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?