Thursday, 28 July 2011


There are certain things that we here up in Northshire regard as essential skills. One of these is navigation for home visits can sometimes involve trips into the wilderness with few road signs in the dark and in adverse weather conditions which in Westminster would be any shower requiring an umbrella as to opposed to a Force 9 easterly and a couple of feet of snow.

A recent trip down South from ND Central to a previously unvisited location and a straw poll of our hosts there revealed that about 50% of our contemporaries and their spouses use Sat Nav to work their way from A to B. The other 50% use a map and compass and other navigational aids such as the trusted sextant and nautical almanac to work our way around the globe.

Navigation has proved over the years to be a problem for some of our doctors in training who despite being extremely able medically would spend many minutes being briefed by our staff on how to find a visit location using the time honoured method of reference points that they knew and instructions to their visit location from these familiar land marks.

This time consuming process was both fascinating and painful to watch at the same time for if one receptionist did not list familiar landmarks another would be tried until a crude idea of location was eventually obtained. The concept of a map was beyond our doctor in training and they were not confident that they could master Sat Nav despite being otherwise very able.

However one navigates occasionally you have to enquire of a local where is such and such?

This weekend we did enquire of locals where is such and such for our maps and compasses suggested together with a noon sextant fix that we were where we should have been. The roadsigns and locals said otherwise.

For once our readings were spot on, we had hit the target but the maps and locals were out of date. Even our hosts did not know of the changes in local road topography.

How accurately can you navigate using the Internet? Some of our doctors in training cannot but we could and did so using basic skills. Perhaps there will be an NHS Nav App to help staff get from A to B? Perhaps its name will be 1592 Map App with up to the last millennium maps to match? Perhaps the technology is already with us in a covert form known as Choose and Book?

If AA Route Planner can get bits so wrong after years of being spot on how well will any NHS Map App do?

Come to think of it how well has any NHS produced software done?

So back to the old fashion history, examination and special investigation routine which will compromise the patient by foregoing the excellence of a clinical dashboard, a referral management centre and a clinical alogorithm and protocol.

Basic grunt navigation works and gets one to ones destination.

Is that a journey?

And guess what we got back too using the mark one human being and without any NHS (re)Direct assist. How did we as a doctor do that?

Praise be to the Party for inventing satellite navigation and ensuring that all who use their software can never screw it up. Thank goodness for grunt training and the fact that not all maps are accurate - even 20 years after inaccuracies are pointed out.

When will the politicians listen? And more importantly can they remember where they went wrong like the maps – 20 or so years ago?

Monday, 25 July 2011

“Quality” and money grabbing bast*rds.

The word “quality” as defined by the Shorter Oxford English Dictionary has many meanings. It can relate to both people and things but we shall use the meanings of excellence or superiority as in a “quality newspaper” as our benchmark for this little ramble. We appreciate that “quality also can be used sarcastically but we are simple folk up here in Northernshire and will stick with the excellence and superiority definitions in their literal sense.

Most, if not all, GPs we suspect are sick of hearing the word “quality” spouted by NHS mandarins for whenever it precedes anything medical it usually means that something which is really poor, time consuming and completely useless to anyone called a patient is coming our way to increase workload in order to tick someones’ box when a steel toe capped boot would do better placed in the same manager’s/politician’s “quality” box.

When used by anything NHS “quality” usually has the same meaning as the Late Modern English word “crap” or, in grunt speak, a word from a Mid Low German origin, and we are sorry for a couple of very naughty grunt expressions “sh*t” or its derivatives pile of s. or croak of s. both of which can be used with the c. word.

You can very quickly think of things with the Q word in the NHS just think QOF (Quality and Outcomes Framework) which is so excellent and superior that it isn’t working.

We are sure many readers will have their own little local Q word initiatives which like the Q-ships in WW1 were thought of as being a good idea at the time but which were superceded by better things than anyone at an average PCT could think of on a good day on a down hill run with wind assist ditto politicians.

Na Zu Labour’s endless persuit of Soviet style bureaucracy for the NHS led to the formation of the Care Quality Commission which like the Q-ships of old appears to be an innocent vessel striving to save others from harm and charged with maintaining standards but in fact like any poorly built tramp steamer is struggling to do its job and already cannot meet its own deadlines such is the quality behind it in terms of thinking and personnel.

Now where do the money grabbing bast*rds come in?

Well the CQC being a benevolent caring organization existing purely to serve the patient will happily relieve any GP practice (and others too) of £ 1500+ to be registered with it for you have no NHS “Choice”. Not registered can’t work, fail inspection cannot work well shafted whatever the outcome of any inspection cough up or else.

So this Q-ship is not charged with preventing harm it is in fact a source of harm and will no doubt shoot and hole many practices below the water line not with a ship terminating Exocet but with something far more deadly like you didn’t have gerbil wipes in your washroom (CQC “quality standard 57.997.47.1101.gerbil.9/11). Bear in mind that the captain of this Q-ship has much experience of being a U-boat, sorry hunting U-boats . . .

One of the members of the alleged listening exercise a once a week man aka part time GP called Professor Field has clearly embraced the market so much that he has given GPs the opportunity (to lose a few grand) to improve “Quality” via something called the Quality Practice Award (QPA).

Notice the little Q word at the front? Impressed are we?

Try googling “quality practice award” as we did as part of our research and see what, and who, else runs “Q” word practice awards and like the Royal College of GPs there are some excellent and superior organizations which put Northernshire’s Harvard and Yale MBAs to shame for not having put forward a Shiteton QPA of intergalactic quality.

We digress for the CQC are prepared to relieve practices of a mere £1500 (a year we believe) for registrartion and inspection by inspectors who we are sure will be our “equals” or betters in terms of qualifications and abilty for something which is a legal necessity and a nice little deficient balancer to boot for any Government in power. Can you imagine Pol Pot inspecting Harvard and Yale medical schools and what the outcome would be but remember we are talking NHS “quality”.

If you look in the small print of the Royal College’s Qboll*cks page, sorry about the offensive grunt speak the Q word slipped out by accident, here you will find out how much Professor Field and his back slapping government stooges would like to relieve their fellow hard working GPs actually on the real frontline, on a full time basis, as consultable GPs a few of whom are not members of the Royal Gentlemen’s club but do exactly the same work.

Have a look at the little red words on the first page (the italics are ours) which say that evidence obtained for certain QPA/mQPA (Version 14) may help providers demonstrate complainace with the Care Quality Commissions essential standards.

Have a look at how much quality has gone into the preparation of the web page and how “quality” means that the word United Kingdom is severely displaced by “quality” and the quality of the logo which looks like it was drawn by a nine year old. Or perhaps someone drunk hit the enter key more than needed? And note version 14 – does that mean someone got the quality not quite right 13 times before this one? We hear rumours that even version 14 is being redone.

We know of some commissioning groups (RCGP mafiosos) that are taking “may” to mean “will” meet CQC registration and thinking of imposing it on practices but the old expression caveat emptor applies. But if you are MRCGP you don’t do Latin or Windows when in collegiate mode for this usually involves real general practice avoidance aka commissioning.

For there is not just one RCGP QPA that might just get you QPC registration scam there are in fact two. Did you notice the subtle mQPA that you can take longer to get? And can you guess who devised this?

So yet another set of different Q words from different organizations but they all have two things in common. No quality and money grabbing bastards. One is the Party's the others are just advising them.

Praise be to the Party for using the Q word as freely as tinpot dictators award themselves medals and charging the punters for the privilege of wearing their baubles as well.

Now will those commissioning groups wanting the RCGP bauble be able to justify to their patients why they spent more than £ 3,900 on a Q word when £ 1500 was all that was legally required especially if the CQC don’t accept it and they still have to pay the government’s income generating lackey as well?

It appears that certain Royal colleges and their members don’t just shaft their trainees they are more than prepared to Qrap on their colleagues too.

Tuesday, 12 July 2011

We think the ladies protest too much . . .

As we drove one of our many practice Ferraris home from ND Central this evening across the high moorland and forest covered hills of rural Northernshire we were listening to the bleatings of a poor Northernshire citizen an alleged victim of the current cause celebre in the UK the phone hackings by the Press of certain peoples’ private data.

In medicine we would call this a breach of confidentiality which is a serious charge against a doctor and yet the loudest of the little bleaters was not one of the numerous maturing lambs we drove past on our way home but one of the biggest advocates of weapons of mass disclosure in our history none other than Gordon Brown something MP, sometime unelected Prime Minister and “saviour” of the World from the destruction of his own making.

On the Radio 4 news programme this evening he said as follows and if there are any factual typographical errors in this transcription it is because we are not audio/touch typists (our press officers had gone to get a late appointment but they were delayed due to leaves on the line):

“. . . if I with all the protection and all the defenses and all of the security that a chancellor of the exchequer or a Prime minister, am is so vulnerable to unscrupulous tactics, to unlawful tactics methods that have been used in the way we have found, what about the ordinary citizen?"

Yes what about the ordinary citizen Mr Brown? It is reckoned that perhaps 4000 peoples’ mobile phones in a population of 60 million have been hacked but you were, in your ignorance and while in power, more than happy to rush through a process to allow 60 million UK residents’ personal medical records to be uploaded without their active consent on to an inherently insecure government sponsored database with at least a million plus users?

Try doing something you have never done in your life called thinking. Which network is most likely to be hacked? Which network has the most holes?

If you are outraged by the disclosure of your family’s records to a select few journalists via dubious means how do you think an “ordinary citizen” will feel when their medical records are hacked for £ 20 of smack to a receptionist dismissed for drug misuse whose smartcard has not been cancelled? That is how easy it is to hack the Summary Care Record.

That is your creation, it is flawed and useless and if you feel that the disclosure of your childrens’ medical records is a problem then perhaps you ought to start thinking instead of bleating with your political colleagues like a Northernshire lamb.

Praise be to the Party for all of their leaders’ concerns about the confidentiality of the privileged. It would seem that they are all biting the hand that feeds them but what will happen when the hand slaps back?

More importantly when will they finally realise the inherent dangers of centralization of patient’s confidential medical information?

Thursday, 7 July 2011

Would you believe it?

Upon opening one of the GP rags this morning a headline screamed out at us here at ND Central.

“Patients shun ‘wasteful’ Darzi centres” it read and yet only a short time before another GP rag said “NHS Choices ranks Darzi centres top”. Surely a slight difference of opinion here but look a little deeper at the first story. The GP magazine contacted 95 PCTs (out of 152 in England) and found some interesting facts about how many patients these Darzhole practices had registered.

Remember these practices are organs of the fromer Party Za Nu Labour’s muppet Lord Darzi, the Iraq born Armenian,  Irish trained surgeon who, based on his vast ignorance of general practice, was asked to advise Messrs Brown and Blair on how to reform it. He pulled from his black hole of knowledge of general practice the idea of the Darzhole practice which led to their imposition creation.

We have commented before how they fit into the Soviet market model that is today’s tripartite political model for healthcare but let us now present the findings. Remember too that the Orwellian porcine principle was applied to all PCTs so that all PCT porkies were considered equal and got the same number of Darzhole centres regardless of whether they were over- or under-doctored. (We love true political equality here at ND Central).

The figures are as follows:

12 % have no registered patients

26% have less than 500 patients

35% have less than 1000 patients.

The most damning figure was that on average the cost per practice per year is £ 1.1 million.

Now we can only go on local experience but a practice with a turnover of about £ 1-1.3 million a year normally has a list size of between 10000 - 12500 patients not none, nil points, zero patients on its list.

We will let you do the maths as to cost per registered patient but look in the article about NHS Isle of Wight which has just one registered patient. £ 1.1 million to spend on one patient they are going to live forever!

This might explain the second headline bearing in mind that virtually no-one uses NHS Choices for choosing anything so for them to claim Darzhole centres are ranked top is to be viewed with deep suspicion but just think if you are the only patient would you ever have a problem getting the phone answered, an appointment when you needed it or to see the doctor of your (NHS) choice?

Your call would be highly valued by a Darzi centre and would be jumped upon by staff with nothing to do in contrast to the real world of general practice where 10000+ patients all want the phone answering NOW.

Perhaps we could make a helpful suggestion.

Given that these highly expensive and underused centres are public money going to waste, perhaps every GPs’ surgery in England could give a list of their top one hundred time wasting heartsink patients to their local PCTs with a view to utilizing under utilized Darzhole centres with patients whose needs are clearly not being met by overstretched underfunded normal GP practices.

Such patients could be told that there is a surgery that will see them at any time and they would never wait for an appointment. If they are quick they could in fact be the only patient at that practice but it might mean a bit of a trip but we are sure that given private sector involvement their every need would be catered for and the PCT would pay for their trip to the Isle of Wight (“we could even have a holiday as well as see the doctor!”).

Just a thought for any new commissioning group keen to utilize underused local GP services efficiently and mop up any inefficient capacity issues within the global corporate structure . . .

Priase be to the Party for giving us Lord Darzi and for the way he has transformed general practice (not), improved access to GP services (for a few) and for all of his and the Party’s financial prudence in doing so. Clearly such good value for money and increased equitable access for all patients especially the one on the Isle of Wight?

We dare anyone to say he was wrong . . .

Tuesday, 5 July 2011

Health tourism.

In the UK the phrase health tourism is taken by your average reader of the UK’s government’s attack chiuaua newspaper the Daily Mail (DM) to mean the swarm of people from non caucasian countries who fly into the UK to take advantage of free medical care. A lot of these people are from former countries of the British Empire and are actually entitled to free healthcare but DM journalists won’t know that.

Disgusting, say most hard working Joes and Joannas, and their non tax paying friends of the Daily Mail readership the benefit claiming non working Wayne and Waynetta Slobs for health tourism clearly explains to them all why they can never get an appointment with their GP.

There is a far more incidious version of health tourism which largely involves the elderly who have a migratory lifestyle. When it is cold, in winter, many of them swarm South to take advantage of the summer, or warmer temperatures, there but as temperatures drop down south they return to the motherland.

When it comes comes to fraud, dishonesty, lying, cheating and shafting the NHS (and the benefits system) in the UK they put the likes of Wayne and Waynetta Slob to shame because they are zen masters at it.

A few examples of health tourists and their abuse of the NHS are presented below. These are not isolated one offs for most are repeat offences time and time again albeit by different patients.

NHS shaft #1

I am going to live in country X in my villa/with my relatives for six months and need all my medication.

The DoH recommends only 3 months supply and technically you should be removed from our lists after 3 months.

You won’t do that will you doctor? I have been with you for years (abroad) . . .

Yes we would and no we won’t give you more than 3 months.

NHS shaft #2

I am just back from 6 months in my villa in a country where healthcare is not free and I am only back here for a month.

I would like a hip replacement, cardiac bypass, varicose vein surgery, a stairlift fitting and my council tax reduction form signing and someone to wheel my wheelie bin on account of my “disability”. Can I have all of them now?

And what do you reckon your chances are? Did you say that you have just flown back unaided from Australia for the 2nd time this year and driven from the airport yourself despite your “disability” in an unmodified car and were on your way to a round of golf?

NHS shaft #3

I have lived abroad for 5 years and before I went away I was referred to see a surgeon. Now I am back I MUST go to the top of the waiting list because I haven’t heard from them after 5 years.

The reason you haven’t heard from them was not that your GP hadn’t referred you, as you claimed, it was the fact that you took advantage of another foreign healthcare system and did not attend your appointment in the UK despite it being sent to and a second follow up one as well.

5 years ago.

Although you are “entitled” to these services you are more than happy to abuse them because they are free and as such you get the special priviledge of going to the bottom of the waiting list.

NHS shaft #4

I am in wherever and I am ringing you at huge personal cost on my mobile and have a medical problem. Can you send a prescription to my relative at home for my acute illness based on my own diagnosis with Google assist but I cannot find a doctor anywhere here (for free).

My relative will cash the prescription for free in my name and send me the drugs.

No if you are not in the UK, and are in central Berlin, the responsilibity for your healthcare is that of the country you are resident in.

This may unfortunately involve a charge and a degree of responsibility on your part to prove that you are actually ill, which you don’t have to in the UK when you see a doctor.

Although a prescription is a freebie to most people (85%+) in the UK it can prove very expensive to any doctor who prescribes on the above basis for they have not seen the patient but they are responsible for any prescription that they sign.

NHS shaft #5

I have decided that the NHS is crap and am paying to go to abroad to have surgery there for my condition. In order to save money I would like you to perform all the preoperative bloods, a chest x-ray and an ECG and declare me fit for an anaesthetic in 3 months time.

We are GPs not anaesthetists and the responsilility for declaring you fit for anaesthesia in 3 months time is not ours now it will be one of our anaesthesiology colleagues then who pay an arm and a leg for medical protection insurance so we would suggest you pay the going rate and not misuse the NHS which you think is carp.

The recent spate of bank holidays and school holidays has led to other forms of health tourism other than the silver shafters for they have educated their ill begat spawn on health tourism these being some of the most common:

I am going on holiday tomorrow this is an EMERGENCY. I need to be better before I go on holiday.

So I MUST have an urgent appointment for a seriously trivial self limiting illness that MIGHT ruin my holiday something that I have paid for and is valuable to me unlike your time.

The corollary of this “serious” case of health tourism is this:

I have had this while on holiday but once healthcare is free I need an urgent consult for this rash I have had for 3 months while in Thailand and I have only just landed after my 16 hour flight. Is this painless ulcer on my genitals of any consequence but I am not worried regarding this?

We are more worried about those you have abused to get these symptoms you disgusting overweight smelly middle aged individual resplenant in unwashed T-shirt, shorts, flip flops and socks. We can treat such sex pats as you for your syphilis for free but who is going to treat those you have abused to get you Thai red chilli rash and painless genital ulcer?

No doubt you will be going again later this year?

I was ill overseas and had to pay for healthcare there (never?). This form needs filling in URGENTLY for it cost me $15000 in the USA which made me better and I had a GP consultation followed by full hospital care and investigation including full blood tests/x-rays/CT scan/MRI all within 6 hours.

And you actually had to pay for healthcare something you can claim back on insurance that would have taken 6 months in the UK to tell you there was nothing wrong just a minor infection?

Of course cost is always urgent while complete investigation is always essential if not needed but unfortunately expensive especially when the individual who receives all of this medical excellence and no treatment realizes how much healthcare ACTUALLY costs for then cost is an EMERGENCY for the first time in their adult life after years of them and their family abusing their GP.

Whilst it may be URGENT to you the more you tell us it is URGENT to fill in your form the longer it will take. We have patients to see who are not better unlike you but unlike the special ones like you who have actually had to pay for healthcare those that we see in the UK do not.

But you are importantly different aren’t you?

I need an urgent appointment because I am going on holiday and want to enjoy it so I thought I would see if you have my scan result from yesterday and they told me the result would be back in a week have you got it?


So this was an urgent consult, so you could selfishly enjoy your holiday, deny someone who might be ill an appointment even though you were told how long it would take?

Let us advise you how this scan and the lack of a result will increase your travel insurance premium and reduce your insurance cover . . .

We wonder whether Brits abroad must be the biggest pains in the proverbial a*se (sorry a grunt word slipped out there) of any healthcare organisation overseas for they fail to realize that healthcare is a very expensive thing.

Healthcare is not the same as buying a pack of fags from a corner shop where you have to pay money up front to someone who serves you who could proberly be trained to do this in a day or two but the average Brit values their fags and booze more highly than healthcare when abroad as they are cheaper (than local healthcare) and so using a “market” model must be consumed with extreme prejudice.

We recall in our naïve years in the UK remembering a scene in a movie where someone asks a patient before they are treated if they are Blue Cross or Blue Shield in terms of insurance before they can get treated. At that stage we thought the NHS was great for patients did not have to get asked this in order to get treated they just were. When you work in healthcare in the UK you realize how little it is valued because it is free. The last Party trivialised healthcare to the point where you can see a highly qualified healthcare professional on the basis of (political) WANT not on the basis of (true) medical NEED within 48 hours.

So if you cannot get an appointment when YOU WANT it, rather than you actually NEED it, remember others may be blocking your access based on their selfish WANT and not wanting to pay for anything else than their holiday. In the recent past this selfish group has been up a third of all “emergency” consultations.

And they think the young are disrespectful idle benefit defrauding scum. The young here in the UK have such excellent role models when it comes to swinging the lead.

Praise be to the Party for the winter fuel allowance which in Barbados must be good for a good few duty free G&Ts rather than a few extra peat briquettes in the burner. GP practices and A&E departments near to airports will know what we mean.