Monday, 31 December 2012

Oh no it won't!

Some of the team have been in communicado by virtue of no internet access while the rest are with their families and cannot be bothered to blog. However a grainy TV picture in some of the more remote outposts of the world enabled us to see this latest government initiative from a far.

Well given every child protection report written says the information was there but not shared can you see how much this will achieve? If professionals police, social services, doctors, nurses etc. do not talk under current freedom of speech will a computer allow us as GPs to detect Johnny or Joanna Scrot child abuser or their abusees?

I'll just plug my Smartcard in and it will allow me to instantly access the police National Computer System, John and Jo's DNA that I just slipped off them when I shook their hands while telling them of their child's unexplained fracture and allow us to access all the local social services' children at risk registers?

Just look at some of the problems we have as GPs dealing with child protection issues at present. Our first port of call used to be our practice attached health visitors but the Party in its infinite retardation took them away from GPs under their TCS policy. Officially it was Transforming Community Services (TCS) although most use Transferring (to the private sector) as the T word as it reflects reality more accurately.

Social services keep a record of children at risk or of concern but cannot for some reason give us a list of children on its register that are patients at ND Central because "it is on paper". They nonetheless expect a GP to attend a case conference when rung late in the afternoon before the meeting to be held next morning with full surgeries already booked. The GMC say we should attend these because Mr. Hodges says so or else.

This is akin to our experiences of working in A&E when asking if a child was on an at risk register meant getting more senior hospital administrators to open safes then it would take to get a nuclear missile's launch codes. And that was in hours if you were lucky and before Data Protection Acts and EU legislation.

Some local intel from CQC and Ofsted inspections from nearby Soviets suggests that communication failures are to blame so will we get our health visitors back? Oh no comrades the communication failures are because computer does not talk onto computer and so this must be addressed immediately.

So we have a local system where the health visitors and social services enter their information on a computer system which does not speak to any GP or hospital clinical system. Add to this the "quality" of the national summary care record noted here and ask yourself do social workers, police officers, neighbours, family members etc. carry the Party card?

One can see the problems looming large like the visible tip of an iceberg miles across. This iceberg is huge and unsinkable due to political diktats and a computer system will not stop it for these problems have existed for years.

Remember the ice breaker here will be produced by British Medical Computing (BMC) which has a superb track record of failure to deliver, failure to deliver on time and failure to provide frontline clinical staff with anything useful.

If professionals now are finding it harder to talk to each other as a result of Party policy (TCS) and computers don't talk to each other now how will this work? The data is sitting in various sources but data in isolation is useless.

You cannot interrogate a computer but "search" a health visitor about little Tom Smith and you won't just get name, rank and serial number you will get a whole lot more. Similarly with social workers, school nurses, police officers et al you get pieces of a jigsaw which sometimes just one piece or person holds the missing link and one might be able to connect all the pieces together. Computers can't do jigsaws.

And will this be delivered by 2015? Dream on guys yet another NHS IT initiative that will deliver nothing but costs.

And will never help those it should. Ever.

Praise be to the Party for giving us yet another IT failure so big it will be seen galaxies away as an information black hole sucking everything into it but giving sod all back out in return.

Until the next one.

Thursday, 20 December 2012

Writer's cramp.

At this time of year we suspect a lot of GPs will be doing something they don't do very often nowadays and that is to write legibly.

With the increasing use of computers to hold medical information most of the time we spend typing away on computers. We only rarely write letters by hand usually only on home visits when admitting patients to hospital and if we write in surgery it is usually only a few words on a post it or instructions to staff on hospital letters etc.

We do still sign prescriptions but the signatures we use are usually a squiggle that over time becomes less and less recognizable as having any letters in it due to the need to repeat it quickly and often several hundred times a day.

Indeed some of the team have 2 signatures one for prescriptions the other for cheques and credit card transactions but these are becoming less often used as PINs replace signatures.

So when one of the team sat down to write a few Christmas cards they experienced something they had last experienced at school - writer's cramp. Writing prescisely involves fine muscle movements and we realized that we don't use these muscles as often as we used to and so after just a few smartly and legibly written and addressed cards our dominant hand hurt.

The last time we experienced this was in our English Literature exam when the grade you got was dependant on the weight of paper you wrote on that the examiner could read and so writing legibly at speed was a must do.

Praise be to the Party for deskilling the muscles in our hands that are needed to do things not dependant on a working computer system. It was surprisingly painful and unexpected and brought back painful memories of English Lit. as well!

Monday, 17 December 2012

NHS 111 is coming.

At this time of year most people will be familiar with the phrase Christmas is coming and has been doing so since last January but a series of meetings some of the team have been to fills us with dread. For we have been told that NHS 111 is coming from next April.

So what is NHS 111 you may ask? You can read the Party's spin on it here and here.

In essence it is the dumbed down version of the spectacular failure of call centre medicine the NHS reDirect service. Instead of nurses reading a US ambulance dispatcher's algorithm they will be replaced by (cheaper less experienced with possibly only 6 weeks training) technicians "supported" by nurses who will read from a US ambulance dispatcher's algorithm.

So marginally better then the NHS Swine flu line but not as "good" as NHS reDirect's nurse using a US ambulance dispatcher's algorithm. After all 6 weeks "training" always tops 3 years training with real patient experience.

Remember comrades that NHS reDirect was said to divert a third of its calls to A&E or GPs. Look at the top of the second link where it says NHS 111 is for "health advice and reassurance" (from technicians). Should it not read for no advice and plenty of redirection?

The worrying thing we have heard as GPs from our local Soviet NHS 111 commissar is that local GPs will be "persuaded" to change their out of hours messages to "advise" the patient to ring the NHS 111 number first (or else).

We are also "advised" NOT to tell our comrade patients of this change before it goes "live" in case they ring the number now and are welcomed to NHS 111 trial sites which may well be outside of their area for there will be a "national" re education programme to ensure that no comrade patient gets it wrong. So remember to stay up late into the small hours to see the public information ads re NHS 111 when adverts are cheap to broadcast.

Now given that the previous Party wanted all comrade patients to only have to make one phone call to access the GP out of hours service is this not a backwards step?

Can you imagine how patients will feel when instead of being able to ask for a GP service they then spend 20 minutes on a phone with a technician before they are told to ring the GP out of hours service, which is what they wanted to do in the first place?

Or better still will they get the call back option that NHS reDirect offers our patients as standard of at least two hours for a nurse call back option? Anyone wonder why A&E admissions go up when the services designed to reduce A&E admissions encourage them?

We are told that NHS 111 will lead to an extra 2 patients per unit of patient numbers per day in daylight hours. Hmmm well NHS reDirect certainly had much better productivity than that comrades and none of them ever needed to be seen within the 4 hours algorithm decided "emergency" time.

Each call will generate a new load of electronic garbage which we suspect will be a mere 36 pages of A4 if printed off in contrast to the current out of hours 3 pages which is full of such stuff like is the patient breathing?

Well if they are talking to you on the phone can you guess what the answer is to that question?

Praise be to the Party for realizing once again that if you have a problem with no solution create a call centre. You know it makes sense.

NHS 111 makes no sense. It will duplicate and increase work in order to get the patient to the same place as they would got to before NHS reDirect and NHS 111 were even thought of and increase costs in order to do so.

Efficiency savings ladies?

Wednesday, 12 December 2012

Times are a changing.

A while back we did a post about our local experience of the decline of the great British pub which for readers from overseas is short for a public house or drinking place for consumption of  alcoholic beverages licensed by the state for this purpose and subject to state regulation.

The decline we noticed in 2009 has continued and accelerated locally to the point that many more pubs are now derelict and empty. Pundits say this is because the pubs cannot compete with the cost of local supermarket sold cheap alcoholic beverages and people are becoming more anti social and drinking at home while playing on their computers (and other things).

 In the recent past as we pilot our Ferraris on to all the needed home visits so freely provided by the Party we have noticed a flurry of building activity in a lot of the once empty and boarded up former large pubs. Can you guess who by?

The local temperance leagues moving in? Any willing providers of healthcare? The Salvation Army?

None of these but the major supermarkets who have gutted several former large public houses and are placing their little mini mes in them using such names as express or local. No doubt to supply the local population with more of their needs (food) and their wants (cheaper alcohol).

The any willing provider (AWP), or is it now, any qualified provider (AQP) of the healthcare market has clearly noticed a gap in the market (large numbers of elderly or not high income groups) and can easily displace the local shop in terms of range and cost of produce they can supply and given the sudden appearance of huge new retail outlets created by the demise/decline of the British pub?

In the same way that market competition has led to the rapid decline of the pub due to a need to pay people to service a bureaucracy we wonder how long these new "social enterprises" will last? What will the effect of minimum pricing of alcohol be?

We are guessing that these may last as long as minimum alcohol is kept off the statue book. Already our patients do not have to go out to buy drink they can order it at home via the net and have a home delivery service into the early hours of the morning.

If minimum alcohol pricing is introduced will Jo and Joanna Public realize that similar such "drive by" services could possibly, subject to legislation, provide a white van social enterprise (AQP) of an importation model for "personal" consumption which might lead to the concept of a local "drive buy" delivery service of EU imported free of minimum unit of alcohol tariff free market booze?

What then would be the effect of a minimum price per unit of alcohol be on the local new supermarket mini mes? More importantly if the market fails who will pick up the costs the failures of the AQP for alcohol?

Anyone remember Prohibition in the USA and the effect it had on public health? Anyone see any similarities between pubs, minimum alcohol unit pricing and British NHS care provision?

Praise be to the Party for once again missing the point. After all in Westminster booze is subsidized and almost open all hours. No doubt they will be exempt by legislation from minimum alcohol pricing per unit or will the honourable members be able to claim back any minimum unit pricing as expenses?

Saturday, 8 December 2012

Newton's revised laws of healthcare.

Newton's first law of healthcare is that a body of legislation continues on regardless of any rational thought until acted upon by a general election.
Newton's second law of healthcare is that the acceleration of healthcare reform is directly proportional to the retardation of the political force acting on it and is inversely proportional to the mass of people voting for it and ultimately benefiting from it.
Newton's third law of healthcare is that for every committee there must be an equal and opposite minimum of one or more subcommittees per committee in order to ensure a reduction in administration via each new reform.
Praise be to the Party for reform. We will stick with Newton's original laws as we will at least know where our cars and aircraft will land up.
As for our patients and their healthcare who knows other than the increase in bureaucracy for no patient gain with every reform. Commissioning anyone?

Wednesday, 28 November 2012

British Medical Computing is crap 001: shafting the tax payer and the end user the basics.

Many years ago some UK GPs discovered computers and realized their potential. GPs were once allowed a choice of an IT system but when those less bright than GPs realized the advantages of them to patient care, namely the patient critical task of administrative data collection, the Party and its NHS administrators took over.

 The Party, then led by a public school educated Scot with no experience of computing or medicine, decided that they knew better and introduced a national retardocracy of computing. This included a plethora of initials including the NHS National Programme for IT (NPfIT) sometimes called NotFit.
A central command and control system of NHS non choice and reduce costs system called Choose and Book, and most importantly, a centralized control of access via the Smartcard to the data doctors and others in healthcare create so allowing the Party complete control of what healthcare professionals need to do their job.

Information (Technology) or IT or our and your medical records.

All of this retardocracy was for the benefit of the comrade patients (but only those that are the former great leader's friends and their financial interests) (not).
So history aside, and there are a few more to come, here is a simple Northernshire practice's experience of BMC (British Medical Computing). We do apologize for there are a few naughty grunt words in what follows which is a reflection (of our frustration) of our own practice customer "experience" of BMC.
A few years ago our local computing gurus based at the local Soviet recommended that several local Northernshire practices adopt the all singing all dancing EMUS (Extremely Medically Useless Systems other such systems are available) primary care computing package.
This was because the local Professor Stephen Hawkings in the IT department, all of whom were full of such words of wisdom regarding modern computing such as “we can’t possibly manage without floppy discs they hold too much information”, had been to a hard sell conference.
They had been stunned by a stand alone laptop (they had not seen a laptop before) demonstration which was not connected to the internet showing the benefits of remote hosting of practice information (they had missed the internet).
This is Northernshire where the racing pigeon is still the king pin of advanced local Soviet communication and every local IT techie is a Harvard and Yale graduate (most would struggle to spell Yale) because they have mastered the light switch magna cum laude by the time they had left school at age 47.
This is a challenge to any other healthcare professional out there. How long did your local Soviet and EMUS (or any other NHS computer supplier) take to get your system to work at anything other than at dial up connection speed?
We have had over the many, many years of crap service the following reasons why our system has never worked faster than a 200 year old tortoise with osteoarthritis in each of its 4 limbs that has just woken up from its winter hibernation weighed down with 4 packs of bricks on its back speed and that is before it gets its first fresh lettuce leaf of the season.
From EMUS (and any other willing shafter of the NHS) you get at the taxpayer’s expense with the local PCT “safeguarding” your multi billion pound investment, excuses like:
1) there is no problem. Do we give a sh*t as we are coining it in?
2) your expectations are too high. Interesting as our expectations are based solely on your salesperson presentation and your trainers’ comments which include them "feeling our pain" suggesting a very large account with Kleenex and many flexi jerk off moments at a senior level in contrast to fixing the problem(s).
3) it will get better with the N3 connection. N3 = New National Network = very expensive but crap broadband connection unless you are Patricia Hewitt when it is a nice little earner. Did it heckers but you ripped our and our patients' tax dollars off wicked.
4) it is the PCT’s server. Nothing to do with us guv honest.
5) it will get better on an EMUS (other willing sh*fters' servers are also available) hosted server. Did it heckers but more wonga for us from you suckers year on year via service charges with added worse year on year service for free.
6) after many years we will come and do some timings. Only takes 10 years to get to this stage when we sent these same timings to you some 10 years ago?And guess what they haven't changed in 10 years.
N3 at your expense say:
1) there is no problem
2) there might be a problem with your router. We will send several engineers out and change for it and charge for it several times with no improvement but considerable disruption.
3) there is a problem with the line (we will do nothing)
4) there is a problem with the local exchange (we will do nothing)
5) there is a problem with your internal wiring contact the PCT (we will do nothing)
The PCT say on our behalf to the above other two parties:
There is no problem.
The PCTs (soon to disappear) have for years as the purchasers of NHS IT spoken (allegedly on our behalf) and "represented" us to EMUS (other suppliers are available but they are the biggest) and N3 (who do not now as part of customer service talk to customers) and tell them there is no problem (as far they are concerned for none of them ever use the systems they peddle/purchase)
It is the PCTs who tell the suppliers that there is no problem and hence there is never any solution for as far as the PCTs are concerned they never use the computer systems they purchase and so there is never a problem. Bit like asking your pet goldfish rather than a pilot why a jumbo jet isn't working?
So millions are being siphoned off by computer companies all of whom think they are doing something useful like making money out of Government suckers while the consumers, sorry end users, GPs, nurses, receptionists and patients get a crap system.
"I am sorry it is taking so long to book you appointment the system is running at slug speed." Any patient not heard that at a practice with data transfer supposedly taking place at the speed of light but daily overtaken by the local slug population?
If you say there is no problem you don't have to do anything and you still get paid. If you then refuse to speak to those who say there is a problem things only get better (for you) but not the patient or the end user.
BMC in a nutshell. There is no problem.
Unless you use it.
Praise be to the Party for creating BMC and delivering fat pickings for a few but lean productivity gains on the ground for those that it was meant to help. And paying an army of retards to do nothing other than say there is no problem.