Maverick mischief or is the worm slowly turning?

As we prepare to fire up the Ferrari for another early Brown shi(f)t, we have learnt overnight by carrier owl, we love stealth technology oop North, that there has been a surprise result in a by-election in a southern part of Northernshire. It would appear that none of the current Tripartite government parties have won this seat instead a maverick is now the elected MP overturning almost 40 years of it being held by one of the tripartite parties.

UK by-elections mid term often throw up surprises which are usually reversed in general elections but this is quite a big early morning surprise.

Praise be to the Party for allowing the people to still vote in elections even if they then ignore what people actually voted for after they have won.

If it is working, investigate?

For many months we have been trying to find out what percentage of referrals are currently made via the Government’s huge white elephant of failed IT called Choose and Book but haven’t found anything. Other figures like the percentage of referrals made by doctors vs secretaries have also eluded us until yesterday when we found this.

We have posted many times before on this huge and useless pile of NHS retarded computing which serves one and only one purpose to gather referral data for the Party. It has, and never has been, about “choice” unless it is to allow NHS managers to restrict true patient choice it is merely a bean counter for NHS managers and part of the (failed) commissioning process.

We respectfully submit to any investigation the following reasons as to why there is a fall in Choose and Book bookings in a simple format used by its architect (hint TB):

1) It is crap
2) It is crap
3) It is crap.

So if ever an investigation is never required it is into Choose and Book. If you have never ever been involved with it, used it or being on the receiving end of Choose and Book it seems a good idea - in theory. In Practice it is a nightmare.

All any investigation needs to do to find out why people are not using it is to try using it in the real world. Such an idea might be dangerous for it might involving those who support C&B interacting with real patients, dealing with real NHS IT and all its huge failings so will never happen.

Praise be to the Party for once again deciding to hold an investigation into something not working rather than fixing the actual problem. If something is good and works people use it. Any NHS manager able to work out the corollary to this argument?

No wonder you need an investigation.

Trouble at t’pumps and politicians.

At lunchtime, after an early start, we ventured out from surgery to do a home visit but before attending to this acutely mobile patient with nothing wrong with them one of the team had to attend a supermarket to get some vitals. Clutching the list we did in the Ferrari ventured forth only to be met by queues akin to the Christmas Eve rush.

The queues were not at the checkouts but at the gasoline station and were actually stopping our patients from getting to their usual lard fix from the supermarket itself.

While traversing the vast Northernshire emptiness from a branch surgery to a local supermarket across the high moors and through the deeply wooded forests of Northernshire we had been listening to various radio stations belonging to the British Broadcasting Corporation usually called the BBC most notably the airplay of Radio 2 and 4.

While there was the usual Party spin of there is no problem comrade the media seemed to have stumbled across a load of Party dullards whose knowledge of what they were talking about was somewhat suspect regarding the fuel crisis and the journalists interviewing them were having a field day. For with each question they were asked the politicians dug themselves deeper into a pit of ignorance while the journalists piled more earth on top of the floundering politicians.

The bits we listened too and were were the news at 13.00 on Radio radio 4 (07.10 mins onwards), a phone in on BBC radio 2 and on channel 4 news here the piece de resistance from this program is here the interview with energy minister Charles Hendry.

The message was don’t panic stay calm but be prepared. Hmmm.

Anyone remember the flu pandemic a few years ago? It is almost deja vu. Still as GPs we still have our all protective anti flu masks and know how to sneeze into our elbows and so this alone will surely magic up some petrol when we most need it?

So comrade healthcare workers listen to your ministers. Fill up your Jerry cans (illegal due to the volumes of fuel in them), put them in your garages (only 22% of comrade workers have them presumably more will have stable blocks instead?) and rely on the fact that no minister will have a problem with a fuel shortage for we are all in this together.

So when you need more fuel for your Ferrari for a 300 round trip tomorrow you can rest assured that in the same queue for aviation grade 5 star extra leaded petrol (if you can remember this at the pumps you are old) you will see Marshall DC and Sam filling up their people carrier, just in case. They will of course not be panicking just being prepared.

Praise be to the Party for repeating the lessons of the flu pan(ic)demic and starting even earlier this time. When nothing is happening (no fuel drivers’ strike has been announced yet) panic the populus. It might make you feel good.

At least it gives you time to er think? Now where is the army? Afghanistan or Dewsbury?

Oh no not again.

The Party loves cards. They are no different to when in junior school certain individuals devised a gang and allowed only certain people to join their “gang” but you could only be a member if you had a “card” issued by the “leader”. No card and you were not in the “in” crowd.

This playground mentality unfortunately persists into adult life as both left and right wing extremist parties have all had similar party card schemes. The NHS is no different for it too issues cards. These actually have a protective function for patients for if they see any individual carrying one they should run a mile.

When we go to meetings there is always a group of people who have been in the bottom third of any Northernshire comprehensive school who got prizes for turning up once or twice a year in a corner forming a circle and instantly identified by the NHS (Dumb) Smartcard wrapped around their necks on an NHS necktie thinking it makes them look important.

They think wearing a NHS Dumbcard round their neck is a sign of “corporate identity” but it is actually a sign of corporate incompetence.

The teams’ attention has been drawn to this website, and this one and another one too and yet another Party card.

What a good idea your average Daily Mail reader will think. We can identify the evil ones, the devil’s spawn causing all UK hospital acquired infections by just giving them all a card. Excellent and by jingo we will have Cl. difficile on the run by Christmas. Another sherry vicar and how are all those wayward children you have been looking after recently?

Read the propaganda above. Look who is providing the information as to how they feel it is useful. Its Debbie, a nurse “consultant” in public health no less, in a sink PCT. Debbie clearly knows nothing but thinks a card will help all and she says so.

Perhaps Debbie (or more importantly her friends who put her up to this) has other ideas for those who should carry cards? Maybe a compulsory card around the neck for the following:

HIV/AIDS                                                                 85,500 (HPA 2009)
MRSA infections                                                        1898 (HPA 2010)
Illegal immigrants                                310,000- 570,000  (Home office 2005)

Working age benefit claiments       5.8 million (Department of Work and Pensions 2011)

The list is endless.

The point is what difference does such a card make? It only identifies those who have HAD Cl. difficile not those who MIGHT have it. If your card carrying patient needs an antibiotic that might cause Cl. difficile to treat a life threatening infection what will a doctor do if a patient presents the card to them?

Would they:

1) Refuse to treat the patient as per card? You might just get really ill rather than die?

2) Treat the patient to the best of their ability even though there is a risk of potentially serious consequences?

3) Do nothing? This is of course the NHS manager’s preferred option as it is cheap and the patient has a NHS sanctioned card?

4) Refer to Debbie who as a “consultant” will never be there before nine or after three?

5) Refer to an NHS manager – see 4?

6) Refer to the card issuer and ask the patient for their PIN? No PIN no treatment?

Whichever retarded Northernshire PCT (and there is more than one sink PCT playing card games) thought this up it has the same potential for discrimination as the Nazis and their yellow stars had. See the Press link above as to how the card would keep the superbug "out" of hospitals.

Given that 3% of the adult population in the UK have the potential for Cl. difficile infection and that Central Lancashire has a population of 457, 900 this means that 13,737 may have the potential for Cl.difficile infection.

So Debbie’s 222 cards (1.6% of potential cases) will make sweet FA difference as by using a high tech NHS stealth cards she will have hit the one latrine tent in a 100 square mile sector of barren desert and missed the huge army of several thousands marching towards her until these unknowns show up with the sh*ts but it is too late then. She will never have seen them as a nurse “consultant” in public health in a sink PCT will she because they do not carry the card?

Still cards are cheaper than real nurses just ask any “consultant” as they daily toil on the wards delivering hands on patient care to those with real Cl.difficile infections. For when real patients have Cl. difficile they want boots on the ground real hands on nursing and medical care even if that means getting someone covered in the proverbial. For when you are seriously ill that is what counts.

Not a card.

Praise be to the Party for ensuring that diversity training for NHS managers means the same as the Shorter Oxford Dictionary word discrimination.

Creeping practice boundaries.

One of the Party’s great ideas is that patients can register with any practice even if they do not live within that practice’s boundary area. For most patients this is not usually the rule. If you don’t live within the practice boundary GPs will not normally register you.

The main reason we suspect why this is still maintained is the fact that registered patients would expect a home visit from their GPs. Too large a practice area leads to a lot of time wasted traveling rather than doing medicine. We suspect that the above idea was fostered by a small group of about 600 patients to whom these rules do not apply. You can see what is provided for them here which we are sure will appeal to the 35 per cent of them from private schools.

When we did our basic GP training we were asked to find out which patient at a training practice lived or worked furthest from the practice area. One of our GP training group was at a practice which had the local MEP on their list so clearly a lot of time would be spent in Brussels or Strasbourg troughing up their expenses and so home visiting would be very time consuming and expensive for the practice. As would any chronic disease management e.g. obesity, increased blood pressure and idleitis sorry stress.

Now for some MPs and we can think of one recently retired prime minister who lives and works almost exclusively from home this will cause no problems. However a lot of MPs actually go to work at the Palace of Westminster and will be resident nearby so being registered at a practice in furthest Northernshire could pose some logistical headaches if they needed an urgent consult for say piles.

It is a little known fact among the British population, which means it will be unknown in the Palace of Westminster, that if you fall ill you can still see a GP even if you are not registered with them.

We get frequent phone calls at holiday times from patients who fall ill while away asking for treatment both in this country and abroad. The advice is always the same go to your nearest surgery and ask to be seen as a temporary resident and no we will not fax a prescription for the 500 benzos you mysteriously lost on your way to your destination but we are so pleased you didn’t lose any of your other usual medications.

So in theory if this little known fact were more widely known there would be no need for any change. However politicians know better and there is a “pilot” trialing the idea that you can be registered essentially where you work but not where you live. We believe that they may struggling to recruit practices for this pilot which is starting this April 2012.

Perhaps what is also not widely known, and this is always the way with Party/DoH pilots, is that the outcomes of such “studies” are already known before the study is completed.

So even though the “pilots” are not even completed, GPs via their local Soviets are being asked to redefine their practice boundaries into an outer and inner boundary. Have a little read here. Most of this document is telling us what is to come even though the results of the pilots are not yet in, for they have not yet started, but the outcome will be sitting already printed in a filing cabinet somewhere.

The title of the document is “Choice of GP Practice”. You notice the Party’s favourite little C-word which tells you that it has been written by a Mr. Hobson and how much of the C-word will be allowed to all those mentioned in Mr. Hobson’s little missive.

Practice boundaries were established for a reason and were agreed by professionals who determined them in the context of what resources they had available to them. The same is so of the open or closed lists system which the document also discusses. If you have a partner or two off sick and/or on maternity leave then you may not have the manpower to accept more patients so temporarily restricting service provision is a safety measure. However the Party does not do safety only policy and dogma by diktat.

The Party does not see this for it is declaring that all practices are to have open lists (i.e. infinite resources) regardless of boots on the ground real resources. Practice capacity can vary on a day to day, week to week, month to month and year to year basis but the Party cannot see this.

We know that the Party leads by example in that for every debate MPs at their place of work will have 100% turnout regardless of illness, maternity leave and any constituency area and they expect the same of the people they allegedly serve.

We do not see them telling a shopkeeper to open their supermarket if all of their staff fall sick. No that is the free market where professionals decide what they can and can’t do. The NHS market does not allow professional decision making it allows only those who couldn’t hack in the real world of commerce to make such decisions on a political whim.

This document does not take long to read but it is chilling reading if you are a GP in an underdoctored area unlike here in Northernshire where the hardest daily decision as doctors we have to make is which 4 doctors can go for a round of golf in the morning and which 4 in the afternoon while still covering the surgeries which are rarely full for we have ticked all the QOF boxes in the first month of each year.

Life is tough up North.

Praise be to the Party for consulting on and piloting more NHS “reform” which has already been decided upon.

Emergencies.

This last week we have seen an ever increasing number of “emergencies”. In contrast to any other “market” driven industry where if customers want more they are charged more the NHS “market” that Andrew L., a right wing or Conservative politician in the UK feels is the way forward, is actually counterproductive for one of his tenets is the fact that no-one should pay for using it. No-one politician from the Tripartite coalition on healthcare has realized this fundamental flaw in their “market” driven policies for none of them have worked in healthcare.

At the end of a long week where all the highly trained and expensively trained healthcare professionals are feeling the strain of seeing no illness just self centered I want and I want it now, a session at the infamous Café Michelle resistance café has led us to produce this. It is based on the huge numbers of comments from patients and staff alike over the last few weeks and is based on a Country and Western song the original words above our take below in italics:

Our little boy came up to his mama in the kitchen this evening

Our patients kept coming up to us in the surgery this evening

While she was fixing supper

While we were on call and working late

And he handed her a piece of paper he'd been writin' on

It was called a complaint

And after wipin' her hands on her apron she read it and this is what it said

And while trying to do a surgery and dealing with numerous abnormal lab test results, requests from social services, Macmillan nurses, and telephone requests for advice and trying to see patients as well

For mowing the yard 5 dollars

For doing your accountants £ 10,000 a year

For making my own bed this week 1 dollar

For our legal advice this year £ 10,000 a year

For going to the store 50 cents

For doing your building work and cocking everything up and not fixing it £ 20,000

For playing with my little brother while you went shopping 25 cents

For being your local vicar

For taking out the trash 1 dollar

For charging you for hiring you 3 skips this year £ 800

For getting a good report card 5 dollars

For wasting time on appraisal

And for raking the yard 2 dollars

For cleaning up the PIP implants and other private sector cock ups

Total amount owed 14 dollars and 75 cents

A fraction of the cost if NHS GPs charged as per the private sector

Well as mama looked at him standing there expectantly

Well as their GP looked at their patients standing there greedily expecting

And I could see the memories flashing through her mind

And we could see our memories of them flashing through our minds

And so she picked up the pen and turning the paper over

If we could we would pick up a 9mm and . . .

This is what she wrote and I read it to him

This would be unprintable . . .

For the nine months she carried you growing inside her, no charge

For the nine months of antenatal care and even pre conceptual care and IVF treatment and your pathetic sick notes, no charge

For the nights we sat up with you, doctoring you, praying for you, no charge

For the nights you demanded home visits for a prescription for Calpol, no charge

For the time and the tears that you've caused through the years there's no charge

For your continued abuse of something that is free, no charge

When you added all up the full cost of our love is no charge

When you add it all up the full cost of UK General Practice to the patient is, no charge

For the nights filled with dread and the worries ahead, no charge

For being able to see a qualified doctor at any time with no illness, no charge

For advice and for knowledge and the cost of your college, no charge

For the costs to the doctors of the future for their advice and knowledge needed to treat you then, no charge.

For the toys food and clothes and for wiping your nose there's no charge

For free prescriptions, free referrals, free treatment, and answering all your pathetic complaints for not getting what you wanted only what you actually needed there’s no charge

When you added all up the full cost of our love is no charge

When you added all up that UK General Practice provides the full cost of our care is no charge

Well when he finished readin' he had big tears in his eyes
And he looked up at his mother and he said mama I sure do love you
Then he took the pen and in great big letter he wrote Paid In Full
When you added all up the full cost of our love is no charge

If only.

And still they come with ever more non illnesses for which they value us even less but it is always an emergency and of course, no charge.

Praise be to the Party for if only the misuse of the NHS was as easy as the child in the song to control.

The child learns a lesson through its ignorance. The NHS misusing patient is only rewarded by politicians for misusing it for they promise ever more.

Spot the difference?

It appears that 2 out of the 3 members of the current Tripartite political system who appear united in their view that market good, NHS bad are having a little disagreement over child benefit. Nothing new about that you might think apart from the fact that child benefit is paid at present to all parents and is not means tested. So if you procreate in the UK regardless of income the Party rewards your horizontal (or otherwise) jogging session(s) with a freebie. The more you jog the more you get no questions asked. It is a “right”.

One only needs to listen to our staff and our patients talking about the fact that contraception is freely available and yet their taxes are paying for people not to work and bring up large families to realize that a lot of people feel this is not a "right". This is but one view and certainly one very strongly held by a vocal group who have worked and brought up their own children on relatively low incomes compared with MPs or their evil under worked golf playing GPs.

But is there a more sinister subplot here the withdrawal of a universal benefit from some parents with children but not from all parents with children?

Is not the NHS a universal benefit? Where could this lead? If you earn above a certain level might you have certain elements of  other (NHS?) benefit withdrawn? Most "benefits" are means tested.

After all the counter argument to the one above we propose is that if you are rich enough (to have children) you can afford it (to do without child benefit) and therefore afford healthcare (for your children)? Or will there be a stealth introduction of withdrawal of benefit (co-payment) for the wealthier parent (patient)?

If 2 out of the 3 Tripartite members are disagreeing now how long will it be before all 3 agree? Think NHS and privatization over the years. Once they were poles apart now you can barely separate them with a piece of paper.

Is this yet another sign of the creep that the Witch Doctor in her blog alludes to?

Think about it.

Praise be to the Party for continuing to promote equality for all when it comes to universal provision of benefit. You know it makes sense? Can’t wait for the budget.

Saints and sinners

A recent conversation with our staff while officer of the day revealed how differently our beloved patients view and value their NHS. Our reception staff daily deal with probably 99% of our patients who use the NHS responsibly and are courteous human beings.

If anyone thinks being a GPs’ receptionist is a simple job they ought to listen to any doctor who works at ND Central in training who will spend a session in reception and they always comment about how difficult being a receptionist is. Our doctors in training are often used as gofers as they do not know what to do for simple things like how do I make an appointment for a blood test?

Yet as doctors in training they will, as do we as GPs, delegate tasks to receptionists to arrange on our behalf along with loads of other tasks seemly simple in isolation but taken as a whole a very complex series of sometimes isolated but sometimes interrelated tasks. Healthcare is not simple unless you are a politician who has never worked in healthcare. Indeed this is the only qualification one needs to be a secretary of health.

Our doctors in training learn to appreciate how many different things receptionists have to deal with – which appointment to make and with whom, which form needs to be filled in and what any costs may be, know which staff member is best placed to deal with an individual and how to utilize resources effectively for example does a request for blood tests and an ECG mean one or two separate appointments?

The medical side of reception work is relatively easy to learn but the more difficult part to learn is how to deal with the people who make up our beloved patients.

Receptionists are relatively cheap and if looked after get better and acquire local knowledge and can reduce workload for both medical professionals and patients alike unlike your average call centre worker, sorry NHS (re)Direct and NHS 911 healthcare “professionals” whose default is a pathetic “see your GP” we are not doctors but are pumped up to be so. Thank goodness our receptionists still make our appointments for us with knowledge of our patients.

So we return to the saints and sinners. The saint was a patient that a few weeks ago came into surgery with a condition. This condition had struck all of a sudden, was incredibly painful and affected them so severely that walking was impossible. The patient was brought to the surgery as it was the nearest point of help.

There were several other professionals nearby who no doubt had fully qualified first aiders, to tick a Health and Safety box but for some reason (other than costs) the patient dropped on us here at ND Central. Makes a mockery of Health and Safety legislation when if you are in an accountants’ office you have to walk down the road for help?

Our reception staff administered first aid, for in contrast to the usual daily and by the minute “emergencies” they see and deal with for this was unusual for the patient looked, and was, indeed very seriously ill.

The on call doctor was informed of the situation, gave advice and then summoned as the patient’s condition worsened very rapidly from when first informed and so they dropped everything to attend to this complete stranger for the best part of an hour, relieving pain and stabilizing their condition until they were transferred for further care leaving ND Central better than they were when first seen.

The on call doctor then proceeded to treat the remainder of their patients most of whom were prepared to wait having been told by the reception staff that the doctor had been delayed. Most of the patients had actually seen what was going on for initially all of this had occurred in the vast antechamber of a palacial GP surgery in reception until the patient stabilized and was well enough to be transferred to some where more private. Most of them brushed off the wait when we apologized for having kept them.

A few days later the same members of staff were on duty and witnessed what happened when a patient turned up for an appointment. The patient was told they did not have an appointment and that their appointment was booked for 4 weeks earlier. The receptionist concerned double checked, for we know that human error does occur but never patient error, and there was no appointment for that patient on the day that they decided to grace us with their worthy prescence.

The patient, a lot younger and fitter than our previous patient, said they had booked an appointment with Dr X for this f**king date and this f**king time are you calling me a f**king liar you twat you are only a receptionist?

This was interesting for Dr X had retired several weeks earlier.

The first patient whose condition was so severe returned to surgery in person a few weeks later. They presented some of our staff with very personalized gifts to those who had treated them and had even though acutely ill remembered individuals’ names as well as those others involved with their care.

The response of the second patient to the receptionist’s offer of an alternative appointment with another doctor after the staff member’s calm explanation as to why the patient could not see Dr X and the fact that they had got the wrong day was:

“You are all a load of f**king shit”.

Praise be to the Party for ensuring that all in the NHS are equal when it comes to abuse but many on the frontline are more equal. What Andrew L gets once in a lifetime and can walk away from with the benefit of ministerial piviledge he and other politicians ensure that as a result of their continuing intereference in healthcare our receptionists get on a daily basis.