Sunday, 17 February 2013

Tales from the Darkside 002: Gok does commissioning.

Now whenever you join a new "gang" as a NewbieCom (new GP commissioner) there is inevitably a steep learning curve which involves a trip to the ghetto to learn the new gang's language. There is also an induction process whereby all those thick kids at school who took the p*ss out of the boffs now have to tell the boffs how to do things properly (not).
The learning of a new language is hard and the term OD which to most doctors means overdose is now used for those of us NewbieComs to mean Organizational Development. We prefer the term institutionalized retardation.
Well girlfriends one of our first sorties into the murky world of clinical commissioning as NewbieComs was an eye opener for those fashionistas among us here at ND Central. We who would normally strut our stuff in a shade of green off set with a subtle hint of max factor face blackening blush were astounded at how much time the fastionistas in the local Soviet spent talking about CQUINs, darlings.
Don't know what CQUINs are darlings?
Of course not girlfriends you are mere GPs (as are we) and patients who pay for the health service so you don't need to know about these pretty, pretty sparkly things that cost you all so dear. And CQUINS are one of many of those many 'brevs (abbreviations) which those into NHS retardation have to work so hard to impress us with so pump those 'brevs hard girlfriends and work 'em ladies.
CQUINs stand for Commissioning for QUality and INnovation.
CQUINs are a classic example of NHS glitz and glamour versus old-fashioned real hard care medicine. As NewbieComs the local retards told of us how they "negotiated" many, many pretty, pretty sparkly CQUINs to "improve" local healthcare and they thought they were "epic" as they bored us with tales of daring do and how clever they were at obtaining value for money and raising care standards with their pretty, pretty sparkly CQUINS.

Until the NewbieComs read what the CQUINS were and dared to ask questions. The detail was hidden behind the briefing paper but doctors are used to reading huge quantities of information quickly and extracting useful data and using it quickly particularly when they see through the bull they are being bored with. 

NHS manager do the reverse they produce huge quantities of information and hide behind it thinking that those thicker than they will be put off by a huge pile of dung. 

We NewbieComs noted that half a million pounds had been spent to prevent a very common complication of a very common hospital procedure. We noted that what had been agreed between the local tractor plant and the local Soviet and signed off meant that the local tractor plant got paid to prevent this complication but managed to exclude every procedure that actually caused it via a pretty, pretty sparkly CQUIN. 

Remember dear reader that those who work in PCT land are in the bottom third of the UK comprehensive system while those in hospital administration are slightly brighter than that, but only just. 

The NewbieComs, after their speed read of detail that would have taken years to produce, dared to ask in a scene reminiscent of Oliver Twist where Twist asks for more, why in the agreement had the local Soviet agreed to exclude every procedure that could ever had led to this complication with the local tractor plant? 

There was a stunned silence as those in the remedial class realized that they had been done, to use a Northernshire expression, which means to have been found out by the teacher. Various excuses followed like the dog ate my homework, I left it on the bus followed by there was "clinical involvement" honest guv so it can't be our fault can it? 

The NewbieComs asked what "clinical" involvement was involved knowing full well it would have been a 20 stone 5 foot HCA whose sickness absence would have greatly exceed your average firefighter's days at work in the last 6 months and who would always appear to be the only worker in a BBC documentary on acute health care showing them serving numerous cups of tea and advising consultants on heart valve replacements and liver transplants dressed in scrubs. 

Only someone that qualified would have been available to those in the local Soviet to provide "clinical involvement" for they would never ever have done the procedure involved in the shiny CQUIN. 

CQUINs pretty, pretty useless things costing a fortunate and delivering sweet FA. What is worse with CQUINs is that after the first year where the local tractor plant gets paid for the work they don't do, the next year the pretty, pretty CQUIN gets written into the contract at no extra cost to the local Soviet. So in essence pay lots of money for nothing to improve nothing and get nothing in the following years and the tractor plant is laughing all the way to the bank.
Praise be to the Party for ensuring that if you exclude the bright in (world class) commissioning you get world class sh*t (sorry re grunt word). We would like to think it might get better but after our first few sorties into the dark Lord's realm we are sure there is plenty more to find.

The dark Lord is still in control as are his very thick storm troopers.  More Staffords vicar?

Sunday, 10 February 2013

A trip to the doctors.

In Northernshire recently we have been bombarded by a series of strong gales, falling temperatures and snow on the ground causing widespread disruption which when combined creates the wind chill effect which means it is bitterly cold. To use the local term (politely) it is freezing our rocks off and there is more to come.
So one of the team, while on a trip to their own doctors, was amazed to watch the TV screens in the waiting room pumping out Party propaganda supplied via a massive satellite dish mounted on the surgery wall for the masses who were waiting for Party care on relevant health issues at this time of year. The team member was supplied every 3 minutes on the TV screen with information on how to deal with a heat wave.
Praise be to the Party for ensuring that in the same way that we were (probably not) the best prepared country in the world for the great flu Panicdemic our population via its state sponsored TV screens in surgeries will now be the best prepared country in the world to deal with a heat wave.
In January? In the United Kingdom in winter? You cannot make this up.
And people are being paid for this out of our tax pounds? What next how to deal with frostbite in the middle of a flaming (wet) June?

Thursday, 7 February 2013

Francis report first thoughts.

Today has been one of fragmentation in terms of communication regarding the release of the long awaited and much delayed Francis report. We drove to work in the dark to do a Gordon (system needed) as opposed to a patient needed worthless exercise. 

We caught a bit of news before work, were at work where we were teaching medical students who knew nothing of Francis and then doctors in training whom we instructed in how to care for patients properly (as individuals) as opposed to local healthcare services (system medicine). 

At lunchtime in the usual 2-hour 2 bottles of wine business lunches that we as GPs normally enjoy 15 minutes of munching a corned beef sandwich, double deep-fried of course, in the mess we downloaded the report and did 2 searches of the document. 

One was for the word Bower and the other for the word Nicholson and found 2 and 6 matches in the 455 pages. 

When we got home we watched the more intelligent and in depth news whose summary was it was a "system failure" and that was why no individuals were named in the report (whitewash?).
As we drove home we caught a bit of bleating, actually a lot of bleating by some bloke called Nicholson who with others missed 1200 excess deaths and was saying sorry so many times it became boring. Later news had Marshall DC saying sorry and add the two lots of sorrys together and it makes the Nick Clegg video spoof seem like a joke that wasn't very funny. 

Presumably if this is the case the "system" was to blame for a few million mass deaths in world war 2 and the Nuremberg trials were a travesty of justice for they singled out a few individual for a system failure for which they should not have been held accountable? 

No doubt if this line continues the Party's response will be to single out the "system" which will have no impact on any individuals who make up and indeed ran the system. The system that ran under Za Nu Labour at the time is at fault but at present will continue unabated and will be financially rewarded by the Parties. Does that mean patient care will get better or that there will be more sorrys to come for sorrys are cheap high quality patient care is not? 

Praise be to the Party for telling us that NHS stands for the National Health System and not a Service and as such a System cannot be blamed or be accountable for the failures of the individuals that make the System up. 

Stalin is quoted as saying that one death is a tragedy a million is a statistic. Is the modern day equivalent that one mid Staffs is a tragedy while a nation of Mid Staffs is a System success due to political interference reform? 

We have to wait 3 weeks to find out how the Parties will play this one. Continue with a failed system or reinvent it? Once again the victims have been failed and at present it looks like the perpetrators will not be blamed or accountable they just have to say sorry. 

Sunday, 3 February 2013

He just doesn't get it.

On the front page of the new format Pulse magazine is pictured a certain Dr Laurence Buckman who is quoted under the headline: 

"Leader of a defeated profession" 

as saying: 

"Ultimately, the Government holds all the cards." 

Now we know we are all thick oop North, but Dr Buckman can you answer our simple question? Who gave the Government all the cards they are playing with now? 

Do you remember who negotiated the 2004 nGMS contract Dr Buckman? 

Did you ever read the bit whereby the government only had "to consult" before changing the contract before you recommended GPs to vote for it? 

The nGMS contract was not a "contract" it is a get out of jail free card in perpetuity for the Government that you gave to them free of charge. If our thick Northern recollections are correct this was "to cover the flu Panicdemic" and other such "emergencies" like a budget deficit. 

Praise be to the Party for the BMA and its negotiators who for a few cream cakes and  a few teas in Whitehall and the hope of a gong gave the Government all the cards.
Perhaps Dr Zorro would like a starter for one for his new idea?