“Quality” and money grabbing bast*rds.

The word “quality” as defined by the Shorter Oxford English Dictionary has many meanings. It can relate to both people and things but we shall use the meanings of excellence or superiority as in a “quality newspaper” as our benchmark for this little ramble. We appreciate that “quality also can be used sarcastically but we are simple folk up here in Northernshire and will stick with the excellence and superiority definitions in their literal sense.

Most, if not all, GPs we suspect are sick of hearing the word “quality” spouted by NHS mandarins for whenever it precedes anything medical it usually means that something which is really poor, time consuming and completely useless to anyone called a patient is coming our way to increase workload in order to tick someones’ box when a steel toe capped boot would do better placed in the same manager’s/politician’s “quality” box.

When used by anything NHS “quality” usually has the same meaning as the Late Modern English word “crap” or, in grunt speak, a word from a Mid Low German origin, and we are sorry for a couple of very naughty grunt expressions “sh*t” or its derivatives pile of s. or croak of s. both of which can be used with the c. word.

You can very quickly think of things with the Q word in the NHS just think QOF (Quality and Outcomes Framework) which is so excellent and superior that it isn’t working.

We are sure many readers will have their own little local Q word initiatives which like the Q-ships in WW1 were thought of as being a good idea at the time but which were superceded by better things than anyone at an average PCT could think of on a good day on a down hill run with wind assist ditto politicians.

Na Zu Labour’s endless persuit of Soviet style bureaucracy for the NHS led to the formation of the Care Quality Commission which like the Q-ships of old appears to be an innocent vessel striving to save others from harm and charged with maintaining standards but in fact like any poorly built tramp steamer is struggling to do its job and already cannot meet its own deadlines such is the quality behind it in terms of thinking and personnel.

Now where do the money grabbing bast*rds come in?

Well the CQC being a benevolent caring organization existing purely to serve the patient will happily relieve any GP practice (and others too) of £ 1500+ to be registered with it for you have no NHS “Choice”. Not registered can’t work, fail inspection cannot work well shafted whatever the outcome of any inspection cough up or else.

So this Q-ship is not charged with preventing harm it is in fact a source of harm and will no doubt shoot and hole many practices below the water line not with a ship terminating Exocet but with something far more deadly like you didn’t have gerbil wipes in your washroom (CQC “quality standard 57.997.47.1101.gerbil.9/11). Bear in mind that the captain of this Q-ship has much experience of being a U-boat, sorry hunting U-boats . . .

One of the members of the alleged listening exercise a once a week man aka part time GP called Professor Field has clearly embraced the market so much that he has given GPs the opportunity (to lose a few grand) to improve “Quality” via something called the Quality Practice Award (QPA).

Notice the little Q word at the front? Impressed are we?

Try googling “quality practice award” as we did as part of our research and see what, and who, else runs “Q” word practice awards and like the Royal College of GPs there are some excellent and superior organizations which put Northernshire’s Harvard and Yale MBAs to shame for not having put forward a Shiteton QPA of intergalactic quality.

We digress for the CQC are prepared to relieve practices of a mere £1500 (a year we believe) for registrartion and inspection by inspectors who we are sure will be our “equals” or betters in terms of qualifications and abilty for something which is a legal necessity and a nice little deficient balancer to boot for any Government in power. Can you imagine Pol Pot inspecting Harvard and Yale medical schools and what the outcome would be but remember we are talking NHS “quality”.

If you look in the small print of the Royal College’s Qboll*cks page, sorry about the offensive grunt speak the Q word slipped out by accident, here you will find out how much Professor Field and his back slapping government stooges would like to relieve their fellow hard working GPs actually on the real frontline, on a full time basis, as consultable GPs a few of whom are not members of the Royal Gentlemen’s club but do exactly the same work.

Have a look at the little red words on the first page (the italics are ours) which say that evidence obtained for certain QPA/mQPA (Version 14) may help providers demonstrate complainace with the Care Quality Commissions essential standards.

Have a look at how much quality has gone into the preparation of the web page and how “quality” means that the word United Kingdom is severely displaced by “quality” and the quality of the logo which looks like it was drawn by a nine year old. Or perhaps someone drunk hit the enter key more than needed? And note version 14 – does that mean someone got the quality not quite right 13 times before this one? We hear rumours that even version 14 is being redone.

We know of some commissioning groups (RCGP mafiosos) that are taking “may” to mean “will” meet CQC registration and thinking of imposing it on practices but the old expression caveat emptor applies. But if you are MRCGP you don’t do Latin or Windows when in collegiate mode for this usually involves real general practice avoidance aka commissioning.

For there is not just one RCGP QPA that might just get you QPC registration scam there are in fact two. Did you notice the subtle mQPA that you can take longer to get? And can you guess who devised this?

So yet another set of different Q words from different organizations but they all have two things in common. No quality and money grabbing bastards. One is the Party's the others are just advising them.

Praise be to the Party for using the Q word as freely as tinpot dictators award themselves medals and charging the punters for the privilege of wearing their baubles as well.

Now will those commissioning groups wanting the RCGP bauble be able to justify to their patients why they spent more than £ 3,900 on a Q word when £ 1500 was all that was legally required especially if the CQC don’t accept it and they still have to pay the government’s income generating lackey as well?

It appears that certain Royal colleges and their members don’t just shaft their trainees they are more than prepared to Qrap on their colleagues too.

Watching the consultants.

If you are a GP in the UK for anything more than a couple of years you notice certain growth areas in healthcare provision most of which are sponsored by those in the bottom third of the UK educational system bright enough to work in UK healthcare management and deliver sweet FA to patients. You also notice that things are essentially the same but change their names often.

For example Shiteton Health Authority becomes the Shiteton Primary Care Group (Nor’ Nor’ West) which merges to become Shiteton (Nor’ West) Primary Care Group which then becomes Shiteton (North Western) Primary Care Trust. Same group of retards rearranging deck chairs on the Titanic awaiting the next ineveitable iceberg of NHS reform striving to finally sink the big ship NHS.

In doing so patient centred care is enhanced by the huge amounts of money spent on NHS letterheads and on NHS corporate provided sign painters all produced to the same high standards of the NHS Brand. This growth industry must be loving the current NHS reforms at the expense of hands on patient care.

For those GPs who read letters we are doing something more active than admiring the changing logos on a weekly basis. We are watching the rise and fall of local NHS hospital departments. This is something most managers will not see for they do not have to ability to retain information but they do have the inability needed to destroy via alleged reform or is it “service” redesign?

Some departments have more than doubled in consultant numbers while our local patient numbers have stayed the same. This is picked up by thick GPs reading the ever changing names of the list of consultants on this week’s new letterhead.

As a stable GP practice we have not seen any similar increase in GP numbers. Despite the increased consultant capacity we are as GPs told by managers that we are over referring to the increased number of consultants.

Another department once had several brilliant consultants and provided excellent medical care in a high demand service. NHS targetization meant that half of them left as they were not allowed to screen or prioritise Choose and Book referrals and now we have a p*ss poor locum service where the locums change on a weekly basis and the remaining consultants struggle to cope with NHS management demands.

We suspect that they will not stay much longer and will follow those who have left for better working lives. We know that the reason they left to pastures new and happier was management interference in clinical care.

This same unit was targeted by local management retards for the fact that the evil overpaid GP scum were over referring to this unit. The consultants treated all those who were referred but this was not good.

It was pointed out to the local retard managers that the same service was once provided more cheaply by local GPs and had been cancelled by them on “quality” grounds and as a result we HAD to refer certain cases once done in general practice to the hospital.

NHS mangers are not bright and they can pretend to read, and understand, spreadsheets (pretty pretty!) and once costs started to rise they thought there was a major problem but they could not see or remember who had caused it.

Referral management schemes were introduced and consultants and GPs hounded over patient “care” = referral numbers, not illness by managers too thick to understand the concept of intended consequences of an action until the (pretty, pretty!) colours on their spreadsheet change. There were inevietably casualties of this seesawing of retard managers’ changes to working practices.

All patients suffered – poorer service longer waits- but these do not appear on the pretty coloured spreadsheets for quality is difficult to measure by retards. Patient seen =yes/no patient better/worse = a Homer positive doeh.

So why should we as humble Northernshire GPs be concerned with hospital foundation trust and PCT moron managers and the games they play and the effects they have on our consultant colleagues? Because it affects our patients.

If 100 new cases of surgery are seen and generate NHS income of 100 Soviet socialised medical units then that is good. The manager is happy. Patient treated job done.

The GP sees otherwise. If comrade consultant Mr Botch Jobb FRCS (eastern bloc) surgeon sees 100 cases and 98 of them are botched then 98 will need to be referred on for corrective surgery. The consultant may not see their botchalisms for they no longer see follow up post op cases for hospital follow up in the NHS internal market is expensive and has been outlawed by the managers.

GPs are cheap and so they now see the follow ups that junior surgeons used to see. This improves consultant training by them not seeing the results of their handiwork and managers are happy for any complications need a new referral (=more income) after the patient is discharged. Consultants and managers don’t see the complications but a good GP will and they will stop referring to Mr Botch Jobb et al.

The NHS manager will not see the 98 problems for they will have seen the 100 cases completed. The complications of surgery will not appear on their spreadsheet and will not be linked to the initial cause. The manager will however see an over referring GP as the problem and this must be terminated for the referral target has been exceeded.

So we GPs continue to watch the consultants come and go. We are often aware of problems for we talk to patients who work and are treated at the local tractor plant. We talk to junior doctors and medical students who have been there too, we talk to our GP colleagues and on odd occasions when we are let out to play we sometimes talk to the consultants. Some of them we see as patients and vice versa.

The question is how many managers watch the consultants? Answer is none they just count the beans whatever the quality (pretty, pretty colours!).

It is responsible GPs who count the patients and their complications despite the NHS managers trying to tell us where to refer and to whom based on cost and their self determined “quality” standards. When we complain we are told to shut up until those who don’t realise there is a problem twig that there is usually after a few years. At which point something brown and smelly spills out of its pit where it usually lurks and covers everyone else in it.

After which the self same self righteous determinators of healthcare move on and crawl back into another cesspit of incomptencae and we loose the more able consultants as a result of witch hunts. There are then inevitable casualties but unfortunately not always the right ones.

Quality in healthcare is a difficult concept to measure, the new NHS reforms emphasis quality as the new competition not price. Will the new breed of GP commissioners do any better for in theory we can now watch and act unlike before?

Praise be to the Party for ensuring that signwriters and letterheads provide us all with high quality healthcare via “sign posting” and logos. Pretty, pretty things however do not good medicine make.

In the same way that the price of freedom is said to be eternal vigilance ensuring good quality healthcare is achieved by the same method. However it helps if you know what you are looking for. So we will keep on watching the consultants most of whom do not need to be watched but a few do.

We will hopefully by doing this save our patients from harm and guide them towards the best treatment which is not always the nearest. Knowledge of who provides what is one of the strengths of British General Practice for healthcare is not a simple as buying a tin of beans although a lot of politicians think it is.