World’s quickest “emergency”.

At one of our regular Resistance meetings at the Café Michelle we were talking about various practice records. With the UK hosting the 2012 Olympics we wish to invite our readers to comment on what they regard as their quickest waster of space for a Gordon/Tony jerk off instant satisfaction within 48 hour access appointment for nothing medically wrong. Our previous record was a massive I have had a sore throat for 2 whole hours and it really really hurts.

Impressed doc as to how ill I am?

Not. It is a virus. Bye bye.

We have now had a new record of I have had a really, really, really, really sore throat for 15 minutes and it really hurts. Good job it wasn’t something serious like a cancer you might have come to some serious harm by waiting that long before seeking a consult and now after 20 minutes you are clearly on the critical list. You desperately need a sick note and a friendly that must be really awful for you poor lovey stat.

Impressed doc as to how ill I am?

Not. It is a virus. Bye bye.

A whole morning of this kind of thing or can I get my blood test results I thought they would be back today when you had them done this morning and the samples haven’t even reached the hospital yet makes you realize how General Practice has become a baby’s pacifier for the politicians to stick in the public's mouth.

In contrast to the “can you see my husband?” who walked into the surgery supported by his wife “he has had severe stomach pain for the last few hours” and looked ghastly. When examined he had a tender abdominal aortic aneurysm. This patient was seen immediately based on patient need not political expediency given IV fluids analgesia oxygen and helemeded for true emergency treatment.

Amazingly this triple A survived, only one of the 1 in 3 that do. You will be more pleased to know that our 2 previous record breakers with sore throats survived despite the complete lack of medical activity that they so richly deserved. They will no doubt be in training to compete in the next round of can I get an appointment even quicker next time Olympics that is the daily rush for acute on the day appointments to meet Gord and Tony’s targets for the treatment of non illness.

Perhaps there should be a new Olympic sport where countries compete to see who can get the quickest on the day appointment with no significant medical illness? In that competition we bet we would win gold for the politicians have been spending huge sums to train our athletes for years in contrast to the sums they provide our real Olympic athletes.

Perhaps we could have Olympic figure visiting whereby requests for visits are judged on the poise and foot mobility of the athletes requesting them? Again we would win gold as we have so many well practiced individuals.

Perhaps we could have an event akin to shot putting called swinging the lead competition whereby patients unable to work due to their bad backs compete to see how far they put the shot and that distance is added to the length of their time off on their sick note? We are sure the Benefit’s Agency would be very interested spectators at that event.

The worrying thing is we are noticing that these appointments are being used more and more by the same small group of individuals some of whom are seen in the morning are not better by lunchtime and so decide to compete again in the afternoon. This used to happen occaisionally but now is becoming more of a marathon not just on one day but sometimes with the same individuals on several days in the same week.

When we were able to set the rules as to who was seen on the same day e.g. no sick notes, no repeat prescription requests we saw more illness now when the Party says any crap can be seen within 48 hours we are seeing more predictable “illness” like another sick note, another repeat prescription or can I have my blood test results.

Have we missed any other general practice Olympic events that need inclusion? Perhaps there is a solution here or failing that try a NHS Walk In centre?

Praise be to the Party for its central control of what it thinks is important which ignores that which is actually important. The Olympics is meant to leave a sporting legacy in its wake. It needn’t bother for the NHS has beaten it to this legacy as our patients are all such good sports.

Instinct and the mess that is child neglection in the current NHS.

It takes between 5-6 years to qualify as a doctor in the UK and about 10 –11 years at present to qualify as a GP. A lot of that time is spent learning certain core facts needed to do the job like anatomy and how drugs work. You need to be able to recognize and treat illness and this can be learnt partly from books but mostly from patients, experience and ones seniors.

One thing that is less easily learnt is what we will call instinct. This is when someone walks into your consulting room and their movements, language and behaviour suggest something is not quite right. That same person could see 2 GPs and one miss their instinct while the other hones in on it. We would hope both doctors would spot something obvious like a broken wrist but realize that not all doctors do instinct.

Such an event happened in the recent past when one of the team saw a family whose first language was not English and what English they had was mumbled, incoherent and mostly incomprehensible. The same GP from the moment the patients walked into the room noticed that something was not right. The ensuing consultation and observation reinforced their initial concerns.

A good officer should provide their commander with options but the Department of Health and politicians are not good officers. Their collective policies especially with regard to child protection via TCS (Transforming Community Services) have made information gathering for GPs a nightmare. For it was barn door obvious that this was an accident waiting to happen.

The local Soviet option is that we should to refer social services. A good option that if you can find a social worker and then one who will actually take any responsibility. Instead the local Soviet now wants an assessment document called a CAF (Common Assessment Framework) completing. They did at one time want GPs to do this before referring anyone to social services until they couldn’t find an open GP practice due to GPs spending all their time doing CAFs.

This is a mind numbing exercise that serves no useful purpose other than deforestation you can read one here and remember this will take longer to fill in than it took to identify the problem in the first place. And this is before they can do anything useful.

No all 4 family members have multiple shrapnel wounds, they are from overseas one has a sucking chest wound, the kids all under 5 have gonorrhoea no doubt caught from the toilet seats and one of them has a crow bar through their head and you want us to fill in an assessment tool? They are at risk and need help not paperwork.

In the good old days any queries would have been directed towards our practice based health visitors who were nurses, not social workers trained to fill in forms to prove how little they do and then withhold all that information from doctors. Our once practice attached health visitors were full trained child protection attack rottweilers who would get their teeth into such a situation and get it sorted. A simple word with them would be all that was required to set loose the pack.

Now we write our concerns in a book. No face to face communication, no questioning of facts or sharing of information just a book and you know something is done because a line is put through your information and you hear nothing.

The Party has cut off our arms and legs in terms of gathering intel as they are now gone via the pseudo privitization that is TCS – thanks Tony and Gordon you clearly cared more about the protection of the child abusers and the private sector than you did for abused children.

So the only option is now to fill in a piece of child protection paper and send it off into the ether in the hope that nothing will happen. It usually does.

You can write to NHS managers about your concerns but in the same way that those that thick in a Northernshire comprehensive ignored their teacher and so became a NHS manager they now ignore letters and never reply probably because they can’t read the big words in such letters like child.

So despite all the additional training and support provided by appraisal, revalidation and CPD a grunt in the field did the only thing they could to try and get more information. They spoke to the only professional who is not hidden behind a wall of paperwork and who is easily identifiable as having responsibility for the family and may actually know them.

They rang a fellow doctor. What they found confirmed their grunt gut instinct. Putting all the gory details into the patients’ records took half an hour and we still haven’t heard from those whose the Party reforms meant we should have. We probably won’t given past experience. We can only do our bit but in isolation that is not very much.

No doubt privitization will make this pathetically dangerous state of affairs even better? Will Clinical Commissioning Groups be able to undo the “progress” in child protection privitization made by TCS?

Praise be to the Party and all its dicks for sticking them up child protection via TCS.

No doubt when the accident happens the “drivers” of such reform will get off Scot free for having done everything to impede progress. It will of course be the passengers’ fault for not doing the paperwork.

Strange when the boot is on the other foot.

If you as a GP work in a part of the world with a local press you will be aware of the fact that most of what it reports is wrong. If you are involved as a doctor with a murder for example or a suicide you may attend the same event as the local press reports and think you had gone to the wrong scene when you read the press version later. Our staff regularly read the local rags to see what Johnnie and Joanna Scrot have been up to, who has died (or sometimes not!), or has been born and the odd kindly thank you for care to patients usually deceased.

A lot of what the local press reports seems to have been trickle fed to them by the local constabulary, Coroner’s and criminal courts. The local Northernshire press seems to delight in local doctor and hospital stories and alot of local doctor and hospital bashing.

Stories are usually along the lines of local doctor missed one in 300 million tumour diagnosis which was finally diagnosed by a Brownie with a first aid badge when the family were at Center Parks on a holiday. A relative is usually so stunned at the Brownie’s ability to do what the doctors did not that they are quoted to have dropped their chips in amazement.

Doctors reported to the GMC are always hot topics but when they are found completely innocent of their alleged injustices while presumed guilty by the Press in headlines leaping out from the pages their acquittal is reported if you can find it towards the back of the paper as a microdot.

Innocence in such circumstances is a bittersweet victory for the damage done by the Press’s reporting lives on in peoples’ minds for a long time and can impact on any doctors so affected lives for a long, long time after.

So while driving home from work in the Ferrari we heard first on the radio and then later on the TV news the assistant editor of the Sun protesting about a witch hunt. Having dealt with colleagues who too had felt the same we felt he may finally understand what it is like to be on the receiving end. We feel this is a bit rich for yes freedom of the press is vital for the provision of information to a wider public be it of good or of ill as long as that information is ACCURATE.

The provision of a free press does not allow it to act as judge, jury and executioner and if anything good comes out of any inquiry at present ongoing it should be that if a newspaper publishes a headline like doctor death killed my relative by stamping on their head when the cause of death was different and involved no medical negligence or culpability that the paper concerned should publish an equally prominent retraction and apology to any individual so wronged. This would be in stark contrast to current press "good" practice of lets assassinate a character and if we get it wrong walk away whistling with our hands in our pockets heads looking skywards as if nothing has happened.

The problem with the British press is that they have got away with so much for so long that they do not like to finally experience what their victims have endured for so long namely the feeling of victimization with little or no redress. Now they are on the receiving end they are able to protest far more and far more loudly than their victims were ever able to do so. For they have friends in high media places. Their victims do not.

Praise be the Party for increasing regulation of doctors within a free society while allowing a free press. Should the same clinical freedom of doctors to act now be extended in the same way by regulation of the Press via the benevolence of the Party?

A General Press Council, annual appraisal and revalidation of “professional” journalists to maintain good press care? Go on you know regulation of professionals makes such good sense . . .

Perhaps the head of a new GPC could be someone who knows a lot about the press like a doctor who has read a newspaper once (the Sun or Daily Star of course) or once watched John Craven's Newsround . . .?

Lansley slips one under.

Regular readers of our blog will know that we have featured the PFI initiative a few times in the past. This is part of the Tripartite policy on healthcare that NHS bad, private good.

This indeed is the crux of the Health and Social Care Bill which is not about health or social care only the denial of both unless provided for by the private sector which is perceived to be more efficient except that cost is not negotiable only quality. And you only need to think breast implants to see how cost is fixed and quality service is dumped in favour of profit only, care not, by some private providers. So look what Andrew is trying to slip one under the radar, always a good game at an English public school on a naïve new boy or members of the public.

A £ 1.5 billion PFI rescue fund. Who could have thought that the super efficient private sector modeled NHS foundation trust or a world class commissioning PCT which funds them would need a rescue fund? After all if you have PIP breast implants the private or any willing providers are queuing up to help you after they have relieved your wallets dearly and you have paid tax too for an NHS that won’t deliver?

Now this £ 1.5 billion is for seven trusts only and there are 103 PFIs. Here are some statistics.

£ 1.5 billion shared by 7 averages £ 214 million per trust. Sounds a lot but this is to be spread over 25 years.

Each PFI agreement will have been negotiated by a few senior NHS managers overseen possibly by a Chief Executive and maybe some at the Department of Health some of whom might be able to read or count and may just have been in the bottom third of a Northernshire comprehensive school when younger.

NHS management attracts the rejects of the UK comprehensive school system while the private sector does slightly better. So it is not surprising that some parts of the NHS are needing a bailout. Looks like some NHS managers are doing a banker and getting a stealth bailout for their and the politicians’ cock ups.

Given that there is a need for £ 20 billion savings in the NHS is there any reason why £ 1.5 billion is being paid to bail out NHS management incompetence? At an average of £ 214 million for each NHS PFI contract failure that is a hell of a reward for a few individuals’ failings.

Remind us Dr Andrew private good NHS bad? Oh yes and don’t forget to blame Labour but who invented PFI? See second paragraph of history here together with some interesting quotes from some of those involved over the years.

Praise be to the Party for ensuring that only in NHS management and banking is incompetence rewarded with government bailouts to the tune of billions and no doubt with promotion as well.

Big Brother’s members continues to get bigger.

We here at ND Central apologize for using smutty innuendo in our title but a piece from the GP magazine caught out eye and a lot of it we found quite offensive for it is showing how clearly the bottom up liberation of the NHS is more of a monster top down command and control exercise. We took offense to the classification of cataract surgery and knee replacement surgery as low clinical value treatment that must only be restricted on the basis of strict evidence based criteria.

Well if these are procedures of low clinical value then we are sure that some alkaline substance sprayed into the eyes of the dumbkopf that thought this was a low clinical value treatment followed by a knee capping might make them realize the high clinical value that both of these procedures have to patients. Not being able to see or to walk comfortably are not fun and correction of these has a very high clinical value to the NHS customer aka our patients.

However it is not the patient who is in charge of the NHS it is the Party. Remember "no decision about me without me"? These are seemingly become more and more meaningless words with each day of top down reform bottom up liberation that passes.

You haven’t yet seen another layer of top down control via bureaucracy coming to control bottom up GP commissioning decisions via the Quality, Innovation, Productivity and Prevention Right Care Team? Not heard of this quango? Give it a Google (ooh no misses!) and you might land up here.

You might want to checkout a Right Care “bespoke” Health Investment Pack (HIP weren’t they formerly another bureaucractic nightmare called Home Information Packs once?) for your area. Go on give it a go for your PCT and look at all the pretty, pretty colours on all of the graphs.

You might want to look at About QIPP Right care and its 3 bullet points

Improved clinical involvement in commissioning.

Is that the same as we are telling you what to do?

Stronger patient involvement through shared decision making.

Is that the same as we are telling you what your only choice (if any) is?

Supporting commissioners with knowledge, information and coaching to consider the legitimacy of variation and thus whether the level of variation.

Is that the same as we are telling what to do in order to make sure you meet our targets outcomes?

And this is all to be “evidence” based? You can even have a HIP Guide for GPs if you choose to register something we think we shall decline.

Seems the more the war of liberation goes on the more the top down reform of healthcare goes on so that GP Commissioning Groups are going to be told what they can and cannot do by all those HIP Right On Care guys and gals at the new and rapidly evolving mushroom cloud that is the NCB.

You know all this makes perfect sense and you can find what all this is really about in the sentence:

"QIPP is working at a national, regional and local level to support clinical teams and NHS organizations to improve the quality of care they deliver while making efficiency savings that can be reinvested in the service and deliver year on year quality improvements."

That is a polite way of saying we will command and control you to reduce services and save money.

Praise be to the Party for its transparency of opacity when it comes to giving the troops on the ground what they need. More diktats and stats Herr Doktors?

At this rate we will soon be ready for another quick QraP.

QOF and squeegee gangs.

We wonder how many patients may have had at this time of year letters along the following lines (we have put our real thoughts in brackets):

The doctor/nurse/adminstrator in charge of your (insert name of a Party determined illness) has noticed that you have not had the following:

blood test/blood pressure/asthma test/cholesterol test/(your head shoved down a toilet test for no reason other than QOF says we should do so test).

As part of the practice’s commitment to your health and well being (that’s a pack of lies we want to get paid if we tell the truth) we invite you to make an appointment for this with a doctor/nurse/healthcare assistant.

It is vital that you have this test to ensure your continued good health (if you don’t all your sexual organs will shrival and drop off or some other implied threat inserted here)

Please ring on the above number to arrange for this test.

Signed


Doctor/Nurse/Another.

Now we bet no GP will have ever have sent such a letter or asked staff to ring certain patients and “invite” them to come in for some “tests”.

The annual GP QOFing season is on so if you are a patient look out for numerous invites to perform tests to ensure that your Party approved illness is well “managed” by the medical process of ticking a box determined by some dullard in Whitehall the sole purpose of which is to try and reduce payment to your evil overpaid GP. Any real illness can be treated usually without all these mostly unnecessary extra tests done for no medical benefit other than doctors’ pay reduction.

A simple example would be if you have a mental illness do you need your cholesterol checked every year if you are well? Would your identical twin without any mental or other illness get the same intensive “treatment” as you? No discrimination here comrades as all patients are equal in the NHS and we are all in it together . . .

We think that as a patient with a long term condition being QOFed is a bit like being squeegeed at the traffic lights. Your windscreen is clean as you are well and so you get from your doctor a totally unnecessary load of soap and old flannel packaged to make it look like it is something useful to you when you don’t actually need it to make someone a fast buck.

Soap and old flannel will we are sure appeal to anyone who went to a public school especially if administered in the showers by a matron in a uniform but to anyone else it will be a load of froth on your windscreen - completely pointless and very annoying.

Praise be to the Party for ensuring that year on year GPs and their staff are spending more time squeeging windscreens than doing real medicine. Don’t worry if you can’t see your GP with real illness. If their QOF points are squeegee clean then they are Party approved excellent GPs for ticking all the Party boxes while ignoring your real healthcare needs. QOF you know it makes sense medicine.

Not.

The new word on the block.

There appears to be a new word on the block in GP land and it is called integration. Now those of us in GP land who have a scientific background know this as a very powerful tool used in mathematics that can produce useful results.

The new tool sorry word on the block seems to have come from the Future forum which is neither the future nor a forum as it is a government appointed quango to lubricate the Health and Social Care Bill up the arses of the unsuspecting British public via a sham consultation and its leader gives us a math’s lesson here. If you want a read you can learn about Mrs Crabtree here someone that no GP will ever have seen or encountered in their professional lives.

Now integration is a word we have seen here before in healthcare in the guise of several previous buzzwords take for example integrated nursing teams.

At the time this buzzword was doing the rounds we had then, pre TCS (Transforming Community Services), our own attached district nursing team based in the surgery with whom we worked with for the benefit of our patients but for some reason they were not integrated. The nurses were employed by the local Soviet but resided in our premises and we played on the same side as they did namely that of the patient and this arrangement seemed fairly well integrated to we who are simple grunts in the field.

However integrated nursing teams were not what it sounded like on the tin. It was in fact the local Soviet asking us as GPs to take on the budget, albeit less than the then current cost, for the nurses and manage it for them hence the term integrated nursing teams. So professionals working together are not integrated you only become integrated when you manage the budget not the patients.

Now in Shiteton in the run up to NHS privatization we have TCS district nurses the location of whom is a top secret for they are now deployed in secret central barracks to ensure greater integration with their medical colleagues and to ensure complete work avoidance and unaccountability. Is the new integration in fact differentiation?

So what of now and the new integration? What is it? Some examples taken from the GP rags say that this involves the overhaul of the GP contract to promote “integration” of practices. What exactly does this mean? New super large health centres 1960’s style or a rebranding of Darzi centres anyone? May be the forced mergers of local practices for efficiency gains?

Clinical commissioning groups must show ability to integrate during authorization process. Haven’t a clue what any of that means but might it be the top down bit of the bottom up liberation of the NHS via the National Commissioning Board (NCB)?

Integration may mean to explore ways to pool health and social care budgets. Is that the same as to save money but not improve care a bit like integrated nursing teams?

When you have been in medicine for a while you hear the same ideas repackaged with new buzz words. It is said that every generation of surgeons who goes to war makes the same mistake and tries to close contaminated wounds rather than leave them open to heal. Just as new surgeons make the same mistakes and do not learn from their predecessors so does every new Party not learn from the mistakes of the previous ones.

Praise be the Party for reintroducing calculus into the medical syllabus. We suspect that those talking of integration missed out at school on how useful real integration can be and are merely using the word as something to paper over a large series of budgetary cracks.

Anybody notice the similarity between the new NCB and the former NCB (National Coal Board) in terms of integrated efficiency on a mammoth scale?