Saturday, 29 October 2011

Dark nights and darker thoughts.

For those of us who live North of the Thames the inevitable move towards autumn and winter leads to a rapid shortening of the daylight hours. Now darkness is good for members of the Resistance based at the infamous Café Michelle for it allows more covert activity and as the temperatures drop the thought of a night with good company and a few fermented fruit beverages is very appealing.

At one recent such meeting we were discussing the state of the current health and social care bill and what had been said at various meetings and events that members of the team go to. We are a very broad church here up North in terms of our interests and associations and as a result encounter a wide range of opinions and thoughts on matters political and practical. After a few fruit juices the thought processes sometimes deviate from true logic and what follows is one such deviation.

For those of you not lucky enough to live in the Shiteton PCT’s area of enlightenment you will not see the results of early GP led commissioning. Here GP commissioners have many fruitful meetings and are reshaping local healthcare by the minute as all our Harvard and Yale educated MBA PCT commissioners always start the meetings with the words:

How can we help you master/mistress? We are here to serve your every whim for the betterment of your patients all praise to Andrew the great prophet and liberator of the NHS.”

We are so lucky but not many leagues away we are aware of the complete opposite where local Soviets are dictating the rules of who can commission what and on what terms and as a result nothing is happening. Equally we know of other Soviets and GP commissioning groups that are in between these extremes.

Historically Government does not like resistance and certainly the old Party did not like GPs for they did what the Party asked but the Party did not like having to pay for that. It is uncertain at present what the current Party’s true thoughts are regarding GPs but it is clearly engaged in a campaign of lies, sorry spin, about how much “support” there is for their reforms in all sectors of the medical profession.

Commissioning has failed expensively over the last 20 years but is being reborn and re-branded but this time with GPs nominally in charge of much larger scale commissioning by GPs than ever before. Previous attempts at commissioning failed in times of plenty while this time we are in a time of recession.

We are told that this will be no top down reorganization but it is clear that local initiative is set to be stifled by the new financial politburo call Monitor and clinically via the new uber super quango the NHS Commissioning Board and its regional under boards.

So if GPs get to play commissioning how many of their ideas will be allowed by the bureaucrats who failed to make commissioning work in its previous guises? The Party can fight any Clinical Commissioning Group (CCG) on two separate fronts to prevent successful GP commissioning. One front is via Monitor using financial constraints and if that does not work they can fail an idea on clinical, quality or outcome grounds with support from other limp organs like NICE via the NHS Commissioning Board.

Add in a recession and reduced funds by virtue of inflation combined with a hugely flawed process and GPs are now fighting on three fronts with no ammunition or weapons centrally provided and still having to do their day job as well.

It is possible that despite “best” intent we GPs may all be looking into the large toothed jaws of possible global failure except that this time the Secretary of State may be able to wipe their hands of their enforced failure for they can blame the GPs instead. Failing that a change of Party might do the same job and blame the GPs as well. Is the strangling of local initiative by centralized Party control part of the Liberation process? And from whom is the NHS to be liberated from?

So in the dark corners of a Northernshire cellar in front of a blazing fire we got to “the what if” stage and dark thoughts loomed large. If GP commissioning fails perhaps the benevolent Party would have to step in and take over via the (its) Commissioning Board and Monitor and maybe a few other central organs of control? The Press would have a field day and say GPs “couldn’t” and therefore “shouldn’t” run the health service.

Completely understandable if you have to fight a boxing match with both hands tied behind your back, wearing a blindfold to outfox your opponent who can see where things are going, with lead boots from local NHS management to facilitate your forward progression and the complete absence of any seconds.

The next step might be to rein in GPs autonomy and perhaps enforce a salaried service in order to control any clinical dissidents and at the same time reduce costs and recoup all the excesses of the failed CCGs. A new leader might be required to sort things out and take charge perhaps a more powerful than now Secretary of State?

The new leader might then be free to bring in the private providers to run things better and then employ them via corporate entities? We won’t mention the words dentist in our discussions on these dark matters for it has happened there already.

Could it be that the Tripartite healthcare policy has one aim and that is to reduce GP control over and involvement in healthcare? For if GPs cannot successfully commission can you successfully refer or treat patients as independent “self employed contractors”? The system would clearly then need “reform”. The thought processes got darker and darker as the evening wore on until someone said some time honoured magic words to rid us of our demons.

Time please ladies and gentlemen of the Resistance haven’t you got nice surgeries to go to tomorrow morning?” Yes we have but dark thoughts will be with us as we see our first commuting toddlers and pensioners at seven thirty hours tomorrow as true beneficiaries of previous “market” reforms.

Then the alarm went off and it was time to get up and go once again. At least this weekend we get an extra hour and the next early morning might not be as dark, for a while longer.

Praise be the Party for always needing to reform things even if they work. Let us hope our dark thoughts were merely a bad dream.

Tuesday, 25 October 2011


Why is it that patients who buy home monitoring blood pressure measuring machines, who record it 5 or more times a day on a spreadsheet that they give to you, who also attend nurse clinics where their blood pressure is taken sometimes the day before you see them always ask if you would “just” take their blood pressure?

Surely this is pandering to the pathetic worried well? Just in case one of the following:

their one Campbell de Morgan spot
their verruca
their paracetamol relieved headache of seconds duration
their self inflicted Gaviscon eased indigestion
their coital avoiding headache
their red face
their feeling dizzy
their not feeling right or myself
their I went to the gym and the instructor felt that a blood pressure of 110/80 at age 97 was a bit high/low

is a sign of high blood pressure?

Patients always know when their blood pressure is high for they can feel it is so when it never is. Could this be a huge revenue earner for the health service?

If you buy a television, even a computer capable of watching TV be it broadcast or via the internet, a DVD/video recorder or mobile phone that can receive TV in the UK you are asked to provide your name rank and serial number and address to the retailer which is then sent off to the TV licensing authorities who check if you have a TV licence.

Perhaps we should have a scheme whereby if you buy a blood pressure machine your details including NHS number are sent off to the new commissioning board who would automatically disqualify you from ever having your blood pressure taken again for you have opted for private healthcare? Given the state of NHS IT when you next see your GP a huge flashing screen would say to any nurse/doctor/healthcare assistant ineligible for NHS BP care and smack a £20 charge if patient asks for their BP to be “just” checked.

Sound familiar? The pandering to the pathetic well is a growth industry and should be ripe for Government picking? Instant deficit reducer. Instant pandering to the pathetic well reducer of unnecessary surgery attendances for many of these patients always opt to be seen within 48 hours or as an “emergency”.

Praise be to the Party for encouraging people to pay for their cake and eat it and then to come back for seconds they don’t need or pay for.

PS we at ND Central do not have a problem with BP monitoring and some of us have in the past regularly done 5 minutely BP readings for when you are bleeding to death from a knife wound it is then useful. When you are a bleeding heart forget it.

Wednesday, 19 October 2011

The 0845 number debacle.

One of the great successes of Za Nu Labour’s running of the National Health Service was its use of a system of government that used to be common in Eastern Europe. It was called communism whereby everything was dictated from the central offices of the all wise Party under the guidance of the supreme leaders the Laurel and Hardy of modern healthcare Mr Blair and Mr Brown all for the benefit of the people.

The former ex great leader was famously handbagged by a patient who asked him about his health reforms and to explain why she could not get an appointment under all of his improved access targets. Under Comrade Blair’s preferred model such dissent would have resulted in a quick trip up to a gulag for a period of re-education but under what remains of democracy and public scrutiny in this country his lack of knowledge of matters healthcare was on view for and enjoyed by all.

Following along from his enlightened leadership one of the reforms that the new General Medical Services (nGMS) contract ushered in was the need for a single phone call to enable instant access to your GP or more importantly the out of hours service.

Now in theory this would seem at first to be a good idea. You dial one number and can access your, or a, GP 24 hours a day. True market reform for the good comrade patients’ benefit no evil private sector backhanders here. The non paying customer, we call them patients, gets instant self centred medical gratification a bit like certain politicians and their DVDs but then these cost the taxpayer via the MPs expenses.

Prior to this at ND Central we had a single telephone number which when the working day used to finish at 18.00hrs would switch on to an answer machine which gave the contact details for the out of hours or deputizing service that we as GPs paid for to cover our patients after hours to allow us some sleep.

Now the blessed Tony, a true socialist conservative Anglican Catholic, who believed in comprehensive education for all, bar his own children, in the NHS for all, except when he was ill, and who can now do no wrong, he only has to confess not to be responsible, thought let us supply the out of hours care using the private sector for private medicine good, socialised medicine bad and costs rose astronomically for a worse service.

Back to the phone call side of things this two phone call issue was clearly a huge problem to the likes of Tony and Gordon for they were all wise and so the nGMS contract gave prizes for a single call. Being true socialists and wishing to share this great idea of a single call for all ills an 0845 HEALTH (we purposely omit the W at the start of ealth) was suggested and PCTs, government sponsored enforcers “encouraged” GPs to sign up for deals with 0845 numbers. If you don’t you won’t get paid for you will fail to provide a Sovietly acceptable one phone call to tick the “quality” box.

Remember dear readers that PCTs are staffed by those who at best were in your remedial class in any Northernshire comprehensive school a few of whom could read and count. So GPs were “encouraged” using the “free” market model so loved by Tony and Gordon to sign up to Party deals for GPs were given the same true NHS Choice offered to patients via the market which is none.

Move forward and although the Party dictated and approved idea is good a few people noticed that some pigs are more equal than others (Hewitt - excuse us we just sneezed) when it comes to profiting from telecommunications and a few dissenters in need of political re-education noticed that if they ring on a mobile, which after all is only the preserve of the politician and drug dealers, not a pensioner on a limited income, they were disadvantaged. For the 0845 number is not a local charge number it has many different costs depending where you ring from to access it.

So the Party does a massive U-turn on its equitable access policy and tells GPs you can’t have a 0845 number. You can look here for who hasn’t by PCT and compare them with the sink estate PCTs, sorry comrades, spearhead PCTs and see which PCTs have the best in remedial NHS management. This does seem to be a recurring association dear reader that we have noticed by chance during our researches over the past few years.

Now this is the history what are the practicalities to current GPs given that the true socialists Brown and Blair have peed over the NHS and retired to pastures newer, richer and more idle lifestyles that befit all true socialist Party members?

Well the first is that local Soviets are asking us (= demanding) that we GPs get them out of the brown stuff they insisting on putting us in. We now have to change our numbers or else.

This is excellent for the remedials who agreed the contracts but could not read all those big words in them for all they saw were the flashy teeth of the nice salesperson who flattered them and told them what a good deal this until they signed. When the X was one the bottom of the contract in the managers' best crayon the salesperson said "Thank you for signing and so long sucker” and disappeared in a puff of fairy dust never to be seen again.

And those signing such “deals” are the “world-class” commissioners of old trumpeted as such by the Laurel and Hardy of UK plc healthcare now joined by their new bum chums the Charlie Chaplain of healthcare (Lansley) with the help of hop(e)along Clegg.

So the get out clauses for GPs for contracts enforced on us are now as follows:

1) you can revert to your original single line with an answer machine and lose money for not providing a single point of access. Not a problem to us comrade GP we merely follow orders.

2) you can keep your current 0845 number and we will shaft you for doing so. Not a problem to us comrade GP we merely follow orders.

3) you can ask your current 0845 provider to change to another number that will be dialled when the patient dials 0845. Your current 0845 number then provides a call switching “service” which would involve no cost to the PCT morons who thought of this but scratch deeper and you find that once the call is switched from the 0845 number to your out of hours provider you the GP then pays for the patients call. So a patient's call to a surgery costs the patient but the patient's diverted call to out of hours costs the GP. Another great buy one pay for two value for NHS money idea like PFI. Not a problem to us comrade GP we merely follow orders.

4) you could consider doing the same using another provider and get stung in the same way. Not a problem to us comrade GP we merely follow orders.

5) you can pay a fortune for reprogramming your current phone system to divert calls which once again you have to pay dearly. Not a problem to us comrade GP we merely follow orders.

Best still we hear that some local Soviets are insisting that practices write to all their patients to tell them of the Practice new number change policy which would mean a net loss to correct "their" folly.

It is said that in any society there are rights and responsibilities. Increasingly in the NHS the rights of the politicians are that they have no responsibility and the same is so in NHS management. Until these groups acquire some responsibilities GPs and all involved in healthcare will continue to spend time not treating patients but mopping up political and management collateral damage inflicted on them via continuous "reform" and incompetence.

In the same way that these “world-class” commissioning managers have screwed up the Darzhole centres they have also screwed up the 0845 numbers and once again someone other than them will be paying for it.

Now if you were a betting man who would you back to win in Mr Lansley’s, new NHS market? The NHS’s commissioning managers, the patient or the private sector? Go on have a flutter it has to be a dead cert . . .

Praise be to the Party for allowing the least able in our society to bugger up the NHS time and time again. Bloody comedians only they ain’t that funny when you're the ones sorting out their fine messes once again.

Thursday, 13 October 2011

Flu clinics and zombie movies.

A few years ago the zombie movie was quite popular and it is a film genre that has been around for decades perhaps the best known of recent British movies is Shaun of the Dead (2004). In virtually all such films there is a scene where lines of the living dead zombies march forward apparently unstoppable towards the heroes or heroines.

There is also the nursery rhyme if you go down the woods today you’ll be sure of a big surprise. Well as a public service announcement we would advise you that if you go down to your surgery at this time of the year you may also be sure of a big surprise. Yes go to your doctor’s surgery at the wrong time and you will see the annual zombie gathering that is a flu clinic.

Watch in amazement as line after line of the living dead hobble in waves towards the surgery seemingly unstoppable. Some can just walk on their own, some use a variety of walking aids that double as lethal weapons to those who are as yet not of the undead be it the form of walking sticks, Zimmer frames, wheelchairs and electric buggies. Others are helped by their relatives or carers and they have been prised out of their pre tombs for the annual march to the surgery for the life preserving anti zombie serum the annual flu jab.

In order to counter the waves of the undead surgeries have developed efficient methods of processing them. The undead are discouraged from regarding these flu clinics as drop in and moan clinics but the undead do not hear well at the best of times. The undead are processed brutally by the heroes and heroines of the annual general practice zombie flick the reception staff who ask them for name rank and serial number, tell zombie 6491 to expose your left (or right arm if left missing having been hacked off by one of the other undeads’ walking aids) and lurch forward to serum room X. NEXT!

At serum room X a nurse, doctor or other trained health care worker will plunge the life giving anti zombie serum into the exposed arm and utter the protective words “NEXT zombie to room X” and dispatch their current zombie before they can open their mouths and utter the well known zombie mantra of “While I am here . . .” NO NEXT!

They will have already tried that at the chemists before they got here as they can’t get their prescription which they forgot to collect the day before from today's zombie, sorry flu, clinic and will run out of tablets before the next surgery which would mean they would join the true undead. “You must help me doctor/nurse/receptionist” they whine with outstretched hands, pleading eyes, gasping their last . . . Wield the chainsaw and blast them with NEXT!

And so in at the front, report to reception no talking or moaning, jab and then out through the back the zombies lurch side to side slowly ever forward until they get back to the zombie mobile parking area. To those of us who are still alive this is as terrifying a place to be as is watching the waves of zombies walking in and through the surgery and out again.

Line upon line of white haired, hunched, swollen ankled, slowly moving from side to side faster than they move forward just defying gravity, spectacle wearing, false teeth clad sufferers of chronic diseases and well rehearsed self pitying regurgitated stories of woe kept going, i.e. just alive but not enjoying it. For we are living longer but not enjoying it, and they are here believing that the anti zombie serum will dent the Reaper’s scythe which it may well but it still keeps hacking away at their general health year on year with an ever worsening decline.

For in the limited space of a surgery the lurching zombie mode of walking is dangerous to most other than lawyers, indeed most of them in a major shipping lane could hit and damage something major usually a floor or failing that a supertanker but worse still is the spectacle of zombie parking wars. Here usually in small cars sometimes with one but sometimes with up to 4 zombies a vehicle they play dodgems and compete to park using the ancient way that headless zombies park using the touch park technique.

Leave your own vehicle here at your peril, walk here at your peril. Our staff park several miles away surrounded by anti terrorism concrete blocks just to be extra sure for whilst parking is a tactile experience for most zombies driving is more of a Braille reading exercise of straddling the white line and feeling for the cat’s eyes to know where to go and avoid bumping the kerbs which they frequently drive over and complain of the worsening potholes. Surgery walls frequently take damage on anti zombie serum days as zombies seek to avoid other stationary zombie mobiles in the car park entrance by giving them at least 3 times the width of the surgery car park as clearance.

Given that zombies are the second most dangerous group of drivers on the road the collection of large numbers of the living dead on a small area of road is lethal. Many of our medical students know them for they are usually the 40 mph in 30mph zone drivers and 40mph anywhere else for they are pushing the envelope of geriatric speed endurance.

The combination of a heater on full, steamed up car windows combined with cataract ridden eyes, out of date glasses wrapped up in fifteen layers of 1950s duffel coats and driving gloves with protective flat cap head wear, unstable bladders desperate to pee somewhere and reaction times 10 times slower than normal means that a right signal means I have priority and I am turning into a car park regardless of on coming traffic as another zombie pulls out unable to see the other vehicles 12 foot in front of them BANG! Left turners fare little better KPOW! CRUNCH!

After several hours of zombie carnage the surgery building and car park go quiet as the living dead have been dispatched with enough anti zombie serum to keep them going for another year. However the living dead leave behind them several things. The odd walking stick, limb prosthesis, glasses, scarves, gloves, hats, car keys, false teeth, mobile phones, handbags, wallets and hacked off body part have all been recovered but the worst bit and this is true of any battle is the smell. Unwashed clothing with the subtle industrial strength eau d’urine being the most easy way to describe the smell of the living dead after their annual visit and it lasts for hours sometimes days even after the use of Agent Orange strength air freshener.

This is not an end to general practice zombie wars for within 3 days of the first wave of zombies receiving their anti zombie serum they start to come back complaining that having had their anti zombie serum they have now become real zombies by virtue of having contracted the flu from their flu jab.

Is the annual zombie movie of the average GP flu clinic all worth it? To a general practice it might generate a few hundred pounds of extra income but that is not without costs in terms of staff time and discomfort. Our understanding is, and we are welcome to be corrected if we are wrong, that it does not reduce hospital admissions one bit. Yes it may protect you against flu but there are plenty of other viral infections in the winter months that will accelerate our proto zombie population into full zombiedom and hence hospital admission.

Praise be to the Party for providing the zombies with their life restoring serum every year. We hope it is worth for you all.

Until next year? Anybody watch the march of the Lords into their bespoke zombie debating chamber . . . ?

Sunday, 9 October 2011

The internal market, NHS “competition” and a Yorkshire practice.

A few bloggers have posted on a practice in Yorkshire offering to do certain operations for their patients for a fee. It seems from this link that health minister Paul Burstow does not think this is on as he and his Party seek to make this more the norm than the exception. How could this come about given the NHS internal market and competition?

Well perhaps it is the result of the true free market as opposed to the NHS Soviet style market? We have commented before on how the only part of the Party’s fixed NHS tariff, the only bit of which you can compete on is quality, not cost, that can be negotiated is the price a PCT can pay a GP to do a job cheaper than a hospital can. This means if a GP refers a patient to see a dermatologist with a mole then the cost of seeing the dermatologist is the same anywhere in the fixed price but competitive internal market that is the NHS Tariff zone. So the Party fixes cost but you can haggle all you like on quality with a hospital only GPs can undercut the hospital tariff price system.

So in general practice you get used to get the situation where NHS managers deep in their bunkers notice that as people become more vain they want moles removing a few of which may be cancerous which are the only ones that NHS commissar managers think really need removing. So being some of the brightest remedial class graduates they think did not GPs used to do that once and more cheaply?

We will give GPs a few farthings to do something that the hospital would do for a couple of hundred sovs and that should save us pounds. So the local Soviet commissars do this and go into the playground to play commissioning games and using the NHS Soviet free market model they restrict the number of cases GPs can do to save even more farthings.

If any of them spoke to GPs instead of dictating to them they would realize that minor skin abnormalities are very common and NHS consumers aka patients pay bugger all for anything so they will use the system as much as they like. NHS consumers, sorry service users, are well used to the concept of the free market especially when it comes to health.

Furthermore if you agree for example that a practice can only do say 30 excisions a quarter and the practice can do that in 4 weeks then where do the others go? Local GPs say that they could do more for cheaper but targets are targets so there is no extra money for doing more work so referrals to hospital continue to go up.

Now if you have been in a remedial class for all of your life and are allowed to play at being God in a PCT then the idea that you can stop your betters having something really appeals to you and so NHS commissars fix the market a little more. Not only do they restrict the number of procedures GPs can do cheaper than the hospital they stop the patients going to a hospital as well. The supply of dermatological surgery in the NHS free market has now been capped by your local PCT but the demand has not and it is not being met.

So you tell all the boffs in your class at school that you used to throw paper balls and other things at to stop being doctors and operating and you also tell them to stop being doctors by referring patients because we are not going to pay you so there! We are so big and clever with it!

Result if doctors cannot treat patient themselves or refer them to hospital because the local Soviet says you can’t how do doctors get round the not being able to treat their patients?

Well this is where the NHS “free” market comes in for it will allow any willing provider to set up shop. GPs are mostly small businesses and if you spot a way to make more money and provide a service being denied by the NHS then this is where the free market can help. You are not allowed as a GP to charge your patient for any NHS care but if the NHS does not provide the care you could set up as a private company and offer a service to patients for a fee. So the “free” market using innovation comes up with a solution to the problem created by the Soviet style NHS internal and centrally regulated market.

Simples. And we are sure that there will be plenty more such innovation as the money becomes tighter like the noose of central regulation of healthcare reform and it is probably an entirely intended consequence that has sneaked out a little too early for political comfort. Not all such any willing providers will be GPs but anyone who can see a way to exploit shortcomings in current and forthcoming NHS provision.

We here at ND Central wonder what will be the next any willing GP or provider opportunity? The way the NHS “market” works means there will be some and if you have the money you can always get better and quicker treatment when the NHS fails to provide.

Praise be to the Party of continuing reform using the current tripartite vision for NHS provided healthcare of expensive market good, cheap socialized medicine bad.

Do not shoot the entrepreneurs for they are just playing by the rules of the game and some of them may well win and win well. Their wins will probably be at the loss of the as of now non-paying consumer our patients and their future healthcare and wealth and all the result of a highly flawed centrally imposed market that has failed for 20 years.

And it continues to do so. Reform of a bad idea does not make it a better idea and even the politicians don’t like the result of their endeavours.

Saturday, 8 October 2011

The results are in and . . .

We posted about the GMC consulting on whether it should regulate doctors’ lives outside of medicine and the results are in and can be read here together with some GMC thoughts on the issue.

In summary in answer to the question do you think the GMC should regulate doctors’ live outside of medicine the results were:

No              1100          94%
Yes                54            5%
Not sure       13            1%
Total         1167

If you look at the percentages if you were a politician you would regard this as a landslide result of a mandate saying that the GMC SHOULD NOT regulate doctors’ lives outside medicine.

However dear reader read further down and see that the amount of column inches given to the comments of the Yes voters is proportionally greater than that given to the No voters as is that given to the Not sure voters.

Read further and see that:

“Given the very large response to this question, we have decided to ask a specific question about doctors lives outside medicine when formal consultation starts later this month.”

Interesting words those for they remind us of the “ratification” of the treaty of Lisbon whereby if the politicians did not like the result of a referendum they wanted they have another one or the old joke that if the British ever solve the Irish question the Irish will change the question.

We are sure an elite team of (Daily Mail?) journalists will be at work drafting the question so as to get the right answer. Here is our crude attempt:

Should the GMC have the power to regulate the personal lives of all doctors if they are paedophiles?

Should result in more Yes votes than the previous question comrades shouldn’t it?

As someone once said on 10 July 1790:

“The condition upon which God hath given liberty to man is eternal vigilance; which condition if he break, servitude is at once the consequence of his crime, and the punishment of his guilt.”

John Philpot Curran Irish judge to which we would add a term some of us heard from modern(ish) military circles in Iraq:

“Stay frosty gents”.

We await the publication of the specific question with interest and whether the formal consultation will be along the lines of the Future Forum consultation on the NHS reforms.

Praise be to the Party for giving us the illusion of democracy within an increasingly Party controlled “free” state.

Tuesday, 4 October 2011

Darzhole centres costing more, delivering less, we mean nothing.

We have been waiting for this story to break and had even toyed with the idea of suggesting it to the medical press but it seems our friends at Pulse have worked it out for themselves. Now what is interesting is the lack of detail as to whether payments have been made for early closure and more importantly how much. These details are “confidential”.

Now given that this is public money that is being spent why should these figures be confidential?

There are one or two reasons for this. The first is the tax paying public would not like to know how much money has been squandered on flights of fancy by those with whom they went to school especially when they realize that these “world-class” commissioners of expensive white elephants were those who were close to the top of their remedial classes at school.

These “world-class” commissioners who negotiated the contracts probably thought they was wicked because they had big numbers involved (more than all their fingers and toes combined at once) and had words printed in a big book with many pages that someone would read to them and they would have put their X at the bottom with their best crayons and thought they were well hard.

The problem was that the commercial sector did an even better job and provided very poor value for money and rubbed their hands with joy at how easy it was to get their hands on taxpayers' money for doing sweet FA but then they knew they were dealing with the “world-class” remedials who were, and still currently are, NHS Commissioners/managers.

We heard rumour, after one of the team’s recent trip South of Watford Gap in July, that the pay-offs are of around twice the annual cost of running a Darzhole practice which was estimated at around £ 1.1 million a year.

If this is the case then not only did “world-class” commissioners get suckered into paying an absolute fortune for contracts that when the targets agreed were met the providers just stopped working but still got paid and do remember 2 patients a day is a lot of fingers to count up and write down in a contract at the same time but best of all is the fact that taxpayers' money is being used to pay off contracts that will be delivering bugger all healthcare for their buck.

This is a scandalous waste of taxpayers’ money paying private firms or PCT stooges to deliver nothing. Of course the real losers apart from the taxpayers will be the local GPs. Now in areas like the Isle of Wight with its one registered patient there probably won’t be much of a capacity issue but look at our post from 2009 and read about spearhead PCTs which are those that cannot provide enough GPs for their population.

Look at those in the top twenty or so of the “world-class” commissioning league table and look at the names at the end of this week's Pulse article. We count 7 out of the 9 on Pulse articles list are in the “top” of the league table but have a look at this list of the spearhead PCTs and see how many of the list of 9 in Pulse are spearhead PCTs we counted 5.

Now spearhead sounds like an elite military unit until you realize that spearhead is actually pronounced as sink in front of the word PCT in a similar way that the word sink is applied before the word estate to describe areas where most politicians would choose to live if they were that lucky to earn so little in order to be able to do so.

So in areas that are under-doctored “world-class” commissioners are paying private firms public money to shut down white elephants that these “world-class” commissioners (morons) agreed contracts for and best of all are paying people NOT to deliver any healthcare to under-doctored PCTs. So much for "equitable access" comrade commissars. The comparison between certain Southern African dictatorships and Za Nu Labour cannot be more relevant (with thanks to Guido Fawkes blog for this little gem).

Will anybody be looking into the true costs involved and investigating the “commissioning” activities of those "world-class" commissioning managers involved?

Somehow we doubt it but we know who will pick up their failures and that will be whatever remains of the local NHS but it won’t involve any extra work for the “world-class” commissioners will it comrades?

More vodka and caviar to celebrate another successful private/public sector misadventure? No doubt many more will follow.

Praise be to the “world-class” commissioners who could not organize the proverbial in a brewery when they were flush with money and were given instructions on how to do so. No doubt their expertise will be available to the newly formed GP commissioning groups who will have to make do with less and will be welcomed like a handful of molten metal.

The future is truly bright for when the private sector fails and "scores", the public sector and the taxpayer will have to pick up the pieces. Time and time again but no doubt efficiency savings will make good all of these “world-class” commissioned losses of hard earned taxpayers' money.

Won't you comrade workers?

Monday, 3 October 2011

Meeting creep.

We here at ND Central used to once have proper Practice meetings. These meetings were when we the GP partners in the Practice met together with our practice managers and other staff (if required) at least once a month to discuss the Practice’s “business” which is providing healthcare for our patients.

For non-UK readers and for most in the UK who think that most GPs are employees of the state most GPs are “self employed contractors”. We are like self employed plumbers or builders albeit contracted to provide services to the middleman of the state called the PCT (Primary Care Trust) soon to be abolished with whom some of us hold a nationally agreed contract.

This means we have to provide certain core services but as professionals we have a greater degree of control and therefore freedom as to how we run our Practice (our business). This can result in innovation and excellence as some Practices adapt their services to suit their local population and its needs but the downside is that it can allow some Practices to slide if high professional standards are not maintained

In the old days practice meetings could last as little as two hours and were often held after hours which meant when the working day once finished at 18.00 Zulu we might get home at 21.00 Zulu after a full working day as well. Complex matters like what colour paint should we have for the window frames or when can we take leave during the school holidays were discussed or how many emergency surgeries do we need/want to provide.

During our training it was always said that GP Practices which had regular Practice meetings were the better practices as there was communication and hopefully Partner participation in the business especially if each Partner had a vote i.e. a democracy as opposed to Practices where the Senior Partner dictated everything. Such meetings were once business meetings and were short(ish) and to the point.

Under Za Nu Labour’s centralized Sovietization of the NHS coupled with their “command and control” policies of the (medical) professions, the team at ND Central have seen meetings increased in both in length, and in number, by imposition of so quality “targets” to tick local retards’ boxes and deliver bugger all health care.

We repeat deliver bugger all healthcare but increase medical arse time on seat doing sweet FA to tick someone’s box.

The military use the term “mission creep” for increased involvement in matters hopeless at the behest of interfering ignorant politicians and we would suggest the term “meeting creep” for something similar in GP land.

Lets us look at some examples of meeting creep that have been imposed from the local Soviet and discuss whether they achieve anything other than a box ticked. Bear (sounds like a Soviet bomber?) in mind these are just of few of the many add-ons imposed by local commissars over the last 13 years.

Let us start with the perceived need by local NHS retards, managers, sorry commissars, who feel that quality involves discussing every new diagnosis of cancer as a “critical incident”.

We feel, as simple grunts on the ground, the need for a huge Homer Simpson “D” word here and may unfortunately have to use a few choice grunt words in what follows for which we apologise.

Listen up f**kwit NHS retard managers sh*t happens every day in medicine but never in your offices for you never see patients.

Grunt rant over and apologies for the extremely rude grunt words. A few facts for your average NHS commissar/manager follow to compensate for our slight impoliteness but then you never deal with real patients just spreadsheets.

Cancer happens. It is not a critical incident unless you are one of those NHS managers who only look out a window on a Friday afternoon?

Why? Because if you didn’t do this on Friday you would have nothing else to do for the rest of the week. (Old medical joke re NHS administrators). Remember what do you call two NHS managers holding hands? A synapse.

Cancer happens it is unfortunately part of life and will kill up to a third of us. If it is missed, through negligence, then that is an INCIDENT but if just happens that is life.

So discussing whether John Doe who has smoked 60 a day for sixty years has got lung cancer will achieve what?


Now the tw*ts that think that this sh*te is important will think that this will make a difference. So Mavis 54 who does not smoke or drink has had 2.4 children who develops breast cancer because she is a woman who has a 1 in 9 chance of developing breast cancer is now a “critical incident” that we have to “discuss”.

Why? What does it achieve? Should we discuss gravity as a critical incident at each meeting because things fall off desks in NHS mangers’ retard offices and patients fall over and break bones? Gravity must be a tsunami of a mission “critical” incident to be discussed at each meeting in future.

Retardation extends even further in the NHS Soviet command and control structure as we now have to discuss as “critical incidents” something that never ever happens in life but is deemed “critical” to NHS managers’ existence the fact that patients do things beyond their limited comprehension and control and they eventually die. Death is now a “critical” incident.

Get the smelling salts out for Whilhelmina Bristlecombe who died peacefully in her sleep at 105 years of age and was subject to a post mortum by the coroner as the last GP to have seen her had done so 3 months earlier when she had been playing baseball and ran a homer with her great grandchildren and didn’t know why her doctor of 40 years was there.

Amazingly the post mortum showed she died of nothing more sinister than “Old Age” but this totally natural death is now a “critical” incident because at age 105 she died.

Why? What does it achieve? Should we discuss the weather as a “critical incident” at our next meeting because it rained?

The worst of all meeting creep add-ons are the imposition of attendance at practice meetings by members of the radical Al Qaeda school of pharmacy the pharmacists employed by the PCT. In the same way that a nurse can now do a doctor’s job on the cheap and people with no qualifications can play at being nurse’s PCT retards feel that a radical pharmacist can now educate doctors and make them perform better.

So many hours are wasted as these Al Qaeda trained pharmacists invite themselves to meetings and demonstrate how much work they do by displaying graphs from laptops for hours at a time. This is not about quality it is about saving the local Soviet money so they can employ more managers. The most recent innovation from the local Soviet who quote words like QUIPP but we think Jonathon Ross would pronounce it more accurately as CRAP is to substitute one non steroidal anti inflammatory drug (NSAID) for a cheaper alternative.

Now the idiots that have thought of this idea clearly only have memory in their computers for the more expensive NSAID appeared in the late 1980s and it became popular because it was much more effective that the one now being promoted by the radical pharmacists who are too young to remember the less effective older drug (they would have been in diapers and probably still are given what comes out of their mouths) and as they do not ever follow up patients for years will have no idea what works and what doesn’t but will happily dispense any sh*t (sorry another grunt word) for profit.

Still they are getting paid to waste doctor’s time by hijacking what should be business meetings about providing healthcare not saving money by the use of less effective drugs.

The increasing layers of retardation coming to GP land are like an atomic bomb. A small explosion in central government leads to a huge, expanding mushroom cloud of retardation that will engulf all in general practice for years to come.

This mushroom cloud of NHS retardation and meeting creep continues to expand, despite the new NHS reforms, and please do remember Marshal DC’s quote "We are not reorganizing the bureaucracy of the NHS, we are abolishing the bureaucracy of the NHS". We suspect that the mushroom cloud of NHS management, albeit in different guises, will spread NHS management to new, and as yet unseen, levels of meeting creep.

For surely we will have to now have commissioning meetings, budget meetings, referral target meetings, feedback from consortia meetings et al on at least a monthly basis and more so towards the end of the financial year when the money starts to run out?

Remember fundholding? No extra work involved in that policy, comrades was there ever? Anyone remember having practice meetings and then additional fundholding meetings. We all know that history never repeats itself.

Praise be to the Party for inventing Practice meetings that will result in GPs treating patients so much better by being in meetings all day. More meetings and longer meetings clearly means more, and better, hands on patient care.

The minutes will prove this for if you die when your GP was in a meeting your GP’s attendance at a meeting means you had true quality care for the meeting minutes will show this to be true. The “evidence” will show this to be true.

Quality healthcare is as we all know delivered by sitting on ones’ arse for longer and longer in meetings and avoiding patients. Just look at nurse managers.