Golden Globes or is it Golden Balls and General Practice?

A certain British actress has scooped a couple of minor gongs in the land of the free. Her speech must surely have been an üburlovey overacting experience to most people watching but not to your average UK frontline healthcare professional.

Clearly the Press have not spent a Monday morning in UK General Practice where the number of patients doing a Winslet is a daily experience. Examples of their acceptance speeches into alleged emergency surgeries include:

“I have had a really, really, sore throat for 2 hours” (Not just a sore throat for that long?)

“I am so dizzy” (but you have driven 20 miles in a Range Rover and stink of alcohol at 09.00hrs after an argument with your spouse and it is an emergency?)

“I am an emergency I have to be at work in 5 minutes” (but you claim to be ill with no symptoms and are fit enough to go to work?)

I am PREGNANT and have toothache. (Pregnancy is ALWAYS an emergency and we are not dentists.)

I am sure that you have seen loads of this (you are quite right we have) and you can do nothing for this (you are quite right we can’t. It is a virus so why are you wasting our time when everyone you know has exactly the same thing and we have not given them any treatment and they got better on their own?).

I have been like this for weeks (but it is an emergency).

I need my blood pressure medication it is an emergency (and you did not notice the fact that you were running out of pills for the last 4 weeks until you had none left?).

I need my blood pressure medication it is an emergency (I am going on holiday in 2 hours time and need to catch my flight. Got your passport and ticket? Of course you have wouldn’t want to miss your holiday you’ve paid for that).

I am really, really ill but you sound just like me. Have you got the same? (Yes and I have what you have but am still at work).

I have just flown back from Spain this morning, at 05.00hrs, and have been really ill for the last two weeks of my holiday . . .(but now healthcare is free it is an emergency despite the fact that you are well tanned rested and reeking of aircraft booze after the taxi dropped you off).

I am having a panic attack! (Well I will sit here and do nothing as you caused it and you will get it better. Call me when you finished your Winslet moment. and then we will resume the consultation).

The team at ND Central have been overwhelmed by theatricals this winter but not by much illness. If you think Kate Winslet was bad look at patients clutching their gongs, sorry props, called tissues, multiple layers of clothing, exaggerated facial grimacing, not being able to move limbs at all until asked to undress, faint pathetic voices, overbreathing, insisting their relatives talk for them they are “so ill”, swooning, saying they are having panic attacks, limping intermittently on different limbs, bursting into tears as they talk and over act for England in order to try to convince health care professionals there is something wrong.

Listen up dudes if you can walk into surgery and whine on uninterrupted for several minutes there is rarely anything seriously wrong with you. Seriously ill people are usually the very, very, very quiet ones not the really, really, really ill ones. They need urgent treatment but the Winslets among you delay that treatment.

This is NHS general practice and A&E everyday.

Lots of Winslets but very, very rarely genuine illness.

Praise be to the Party and all of the billions they provide to support amateur thespians in this country each year.

A thought, what if Kate gets an Oscar? Will she go into histrionics overdrive? We wouldn’t want to do the emergency surgery after that performance. Perhaps she should see her GP when she gets back . . . .

Heaven help that GP - a real actress doing a Winslet? They might get confused.

A Recent Symposium

ND and fellow Resistance Fighters were recently at a true symposium (the Greek meaning of the word) at the Café Michelle. As they indulged in a bit of symposing inevitably the conversation turned to the increasing top down dumping of useless work on doctors by non medically qualified managers. As by now a lot of symposium “work” had been done there was a lot of irreverent humour floating about.

During this period someone jokingly said:

“I think therefore I am. You think therefore you aren’t!”

This was met by one of those stone cold silences that stop laughter dead when all realize that something profound has been said.

Someone had encapsulated the current state of the relationship between NHS managers and medical staff in Northernshire. It is called “clinical engagement”.

Praise be to the symposium for sometimes in vino veritas.

Postscript: a few days after that remark was made a story broke regarding child protection issues in a town in the south of Northernshire. The issue that gave rise to the above comment was proposed changes to local child protection procedures and the model proposed by the local Politburo commissars was that used in the same town in the news story.

Praise be to the Party and its local Politburo commissar managers for they always know better especially regarding child protection.

Dementia

We woke up this morning and were told that GPs are to get extra training in something but we cannot remember what it was?

We used to know but we forget that we had lots of lectures on it at medical school and how we should investigate it to rule out serious, but incredibly rare causes of it, but then we forget. When we were junior grunts we saw lots of patients with this disease and spent hours seeing patients we admitted with this disease in A&E, on medical and surgical wards but we have forgotten all of this.

We did then do GP training and forgot all we learnt about this disease but fortunately the politicians did remind us that we have forgotten and about how hard it is to diagnose and how it can take months or even years to come to a diagnosis but with “re education” we will be able to spot it in seconds as politicians can do.

They however know better as they see this forgotten disease on a daily basis in their once weekly “surgeries” for they say “yes, Granny is a problem, go and see your GP” and do nothing about Granny for they control the money.

Reading this we must be suffering from something but we cannot remember all those years of training and what we are suffering from. Do we all need an urgent consult with a politician?

Unfortunately while the Party has just discovered “dementia” many families have discovered how lacking the NHS is in its provision for this disease.

The caring ones struggle against the progressive loss of function that dementia brings and even fight the local Politburos who regard it as an expensive inconvenience to treat someone who will die and never get better but in living will cost more with each painful year of functional decline. The less caring dump and run at A&E.

ND and the team have seen the same disease process year after year despite the fact that we know nothing about it. The desperate call “you have to do something about this” almost always for a home visit when Granny wanders the street at night in sub zero temperatures in her nightdress or Granddad starts thinking that petrol and vinegar will sort his bowels out as he has a fag on the toilet are not too uncommon scenarios to frontline NHS staff. But not for the politicians for they know what Northern Docs do not.

Dementia is like childhood but in reverse. Children start as completely dependant but with nurturing and education gradually become fully independent. Dementia patients start as fully independent people who regardless of how much nurturing or help is given become progressively more dependant until finally, and often mercifully, they are released by Death.

The human brain is a very subtle, delicate organ, which if we can quote from medical school “in life has the consistency of yoghurt”. It is easily damaged for example by a baseball bat that can change a Nobel prize winning scientist to an incontinent rambling idiot in seconds. Unfortunately age too can destroy an intelligent self functioning, caring individual into a dement but the process can take years.

Whilst we can potentially prevent the Nobel prize winner’s argument with a baseball bat we can do sod all against aging. If you live long enough it may happen to you and you won’t care because you may not know but fortunately the politicians will. They will be there to care for you as they are now “re educating” doctors in all they have forgotten or rather did not know (if you believe the Party).

The dementia process is irreversible, we do not as yet understand it, but nonetheless re education at the Gulags will make us better able to “treat” it.

Extra funding and resources will off course be of no help to the families who struggle with dementia as it will not be provided. Ticking a few “re education” boxes is so cheap compared with providing adequate care in the community (or anywhere) for a dementia sufferer.

Praise be to the Party and can they tell us what we are all suffering from and how to treat it as we have forgotten? Clearly GPs need “collective re education” (sound familiar comrades?) and the Party clearly feels GPs should be sent to the Gulags for this.

(This piece is respectfully dedicated to a family in Northernshire who have fought the Party and its local Politburo for years to look after their parents and got nothing from the Party without a huge fight despite the patient, their spouse and children all having worked and paid taxes for all of their working lives. ND’s team have huge respect for these fellow Resistance Fighters. This is dementia in the real world. A war against the uncaring NHS management.

We will see if St. Fiona Phillips has the same problems as those outside of celeb la la land do. There is a programme on channel 4 tonight on this subject. We hope it is better than the aforementioned Sts coverage of MMR over the years) .

A few Odds and Sods Techno corner

So the use of mobile ‘phones is to be allowed after many years of being banned in NHS hospitals. The well established Dr Crippen (much respect) have their own thoughts on this momentous day for the appliance of science overcoming management ignorance.

A personal observation over the years has always been that the more senior the person wielding the mobile phone the less interference it has always caused even if it was exactly the same model as the one you owned. So consultants and nurse managers’ mobile phones have never ever had any problem with interference as these are shielded by the invisible cloak of importance as are senior managers’ phones which always have double shielding to everything especially to knowledge and common sense.

Due to technological progress this shield it would appear is now fitted as standard on all mobiles not just the top “end” of the spectrum.

Bit like the huge problems that microwave cookers caused to air traffic control and internal organs in the Seventies?

Had a computer problem at work they didn’t work. Problem was apparently a power cut to a certain part of a Northernshire conurbation. According to the company’s blurb this should not cause a problem to the maintainace of a seamless service they provide at huge expense to the taxpayer as there is a second back up server that should kick in Ninja like at another location.

Given that this didn’t happen we can only presume that the back up was in the same segment that lost power possibly the computer next door?

This needs investigating we thinks as if this is the case the centralization of data will make it very vulnerable to sabotage.

Given the Governments urge for centralization of patient records had one been a patient at one of the several Northernshire practices affected who had need urgent treatment presumeably the patient would have died as there was no central record?

No-one did die. Amazing.

Praise as always be to the Party as it is all wise.

NHS Rangers lead the way - the War on MRSA #4

Another great idea that the NHS Rangers have come up with is that if MRSA cannot see patients it cannot fly through the air to infect them (all NHS Rangers know about the stealth flying mode of NHS MRSA transmission as it guides all their policies). The NHS Rangers corps has therefore copied another tactic from the military to prevent MRSA being able to see patients called the smoke screen.

This simple technique is being employed at the front line of all NHS hospitals nationwide. Furthermore it is a free service and a credit to the British people as any foreigner who enters a NHS hospital has to cross this defensive line before gaining access (to free healthcare) and to the MRSA free ward area that lurk behind this NHS smokescreen.

As well as the defensive smoke screen the NHS Rangers, mindful of the environment impact of discarded smoke grenades, utilize the dog ends that are so full of carcinogens that the MRSA on the hands of smokers will never be trampled into the hospital on their feet and so the “smoke screen” tactic helps defeat MRSA in a pincer manoeuvre so beloved of NHS modern matrons while eating chocolate eclairs.

Furthermore in addition to adopting an outside in approach to defeating MRSA the Party also utilize an inside out approach and engage, at no cost to themselves, the patients who are free of MRSA to contribute to this hugely successful smoke screen.

NHS Rangers lead the way.

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.

NHS Management and how it pays GPs not to do work

(This piece was inspired by the stories towards the end of last year of GPs being paid not to refer patients and is provided as an example of how this stupidity comes about in one part of Northernshire).

ND and the team are constantly frustrated by the ability of NHS managers not to use what they have already got and waste NHS money in doing so. If they were standing in the middle of the Kielder forest, an area of 250 square miles of forest in Northumberland, you can bet your bottom dollar that they would be holding meetings to increase the number of trees planted around them as their reports show them there are none. There would also be a sub committee reporting on the lack of water in that area as well.

This is the same with minor surgery provision in one part of Northernshire. For individual surgeries there is a fixed local Politburo or PCT pot of money to pay local GPs to do a fixed number of minor surgical procedures per year. This lasts about 3 months per practice before it runs out.

In today’s modern NHS everything has a cost so GPs have essentially 3 choices when the money runs out. They could:

1) Stop doing minor surgery
2) Continue to do minor surgery by funding it themselves
3) Refer all minor surgery to the local hospital.

Given that most GPs run businesses then to a rational businessman option 3 is the only viable option.

After a few months the local Politburo managers notice that referrals for minor surgical procedures go up. They wonder why and have lots of meetings to figure this out. Of course the root cause must be the GPs so they devise a Practice Based Commissioning (PBC) plan that will reward GPs if they cut the number of referrals for minor surgery.

In other words if GPs don’t treat their patients, by not referring them to a hospital for minor surgery, they get paid to do so because the PCT saves money as it does not pay the hospital for the minor surgery which costs the PCT more than if the GP were to be paid directly to do the surgery themselves.

So the solution to too many patients needing minor surgery is not to use the redundant capacity in general practice to do the minor surgery, by paying them to do it, the solution is to pay the same people who could do the surgery to not refer the patients for the surgery.

Logical is it not?

You have a redundant solution to a problem available so you pay the solution not to solve the problem.

This is how local Politburos reward their GPs for not referring patients. It is a bit like the EEC paying farmers not to farm. This may seem daft but if there is over capacity there may be some sense in it. However, when there is a shortage of the product, then this is daft.

Excess grain can be easily stored but unfortunately excess illness does not go away so quickly. It has a habit of moaning to GPs who will usually refer in order to sort the problem out (that is after all what we are trained and paid to do). In this case the GP gets paid to do the referral under his normal contract but does not earn extra from the local PBC plan because admission rates go up.

In this case the patient gets their treatment albeit at a wait. The Politburo thinks it has won (because it hasn’t paid the GPs to do minor surgery and it hasn’t paid them for reducing admissions) but dear readers there is another way of looking at it.

The Politburo has in fact lost because it is paying over the odds for it to get the surgery done at the hospital and it has failed to meet its own PBC plan. It has also spent lots of new money building new health centers with specially equipped operating theatres to do the minor surgery that it won’t then pay for.

So NHS managers often stand in the middle of a forest not seeing the trees but planning on ways to increase tree capacity and paying people not to make trees.

If you read this last sentence and think this is stupid then you are normal. If however you read it and think it is all common sense then please apply at once for NHS management. They need you.

Praise be to the Party and its ever wise managers who achieve so little by doing so much at our expense. They also can’t see the trees around them or the solutions to the problems they engineer.