the ground. We have already posted about the availability of Tamiflu (June 16) but this is what is happening here in Northernshire.

A local GP has been having a phantom pregnancy of swine flu for the last 2 weeks having had it themselves for this long. They saw an unwell child with a fever and diagnosed swine flu in the wee child. They then rang the Health Protection Agency to ask what to do.

An hour later they got through and were told to go to the local A&E department to get swabs. They got the last one issued as the local A&E had all but run out of swabs and were refusing to issue them to GPs. The patient and family were confined to barracks to prevent spread of the flu and then the practice waited for the swab results under the impression that it would take 48 hours.

This was over a week ago. No swab results but daily phone calls from the confined to barracks parent whose child was better 24 hours after seeing the GP asking if they could leave the house? The answer was no until the swab result came back. You can imagine the angst here.

If the swabs came back positive would Tamiflu be issued given our experience thus far? Or would there have to be an urgent convening of the local Soviet of Tamiflu Guardians (next week) to decide if they could afford to issue any Tamiflu and to whom?

Now we as far as we know have no confirmed cases of Swine flu in our part of Northernshire but if the checklist for GPs goes along the lines of:

1) Do you feel poorly?
2) Has anyone you know, or yourself, been to a Spanish speaking country in the last 12 months?

Can we see what will follow next?

We are now entering the “treatment” phase. Given that virtually every patient with a cold or sore throat has self diagnosed themselves with “flu” before they even see a GP could we have a run on Tamiflu akin to what happened when the Northern Rock building Society was rumoured to be in a bit of bother?

Praise be to the Party and its Plans. With all its Prudent management of the UK economy we know we are in safe hands during the flu pandemic. The grunts on the ground will just have to cope as best we can.

Still we can practise using the Department of Health’s NHS Flu pandemic game here (they have been such busy boys and girls here haven’t they?) or a more interactive game here. Thanks to Dr Grumble for these little gems.

Wednesday, 1 July 2009

Where have all the ill patients gone?

We at ND Central had a crap day last Friday. We have spent more time waiting than we have working a clear benefit of Gordon (the MoreOn)’s NHS “reforms” for General Practice.

If we had actually spent our whole day working, we could have seen and dealt with all our patients in it in just over 3 hours rather than the long drawn out, agonisingly boring wait for patients that stretched it out and took almost 9 hours to finish.

This morning we worked from 09.00-11.30hrs and spent an hour and ten minutes seeing patients. The rest of the time we spent waiting for patients to arrive (1 hour twenty minutes). If you cannot see a doctor read on to work out why. The Fat Controller’s influence is all pervasive in healthcare as it is in our increasingly affluent economy over which he presides.

In amongst this morning’s waiting, sorry work, was a patient who brought their child in and proceeded to moan about how they and their family could not get a same day appointment at a GP Practice in the English NHS and had to go to A&E to be seen straight away. They felt that this was wrong (as they paid a lot of tax to the Fat Controller) and also they asked about any local private GPs (of which there are hundreds in our affluent neck of the woods).

They contrasted their experience to that in Southern Ireland and in Europe where they have had to pay to see GPs but could always get same day appointments. The law of supply and demand at work, perchance?

We know from the A&E discharge summary that the patient had a GP treatable condition but due to Party reforms and a “World Class” Commissioning PCT, they cannot get a GP appointment. But the Fat Controller rewards local idiots for their incompetence and they and he think they are doing a good job. Neither ever talks to patients so they know better than do we.

We then sorted out visits for the whole of the practice on our own that weren’t needed and then signed 350 urgent repeat prescriptions before moving on to minor administrative queries and problems that did not involve any direct patient contact.
This afternoon on an emergency appointment list we saw 17 patients in 1.5 hours in the only time in the week we don’t do a Gordon or centrally dictated surgery.

Amazingly, this non Party prescribed system works well, but when you leave work people are staring daggers at you for seeing sometimes 8 patients in the 20 minutes plus they are waiting to see a doctor doing 10 minute Gordon appointments.

In a whole day no one had any illness that was life threatening.

4 out of the afternoon “open access” (to meet the 48 hour Gordon access target) wanted (non) urgent blood results.

Another 4 had booked into get a Party prescribed (Gordon) annual medication review for a (non) urgent annually needed hay fever treatment

4 came back to ask for repeat sick notes which they knew they would need when they got the first one but they did not book an appointment at that time.

Oh yes and one patient did not show (but we still had to wait 10 minutes just in case they did).

So most of the same day (urgent) Gordon appointments were for things that did not need to be seen within 48 hours or even that week based on MEDICAL priority or need but Gordon knows best as he never went to medical school.

We used to use this “something for the weekend surgery” as “emergency” only appointments to try to see acute illness but now they are open to whatever crap wants to come in thanks to Gordon and Tony. And it does and in doing so blocks illness.

What used to be an “emergency” surgery has now become a “I can’t be bothered (to plan my life) surgery but as it is free I will (ab)use it”. Our reception staff have noticed that there is a hard core of patients that always (ab)use these surgeries which occur twice daily every working day. Some patients will use the afternoon surgery if they are unhappy that they didn’t get want they wanted in the morning and worse than this even the next days surgeries as well.

Where has all the illness gone? We know it is there but we are not seeing it.

This worries us.

A former comrade at arms who works in the other front line of NHS care, Accident and Emergency medicine, noted that their workload at night went up by 20% in the first year of the new GP contract. It has got worse since our comrade tells us as if people can’t get an appointment with their GP they go straight to A&E. They are seeing less Accident and Emergency medicine but more general practice “because I can’t see my GP”.

At practice based commissioning meetings the local Thickerrazi tells us that A&E attendances are going up and they want us to stop people going there to reduce costs. Is this were all the illness is going?

We know not but, if you see almost 30% less patients then you used due to Party reforms then, if illness is distributed randomly, it will take you longer to see it. Maybe that is why we are seeing less illness because we are now seeing less patients and taking longer to do so in order to meet government targets?

Of course illness could be struggling into the extended hours surgery that Gordon thought was a good idea. All those early morning surgeries for busy commuting pensioners and children and the Saturday mornings where often a third don’t turn up as they are busy sleeping off their intensive health promotion Friday night workouts (8 pints, a curry and a glassing). Is this where all the illness has gone?

We doubt it as all of these are pre booked appointments so no acute illness. The extra surgeries do not make up the appointments lost by the Party’s insistence that all consultations should be 10 minutes long, comrade. Still the Fat Controller thinks our staffs’ weekends should be disrupted to try and keep him in power. (We like true socialists who look after the workers, comrades).

Could it have gone to NHS (re)Direct? We don’t think so as a third of their workload is bounced back to GPs or A&Es so we should eventually see some of it?

Could it have done to the Darzi centres or rather the Equitable Access centres or whatever other name is currently applied to the squandering of finite NHS resources on the private sector regardless of need?

We don’t know as yet but our patients are not leaving in huge wildebeest like droves to join these expensive white elephants so it is just possible they may be seeing all the ill patients we are not?

We drove past a GP Walk In centre in one of the largest cities locally yesterday at 17.00hrs and saw one patient in the waiting room when ours would be full. That is one more than we have seen the last 3 times we have driven past it.

Might illness have gone to other Walk In (get nothing done and then see your GP) centers?

Same logic as here as with NHS (re)Direct.

So where has all the illness gone?

Praise be to the Party for reducing illness by its health policies. Make GPs do less, spend more time waiting than working, and then blame them when patients moan.

Anyone else struggling to see illness or is this phenomena peculiar to the ever over affluent North? More pork scratchings and chips anyone?