The cup of human kindness at Yuletide overfloweth in Northernshire . . .

Following on from our last post about Christmas in GP land up North we thought our few interested readers would like to know what has happened since.

First the snow has gone and temperatures have risen above zero (just). The snow chains and winter tyres are off the Ferraris that all UK GPs drive and is now replaced by dense fog and new hazards on the roads which haven’t seen much traffic for 4 days like dog walkers in the middle of the normally quiet high moorland roads (not as obvious as your average tank!).

The baronial estate’s moat (all UK GPs have a moat if you believe the Daily Mail) has frozen completely solid which was fortunate as a younger relative thought they would bomb it at Christmas. 3 foot of solid ice resulted in a sore bum rather than a potential hypothermic dig under the ice rescue (not fun).

On Christmas Eve one of us ventured across the almost impassable high moorland roads in the Ferrari to do an evening surgery. Snow chains and tyres struggled for grip but we made it in for surely our patients would need urgent medical assistance prior to the long Bank Holiday weekend?

Believe us, brother and sisters, the need there was great, say Amen, we say again, say Amen for their need of healthcare on Christmas Eve so we must ensure as a righteous god fearing group of caring family GPs that our patients’ healthcare needs are met for Christmas. Praise the Lord for the Secretary of Health!

Believe us, brothers and sisters, we did truly service the needs of our congregation, oops sorry patients, for in a 2.5 hour evening surgery in a remote Northernshire surgery a team of dedicated, caring healthcare professionals struggled to deal with the following pre Christmas “surge” of illness:

No patients.
3 urgently demanded prescriptions to be signed but only 1 prescription actually collected.
A phone call from a regular drunk patient.

We are sure our patients must have all been out with their families celebrating a pre midnight mass for Christmas, carol singing, decorating the Christmas trees and wrapping presents, buying last minute Christmas presents for loved ones, visiting the needy, sick and orphans at Christmas foregoing their own personal healthcare to help others more deserving or more likely warming up their livers with a pre Christmas workout getting absolutely rat faced . . .

This week has been different for although most of the UK population is on an extended 2 week Christmas holiday shutdown, given the deserted no vehicles at all on the roads drive into work, the scene at surgery was as if fifteen fully laden coaches had simultaneously crashed in Northernshire.

We know from our colleagues in the local A&E departments that they too had multiple coach crashes to deal with to the point that today one local PCT was broadcasting on the local news for people with colds, sorry flu, not to go to A&E but to stay at home.

We know the conversations that will be going on at your average local A&E department with the triage team:

“Why is a sore throat of 4 hours duration an accident or an emergency?”

"I TRIED to see my GP (I rang and it was engaged/didn’t bother ringing) and they WOULD NOT visit (I rang and it was engaged/ didn’t bother ringing) and it is a really, really sore throat (not just hurts a bit?) so it is therefore an emergency . . .

The stories of how these survivors of the coach crash that is a bank holiday have so courteously addressed our staff have brought lumps to our throats. Here are a few:

Our receptionists were told it was THEIR FAULT we had been shut for 4 days. (NO mention of the statutory Bank Holidays that our patients would be enjoying but Bank Holidays are not THIR FAULT so they just HAVE to endure them?)

We had been SO ILL we went to A&E but they told us there was a six hour wait so we went home waited 2 days and came and saw you instead as an emergency and are better now but we didn’t want to waste the appointment can you take my blood pressure . . . ?

(Clearly the abolition of the 4 hour wait target is going to seriously inconvenience the well and their accessing of care for real ACCIDENTS and life threatening EMERGENCIES that they might have to wait 2 whole days for a sore throat that gets better on its own. I think this is disgusting . . .).

Some people have been so ill they went to A&E, 3 days ago, got the wait story, rang surgery this am because it is an EMERGENCY and there were no appointments so THEY HAVE TO HAVE A HOME VISIT . . .

(Because they can’t have an appointment because others are allegedly ill as well. That’s disgusting . . . )

The emergency surgeries we have done today have consisted of 3 “urgent” = unnecessary blood pressure checks, a medication review, a regular nutter whose only source of social intercourse is the free NHS and loads and loads of alleged ‘flu (minor self limiting viral upper respiratory infections) all of which were EMERGENCIES and nearly all of which got no treatment.

True cases of influenza do not walk into GPs surgeries so the RCGP (god bless them they are useless bunch of half wit pseudo academics used by Government to pretend that they are useful) are talking sh*te as “flu” cases increase.

Once again home visits have gone ballistic for they are too ill to go to surgery but are not in when we call. When they ring later to ask why we have not been they have been out to the sales, popped round to a friends . . .

We have had 4 day bank holiday weekends before but for some reason this one has been full of more self centred well people demanding emergency appointments who then do not show but a few days later there will appear a letter from A&E saying that they attended there.

(Clearly waiting for half an hour after you have rung and blagged an emergency appointment is too long to wait so it will be quicker to go up and wait 6 hours in A&E. Good logic and clearly another selfless action by blocking sorry not needing a GP appointment that you don’t then cancel.)

And although patients may sometimes be really ill the sickest are the local idiots in NHS PCT land who are struggling to cope for they do nothing useful. We heard from some local colleagues of another email that they received suggesting that maybe surgeries would like to open on the New Year’s Day Bank Holiday?

Where do they get these morons from? They are the people who have commissioned all these services and clearly have got it wrong so who are they asking to bail themselves of the hole they dug? The little black book from the Dad’s Army U-boat episode is starting to get full of names over this Christmas period.

This year’s “festive” period has been usually busy and people especially nasty and very difficult but we know not why. We have struggled to cope with the excess demand and are seeing extras ad nauseum but very little real illness that requires treatment.

Should we be doing the New Year’s Day extra surgeries for no payment on what is after all a Bank Holiday or do you think we should allow ourselves and our staff some time out for come Tuesday it will all kick off again?

Praise be to the Party for we are all sure MPs will be working during their hard earned Christmas break from 21 December to January 10. Or will those medically qualified MPs be popping down to their local GP’s surgery or A&E department on the Bank Holiday Monday to lend a hand for nothing?

PS a Happy New Year to all who kindly frequent our blog and a healthy one too hopefully.

T’was the week before Christmas and in GP Land not a creature was stirring . . .

At present it is a winter wonderland in Northernshire if you are aged seven and a half. Schools have shut early, there is snow on the ground and beautiful clear sunny days for sledging and snowmen (sorry person) building activities and a warm house at night to come home to and dream of Christmas presents to come.

Unfortunately in Northernshire general practice this seven and a half years olds’ paradise is now a land of nightmares as the great British public rushes out to spend millions at shopping malls and online while at the same time expecting UK GP plc to do the same as the shops but for free gratis and nothing.

Spend more and we will produce and sell you more but in the NHS it is a case of demand more and there is no extra cash or goods and we will struggle to cope. So let us look at a few trends in Northernshire GP land these past few days.

Demand has gone ballistic.

At Christmas inter family relationships become more fraught than those current on the Korean border and so grandparents, parents and children all HAVE to be well for Christmas to avoid the Armageddon nightmare meltdown over the festive period of someone actually being ill for there is absolutely no healthcare available at Christmas in the UK. None whatsoever.

Trust us we are doctors and our patients tell us this. So two holiday periods of 4 days and 3 days is a life threatening emergency.

If illness happens it will RUIN ALL of our Christmas so see us all NOW. Any excuse for an argument in a dysfunctional family at Christmas but illness is always a great get out of jail free card for it is never your fault and you can always blame it on the GP.

So conditions that have smouldered away for years are now being presented as life threatening emergencies because they all HAVE to be BETTER by Christmas.

Our reception staff are not enjoying this for when they finish work they have to battle the same loving, generous punters in the shops for they too need to eat as well as have healthcare but our staff are not as yet on holiday.

We have seen the need for “emergency” appointments for:

“I have to be better for Christmas . . .”
(no chance tough luck)

or

“I would like something just in case”
(no can do because just in case ain’t a treatable illness)

or

“I don’t think I could manage to work”
(yes we know you have had a week off already and with the extended holiday there is no point giving you a note for less than 2 weeks for we will be closed so the work shy always win this one, unfortunately).

or

“I need this and this for my holiday (good luck at the airports) and although I have paid thousands for this I would like these drugs for you have to pay £100 to see a doctor abroad (really? Healthcare actually costs something but your holiday is free?). Can I have them just in case?"
(see above).

or

“Merry Christmas and hi y'all we are from overseas staying with our relatives for Christmas and happen to have left all of medication at home and hear that if we claim that we are emergencies you will see us for free and if you are dumb enough to treat us on the NHS then we can get several hundred pounds of drugs for a few pounds of prescription charges?”
(Words like something and die follow and a bit of detective work means someone with the above story and no reciprocal health arrangement gets a Christmas present, together with the words Merry Christmas with true sincerity as they did onto us, they did not anticipate. We love health tourists especially at Christmas).

Clearly we in GP happy Christmas holiday land have not anticipated the complete absence of pharmaceutical products for a couple of weeks for many mornings this week we have had as many requests for repeat prescriptions in 2 hours as we would have in 2 days and all of them have to be ready 5 minutes after they are requested so as not to interrupt Christmas shopping.

A Government desperate to offload anti flu drugs and vaccines before their use by dates may possibly be using the media to generate demand for these products for our midwifes are being inundated with calls from pregnant women for advice re swine flu.

Nurseries too have been printing off NHS Choices leaflets (always a reliable source of disinformation) and suggesting that any snotty nose kid has swine flu as virology we understand is a 3 year degree course for all nursery nurses and so add to the end of the day emergency surge of kids collected from nurseries.

Home visits also increase as every Granny wants to be well for Christmas and the usual story is we brought (ill) Granny 700 miles down from John O’Groats to Northernshire and she suddenly became unwell is about as convincing as the Vatican is a large country 26,000 miles across whose GDP is 4 million times that of the USA and China combined and it is the world’s largest oil producer.

(If Granny needs a home visit under these circumstances Granny needs to be in hospital and that will bugger the family’s Christmas up no end as hospital visiting does not coincide with Christmas Top of the Pops so there).

Granny dumping becomes endemic at this time of year and there are lots of concerned phone calls from relatives, care workers and social services all wanting visits just in case. A home visit grants such informants instant absolution from any duty of care over the festive period for they have rung the doctor especially if it results in a dump and run social admission to a hospital.

(You will get a visit but if it ain’t medical the ball bounces straight back to you).

The great thing about a health service that does operate 24 hours a day 365 days a years is the fact that illness is unpredictable and this has a serious impact on people whose sole aim over the festive period is to indulge in a totally predictable uninterrupted period of gross calorie consumption of unnecessary food, copious amounts of alcohol and numerous workouts on the remote control to go for the burn.

They have worked, some of them have paid taxes and if illness interrupts any of this planned gross over indulgence it is not their fault and there is hell to pay for it for they want what they have paid for back. In general practice hell starts in the run up to Christmas for we all know that illness is always totally predictable and will always be made better by Christmas (as it is in the films?) for illness is never the patients’ fault but always the doctor’s responsibility.

Praise be to the Party for once again giving us Christmas and resurrecting the usual ghosts of Christmas past, present and the spectre of the Christmas to come in healthcare in the guise of our every giving patients so full of self centred Christmas spirit onto to all in healthcare.

Is it over yet?

NHS email requests during winter “crisis” and their link to a load of male anatomy.

Your average NHS manager is thick. When we talk about thick we are talking bottom of the pile. At best they may have struggled to get into the bottom third of the UK comprehensive education system and managed at best to get a CSE but most did not. Hence they arrived in NHS management.

Certain areas of NHS managers are full of those from educational sink estates but they now call themselves “world-class” commissioning PCTs and even those in Government wonder why they are so good not realising that self awarded Soviet style accolades for managers who fail are not those being rewarded for success but for gross incompetence. See how good, or bad your local PCT is here.

Winter sometimes happens in the UK and it gets cold, there is snow and ice and disruption occurs. As a result NHS managers cannot cope but that is normal for them.

If you have a huge amount of snow and cannot get into work then equally patients may have the same problem. Most NHS GP consultations involve self-limiting illness. In other words it will get better if you do absolutely NOTHING.

So amazingly surgeries do not actually have to be open most of the time to deal with the occasional REAL ILLNESS. Medical students are always amazed at how little real illness they see in general practice and nearly always say at some point when they are with us “I would NEVER go and see my GP with THAT! (minor self limiting disease)”.

NHS retard managers, and we have to apologize to those at the Northernshire Soviet where every PCT employee has either a Havard or a Yale MBA they are that good, do not understand winter.

They struggle with the days of the week and what the time is. The concept of the big and little hand and telling the time as well doing adds and take aways severely taxes them. Add some cooled precipitation of water and this barely understood by them concept of snow freezes their primitive neuronal systems and sends them into retardation meltdown.

From going to a few meetings as well as work, despite the snow, we have come across various examples of how low the thickest in UK society will get. Consider some of these requests by local NHS managers we have heard of from our colleagues around Northernshire which we have altered slightly:

Comrade GP you have had to shut because you have been unable to move because of the snow. We would suggest that you arrange extra weekend surgeries to make up for your loss of business activities during the bad weather.

Comrade GPs the seasonal festivities fall upon a designated weekend and there is a public holiday. As a result we feel there will be a drop in the provision of allocatable slots for the provision of world-class PCT provided healthcare over the holiday weekend. We would suggest that you as a primary business provider open your surgery on both Christmas and Boxing days to alleviate demand anticipated over the longer than usual holiday period.

Comrade GPs there are a lot of coughs and colds at this time of year and there is a huge stock of unused antiviral medication. Please consider chucking bad money away and using this useless medicine on the off chance someone may actually have a real case of influenza.

Comrade GPs in order to test the success of our Prepared for Winter Strategic Plan 2009/10, the Winter Robustness and Resilience Strategic Planning Commissariat require the completion of this 120 page questionnaire in triplicate and its return to us by 15.00 on the 24/12/10 for urgent analysis. A 300 page document on what information is required is attached for you to print off and use to facilitate your completion of this. (Received late on Friday 18/12/10 afternoon).

Of course comrade GP we will provide the same level of PCT business support to our contractors in terms of full operational support including IT during our normal business hours of 10.00 –1500 Mon to Thurs, 10.00-12.00 Fri excluding ALL bank holidays and weekends in keeping with our world-class status so you need not feel alone in your struggle to keep people well during these extra voluntary bad weather and holiday sessions.

We would like to say a lot of very naughty grunt words to the idiot authors of these suggestions mostly of the two word variety ending in off but for the more articulate we would add “and die”.

These are people employed at the public’s expense who clearly know nothing. They are thick beyond belief and worse still are getting paid to do sweet FA. They have never worked in general practice and do not understand what usually happens in general practice when there is heavy snow and no-one can move.

If you, as a GP and your staff, cannot get to surgery neither can most patients and so there is usually a huge no show for surgeries. As roads start to clear then people start to venture out and surgeries for a day or so may not operate at anything near full capacity. For a couple of days after this slack period when movement becomes almost back to normal then surgeries may be busier than normal then things go back to normal.

There is usually no need for “extra” surgeries as the perceived need for them does not exist in the real world. This happens every time there is snow and travel disruption and has done so for all the years we have worked in general practice.

Those of us who are mobile go into work. If cars are not running people turn to other means of transport and will struggle to get in even if the journey takes 4 times longer than usual. So most surgeries in Northernshire are open albeit with reduced capacity but then there is usually reduced demand.

Hardly rocket science unless you work at a PCT

Praise be to the Party for making sure that those of us not bright enough to be NHS managers went to medical school.

If we had not, would the next email we send be to all comrade GPs and their staff who cannot get into work be:

Due to the snow all GPs and their staff who are unable to get to work should now make their way to PCT Central to be redeployed to other surgeries or to road clearing operations. If you do not you will be forced to take the time off as voluntary annual leave.

And how do we get there? DoH.

NICE goes in hard on pubic health?

Following on from the White Paper and the increasing role of NICE in deciding the new targets, sorry comrade, outcomes, a little piece in the GP magazine Pulse caught our caught our eye and after consuming some fermented organic chemical containing beverages led to a few thoughts.

So the Party, after restricting drugs for erectile dysfunction (ED) to only certain worthy groups of ED sufferers, while allowing any spotty Herbert to have anti acne drugs, for we all know that sex is purely for reproductive purposes, is now going to set targets to “incentivise” GPs to prescribe drugs for ED. A slight change there from a policy of proscription to one now of prescription?

Oh misses titter ye not but before you all get excited you ‘orrible little dirty buggers, the article goes on to say a pilot will test 4 new “indicators” to incentivise (its that word again) practices to case find and prescribe treatment for ED in men with diabetes . . .

“Private Nobbings you has diabetes and a touch of the EDs get yourself off to the MO at the double for he ‘as an incentive to get you up ASAP! Left right left right . . .”

Pray tell what will the 4 new indicators be? Will there be new nurse or GP led new ED detection clinics (EDD Cs as opposed to Ed M)? How will success be measured? Will there be a new NICE ED scale similar to the MRC muscle weakness scale and will its units be in degrees or possibly mmHg?

The article goes onto say the aim will be to increase patient awareness and treatment of erectile dysfunction in men with diabetes.

Did we miss something but didn’t the marketing of the drug called Viagra do just that a few years ago? Clearly those up standing members of NICE spend absolutely no time in general practice for if they did they would know that men both with, and without, diabetes frequently come in not having read anything NICE and ask for treatment for ED?

We won’t use words like U-turn but the move from positively discouraging ED treatments to now actually suggesting sending out ED patrols to seek, find and treat with extreme prejudice all diabetic males with ED does raise a few titters here at ND Central.

Will these patrols go out shouting bring out your limp and floppy diabetic ones under cover of darkness or will it be the discrete under the counter brown envelope something for the weakend approach?

Perhaps somewhere in the ConDem coalition there has been a softening somewhere along the line of the members’ attitudes to this topic and someone has had a word with someone NICE to see if they could help them with their little problem?

Nudge nudge wink wink say no more. Where are Kenneth Williams and Frankie Howard when you need them most?

If ever there was a case for NICE being disbanded this is it. Put all ED drugs on FP10s for all patients 30 seconds worth of news on Gormless Moron TV sorry Daybreak and you will pick up more cases of ED in both diabetics and non diabetics than any QOF indicators and for a fraction of the cost.

Praise be to the Party for giving us something NICE to ponder upon after a few stiff drinks. We are sure there will be a lot of hard evidence for this approach and all those at NICE will once again present us with a solid shaft of evidence for these new QOF indicators. We did notice in the article that someone from NICE has had their name withdrawn at their request was this at the last moment as they thought better of their dalliance with matters sexual?

Prescribing creep.

If you have not yet discovered the peculiar style of the medical blogger the Witch Doctor you may not be aware of the concept of creep. If we can try and precis many of Witchypoo’s posts, it is the process by which change is imposed by subtle small changes within an alleged democratic society to the point that the end result is that which a totalitarian state would impose from the start.

Think Nazi Germany or Soviet Russia or Za Nu Labour’s attack on the NHS and you might get an idea of the general method of creep aka REFORM for the better that ultimately leads to a worse net end result albeit by small, subtle changes all passively approved for no-one sees or realizes the bigger picture.

This process is still ongoing and recently surfaced in seemingly innocent, but ultimately insidious, developments in the way a small Northernshire GP practice accesses their own patients’ medical records and issues their repeat prescriptions.

A few years ago we had some visits from what we shall term the Al Qaeda school of radical pharmacists who were employed by the local Soviet. This clique had done some Party sponsored “audits” and it would seem that certain prescribing criteria were deficient in their humble ill informed, ignorant opinions.

As we sat around their campfires words of revolutionary zeal like “concordance”, “equivalence” and “co-equivalence” were muttered but we drank their tea and coffee and thought “what are they talking about?” as we inhaled the smoke from their campfires long into the night.

None of these words had we ever heard before in the first world we inhabit. Some of us had been educated in undergraduate pharmacology, clinical pharmacology and postgraduate lectures regarding pharmacology but we had never heard these holy words before. We had even met with pharmacists to discuss the dark arts of dispensing but never heard such magic words before.

We asked them from behind their masked faces to quote their sources. This was akin to prizing limpets from a rock, always a good way to identify those trying to shaft one, but eventually we got an answer. It would appear that the source of the radical Al Qaeda school of pharmacists is none other than an alleged university in the Midlands of the UK.

This university is not known for producing anything academic for when some of us were at school any parent with a thick child called Precious, who academically would struggle to only ever get to a minor Polytechnic, could always get them to go to an alleged “university” and do social sciences or media studies at this university and so get a “university” degree in a nousetoanyoneology.

So we wasted several hours of our time with these Al Qaeda operatives and came away thinking what a load of b*ll*cks. This painfully acquired but useless information was placed in the filing cabinet of the brain aka waste bin and left to do nothing useful.

Fast forward and the local Soviet are now promoting the Electronic Prescription Service and you can read the propaganda here. Remember Choose and Book? Another “paperless” centrally imposed system coming our way with all its benefits? Just read the propaganda. Things will surely be so much better like Choose and Book.

Well move on with the creep and have any other doctors noticed changes to the way they are being prompting to log into their Practice’s computer system?

Anyone noticed that whereas before each practice could set its own access rights for individual users and its own passwords there are now at least 2 prompts for a Party Card or NHS "Smartcard" when logging in?

Remember how under Za Nu Labour’s new GP contract responsibility for IT became the responsibility of the local Soviet aka PCT with no doubt efficiency savings, sorry comrades, new word is “gains”?

So where does all of this lead to?

Well the simple act of a GP reauthorizing a patient’s repeat medication led to a message saying that the prescription was not Party approved for the EPS system and one of the three holy words from earlier appeared on the screen.

As a result the practice’s computer system would not allow a GP to issue a prescription for one of their patients because it did not comply with a central diktat. The prescription itself had no errors but the Party said no. It was not EPS compliant.

Result a hand written prescription as a GP could not issue the prescription. Result all details had to be entered manually so combined with the handwritten prescription progress had lengthened the simple act of issuing a repeat prescription. The thin end of a longer wedge in a paperless Electronic Prescription System?

So to our simple Northernshire minds the legacy of Soviet Za Nu Labour’s centralization of medicine, combined with radical Al Queda pharmacists means that GPs can no longer prescribe unless it meets Party approved “standards”.

By way of some other EPS bits all of our receptionists who have been trained by these radical pharmacists have asked us what do we think re EPS? Our replies have been curt as we had the same “training” from the same radicals a couple of years ago but all our staff have said the same one thing about the EPS.

It is a fraudster’s field day.

And best of all in order to use this pile of very expensive taxpayers’ funded useless pile of sh*te you will now need to use a Party Card or Smartcard. No doubt as our log in screens now prompt us to use a Smartcard we can see where this is going and it is not big or clever.

Praise be to the Party for ensuring that all who work for the Party will have to have a Party Card. We all know that the Party Card is there to protect your data from those who would want to hack it.

Or is it there for the Party to control those who are allowed to work, and especially prescribe, in medicine?

In winter up North your best friends are sometimes a couple of Yetis.

In the UK weather does not happen. It is by and large always grey, overcast and raining. If anything different does happen, for example a heat wave or extreme winter weather, anywhere other than a large gentlemen’s club just North of the Thames then it does not happen.

South of the Thames then any hardship induced by the weather is always national news and how do all those busy commuters cope when they get home from work at 21.00hrs instead of 17.14hrs on the dot. Yes winter in Northernshire arrived a few days before the national news networks noticed.

Here up North people are generally able to cope after years of experience of being ignored and in doing so one acquires ways of coping and new friends.

This year’s dump, we like that new journalistic word for a deposit of snow, as it has other meanings not related to snow, of over a foot of snow creates problems especially when walking.

Now if you are not familiar with Yetis they are well used to snow and many other adverse conditions underfoot and in order to get into work a couple of good Yeti friends are no end of help.

For starters they help keep your legs warm as they go before your legs and feet and clear the snow in front of them while at the same time their coats keep you free from wet snow as well as warm in sub zero 10 below temperatures.

A couple of Yetis are great friends in winter. If you can find a couple of them they make walking much easier than if for example one puts on ones Hunter Wellington boots. Their unique abilities of snow clearance allow the tread of a good pair of boots to grip so much better than lesser footwear products albeit at the expense of befriending a couple of Yetis.

A couple of good Yetis enable to allow your boots to grip frozen snow underneath a fresh fall much better than a Wellington boot would and keep you mobile. If the going gets really tough a couple of good Yetis will allow the application and safe use of a pair of crampons which combined with an ice axe could enable you to be mobile vertically if required.

Yetis, although generally benign, are also hardy beasts. If one is unfamiliar with them then there is a lot of hard physical work involved to ensure that they get to do their job. This may involve many hours of hard labour as well as certain tools to tame your Yetis.

This may result in one, after ones first encounter with a Yeti or two, having unexplained aches and pains the day after struggling to get them to do what you want them to, namely to be there when you need them in the snow.

Yetis are also loyal creatures once tamed and will stick with you like glue. If you decide to jettison them prematurely they will wander off and present you with problems in the snow that a couple of Yeti friends could so easily avoid. Yetis will not return without the struggle described above until the next year you need them but they will not stop your otherwise normal non winter activities once they are off and wandering free.

So fellow Yeti spotters, which Yeti species are we talking about? None other than this one.

Wellies are pants compared with these and that is if you can find wellies at present up North. A couple of Yetis and a good pair of boots give one the option to be mobile up North when vehicles are restricted.

If you have not yet discovered Yetis go out and get some. You will, once you have conquered them, not regret your Yeti friends especially when home visiting is required in huge dumps of snow. Ice axes and crampons similarly have their uses but without your Yeti friends these may have a more limited use than with them.

Praise be to the Party for giving us winter and snow together with the infrastructure to survive it. As with swine flu we are once again the best prepared nation to deal with snow, if you reside in Westminster? In winter you soon find out who your real friends are!

When the Party allows choice the people decide.

A small article in the GP rag Pulse caught one of the teams eye.

Now one of Za Nu Labour’s big buzz words was that of Choice. For those of us who have worked in the NHS for years know patients have nearly always had a choice of which consultant they could see and at which hospital. The old fashioned and now verboten method of referral called the paper referral letter could be put in an envelope and sent anywhere in the UK.

However, Tony and Gordon after all their years in healthcare, felt that patients had no choice and so preached about choice and introduced the Soviet style command and control structure called Choose and Book. They thought this was good for it gave the patient any choice that their local Soviet felt they could allow to be put on their local system or what is popularly known as Hobson’s choice.

Tony and Gordon felt that all people wanted their personal medical records to be on one uber computerized records system called the Summary Care Record and again patients were given a Hobson’s choice of opt in or opt in.

Unfortunately for Tony and Gordon the people sometimes do get a choice and at the general election they chose not to choose more of Tony and Gordon’s Za Nu Labour. Unfortunately there was not much better choice and so we have a coalition government who seem not too dissimilar to their predecessors.

We digress slightly but look at the article and see what happens when 2.24 million people were invited to, not told to, open an advanced HealthSpace account. If you have not heard of it don’t worry most of us knew not of its existence but if you are snowed in and bored here is a link.

So how many people opened such an account? A million? Well Connecting for Health reckoned 5-10% and they of all people should know about matters health electronique.

So when given a free choice how many of the 2.24 million invited actually registered?

2,913 or a massive 0.13% according to Pulse. Does that tell one anything?

Praise be to the Party for sometimes allowing patients a free choice. Freedom is a wonderful to those who have it but to those who allow it, it can sometimes hit you back in the face. Ignore it at your peril especially when spending large sums of public money.

People want face to face healthcare not electronic smoke and mirrors manifesting as real healthcare.

Wikileaks and the NHS sieve.

The news has had some items the past couple of days about the website Wikileaks and some embarrassing disclosures about the US diplomatic service. This surely must represent a warning about the use of electronic records to store sensitive personal information.

In the good old days to steal information you usually needed to get hold of paper documents which are large or use small cameras to smuggle the information out. Electronic storage of information pre internet meant you could get information, large amounts of it on magnetic tape and then as technology progressed on a small portable hard drive.

The internet has made getting information even easier for you do not now have to go anywhere near the site where the data is stored. The ability of teenagers to hack into sensitive databases means that most people with a bit of thought could get into a sensitive database.

So what has this to do with healthcare? Well think what the old, and it would appear the new Party, want to do with your GP records held on computer. The technology that is used in defence and the diplomatic service of the US is being applied to your GP’s medical records.

The paper Lloyd George envelopes have been replaced by local GPs holding electronic records on their own practice based servers which are now being replaced by large server centres holding many practices records all in one convenient place all now paid for by the State who manages them on your behalf via the local PCT.

So look at the alleged source of the leaks we believe to be a US private one of about 1.5 million service personnel in a total population of 300 million.

This could not happen here could it? Read any NHS propaganda website on this issue and you will know doubt be reassured.

But please think in a population of 60 million over 600,000 NHS Smart cards have been issued and no-one knows how many have gone missing. One private out of 1.5 million out of a total population of 300 million versus one disgruntled NHS employee out of over 600,000 in a population of 60 million.

Which nation has the greater chance of a leak via the National NHS electronic sieve?

And if you do look at or leak confidential information what do you suppose the penalties are? Hardly military discipline.

Compare that with the potential rewards to a journalist or a drug company. Imagine being able to search for patients with for example erectile dysfunction and what you could do with that information.

Praise be to the Party(s) for giving the world WikiNHSleaks free of charge to the patient and, at present, without your consent.

Better late than never?

This morning we watched this item on an otherwise news depleted Saturday morning.

It seems that A&E departments are being misused. Never! Must be those idle GP scum again not the ignorance of the British people. After 60+ years of the NHS someone thinks perhaps people, in this case children, need to be taught how to use it.

Well dudes they have already learnt how to both use and misuse the NHS for however many times you misuse it there is no sanction. They have been well educated by their great grandparents, grandparents and parents on how to use the NHS for decades.

So if Tarquin Jr. or Chantelle Jr. get ill they ring the GP for an emergency prescription of paracetamol because the kid is disrupting X-factor or Strictly Come Dancing. If their GP is shut, or they are not considered an amergency (case for a paracetamol prescription) by thier own GP or an out of hours call handler, or doctor, they explore the local NHS “market” and try the local Darzi centre or walk in centre but guess what the market does not allow them to use it!

Chuffing hell somemic will be doing Tarquin or Chantelle (seniors’) heads in, they will have got through a pack of fags, cheaper than the Paracetamol they want from the NHS, so they will be well stressed and will ring NHS reDirect and explain their problem and might, big might, be advised to go to a pharmacist and purchase some paracetamol.

Eventually Tarquin or Chantelle (senior)and “will have no (f**king) choice” but to dial 999 “it is an (f**king)emergency” and get conveyed by the free, no questions asked, executive taxi service to an A&E department.

And get some Paracetamol but at what cost?

This process has been going on for decades and to try and address such behaviour as a healthcare worker will result in complaints against anyone who tries it for the non paying, totally unresponsible NHS customer is king.

Even if you misuse your GP enough you can only get booted off the list. And you can still go onto another GP and so on. Misuse the ambulance service and they still have to attend. And so on.

At least now after 60 years our secondary school children will get lessons about the NHS. This will be useful for given the paucity of sex education in secondary education they will probably need to use it when their kids become ill 2 or 3 years after their NHS sexless education lessons.

Praise be to the Party who no doubt will be preparing lesson plans for a few years time about the fact that smoking is harmful to health some 50+ years too late. Talk about slamming the stable door shut when the horse has bolted all over the UK and is still running unchecked 24/7.

At least the stable door will now be finally shut. Isn’t UK education wonderful?

Memory.

One of the great things about a health service where nobody pays the doctor directly is the effect it has on our patients. We had a discussion at our weekly resistance meeting at the Café Michelle about our collective experiences at one of our more “exclusive” rural branch surgeries.

At this surgery you are immediately out numbered in the car park by the scores of Range and Land Rovers driven by our patients as well as their employees’ tractors and various instruments of agricultural production.

Given that the Ferraris driven by all UK GPs and their staff, are low riding beasts compared with those above us, this is a truly hazardous place to be in. One misplaced dung dispenser dispensing could seriously damage the shine on the average UK GP’s Ferrari.

Still that was just the car park. Worse is yet to come when we deal with the owners of these vehicles our patients whom we allegedly serve. For some unknown reason when a patient sees their doctor in the UK, the National Health Service manages, at no cost to the patient or the State, to perform a partial cerebral lobotomy the minute they walk into their GPs’ consulting room.

Our patients are in effect rendered brain dead but unfortunately still breathing, walking and worse still talking. After their NHS “free at the point of care” partial lobotomy the response to open questions such as “what is the problem?” or “how can we help you today?” is:

“I don’t know? You’re the doctor, you tell me!”

Oh so original, you can tell a farmer a mile off. They’ll talk to their vet ad nauseam about a speechless animal whom they pay for but come to a doctor, whom they do not pay for, and they will expect a full tank of diesel and a diagnosis before they go off to spend their EU subsidies.

A quick “if you want to play stupid see your vet (they charge)” usually results in the realization that it is not the doctor who has the problem but the patient and the doctor needs something called a history in order to do their job.

In other words talk to us (you dumb animal).

The NHS “free at the point of care” lobotomized patient then usually goes onto refer to their problem as “it”. Even when questioned about every standard symptom of disease for example is “it” chest pain, or shortness of breath and so on the problem is still “it”. What “it” is we sometimes never know especially in the demented when they attend sans relative, an increasing phenomenon.

We are not veterinary surgeons for in the UK they are usually much brighter than we doctors. Their patients do not talk but their owners do in order to get value for their money. However, when patients present to their GPs without their pets which cost, they are allowed to be dumber than your average vets’ patients (the animals that is).

At this stage in the UK, a GP presented with their lobotomised patient inability to communicate may then have to examine their patient. This always presents further problems. Simple instructions like lie on the couch on your back can result in the lobotomised patient assuming a knees elbow position on the desk or lying sidewise facing you in the room next door for reasons beyond our comprehension.

Even if you can get your patient into the correct position you are then faced with the fact that the patient cannot remember what clothes they put on in which order and so 5 minutes can be spent trying to get to an upper arm released, with help from a relative/carer/friend, from the unique combination of bra, bodice, corset, suspender belt, vest, incontinence pad(s), catheters and thermal long Johns. Did we forget the body warmer and hat too and to remove your glasses as well when the ankle is being examined?

And that is just in those patients called John. Jane Does are worse. Which bits of the English language they missed at school we know not but our medical students frequently comment on how thick our lobotomised patients are. For even as medical students they know the difference between up and down, left and right, arm and leg. Remarkable.

Following the “history” and “examination” part, one may then have to prescribe a treatment.

This is fraught with hazards as such questions as “Do you have any allergies to any medications?” will result in answers such as “Yes it is something with an A in it. Or is it a C?” or “Are you on any other medication?” are usually met with responses such as:

“Yes I am. You will know what I am taking.”

You are asked to prescribe a drug, a poison, which they take regularly but don’t know what it is? The hospital, or you, “just” gave it to them and “it will (always) be in the letter” you have not yet got as they only saw the consultant yesterday.

Notice the “it” word again?

If this isn’t the case they will have of course taken all the tablets and disposed of all boxes, any discharge letters or prescriptions but the patients and their relatives will always say:

“You will know what it is it will be ON YOUR RECORDS."

Whatever a patient does not know it is always ON YOUR RECORDS.

“You will know my case. I am a new patient it will be ON YOUR RECORDS”.

“I have seen a doctor at the hospital and rang the labs and they tell me the results are there. Can you get them for me? It will be ON YOUR RECORDS the hospital said so”.

Top tip if a doctor in hospitals says a letter will be with your GP in less than 2 weeks ignore it.

2 weeks is a BARE minimum so don’t waste an appointment try, if you can bringing the drug boxes, or the discharge letter for the helpful phrase heard so often in General Practice of “They are THE little white tablets” is about as helpful to a GP as “it was a blue car with wheels on” is to a Police officer.

Which doctor, which hospital, which department? Which car?

"I don’t know? It will be ON YOUR RECORDS."

In reception you will hear the following “I would like my tablets”.

“Which one? (of the twenty you take)”

"I don’t know it will be ON YOUR RECORDS." Now this is the NHS, which is free, but try asking the same lobotomised patients what car they drive?

They will have already clocked your car, told you how Top Gear have rated it and how their relatives have something so much better than your NHS Ferrari. They can complain about how much petrol costs per litre to the nearest tenth of a penny when its MOT is due and how much a full service costs. You will get the full spec and any problems they have ever had with their vehicle without you ever hearing them say “I don’t know it is ON YOUR RECORDS”.

The amazing thing about the NHS “free at the point of care” partial lobotomy is that once the patient leaves the surgery they suffer from instant recall about the whole of the consultation and leave with super uber enhanced memory powers. You then hear them saying in the supermarket:

“My doctor could not tell me what was wrong with me and I told them everything . . .”

“My doctor did not even know what tablets I was on . . .”

“The doctor didn't have a clue I don’t know what they are paid for. . .”

This is especially so when they sniff the quick buck of litigation and enhanced memory goes into overdrive. People who could not remember the 1 times table at school can suddenly quote pi to a billion digits to a lawyer.

We have been trying to find the origin of a quote we once heard that we thinks may explains this (almost) universal amnesia of the UK population when it goes to the GP and we think it goes something like this:

That which you do not pay for, you value not.

That which you value not, you respect not.

That which you respect not, you despise.

That which you despise, you abuse.

Anyone working in healthcare disagree? We bet none of you have had patients like ours?

Praise be to the Party for free healthcare and education. One of them works despite the other failing completely. Problem is we at ND Central can’t remember which is which.

Curious that? Must have breathed something in, it must be very infectious . . .

PS Anyone who can help us with the original quote above we would be grateful. Over a century of collective medical experience gets a bit forgetful . . . you will know what it is doctor it will be ON YOUR RECORDS!

The third of possibly many ways?

A few days ago the good Dr Grumble reproduced an article which pretty much sums up what many feel is slowly happening to the NHS. The Ferret Fancier, welcome back you have been missed by we heathens up North, also commented on the piece. Now there is a phrase called the Third way (possibly more in this process?) and we wonder if this is already happening within the NHS.

Imagine a scenario where a PCT devolves responsibility for a service to a sub section of its staff and puts them in a separate unit let us call it Bletchley Park and runs it for a while. If the PCT decides as a result of “budget constraints” or a “service redesign” it can no long afford to run it what does it do then?

Perhaps it could set it up as a private concern using a variety of guises for example a limited company or a corporation or a federation. This "private" entity could then run the same service while being paid by the PCT and later even have it bid against a “competitor” by submitting a tendor which the PCT would consider.

If this “independent” business entity wins then they hold the contract. All good and ethical business’ practice.

Now consider the state of PCTs which will be disappearing soon. Their staff will be fearful of their jobs. What better way of preserving some of them than by farming out certain services to this “private" sector?

Consider next what will happen when GPs start commissioning. If there are good local services up and running cheaply GP consortia will properly use them rather than go through a long and complex commissioning process.

There is another aspect in that it might be conceivable that the true private sector might want certain services in a particular area and might offer to buy out the “private” former PCT provider.

Look carefully at your own area for this process may already be occurring albeit slowly and by stealth, or as the Witch Doctor blogger puts it by “creep”.

Could it be a case of PCT self preservation by creep and in doing also the selling of the family silver?

Praise be to the Party for giving us the Third Way but where that Way will lead nobody knows. Or do they?

The guilt of the sum is greater than that of all of its parts?

Once again this week the tragic case of Baby P(eter) is on the news screens of the UK and once again the Press screams about individual’s incompetence as the failing(s) but it may miss the collective target in terms of overall responsibility.

Imagine if you can a situation in the UK where a group of GPs work closely with a group of health visitors in a practice setting. Over the years they develop a rapport where each knows the strengths and weaknesses of each other and also they know their patients.

Their social intercourse on a daily basis means that little snippets of information are passed between them. For example there might be a family of concern about whom a conversation similar to this might take place en passant:

"Hello Northern Doc, you mentioned the other day that child X had condition Y."

"Yes I did. What of it?"

"Well did you know that their Mum was assaulted last week?"

"No, I did not. Who by? "

"Her new partner."

"Who’s that?"

"Dicky W*nker. "

"Really? Didn’t he do time a few years back for indecent exposure to minors in the local park?"

"I didn’t know that Northern Doc but I am now on the case. . . "

A simple sharing of information like that combined with follow up by those concerned might just lead to the exposure of a Schedule 1 sex offender who had been beneath the radar for years.

Now the Party does not do information sharing between professionals although it wants you to share all of your information between Party members via the Summary Care Record. Information is often the key to protecting children but information in isolation is often useless.

Protecting children, and the elderly, is like a jigsaw puzzle. If you hold a small piece of the jigsaw in isolation you do not see the whole picture. The ability to share the pieces may give you an increased chance of seeing the whole picture.

Which is why the Party took away our health visitors and reorganised the way in which we now work. What used to take one conversation like the one above now takes several phone calls and days of waiting just to identify the responsible individual. Having identified them you then have to find them to actually talk to them and share the information.

The current state of NHS health visiting means that trying to complete the jigsaw as a GP is hampered by the NHS adopting so called “silo working”.

The sum, here the protection of the individual, is greater than all of its parts, for all of the parts are usually there. They, as usual, are not shared. So the sum fails but the individuals are blamed. They are blamed for the failings of those who instituted the sum.

The sum was devised by our politicians and all their little local commissars. It was they who ultimately employed all those who failed and it is they who also dictated their terms of engagement.

Praise be to the Party for they are once again all wise (after the event). The problem with the Party is that when the system fails all fail for they cannot without the system.

The depressing thing is that it is said it will happen again. Unfortunately it will and all of the NHS reforms of the last 13 years have made it easier than ever to happen for they have destroyed the information sharing that is vital if these tragedies are to stand a chance of being avoided.

Rats leaving the sinking ship?

Well the change in the UK Government and its great White Paper of NHS liberation has locally led to the very loud sound of the scurrying of claws being heard on the wooden deck of the super liner that is NHS management.

In our local shires loads of rats are apparently leaving, nay, high jumping and triple jumping away from their ships and looking for pastures new. They continue to deposit their droppings for as they scurry away their underlings are being promoted above and beyond their limited incompetence. Lots of their junior offspring are struggling to function for NHS management is a rigid Soviet style dictatorship and no-one dare make a decision without the say so of the local Great Leader(s).

New junior rats, in the same way as in war field promotions are rapid, are crawling up the stairways of the sinking ships of local PCTs. While grandiose titles are being bestowed upon them and may sound good they are merely the equivalent of being promoted to being the executive officer on the RMS Titanic.

The captain of the Titanic at least had the grace to go down with the ship he had mismanaged. The rats however are climbing the greasy pole in the hope that if they sh*te hard enough on their colleagues they may just reach the heady heights of the as yet undefined new super carrier of NHS management called the NHS Commissioning Board.

The rats that are jumping the sinking PCT/SHA ship may yet live another day and unfortunately populate the new SS NHS Commissioning Board when it is finally launched. This means that however good GP consortia may become those who have mismanaged the local Soviets for years may scupper any improvements that might come out of GP consortia when they are finally allowed to do something.

We thought, after talking to some colleagues from other Northern shires, that this process was just peculiar to the local and neighbouring Soviets but it would appear that the rats are now more like lemmings if this article is to be believed.

Praise be to the Party who will ensure that the new NHS Commissioning Board will be full of great captains like Admiral Nelson. Or will it be more like the Caine mutiny?

Defence reviews, the NHS and who is the real enemy?

This week in the UK there has been published a defence review which is a euphemism for defence cuts against a background of a bankrupt economy which must see things go.

Certain things here at ND Central struck us at how defence and the NHS ride a similar route to obtain the same result. While defence is about protecting us from without should we not be looking at the enemy within namely Government and Party ideologically driven incompetence?

One of the biggest things in the defence review is that the UK will spend £ 6 billion on 2 new aircraft carriers. Most excellent news apart from the fact that they will have no jet aircraft on them for many a few years to come.

This would never happen in the NHS. No-one would be daft enough to spend £ 12 billion on a failed computer system meant to do 90% of all NHS referrals by December 2006 that only now just manages 50% of referrals. Would they?

No-one would top slice budgets to fund privately run ISTCs (Independent Sector Treatment Centres) which run at below capacity but, at which whatever level they run, still cost the tax payer 100% of cost regardless of numbers of patients treated (or aircraft taking off from them?). Would they?

New defence threats have been identified like that of an influenza pandemic. Did we not have one of those PanicDemics last year whereby the collective incompetence of Government invented a nonexistent threat that almost took down general practice due to goading of the Public to panic in mass numbers? Nobody would be that daft, would they?

Cyber terrorism is identified as a “new” threat to the UK. This is made so much easier by incompetent but expensive IT provision at the behest of the State. NHS IT is a victim of its own incompetence as the drive towards centralisation of medical records leaves it open to being crippled by a few well placed pounds of explosive or a local IT idiot who knows nothing. No-one would design a central medical records’ system that vulnerable to being crippled on a regular basis by its own, would they?

All of these of examples of how poor the NHS/Defence departments are. All of the above of examples whereby there is an enemy which impacts on those on the front line.

Who is that enemy? Well in general practice it is the Department of Health and the local Soviets aka PCTs who for years have been mismanaging locally central policy and whenever they cock up it is our problem to sort out even though it is their responsibility.

And the MOD? Well far be it for us to comment given that locally jobs will go.

Praise be to the Party for all of their reviews. They serve us all so well.

We in general practice, and our colleagues in secondary care, will carry on picking up the pieces. The Party may not be happy for some “aircraft” may be forced to land on "aircraft carriers" that they should not be allowed to.

And that is less expensive and better than ditching in the drink . . . but GP commissioning should stop all of that by delivering empty carriers like the defence department?

The absurdity of the NHS internal “market”.

A while ago one of the team flew a sortie to another part of the UK for a meet with fellow comrades from grunt school some of whom had come from other countries. As with all reunions it is a time for catch up, compare and contrast individuals’ experiences and consume a few naturally fermented organic chemical containing beverages.

Specialities tend to congregate and after a while the conversation turned to GP commissioning and what was happening locally. What was interesting was the compare and contrast element against a worldwide background.

One of the squad told us that in their patch a Darzi practice, paid for from the public purse to benefit the private sector had been so “successful” that it had been told to stop “treating” patients. Others said that those Darzhole practices on their patch(es) were being terminated due to the fact that they cost more than local GPs but then the lawyers became involved . . .

Despite the fact the collective IQ at this point was in the thousands, the individual blood alcohol levels were well above local legal driving limits, everyone had a Homer Simpson “D” word moment as these issues were discussed. A heated conversation followed and there was a diverse nature of opinions about this situation, always the case when more than 2 doctors meet and talk especially when they were from different specialities and parts of the world.

One group said this made no economic sense for although a Darzhole centre was successful it was public money paid to the private sector and the private sector should be exploited to the full.

Another group said can you imagine if this was McDonalds who had opened a new restaurant that had exceed targets would they shut it down? Hell no they would chuck more money at it and milk their success.

A third group (way?) said this is the current NHS “market” whereby contracts operate within the framework of the alleged free market but the NHS commissars who administer them are former Soviet Bloc Party driven target obsessed commissars who cannot see that what they have done is a) successful b) an efficient use of public funds and c) that by their actions and inabilities they are actually denying patients healthcare which is what they are charged with to provide and were actually meant to provide as comrade commissar NHS “commissioners”.

There was a lot of input from those overseas saying that they wished they were in that position for they could use the increased success to improve capacity and therefore income while increasing the provision of service to patients albeit at a price. There were also a lot of opinions at this stage of the evening that were unprintable.

This led onto a discussion about GP led commissioning as proposed by the current Party(s). Fine in principle, the alleged free market one, but if applied against the background of a (failed) Soviet styled centrally fixed price market and heaps and heaps of paper shifting between bureaucrats as opposed to hands on patient care will generate what exactly?

The same but different?

Will the White Paper improve things or will it drown us as GPs in a sea of mountainous bureaucracy while denying us seeing any patients? The overwhelming opinion based on this discussion is that it will.

It is like trying to break the 100m spirit world record while wearing leg irons. However much you talk it up you will never succeed under the current rules of engagement.

But then it will all be the GPs’ fault won’t it?

The market. Certain elements are successful for example private medicine and McDonalds and then there is the NHS “internal” market.

Our patients tell us which they would like and also which one they actually get, and will get, as they tell us we currently have billions to spend (not).

Praise be to the Party for all new NHS reforms. We are lucky to have once again met up with our colleagues from grunt school. The debate will continue. And what of patient care?

Whatever. Politicians come, bugger up the NHS, and go. Doctors and nurses pick up the pieces time and time again. It will be no different this time.

Sex and the elderly.

In the United Kingdom sex does not happen. It is officially not talked about but amazingly we have some statistics to be proud of despite its non existence for example the high rates of teenage pregnancies and increasing rates of STD in the elderly.

Increasingly the idea that elderly people, like those over about 23 years of age, are actually having, and worse still enjoying it, is causing some disquiet in certain journalistic circles.

This might be due to the fact that if you have sex, an allegedly pleasurable activity, it might incur some risks as well as be morally abhorrent to the ruling classes unless it is for procreation purposes rather than recreational purposes (dirty buggers says the average Daily Mail reader).

It would appear that there is an increasingly high rate of STDs in our “senior citizens” of the bonkaholic generation. Remember that these bonkaholics grew up in the generation that created sex in the swinging sixties and it would seem they are still swinging.

The contraceptive pill is now passé for they are postmenopausal and so the threat of pregnancy has passed them by but has been replaced by other problems like certain dry or limp areas.

HRT is now the WD40 for the females who pioneered the liberation of women and the permissive society by using the Pill (dirty buggers) and the new male Wild Ones are using the Harley Davidson of the shaft world called Viagra (dirty buggers) and its successors to spread STDs to new levels in their age group.

From talking to GP colleagues whose practices dispense these drugs they are now the suppliers of lots of discrete under the counter brown paper packages of Viagra to the elderly who insist that these packages are supplied to them “with discretion” as they don’t want their wives to know of their purchases.

Furthermore the number of requests for “blue pills” for those over fifty who are “disappointing their wives” (aren’t males just so selfless?) or “who have met a new lady friend” increases year on year. A number of elderly “gentlemen” also request these pills in catering packs especially those who spend many months a year abroad in countries such as Thailand the so called “Sex Pats” (and they claim their winter fuel allowances!).

Curious how the sexual liberators of the sixties are now being liberated from the problems of elderly sex that would have denied their grandparents what they can now enjoy so much and freely? Isn’t pharmacology great?

Praise be to the Party for liberating the NHS and for “liberating” some of our elderly patients. Curious how HRT is free to all pensioners but other drugs are not. Did we miss sex equality? A lot of our patients do (dirty buggers).

Work, ethics and patients. To treat or not?

One of the team has recently had one of the most uncomfortable consultations we think one can have as a doctor. This is the consultation where, after treating a patient, you have to then treat the cause of your first patient’s illness namely another patient. We had a long chat about this situation.

This is especially hard in certain situations. The most obvious is in combat where if you play by the “rules” you have to treat enemy combatants as well as your own.

Who do you treat first? The “right” answer is the most serious injured but the emotional answer is very different. In current conflicts it might be do you treat the Taliban or your own troops first? Medical ethics would determine that you treat impartially but human emotions may cloud that professional impartiality.

What about the situation when you treat a patient who has been hit by a Heavy Goods Vehicle (HGV or truck). You spend an hour treating them in an Accident and Emergency Department (ER) and despite your best efforts the patient dies?

The next patient in the A&E department you are asked to see is the driver of the HGV that killed the patient because they are “upset” but they are unhurt, not dead, and still alive. Sometimes they are racked with guilt sometimes merely inconvenienced.

You may then have had to deliver the deathogram to the family of the patient involved when they turn up in A&E an hour or so later having been told, euphemistically by the Police or a work colleague that a relative is seriously “ill” and they should go to hospital ASAP. Not just doctors involved here but nurses, police officers, fireman and ambulance crews too have these scenarios to deal with from time to time.

What about the situation where you see an abused child and treat them only to see their abuser as the next patient claiming an “alleged” assault by the mother of the child and wanting treatment?

These are some of the consults the team at ND have collectively done over the years and raise loads of questions about ethics, morality, impartiality and more importantly what one does as a doctor in these situations and how one copes.

The laws of physics are said to be absolute. Certain principles in medicine are said to be the same but are more likely relative.

Could you go home at night having saved the victim of a stabbing who only later turns out to have been the abuser of the stabber? Could you save the life of someone who had shot one of your own and still treat them after you know the facts?

We have had the self same situations in civilian practice and it is not easy. Fortunately such situations are rare but they always provoke thought and discussion for they are not easy to deal with.

Praise be to the Party who via the GMC provide us all as doctors with their “ethical” guidance. We thank our colleagues, both medical, nursing and in the emergency services and the UK medical defence societies for their more practical support in such scenarios.

GP Trainers.

In the United Kingdom most people when they are “ill” are seen by a GP. In the US we believe this is known as family medicine. In the long distant past you could become a GP after you had done a year’s worth of hospital medicine and then go out “into Practice”.

The UK Doctor in the House series of films based on a series of books by Richard Gordon illustrates this state of affairs in earlier times but in order to watch these antique films (50+ years old) you will have to find them. Sometimes they are aired on UK TV.

Watch them as a doctor and you will see how little has change watch them as a non medic and they are quite funny at times.

In 1981 we believe that the UK introduced VTS (Vocational Training Schemes) for General Practice. A seemingly good idea to ensure that any future GP would be trained to a basic minimal standard. In 2007 they also introduced a compulsory exam the MRCGP.

We have commented before re useless unnecessary electronic crap for medical training but this week we have been listening to a group of highly intelligent, well motivated doctors in training wanting to be GPs and also those who have recently qualified as GPs who were all saying the same thing while chatting in the breaks at a meeting.

All are enthusiastic, far better qualified in terms of letters after their names than are we but perhaps less qualified in terms of hours in the air.

They are complaining, quite rightly, about an increasing amount of totally unnecessary information that needs, or needed, to be uploaded to their e-portfolio at incredibly short notice. This is at the behest of their trainers and other educational supervisers. Here is a link to what an e-portfolio is and we love the description or it as “glue” which these young doctors were complained that they were increasingly stuck in.

For those that are not familiar with e-portfolios this is basically a useless piece of NHS software insisted upon by a generation of GPs who never understood computers but who thought they were great. They thought that if you could book a hospital appointment for a patient online then you could justify a half hour appointment time and so avoid any real work by being a booking clerk. Unfortunately they are in charge and so busy jerking off to matters electronic that they miss the basics of education.

They missed the space age, log table, slide rule and electronic calculator and no doubt feel that the film the Wicker Man is progress as it shows community involvement in holistic care. This is the Royal College of General Practitioners whose journal is so full of real science that you would believe the world is flat after reading it.

Now to become a GP trainer, in order to train a GP registrar, a future GP, you have to undergo a series of courses and approval visits as well as have the MRCGP exam. Being a human being is not an essential requirement as the training ensures that trainers are Party approved quislings. No bad thing but what is the net result of these?

Well from our own experiences and our conversations with new qualified GPs and those still in training and despite all of the “supervision” from the RCGP, locally we have a series of GP trainers who:

Ensure that all home visits are done by their GP registrars.

Ensure that all the on call work is done by the registrar.

Ensure that when they go to meetings the registrar covers their workload.

Ensure that if there is a visit each for a registrar and their trainer the registrar gets both.

Ensure that a registrar will cover their surgeries and on call whenever they can’t be arsed.

Ensure that the registrar on call for an out of hours session has all workload vetted by a trainer and done by the registrar

Such abuses are overseen, and approved by the RCGP. This was the experiences of the GPs and registrars we spoke to this week and is no different from those that we have endured under the 20+ years of VTS.

And some of the current RCGP abusers want GP training to go to 5 years? An extra 2 years of uninterrupted time on the golf course for GP trainers? Excellent.

There are a lot of intelligent GP trainees who despite having passed their exams are being abused by those meant to be supervising them.

There are also a lot of good and excellent GP Trainers who protect their Registrars from such abuse. This post is not about them it is about their less than professional colleagues.

This is not on.

Praise be to the Party for ensuring that despite slavery being illegal in the UK it still is allowed under the auspices of the RCGP. And this has been so for the last 20+ years and from what our younger colleagues were telling us was not too dissimilar to that which we experienced during our “training”.

Who can tell the RCGP of the abuse? None other than the GP Registrar who in order to qualify has to be signed up by none other than their abuser.

Sound familiar?

Sun, sea and shafters. The new lowest of the low?

From time to time there are surveys published about which professions the public feels are the lowest of the low in terms of whom they trust in our society.

Most trusted.

Least trusted.

However there a is rarely mentioned increasingly new super class of scum that few see but who make the lives of their customers, GPs and their staff a misery in their pursuit of self interested greed. These are the sellers and administrators of travel insurance.

For the vast majority of the British public there is an assumption that as we have a free healthcare service at home then if we go abroad everyone will speak English and give us free healthcare in the same way that we do to foreign nationals unlucky enough to fall ill in the UK.

Healthcare after all costs us nothing, we’ve paid our taxes, so your average UK Joe the Moron will happily accept "free "holiday insurance sold to them by a Chantelle who might even have an NVQ but who is more likely is after commission. So Joe thinks I have paid for my (National Insurance) and had to pay EXTRA for my free health insurance and so I am well covered.

How wrong Joe the UK Moron is. When you purchase travel insurance in the UK you pay for nothing more than a maybe or "on a promise".

Let us fast forward to when Joe the UK Moron needs to claim on Moron Insurance abroad. Joe assumes that healthcare abroad is the same as that which Joe abuses in this country namely the NHS. When Joe lands up in a hospital, which he does not have to pay for at home, he assumes that he can walk into any hospital in the world with whatever crap he has and it is paid for by the State. It will cost Joe nothing.

For the first time in their life any British subject who falls ill overseas is presented with a bill for their healthcare. Joe the Moron is disgusted for Joe the Moron UK suddenly discovers that there is someone that costs more than he can rip off his customers back home.

Joe’s healthcare at home is free, he pays his taxes and fiddles a lot of them too, but he never charges this much to fix a minor problem like a sprained ankle caused by falling off a kerb after his “free” 18 pints of lager.

Joe and his family are mortified for the £ 200 for all eight of them to go abroad for 2 weeks which they thought was extortionate is now a £ 20,000 bill for his fractured ankle and repatriation costs home as he cannot now walk. He, as a plumber, will earn that in a week if he rips off his customers.

However, Joe being a patient of the NHS, knows that anything he does wrong, is never Joe’s fault. The NHS will pay for it no questions asked. The locals dial “999” and Joe sees a “doctor” who just happens to be a private doctor who admits Joe to a private hospital. Joe is happy at this point for he has got what all “Joes” in the UK pay for namely free healthcare. Joe also has an E111 aka a European Healthcard.

At this point Joe is now a prisoner in his holiday hospital and despite his fluent use of the language called f**k, healthcare, unbeknown to Joe, the extortionist plumber, is not cheap.

So Joe, or his family, ring their insurance company not knowing that any alcohol related injury will be excluded from the generous healthcare cover provided by their “free” health insurance in contrast to Joe’s NHS cover.

Joe’s GP, and their staff, are not on holiday and are busily seeing loads of Joes, none of whom are as “ill” as Joe is. For Joe is suffering from a case of self inflicted severe financial distress syndrome which is never Joes’s fault.

While they struggle to cope with the daily tide of wellness Joe’s Practice will, within an hour of Joe, or his relatives, ringing their insurance company have received 3 “Urgent” faxes from Joe’s travel insurance company and a couple of phone calls too. This is before Joe’s UK GP has even finished their morning surgery. But Joe’s “healthcare” from the insurance industry’s point of view is now “URGENT”.

These requests are not for Joe’s medical bills to be paid. They are in fact for the complete opposite.

The faxes will say via a standard letter telling us that “in order to ensure Joe gets treated” we need medical information “to help the doctors treating Joe” (even if Joe is dead) and oh yes the “doctors” treating Joe just happen to “need . . . the last 3-5 years of Joe’s past medical history for a sprained ankle.”

Nothing wrong with that you might think except that these letters are often faxed with the patients having already been treated, waiting in a hospital unable to go home until their medical bills are paid and Joe, and his family are being repeatedly hassled for this payment. The consent to disclosure of medical records may well have been forged too

The travel insurance industry in the UK are manipulators par excellence for they sell “promises”, sorry insurance, to punters who only when they claim realise the “promise” element of what they have “purchased”.

The travel insurance industry are scum for they feel they can bombard the patient’s GP with faxes and phone calls to “help Joe” which are nothing to do with healthcare. They are purely doing this as part of their “claims verification procedure”, their words not ours, in other words trying to avoid paying anything out at all hence the urgency of their requests to "help" Joe.

A few years ago we discovered the extent to which the holiday insurance industry would go to avoid paying out and as a result we decided that in the same way that the travel insurance industry considers itself to be a charity and as such charges for its charitable services we would start doing the same.

Being scum they have shown their true colours. Despite requesting 5 years worth of medical records photocopied and faxed, completion of forms 3 A4 sides long which involves a doctor going through a patient's entire medical history to answer their specific questions, they demand all of this from UK GPs for no charge.

They instead tell patients that “their GP is holding up their relative’s treatment abroad” and advise relatives “to apply pressure on GPs”. Remember Joe is treated at this point.

They forget that the responsibility for healthcare of UK Nationals abroad is NOT that of their GPs in the UK. It is that of the country in which they are resident. However, the travel insurance industry also forget that they might just have a contractual agreement to fund these patients’ care. They have a contract which is between the travel insurance company and Joe and to which we as GPs DID NOT sign up to.

A few quids worth of abusive phone calls to GPs and their staff could save the UK travel insurance industry thousands and cost our patients thousands.

And what is worse if, a request for payment from a travel insurance company from a GP for what is after all NOT NHS work (remember who is responsible for patients ill abroad?) which is very time consuming, and may ultimately be of no benefit to the patient, the travel insurance industry will insist that the RELATIVES pay the GP for the information requested by the travel insurance companies for their "claims verification procedure", sorry, “to help the doctors treating Joe”.

This shows how low the travel insurance industry goes. They charge you a fee for a “service”, which when you need it, they will then happily charge you another fee for information THEY need, to see if what you thought you had bought you can actually have. If you are lucky you can reclaim the costs for Joe’s doctor’s non NHS work for the travel insurance industry’s attempt to avoid paying their insured, the patient, anything.

If your claim is rejected, not only do you pay for insurance that doesn’t pay out, but you also pay your doctor for information that the insurance industry wants to shaft your claim for they insist that you do so. And then you pay for your healthcare on top. In these circumstances, the insurance industry, sometimes, very generously pays you your original premium back. £ 40 for a £ 20,000 claim they are true humanitarian saints.

Excellent shaft guys. Is that why all the abusive phone calls we get from your staff sound like they are from those who previously worked for the Taliban where medical care was considered heresy?

Only go abroad if you have a spare million and have never seen a doctor with anything in your life. Otherwise you gamble your financial future and that of your family. An extreme case of caveat emptor?

It is bad enough to be ill in a foreign country where you may not speak the language or know the system but don’t worry those who you have paid to help you will ensure that things WILL get worse.

Praise be to the Party for institutionalizing commercial shafting. And they get away with it year on year.