Tuesday, 16 December 2014

Silly season.

One of the great things about living in a country with socialized medicine is that you also get socialized education for most. Those who can avoid it go to so called public schools or more acutely privately paid for schools by the parents of the offspring who go to these public schools. These produce a lot of politicians.

The medical press has been reporting one or two things in the past few days that might invite a little bit of comment. The first is that there have been record numbers of admissions last week.

How can this be? We mentioned that politicians go to public schools well NHS managers are usually the products of socialized education and NHS England acts as a repository for those in the bottom third of your average Northernshire comprehensive school. This intellectual elite have been foisting completely unnecessary pieces of work onto GPs in order to prevent admissions and A&E attendances.

So care plans, risk stratification, admission avoidance schemes all thought up by the elite of England’s management cream who don’t work in the private sector should have meant that there were no admissions. Of course these complete wastes of general practice time and effort have come home to roost as anyone doing these retarded piles of excrement realized as soon as they were announced. In the run up towards Christmas the old saying that the proof of the pudding is in the eating applies to NHS England’s plans.

But despair not dear reader for one of the intellectual elite has gone one better. You can read about it here. What a good idea from a man clearly with his fingers on the pulse probably of a patient with asystole and saying to all admiring his skill we have a live one here comrades while busy doing nothing useful about the situation.

This is clearly a man who believes that at 15.55 on a Friday afternoon all GPs up and down the land will be sitting in front of a warming fire supping cocoa and looking forward to a well earned weekend away from the coal face. They won’t be busy doing the something for the weekend Friday afternoon surgeries, seeing numerous extras claiming to be emergencies because they want their contraceptive pill they forgot to order as they are going on holiday tomorrow or they lost their benzo prescription in a fight when they were busy doing their Christmas shop lifting.

Just supping cocoa and winding down. So what a good idea to send an email out with cheery, practical advice. No doubt the computer will be switched on and the email picked up instantly and Johnnie and Joanna GP will spring into action to help an NHS England intellectual out in their time of acute need (for something functioning in between their ears).

They would surely call their man servant over and ask them to bring their leather bound phone book with the names and addresses of all those who are vulnerable and needy, all practices will have lists of these as a result of some of the above initiatives. The GPs could then ask their man servant to dial the numbers and after a few cheery words from the doctor all these patients will become well again and so not need an ambulance or a hospital admission.

And after ringing say one per cent of an average practice list size of say 1780 patients a mere 178 phone calls at a minute each the GP starting at 16.00 will have finished at 18.58 only 28 minutes after their core hours but what a difference this will have made.

And all thanks to yet another great idea from one of NHS England’s finest.

Praise be to the Party for not have to think to make this up. Whatever next an emergency requisition of a cocoa urn for each practice so that on Christmas Eve the GPs can go out dressed as Santa on a sleigh pulled by reindeer to deliver a warm cup of cocoa to each of their patients at home to keep them all out of hospital over the 4 day Christmas break?

Good idea I’ll email that one out at 17.00 on Xmas Eve just to check the idle buggers are still at work . . .

Thursday, 27 November 2014

A Gift.

Sometimes people who abuse the NHS free at the point of care just do not realize how stupid they are and how lame their excuses for doing so are too. Just look at this piece in a GP magazine to realize why the A&E politically generated "crisis" exists.

Now you have to admire a man who blames GPs for the A&E crisis and then insists that GPs working weekends will ease the A&E “crisis”. This is a man who has had the advantage of a highly privileged education albeit a PPE degree from Oxford University.

So let us apply some political logic here. If Mr Hunt thinks that GPs working at the weekend will ease the A&E crisis yet highly educated people “cannot wait” to see a GP no doubt because that will interfere with Tarquin’s trip to the pony club or Jemimah’s ballet classes or Daddy further screwing up the health service then clearly those less well educated than you will follow your lead.

It’s an emergency – whatever, whenever and it is free at the point at abuse by anyone.

Praise be to the Party for leadership from above and by example. Let us now wait for the first politician to criticize A&E waits or as an old joke goes let they without sin cast the first stone . . . put them down Jeremy and Andy . . .

Monday, 10 November 2014


The Party is desperate for patients’ data what they would call dirt that they could acquire to use for their own purposes called profit or dissing individuals. Imagine how and what they could use it for.

To this end it has taken over GPs’ IT systems, a seemingly generous act in that it “relieves” GPs of some of the burden, but left them with crap. They have created a national IT network that is slower than communication between the Apollo space craft and mission control and claimed this is “progress” (profit).

Instead of GPs having their own patients’ records hosted on a practice’s own server or previously in patient records written by GPs they now have huge data banks with many such discs (blade servers) holding the data which can be viewed at the click of a mouse by those with the right (Party) authority.

In the good old days to view one patient’s medical records you would have had to go to that patient’s surgery and request the paper records but now anyone anywhere in the world could hack in and get the information not just on one patient but on thousands. Indeed the NHS IT system allows access to servers from overseas to help with this process.

Of course the Party will claim it is secure and protected by numerous layers of security just like the Pentagon was/is which is why teenagers have been able to hack in over the years and nothing has changed apart from the continual denial of any problem.

The Party even(tually) gave patients the right to opt out of having an electronic record called the Summary Care Record (SCR) which a few did but then they changed the rules so that opting out of the SCR is not the same as opting out of the care.data Party shaft.

This is where the Party in your (its?) best interest allows plundering of your confidential medical records for Party profit for any commercial requester who has to pay a small consideration for information on you or others. The more they pay the more they get. The data they get is not to be patient identifiable but you don’t have to be a rocket scientist to work out who patients are for a trip to a local library to view the electoral roll will enable you do this.

The recent Electronic Prescription Service (EPS) is another example of how the Party seeks to improve things but at a price to your privacy. Did you know that instead of simply sending your prescription electronically to your nearest chemist which given the symbiotic relationship between surgeries and pharmacies may be very close by, the Party has decided to send all of your personal information, name, rank, serial number and medication details via and to the NHS Spine 2?

This information is then relayed not in milliseconds, remember this is NHS IT which is slower than Earth to Mars radio communication, this can take anything from hours to days to be sent from the NHS Spine to your nearest pharmacy depending on who you talk to. In fact printing a prescription and giving it to a patient to take to a pharmacy is quicker than the sub light speed of EPS and more confidential too.

And if you read here look at what else the Party does with this information. So if you have opted out of the SCR but opted for the EPS then you have in fact given the Party the right to extract your medicines data and add it to your electronic record depending how you read it?

What is not clear is whether having opted out of the SCR +/- care.data entitles your medication details to be omitted from the Spine if you use EPS. If you opted out of the SCR this did not mean that you had opted out of the care.data scheme did it?

Try finding an answer for the NHS IT system is what Adolf Hitler and Joseph Stalin dreamed of and any Party always wants control. Hence the desire to have centrally held records, centrally held appointment booking systems, centrally held electronic referral systems and more important central control of who can access this via the centrally controlled issue of Party cards, sorry comradesit is 25 years since liberation, the Smartcard. If one was generous you would say this is just for the needs of bean counters being met by IT for the simple benign collection of data.

If you were cynical you would say that this is a command and control structure of patients and professions which is being implemented by stealth.

EPS is not your GP simply sending your prescription to the nearest chemist it may be another way like care.data for the Party to get its grubby little hands on your personal medical data. So before you sign up to the EPS see if you can get answers to some of the confidentiality issues we have raised above.

Praise be to the Party for ensuring that the freedom of the Party to liberate your confidential information always trumps the freedom of the individual to medical confidentiality.

Does this mean that doctors who use the EPS are breaking patient’s confidentiality if the patient did not want a SCR and in doing so becoming organs of the State? Data mining by stealth and it’s your data and most importantly your NHS “Choice”.

Tuesday, 4 November 2014

Why you cannot get to see your GP the same day.

When our new medical students and doctors in training start at ND Central we ask these bright, intelligent, enthusiastic young people who have thus far been only been groomed in hospital medicine where they are daily exposed to acute life threatening emergencies how many of our book on the same day patients to meet a political target of 48 hour access to a healthcare professional are true medical emergencies?

A simple definition of an emergency is that it is a medical condition which if it is not attended to urgently will result in death or serious physical harm. Examples being a heart attack, meningitis, appendicitis, stroke etc.

Another definition is where no treatment might result in serious pain or disability if a medical practitioner is not consulted. For example a urinary tract infection which might result in septicaemia, a broken bone, a suspected cancer etc.

The final definition from North of the Wall is that an emergency is a complete waste of medical time but needs to be seen within 48 hours whatever.

This is the Gordon and Tony (G&T) school of Scottish education whereby the wishes of the Vicky Pollard school of advanced socialized medicine which is whatever, whenever I want it NOW it is a f**king EMERGENCY and it is FREE with no come back has come from and if I shout at a receptionist I will get it.

Such G&T crap displaces true illness from general practice via book on the day or 48 hour access Party diktat via QOF the so called “Quality” and Outcomes Framework where points mean prizes for GPs but frustration for genuinely ill patients.

Of course Scotland produces more doctors, has more doctors per head of population and Scottish GPs have smaller lists of patients per GP so pandering to Vicky Pollard the pathetic is easier North of the wall. 

So at this week’s cafĂ© Michelle end of the week resistance meeting we pooled some of our something for the weekend need to be seen within 48 hours top 10 “emergency” consults in the forlorn hope that the architects of this retardation might see sense. However when you are busy doing nothing useful in the Middle East (other than kill British soldiers) and “educating the world” to your same low standards it is indeed a forlorn hope. But then nothing ventured nothing gained. 

Every day, in every surgery in the UK this is what GPs’ Party determined 48 hour access work is. So if you are ill then read on for this is why you cannot see your GP on the same day when you might be genuinely ill: 

1) I need my x-ray results from yesterday. 

Not available. You were told that we get an X-ray report from a consultant radiologist a week after the X-ray was taken.

Thank you for wasting our time. 

2) I need my blood tests from the hospital. The consultant said they would be available last week and if I came today I could get them because I have a letter saying so. 

Strange your letter came by the Royal Mail and we have not yet received your clinic letter but it was only 4 days ago not the week as you lied claim and it normally takes 2 weeks if we are lucky to get an outpatient clinic letter as it comes via the internal NHS post which takes forever. There is always a backlog of typing for no one including you wants to pay medical secretaries more than a pittance.

NB in the recent past there has been an upsurge in the pathetic trying to blag results sooner than they have been told using G&T appointments. Still if you don’t get it first time try again and displace ill patients from seeing Drs because you are more important than they are.

Thank you for wasting our time. 

3) My 5 year old child has an asymptomatic wart on a part of their body normally hidden by clothing. We have treated it with over the counter medication and it has not get better what should I do? 

Nothing. It will get better on its own given time.

Thank you for wasting our time once again to be told what you have been told more than once before at this surgery. A wart of 2 weeks duration does not merit 6 same day appointments in 2 weeks for a non-life threatening "emergency" because it is doing poor little Tarquin’s and his mother’s head in.

Thank you for wasting our time. 

4) I am due to have surgery next week and they have sent me a letter suggesting it will not be a day case job as I thought it would be. They sent me a leaflet all about it and I am confused. 

Ever thought of reading the leaflet that explains all about the surgery you are having and what happens on each of the 14 days after it? You have had numerous outpatient appointments leading up to this letter which all say it is not day case surgery it is MAJOR surgery. 

Thank you for booking a same day appointment to clarify this. 

5) I need my ultrasound report and x-ray reports and still have pain but have an NHS referral should I go private? 

All your test results done a month ago are normal as you already knEw (a month ago) so it is your call.

Thank you for wasting our time to clarify this. 

6) I saw a doctor over a month ago who told me to book an appointment to get my blood pressure checked after they put me on tablets. I have run out of tablets so need some more. I haven’t taken them for a week can you do my blood pressure? 


Thank you for wasting our time so you can have a prescription but which bit of the I need to check your blood pressure AFTER treatment did we or more importantly did you miss? And thank you for wasting our time today and for booking your next appointment when only one was needed.

Thank you for wasting our time. 

7) My sick note ran out a week ago but I couldn’t get in because I was “busy”. I need one today or I don’t get my money (to buy more drugs). 

Totally predictable sick note needs renewing and try and blag some drugs as well 2-3 appointments every Friday without fail all by those as high as kites and on top of all the extras. No is such a lovely word to say to them combined with a friendly cheery grunt expression ending in off and die. Lethal force would be even better and save everyone for a few pence of ammunition a fortune (Police, out of hours, A&E, prison, probation service, social services, council housing, council waste disposal etc.etc.  . .  .) all of whom will be consulted with the same degree of urgency daily (can you get me some more drugs, a letter to avoid court, get me rehoused etc.etc.).

Thank you for wasting our time for your emergency blag of something for the weekend. 

8) I have had this skin problem for years, have seen a consultant, have had biopsies and had treatment for it 10 years ago and if I do what I am told I can look after it but it is no better. 

Same day appointment for all of the above because you are not happy that you have an illness that is not in the least bit serious or harmful and is what is known as chronic and which you have omitted to treat hence need to be seen today?

Thank you for wasting our time. 

9) I need a repeat contraceptive pill prescription. 

So you had your last prescription a year ago and it was totally predictable when you would run out. Instead of planning ahead you needed a same day appointment for this? And during the course of your consultation you moan about how far in advance you have had to book your taxi for a wedding reception this weekend and how much it will cost you to go 33 miles to your best friend’s wedding?

Why not try booking it this weekend for free 5 minutes before you are due to be there?

Thank you for wasting NHS time. 

10) My relative has had an illness, usually not related by genetics, and a friend has told me I should see a GP urgently (on Friday afternoon at 18.27) to get a blood test – just in case. 

Would you like to book a flight in Concorde at the same time because your friend said it was urgent?

Thank you for wasting our time.

So please dear reader think about our definitions of emergencies above and think how many of the above examples qualify for the first definition? How many for the second? And how many of the above are G&Ts for the Daily Mail readers?

GPs as professionals used to be able to define what counted as emergencies and things like results, repeat prescriptions or sick notes were once not eligible for same day appointments but amazingly illness was allowed. However these GPs were not educated North of the wall and so are thick and are why the NHS and socialized medicine needed G&T Care.

And our final year medical students and doctors in training after just one book on the day surgery realize how much Sierra Hotel India Tangos GPs see each day and after several weeks think I want to see illness not crap. Does any politician wonder why no one wants to be a GP?

Praise be to the Party for ensuring that all NHS 48 hour access appointments are emergencies and so displace illness to ensure that patient selfishness is treated way before illness by politicians. Ask of your politician why you cannot see your GP when you are ill and yet crap gets seen in your place? What do you think they will say?

I’ll have a G&T, Bob . . . see me in my next 2 hour surgery next month for this month’s surgery is so full I am so busy.