Monday, 29 August 2011

Appraisal made simple.

Once a year as a doctor in the UK one has to reach an intellectual low point the ultimate test of medical retardation called appraisal. This we suspect to most doctors is like pulling your own teeth out with a mole wrench while being told you will look better for doing so and it won’t hurt a bit. It is like the “What I did in my summer holidays” essay at school when you were the only kid in the class who hadn’t been to Disneyland it is so painful and like the essay a complete waste of time and effort achieving nothing but happens each year.

Appraisal, although officially denied by those who missed Harold H. Shipman the multiple mass murdering GP in the UK, was introduced by the GMC as part of licensing and revalidation all of which are tools to curtail professional freedom and ensure that all doctors are dumb ar*ed Party organs. Harold H. could at least objectively quantify his achievements something that the gentlemen’s club cannot but Harold H. was of course not the GMC’s fault. How could it ever be? It is a bureaucracy that costs doctors who actually do real work dear each year.

Check the GMC website here and see how easy it is to identify a crap doctor. Can you find a dodgy doctors’ list here?

We have on several occasions identified dodgy doctors and checked the helpful GMC website and their details have been wrong. We have then informed the GMC and it takes at least two attempts per doctor to change things. Some examples of dodgy doctoring we have come across in our collective careers include such minor infringements of high professional standards like accessing highly dodgy porn while allegedly working or giving false qualifications. The initial phone calls were ignored as was a subsequent letter sent recorded delivery until someone who could read found it by chance.

We follow the individuals concerned with interest in the hope that concerns reported do not result, a quarter of century later, in the next Harold H. Shipman. We have discharged our duty as doctors in the field but has the GMC done its protecting patients bit?

The great thing about the GMC is that although it now provides licenses (not the ones we would really like) called licenses to practice if you resign from the gentlemen’s club then they have no sanction against you. We have seen this locally too and the only sanction relatives have is the legal one and so a protective GMC is a totally toothless tiger when protecting patients in contrast to its full set of armour plated nashers when savaging the profession. It has failed to protect and anyone who has failed in any NHS managerial capacity gets away with it and just carries on.

Enough of the grunts’ rants. If the officers are incompetent then the grunts will fail. Not a problem in war you just die but when patients are harmed someone may just get sued and more importantly patients get hurt due to incompetence. Hurting patients is not on but still the regulators blame and penalize all the doctors for their regulatory failings.

There are a variety of other medical bloggers who have realized the self same things about appraisal, revalidation, licensing and those in charge. Have a look here, here and here for a selective snap shot but type GMC into their blog search engines and there is plenty more to read. Remember power corrupts and absolute power (with no accountability) corrupts absolutely.

Although officially denied on its web site (Q. 8) that “appraisal”, which is part of “revalidation”, is in response Harold H. Shipman can you see anywhere a reference to Harold H. on its timeline? Neither can we but that must be because some of us haven’t yet had our annual appraisal and so will be nearing the end of the boosting charge to doctor performance that is the annual appraisal. Appraisal is that impo(r)tent to making us perform better as doctors after it just like the summer holiday essay turned us into budding Shakepeares.

You can imagine how appraisal was “thought” of as any doctor married to a nurse in the UK will have had this, or a similar, conversation in the last 10-20 years prior to doctor appraisal being brought in.

Picture the scene thus:

The Gary Grant like doctor, a member of the GMC, is cuddling up to Doris Day his wife, a caring nurse manager, in full body pyjamas in their separate single beds after they had both had their full days “work” in their respective “managerial” but hands off patient caring roles. If Gary and Doris don’t do it for you imagine the former Chief Medical officer Sir Liam Donaldson and the former Chief Nursing Officer Dame Christine Beasley instead who brought all this in. The sick bags are located in the seat in front of you if needed.

GC: Darling, the GMC have asked me to come up with something cracking to check that all doctors in the UK are all damned good chaps.

DD: Really darling? Why would they need to do that? You are all such good sports and pay for my swimming pool, Porsche and all I have to do is to lie here on my back and think of England. I get paid as well for doing absolutely nothing at one’s splendid hospital as a modern matron.

GC: Oh darling do not be so gay with these matters. I haven’t got a clue what to do but need an answer by tomorrow, my dear love.

DD: But darling that is why you work for the GMC? Oodles and oodles of money for doing absolutely nothing worthwhile!

GC: You are right as always darling, I forgot about that, but you are such a top hole sport can you help?

DD: I think I might just be able to help you. We nurses have a completely useless system called appraisal. Nobody likes it, it achieves absolutely nothing but piles of paperwork and the killers get away with it all the time. What do you think?

GC: Splendid idea Doris! I can feel one of those jiffy moments coming on and will present this as an original idea tomorrow at the GMC. Should be easy to get though as I pull a string and everyone votes yes. I am sure it will work as well as the crystal set I put into my car although the radio does go on and off over every bump but someone has to try “new” ideas despite the ups and downs.

And so appraisal may have been born for the medical profession after it had failed elsewhere and continues to do so.

If you think appraisal for GPs is quality tough stuff check out this link.

Have a read of the forms and remember all a doctor has to do is write something in the boxes. Nowhere is the care given by that doctor actually assessed. Not once in all the years that appraisal has been running have we been ever asked to show even one set of patient records. Just the filled in appraisal forms. Convinced this will ensure good quality doctors? Read on.

Check out this link for “minimum appraisal standards” here. Think Harold Shipman as you do so and substitute the word worthless for limitless in the first sentence.

We believe that he met all the then current educational “standards” and had to provide certificates of attendance at courses to qualify for educational payments called Post Graduate Educational Allowance (PGEA). That’s right to qualify for payment not to check quality of care.

We will say the word again payments so no conflict of professional interests, or of professionals maintaining their own professional standards because they think it is the right thing to do.

In summary before the more rigorous system of appraisal if you sat on your ar*e at any educational meeting and got enough certificates you were deemed a “good” or Shipman equivalent doctor. Collect your PGEA money, pay your GMC fee, no questions asked so carry on killing doctor.

Given the fact that a lot of “educational meetings” were sponsored at posh restaurants and hotels by drug companies you can rest assured that all doctors with a full PGEA payment were uninfluenced by commercial organizations only by their “love” for (money) professional advancement (and good food) which some of us have always done for nothing using the time honoured method of reading original research and doing something verboten in the current NHS thinking what is best for the individual patient not following a Party (or drug company sponsored) diktat.

We regard this as part of the job if you are a “professional” and we do this for free and do not collect “trophies” for doing so. Others however feel that keeping up to date should be paid for and rewarded with little baubles.

Check this site for it provides the “minimum” paperwork you need to comply with appraisal paperwork. You can fill it all in less than half hour. Have a read of a structured reflective template and see if you can fill them all in with something you made up that might appear real.

If you are struggling then an episode of the BBC’s Doctors soap will be more than you will need to do so. The soap is a fictional work but patient care is non fiction. Appraisal in minutes, we have done this in 20 minutes and the best bit of it was nobody read any of it but we completed our appraisal. We found this by chance (just read post #16) doing our research so it appears that others do even less than this. See how long the Party and its organs feel you spend (top of second page) on your “What I did in my summer holiday” essay here.

So current GP appraisal consists of telling a local colleague how wonderful you are in 2 hours while your colleague gets a bung of about 500 quid to sit and listen to you after a 2 day training course to become an appraiser and identify any proto Harold H.. They may even have read the sh*te you wrote on the forms but often don’t. They are getting so bored with the process, probably because no-one likes doing it and rightly so for appraisees (notice the subservient term aka trainees) are giving the Quislings a hard time so now that the whole thing takes just over an hour.

Appraisal is meant to be part of revalidation for doctors a process that is so straight forward an idea that the other great medical gentlemen’s club the RCGP have published 5 versions of the RCGP Guide to Revalidation of General Practitioners. Not over many years but between April 2009 and December 2010 so no-one is making things up as they go along are they?

Praise be to the Party for ensuring that Harold got away with murder and was educationally up to date and got paid for it. Thank God the Party and its stooges have realized this and tightened things so much up that what Harold could do in hours of education you can now do in less than 30 minutes of downloads and a 2 hour (or less) chat called appraisal.

In order to practice as a GP you have to have been appraised but before you can fail as a GP in the eyes of the GMC you have to have passed appraisal. Makes sense doesn’t it? Protecting patients guiding doctors?

Wednesday, 24 August 2011

Government to finally consult over IT matters?

A small piece in this week’s GP online caught our eye. Have a read and ask yourself is this a true government engagement with the profession (unlikely) or another variant of an alleged listening exercise now on “listening” (to cronies) exercise 2 the sequel? There is a bit more information here (even an app blog!) and here on Party websites that give a bit more spin. Can you spot the subtle play on words?

We could think of a few apps for any health minister to put on their smart phone in our attempt to improve the NHS and of course improve patient (and staff) well being the first is the:

Scrap Cab app.

If pressed this would stop all Choose and Book systems dead thus enabling referrals to make it to their intended targets and give patients real choice via the power of paper.

Health secretary Andrew Lansley said the campaign to develop new apps was a political gimmick to divert people’s attention away from something else is part of a drive to give patients better access to information that ‘will put them in control of their health’.

As well as submitting ideas for new health apps, professionals are also being asked to name their favourite exciting health application.

Perhaps if Mr Lansley asks his nice secretary when they have switched his computer on and before he plays his favourite computer game NHS Battleships to point out the Google app on it he will discover the app most patients already know about and use regularly that “put them in control of their health”.

We are sure there could be other apps that could benefit the NHS like:

The Waynetta Dullard app

will automatically block any 999 call for a broken nail and divert them to the emergency on call beautician.

The Holiday Emergency app

would automatically block any call to a GP from within 30 miles of an international airport when the caller says “I have just got back from holiday and need an emergency . . .”

The Find My Dealer app

Simply place your drug dealer’s mobile number into this and it will display a map showing their current location. If their phone is switched off or is located in any of Her Majesty’s prisons or police stations it will automatically look for any other willing provider or failing that your nearest GPs’ surgery or NHS Walk In centre.

The Are you alright? app.

Vital to ensure that you are always a worried well in peak shape this handy app asks you at least once a day (other options available you can’t be too careful) if you feel alright. If you answer yes nothing will happen but any other answer will randomly dial either NHS 911, NHS Direct, your GP or 999 to ensure that you get instant gratification for not feeling right.

iBoob Checker

This app will enable anyone worried about breast disease to consult instantly with a trained pervert professional who can in real time review images that might suggest disease. If need be a real time video consultation can be arranged and advise you how best to examine yourself via your phone’s camera. Images may be recorded and used for training or security purposes. (Other iCheckers are in development).

We really must start doing some real work but we are sure there are plenty of other ideas out there so you know where to send them. Click the link at the bottom left of this page to see what other "hot ideas" have been rolled out so far.

Praise be to the Party for once again thinking that technology is the answer and completely missing the point about what real healthcare is.

Tuesday, 23 August 2011

The rise in NHS bureaucracy even stops you dying at your anointed time.

We are sure that a few of our fellow GPs and district nursing colleagues will have noticed the emergence of the DNR form. DNR form? Well it stands for Do Not Resuscitate form which has made its appearance as an additional passport now needed by the dying patient from NHS bureaucrats to speed up their navigation on their final NHS journey.

Imagine as the on call doctor in your average NHS GP’s consulting room you are happily practising a few putts on your golf simulator with your three 96 inch plasma screen 3Ds displays and surround sound when there is a knock on your door that distracts you from winning the last US Masters with your expert putt after years of practice while on call.

In walks 37 stone of experienced cream cake eating and work avoiding district nurse commissar Kristina Brinklocova whose proud boast is that she always puts paperwork first. This former Eastern European chocolate putter then thrusts a DNR form in front of your face and drawing herself up to her full 4 foot 6 inches of honed work avoiding lard while making her once every 3 monthly appearance at ND Central as a new modern matron of remotely hosted district nursing service says sign this.

Not that we are easily intimidated here at ND Central but when your only defence between being crushed to death is a golf putter then discretion is sometimes the better part of valour (thanks Dr Z).

You then read the mountain of paperwork that is a DNR form and see that Ernest Thistlewaite age 65 who your friendly local oncologist has given odds of he will not last to the end of the month as most of his lungs and body organs have been replaced by small cell lung cancer and was, and is still, a 60 a day smoker whose sole nutritional support is alcohol is, until you sign otherwise, to be resuscitated in the event of any preterminal cardio-respiratory arrest.

He is being given the privileged of going AWOL from death and avoiding CPR even though death is seriously on his case despite the nurse commissar whose response time in the event of a code blue would be hours, just to assume a vertical posture from lying down.

The DNR is yet another sign of the paperwork generating NHS for unless one is signed, given to the district nurses, relatives of the patient, Police, Ambulance and Fire services, local boy scouts and local girl guides together with the local Women’s Institutes then anyone unfortunate enough to be on a very short haul flight to meet the Grim Reaper may have their stay in the departure lounge extended by all of the above jumping up and down on their chest for no useful purpose other than protocol.

Not so long ago GPs and district nurses worked together. They knew and discussed patients together and with their relatives and if a patient was about to die we discussed the issue of dying and CPR and if appropriate we agreed when we would/would not. The out of hours services were also informed so instead of dispatching life saving paramedics a death confirming doctor would be sent.

We would call this death with dignity. No unnecessary heroics just an unassuming passage into the after life with minimal bureaucracy in the here and now.

For reasons better known to those with less experience than us it appears that all punters are for resuscitation at all costs unless a DNR is signed. An interesting point that isn’t it? Patients have by implication given their consent to CPR even if they are dying from incurable diseases and have NEVER been asked? Remember "no descision about me without me"?

Who is worthy of resuscitation? Well as all comrades are equal in the NHS then obviously everyone is regardless of their physical condition even Ernest whose body is being painfully eaten away by a cancer that no-one can do anything for. If Ernest stops breathing or loses a pulse should all the stops be pulled out to resuscitate Ernest back to life so that he can continue to live out his remaining life in pain with no hope of remission unless the parole board give him a DNR?

Well over the years we have worked with doctors who would happily gone into a graveyard to dig up corpses to practice resuscitation on. This is an example where common sense used to prevail but not now the bureaucrats have taken over. It is now “policy” dictated by “protocol” that means that regardless of any patient’s medical condition being assessed individually people should be resuscitated by NHS corporate policy. You cannot die with NHS care although you may often die because of it.

The thought that the application of military triage principles be applied clearly frightens some. After all who would be able in today’s NHS to fathom out those who will not survive, those that will survive with treatment and those that need no immediate treatment? An article in this week’s BMJ highlighted the default position being that of resuscitate without any thought except in certain instances such as “rigor mortis, decapitation, decomposition or dependant lividity”.

We like that last one how many UK sixth formers doing General Studies A level grade U or E- or below soon to be next week’s elite NHS managers would know what “dependant lividity” meant? Is it an Excel Word or on Facebook thingy? Perhaps some others like doubly incontinent, demented, not moved for years after multiple stokes with pressure sores or dying of something incurable should be added to the list? And can it get worse?

Yes it can! For any DNR order now has a review date, an excellent increase in totally pointless bureaucracy and multiple form signing.

So let us return to Ernest whose life has got even shorter since we last mentioned his name by a disease over which we have no power to defeat. If you were a thinking person and were asked to complete the DNR for him you would think that the review date is postponed indefinitely but oh no Matron will not allow more than a few days grace in case something changes. If it does and he gets cured we promise we will ring the Pope but a review date get real?

At this point anyone with intelligence will have lost the will to live or be suffering a cerebral haemorrhage of some description as a result of repeated banging of a head against a wall. Can it get worse? Yes it can for before these worthless pieces of paper came along we were sent letters saying how much “effort” had gone into devising these pieces of soiled lavatory paper. Lots of words like “consultation”, “partners” “co-operation” “inter agency working” but how come no-one told, or asked, the grunts on the ground?

Praise be the Party whose concern to provide first world medicine for patients is always trumped by its desire to add more paperwork in order to evidence its patient centred activity. When Ernest dies there will not just be a death certificate and a hopefully dignified pain free death to justify his well taxed self abusing life style there will also be a DNR audit and quality care paper trial available to justify Matron’s huge girth.

Why make things simple that work when you can have NHS care? The morons are well and truly in charge. We must away to read the next protocol and avoid patient care as a result.

And no doubt Matron will get through some chockys and cake while doing more essential DNR forms and ignoring the morphine. One involves meaningless paperwork the other involves hands on patient care. Which is most important?

Sunday, 21 August 2011

NHS IT and accurate information.

After a particularly hard night of resistance work at the infamous Café Michelle some of the team decided to check the NHS Choices website for a laugh. You know how it is when you are waiting for the liver to do its job and the Sunday morning bacon buttie to get digested. We have visited it before and commented on its value for money.

Well we started by putting in our postcode and looking at our empire. We looked at how many doctors there were at each surgery site and none of the figures were correct for the same number of doctors are present at each site and the same sex ratio applied but not on the NHS Choices website that gave you several Party approved “NHS Choices” none of which actually applied.

What amazed us more was that the distances from the postcode we put into NHS Choices to many local neighbouring surgeries were at complete odds with our regular commutes and the figures on our milometer. Our most rural surgery was closer in distance to our main surgery than another surgery site in the same small rural conurbation according to NHS Choices. Clearly something strange is distorting the space-time continuum in Northershire and we will need either Doctor Who or Mr Spock to explain how a journey of many miles over high moors has been reduced to a few tenths of a mile.

This could be interesting as neither Dr Who or Mr Spock would be qualified to work in NHS IT but we are sure a sonic screwdriver or a translator device would help them “crack” this NHS Choices conundrum.

If you click on the map it shows the correct locations of the surgeries and shows the same distances but if you look at the scale bar on the map then the distances quoted by NHS Choices are clearly wrong. Can't be Google's fault can it?

We did this for a few other locations we knew well and the same errors were there too for distances quoted. Indeed 2 surgeries at approximately the same true (map) distance were quoted as being 0.3 and 0.9 miles from the postcode entered.

One of the reasons we did this was to see if any comments had been posted since we last visited and the website showed that we had scored one hit. Salivating at the thought that someone might actually like us enough to post a comment on the NHS Choices website which surely would reward us with untold riches due to a surge in patients wishing to register we clicked the link and were invited to be the first to post a comment.

Strange we thought could there be a programming error so we used our provisional number of comments =number quoted minus 1 formula and tried one of our neighbouring surgeries which confirmed the formula worked for they had 2 comments but only one was visible.

Being on an Einsteinian mathematical roll we went to the local dross practice which was sporting a massive 0 out of 2 comments recommending the practice so we thought we would be in for a laugh and see maybe one comment but there were in fact 3 one in favour two against.

There was lots of other similar information available like the fact that we opened at weekends which was news to us as was the fact that we offered extended hours at times which we did not. We found this by clicking our surgery name.

Extending our search we found degrees that we have never been awarded but it is good to know that we have doctorates in subjects we have never studied while lacking even a basic medical degree.

All in all an interesting website if you have nothing else to do other than work off a hang over and fancy a laugh. Reminds us of reading the Sunday Sport to get real news.

Go on try it for your own and local surgeries. If it is as accurate as it is for Northernshire surgeries and places where we trained then you will be “recommending” it to your friends. More likely you will ignore it as most people do when choosing a doctor and go on personal recommendation.

Praise be to the Party for spending millions on crap websites to provide factually incorrect information. Once again the NHS is leading the world backwards in provision of IT services for patients.

And spending millions in doing so which could be better spent on treating real patients rather than providing useless but expensive websites.

Wednesday, 17 August 2011

The taxman sayeth sorry?

How GPs get paid is a mystery to most of our patients as they can see highly trained professionals for free in contrast to their lawyers, plumbers, builders and dentists for whom a small honorarium is usually required from our patients in order for them to avail themselves of these professionals’ services. In the same way that anything provided for free should not be paid for which is the view of government the way in which GPs are taxed is a mystery to most including GPs.

Most GPs are self-employed and to put it simply we pay tax twice a year on the 31 January and 31 July. This is in contrast to most employed people who have tax taken from them on their monthly earnings.

The Inland Revenue are not normally viewed as the kindest of people but those of us who live in a civilized society and like roads upon which to drive our Ferraris, as all UK GPs do, realize that tax is a necessary evil in order to provide public services.

So each month that we work we GPs here at ND Central put aside enough money to pay the taxman (or woman) must show we understand “diversity” for we know our place in January and July each year.

Now because the country needs money it is important that Her Majesty’s Revenue and Customs (HMRC) run a smooth well oiled ship but this year several of the team at ND Central did not receive the paying in slips that HMRC send out twice a year before the 31 July deadline.

If you as a taxpayer miss the Party’s deadlines then a fine and interest are slapped on you and you have to still pay the tax. So the non receipt of the paying in slips caused a bit of bother but fortunately our accountants who, you will be pleased to know operate on the same charitable status that our patients can see us, were ahead of the game and advised us how much to pay to keep the HMRC wolf away from our doors.

So imagine our surprise to receive on the 17 August our paying in slip dated 3 July 2011. Now can you imagine the self righteousness of any individual’s indignation if they were to complain to the Revenue about this late arrival and their non payment as a result of this error for the benevolent HMRC suspends the innocent until proven guilty principle of common law and replaces it with you are guilty until you can prove you are whiter than white and we mean Snow White with no hint of even one of the seven dwarfs within a hundred miles of her in terms of pure innocence.

After a hefty dose of sodium nitroprusside IV to control the understandable rise in blood pressure we read the accompanying paperwork and found the form at the start of this piece but despite trying the official website we could not find it for you.

Still it is a first we think. Who knows if HMRC can start saying sorry maybe politicians who have buggered up the NHS will do the same next . . .?

Praise be to the Party for allowing us the privilege of free healthcare and of 70%+ taxation (if you include National Insurance in its various guises) in order for us to pay for what we deliver. Still for once we as GPs are not in the wrong . . .

Sunday, 14 August 2011

Riots – a thought.

One of the great things about the NHS is that whatever you do as a patient it is never your fault. Take for example the following:

I am fat (nothing to do with you being greedy)

I smoke (nothing to do with choice and will power)

I am a drug addict (nothing to do with you choosing to do so)

I am in debt (nothing to do with you over reaching yourself)

I beat my wife and children (nothing to do with you being a self centred bully)

and so on.

All of the above are examples of the no blame culture that exists in the UK at present especially in healthcare. All of the above are examples of the crap that UK GPs see on a daily basis where it is never the patients’ fault but it is always the doctor’s responsibility to put right.

And you can bet your bottom dollar that someone who has rioted, been arrested and charged will want a doctor’s letter to tell the courts that their limp meant they had to carry a plasma TV to help them walk more evenly while wearing a hood to protect their photosensitive skin from the sun (at night).

We wonder which GP will be the lucky one to be the first to receive such a request for after all it is never their fault it will all be because they have an “illness” or a "medical problem"? And they do know their rights . . .

Praise be to the Party for allowing choice of action via rights. When responsibility does not enter into the equation rights become meaningless - just ask the victims of the riots for they too had rights that were violated by the mob.

Both groups be be seeing doctors in the next few days and we are lucky as doctors in the UK that we will not be prosecuted for seeing one of these groups although we still have to treat them.

Saturday, 6 August 2011

GP led commissioning?

The great work of fantasy fiction the novel called Liberating the NHS was supposed to give GP’s the chance to commission services for their patients. Remember such words as these:

“The headquarters of the NHS will not be the in the Department of Health or in the new NHS Commissioning Board but instead, power will be given to the front-line clinicians and patients.

The headquarters will be in the consulting room and the clinic.”

A piece in this weekend’s press shows how much of a fantasy this was. Have a look at the diagram and see where GPs fit in. Look at the mountain of beaurocracy that has been created something that we felt was self evident in the great liberation war. It looks like the headquaters has not moved to the consulting room and the clinic but has dug itself deeper into existing layers of beaurocracy and entrenched themselves more firmly than ever merely changing their names.

Although some of these new and increased layers of bureaucracy are set to disappear (cluster PCTs/SHAs, PCTs/SHAs) you can bet that the manpower will not and will continue to function as command and control organs rather than liberators.

It makes the Soviet style control of healthcare even more powerful than under Za Nu Labour and as anyone at the coalface knows the names may have changed but the same idiots are still in control.

So much for Marshal DC’s claim that

'We are not reorganising the bureaucracy of the NHS, we are abolishing the bureaucracy of the NHS.'


As the song of all governments goes Things can only get better . . .

Praise be to the Party for our liberation. The chains get heavier with each day that passes . . .

Thursday, 4 August 2011

Emergency 911.

One of the great ideas to improve healthcare of recent times is that politicians think that if you have a “problem” then in order to solve it you must dumb down and create a call centre. One only needs to think of the success of NHS (re)Direct which continues to send GPs unadulterated crap as emergency must see GP immediately who are usually sent away with no treatment whatsoever and who are also told that NHS (re)Direct always tell patients this.

This is usually after the patient apologizes for wasting our time after being told it will get better on its own. There are possibly moves a foot to abolish this expensive redirection non healthcare service and replace it with a new dumber and call centre based service called 111. We still can’t think why 111 was chosen despite watching American medical dramas to keep us in touch with First World medicine.

One of the coalition’s NHS War of Liberation ideas was to replace efficiency savings with efficiency gains and we are sure in the Kremlin Marshals NC/DC will be having a vodka, sorry comrades a Pimms or two it is after all the British summer, over some news we spotted in this medical magazine.

Their new “service” has beaten all previous production targets of turfing a third of all calls to NHS Direct to see either a GP or to A&E and managed to redirect 42 per cent of calls to GPs (it does not say how “urgently” these turfs would be) and beat this comrades 5% will land up in A&E.

Praise be to the Party for great healthcare ideas that could be reproduced more cheaply by tossing a coin. Something to put in ones home first aid kit on top of the old NHS (re)Direct number to remind you of its replacement's improved efficiency and save you having to make a call.

Tuesday, 2 August 2011

Benzo Wars.

Our fellow blogger (respect JD) did a piece on benzodiazepines following hearing a piece on this programme. What JD said is true but perhaps the “experts” in the ivory towers of academia and alongside the Thames ought to spend some time in the field.

At the infamous Café Michelle home of the Northernshire resistance a couple of us tuned our crystal sets to listen to the original piece (BBC Radio 4 Face the “Facts” 27/07/11) and would take issue with some of the points raised.

The alleged GP fuelled epidemic of benzo addiction is due to the “power of the pharmaceutical industry.” Interesting point GP bashing BBC reporter dude for is prescribing of benzos in a practice where no GP sees pharmaceutical representatives an illustration of your point? Or perhaps if you are a scientist might there be other hypotheses to consider, analyse and prove or disprove? Something we are sure you did at journalism school in your lecture entitled fact, science and sensationalism.

According to our local psychiatric colleagues who deal with addiction are the BBC and Government GP bashers aware that the biggest problem they are facing is a huge rise in illegal benzo imports from the Indian subcontinent and Far East?

Heroin addicts need several grams of alleged heroin a day to fuel an addiction but our local scrot population of illegal users seem to get by on 40-80mg a day of benzos usually Diazepam. For BBC journalists a gram is the same as 1000mg so if you do the share bys you might just see the points we are making.

Trafficing heroin carrys serious bird if caught and involves quantities of weight almost a 100 times greater than benzos. Given that the NHS run by politicians believes in a fixed price "free" market for healthcare can anyone see where the true (illegal) free market will head?

Current street prices for legit benzos are about £1-10 a tablet for drug addicts depending on supply and prescribed benzos get a mark up. This is about the same as a less than legit “gram” of heroin/talc/brickdust etc. We believe that 3mg Warfarin tablets have the same size and shape as certain benzos something we are more than happy to prescribe for those with a legit use.

If you are a drug dealer which substance might be most profitable and less risky?

The BBC programme said that the cost of a prescription for benzos for a month was less than 2 pounds. Lets say a pound fifty for one 5 mg tablet of diazepam a night for a month 28 in total.

Get a free prescription in the United Kingdom, unless you are one of the unlucky 10% who live in England and have to pay, and if you don’t actually need your benzos but tell your caring GP, who has no way of checking that you do, then your monthly prescription becomes a State funded up to £280 a month additional tax free income.

Is it any wonder that some of our benzo users regularly lose prescriptions to the point where if they see other doctors at other practices and the out of hours services they can obtain 500+ tablets in a 3 week period. That is a massive 5 grand for 3 weeks blagging and all state and taxpayer sponsored and legal.

Now some would argue why do GPs give in? Well going back a few decades when informed medical opinion tried reducing benzos in the same way as they did alcohol and heroin there were a few little problems like fitting. A few patients admitting fitting in the absence of the guidance now available does tend to make GPs cautious.

The addicts in the BBC programme cite a lack of support for the reason they could not come of. In our humble experience they need a lot of support sometimes for 2 years before they become clean. They also need a very cynical degree of supervision for some will lose their grandmother 24 times in a year, have problems with their children all 14 of them at least twice a week and as for the canine morbidity and mortality well we have exhausted our tissue boxes dealing with these excuses not to reduce but to increase their benzo use under such times of domestic "stress".

The BBC programme said that in 1988 a warning was issued. The oldest copy of a current BNF we have is from 1984 and it issues warnings of addiction and those of us young enough to have read this edition of the BNF were warned big time about the risks of addiction with benzos by our seniors then. A copy of the 1976-78 edition page 79 makes the observation that "Hypnotics are overprescribed and patients are kept on them for years". The following page makes this observation "There is no justification for using them for long periods".

Temazepam and Paracetamol were routinely prescribed by house officers as “prn” (as required drugs) to prevent being awakened because a patient could not sleep in hospital or had a headache and sometimes would be prescribed as a take home drug. We regularly used to stop these drugs being prescribed as take home medication but we know many other doctors did not.

Another problem locally is that local substance misuse services seem to regard benzos as the cure for opiate addiction and try to substitute them for heroin. We would suggest this is like trying to cure an alcoholic of drinking by saying stop the scotch and will we will prescribe you beer instead.

As a result a large number of benzo prescriptions are initiated by consultants that then get carried on by GPs who wish not to deviate from consultant led “shared care arrangements” = Party approved we will not pay for specialists whose price is fixed to look after difficult patients we will pay for “quality” and price reduction by sub contracting specialist services to GPs the only negotiable part of the new NHS market.

As a result GPs are seeing many multiply addicted patients using heroin, cannabis, methadone, alcohol, benzos, crack all of whom feel they are not supported but whenever they feel, sorry re grunt word, sh*t, see their GP for a panacea to “get them through”. After all 28 benzos = 28 wraps or £280 pounds for a Party approved ten minute consultation = £1680 an hour for something costing less than couple of quid.

There is a simple solution to this problem. Put benzos on the same prescribing status as anti malarial drugs and ensure that the only way patients can get them is on a private prescription. The NHS “market” would then decide.

If GPs were over prescribing them this should in theory lead to a reduction in demand as GP over supply would lead to a reduction in consumer demand as market costs apply. If it is in effect a patient led demand then benzo prescriptions would soar especially in young people who are buying them because they are so cheap. Perhaps the government could help with a benzo added tax (BAT) on such private services as a deficiet reduction scheme?

Obviously there would have to be a period whereby addicts could come off if they wished but we wonder where NHS market forces would lead?

Simples. No more BBC programmes regarding crap GPs and health ministers telling us that we need retraining.

Praise be to the Party for waking up at least a quarter of a century too late to benzos.

We here at ND Central need more training for this week we had to deal with the dog ate my benzos, my children put my benzos in the bin/washing machine/shredder/customs ceased my benzos, I am out of prison and on a self run heroin detox can I have some benzos, my benzos were on a window sill and the window was open because it was hot and they have melted . . . can I have another prescription?

How much more training do we need?

The answer to all of the above replacement requests will be no until we actually get a request to replace their lost paracetamol. Several decade’s collective experience totalling over a century in practice we have never had one of these requests ever. Wonder why? Perhaps the BBC should investigate the failure of GPs to replace lost paracetamol prescriptions “Millions of Britains are suffering unnecessary pain due to the failure of GPs to . . . ?