Monday, 23 January 2012

The new word on the block.

There appears to be a new word on the block in GP land and it is called integration. Now those of us in GP land who have a scientific background know this as a very powerful tool used in mathematics that can produce useful results.

The new tool sorry word on the block seems to have come from the Future forum which is neither the future nor a forum as it is a government appointed quango to lubricate the Health and Social Care Bill up the arses of the unsuspecting British public via a sham consultation and its leader gives us a math’s lesson here. If you want a read you can learn about Mrs Crabtree here someone that no GP will ever have seen or encountered in their professional lives.

Now integration is a word we have seen here before in healthcare in the guise of several previous buzzwords take for example integrated nursing teams.

At the time this buzzword was doing the rounds we had then, pre TCS (Transforming Community Services), our own attached district nursing team based in the surgery with whom we worked with for the benefit of our patients but for some reason they were not integrated. The nurses were employed by the local Soviet but resided in our premises and we played on the same side as they did namely that of the patient and this arrangement seemed fairly well integrated to we who are simple grunts in the field.

However integrated nursing teams were not what it sounded like on the tin. It was in fact the local Soviet asking us as GPs to take on the budget, albeit less than the then current cost, for the nurses and manage it for them hence the term integrated nursing teams. So professionals working together are not integrated you only become integrated when you manage the budget not the patients.

Now in Shiteton in the run up to NHS privatization we have TCS district nurses the location of whom is a top secret for they are now deployed in secret central barracks to ensure greater integration with their medical colleagues and to ensure complete work avoidance and unaccountability. Is the new integration in fact differentiation?

So what of now and the new integration? What is it? Some examples taken from the GP rags say that this involves the overhaul of the GP contract to promote “integration” of practices. What exactly does this mean? New super large health centres 1960’s style or a rebranding of Darzi centres anyone? May be the forced mergers of local practices for efficiency gains?

Clinical commissioning groups must show ability to integrate during authorization process. Haven’t a clue what any of that means but might it be the top down bit of the bottom up liberation of the NHS via the National Commissioning Board (NCB)?

Integration may mean to explore ways to pool health and social care budgets. Is that the same as to save money but not improve care a bit like integrated nursing teams?

When you have been in medicine for a while you hear the same ideas repackaged with new buzz words. It is said that every generation of surgeons who goes to war makes the same mistake and tries to close contaminated wounds rather than leave them open to heal. Just as new surgeons make the same mistakes and do not learn from their predecessors so does every new Party not learn from the mistakes of the previous ones.

Praise be the Party for reintroducing calculus into the medical syllabus. We suspect that those talking of integration missed out at school on how useful real integration can be and are merely using the word as something to paper over a large series of budgetary cracks.

Anybody notice the similarity between the new NCB and the former NCB (National Coal Board) in terms of integrated efficiency on a mammoth scale?

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