Laughing all the way to the bank.

One of the greatest successes of the Blair/Brown administration was the ending of NHS dentistry and the preparation of the NHS for privatization. An article in the Daily Telegraph and on the early morning BBC news shows a report showing what a success their policy has been.

Now we are sure most dentists are honourable professionals who do their best for their patients teeth and forgo personal profit but we all know if you are paid to operate surgeons will operate whether the operation is medically (or dentally) necessary or not.

One of our attached medical students a good few years ago said that in their country obstetricians said that babes born by Caesarian section were more intelligent. They went on to explain that there were few trained midwifes in their country and so rather than attend a long labour the obstetricians prefer to do an operation because it was quicker and they earned more.

Needless to say this young doctor to be thought the NHS was a much better system because patients weren't being ripped off.

Of course we are also sure that no patient registered with a non NHS dentist will be forced to pay a monthly health insurance to remain registered for we know that if we charged our patients a £ 100 a year just to be registered, less than a TV license or a gym membership fee, we would earn more per year than we do by working full time. Any additional work like seeing patients for an additional fee would greatly increase our earnings towards dentist levels. If it works so well for dental care why not extend it from general dental practice to general practice?

But do not think as GP patients you do not get completely unnecessary treatment from your GP as well. They are called the annual QOF "checks" that diabetic, asthmatics and other Party defined disease sufferers get called in for. The only difference is that in contrast to a dentist doing work that will cost you the only thing you will lose for medically unnecessary work is your time.

Praise be to the Party for its continued commitment to make the NHS ever better. They are doing so well especially in the leader of the pack NHS dentistry. Well done lads and lasses and keep smiling or more likely laughing :)).

Morphing and recycling.

A little piece of interest crossed our sights yesterday afternoon while once again playing golf in Northernshire and here is a link to it. You can see all of the full Party spin in all its glory here. The Party have published a list of all the new (GP led, allegedly) clinical commissioning groups (CCGs) and how many bungs sorry how much funding they will each get.

Remember the Party's great leader's commitment to reduce NHS bureaucracy? We are sure that you will all marvel at the fact that 152 PCTs are to be replaced by no less than 212 CCGs which no doubt will employ many times less people to do the same job as PCTs and so more will clearly be less. The Party is indeed great in its infinite wisdom.

If you look at the list that includes the whole of Englandshire you would think that all  of Englandshire has embraced GP commissioning with open arms. Scratch a little deeper and we know there are areas listed that have a named CCG with an allocated budget but where there is no CCG in existence as yet.

Have you also noticed the less than subtle recycling by morphing of NHS nomenclature? Look for your PCT by name and think back. Take our own local Soviet which was once Shiteton Health Authority.

Morph it once and it became via the mighty morphing machine that is Westminster:

Shiteton Primary Care groups (s).

Morph one more time and you have:

Shiteton PCT.

Another trip through the mighty morphing machine and Shiteton PCT becomes:

NHS Shiteton.

Change the Party and morph one more time and you now have:

NHS Shiteton CCG.

The sad thing is that all this morphing has not improved things it has only consumed time, money and effort to recycle the same individuals into the same jobs with different names in the same organization with ever changing names. Now we are thick up North but recycling bureaucracy time and time again does nothing to improve healthcare for the better.

La plus ca change la plus la meme chose?

Praise be to the Party for its continued commitment to recycling and morphing the same bureaucracy over and over again for no useful healthcare change or gain. It makes such good sense. So until the next great morph whenever that maybe we just carry on with the day job. Next!

Morph or patient? Which will come sooner?

The increasing cost of ageing.

For centuries crude indicators such as infant mortality and life expectancy have been used to define how "healthy" a country is. Although life expectancy in the UK has increased life quality has not.

We are living longer but not enjoying doing so. As life expectancy increases so does health need and as birth rates drop the income and personnel needed to service this increased demand become inversely proportional.

For simple grunts on the ground nowhere has this become more apparent than when signing repeat prescriptions. You can spend an hour or more some days checking and signing the repeat prescriptions for most of the practice sometimes 250 - 600 (depending on the time of year) for the bulk of patients who are on monthly prescriptions and then spend another hour or more of your time checking and signing what are known in these parts of the Northernshire as the "weeklies".

What are "weeklies" you may ask? Well they are not part timers like a certain Professor they are people who because they are old and gradually losing it receive their medication in little boxes which have a variety of names to ensure that they are prompted to take their medication. Seemingly a good idea but this is but the start of an increasingly steep slippery slope which goes one way only.

Often it is a carer or relative that suggests this because Mabel or George are becoming a bit forgetful. It is but a sticking plaster on the decline of people living too long as "winners" of the war of increasing longevity but living as victims of the peace that increased morbidity has secured for them (and us) . The victory has merely been on the numbers front only for the defeat suffered by us all is the decreased quality of life this increased survival has given us all.

Now most drugs come in packs of a month's supply usually defined as a 28 day or a 30 day month by the drugs' industry. When drugs have to be prescribed on a weekly basis with a daily defined dosage schedule and placed into a little box with different compartments then this causes the average retail chemist a problem.

Pull a pack of old age prolongation medicine off the shelf and dispense it the chemist will get a dispensing fee plus any profit over the cost they purchased the drug from a wholesaler that is reimbursed by the drug tariff price that the NHS pays for that particular drug.

However if a slowly dementing patient requires weeklies then this starts to cost the chemist time and money and as a result costs the NHS and GPs more. For instead of just asking for a once a month prescription the chemist insists on 4 prescriptions per month = 4 dispensing fees per prescription dispensed instead of 1 hence the "weeklies".

If you have ever watched a dispensary do "weeklies" for a pensioner on 14 drugs a month some of which are taken sometimes 4 or more times a day it is an incredibly time and labour consuming exercise as relatively inexperienced personnel suddenly have to take the responsibility of what a patient or a relative should do namely look after an elderly relative and their medication. Do the maths 14 drugs X one month drug supply = 14 boxes of drugs.

14 drugs X 4 weeks supply = 64 separately packaged drugs per month and then add in the number of times a day each of the 14 drugs needs to be administered and you can see the costs escalate to ensure that relatives are relieved of the responsibility of checking up on elderly relatives or that slowly declining patients can stand a chance of administering the drugs themselves with reduced risk of overdose or omission.

Heaven forbid that a paid carer could be allowed to administer a drug from such a weeklies box health and safety would ensure that a carer capable of taking paracetamol 4 times a day themselves would be incapable of administering a drug from a weeklies box they can only "prompt" the patient to do so.

So GPs and their staff have to evolve systems to cope with the fact that a small number of patients can generate more "prescriptions" per month than the rest of their entire practice population on repeat prescriptions. Now we will not say that this gives chemists opportunities for fraud.

However, when you as a GP are asked, by a large pharmaceutical company, to replace every prescription for a patient on a "weeklie" in a large secure institution, you do start to wonder if the "weeklies" are a bit of a con that needs addressing?

This minor concern follows a surprise "inspection", by a large pharmaceutical company's pharmacist, who just happened to be the same large pharmaceutical company's pharmacist who dispensed all of the weeklies and this "inspection" reveals that all of the weeklies so dispensed are out of date. And the large pharmaceutical company via the same pharmacist then asks the GP to replace every patients' weeklies as a result?

It is a huge waste of GP time, a hugely expensive exercise for chemists and ultimately a complete waste of time for the patients concerned as they nearly always land up going into residential or other care. Usually because of drug or other cock-ups.

Praise be to the Party for ensuring that its provision of care for the elderly is still as crap as ever. Work all your life, pay your taxes and then get bugger all as a result other than a little tablet box. Surely such august bodies as the future forum, the RCGP et al will be on this case?

This must be costing a fortune and the numbers go up every year that we have been in practice.

Recycling the QraP.

One thing the NHS does really well is recycling. We are not talking about the recycling of reusable resources in short supply in order to maintain their future availability for the NHS does not do any such useful recycling.

Instead the NHS does the recycling of the same old ideas that an eleven year old child could probably work out why they will not work or deliver anything useful. Unfortunately a lot of people in healthcare are not as bright as an eleven year and so look what piece of recycling has gone into this year's pile of QraP.

QraP is the name we dedicated healthcare professionals here at ND Central have for the QP indicators in the nGMS contract QOF points and stands for Quality and Productivity but equates to neither of these 2 words in reality.

Last year we played the let us waste time and interfere with well controlled patients' medications as part of QraPing and this year it is a well roasted chestnut that is now blacked and charred beyond all recognition as the QraP idea. Have a look at QraP indicators QP 12-14.

So once again GPs instead of treating patients are being asked to stare into dark black holes which we have stared into many, many times before and have achieved nothing by doing so. Can you remember Public Health lectures and A&E lectures as medical students and in any specialty since asking the same question how do we reduce admissions? Deja vu?

The purpose is in the first paragraph and says they "aim to reduce avoidable Accident and Emergency attendances". In your dreams.

All accidents are potentially avoidable but for some reason they still happen. A lot of illness is avoidable but still happens. And the reasons people still attend A&E are still the same as when we were at grunt school and include some of the following excuses/reasons and amongst them are the following inalienable rights:

1) I can.

2) It is free.
3) There is no sanction for (NHS Choice ®™) choosing to do so.
4) It is closer to home.
5) I rang my GP who wouldn't see me that minute so I came here instead.

and so on.

So if you can't get to see a GP and find you have to go to A&E to be seen do you think that the diversion of GPs away from surgery work to stare at pretty, pretty practice data on A&E attendances (QP 12 monthly) and then have a GP group love and hug in with doctors from other practices to do the same (QP 13) in order to produce reports and improvement plans to reduce avoidable attendances (QP 14) might have anything to do with these attendances?

Doctors wasting more time QraPing and staring into black holes will not improve patient care it is simply trying to save money by wasting time and as a result compounding the problem they are meant to be solving. GPs do not send the vast majority of patients to A&E it is patient NHS Choice ®™.

A far simpler method would be a flat charge for attending A&E payable in advance and refundable if you have a genuine Accident or Emergency lets say £50. If you have a heart attack or a broken bone you get your £ 50 back.

If you are drunk or have a sore throat you don't. A few £ 50 a time Friday night attendences and we suspect that this alone would make people think twice whereas now they don't give a damn (and that is being polite). But we hear you say the NHS is free at the point of access and we don't want to be charging people for using A&E, do we?

Are we not already doing this already? Yes we are and if you have a Road Traffic Accident you may be sent a bill which you normally pass onto your insurers.

So maybe if you attend A&E and do not wait to be seen, or it is not a real accident or emergency the NHS could do as it does to the sufferer of a Road Traffic "Accident" and send them a bill? That is perfectly legal and within the current NHS "market" ethos. It would only require a small change to legislation and should not hurt anyone who is genuinely ill.

Praise be to the Party for ensuring that when it comes to increasing access to GPs this is best done by taking them away from their surgeries and sending them all for one huge great collective QraP (QP 12-14).

Haven't we all done this before many times and it makes bugger all difference?

Doing a dentist baby do it one more time again and again and again.

One of the Party’s greatest healthcare achievements via reforms of something that worked was the abolition of NHS dentistry. If you are a British citizen you will know what we mean. If you were once able to see a dentist on the NHS and now cannot see a dentist unless you subscribe or pay for your dental care you will know exactly what we mean. It appears that Dr Rant, our inspiration to start blogging, has had the same experiences as have we in the recent past.

The phrase “doing a dentist” means that dentists who once worked under NHS contracts have now moved on to being private dentists for the simple reason that NHS dentistry does not pay well and may well compromise good dental care. As a result they earn more than doing a GP where the Party strives continuously to limit income and reduce costs in contrast to the private sector in dentistry where the reverse "market" philosophy applies.

Could this be due to the fact that white teeth smiley faces are more important to politicians than basic healthcare? Think Blair vanity and self interest before healthcare for the populous.

Of course the Party in its infinite retardation could not allow its non paying customers to be without 48 hour access to a dentist so they merely changed their name to GPs. So now any dentally deprived or challenged patient can now be seen with any dental problems within 48 hours by someone with no dental training at all and best of all completely free.

Local dentists are well aware of this NHS freebie and we have seen a rise in the following medical “emergencies” all “referred” to us by local dentists:

1) Patient is allergic to Penicillin I cannot/do not know which antibiotic I can prescribe. See your GP.

2) Patient has pain and I do not know what drug to prescribe for them. See your GP.

3) Patient has a condition that I know not about so see your GP to find out if I can or cannot treat you to relieve your (pain) wallet.

4) I can prescribe you an antibiotic but you will have to pay for the consultation to get the prescription so see your GP instead. I can earn more from treating someone rather than prescribing.

And so on. Some weeks we have had one or two such consultations a day and remember all of these are "emergencies" and have been "referred" by an alleged healthcare "professional".

Clearly the need for a same day appointment is the need to preserve income stream not the need to provide quality dental care for any well trained dentist should be able to work out the answers to the simple questions above. Most of our medical students can after a week with us!

We thought we would like to offer some friendly advice to our dental colleagues.

There used to be a book called the British Dental Formulary which listed the drugs that you as a dentist could prescribe. You may never have read it as it would have been buried below twenty pound notes for totally unnecessary scales and polishes. We believe there is now a book called the British National Formulary at the end of which there is a page with writing on both sides.

There is a list of drugs, granted many more than the 32 teeth in an adult’s mouth that you can so richly exploit by filling, crowning, polishing, whitening, straightening and removing to generate income, that you as a dentist can prescribe.

With us thus far? So if someone is allergic to penicillin or needs a painkiller there is a little aide memoire for you if you can read and know more than what 2 drugs called Amoxycillin and Paracetamol do you can use. Simples.

And if you have trouble with medical conditions there are also books called textbooks for you to consult. At the end of the day the decision to operate is not that of the GP it is that of the (dental) surgeon who plans to undertake the surgery.

The team are on the case and the next such patient(s) we see we will be phoning their General Dental Practitioner and insisting on a urgent same day appointment for a medical "emergency" and will send them clutching the page number in the BNF. If you don’t see them we will be writing to the local PCT and General Dental Council.

If nothing else responding to the complaints alone will cost you more twenty quid notes than actually dealing with the problems you were presented with in the first chuffing place. (Apologies for the grunt word for what used to be a once or twice a year event has escalated somewhat).

You have been warned.

Praise be to the Party for increasing access to dentists by the creation of a sub dentist specialty called GPs and all for a fraction of the cost of real dentists and all of whom have no knowledge of the speciality at all.