Tuesday, 29 May 2012

Flogging a dead horse?

While once again waiting for all the poor cripples attending an emergency extra extra extra surgery for I have run out of my pills or had this for 3 months and it is now a Gordon surgery we were busy surfing the net for tips on improving our golf and we found this little gem on the continued war of liberation of the NHS here.

There is quite a lot here to read and you can go to the original source material here which we only glanced at this afternoon - particularly like the Stargate like mystery knob design diagram (Fig. 1 section 2.6 if interested) and there is also  a reasoned editorial about the conflicts of current NHS IT policy.

The sentence that really caught our eye was this one:

"The DH is even looking at giving patients direct access to Choose and Book though NHS Choices so they can book their own appointments."

Comrade Marshals Dave and Nick bring this on ASAP to liberate the people from their chains! To do so will be to the medical profession the equivalent  of the tanker drivers winning by the mere threat of a strike but without them actually striking.

Think about it.

All patients have to have 4 hours training to use Choose and Book.
(That will delay all referrals to at least the next financial year or next Government).

In order to make it secure all users will have to be photographed and have a Smartcard issued taking 10 minutes each and needing 2 referees.
(A back door identity card scheme should be good for outing a few illegals and winning votes).

They would then need a PC and a card reader to get onto C&B.
(Equitable access you need a computer to get on line and then pay extra for a state sponsored Smartcard reader. All good deficit reduction via voluntary contributions to Party sponsors.)

There would be loads of playing guess where to find a service games. For example would gallstones be under:

General Surgery > Hepatobilary surgery > Gallstones

or would it be

Gastroenterology > Hepatology > Investigations

first and then the one above

or the local Soviets only dysfunctional hierarchy

surgeon >something >general dustbin> I feel lucky option.
(Playing such games would be bread and circuses to distract the people away from the economy for months).

If the patients get any problems there will always be a helpful PCT IT technician to guide them through their problems with words like "there is an issue with C&B we know about it".
(Or more likely by either not returning their calls or not answering them at all).

Having selected themselves from a huge secure database of John Smiths can anyone see what would happen? Wrong patient wrong clinic you can see it now can't you?

This is a challenge to the Party. We have not yet read the whole of the liberation document but if as Pulse says this is your idea then implement it ASAP with extreme prejudice.

If Choose and Book is as good a system as you say let the people decide!

The Party would know very quickly if it was sh*te NHS IT or merely illiterate GPs and their staff obstructing the Party's magnificent software. Patients are used to shopping on line, emailing, betting on line, booking car services, etc. with far less hassle than anything the NHS offers and more importantly getting something as a result.

Power to the people! Let them have true NHS "Choice".


Praise be to the Party for allowing a potential solution to a problem that GPs, their staff and their patients have endured on a political whim for years.

Choice has always been available on the NHS so please let the people decide if the alleged instrument of Choice is indeed that or merely the Party's instrument of control.

48 hours of patient power would be all that is needed . . .

Laughing all the way to the bank.

One of the greatest successes of the Blair/Brown administration was the ending of NHS dentistry and the preparation of the NHS for privatization. An article in the Daily Telegraph and on the early morning BBC news shows a report showing what a success their policy has been.

Now we are sure most dentists are honourable professionals who do their best for their patients teeth and forgo personal profit but we all know if you are paid to operate surgeons will operate whether the operation is medically (or dentally) necessary or not.

One of our attached medical students a good few years ago said that in their country obstetricians said that babes born by Caesarian section were more intelligent. They went on to explain that there were few trained midwifes in their country and so rather than attend a long labour the obstetricians prefer to do an operation because it was quicker and they earned more.

Needless to say this young doctor to be thought the NHS was a much better system because patients weren't being ripped off.

Of course we are also sure that no patient registered with a non NHS dentist will be forced to pay a monthly health insurance to remain registered for we know that if we charged our patients a £ 100 a year just to be registered, less than a TV license or a gym membership fee, we would earn more per year than we do by working full time. Any additional work like seeing patients for an additional fee would greatly increase our earnings towards dentist levels. If it works so well for dental care why not extend it from general dental practice to general practice?

But do not think as GP patients you do not get completely unnecessary treatment from your GP as well. They are called the annual QOF "checks" that diabetic, asthmatics and other Party defined disease sufferers get called in for. The only difference is that in contrast to a dentist doing work that will cost you the only thing you will lose for medically unnecessary work is your time.

Praise be to the Party for its continued commitment to make the NHS ever better. They are doing so well especially in the leader of the pack NHS dentistry. Well done lads and lasses and keep smiling or more likely laughing :)).

Saturday, 26 May 2012

Morphing and recycling.

A little piece of interest crossed our sights yesterday afternoon while once again playing golf in Northernshire and here is a link to it. You can see all of the full Party spin in all its glory here. The Party have published a list of all the new (GP led, allegedly) clinical commissioning groups (CCGs) and how many bungs sorry how much funding they will each get.

Remember the Party's great leader's commitment to reduce NHS bureaucracy? We are sure that you will all marvel at the fact that 152 PCTs are to be replaced by no less than 212 CCGs which no doubt will employ many times less people to do the same job as PCTs and so more will clearly be less. The Party is indeed great in its infinite wisdom.

If you look at the list that includes the whole of Englandshire you would think that all  of Englandshire has embraced GP commissioning with open arms. Scratch a little deeper and we know there are areas listed that have a named CCG with an allocated budget but where there is no CCG in existence as yet.

Have you also noticed the less than subtle recycling by morphing of NHS nomenclature? Look for your PCT by name and think back. Take our own local Soviet which was once Shiteton Health Authority.

Morph it once and it became via the mighty morphing machine that is Westminster:

Shiteton Primary Care groups (s).

Morph one more time and you have:

Shiteton PCT.

Another trip through the mighty morphing machine and Shiteton PCT becomes:

NHS Shiteton.

Change the Party and morph one more time and you now have:

NHS Shiteton CCG.

The sad thing is that all this morphing has not improved things it has only consumed time, money and effort to recycle the same individuals into the same jobs with different names in the same organization with ever changing names. Now we are thick up North but recycling bureaucracy time and time again does nothing to improve healthcare for the better.

La plus ca change la plus la meme chose?

Praise be to the Party for its continued commitment to recycling and morphing the same bureaucracy over and over again for no useful healthcare change or gain. It makes such good sense. So until the next great morph whenever that maybe we just carry on with the day job. Next!

Morph or patient? Which will come sooner?

Monday, 21 May 2012

The increasing cost of ageing.

For centuries crude indicators such as infant mortality and life expectancy have been used to define how "healthy" a country is. Although life expectancy in the UK has increased life quality has not.

We are living longer but not enjoying doing so. As life expectancy increases so does health need and as birth rates drop the income and personnel needed to service this increased demand become inversely proportional.

For simple grunts on the ground nowhere has this become more apparent than when signing repeat prescriptions. You can spend an hour or more some days checking and signing the repeat prescriptions for most of the practice sometimes 250 - 600 (depending on the time of year) for the bulk of patients who are on monthly prescriptions and then spend another hour or more of your time checking and signing what are known in these parts of the Northernshire as the "weeklies".

What are "weeklies" you may ask? Well they are not part timers like a certain Professor they are people who because they are old and gradually losing it receive their medication in little boxes which have a variety of names to ensure that they are prompted to take their medication. Seemingly a good idea but this is but the start of an increasingly steep slippery slope which goes one way only.

Often it is a carer or relative that suggests this because Mabel or George are becoming a bit forgetful. It is but a sticking plaster on the decline of people living too long as "winners" of the war of increasing longevity but living as victims of the peace that increased morbidity has secured for them (and us) . The victory has merely been on the numbers front only for the defeat suffered by us all is the decreased quality of life this increased survival has given us all.

Now most drugs come in packs of a month's supply usually defined as a 28 day or a 30 day month by the drugs' industry. When drugs have to be prescribed on a weekly basis with a daily defined dosage schedule and placed into a little box with different compartments then this causes the average retail chemist a problem.

Pull a pack of old age prolongation medicine off the shelf and dispense it the chemist will get a dispensing fee plus any profit over the cost they purchased the drug from a wholesaler that is reimbursed by the drug tariff price that the NHS pays for that particular drug.

However if a slowly dementing patient requires weeklies then this starts to cost the chemist time and money and as a result costs the NHS and GPs more. For instead of just asking for a once a month prescription the chemist insists on 4 prescriptions per month = 4 dispensing fees per prescription dispensed instead of 1 hence the "weeklies".

If you have ever watched a dispensary do "weeklies" for a pensioner on 14 drugs a month some of which are taken sometimes 4 or more times a day it is an incredibly time and labour consuming exercise as relatively inexperienced personnel suddenly have to take the responsibility of what a patient or a relative should do namely look after an elderly relative and their medication. Do the maths 14 drugs X one month drug supply = 14 boxes of drugs.

14 drugs X 4 weeks supply = 64 separately packaged drugs per month and then add in the number of times a day each of the 14 drugs needs to be administered and you can see the costs escalate to ensure that relatives are relieved of the responsibility of checking up on elderly relatives or that slowly declining patients can stand a chance of administering the drugs themselves with reduced risk of overdose or omission.

Heaven forbid that a paid carer could be allowed to administer a drug from such a weeklies box health and safety would ensure that a carer capable of taking paracetamol 4 times a day themselves would be incapable of administering a drug from a weeklies box they can only "prompt" the patient to do so.

So GPs and their staff have to evolve systems to cope with the fact that a small number of patients can generate more "prescriptions" per month than the rest of their entire practice population on repeat prescriptions. Now we will not say that this gives chemists opportunities for fraud.

However, when you as a GP are asked, by a large pharmaceutical company, to replace every prescription for a patient on a "weeklie" in a large secure institution, you do start to wonder if the "weeklies" are a bit of a con that needs addressing?

This minor concern follows a surprise "inspection", by a large pharmaceutical company's pharmacist, who just happened to be the same large pharmaceutical company's pharmacist who dispensed all of the weeklies and this "inspection" reveals that all of the weeklies so dispensed are out of date. And the large pharmaceutical company via the same pharmacist then asks the GP to replace every patients' weeklies as a result?

It is a huge waste of GP time, a hugely expensive exercise for chemists and ultimately a complete waste of time for the patients concerned as they nearly always land up going into residential or other care. Usually because of drug or other cock-ups.

Praise be to the Party for ensuring that its provision of care for the elderly is still as crap as ever. Work all your life, pay your taxes and then get bugger all as a result other than a little tablet box. Surely such august bodies as the future forum, the RCGP et al will be on this case?

This must be costing a fortune and the numbers go up every year that we have been in practice.