More joined up thinking?

This morning we trawled the medical press and found this article in the UK GP magazine Pulse. Not been able to find anything definite to back it up on the DoH website unless it is hidden in Sir Liam's fortnightly bulletin for journalists. A real rivoting read fully of pretty graphs all in colour too.

Later in the day when we were working we found that the Jobbing Doctor (respect) posted this piece.

What are we simple GPs missing?

A National Health Service?

The message?

Which is . . .

Praise be to the Party for its consistency in a “crisis” of its own making which means we here in the UK in general practice are clearly like mushrooms kept in the dark.

And when the "big one" hits, what then? Doesn't bear thinking about but we will have to cope regardless of such co-ordinated central "planning".

You could not make this up – could you?

We were here at ND Central were hoping to break the large amount of swine flu posts with something different but today institutionalised incompetence reared its ugly head again.

Readers may recall an earlier post about what the mask issued to our Practice to protect us would actually protect against.

One of our Practice nurses informed us 2 days ago that an Infection Control person was coming to collect the masks as there was a “problem” with the filters.

We shall keep you posted as to what this “problem” is, if we ever find out, although we suspect we know the answer as it might have been in our previous post.

Still the team will be on the phone to technical support at 3M the manufacturers and onto our colleagues at Porton Down and Atlanta CDC to find out if just perchance the local Thickerazzi have cocked up? After all given the option of a scalpel to do an operation versus a flint knife they would opt for the later as it is cheap and they would not know the difference as they still walk on their knuckles.

May be someone mentioned the “Health and Safety” word or asked a question like “do the masks work”? Imagine the commissioning process that must have gone on in a well prepared “world class” commissioning PCT.

Once again a top “world class” commissioning PCT in the “best prepared” country in the world sends out masks to protect us that now have a “problem” with the filters. And they want them back.

Why? To conceal the evidence of institutionalised incompetence?

We haven’t been given any replacements either.

It’s a bit like sending a soldier to war with a rifle and giving them ammunition that does not fit the gun. Yes, you have a rifle but it can’t do anything useful. Can we have it back please?

Praise be to the Party and all its wise planners. Did we also tell you that Tamiflu has already surfaced at local car boot sales? We are so well prepared it is unbelievable.

A Present from the Party, the success of the Swine Flu line and Things can only get better 003

Another day at the front and we each had on our desks a gift from the local Party commissars. Our own personal flu protection mask this time with not just one set of filters (2 per mask) but 2 X 2 filters.

Clearly this will be a long campaign for front line doctors to be protected against the hazards of interior decorating namely paint spraying and sanding which these masks are designed to protect against but our staff just have to manage without any protection. The learned local commissars feel that nurses and receptionists do not need any protection.

You can see what these masks are designed to protect their wearer against in the following paragraph taken from this link look for the section regarding the filter 2138 the ones issued to us to see how it protects us against swine flu. In fact are any of the filters designed for swine flu?

Some more research on the effectiveness of the filters is found here.

This gives the following information about the supplied filters:

“The 2138 filter has been classified as a GP3 particulate filter, and is thus able to be used for protection from mechanically and/or thermally generated particulates i.e. it provides protection against dusts, mists, fumes & ozone as well as for toxic materials like beryllium. It is also suitable for use against low vapour pressure chemicals (V.P. <1.3 Pa or 0.01 mm Hg at 25 deg C) up to ten times the Exposure Standard and also offers relief from nuisance* levels of organic vapours and acid gases such as chlorine & sulphur dioxide.

NOTE: The 3M™ Disc Filter 2138 provides GP3 protection only with full facepiece
respirator. Provides GP2 protection with half facepiece respirator.”

You will see that a lot of thought has gone into supplying us with filters that specifically stop the transmission of the flu virus as outlined above. At £ 15.00 + a mask and filters on top clearly public money well spent on something that offers no apparent protection against viral particles but scares patients.

The commissars are clearly worried as they realise even though they have their own masks and Tamiflu they cannot run the health service when even minor illness strikes. Clearly there is fear and panic in issuing these masks to personnel less important than themselves as this goes against Party policy of GPs = under worked overpaid scum on golf course.

The NHS Flu Pandemic line has been a great success that demonstrates the years of planning (panic) that has gone into the best prepared country in the worlds planning for this crisis.

Sir Liam was on G(ormless) M(oron) TV saying that the best prepared country’s plans had only estimated 25,000 calls per day not the 9.3 million calls (estimated) in the first hour. A mere miscalculation of some 2 orders of magnitude which I am sure is allowed for in emergency planning in the same way that inches versus centimetres helps land Mars missions successfully.

Add to that a late start and it is all coming together that the UK is the best prepared country in the world for swine flu. We are so well prepared that we have to export ill patients to Sweden for life saving treatment.

Today we have had patients who have dutifully followed the Party’s advice to ring NHS Swine Flu (Porky Pie) line only to be unable to understand their operatives English. “They speak too fast” and “I can’t understand them” were comments relayed to us. So where do they go?

To their GP.

Another patient was given a Tamiflu prescription authorisation code but the chemist did not recognize it so where did the patient go?

To their GP to get a correctly written prescription.

Another success in relieving GP workload. Yes less phone calls but more work sorting out problems generated by the Flu Line which is so different to other great Party successes like NHS reDirect.

Patients from a nearby town were forced to travel 20 miles to get their prescription as they were given a code that was only valid at a Tamiflu distribution point (TamDP) 20 miles from where they lived.

We thought this was just local to us but it was on the evening local news from a region far south of us that other places in Northernshire had the same problem. See this link.

You will notice in this link how the flu buddy aka the patient is sent to collect the Tamiflu in person to minimise the risk to the admin staff now issuing and dispensing drugs. Clearly another sign of the plan's success in action.

The official way of getting Tamiflu in the far south of Northenshire we found here and in case you think the TamDPs are secret as per the clip try this link to find yours.

No contradictory advice here then?

Clearly the best prepared country in the world?

Like the lager, probably not in the slightest.

Also we have predicted the black market for Tamiflu. There is a rumour going round that a delivery truck to a TamDP was knocked off and the only drug taken was the magical Tamiflu.

And we are being told not to panic by none other than the new health minister himself. Seems that there may be a slightly critical report about the flu preparation coming this week. Surely this cannot be a problem for the Government of the best prepared country in the world? Probably a lot of problems given how we and other bloggers have seen this preparation in action.

Praise be to the Party and their prudent panicking, sorry planning.

The NHS Flu Pandemic Plan vs reality 003 May the Surge be with you

We here at ND Central may had been a little critical about local arrangements for the Swine Flu Pandemic so we thought we ought to look at those in charge’s perception of the “crisis”. We are, as is the whole country, in the hands of the legions of faceless mandarins who for years, possibly since 1919 but, unlikely, as they don’t have that many fingers to count with, have “planned” for the flu pandemic in the background with no thanks what so ever for doing nothing.

We have posted on the results of this foresight and ever wise planning but thought we would, for balance, consult their views on how Northernshire, sorry the whole NHS is prepared, for the impending Swine Flu problem.

We therefore consulted the Comic, aka the Health Services Journal, and attach a few links for you to realize how Swine Flu is just about imposing on their ever busy existence and how well they are coping.

It would appear that PCTs’ swine flu pans are being tested by real life. A real shock to your average NHS manager as that might mean that a real person, or a patient, a totally alien concept to them, is ill (and importantly costs money).

We particularly liked the comment of a certain Professor towards the end of the article:

“Where flu starts to hit one particular area it is important PCT chief executives are visible to GPs.”

Why? What good will they do? They won’t see or treat a single patient. Unless he means visible in the crosshairs to GPs . . . ?

In the 10+ years we have worked in Northernshie we have only ever seen a Chief exec once and could not understand a word they said.

We are also relieved that a national director for “social care flu resilence” has been appointed.

We here at ND Central have been losing sleep over this gap in our "advanced" flu planning. Thank goodness the all wise managers have created such a post. We can now sleep soundly in our beds knowning that there is a national director for social care flu resilience - what ever that is? It will no doubt make our jobs so much easier.

Lots and lots of tough words from the flu czar here.

He wants PCTs to review their “surge" plans. Don’t know what these are but we bet it won’t be anything like the American surge in Iraq but we know where the word was copied from. Perhaps it is how quickly a PCT can evacuate its headquarters when large public gatherings are banned if real flu takes a hold with the exceptions of GP surgeries and hospitals which will have to remain open regardless?

“PCTs must “give a very high priority” to making sure GPs have the capacity to look after all patients, regardless of how widely the disease spreads”, he said (as all GPs and Hospital doctors and nurses will be spared the flu).

Think he might find that virtually impossible as they can’t even look after all patients in the absence of a flu pandemic so another highly paid NHS commissar living in Never Never Land with Micheal J and getting paid to do so. But isn’t Michael now brain dead?

Hospitals will be expected to make sure they can “surge” their critical care capacity for several months if necessary. And human resources advice produced by NHS Employers recommends skills audits and plans to redeploy staff to areas of need.

The “surge” word again obviously a popular word for managers at present. We have already mentioned one plan that is probably in place to redeploy staff to areas of need (their homes) but a skills audit? Can you see Chief Executives asking their HR departments “how many GPs do we actually have?” for the first time ever?

Asked whether discussions were taking place over how the system might respond to financial pressures such as a “surge” (it is there again) in accident and emergency admissions, Mr Dalton said: “Our job is to ensure any impact is managed properly.”

More “surging” or managers coming our way?

Interesting how the system might respond when it has already 100% bed occupancy and struggles to cope with the current state of play so if there is a nasty flu pandemic we will be pleased that the shortage of resources already in place will be “managed properly” when the brown stuff hits the fan.

He also said the Department of Health is still planning to launch its national flu line in October. Really? Looks like that has been “surged” forward a bit something we are sure was foreseen in all of those advanced flu plans.

Listen up the flu is here now, the Chief Medical Officer has said 100,000 cases per day in August and you were planning to respond in October but now it is in 3 days time?

Surely no panic here as it was all in the plan? Can we have your job? Sitting on your hands and being paid big bucks we like that idea of work. Try dealing with the "surge" in phone calls your advice to patients has generated in the real world to pander to the pathetic.

There is also an article about GPs getting unclear advice on dealing with swine flu.

Surely not? Just look at our previous posts to see what is happening in one of the top World Class Commissioning PCTs to see that this is not happening.

A few intersting comments at the bottom. So we at ND Central are not alone?

And finally a little piece about what might happen to NHS managers if their flu plans don’t succeed.

“Some PCTs will get it right, others will be lucky. Those who get it wrong and are unlucky will be exposed to the full force of public anger. The exemplary performance of the best PCTs will be used as a stick with which to beat the worst.

Local managers should be in no doubt about what they will endure if they fail. After five years of preparation, millions of pounds of investment, months of warning over swine flu and endless declarations that the country is ready, the public and local and national media will lynch you.”

So if your PCT has a higher death rate due to your flu plan the public will lynch you as they did in Staffordshire? Looks like a lot of NHS managers will be getting some hefty promotions if a flu pandemic strikes. How many more NHS Chief Executives can the country afford to fund to reward high flu death rates?

Praise be to the Party and all its wise managers and their flu plans.

What would we do without all of their work?

Manage?

Perhaps? On our own, as always?

Things can only get better 002

Following our last post things have improved further. All of yesterday’s Swine (flu) phone calls were nothing like flu. Our on call doctor noted, as we did the day before, that there was a “surge” (more on this in a later post) of calls towards the end of the working day.

Another trend we have noted is that a lot of people were ringing from work:

“I can’t come down to see you in case it is something else, I’m at WORK!”

Are people starting to take the proverbial pee? They could after all ring NHS (re)Direct but they already have and what do they get?

NHS (re)Direct is telling patients they can’t do anything (nothing new there and a huge waste of money in the process) go and see your GP. Yes we had that yesterday afternoon as well.

Of course the swine flu hysteria has become a skivers’ charter. You ring your GP and get Tamiflu and go into work with it. What happens?

The boss either sends you straight home relieved to get the evil flu away from them or your co-workers on seeing the box panic and evacuate the building (faster than if someone had chucked tear gas in) to go home and get Tamiflu for themselves after exposure to a “confirmed” case. Easy week off either way.

While doctors can often diagnose over the phone simple things our biggest concern is children.

If Shaza rings and says Tarquin has “flu” can she have some Tamiflu and omits to tell you about the rapidly spreading rash that she hasn’t noticed, due to booze and watching Home and Away while having her lunchtime 20 Rothmans, Shaza will be so forgiving when Tarquin’s meningococcal septicaemia fails to respond to your Tamiflu.

We here at ND Central are confident that Sir Liam et al will be indemnifying us especially as they don’t pay for this. Will the “I was only following Party orders” be an acceptable defence?

After all, Shaza will be upset for not telling her GP about the rash that she will do penance at her local no win, no fee solicitor. And who will lose if we follow the Party’s advice? Tarquin and you?

So kids will be coming to surgery regardless of what we are told. We suspect so will adults as telephone consultations take so much longer than face to face ones. Will the “I’m at WORK” crowd then come down? We shall see.

The “world’s best prepared country to counter flu plan” is working so well. One prescription for Tamiflu was issued yesterday and the patient’s flu “buddy” came down to collect it.

The “flu buddy” was none other than the patient themselves.

And of course we know we can be confident about our diagnoses as we are no longer able to do swabs to confirm the disease. Given that only about 1 in 4 of swabs done so far were actually positive for swine flu it is likely that a lot of anti virals will be given for something that isn’t swine flu. The more anti virals used the quicker resistance will develop. Guess work is a poor substitute for accurate laboratory diagnosis. But our odds of getting it right are higher than losing at Russian roulette.

We suspect it is only a matter of time before drug addicts realize that Tamiflu is a marketable product and start feigning “flu like” symptoms. A packet of Tamiflu with a suitably endorsed prescription to prove it is the real McCoy could provide the next few fixes for a few minutes of blagging.

Praise be to the Party and its plans. Things can only get better?

We await the "who will get the flu vaccines" announcement from yesterday afternoon's high level meeting with interest. We think the list will be Gordon, Sir Liam, Lord Mandelson, Sir Humphrey . . .

Things can only get better.

Well another Northernshire Blogger’s practice has posted on the “best prepared” country in the world’s flu plans and its impact on workload before anything serious, like real virulent flu, has happened. Jobbing Doctor post 13 July 2009.

We are constantly being told here that we are the best prepared country in the world to tackle flu. This is by people who retired from real medicine years ago or good honest politicians whose every word can be believed. The front line is struggling already and we are still in the phoney war stage. The enemy is not virulent yet but it is spreading

Now children let us do this very simply.

One flu sufferer coughs and sneezes and so infects another passer by. This becomes 2 flu suffers who then become 4 then 8 and so one and hence the Flu intellectualazzi are proved right. We might have 100,000 people with flu a day by August. Simple mathematics.

Unfortunately although “we are the world’s best prepared country” have any of them thought of another malignant virus that could cripple health care before “real” flu even arrives?

The exponential Shaza effect (ESE)?

It works like this:

“Wotcha Shaza just watched GMTV and when yer texted us that your Tarquin has a cough, sore throat and a temperature I fort he might have swine flu.

As yer Tarquin was at nursery with mine I have texted all 400 of me mates on me mobile to let ‘em know he has swine flu and that you are ringing the doctor just in case. I’ve also e-mailed my 600 clients just to let them know as a qualified beautician they may all have SWINE FLU as our Chantelle were in Mexico 9 week ago.

She is OK but woz getting her nails done here 4 weeks ago and her cousin’s kids woz with Tarquin 2 weeks ago at MacDonalds for a birthday party. I told them at school about Tarquin’s swine flu and they are sending notices out. Any road I’m ringing my GP just in case can’t be too careful - it says so on t’news.

It is so stressful it is doing my head in . . . I tried to ring NHS Direct but gave up after 2 rings and even me GP ain’t answering as its always engaged. I’m off to A&E.”

Has Sir Liam any idea how many people get a temperature, sore throat and cough each day?

Of course not. Sir Liam has not practised real medicine for years although he has more initials after his name than all the doctors here in Northernshire who are dealing with this kind of crap. And it is getting rapidly worse.

We had in one hour yesterday 8 phone calls all demanding to speak to the on call doctor because they thought they had swine flu. And that was while we were trying to see patients in a surgery which Gordon and the Party ration to 6 per hour so 8+6 in an hour is without a Party target. That was just in one hour up from 4 calls for the whole of the day before and the hour before that after lunch.

Some had had it for days and were getting better but they rang “just in case”. Some had been to a NHS walk in centres in cities 60 miles away and had been sent home to ring the GP. Others were ringing from work 30 miles away about patients who they would not allow us to speak to as they were asleep but could we have some Tamiflu just in case? None of them had rung of their own accord other people had told them they had swine flu and to ring just in case.

Welcome Sir Liam to General Practice in the UK. Depending which figure you believe here in Northernshire there is no spare capacity. We cannot deliver first world medicine (US standard) to our patients in the absence of a flu problem.

There are 250 million GP consultations a year. If everyone gets 2 sore throats a year then that is 120 million potential slots lost to sore throats alone. If every child suffers one illness a month AND sees their GP for each of these then that is 120 million consultations per year. Ball park figures these but these 2 conditions alone have all but swamped the NHS GP system.

Not all patients see their GPs or take their children to see GPs with these conditions but these are just 2 conditions and there are many more conditions as well. However the fact that certainly here in Northernshire we have very few slots free on any day in the year means that the NHS is one of the best prepared countries in the world to handle any extra swine flu workload.

We have so much spare capacity we could export it to the third World! Not.

We are having to deal with more crap that is accelerating due to the exponential Shaza effect as a result of ill informed media scare mongering. One only needs to see the effect of one idiot declaring that measles is in a school on workload to see how panic and ignorance grips a small population. Apply the power of media and Government to the whole population and you can guess the rest.

Thanks for the facemask and its 2 filters. That really reassures us on the front lines. Will you be sending soldiers to deal with the Taliban with tissue paper as a weapon? Must have been going cheap at Wickes builder’s merchants if you read the spec here to see how this will protect us against air bourn viruses. For anyone unfamiliar with this type of kit there is even a training video that shows why you need two filters which we provide as a public service for educational purposes.

Praise be to the Party how can we ever fail given their all seeing wisdom and forward planning? Patients are already complaining they can’t get through to NHS Direct due to the pandering to the pathetic and the Flu centres will be opening in October.

The genie is well and truly out of the bottle and keeping the bottle at home isn’t going to stop the genie spreading. It has already spread worldwide and we all breathe the same air.

So why tell people to stay at home and ring their GP if they “think” they have flu but still allow sporting events? Will that contain the genie?