Saturday, 24 September 2011

Dear GMC,

I am an average British GP.

I am Caucasian/Afro-Caribbean/Indian/Chinese/Australasian /mixed race.

I am male/female.

I am a Christian/Muslim/Jewish/Sikh/Buddhist as well as agnostic/atheist and part time Satanist.

I am heterosexual/bisexual/gay/celibate.

I am a member of the Conservative/Labour/Liberal Democrat Parties together with being a Communist and a Fascist and many other political parties too.

I read The Times/The Guardian/The Daily Telegraph/The Daily Mail/The Daily Express/The Mirror/The Sun/Daily Star as well as Pravda and the Morning Star and many other journals including Railway Modeller and those in our native languages including occasionally English.

I shop at Sainsburys/Tesco/Waitrose/Aldi/Morrisons/Marks and Spencers/Lidi and a local corner shop amongst a host of others.

I watch BBC1/BBC2/ITV/Channel 4/Channel 5 and subscribe to Sky but never watch any late night pay to view channels honest.

I drink alcohol, smoke tobacco and eat far too much and sometimes far too little and may even be teetotal or vegetarian.

I drive a car, ride a bike or a motorbike, fly planes, sail and sometimes walk and race lawnmowers.

I enjoy sailing/shooting/horseriding/unarmedombat but sometimes flower arranging/needlework/reading/my family/exercise/reading and loads of other legal sports, hobbies and activities including work with religious and youth organizations.

I go to a church/mosque/temple/synagogue and the odd covern.

I am a member of the Territorial Army/British Red Cross/Medicins san Frontiers/Cafod/Unicef and a host of other organizations and charities to whom I give my time for free or for payment.

I have killed, maimed, seriously injured and broken the bones of my fellow human beings sometimes in war, sometimes in peace and many times on the sport’s field.

I have suffered illness sometimes self inflicted, sometimes acquired and worse still have prescribed for others who are not registered patients in time of emergency.

I read and write blogs.

All of the above statements apply to the some of the many doctors’ life experiences that we here at ND Central have learned of while working with them over our collective lifetime in medicine.

So why GMC are we writing to you?

It appears that you at the GMC are undertaking a sham consultation as to whether you should regulate our “personal” lives as doctors. We all know that consultations of this kind are merely precursors to a done deal.

Perhaps you should put on your consultation what an ideal doctor should be? Dr Finlay? Dr Kildare? Dr Frankenstein? Dr Watson? Dr Shipman? Dr Mengele? Dr Forest? Dr Donaldson?

And who will decide who is racially and socially pure enough to have a private life free from GMC regulation?

We do not have a problem with professional regulation but when we are not at work that time is ours, not yours, it is called freedom. If what we do with it is legal and does not abuse anyone what is it to you?

This increasing regulatory approach reminds us of some other regulators from history some of whom you probably admire with first names like Adolf, Joseph and Mao. Will you be advising us next on an appropriate dress style for use in our free time? Perhaps a black uniform with matching red armbands and long black boots or will it be a tweed jacket and brown brogues?

By way of conclusion and we know you are above the law remember the Human Rights Act 1998 and the European Convention on Human Rights article 8 which we reproduce for you in the hope that someone can read, and more importantly, understand it:


1. Everyone has the right to respect for his private and family life, his home and his correspondence.

2. There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.

And if we may be allowed to use a quote from a religious book:

"You hypocrite, cast out first the beam out of your own eye, and then shall you see to cast out the mote out of your brother's eye".

The Bible, The New Testament, Matthew 7:5.

And on a lighter note there is the old religious joke whereby Jesus says “Let he who is without sin cast the first stone” which is followed by the punch line “Put that stone down mother!”

Is the modern version now to be “Put that stone down Niall!”?

Is the standard for doctors’ personal lives to be those high ones that are currently abroad in today’s journalistic profession?

If you want to comment you may do so here.

Praise be to the Party for this highly hidden gem of consultation as they all are. You know they make sense. No doubt all those who dare to express an opinion will be monitored for any deviation from the future Party line.

Tuesday, 20 September 2011

Computer “games” and the current "state" that is NHS IT.

Not all of us at ND Central are of an artistic streak although most of us are when at the infamous Café Michelle watering hole. One of the team who is really sad is a scientist by training. A week ago for reasons best known only to the deviant scientific mind they decided to try and play an old computer strategy game.

You would think that as the software was already on their computer that it would be a case of pop a DVD into a disc drive and the game should work as it did a few years ago a bit like if you as a doctor had a holiday and came back and expected your NHS computer to work as it did before. It rarely does but it is always your fault.

Of course this was not the case. The game demanded that the user downloads many megabytes of software from a remote server which is all well and good if you live in the first world of internet communications but here in Northernshire this takes many hours. Please remember that what takes many hours on a private individual’s internet connection this amount of data would take days via NHS broadband.

After several attempts at downloading the compulsory patches the game did not work but all the right patches were there. After a lot of headbanging our Practice techie got the game to work by disconnecting from the internet and going back to basics.

The basics in this instance was to install the software on a computer but forego the added enhancement of the game being only playable via connection to a remote server by disconnecting from the internet. Problem solved game worked, hours of unnecessary and unworkable downloads avoided and the game worked.

This is similar to the way in which doctors used to use computers. Each Practice had its own set of data called patient records which it could access locally usually from a hard drive within the practice itself. Now the good comrades from the Za Nu Labour Party thought this was not a good idea for while politicians are allowed security you as patients are not your medical records should be in the hands of the all powerful Party.

Now there may also be some shrewd business movers here as there has been a move away from information created locally being used and held locally to having GP practice records hosted remotely on servers owned by the private sector, and this is worrying, paid for by the Party via its PCT lackeys. Business has used similar successful methods as these to great success for example transferring call centres to the Indian subcontinent.

As a great grandparent a patient said to one of the team a few years ago "My family and I have been with your practice for more than 50 years and have always trusted you and the doctors that work here over the years with our medical records. We’re not trusting any Government with ours so we opt out and want paper records with you only".

This is not too dissimilar to our scientist colleague’s dilemma. They had purchased a game that they were once able to play (access) and were now denied access to what they had bought. This is like doctors creating medical records the prime purpose of which is to allow them and other doctors the ability to see what has happened and is being planned for the patients they care for.

When we were at grunt school we were told that the medical record should be such that if another doctor who has never seen the patient picks them up and reads them they should then be able to follow on even if the original doctor is no longer there. It is like a lot of medical information it is primarily there for people treating patients and they are the ones who can use it and should have unfettered access to it.

In essence the purpose of the medical record is to be a record for medics and as such access should be primarily for medics in the same way that if you buy a game you should be able to play it at home on your computer without any 3rd party involvement.

We are aware that there is piracy with games and can to a point understand the games industry trying to preserve their copyrighted products but when they prevent you using what you have purchased they are denying you what you allegedly own.

The Party is no different for it to is potentially the biggest pirate of medical and personal information. It is increasingly trying to restrict access for doctors to medical information that doctors need and have indeed created. The Party wants remotely hosted medical information and if you do not know how vulnerable this system currently is look at this recent story and you can bet they said the same about the Titanic and our practice Titanic has already sunk many more times than once losing days of work as a result. We bet also that any GP practice regardless of which system it uses has had its own DOS (Denial of Service) story.

The Party want all healthcare workers to have Smartcards which is nothing to do with protecting patient data, for if this was a major concern then the national patient summary care record would be a non starter, it is nothing more than a command and control device which anyone dumb enough to use a “Smart” card will have experienced when all of a sudden you cannot log on.

Doctors no longer have control over the information that they created and need to use in order to do their jobs and this is becoming an increasing problem with the Party approved extended hours. We have commented on this before but if a computer goes down outside of normal NHS IT working hours 10.00-15.00hrs you are left in the dark that is assuming you can get through to a local PCT IT “help” desk who say its not our problem please ring someone else.

Bit like the computer game. What once worked now does not despite the improvements in technology allegedly improving things. The same has happened not just to computer medical records but to laboratory results access to x-rays all things that used to be easily accessed which are incredibly useful to doctors but increasingly denied by centralization of IT control usually by idiots whose terminally inability enables them to be intellectually unable to use the data they now control.

This minor handicap does not prevent them exercising their terminal inability to prevent those who can use the information they control doing so and in doing so seriously compromise patient care. This NHS underclass of IT technicians seek to deny to doctors information by increasing layers of bureaucratic retardation but then they could never spell the I or the T bit of IT for they were very, very big words. Hint the I in IT stands for in-form-a-tion and it helps doc-tors do their job if they can see it.

So if you get frustrated by your inability to play a computer game because of the need for remote access even if your computer is up to the game imagine how your doctor feels when they cannot access what used to be their records, hosted on their computers now only available from remote locations. It is not just doctors it is nurses, receptionists and secretaries who cannot play what used to be a simple game called the written record or locally hosted computer record.

All because the Party wants control of UK medical records. Why should that be so important and costly? Just let us do our jobs, easily. Give us our records back we do know how to look after them honest. More importantly we know how to use them too.

Praise be to the Party whose idea of NHS IT will means that in contrast to the concept of the world wide web surviving a nuclear strike the NHS IT revolution cannot even survive a power cut.

Those of us old enough to remember power cuts can remember eating and reading via candlelight paper documents. Could we do the same with medical records in general practice now? More importantly could we practice?

NHS IT making it easier to take down a health service than ever before and denying those who need the information to do their jobs via institutionalized incompetence. And they keep getting better at doing it with each upgrade.

Tuesday, 13 September 2011

Wasteful class commissioning.

One of the terms we have not heard banded about for a while is world class commissioning (WCC). What is that you may ask and how does it affect my healthcare? A good question and the answer is it was a buzzword used by those who might have been close to the top of your school’s remedial classes in order to make them sound clever.

You would have thought that such intellectuals who were destined to run PCTs would have used their WCC skills to ensure that public money was well spent and maximize tax payers’ investment. Unfortunately they were not at the top of your average Northernshire comprehensive school’s remedial classes for those brighter than them will either be guests of her Majesty or rubbing their hands with greed for they could spell two 6 letter words a week, instead of the one 5 letter word a week needed to be a world class commissioner of healthcare, and they went into the private sector.

A small piece shows how well the WCC remedials have done in out foxing the private sector. If you cannot sleep well at night we suggest you download the full accounts from here but we do warn you if you are on a NHS N3 connection the massive size of the download (10Mb) could cripple your practice computer system for days.

Just look at the costs on these world class commissioned projects and in particular the weaselly words that describe world class crap. They are under the heading of 31 Losses and Special Payments and other Accounting notes p133 using Adobe reader (128 using account page numbers) and subdivided into the following headings:

Claims abandoned.

The National Decontamination Programme (was that ethnic cleansing or some other form of NHS cleansing for example ward cleaning does anyone know what it actually is?) has written off £ 1,125,841 on two schemes as neither was able to complete its procurement due to insolvency on the part of the preferred bidder.

Excellent even those just retarded enough to be involved in WCC don’t have enough fingers to work out the difference between positive and negative. No doubt their betters in their remedial class will know where the £ 1.25 million has gone or the money needed to run a 10000+ patient GP practice for a year has just gone puff the magic dragon into thin air.

Store losses.

Emergency Preparedness Stockpiles which we are sure that all GPs and hospital doctors will have ready access to in the event of “accidental or malicious release of chemical, biological, radiological or nuclear agents.” This is an understandable mere £ 30,948,109. Anyone know where the current stock is kept just in case we need it?

Pandemic Flu Countermeasures Stockpile The department wrote-off £59 million in relation to counter measures held for the pan(ic)demic flu preparedness (another one for the bingo card) that have now passed their shelf life. An interesting phrase which could be translated as completely useless products.

Fruitless losses.

£ 8 million pay off to a private firm to terminate an ISTC contract. Seems a lot when the cost of ammunition to terminate international terrorist leaders is pence. Still someone will be laughing at the taxpayers’ expense and be assured that as this was at the request of NHS London which was responsible for the management of the contract there will have been plenty of WCC to account for this loss but not to make it good.

Constructive losses

E-learning for healthcare. Bet you knew nothing about this one but following a review of capital projects a decision was made not to allocate further capital to E-learning projects and 20 were cancelled at a loss of £ 6.1 million which cannot be recovered. We can think of plenty of other E-something projects that could do with going the same way.

Look at the recovery of loss recorded in 2009-10. A loss of £ 79.2 million in 2009-10 was reduced by £ 13.7 million because someone found the paperwork. Given that WCC is nothing more than paperwork how could someone not have the relevant paperwork for storage of anti flu drugs to the tune of £ 65.5 million?

There are plenty of other little bits to delight you in this 154 page document try p22(18) and see how much per head your region costs the tax payer, how much cars cost for certain senior doctors and managers p51(47), how much certain senior doctors and nurses got as salaries p53(49) and in pensions and lump sums p54(50) together with DoH expenditure to organizations which certain individuals have connections with p135(131).

Look at the end of the article to see how little politicians understand the health service that they, and they predecessors, have created and seek to improve using the Tripartite market model. The person quoted here is none other than health minister Simon Burns the italics are our additions:

“All these payments relate to contracts signed under Labour (we will do it so much better), who gave the private sector preferential treatment in the NHS (so we won’t of course do that just any willing provider). The contracts were overpriced and the delivery often inadequate.

Our Health and Social Care Bill introduces safeguards that will stop (encourage) this, whilst ensuring that patients are given the best (most expensive) choice of a wide (more limited) range of (privately provided) services (completely similar to the ISTC contracts but with different names).”

Praise be to the Party for ensuring that in the United Kingdom no-one is too thick to fail as there is always NHS management. You cannot fail there either for gross incompetence is always rewarded with success albeit it at the penalty of a sideward promotion and a healthy pension.

And there is more of the same coming our way very soon.

Thursday, 8 September 2011

Medicine north of the wall.

One of the team recounted a conversation they had had with a relative who lives way up North in some of the now darker reaches of Northernshire. As any GP knows whenever you talk to a family member or friend they immediately think that you want to hear about their latest brush with illness or the NHS. This conversation was no different and it went something like this:

"I went to the doctor who was really good. They were English. They started by talking to me and asking questions about my illness. When they had finished they examined me and then told me what they thought was wrong before giving me some treatment. Not like the other (local) GPs."

An interesting observation which got us thinking how else does one do general practice? Clearly our relative had noticed a difference in their part of Northernshire large enough to comment on it.

Perhaps this is why 2 previous Prime Ministers hate GPs so much for they have never done it the English way before?

Praise be to the Party for giving us a National Health Service of 4 nation’s health services. Is there any St Patrick out there that can explain the current 4 leaved sham(rock) that is the NHS to us simple believers? Will it be any simpler (better) after the “reforms"?

Sunday, 4 September 2011

Mystic Darzi foretells the future of the NHS.

One of the few advantages of being a GP is that when you have found the right patch you are a bit like a good copper and you get to know your manor or beat.

You get to know:

the patients (some of whom are villains most are just punters taking a free ride a few are actually ill),

the local hospitals (the local CID and CSI when you are stuck),

your staff (hopefully a highly trained professional team who will back you in a firefight),

the Harvard and Yale MBA commissars at your local PCT (the local Russian Mafia when it comes to shafting patients and their healthcare)

and there evolves over time a status quo with some of the players competing with others to provide first world medicine while others wish to bash such hopes on the rocks of incompetence which usually succeed at the expense of patients. You also start to see the impact of international crime on your patch illegal drugs in the case of the Police but NHS privitisation in the case of the GP.

Of course not all are so lucky to live in enlightened Northernshire and if, under current training arrangements, you start as a newly qualified GP you will have left school at 18 and be just under thirty before you can practise as a GP principal. If you are lucky and find your niche you may then be there for up to 35 years – longer if current pension reforms continue the way they are – although most GPs have had enough (of NHS bureaucracy) and tend to retire, if they can, at age 60.

Politicians, unless you are a certain Colonel G in North Africa, are never there that long in one job or place but amazingly if you listen to them they listen far more than your average GP. They even have listening "exercises" and no doubt a few personal "trainers" to help them benefit from "exercise" and ensure that they are “fit” to govern.

Which is why some (now) very rich (allegedly socialist) former Za Nu Labour politicians thought who better to consult on reforming NHS General Practice than Mystic (Lord) Darzi a man whose days in general practice could be counted on the remaining fingers of Abu Hamza’s hands

This consultation process was no different to the politicians of old consulting oracles or basing decisions on the entrails of sacrificed animals prior to going out to wage war (Iraq) or spend huge amounts of money on follies (NHS IT, commissioning).

Their consultation of a high priest all wise in General Practice who is an Armenian born Irish trained surgeon would be like the Americans consulting the oracle of Pol Pot about the Apollo space programme and who best should they employ to make the rocket take off as opposed to hit ground zero something all three political parties seem to regard as the end result of the space race that is current NHS “reform”.

Well it appears that Mystic Darzi is turning out to be on a par with mystic Meg as an accurate foreteller of healthcare to come. He may just by chance, rather than ability in his chosen field of general practice, been consulted but his oracle like predictions and advice to the Party are showing us what may happen with the current round of entrail driven NHS reforms.

All three Parties are no different for all three are busily typing away like monkeys at random hoping to produce Shakespeare not realizing that all that has past has failed but each is still hoping that maybe one of them will get lucky and healthcare right if they change a few words here and there.

You can have quality healthcare, you can have universal healthcare and you can have cheap healthcare. You can however only ever have 2 out of the 3.

We hear that the Darzi centres and their drive for equitable access are about to be ditched in some parts despite all the “world-class commissioning” of their contracts which in some cases have failed spectacularly. Costs are far greater than normal general practices and they deliver less and cost more.

So what will happen if Darzi centres slowly fold? You would have thought that under the great war of liberation of the current NHS there would be hundreds of any willing providers queuing up to say “Yes we can” do it better and cheaper than they anyone else in the "free" NHS market where price is not negotiable only “quality” which is the new “choice” word which is strange as all Darzi centres were put out to a competitive tender process run by the Soviet run PCTs.

So there will be no worries regarding where patients will go for the remaining PCTs, under the supervision of their PCT clusters, the result of reduced NHS bureaucracy, will be busy commissioning any willing providers to fill the gap. We hear rumours from colleagues down South that they have already found many cost efficient (un)willing providers to mop up the Darzi centre patients as the local Soviets start to shut them down.

And who do you think these any (un)willing providers cost efficient providers will be? None other than the existing hugely inefficient local GPs that Darzi centres were meant to replace. Of course under the NHS Choice agenda those who did choose to run Darzi centres (for profit) could choose to do so while those who have to pick up the pieces of their expensive failure are given true NHS choice which is none.

It is not difficult to see the same thing happening using Mystic Darzi’s model in a few years time. GP commissioning groups will reinvent the Darzhole centre or its then political equivalent and when the Party changes have to find another (un)willing provider to replace it when people realize how much things cost and how little they deliver.

Who will have seen this process come and go for decades and realise that history often repeats itself? Those who at best last a decade in politics or those that provide consistent healthcare for families for decades?

There has been a listening exercise recently but no-one has listened for politicians never listen. GPs listen to the failings of the politically driven NHS bureaucracy they are called patients but we cannot spend all our time fighting it. If we did we would cease to see patients so we have to ask them to do so. Politicians spend so much time listening to patients who they sprinkle like spices into their speeches to show that they care (for you) but spend far more time ignoring them when it comes to their political actions when they are caring for those that they truly love.

Praise be to the Party who forever quote from history but rarely learn from it. Any guesses who will be mopping up the next load of politically driven expensive private failures? Whatever then remains of the non private NHS.

GPs perhaps? It has started already and Mystic Darzi has shown us the way.