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.

The Pig is back?

This time last year we were slowly winding down as GPs from the great swine flu PanicDemic that never was. This year we are starting to prepare for one of the greatest public health cons namely that of the annual influenza vaccination program whereby all those vulnerable and at risk patients are offered the 'flu jab.

Already in reception it is like local travel agents at certain times of the year as people are asking if the can book themselves onto the annual hajj for the elderly (which is probably three times bigger than the real Hajj) whereby there is a mass migration on certain days of the year to the place of worship called the GP’s surgery.

Here the pilgrims line up, take a number and freely expose their arms from under their 5 layers of winter warmth to receive their communion with the needle that will provide them with absolution through the winter from all ailments known to man.

Three days later a lot of them will be back saying “The jab didn’t work, I've got 'FLU”. Still all these grateful pilgrims leave behind them a little token of their gratitude to those administering their absolution and, also their fellow patients who follow, in that there is always an unmistakable odour after any flu clinic that lingers for a day or so after.

But enough ranting about the practicalities of mass cons we noted a small article in one of the GP rags which announces the return of the pig.

Did you know that this year’s flu jab contains the deadly, evil, lethal, killer swine flu pandemic virus (H1N1) as one of the viruses it will protect the pilgrims from?

Think of the ethical implications, to tell or not to tell?

Remember all the concern last year about whether it was safe? The concern last year was of Guillian-Barré syndrome but this year’s concern is, is it linked to narcolepsy? Remember how long it would take to explain the science and what we knew?

Flu clinics are masterpieces of medical mass production and are usually timed with military precision with X patients per minute.

If we say "Do you know the vaccine has swine flu in it?" can you imagine how much extra time that we add to one single immunization attempt?

“Well I don’t know. Will it give me swine flu? That kills you doesn’t it? Can I ring my son? Can I ask my friend Mavis? I didn’t want that one last year. I just want the normal flu jab, can I have that instead? If I get flu from the flu jab will it kill me? If I get flu can I have Tamiflu? Can I have Tamiflu just in case?”

And any others we have missed. We can see the lightening speed of your average geriatrics’ central processing unit trying to digest this new piece of information, form a conclusion and plan of action in nanoseconds.

The well oiled engine of the winter flu pilgrimage would splutter to a halt in the same way that your car would if the fuel injection system failed. What would normally take 2 hours will take . . . how long?

Praise be to the Party for keeping this one quiet. What fun we may all have over the ethics and practicality of what this information may unleash. Piggy’s back and that’s not the viral one (yet?).

Choose and Book – get some more!

Earlier in the year we posted a piece of about one of the teams family’s experience of using Choose and Book.

We thought we would update you as to how well Choose and Book is serving its users. When we left we were still waiting to get an appointment with one speciality but had booked another appointment via Choose and Book at a date and a time of our Choice only to have the hospital rearrange (C&B) it for us.

A few days after the post we went on line and instead of the usual message we had seen for the past 4 and a bit weeks:

There are currently no appointments available please try again later. Please call the C&B Appointment Line on 0845 6066 8888 for further information.

This was the sight of an oasis in the desert of appointments for this speciality - 4 whole appointments. This was early in the morning before work and so the person who needed the appointment was roused from their bed, before reveille, and with much protestation and was asked “which one do you want?” for we know that when these appointments appear they disappear like snow in the Sahara at midday.

A rapid consultation of 2 peoples’ work schedules followed and 2 of these appointments were at the right hospital and at a convenient time and so one was booked and the details printed off.

At last we had been given a Choice and were able to Book it. Job done but now the real wait began.

Remember what the Party propaganda says:

“Choose and Book is a service that lets you choose your hospital or clinic and book your first appointment.”

But not your consultant . . .

“ . . . fit your treatment in with your other commitments and work . . . choose your appointment that fit your carer’s schedule . . .”

but only after several weeks wait and from a choice of only 4 slots only 2 of which were at the right hospital so clearly the promise of being able to book in the doctor’s surgery with the doctor then and there was honoured.

Now if you are dealing with children, the elderly or dependant patients the ability to choose a time is important. We usually reckon that if you have a hospital out patient appointment it means losing half a days work which as a GP would mean cancelling a full surgery, possibly not doing visits and possibly another clinic or minor operating session.

We here at ND Central try to get appointments on half days off or do an extra surgery to make up for an appointment but we can be flexible. A lot of employed people do not have such flexibility or understanding from their employers. If you are an employee with a child or an elderly relative this can mean that hospital appointments, especially if recurring, be a real nightmare.

So having a fixed appointment means you can plan ahead which we did.

A week later we received a letter saying we needed to ring the hospital in order to book an appointment which we thought we had already done and being technocrats we had done it the sleek modern way online. How smug are we!

So we rang the number on the letter and this is the conversation that followed:

“Comrade patient I am Comrade Senior Appointment Clerk Commissar Olga Bollocovic how can I help you?”

“We have had a letter saying we need to ring to make an appointment but we already have one we booked online.”

“That is because comrade patient you cancelled it the computer says you did so 3.473 days after you made it.”

“No we did not!”

“Oh we meant the consultant read your comrade doctor’s referral letter and decided that you had booked the wrong clinic so you now have to make a new appointment . . .”

So after over a month of waiting, booking an appointment online, with only a choice of times and places not clinic types, we are told we had cancelled the appointment and now had to make another one which we did.

If this situation happens where a patient books a clinic but when the consultant finally sees the referral letter decides it is the wrong clinic we are told it should be the hospital’s job to rebook the appointment.

This happens all the time as many patients do not know what clinic they need so if for example they have a cataract they will book an "eye surgeon" appointment which may mean they land up in a squint clinic for children such is the sophistication of the C&B software and the fact that the consultants no longer allocate the appointments after reading a referral letter.

The new improved computer interface allows the patient, who may not know what is wrong with them, or what clinic they need to book the appointment before the referral letter has even been done. Choose and Book software is all knowing and all powerful and can sort all of this out.

We then had to reschedule surgeries school runs as a result.

We counted up how much effort we had put in to get 2 hospital appointments. We have a total of 9 pages of A4 paper sent out from hospitals to make/cancel/rearrange 2 appointments. We have had to make several phone calls to confirm/ rearrange appointments as well as confirm our intended attendance. We have had to go online every day for over a month to try and get an appointment – you could, if you wish, ring up every day to be told there are none.

Not bad eh? Clearly an improvement over the send one letter get one appointment back usually for the right clinic.

Praise to the Party for whom Progress means taking one step into the electronic age and in doing so going 15 steps further back into the Stone Age. The worst bit about it is that those who trained us and mandated Choose and Book use said it would be a paperless, one stop exercise.

Did we miss something? And remember this is being repeated all over the country many, many times each day. Efficiency saving, sorry, gain anyone?

A particularly British way of doing things.

There was not much real news in the UK last week as the main news channels seemed more interested in covering the motorcades of a man dressed in white but a couple of the early birds at ND Central caught some bits of “real” news last week.

The first is that the UK is entering a synchronized swimming team in an international competition for the first time in 15 years. The second is that a cardinal has described Britain as a third world country.

So you might ask what is the connection between these and healthcare? Well bear with us as we explain what caught our imagination about these seemingly unrelated events.

The first is that the last UK synchronized swimming team used to train as individuals and only meet up as a team for a couple of weekends a year. Now did we miss something or are teams not groups of individuals working together for a common purpose?

And then look at how political reform of the NHS has operated.

Every group in Government has come in with their own politically led way of doing things. A bit like every coach in isolation training an individual swimmer but for some unknown reason ignoring the bigger picture of making a team, here the NHS, work.

Fine at an individual level but, for large groups of people, or teams, to work they need to work together in a co-ordinated not a repeatedly fragmented fashion.

Perhaps the success in the last 15 years of British synchronized swimming is on a par with the success of the last 15 years of NHS reform? They both utilize the same “training” tactics and no doubt share similar results.

Still the swimmers seem to have realized the error of their ways and, for some unknown reason, for the last 3 years have been training together at the same pool.

And an ill informed, possibly racist, remark by a 77 year old German cardinal is no different to your average local 77 year old patient’s and their relatives’ comments about their local healthcare.

“We have been in hospital X and no-one talks to each other. We are sent home without anything . . . it is like a third world country”.

Could synchronized swimming GB and NHS GB have one or two things in common? One of them appears to have now learnt the error of their ways.

Praise be to the Party all of whom are team players. Shame none of them are on the healthcare professionals’ or the patients’ team.

We do have a particularly British way of doing things in sport and healthcare don’t we?

We all know it is not the winning, it is the taking part that is important . . . or is it just playing the “Game”?

Liberating the NHS: some thoughts on the Great Patriotic White Paper 007 of 007.

Well comrades we are almost at the end of the Great Patriotic White Paper and like all those involved in wars of “liberation” are tired. But we must get up and go onward to the final section where hopefully all the threads and loose ends will no doubt come together as do all NHS reforms to produce a “better” and in this case a more “liberated” NHS.

Whatever that will be.

And so we begin section 6 the "Conclusion: making it happen". Onward to “Engaging external organisations”. Does that mean us as GPs by any chance?

It begins with a statement of the obvious and follows with a statement of the less obvious saying that “It provides clarity of purpose: a more responsive, patient-centred NHS, which achieves outcomes that are among the best in the world”.

Sounds like care on the cheap through an increase in bureaucracy that as we write is still being decided (invented?).

“It provides certainty, through a clear policy framework to support that ambition, with increased autonomy and clear accountability at every level in the NHS.”

Did we miss this bit? The NHS Commissioning Board and NICE giving us all of the above?

For what follows is “Much work now needs to be undertaken over the next two to three years, both to manage the transition, as well as to flesh out the policy details”.

So the liberation of the NHS is not being thought of on the hoof?

Oh no for words like “partnership”, “external organizations”, “ shared decision-making” and “choice” follow. Sound familiar?

More “consultation” follows, always a good way of saying the decision has already been made, and look what they will consult about “. . . on strengthening the NHS Constitution . . .”.

Brilliant! Consulting on something that is meaningless to those grunts on the ground. The NHS ran for decades without a meaningless “Constitution”, aka Charter in old money, while certain countries were founded on one. Compare and contrast anyone especially when it comes to quality (not availability) of healthcare.

The new Party goes onto say it will be:

“ . . . seeking views on commissioning for patients (the implementation of the NHS Commissioning Board and GP consortia) . . .”

Curious that when we see patients we are never asked about commissioning by patients only about where can they get the best healthcare.

“. . . local democratic legitimacy in health . . .”

Curious that in a NHS run along Soviet lines since its inception.

“ . . . freeing providers and economic regulation . . .”

No free market agenda here eh comrades?

“ . . . the NHS outcomes framework.”

The care on the cheap new alternative to the former targets now known as “outcomes”. Yet to be decided so no commissioning yet comrades just sit on your hands . . . and wait . . . and wait.

And look at para 6.5 “To support the ownership of the strategy within the NHS . . .” which no doubt means the same “. . . series of consultation activities . . .” as would have happen before the Charge of the Light Brigade in that our comrade Marshals feel that collective “ownership of stratergy” is different from top down imposition of political policy.

Para 6.6 is more management brown smelly bovine excrement until you read “The proper management of financial risk will be of particular importance.”

Someone finally realised that Houston we may have a problem?

On now to “Proposals for legislation”. Another of those cuddly grey box follows which gives a summary of all those layers of bureaucracy that are to be dissolved and all those that will take their place.

In brief no less than the creation a “Public Health Service”, a transference of “local health improvement functions” to “local authorities” known here in the UK as councils with “accountability to the Secretary of State for Health” so once again no Soviet centralized control of NHS plc.

Placing the “Health and Social Care Information Centre”, currently a Special Health Authority on a statutory footing.

Making the “National Institute for Health and Clinical Excellence” a non departmental public body which means no political control on the new 150 targets, sorry “outcomes” comrades.

Establishing the “independent” “NHS Commissioning Board” who just happen to be accountable to the Secretary of State and if you have fought thorough the White Paper thus far you may have wondered how it will manage all its new found roles without the establishment of more bureaucracy than you could imagine.

Establishing a statutory framework for a “comprehensive system of GP consortia”. An excellent idea if as we have here in Northernshire more GPs than can actually find enough work to fill a morning let alone a full day and if every employee of the local Soviet is at worst a Harvard or Yale MBA with distinction as we have locally.

GPs cannot deliver both without compromising either their face to face healthcare or their efficient management of healthcare provision.

And finally establishing “Health Watch”, no passing similarity to a popular crime solving program in the UK to be part of the Care Quality Commission whose first head’s credentials in terms of missing poor quality care are alluded to here by Dr Grumble.

“Reforming the foundation trust model”, “strengthening the role of the Care Quality Commission” and “developing Monitor” anyone see several subtle links to the establishing of Foundation Trusts and events in the county of “Staffordshire” here?

We think there will be a lot of work for toothless tiger orthodontists in amongst these organizations and the mad grab for Foundation status.

And para 6.8 invites you the public to be consulted about how best to manage the changes which brings us on to the next section “Managing the transition”.

The first paragraph states the bleeding obvious that change is a coming big time but for once they:

“ . . . will happen bottom-up, for example GP consortia having greater say and responsibility as rapidly as possible . . .”.

Nice thought but it ain’t happening. Most PCTs, Northernshire’s “enlightened” ones being obvious exceptions, are very conservative and won’t do anything until someone up high says it can happen. They are already blocking any changes for the better for they are still in control.

Para 6.10 is a big one and it illustrates the problem that will inevitably happen more management although it implies less. But then so often is the case that less is often more. Think of fundholding where practices often employed a fund manager in addition to a practice manager.

But commissioning is not fundholding so that will never happen. Or will it?

Section then follows entitled “Timetable for action” which despite all the hype about GPs spending billions really says that nothing much will happen until about 2012. Just look at how long it takes to reinvent the NHS tariffs or are they now currencies? Good to see free (Soviet) markets will flourish under the liberated NHS with centrally fixed pricing to continue.

That will really encourage the GP entrepreneurs or will it be the private sector?

So until autumn 2012 when the NHS Commissionning Board makes its allocations for 2013/14 direct to GP consortia GPs in consortia will be going to lots of meetings but they will have no money to pay the piper.

Worse is that GP consortia cannot hold contracts with providers until April 2013 and as commissioning is said to be based on NICE produced outcomes all 150 of them which won’t be ready until July 2015.

So unless the rules of engagement change dramatically, it looks like for the vast majority of GPs and consortia it is business as usual. Sit in meetings and do nothing useful. The current raft of NHS managers have a 3 year retreat during which they could handicap GP led commissioning for years to come.

Praise be to the Party for its plans to liberate the NHS. He who pays the piper is said to play the tune. Money is also said to be the sinews of war.

Our reading of this is that GP consortia will wait a long time to fight any wars or play any tunes while the Old Guard carry on as usual, and, when we finally get to play, we could be left with a mess by a defeated and by then disbanded Old Guard?

Still fighting the war is often easier than winning the Peace that follows. Back to the day job for quite a long while to come for despite all the hype it looks like business as usual.

We in healthcare on the frontline are going to wait a long time for liberation based on this White Paper and so will our patients.

Educationalists, inspections and computers.

There are a lot of thick people in medical education who think that the way “forward” is by using the computer. We at ND Central recently have had a load of educational and local Soviet “inspections” and the recommendations of these have all been along these same lines namely that:

"You are doing everything right and everything that you are doing needs “to be put online” to meet “quality” standards."

Does that mean tick one of our boxes?

This is a classic example of ill informed administrators, both educationalist and local Soviet ones, dumbing down to the point of blind incompetence, and even greater, ignorance.

We take issue with this complete load of bull for the following reasons:

1) If you are doing things right you are doing them right.

2) If you have the information and it is available then it is there.

3) If an educationalist is sufficiently anally challenged that all they can see is up their dark ar*e for information that is their problem, not ours. We can read and see points 1 and 2. (Think about it).

4) Ticking boxes is not the same as treating patients.

5) Those of us on the front line do not take a memory stick from our patients and plug it into our computers to get the diagnosis.

6) The presence of protocols, audits and e-portfolios on our desktop are of no relevance to our treating of patients. If the truth be told the time taken to find, load and read a resuscitation protocol will kill a patient. If you need to read an electronic protocol you haven’t been trained or are an educationalist and should not be treating patients period.

7) GPs do not have access to a huge amount of electronically stored data that (may be) useful when they are consulting but can still do their jobs despite of this “apparent” newly discovered “shortcoming”.

8) Anything online is hackable, and therefore is both compromisible and corruptible. We still have a duty of confidentiality, and of care, as GPs.

9) How does putting information on a computer improve medical care? Do we talk and look at our patients or spend our time clicking on protocols instead?

If a doctor/nurse sees and ignores anything on a computer it is there but maybe useless. If a doctor/nurse sees and ignores anything on patient it is there but maybe useless. Which is more important?

That which is on the patient, the alleged centre of healthcare professionals’ activities, is surely more important that which is on the screen?

Basic training to high standards, not loads of crap on computers, is the key to quality patient care. You can take quality training anywhere, computers are less portable than medical staff and their acquired knowledge.

It is the acquisition and application of medical knowledge that is the skill needed to deliver high quality medical care not the alleged “quality issue” of protocols being on a computer that (allegedly) “represents quality care”. An unread file on a computer may be there but if not used it may as well be in the Mekong delta of NHS computer clarity.

Treating patients in the field, for example at a roadside crash, a remote farmhouse with no piped water or oxygen, only what you have in the boot of a car or in a remote valley with limited, or no mobile phone and internet coverage and no phone lines is not the same as your average GP educationalist trying to demonstrate their complete lack of electronic skill when their memory stick does not work for a lecture given to medical students.

One such doctor is a waste of space, the other such doctor might be able to do things useful albeit at the handicap of no protocols loaded onto a PC to read while they treat a patient in the field. One is providing hands on care the other is a . . . ?

And finally most of the educationalist twats insisting on these changes are so old and backward they went to Universities whose medical schools did not have computers for them as students to use. Some of them will have gone through the whole of their training with no undergraduate teaching on MRI and CT scanning.

Some of us did not have this handicap that current educationalists have for we know that the computer is a tool. Most GP educationists have more computing power on their desks, or their barely used iPhones, than the astronauts in Apollo 11 had in their spacecraft.

What separates the astronauts from UK GP educationalists is the ability to use what is available on the ground as a tool. Storing information is not the same as using it or processing it. One is a clerical task the other requires thought and ability.

Medicine used to be a process that required thought but increasingly has become a clerical task via the “protocol” and the ignoramus’ tick box called QOF whereby “populations” = group of individuals rather than “individuals” = patients are treated. Hence the corporate drive to tick boxes to demonstrate “quality”.

Should we not be removing all of the pre electronic garbage from UK medicine as it is clearly substandard as they trained without the benefit of any electronic storage of data that all new doctors have to deal with?

Medical students, F2s and registrars hate e-portfolios and we at ND Central hate duplication of crap for no gain whatsoever other than a box ticked.

Praise be to the Party of all things electronic and how what used to be a simple process called education has been turned into an electronic nightmare.

Are the doctors now produced electronically any better than those produced using paper records? And are those who insist on electronic records for training actually fit for purpose for they have no e-portfolioes but insist that juniors should have them?

The hypocrisy of ignorance stinks and generates loads of useless work for those forced to use them for no useful purpose.

Fifty Years.

This weekend one of the team went to a Golden Wedding celebration. Not an onerous task but, given that most people there would be old and potentially ill, one that as a sortie could be potentially hazardous to any off duty Northernshire GP in attendance.

It turned out to be a very happy event. We met many people from our past and also discussed those who would care for us in the future. For some of those present had taught us and we had returned the favour by teaching their children who are now local doctors.

During the course of many conversations with people we had not met before there turned out to be some very interesting links.

Someone who had lived and drank in a pub in a village down South recognized one of the host’s children’s wife as a former barmaid. Another guest spoke to a friend of the family about matters nautical and this aged friend thought that her brother’s National Service may have been on a ship they too had sailed.

More spooky was the fact that two people present had been born at the same hospital on the other sided of the world. Given the wide geographical distribution of where the guests had come, all from the UK, from you realize how very small the world is at events like this an illustration of the six degrees of separation theory.

We listened to, and overhead various comments about our hosts and the comments all said the same things. How nice the couple who were celebrating their Golden Wedding were and how helpful they had been to those gathered over the years. They were not medical by the way but involved in education as were most of their friends who had gathered there.

It was an interesting afternoon for not only had we endured this afternoon’s social event but, some 25 years earlier, we had also been invited to the couples parents’ fiftieth anniversary. So in one Northern GPs lifetime we had been to two celebrations of marriages totaling over a century.

Are we missing something here? For one of the more senior members of the gathering was appalled at this gathering to hear of 13 year old girls who were pregnant giving birth? They attacked the midwife to whom they spoke about this state of affairs as if it was their fault and the area where they lived.

Now midwifes are rottweilers in skirts and so a senior retired teacher more than met their match but the point of family stability was not lost on others there hearing this conversation and subsequent "debate".

Like has a habit of begating like and we as human beings tend to learn from those around us. This is a huge generalization but stability in families tends to begat stability.

You do not realize this until you have been in general practice for a couple of generations. When you start to see the third generation following the two previous ones and producing grandchildren either, in very stable family set ups, or, in complete chaos where it is a game of guess which child has which father you start to wonder which is the actually the better set up?

Perhaps we are getting old here at ND Central but we doubt we will attend another fiftieth wedding anniversary although it is just possible that we might live long enough to see the first of the couple’s children to marry 50th celebration. We doubt it and so does the company who provided our life insurance. Perhaps we shall just have to settle for the couple’s grandchildrens’ wedding.

Question is will they be there for that event? Aren’t families fascinating at such times?

Praise be to the Party for looking after the family in our new Big Society.

Compared with the disorder that we as GPs, nurses, midwifes and health visitors sometimes have to “support”, this family was to the State a godsend for this family had managed mostly without it. Still back to work on Monday.