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.