Darzhole centres costing more, delivering less, we mean nothing.

We have been waiting for this story to break and had even toyed with the idea of suggesting it to the medical press but it seems our friends at Pulse have worked it out for themselves. Now what is interesting is the lack of detail as to whether payments have been made for early closure and more importantly how much. These details are “confidential”.

Now given that this is public money that is being spent why should these figures be confidential?

There are one or two reasons for this. The first is the tax paying public would not like to know how much money has been squandered on flights of fancy by those with whom they went to school especially when they realize that these “world-class” commissioners of expensive white elephants were those who were close to the top of their remedial classes at school.

These “world-class” commissioners who negotiated the contracts probably thought they was wicked because they had big numbers involved (more than all their fingers and toes combined at once) and had words printed in a big book with many pages that someone would read to them and they would have put their X at the bottom with their best crayons and thought they were well hard.

The problem was that the commercial sector did an even better job and provided very poor value for money and rubbed their hands with joy at how easy it was to get their hands on taxpayers' money for doing sweet FA but then they knew they were dealing with the “world-class” remedials who were, and still currently are, NHS Commissioners/managers.

We heard rumour, after one of the team’s recent trip South of Watford Gap in July, that the pay-offs are of around twice the annual cost of running a Darzhole practice which was estimated at around £ 1.1 million a year.

If this is the case then not only did “world-class” commissioners get suckered into paying an absolute fortune for contracts that when the targets agreed were met the providers just stopped working but still got paid and do remember 2 patients a day is a lot of fingers to count up and write down in a contract at the same time but best of all is the fact that taxpayers' money is being used to pay off contracts that will be delivering bugger all healthcare for their buck.

This is a scandalous waste of taxpayers’ money paying private firms or PCT stooges to deliver nothing. Of course the real losers apart from the taxpayers will be the local GPs. Now in areas like the Isle of Wight with its one registered patient there probably won’t be much of a capacity issue but look at our post from 2009 and read about spearhead PCTs which are those that cannot provide enough GPs for their population.

Look at those in the top twenty or so of the “world-class” commissioning league table and look at the names at the end of this week's Pulse article. We count 7 out of the 9 on Pulse articles list are in the “top” of the league table but have a look at this list of the spearhead PCTs and see how many of the list of 9 in Pulse are spearhead PCTs we counted 5.

Now spearhead sounds like an elite military unit until you realize that spearhead is actually pronounced as sink in front of the word PCT in a similar way that the word sink is applied before the word estate to describe areas where most politicians would choose to live if they were that lucky to earn so little in order to be able to do so.

So in areas that are under-doctored “world-class” commissioners are paying private firms public money to shut down white elephants that these “world-class” commissioners (morons) agreed contracts for and best of all are paying people NOT to deliver any healthcare to under-doctored PCTs. So much for "equitable access" comrade commissars. The comparison between certain Southern African dictatorships and Za Nu Labour cannot be more relevant (with thanks to Guido Fawkes blog for this little gem).

Will anybody be looking into the true costs involved and investigating the “commissioning” activities of those "world-class" commissioning managers involved?

Somehow we doubt it but we know who will pick up their failures and that will be whatever remains of the local NHS but it won’t involve any extra work for the “world-class” commissioners will it comrades?

More vodka and caviar to celebrate another successful private/public sector misadventure? No doubt many more will follow.

Praise be to the “world-class” commissioners who could not organize the proverbial in a brewery when they were flush with money and were given instructions on how to do so. No doubt their expertise will be available to the newly formed GP commissioning groups who will have to make do with less and will be welcomed like a handful of molten metal.

The future is truly bright for when the private sector fails and "scores", the public sector and the taxpayer will have to pick up the pieces. Time and time again but no doubt efficiency savings will make good all of these “world-class” commissioned losses of hard earned taxpayers' money.

Won't you comrade workers?

Would you believe it?

Upon opening one of the GP rags this morning a headline screamed out at us here at ND Central.

“Patients shun ‘wasteful’ Darzi centres” it read and yet only a short time before another GP rag said “NHS Choices ranks Darzi centres top”. Surely a slight difference of opinion here but look a little deeper at the first story. The GP magazine contacted 95 PCTs (out of 152 in England) and found some interesting facts about how many patients these Darzhole practices had registered.

Remember these practices are organs of the fromer Party Za Nu Labour’s muppet Lord Darzi, the Iraq born Armenian,  Irish trained surgeon who, based on his vast ignorance of general practice, was asked to advise Messrs Brown and Blair on how to reform it. He pulled from his black hole of knowledge of general practice the idea of the Darzhole practice which led to their imposition creation.

We have commented before how they fit into the Soviet market model that is today’s tripartite political model for healthcare but let us now present the findings. Remember too that the Orwellian porcine principle was applied to all PCTs so that all PCT porkies were considered equal and got the same number of Darzhole centres regardless of whether they were over- or under-doctored. (We love true political equality here at ND Central).

The figures are as follows:

12 % have no registered patients

26% have less than 500 patients

35% have less than 1000 patients.

The most damning figure was that on average the cost per practice per year is £ 1.1 million.

Now we can only go on local experience but a practice with a turnover of about £ 1-1.3 million a year normally has a list size of between 10000 - 12500 patients not none, nil points, zero patients on its list.

We will let you do the maths as to cost per registered patient but look in the article about NHS Isle of Wight which has just one registered patient. £ 1.1 million to spend on one patient they are going to live forever!

This might explain the second headline bearing in mind that virtually no-one uses NHS Choices for choosing anything so for them to claim Darzhole centres are ranked top is to be viewed with deep suspicion but just think if you are the only patient would you ever have a problem getting the phone answered, an appointment when you needed it or to see the doctor of your (NHS) choice?

Your call would be highly valued by a Darzi centre and would be jumped upon by staff with nothing to do in contrast to the real world of general practice where 10000+ patients all want the phone answering NOW.

Perhaps we could make a helpful suggestion.

Given that these highly expensive and underused centres are public money going to waste, perhaps every GPs’ surgery in England could give a list of their top one hundred time wasting heartsink patients to their local PCTs with a view to utilizing under utilized Darzhole centres with patients whose needs are clearly not being met by overstretched underfunded normal GP practices.

Such patients could be told that there is a surgery that will see them at any time and they would never wait for an appointment. If they are quick they could in fact be the only patient at that practice but it might mean a bit of a trip but we are sure that given private sector involvement their every need would be catered for and the PCT would pay for their trip to the Isle of Wight (“we could even have a holiday as well as see the doctor!”).

Just a thought for any new commissioning group keen to utilize underused local GP services efficiently and mop up any inefficient capacity issues within the global corporate structure . . .

Priase be to the Party for giving us Lord Darzi and for the way he has transformed general practice (not), improved access to GP services (for a few) and for all of his and the Party’s financial prudence in doing so. Clearly such good value for money and increased equitable access for all patients especially the one on the Isle of Wight?

We dare anyone to say he was wrong . . .

NHS General Practice, vets and Darzi centres too

There is a popular myth that if the NHS did not exist and if it were not free at the point of service then the whole population would die a hideous death from undiagnosed and treated illness.

We know this is true as every other nation in the world is swamped with death due to a lack of free healthcare but amazingly “suffers” with better health care systems than the NHS which is dropping year on year in the international rankings.

One of the ND team did have need to consult with a veterinary surgeon this weekend and despite this nation being a nation of dog lovers were amazed to discover that you had to pay to see a vet. Surely not?

Now ND does not disrespect vets as some of the team trained with them and by enlarge they are slightly more intelligent than Drs. What really p**d ND of was the fact that the cost of the consultation was cheaper than an NHS Direct phone call.

Granted the person to whom we spoke was a qualified vet, who took the trouble to listen to us, to examine the dog, the patient, and even more amazingly, we were not sent to A&E or our GP and a computer was not consulted to make the diagnosis.

The appointment system ran at 10 minute intervals throughout the day, a Saturday, and we only had to wait an hour and twenty minutes to get an appointment. In the 20 minutes we were there in the waiting room they took £200 from the paying punters who by and large were happy to part with their cash.

This was a well organized practice who had managed to provide a 10 minute appointment system without a government diktat. It is also a teaching practice.

Whilst the idea of paying for healthcare is heresy in the UK if you want to reduce waits to see a doctor then the idea of a charge for A&E attendance or to see a GP we suspect would reduce waits of weeks down to days or even hours. The thought of having to part with some cash to be told you have a cold or a sore throat, that will get better on its own would, we suspect, put most of the punters off wasting Drs time after a few attendances with life threatening or “emergency” consultations that are not treated but do cost (the taxpayer at present).

Whilst doctors cannot treat animals we believe that vets are able to treat humans. So if you want to be seen quickly by a qualified person you might consider seeing a vet rather than a phone call to NHS Direct. It will be cheaper and you will probably get more out of it although you will have to pay out of your own pocket rather than out of your taxes.

The Party thinks that the private sector (the vets, rather than the GPs) can do things better and they can but, and, there is always a but, in this case a huge but, the public will have to pay for it some how. The apparent move to Darzi centres being provided (possibly and mostly) by private providers will cost us all but not at the point of use which is OK to Joe “the plumber who charges for their service (and it will cost) but expects his health care for free” Public.

Some figures seen by the team on their travels suggest that the cost of a “Darzi” centre could be between £ 900,000 to £ 2 million a year to provide a 3 doctor practice as against a £ 1.2 million a year to provide a “normal” current NHS 8 doctor practice in the same area.

Of course like the vets the Darzi centres will be privately run and like some veterinary practices these are staffed by salaried vets in training who do not earn as much as their owners who will cream off the profits. So if there is a fixed pot to run a Darzi centre you can see what will happen. Staffed by cheap salaried doctors with happy rich owners.

Quality is said to cost. Crap also costs. Will Darzi centres provide the same quality as good vets do?

These are being applied equally across the country regardless of need so may provide a degree of catch up in providing extra doctors in areas of need (if they can be recreated to work in these areas) while providing more doctors in already well doctored (popular areas for GPs to work in) regions. Some may be of use but others will be hugely expensive white elephants unless you are the owner of a Darzi practice. These white elephants will be funded for 5 years and properly earn their owners millions in the process.

Of course there may be large capital start up costs for premises etc but we at ND do wonder if the move towards privatization is actually going to cost more than it can ever save. The team at ND know that if we were greedy then providing less than half the service we do at the moment at twice the costs would mean we could each earn more than the £250,000 that all Northern Docs’ do already (not) earn. And we would have to do none of the medical work to earn these sums the salaried vets would do it all for us!

Praise be to Lord Darzi for helping “improve” primary care and to the Party but at what cost to Joe “the Plumber who charges for their service (and it will cost) but expects his health care for free” Public?

Time will tell if it will be as successful as the Independent Sector Treatment Centers have been.