Saturday, 28 May 2011

Bank holidays, dogs, dentists and the coming of CQC.

The recent spate of bank holidays has given a few of us the chance to travel to places new and talk to others involved in medicine. One of our travels involved a chat with a dentist.

Dentists deal with mouths and teeth and have done very well out of NHS dental reforms. This have resulted in most dentists earning far more by doing less and have created the phrase of “doing a dentist” which if GPs did the same as a result of market led NHS reform would lead to very long queues outside those GPs who could afford to work for very little for the NHS as per the NHS dentists. A clear victory for NHS market led reform in increasing provision of dental care to those best able to afford it at the expense of those who need it most. Still toothache = see NHS GP.

We chatted to this dentist who asked of us how we GPs were affected by the Care Quality Commission (CQC). The overwhelming impression we got was that this was bureaucracy gone mental. In 20 minutes of a quite in depth discussion, for dentists are ahead of GPs here, one of us was reminded of an expression that one of the team who used to help out in remedial classes recalled being shouted out loud when one of the class couldn’t spell a word one of their peers thought was easy to spell.

The word was “retard”. As we spoke it became apparant that a lot of general practice time will be spent on matters of retardation rather than anything to do with medical care. Remember retard and retardation were words used to insult those who could only just spell 5 letter words better than their fellow pupils in a remedial class. Old words were revisited in the context of what crap, nay in grunt speak sh*t, is about to be inflicted on professionals by the Care (Blair) Quality Commission C(B)QC.

As we spoke more to this dentist about the C(B)QC process the word retard got louder and louder in our brains until we were told about the section dealing with dogs when an atomic explosion of retardation gone mentally ballistic occured.

Now forgive us for being thick at ND Central but when did dentists do dogs? Err perhaps we ought to rephrase that as to when did dogs become big issues in your average dentist’s clinical practice other than blind or support dogs? But we forgot there is a war on terror and as a result in the search for weapons of mass destruction as a large government “organ” the C(B)QC may be ahead of the game.

Maybe as part of the defence of the realm all dental practices are the new Home Guard and therefore have to have a policy on provision of rest rooms for bomb disposal dogs (Armed Forces Dogs section A), enemy combatant sniffer dogs (Police Dogs section B) as well as substance misuse sniffing dogs (Drug Enforcement Dogs section C). All essential for your average dentist’s quick look in your mouth, scale and polish and charge you service.

Maybe as part of the “patient experience”, a new C(B)QC retard buzz word for the buzz word bingo card, there has to be a policy on provision of crèches for dogs at dental surgeries?

With sub sections on provision by dental surgeries for dogs’ urinary excretion needs (quality care for clients’ dogs section 1.1.a), dogs’ faecal excretion (quality care for clients’ dogs section 1.2.1a), needs with special reference to disabled dogs excretory needs (quality care for clients’ dogs section dogs 1.2.1b), and special provision for dogs with Zimmer frame needs(quality care for clients’ care for clients’ dogs section 4)?

All essential layers of retardation for the provision of “care” and “quality” assured dental services (perhaps with a little red lion mark too?) at your average general dental practioner’s surgery. Ditto the same to come for GPs?

Now GPs are not immune to the layers of retardation that have come the dentists’ way for we have already seen the 6 inches thick of ring binders full of paper that needs to be completed. We can take comfort from the fact that if all those at CQC piled their brains up we would still be able to see these ring files from space with a magnifying glass for there would be no meaningful obstruction to the passage of light as that usually travels in a straight line unless it encounters a large quantity of dense matter called a black hole in which case the light might curve and render it invisible. (In our dreams).

It would only take 4 GP’s brains to hide them from view. If the C(B)QC lost their brains they would still be able to function unhindered and deliver world-class retardation and zero patient care but completing this monster pile of retardation gone wild sh*te will lead to many GPs losing their minds in the cesspit of alleded quality and care that is C(B)QC.

No doubt for general practice the C(B)QC will be more “rigorous” and “robust” and the layers of retardation will extend to cover other areas of Linnaeian classification so no doubt hamster and gerbil policies will be de rigor to ensure a “good patient experience” and maintain alleged “quality” and “care” as per the new Soviet style commissariat?

Figures we have seen suggest that 90 hours of work will be required to complete this monsterous pile of rain forest deforestation and intellectual retardation. If you are a single handed GP that equates to almost 3 weeks less medical care in order to demonstrate “care” and “quality”. Do patients want to see a completed C(B)QC folder or a doctor when ill?

Heaven forbid if a spot CQC inspection found that little Joanna’s visit to their doctor with a minor self limiting illness was compromised because the practice did not provide gerbil wipes for little Misha their pet gerbil who happened to do a whoopse in their travel cage in their 4X4 wally wagon parked in the practice car park and poor Joanna were to be distressed as a result of the lack of provision of a rodent rest room at the practice with gerbil friendly changing facilities (red gerbil mark anyone?).

They will be in therapy for years unless the C(B)QC and it fully retarded personnel are there to maintain high “quality” medical “care” standards via the important task of completing a tick box and devising “action plans” for the provision of rodent rest rooms and all things C(B)QC led improvement.

Now the dentists seem have got their act together in contrast to the Government stooges called the BMA and are helping their members (in contrast to the BMA). The Blair Quality Commission has powers without ability (sounds familiar) but is coming our way as GPs.

It is retardation gone wild and enables all of those who failed in the UK education system to get their own back on those who were bright. For there are not enough qualified people to inspect all those even more well qualified people who provide healthcare without compromising the provision of healthcare itself.

Instead it will be the job of those who have failed. Only those who are expert in providing layers of retardation can do this and there will be plenty of people made redundant from PCTs and SHAs who will be up to the mark and they will do so to the best of their exceptionally limited abilities but at least your gerbil will be well cared for as a result. Your grandparents will die as a result as their current leader is well qualified in not registering multiple deaths on their radar.

The CQC is not about care, it is not about quality, it is merely another layer of retarded bureaucracy and in having to fill in its mind destroying paperwork it will distract those who actually provide quality care from doing just that.

For if we, in healthcare do not fill it in “properly” to retard levels of “quality” and to retard “care” levels the retards can and will shut down the asylum and be totally unaccountable but at least we can take comfort from the fact that the gerbils will be well looked after as a result of the moron generated retarded enforcement notices and action plans if you pass.

Praise be to the Party of free enterprise for ensuring that with each Party the layers of retardation increase year on year despite their increasing promises of red tape reduction.

If it carries on at this rate the weight of the (gerbil friendly) protocols and bureaucracy will crush your average GP’s practice under their weight more efficiently than any Japanese tsunami and aircraft will never fly for the weight of pilot ticked retardation will be greater than the ability of the plane to take off.

And if the plane never takes off and the patient is never treated then no-one comes to any harm but rest assured all the boxes are ticked and all the policies are there to prevent harm (or treatment?).

Now that is important, isn’t it?

(We know we missed a doggie i before you start!)

Tuesday, 17 May 2011

It’s not working. Never?

Being early birds (well most of us are) we awoke to see the electronic care records scheme as the first item on the BBC news this morning. Nothing new to anyone who works in frontline medicine but either there was little else to report, like the Queen visiting Southern Ireland for the first time or people are slowing realizing that there is a project haemorrhaging money away and delivering nothing.

One of the biggest problems is that the people employed in local Politbeau IT departments are some of the thickest in the country. They can only be employed in NHS IT according to one of our friends from the first world from many years ago who works at the opposite end of the IT evolutionary scale who had the misfortune to dabble in NHS IT many years ago. They commented that anyone who is any good at IT goes into the private sector for the rewards are better. Perhaps that is why a few years ago parts of the private sector pulled out of the NHS IT project?

The BBC news item showed pictures of doctors looking at x-rays on their desktop. We used to have that service as a trial a few years ago and we posted on how the special groups of decerebrate vermin that inhabit the swamp of mediocracy that is your average PCT IT department can, using age old excuses, deny intelligent people use of data that they have control over but do not have the abilty to use.

We used to be able to see pictures but all of a sudden a few months ago they disappeared from our screens. No explanation, no consultation just disappeared overnight.

Now swamps are difficult places in which to navigate and so it took us several weeks speaking to many IT morons who were just able to stay out of the water for a few minutes of work before they had to return there to breathe again. Eventually we got a name and found the reason which must have been dreamt up by some form of IT department low life who had been out of their pond for so long there was little oxygen reaching their few functioning neurones.

So we at ND Central took a few small steps forward and NHS IT has sent us back to where we were on the whim of a decerebrate invertebrate. This was the same problem our first world friend had with NHS IT and its morons many years ago when we were junior grunts and still is today. The technology is there but the intellectual ability is not. Hence while we can see and treat patients, read and interpret x-rays those who cannot do any of the aforementioned deny us access to information that is useful for our jobs and is known as IT. It is meant to help clinicians but we are kept away from it and its development.

This is apparently the third report by the National Audit Office and what it says is a reflection of what we troops on the ground see and deal with daily. We however knew that. Thank you Auntie for just realizing that.

Praise be to the Party for giving us the IT equivalent of the Apollo space programme. Some of us know you can get to the moon and back but whilst the Americans used the best available the British just use those who failed to find work in world-class organizations like McDonalds.

No wonder we are so good.

Saturday, 14 May 2011

Watching the consultants.

If you are a GP in the UK for anything more than a couple of years you notice certain growth areas in healthcare provision most of which are sponsored by those in the bottom third of the UK educational system bright enough to work in UK healthcare management and deliver sweet FA to patients. You also notice that things are essentially the same but change their names often.

For example Shiteton Health Authority becomes the Shiteton Primary Care Group (Nor’ Nor’ West) which merges to become Shiteton (Nor’ West) Primary Care Group which then becomes Shiteton (North Western) Primary Care Trust. Same group of retards rearranging deck chairs on the Titanic awaiting the next ineveitable iceberg of NHS reform striving to finally sink the big ship NHS.

In doing so patient centred care is enhanced by the huge amounts of money spent on NHS letterheads and on NHS corporate provided sign painters all produced to the same high standards of the NHS Brand. This growth industry must be loving the current NHS reforms at the expense of hands on patient care.

For those GPs who read letters we are doing something more active than admiring the changing logos on a weekly basis. We are watching the rise and fall of local NHS hospital departments. This is something most managers will not see for they do not have to ability to retain information but they do have the inability needed to destroy via alleged reform or is it “service” redesign?

Some departments have more than doubled in consultant numbers while our local patient numbers have stayed the same. This is picked up by thick GPs reading the ever changing names of the list of consultants on this week’s new letterhead.

As a stable GP practice we have not seen any similar increase in GP numbers. Despite the increased consultant capacity we are as GPs told by managers that we are over referring to the increased number of consultants.

Another department once had several brilliant consultants and provided excellent medical care in a high demand service. NHS targetization meant that half of them left as they were not allowed to screen or prioritise Choose and Book referrals and now we have a p*ss poor locum service where the locums change on a weekly basis and the remaining consultants struggle to cope with NHS management demands.

We suspect that they will not stay much longer and will follow those who have left for better working lives. We know that the reason they left to pastures new and happier was management interference in clinical care.

This same unit was targeted by local management retards for the fact that the evil overpaid GP scum were over referring to this unit. The consultants treated all those who were referred but this was not good.

It was pointed out to the local retard managers that the same service was once provided more cheaply by local GPs and had been cancelled by them on “quality” grounds and as a result we HAD to refer certain cases once done in general practice to the hospital.

NHS mangers are not bright and they can pretend to read, and understand, spreadsheets (pretty pretty!) and once costs started to rise they thought there was a major problem but they could not see or remember who had caused it.

Referral management schemes were introduced and consultants and GPs hounded over patient “care” = referral numbers, not illness by managers too thick to understand the concept of intended consequences of an action until the (pretty, pretty!) colours on their spreadsheet change. There were inevietably casualties of this seesawing of retard managers’ changes to working practices.

All patients suffered – poorer service longer waits- but these do not appear on the pretty coloured spreadsheets for quality is difficult to measure by retards. Patient seen =yes/no patient better/worse = a Homer positive doeh.

So why should we as humble Northernshire GPs be concerned with hospital foundation trust and PCT moron managers and the games they play and the effects they have on our consultant colleagues? Because it affects our patients.

If 100 new cases of surgery are seen and generate NHS income of 100 Soviet socialised medical units then that is good. The manager is happy. Patient treated job done.

The GP sees otherwise. If comrade consultant Mr Botch Jobb FRCS (eastern bloc) surgeon sees 100 cases and 98 of them are botched then 98 will need to be referred on for corrective surgery. The consultant may not see their botchalisms for they no longer see follow up post op cases for hospital follow up in the NHS internal market is expensive and has been outlawed by the managers.

GPs are cheap and so they now see the follow ups that junior surgeons used to see. This improves consultant training by them not seeing the results of their handiwork and managers are happy for any complications need a new referral (=more income) after the patient is discharged. Consultants and managers don’t see the complications but a good GP will and they will stop referring to Mr Botch Jobb et al.

The NHS manager will not see the 98 problems for they will have seen the 100 cases completed. The complications of surgery will not appear on their spreadsheet and will not be linked to the initial cause. The manager will however see an over referring GP as the problem and this must be terminated for the referral target has been exceeded.

So we GPs continue to watch the consultants come and go. We are often aware of problems for we talk to patients who work and are treated at the local tractor plant. We talk to junior doctors and medical students who have been there too, we talk to our GP colleagues and on odd occasions when we are let out to play we sometimes talk to the consultants. Some of them we see as patients and vice versa.

The question is how many managers watch the consultants? Answer is none they just count the beans whatever the quality (pretty, pretty colours!).

It is responsible GPs who count the patients and their complications despite the NHS managers trying to tell us where to refer and to whom based on cost and their self determined “quality” standards. When we complain we are told to shut up until those who don’t realise there is a problem twig that there is usually after a few years. At which point something brown and smelly spills out of its pit where it usually lurks and covers everyone else in it.

After which the self same self righteous determinators of healthcare move on and crawl back into another cesspit of incomptencae and we loose the more able consultants as a result of witch hunts. There are then inevitable casualties but unfortunately not always the right ones.

Quality in healthcare is a difficult concept to measure, the new NHS reforms emphasis quality as the new competition not price. Will the new breed of GP commissioners do any better for in theory we can now watch and act unlike before?

Praise be to the Party for ensuring that signwriters and letterheads provide us all with high quality healthcare via “sign posting” and logos. Pretty, pretty things however do not good medicine make.

In the same way that the price of freedom is said to be eternal vigilance ensuring good quality healthcare is achieved by the same method. However it helps if you know what you are looking for. So we will keep on watching the consultants most of whom do not need to be watched but a few do.

We will hopefully by doing this save our patients from harm and guide them towards the best treatment which is not always the nearest. Knowledge of who provides what is one of the strengths of British General Practice for healthcare is not a simple as buying a tin of beans although a lot of politicians think it is.

Sunday, 8 May 2011

Screening programme a “political” project, surely not?

While once again busily waiting for patients one of us stumbled across a headline from Pulse 27 April 2011 which screamed out “Vascular screening was a ‘political’ project admits DH official” although you will notice that the electronic version of Pulse magazine has a different headline.

Great headline but what about the reality? Now we assume that “vascular screening” was one of the former Party’s great ideas was that too many people were dying from aortic annerysms bursting. Ergo a huge expensive screening program will save countless lives and of course there is the usual expensive but totally useless website which tells you (little) about it here.

The medical stats are if you have a ruptured abdominal aortic anneruysm (AAA or triple A) and get to hospital you have a 1 in 3 chance of survivial but if, your enlarged aortic anneysm is picked up routinely and referred for elective surgery you have a 95% chance of survival.

So for the great health gurus Tony and Gordon, whose years on the frontline of medical care mean that their knowledge of everything transcends all that any who are medically educated like a health care assistant, this means that this has to be a NHS priority, for they are holy beyond all others than Mugabe. For Tony and Gordon are well known for seeing what mere medically trained mortals cannot see for example WMD and the end to boom and bust.

Now we would not suggest that this little idea of screening would be of benefit to the private sector for we all know that there is such a huge surplus of radiological provison of ultrasound scanners in the UK so screening for triple A for a few thousand would clearly never impact on routine provision of ultrasound scans for ill people nor would subsequent repeated annual follow up.

A lot of column inches have been devoted as to how GPs could provide the screening service (for a fee) and the private sector would also be rubbing their hands with glee as many patients have come to surgery clutching leaflets pushed through their mail boxes offering them life saving scans for triple A and numerous other “preventable” diseases for a small charitable donation to ask is it worth it?

Look at this site here, read the propanganda and see the costs which we reckon are more than to see a consultant privately in Northernshire or google private ultrasound uk for more such charitable lifesaving healthcare providers.

Now the curious thing is that there is already a national screening program for aneurysms it is called your GP. Most GPs will pick up anerusyms far more cheaply using a very nontechnical method called examination of the patient using a pair of hands. Now Tony and Gordon will have listened to a sound bite and realised that GPs do nothing and so a national programme was essential.

Hands up any GP who has never found an undetected triple A in 10 years? Of course being GPs we would never have referred them for follow up to a vascular surgeon or checked their blood pressure, cholesterol, or indeed done anything for GPs are not blessed with Gordon or Tony’s medical experience and are therefore thick.

Heaven forbid that a GP on finding a pulsatile lump in a patient’s abdomen and, daring to suspect an aneurysm, would send their patient for an ultrasound which of course proved the GP wrong for the aneurysm was in fact an undiagnosed abdominal tumour which the patient survived despite their GP’s pathetic application of non Party approved medical knowledge.

Returning to the article look what was said to the prestigous gentlemen’s club called the Royal Society of Medicine who have invited most of us at ND Central to become fellows based on our huge contribution to medicine for a small fee (charitable donation).

Someone called Heather White, deputy branch head of the DH vascular programme, is quoted as claiming that the roll-out had been based on a “convincing model but said that the scheme was launched after pressure from the then Labour government”.

She went onto say that “We maybe should have tested and had pilots, but the Government was clear that it believed the information and was happy with the evidence. Preventive programmes were high on the political agenda.”

And furthermore she went on when asked about why the model was not peered reviewed to say “The model was consulted on.” and “If everything had been peer reviewed and we’d done randomised testing it would have been delayed for years.”

Interesting point that political expediancy versus hard science. Or is that how numerous healthcare reforms have been devised and delivered over the years and dumped on the NHS for no benefit. We are absolutely sure here at ND Central that things like that will not be going on now will they?

Praise be to the Party who allow politicians to think up ideas on a whim and implement them with no testing. If drug companies did the same wonder which drug they would come up with? Why bother testing ideas when you can just roll them out as political projects?

Thursday, 5 May 2011

It would be funny but it is too close to the truth?

Just a quick one. While busy doing nothing other than waiting for patients who were struggling to fill the whole of the Party approved 10 minute appointments with any real illness, or even struggling to turn up at all (must be the heat?), one of the team espied this little piece of news.

Anyone who has worked in the health service of late will realize that this piece of "news" is rather too close to reality. We wonder if any politicians reforming the NHS could see the satirical humour or would they just see it as someone criticising their best efforts?

Praise be to the Party for giving us free broadband internet access to fill out our time while we meet their targets. It is so very useful to us for medical matters and money well spent.

Tuesday, 3 May 2011

We now earn £ 600,000 plus a bit of sense for a change.

Well we idle over paid GPs have had another sun drenched 4 days off work in the form of a Royal Wedding Bank holiday and a May Day Bank holiday (comrades) in contrast to all those hard working PCT managers who felt that we should not have the same as they are entitled to. This gave the team the chance to do some reading of everyones favourite GP bashing newspaper The Mail on Sunday (MoS).

Now how could anyone ignore this headline that your “average” (sarcasm) family GP is on £ 665,000 a year for doing bugger all?

This is up a massive £ 165,000 in just a year according to the MoS yet only a year earlier they were earning on “average” £ 380,000 a year and getting £ 200 an hour for work they used to do for free!

So in less than 2 years your “average” GP has seen their income rise from £ 380,000 in December 2009 to a massive £ 665,000 now. No wonder new medical graduates sleep rough in our car park and pester us as we walk from our Ferraris as our staff hold umbrellas above our heads to shade us from the sun as we are carried in our sedan chairs into our large offices to await the great unwashed unwell who frequent our humble abodes and pay us so much to do so little.

Who would not beg to be a GP Registrar if you knew that according to the Mail on Sunday your income would increase by just under £ 16,000 a month, month on month in just 18 months? No wonder the government of hypocrites sees fit to relieve of us about 70% of every illgotten tax pound we earn. Digusting it shouldn’t be allowed.

But a more in depth trawl of the MoS publication led us to find this little gem.

Now if you have been reading UK medico-political blogs over the last 3 years this is nothing new but this little gem that should be shining out much more brightly was hidden in the Review section of the MoS. Reviews are normally about about opera, theatre and the finer things in life for some who read what are popularly known as the broadsheets. Regular readers of the Stoat Tickler's Gazette, our favourite rural read here at ND Cnetral, can't even spell review.

On the day before the death of Osama Bin Laden is reported the MoS has finally realized that there are people in the UK who have done more to terrorize the frail and vulnerable in our society than any terrorist or maverick GP has.

Terrorists usually target the fit and healthy. NHS managers get to target the opposite and it is these people who need the NHS the most and are most frequently let down by NHS managers. We call this institionalized incompetence and the 2 individuals in the MoS articles are masters of it and if the article is to be believed totally unapologetic in one case.

Now Bin Laden is no longer the world’s most wanted person, that title will undoubtably pass to the man, or the woman, who got the head shot, will the UK’s government turn its attention to those mass murderers who continue in the NHS?

Probably not for if every hospital is to become an NHS Foundation Trust the Party will need more of them.

Praise be to the Party for rewarding incompetence with promotion. For if a NHS manager screws up they are moved sideways into a new career.

Shipman did the honourable thing, Bin Laden was taken out and what will Nicholson et al do? They will just carry on and kill create more Foundatin Trusts as per Party orders and get away with it for NHS managers are never wrong and there is no GMC for NHS managers.

Only promotions and honours.