Saturday, 31 October 2009

Halloween some Odds and Sods

A few little bits have caught our collective eyes as we here at ND Central go through the 100+ letters we each get a week.

We are always keen to “embrace” new treatment options and the suggestion by one of our local eye consultants for us to arrange “dermatological relief” for a patient was interesting.

It reminded one of us a line from a UK gangster film, we think it was The Squeeze 1977, where a cop was asked if they wanted “special relief”?

Another new therapy we observed for treatment of a fracture from an orthopaedic clinic was to try “vibration massage therapy”.

Long gone are the simple days of plaster of Paris, metalwork and the odd antibiotic as core orthopaedic treatments.

As none of us knew what these actually meant we felt we have either been out of hospital medicine too long, watch the wrong kind of films or have an odd sense of humour?

We could also just be plain pig ignorant. Still it gave us a few giggles.

The Walk In Centres continue to provide us with lots of evidence of rain forest deforestation but not much evidence of useful work.

One punter, sorry patient, there is of course no real market in the NHS, had been 5 times in 4 weeks and the history and treatment was the same on all 10 sheets of A4 paper produced.

The same history, examination and conclusion = “viral infection”, all 4 lines of it, in the 2 sheets of A4 per attendance repeated 5 times was as relevant to us as GPs as a used piece of toilet paper in a sewer.

Unfortunately one question had been consistently missed and had it been asked, 2 weeks ago, would have given the diagnosis in 2 minutes not the 5 times 20 minute consultations.

We asked the relevant question and the patient got better with the right treatment.

Someone has said that 85% of diagnoses in General Practice you can get on the history alone.

All of our consultants at medical school said that a good history was vital and only after a few decades of multiple history taking and seeing lots of patients and doing sometimes many unnecessary tests do you realise that this is true as a result of experience not a short course.

Until you observe those in training (medical students, F2 trainees, registrars and even nurse practitioners the new Vim of medical healthcare on the cheap) and how they fail to listen though inexperience, not inability, you do not realise that taking a good history from a patient is an art that takes a long time to do well.

That is if you can remember your own short comings, which we feel is vital in teaching, for if you forget how bad you were once, you become intolerant of ignorance which we should be correcting via education not humiliation.

These skills cannot be learnt in a few short weeks or, even less now, as “education” has improved so much under ZaNu Labour’s rule, that in 3 hours of Party sponsored “how to (mis)diagnose swine flu” courses anyone can play doctor and get away with murder.

We are situated close to several largish conurbations and we have noticed a number of different formats of walk in consultation printouts (mostly rain forest and knowledge unfriendly) but one we had not seen until now had the following code sitting in amongst the crap printed on them:

Mobility: WALKING

We shall be looking out for any variations on this one given that these are “Walk In” centres.

Would one get treated if you “hopped in”, “roller bladed in” or were “carried in”? Would that alter the mobility code?

Surely given their name, all mobility codes should be “Walking”?

Heaven forbid someone from a local military base might abseil in from a helicopter but we are sure there must be a code for that, comrades? Or would they be denied treatment as they did not walk in?

Finally we asked each other how many cases of genuine swine flu we have seen?

Answer none. Lots of Tamiflu positive patients but no genuine confirmed cases. There are rumours that the Health Protection Agency have been swabbing patients and finding large number of people have had swine flu but with little or no symptoms. These are just rumours which will no doubt be suppressed as if this got out there would be nothing left to panic the population with and the benevolent vaccination program might not be of any use.

Still our patients know better than as all of them are convinced they have “flu” but they have managed to drive in, park their cars after taking their kids to school, on their way into work and then walk in to see us to tell us they have “flu”.

These acts themselves tell us they do not have real “flu” most of them just have minor upper respiratory infections as do the rest of their families, schools and work places which is usual at this time of the year. We are still waiting for our first proven real bacon butty case of flu.

It is of course Halloween so no doubt the Department of Health will be allowed out to play out unchecked for one night of the year in contrast to the rest of the year when it inflicts all manner of horrors on patients via their “initiatives”. This morning’s patients at one of their bright ideas, the Gordon surgery for busy commuting pensioners, at one of our less affluent branch surgeries more than surpassed the local supermarket’s Halloween horrors and that was in daylight.

Praise be to the Party and all its new health reforms.

We wonder which one of them was responsible for the new “reliefs” and “therapies”? Sir Liam or possibly Dame Christine or maybe it was a joint effort?

No doubt NICE approved all of them as part of evidence based politico-economic medicine if only we could recover their rainforest depleting missives from our shredder to read the relevant ones . . .

Has science finally disappeared from good medical practice or are we just taking the proverbial?

You decide dear reader we just live this daily. Beware the ghouls and beasties tonight for if they do not get you the DoH will!

Sunday, 25 October 2009

Beware Greeks bearing gifts.

Being in the “market”, a real market not the management structure called the “NHS market”, for a new partner a few of us saw our eyes drawn to an article in the GP rag called Pulse magazine.

Now anyone here in the UK looking to recruit a new partner as an established GP practice would look upon £225,000 (over 3 years) as a god send to boost income as virtually all GP Practices have, and will see, a drop in income as a reward for fulfilling their side of the new GP contract which has displeased our political masters so much.

The exception being the “private” contractors, some of whom will also be local GPs, supplying the Darzhole centres who we reckon will, for providing less than half the services that we do at ND Central, will be raking in as much in PROFIT as our whole Practice TURNOVER. These will be generously funded to ensure their success as they are political structures provided by “private” providers rather than things that are actually needed.

In English this means a million quid for an 8 doctor practice which includes the doctors pay versus 2 million quid for a 3 doctor practice but here the profit is the same as our turnover. Private is clearly best, comrades, it costs so much less than Publicly funded general practice.

This is why we say onto thee, dear reader, beware of Greeks bearing gifts.

The Trojan Horse is the fact that any Practice(s) greedy enough to take the comrade Commissar’s schilling will in effect be losing any independence they have as they will be expected to sign up for a PMS (Personal Medical Services) contract.

Historically PMS contracts for GPs in the UK have been financially better paid (although that is changing) but the downside is that you lose your medical independence as the Party seeks to control how you “practise” medicine via the PMS contract it negotiates with you.

Although there is an alleged” National Health Service” in the UK it is in fact a multi national health service with each local Politburo or Soviet (PCT) dictating the local supreme idiot commissar’s (Chief Executive) policy for local healthcare loosely based on the supreme Soviet’s (Department of Health) view of the current Party’s (Government) healthcare policy.

If, and this is a huge if, the local commissar has a brain this might result in some degree of local improvement.

However, the NHS’s “socialized medicine” means that this is nothing more than an attempt to cut costs via imposing a PMS contract = more local idiot Party commissar’s control.

For any US, and indeed UK readers’, you have to realize that all NHS commissars have at least 3 degrees from either Harvard or Yale or, in some cases from the lesser universities of Oxford or Cambridge as historically the brightest of the United Kingdom’s graduates go into NHS management in contrast to those who struggle to make it into medical school (not!).

This is why NHS managers struggle to improve healthcare in the UK as they are always hampered in their efforts by the less intelligent medical profession. This then angers the Party, who being true Socialists, hate the bourgeoisie called medicine as the Party represent the “workers” of the private sector and will happily trouser anything forthcoming from them.

So while we would like to replace a partner there are no local Party bungs unless we sell our souls to the dark side of “socialized medicine” = total Party control. Although we would like to be as intelligent as the local commissars we know we would struggle to keep up so we shall decline their gift of a horse even if it means a few more years of siege.

But still like the Trojans, after almost as many years of siege by Za Nu Labour, sorry the Greeks, there will be those in the Resistance who may take Gordon’s commissar’s schilling and sell out.

We here at ND would urge caution for having invited the Greeks in, you may find that far from bearing gifts, they will in fact raid your family silver for years to come which you will have to pay for year on year.

Praise be the Party for free healthcare and for encouraging GP Partnerships in these austere times. They are all wise and as good socialists they want even.

As someone is said to have said (sometimes Lenin and Stalin are quoted as originators of this phrase) and we have checked our sources:

“The [capitalists] will sell us the ropes with which to hang them”.

So will they now “pay us” for new GP Partners?

Saturday, 24 October 2009

Job Clubs in the ‘80s recession, now in the Noughties, welcome the Leg Club.

While trawling the web, in yet another busy surgery waiting for work, we decided to have a look at The Comic and found an interesting article here that caught our eye.

Those of us old enough to remember the 1980s were reminded of “Job Clubs” where unemployed people were meant to meet up, exchange ideas and get advice to try and help them to find work (when there was actually very little or no work to be found).

We remember them well. We walked past people with no jobs in groups, usually of men, smoking lurking around the Job Club doors spilling out on to the street and looking like a posse you would try to avoid at all costs often funded by local councils.

We thought given, our memories of the former Job Clubs of the Eighties, we would have a look at the Comic’s “Resource Centre” where there is a new form of club, the Leg Club.

In summary it is “social model to manage treatment such as ulcer care”.

Sounds a little vague. Leg Clubs: a social model to manage treatment such as ulcer care? Can a “social model” manage other “treatments” such as coronary artery bypass surgery in a CABS Club?

We read on.

It tells us that leg ulcers affect people mostly over 65. Well nothing there new to your average Northernshire GP, district or practice nurse. “Evidence” shows this is expensive with slow healing rates and a high incidence of recurrence”.


Does “evidence” reflect the team here at ND Central’s experience that it is usually little old ladies whose only source of social contact is their ulcer?

If they complied with treatment their ulcer would get better but instead they remove dressings, develop multiple allergies to all known dressings and let their favourite pussy rub up against their festering ulcers and then complain it never seems to get better. And they sit with their leg down to “improve” circulation and “facilitate” healing and still they never get better.

OK rant over that description was just our own Grandparents over whom we had a degree of control and who mimicked every other geriatric leg ulcer patient we see. Patients, however, are more manipulative. For example ringing nurses after they have just put a new dressing on to tell them it has “fallen off” with no patient helping hands whatsoever honest guv.

Yes, ulcers heal slowly, and they do recur but if your ulcer is your only source of social intercourse then there is no incentive to get better.

It is also usually a pre morbid condition caused mostly by poor circulation which gets worse as you get older but we digress. These were just some thoughts from those on the frontline based on years of experience.

We were only on paragraph 2 just wait for paragraph 3 and its little “QUIP” and being “referenced” whatever that means by the Department of Health. So it already is doomed to failure or care on the crap sorry cheap.

The Leg Club idea was apparently developed by a former nurse of the year who goes on to say that “Collabrative working (comrade) is the bedrock of each Leg Club”.

Fourth paragraph and a good Party phrase or two already mentioned for the comrades in NHS management to absorb in their working week off.

The next two paragraphs, with lots of Partyspeak (if you want more of this check out this inpiring link on Leg Clubs) describe how they work which to our slightly cynical eyes at ND Central sound very like the current dressing clinics and tissue viability clinics held at local surgeries and dermatology clinics.

Further on GP involvement is kept to a “minimum”.

Excellent idea! Keep the idle educated GPs away from patients.

Next paragraph starts to shed a little light on where this might be coming from as:

“Established and run by volunteers in partnership (excellent Party word!), they are self funding (cheap), with patients finding ways of raising the money for the rent and equipment (remember care free at the point of need?). The cost to the Commissioner (ah ha the important one in the equation the new force of Darkness in NHS management) is in the nursing time and dressings.

True Party Central Utopia no cost!

Hmmm. Could we perhaps re write that paragraph to describe the current system as such:

“Established and run by district nurse, practice nurse and GPs they are cost neutral to the patients as the care is delivered in their own homes. The cost to the Commissioner is the nursing time and dressings. There may also, unfortunately, be GP and dermatologist involvement but at no extra cost to the commissars.”

Have they forgotten the additional costs for genuinely housebound patients like “Vera”, the case study, who will no doubt be volunteering to self fund taxi services to mosey on down to her local Leg Club shin dig in the same way that Vera does not now come to surgery so no cost there comrade commissar in you needing to provide transport to the Leg Clubs via the ambulance (free taxi for OAPs) service.

Read on dear reader for things are getting worse.

It turns out that clubs are supported by the Lindsay Leg Club Foundation which presumably is the new version of the Rotary Club devoted to charitable good causes?

Now it really starts to get interesting.

Click on the Leg Club Foundation link > Useful documents link and download the Leg Club brochure.

Just look at how a “Leg Club” will transform your patients.

Take Mavis Thistlewaite, 30 stone, five foot nothing, 60 a day lifetime smoker and a bottle a day of Scotch for good measure in her farmhouse high on a moor some 10 miles = 25 minutes drive to any social centre, with ulcers for 10 years as she watches day time TV with her legs massaged regularly by her 5 cats surrounded by their droppings and see how she will be transformed into a Leg Club brochure babe of the month.

Patients (sorry well looking geriatric models not real patients) wading in the sea, worshipping the Leg Club, practising martial art manoeuvres, smiling holding hands and not an ulcer or bandage in sight. Please look and see how Leg Clubs have been so successful.

Instead of just looking at the pictures of ulcers “transformed” try reading and see what the bottom line is. If you are just a tad cynical and bored by now just read the “Setting Up a Leg Club” section on page 8. Is this a possible Third way model for funding ulcer care?

Oh Lordy we are reading this and seeing our patients transformed by this new Messiah. Like St. Paul we now see the light and will start following the guide word for word. Tell us how do we get the handbook? Will there perhaps be a small donation to the Leg Club’s Messiah’s charity? (We couldn’t find that bit).

Still Resistance work at the café Michelle is hard. So after another trip to the Quartermaster for some top up rations we sat down for some more self directed learning from their website.

We looked at the “Corporate Partners” a few names we recognised and we are sure none would have any vested interests in this particular field of medical and nursing care except the one which had “wound care” in its name. Still 1 out of 16 may just be allowable.

This can’t be a public private initiative via a charity? We can’t be that cynical given our recent religious conversion to the “Leg Club” creed? But it is “referenced” by the Department of Health which we know likes care on the cheap and lots of private sector involvement to save money ( = pay more for less) a good Prudent “socialized medicine” policy (we do like that phrase here at ND Central it sounds so much better than incompetence).

But then we noticed, after more rations, and this Resistance meeting was after an early and a late Gordon shi*t for some of us, the link “Information for Motorcyclists”.



Well you can imagine the imagery that came to our collective minds at this stage in the evening.

Poor old housebound Mavis Thistlewaite on the back of a Harley being whisked to get over to her Leg Club by the local Hell’s Angels Chapter perhaps? A Community Partnership?

Will there now be a Northernshire Chapter of the Angels called the Leg Club Ulcer Seniors, the LCrUS Seniors for short, using a “social model” to help their leg ulcers? Nora Batty on a motorbike anyone?

We fell apart laughing at this point it had been a long day.

(For our overseas readers Nora Batty is a comic character from a long running gentle humoured comedy called Last of the Summer Wine set in southern Northernshire who was the love interest of a rough geriatric scruff who yearned after her wrinkled stockings. The picture here is not too dissimilar from your average Northernshire leg ulcer patient although Nora was a lot more mobile even on motorbikes).

A few more mouse clicks and we found a picture. Could this possibly be of the new “Messiah” mounted astride a Hog?

Well you can imagine that any more serious critique had long since evaporated at that point.

We do not know if Leg Clubs work. The nearest one to us in Northernshire would be about an hours flying time to reach such is their obvious success up North and we here at ND Central certainly have no axe to grind with Ms Lindsay but we do thank her and the Comic for inspiring this irreverent piece.

After a long hard day at the coal face and a few top up rations you do need a bit of light relief. It will take a while to get the imagery out of heads.

We really must get back to 5 minute appointments it will stop us trawling the Net in our downtime but the Party has decreed 10 minutes good = pay but 5 minutes bad = no pay.

Bored minds do mischief make. And we ain’t teenagers on a street corner.

Praise be to the Party and NHS Innovation. Heath Robinson’s ideas seem workable in comparison with some of theirs.

Those of us old enough to remember grants and UB40 cards as medical students here in the UK will be off to the Leg Clubs in the same way that we went to Job Clubs in the eighties. They were such a good idea. Some Job Clubs may still be here today? None locally but GPs and district nurses are still here so are the leg ulcers.

Monday, 19 October 2009

A meeting with the Party in General Practice.

In business in the UK a lunch break is at least an hour, according to friends in the City. Sometimes hosted at a gentlemen’s club with a couple of bottles of wine per attendee. Then back to work.

Lunch in GP land is usually a ten minute meal grabbed on the move between surgeries, clinics, telephone calls, prescriptions, correspondence and visits.

Once again this alleged lunch “hour” that people in the UK are meant to have, but certainly in General Practice never have, was hijacked by a the local Party for a “meeting” to explain a new “improved” service from on high.

Meetings in the NHS General Practice workplace are where GPs are forced to listen to people from the local Politburo with about as much ability as your average permanently excluded child with ADAH in today’s schools who live in an exclusion unit if they ever turn up that is.

They are usually rehashed NHS corporate laptop presentations about something “new” = reinventing the wheel to ensure that it is square that the Department of Health and its local Politburos thinks will improve things above and beyond any of their previous “ideas” that have gone before and failed miserably.

Beware any new ideas from the Department of Health. They usually mean more work to deliver less and take longer to do than it ever used to.

Just think Choose and Book and then mentally conjuror up the image of a £ 12,000,000,000 smoking dung heap.

Most UK GPs and their poor frustrated secretaries/receptionists will know what we mean by this complete failure of NHS “progress”. They who have to use it, not that it is use is voluntary as it has been “mandated” to ensure people use it because it is so crap, are so grateful for the extra work it has generated and how little it cost patients or tax payers or delivers to them as customers (we almost forgot the non existentmarket” there dear reader how silly of us to do that).

Good constructive meetings are usually short, with a fixed purpose, to achieve an objective, properly chaired and hopefully deliver an outcome. The Party does not do good meetings but they do lots of meetings similar to this one.

It started in the usual way when someone large and fat, they always are, (did we mention thick as well?), turned up late and waddled in clutching their badge of office a laptop. They then said they were waiting for someone else important from another commissariat who was also late.

Obviously these people are all very busy people (they are never there on a Friday afternoon)but it is all right to keep lazy idle GPs, nurses and reception staff all of whom actually deal with patients waiting as they have nothing else to do (in contrast to NHS managers who do what exactly?).

In true Party fashion when they eventually arrived 15 minutes late, with a room full of bored nurses, receptionists and doctors all of whom could be doing something useful if otherwise not engaged with local Party commissars.

It took the two local Party Commissars about 20 minutes to wire up a laptop to a projector and then wait for the valves to warm up to the point where they could finally display a Party produced presentation. The smell of ozone was over powering and the generators were struggling to cope supplying the gigawatts of power needed to get the meeting off the ground.

There then followed a 20 minute praising and presentation of a pilot and “research” work (think dung heap) and the thoughts of Chairman Gordon, comrade Andy Burnham which had worked so well somewhere elsewhere that the local Northernshire Politburo (Praise be) had been specially “selected” to roll out this most “excellent” idea across the whole of the local Soviet.

Given the huge affluence and intellectual prowess of Northenshire PCT, they in their infinite thickness, think this is truly a great honour being bestowed on the local Politburo and a great honour as they are truly worthy but those of us who dare to think realize it is because Party Central wanted someone dumb enough to do it.

Hence Northernshire PCT was chosen because it is in the top twenty “world-class commissioning PCTs” which means if anything will fail it will fail here first on a “sink PCT”, sorry the correct term is a “spearhead” PCT, a lot of which are in the top 20 world class commissioning PCTs. Gross incompetence and inability under Za Nu Labour = success.

The body from the other commissariat was then allowed their 10 minutes of fame to explain that they would (without consent) extract data about patients to make the pilot “work”. This was interesting as the same department had not made a NHS clinical system work in over 3 years of trying but they have been well paid for their incompetence.

So at the end of this 30 minute presentation (after 20 minute set up time and 15 minutes waiting) for what we were told would be no more than an hour there then followed a Party stooge presenting the local Chief Commissar’s thoughts on what the financial situation would be over the next few years and how there would have to be clinical staff cuts but no management cuts as employing more Commissars was the way forward to save money.

Right. This took another 45 minutes and then the question and answer session followed.

After the 5 minutes waiting for the commissars most people found the ceiling to be slightly more interesting and motivating viewing than the presentation and it remained so throughout the meeting.

At the 2 hour stage (remember it was only meant to be an hour of our valuable time as the Party think GPs and their staff actually do not do anything useful) people started leaving for surgeries, clinics etc but not the commissars as they were still busy on the front line of healthcare sitting in a GP practice and clearly working very, very hard at doing nothing.

This meeting was a complete waste of time. It involves a “pilot” of a system to help patients use the NHS following a Department of Health initiative which means it is doomed for failure before it starts.

It appears to be a complete work avoidance program for nurses being trialled in Northernshire. It will involve them manning a phone line, sound familiar? A possible refinement or reworking of NHS reDirect?

After the meeting a few of the Resistance met up and discussed it before going on to do real work with real patients. All of us knew how to save money. It was so blinding obviously that only the Chief Commissar at the local Politburo could not see it.

But the Chief Commissar thought this “pilot” was the way forward but they were blinded by the incompetence that is NHS management which is a classic example of the Peter Principle.

Another successful Party sponsored meeting in General Practice. Lots of doctors and their staff’s time wasted, work disrupted all for absolutely nothing useful.

Praise be to the Party and all its wise local Chief Commissars for they see what we cannot see and believe it works. This is frighteningly worrying but they do at least have the Department of Health to guide them.

No wonder the Americans are worried re socialized medicine.

Why have quality care when you can replace it with crap? Thank God for a genuine world-class education to protect patients from incompetence. It is, however, very hard working daily in the face of gross institutionalized incompetence.

Can’t wait for the next one . . .

Tuesday, 13 October 2009

A few small victories for common sense.

We do not know what has happened locally in our patch in Northernshire as for some reason our surgeries are not full. For the second time in a week we finished early and this on our busiest day of the week a Monday when the something for after the weekend crowd pile in.

So once again on the long cross country stonk home, and it was a good one this evening as there was no other traffic, we caught the full headlines of the 6 o’clock news. There was the story about our glorious leader having to repay a mere £12,000+ back in unjustified expenses and the Home Secretary saying sorry for fiddling, we meant “breaching rules on second home expenses”.

A report into the arrest of the opposition MP Damian Green late last year during an inquiry into parliamentary leaks was deemed “not proportionate” as the leaks were not a security concern.

The children’s secretary is writing to Ofsted saying that inspectors should not interfere with private arrangements for looking after children between friends following the ridiculous case of 2 job sharing female police officers looking after each others children being told this was illegal.

And this morning we hear that a nurse suspended for breaching confidentiality in exposing neglect for a TV documentary is to have her suspension of registration lifted. Not completely cleared as she has a year’s caution whereas if she had stayed quiet about neglect she would have a completely clear record rather than a caution.

No patients in our surgeries and a huge amount of common sense in less than 24 hours something must be seriously wrong somewhere?

Praise be to the Party as it is not often that we hear a lot of good news in a such a short period of time. A few small victories for common sense does go some way to restoring our belief in some form of natural justice. And makes the drive home and to work a little more enjoyable as well as the nights draw in we arrived home with some daylight to spare.

Sunday, 11 October 2009

Child Protection, away days and Lord Laming’s report and is VIC there?

Is VIC there?

This week we had a scheduled meeting with the finally identified (after many, many months of searching), fully paid up but, totally unaccountable but important Party idiot and elite member of the local Thickerazzi, who had rearranged health visiting in Northernshire using what we shall term the highly successful “Doncaster” model - their words not ours. It is like Haringey child protection only better as it is “world-class” again their words in quotes not ours.

The, totally unaccountable but important Party idiot and elite member of the local Thickerazzi, was unable to attend this meeting. They had to “rush” away to another “important” meeting no doubt in one of the larger shire towns here in Northernshire.

Remember no one ever “goes” to hospital (with their life threatening bunions) they are always “rushed” there.

Likewise with local Politburo commissars where all Party approved meetings are always “very important” as is their avoidance of meetings arranged a long time in advance (because of the importance of Very Important Commissars VICs). It is also essential for their avoidance of responsibility for inaction.

No meeting = no problem identified by the local Party Politburo to paraphrase the originator of current Politburo thinking and (in)action in the UK a certain Joseph Stalin.

Cancellation, at short notice, adds to this avoidance of responsibility and devolves the accountability to their juniors or to those asking for the meeting.

“It can’t have been that important, comrade, or we would have been there . . .”

Nice work if you can get it, comrade VIC, all expenses paid and work avoidance too.

We landed up having a meeting with a junior, but elite member in training of the local Thickerazzi, who was there to “support” (= do nothing) the workers in another profession who care on the front line for patients whose service had been rearranged on similar lines to the “Doncaster/Haringey” model which was failing spectacularly to deliver the previous levels of service that had actually worked.

This NHS “success” had been arranged by the totally unaccountable but important Party idiot and elite member of the local Thickerazzi who just happened to be absent.

Remember “reform” of the health service is the process where if something works it has to be replaced by something that does not and creates in doing so more managers to ensure that less is achieved.

Support is an interesting word in NHS management as it usually means do nothing and if something brown hits the fan then senior NHS managers usually are conspicuous by their absence and get promoted. The grunts on the ground usually get shafted.

The comrade workers being “supported” were duly lined up, in uniform and on parade, as heroes in the Great Patriotic War always are, to show that the local Politburo were (again) in the top twenty of world rankings (we think there may be a silent w or Rossey r missing here) for “world class commissioning”.

The issues that we had wished to discuss with the totally unaccountable but important Party idiot and elite member of the local Thickerazzi are already those that His Lordship Lord Laming has highlighted as child protection failings but the VIC responsible was not there.

They had more important things to do than talk with frontline healthcare professionals called GPs. Our concern was not to miss the next Baby P(eter).

But this was not discussed due to the absence of the totally unaccountable but important Party idiot and elite member of the local Thickerazzi who had created all of the problems.

We know not what they were concerned about but their meeting must have been very, very important?

Praise be to the Party and its numerous and totally unaccountable but important Party idiots and elite members of the local Thickerazzi. These are the people that institute the policies that fail patients so badly.

When concerns are raised and they are finally identified what do they do?


They run away and hide in another meeting. And eventually get promoted. They are important as they do nothing for anyone least of all our children.

Friday, 9 October 2009

Swine Flu: the Pig kicks back

(click image to enlarge)

We thought our last post might just be a one off about Porcine Panic, sorry Swine Flu, for the time being but those busy comrades at Party HQ have been making mischief again using that well known NHS management system of take a (relatively) simple system that works, redesign, it and make it more complicated.

So for most GPs in the United Kingdom to issue a prescription you can print the prescription, or handwrite it for example on a totally unnecessary home visit, on a form usually known as a FP10 and the patient takes it to the chemist (if they don’t throw it in the nearest bin outside the surgery first) and get their drugs.

For the magic Tamiflu the Party and its local Politburos’ made this simple process a little more complicated in that you could do the prescription as above but you had to write the magic Tamiflu spell on the FP10 to unleash the magical power of Saint Tamiflu the miracle worker against the evil swine.

This system did not work due to the infectious nature of the agent called Media who advised the populace to panic. The NHS was then over whelmed by the daily surge of wellness it sees in surgeries being told to stay at home by the chief Medical Officer et al and ring their GP to “contain” the Pandemic (almost an oxymoron) so the National Flu Pandemic Panic Line was launched and a voucher system introduced which worked so well (see here).

Remember, dear reader, all of these things had been planned for years before and so all the Public and Healthcare workers on the ground saw was a “seamless roll out” of these plans in the best prepared country in the world for the Swine Flu.

A small item in one of the GP rags a few paragraphs long said that new vouchers for the magic Tamiflu were being launched and we had seen them being unloaded that day.

We liked the line saying that the vouchers must be destroyed in the presence of a witness clearly to ensure that their magical powers are well and truly ended for fear that they might fall into the hands of those working for the forces of Darkness.

Today we saw them in all of their glory and most of us lost the will to live. In the article it says 3 but in our pack there were 4.

If you click the image at the head of this post you might see why. Gone is the simple FP10 prescription pad and the magic spell to be replaced by not one pad for all ages but a total of 4 pads for children and as well as the FP10 for adults. And the vouchers from the flu line.

May be because we live up North (and are thick) we cannot see why we need a voucher for:

children under 6 months of age
children 6 months and over and up to 1 year of age
children under the age of 1
patients (not children) aged 1 and over?

Surely there will have been no cockups in this well prepared country after all the years of planning?

All of these will have been produced at taxpayers expense and sent to each surgery in the country.

So in the best prepared country in the world for flu has someone only now realised that there are different doses for anti flu drugs in different ages after almost 6 months of disease? Obviously no paediatric or anaesthetic input in these plans given the weight charts on the forms.

At a recent meeting we went to when a collection of 10 GPs were asked how many Tamiflu prescriptions had they issued it came to 3 in a population of some 15,000 but each GP when asked how many patients they had seen who had had Tamiflu most said about 10 each via the Swine Flu line. All these patients came back because they were no better.

Praise be to the Party whose management motto must be if it is simple and works make it more complicated and break it. The Pig is well and truly kicking the best prepared country in the world in the nuts and making some people look like complete idiots.

It hasn’t even turned nasty yet. What if it does?

Tuesday, 6 October 2009

Swine Flu Line not dead but now offering “enhanced” diagnostic services.

For most people the phantom pandemic that is Swine flu has died a death mainly due to the fact that the infectious agent, the Media, has found Party conferences far more suitable sources of nourishment to feed its parasite like activities.

However, the great Party success that is the National Flu Panic line has resulted in lots of “cures” from its highly trained advisors after 3 hours of intense medical training.

All of us at ND Central have seen many such “cures” who come clutching the sacred relics of the Saint Tamiflu box of pills saying that they have had swine flu but for some reason they are no better despite the “miracle” cure that is St Tamiflu.

From various news items there may be a set of similar holy relics touring the country which might provide better “flu” cures for those that believe not in the National Panic Flu line and the power of Tamiflu. For completeness we provide a link here although as doctors with a scientific training we would not use or recommend it to our patients but it might work if Tamiflu does nothing.

We digress somewhat as it would appear that now that the fully qualified doctors on the National Panic line are now telling patients that they don’t have swine flu they now have:


As a result they are given a voucher number for their Tamiflu (that they don’t need) and told to see their GP as an EMERGENCY.

Enter stage right Wilberforce a 5 year old who has had a clear nasal discharge for 5 days, a sore throat, a temperature, a dry cough and a croaky voice but is otherwise well. Both Wilberforce’s parents have had the same symptoms as have his brother and sister who have all got better on their own. Wilberforce’s parents after a disturbed night rang NHS (re)Direct who did exactly what it says on the tin and thought it might be flu and so onto the National Flu Panic line.

Now part of training doctors is talking to young doctors who do not want to do general practice but as part of their foundation training program (another great Party failure) find they spend sometime in general practice. Our current foundation trainee, who is very good, has in the last few weeks become very able at distinguishing between viral and bacterial infections and what does and does not need antibiotics.

Unlike the experts on the National Flu Pandemic Line who have at least 3 hours training our current F2 trainee has the disadvantages and handicaps of the following:

5 years medical training
one year of foundation training (F1) formerly called house jobs
and are currently in their second (F2) year of foundation training formerly called Senior House Officer.

They also have no algorithm to follow just basic grunt training.

This evening we discussed the various respiratory infections we see at this time of year and despite a complete lack of advanced National Flu Panic line training (3 hours) and all of the handicaps we list above our current F2 doctor is able to diagnose that Wilberforce has a simple viral upper respiratory tract infection and needs nothing more at this stage than TLC and will most probably get better on their own.

No complications of swine flu in fact no swine flu.

Praise be to the Party and all its algorithms.

Welcome to the new improved National Pandemic Flu Line now with added “complications of flu” diagnostics as well. They will be doing triple bypasses over the phone next week as well at this rate of evolution.

Monday, 5 October 2009

Just read our post and . . .

One of the daily grinds that we as GPs do hopefully each day is read our post. This is useful as sometimes it gives us the results of questions we asked when we referred our patients for to a consultant. Often we learn from it sometimes it is funny. Some of it goes straight in the bin especially if it says NICE on it.

Sometimes it just illustrates how bad “socialized medicine” in the UK is at this point in time. These are two “walk in” centre consultations in our trays this morning from 2 different Northernshire towns near by. Both were with a “Specialist Nurse Practitioner” which must be some new über version of the Nurse Prattitioner.

Both had the standard 2 sides of A4 printout perhaps 2 lines of which have any relevance to a GP reading them full of useless bits of information like:

Main spoken language English English speaker Yes

Last bit looked a bit Greek to us when we first saw it but onward to the consults:

Case 1

History: has a rash
Examination: red rash on arm
Diagnosis: rash ? cause
Plan: appt made to see own GP re rash

Case 2

History: wants more contraceptive pill
Examination: BP 120/80
Diagnosis: wants more contraceptive pill
Plan: to see own GP for contraceptive pill.

Both of these were from "Darzi" care NHS Walk In centres. No doubt cost more than a normal GP consultation and delivered nothing useful to anyone. A good use of tax payers’ hard earned cash?

Praise be to the Party for Specialist Nurse Practitioners. So specialized they can do nothing useful. Still afternoon surgery to come things can only get better?

“Beauty” and the “Beast” that is Obesity. Some idle thoughts while driving home.

Driving home one evening last week, after a relatively early finish, we caught a piece towards the end of the Radio 4 PM programme about a BMJ obesity report with the incredibly media friendly Dr Sarah Jarvis talking with a surgeon who was advocating annual weight checks.

(The scientists among us here at ND like her media appearances particularly her one during the great flu Panic(demic) saying that a sneeze is the speed of a bullet. It got us thinking if one accidently sniffed a piece of lead shot up ones nose before seeing a favourite patient it would have to be death by natural causes?)

But we digress, Dr Jarvis was countering a surgeon who had only lost weight by gastric banding by saying it would make very little difference. We agree with what she said. She may actually do some real general practice from time to time from what she said.

Obesity is basic thermodynamics although lard arses never have the same problems with their cars. Some basic facts:

1)You are what you eat.
2) Eat more than you burn off then you get fatter.
3) Put more fuel in your car than you burn off when you drive your car and it gets heavier and slower.

Try watching Formula 1 for a believable explanation of the above thermodynamic principles but remember what happens to petrol in a Formula 1 car does not ever apply to food or patients.

However, you can bet that your average lard arse will be an expert on fuel strategy as they will watch a Formula 1 Grand Prix and then spend hours at their GPs saying they cannot understand why their weight goes up after a hard worked Grand Prix watching session of burgers and tinnies combined with a heavy physical workout on their remote control.

If you are fat it is not because:

you are big boned that is just a longer version of the word fat,
you eat healthy foods and have a “good” diet as healthy eaters are not fat,
it is not because your metabolism is slow (OK you may have a roughly 1 in 50 chance of thyroid disease.)

You are fat because you are greedy and idle so please do not waste your doctor’s time trying to convince them that your case is different - unless you have an under active thyroid gland or you have some incredibly rare metabolic condition (other than eating too much and doing sod all) which we will happily look for but rarely, if ever, find in patients who can’t lose weight.

Some of us here at ND Central have stopped giving anti obesity drugs because all that happens is that people keep coming back and pleading for them as they do not loose weight on them for the very simple reason that they are missing the point.

They eat too much and do even less. Rant over (well actually several rants by us here at ND Central which is what prompted this post.)

People like their food and what they want is to lose weight but carry on eating the same as before. Listen up people it does not work.

So as we trundled along the high moors and forests of rural Northernshire heading home for a healthy calorie rich Chinese take away, Double Choc Sara Lee gateau washed down by bottles of a well known Northernshire brown ale which our patients insist is healthy eating we got thinking as to how could we help the Party with the obesity problem?

Of course the Party resent paying anyone other than lawyers and management consultants huge salaries for dealing with huge numbers of patients and feel that giving GPs the task of reducing obesity is a most excellent and cost (and benefit) neutral idea as it won’t work and so GPs won’t get paid. This is why they have been trying to introduce obesity into the points for payment scheme called QOF (Quality and Outcomes Framework) for GPs.

Given the success of supermarkets we thought why not introduce a Lard Arse Tax (Latax) at the point of sale?

Historically Governments have not liked the idea of taxing food but why not tax the person buying the food?

A new Porky Poll tax perhaps?

It might work like this:

If a person of ideal BMI (Body Mass Index) buys their groceries they get charged no tax as they stand on a scale at the checkout which says welcome to supermarket X you are healthy no tax to pay please come again. Have a nice day.

If your average “I don’t eat anything, I eat healthily and I am always on the go” lard arse steps on the supermarket taxometer scales and it says you are a fat b*****d, soory have a high BMI, you have to pay double/triple/quadruple or more for your food based on a sliding scale based on your BMI can you see what might happen?

Well certainly the surgeon on Radio 4’s PM program will be very happy as they will get much more than a just annual weight check. Twice weekly perhaps even better as for some reason an annual weight check would have stopped him, a very intelligent person, putting on 10 stones.

The Treasury will be rubbing its hands with glee as given the increasing amount of obesity and the fact that food is essential for life they are on an instant earner to rapidly reduce the National Debt. Just like if you pollute the atmosphere with a gas guzzling car you have to pay more road tax and fuel duty and so stop driving the same could apply as an environmentally friendly “green” tax as food production causes pollution too.

A most Prudent idea perhaps?

Of course it is unlikely to cause a rapid drop in weight in those poor “ill” people who “don’t eat anything, eat healthily and are always on the go” but we are sure that sales of helium, light weight clothing and methods of fiddling the scales will be devised very rapidly as people try to avoid paying tax.

There might be a few, probably those who hire accountants to reduce their tax bills, who might invest in personal trainers but most will do nothing about it.

We imagine that that there will develop a black economy where cachectic, malnourished, underweight people will be seen repeatedly wheeling trolleys round different supermarkets loading them up to the gunnels (as they might qualify for a tax discount?) and so the fat will employ "personal shoppers", not personal trainers, to avoid tax and get fatter as they won’t even have to walk round the supermarkets anymore.

They will probably go to see their GPs to get “tax exemption” certificates with spurious medical conditions saying that it is physically impossible for them to lose weight and so they can avoid paying tax but carry on eating.

People like food. Historically producing more food has been both Government and a European policy to protect against war. We have been so successful in that it has led to grain, butter and beef mountains together with wine and milk lakes due to over production.

Obesity is a consequence of food policy, production, cost and availability. Oh yes we forgot “choice” which is why it is never the lard arse’s fault but always the doctor’s responsibility.

GPs are powerless against Government policy and plenty of food.

And yet in most of the world for some reason obesity is not a problem. If you do not have enough food you do not get fat(ter). We can’t work that one out here at ND Central but then nor can our patients.

We must be very thick here up North.

Praise be to the Party and all it has done for the obesity epidemic.

We were surprised they weren’t boasting about it at their conference as an area of consistent year on year growth over the last 12 years but no doubt it will be used to save money on health expenditure as pay back time approaches to service the National Gordon Debt at GPs’ expense.

We really must stop thinking on our long drives home.