A small victory for common sense?

One of the team saw this news item in Pulse magazine this weekend. For reasons best known to the Party it is scrapping its target that 90% of referrals should be made via the hugely expensive and failed Choose and Book (C&B) system.

Now this does not sound like an earth shattering story but look at when this target was supposed to have been met. Look to the article to see what the latest figures for percentage of referrals being made by C&B. 53% in June of this year (2010) and in June 2009 the figure was the same and that was down from a “high” of 56% the previous October.

res ipsa loquitur?

GPs know C&B is crap, anyone who uses it, predominantly medical secretaries in GP practices, know it is crap which gets crapper with every upgrade made to it. It is nothing more than a Party sponsored bean counter and a means to control access to secondary care. It is the prime denier of choice within the NHS as we know it and is still Party sponsored.

We said it was a small victory and that it is all it is. We know of some Soviets that are still forcing GPs to use C&B using the well known Soviet principle of Hobson’s choice.

More worrying is the bit in the article which says:

“The DH has indicated that GP consortia should maintain and invest in the system as they take over from PCTs and this week backed the system despite dropping the 90% target.”

Given the choice of investing in real healthcare for an ill patient, or investing in a very expensive failed piece of Party enforced IT, we wonder what our patients would want any GP commissioners to spend their tax pounds on?

What will the free from top down interference new Party allow? Will a certain percentage use of C&B now be a NICE new “outcome” to reflect “quality” practice and thereby tick another box instead of a top down “target”?

Praise be the Party for appearing to realize the error of their ways but in practice it is business as usual.

GP Commissioning. Anyone done the maths?

We are not very bright here up North and most of us struggle to count our 10 ferrets without using all our fingers but we have been reading Dr Grumble’s blog and his nice letter from Mr Dave Cameron telling us all about the myths and a reply to Mr Cameron.

Now maths is very hard and we can just about manage to add up and take away on our fingers but when it comes to advanced mathematics like times and share bys we start to struggle. We are, however, as GPs very lucky here in affluent Northernshire for we are so over-doctored that most of the working week is spent on the golf course.

We also have co-operative PCTs, all staffed by Harvard and Yale MBAs, who do our every bidding and are actively embracing GP led commissioning and volunteering to throw themselves on their swords in order to meet the 45% reduction in NHS management costs. The over-doctoring means that each local practice can afford 3 or 4 full time doctors to work full time at GP led commissioning without compromising patient care or, most importantly, time on the links.

However not all practices or PCTs are that lucky. There are many PCTs up North that are well under-doctored. This means that hard choices will have to be made as to how much time doctors in these practices can afford to spend commissioning. Are you lucky enough to live in one of these areas?

GPs often know a lot about illness in their area for they spend time treating it and know what particular needs may be required in terms of specialist services for their patch and it is only human nature to want to get the best for those for whom you are responsible. In order to do that this means being represented in a consortium but this means compromising frontline medical care in order to do so or incurring cost to cover the absent GP’s workload.

Perhaps GP Practices that get along will join up and second a smaller group of GPs to provide services for all but will these GPs be from larger Practices with more doctors or small practices? Will they be full time or part time commissioning GPs?

If you take one GP out of a ten doctor practice to do commissioning than the workload is shared between the remaining nine. Assuming they are all full time, as is the absent from the frontline commissioning GP, that would mean the remaining GPs would get 1/9 of a full timers work added to their current workload. However what about a 3 partner practice where the increase in workload would be 50%?

The UK compared with Europe is under-doctored which means that there is not a huge amount of spare capacity apart from of course in the intergalactic-class Northernshire PCT where ND Central is located.

In order to win wars of liberation you need troops on the ground ideally a volunteer army rather than a conscripted one. Usually when attacking a defensive position it is reckoned you need at least a three to one advantage.

Do we as GPs have the numbers to replace those managers doing the current commissioning and still maintain frontline GP services? Wars have to be fought full time in order to win and troops take time to train if they are to fight well. Do we have both the numbers and time to train the army of GPs needed to liberate the NHS?

If you do not live in a Northernshire PCT like ours you will no doubt be doing mathematics along these lines and perhaps are realizing that the war to liberate the NHS is not going to be easy.

Most GPs are currently fighting full time on one front. Is there the capacity to open a second front of GP led commissioning? Historically fighting on 2 fronts is not usually a good tactic unless you are looking for the defeat of those fighting on two fronts. Those that GPs will now have to become allied with have historically believed the GP to be the enemy. Does that make for good working relationships?

Will GPs be as well equipped and trained as the Allies were on D-day? Will those GPs doing commissioning be full time, fully trained to do so and have all the equipment they will need or will they be a Dad’s army of part timers doing 2 jobs?

If you were fighting a war of liberation which army do you think might do better in terms of a quick victory? Where is this army of GPs to do commissioning going to come from? If they are not available in sufficient numbers, will we have to hire mercenaries to make up the numbers? Are mercenaries the most committed troops to have in a fight?

Anyone done the maths yet and more importantly got the answers?

Praise be to the Party for all of its planning to liberate the NHS. If their maths is correct then it is going to be such a pleasant walk in the park for no patient anywhere will be compromised by their GP doing another job the numbers are so good.

Next stop Berlin or will it be somewhere else?

The top down noose gets ever tighter.

One of the team saw this little gem on the web this morning. Quite frightening if true for it means that GPs will no longer be able to resist the will of the new Party for they will have to obey its new set of organs the consortia.

Fine if you have enlightened forward thinking intelligent GPs in charge but if your consortia GPs are at best a quarter of a century out of date being led by PCTs who don’t even know the Berlin Wall has come down where does that leave the individual GP? Can you see the GMC being lenient on a GP who cocks up and uses the “I was only following consortia orders” excuse? Didn’t work that well at Nuremberg did it?

Praise be the Party for liberating GPs and the NHS from top down reorganization and Big Government. Things can only get better?

Hands and necks.

It is said, by those for whom appearance is all, that aging is best shown by hands and necks. We recall being told that if you wash your hands often enough and use them that your fingerprints become less prominent.

Is that why we GPs struggle at the self-service checkouts to open a freebie bag?

Praise be to the Party for the ever so clean hands of its GPs.

Or are we missing something like the repeated use and sharing of saliva on supermarket bags to open them as a public health issue?

Diseases spread by saliva include . . .

A busy few days at the office. To privatitize, or not to privatitize the NHS, that is the question . . .?

The last few days here at ND Central the King Canute like tide of wellness has been well and truly lapping at your average Northernshire GPs’ throne like a tsunami.

A combination of a shortage of doctors and a huge surge of alleged illness has resulted in the number of extras per GP spiralling. Coupled with our ever loving, and increasingly abusive, patients the few doctors and reception staff still standing on the frontline are struggling to cope.

We think the last time it was this busy was in the mid nineties but at least then most people we saw were actually ill and polite with it in contrast to now where very few are. As an example at last night’s surgery 9 extras demanded to be seen in one GP’s branch surgery session. The alleged “emergencies” broke down as follows:

Number of life threatening conditions seen = 0.
Number of ill patients seen = 0.
Number or prescriptions issued = 0.
Number of self limiting minor illness seen requiring no treatment = 9.

At the same time as the local healthcare markets are burning with alleged illness, but with no extra resources to quench the fires of demand for instant medical care, our political masters are fiddling away and tell us how competition and markets are the way forward to improve healthcare. Hmmm.

As very simple grunts on the frontline we thought about how would we cope with the situation of too many (allegedly ill patients) with too few doctors. We present 3 options based on current, and past Za Nu Labour/ConDem, policies:

Option 1:

In a true market the patient as the consumer would pay directly for healthcare. The healthcare provider (GP) could then charge the market rate. If demand = illness was high and healthcare provision = supply was sparse then the laws of supply and demand would dictate that in order to see a GP costs would rise as demand does in order to reduce GP workload.

Examples might be you can see a GP for a routine appointment in a couple of days and we will charge you £20. If you, as the customer demand that your illness is an emergency, your NHS Choice, we will charge you £50.00 to be seen the same day. If you feel that you cannot possibly come to surgery then we will charge you £100.00 for a home visit.

To reduce unnecessary demand in a free market then A&E departments if busy could up their charges to say £70 a shot. £250 if you call an ambulance.

Think about which of the above options you would choose and whether the cost would determine whether your condition was a true emergency or could wait. At the moment if we were on piece rates we would be more than happy to cope with demand as it is now for our extra effort, and that of our staff via overtime, would be richly rewarded.

Works well for lawyers, accountants and, possibly, consultants too?

Option 2:

In the pseudo free world Soviet regulated by the internal (non) market, a Soviet institution called a PCT agrees a contract with a private provider and limits the number of patients they are allowed to see. In other words there is a cap on how much illness the private provider can see and treat. This we have commented upon before.

“Oh no comrade patient you are illness case 101,326 this month but the Party’s contract allows us only 101,325 illness commissioned events by your preferred contracted provider this month so you cannot be treated until next month. We do have a contract you know regardless of your illness.”

So the private sector treats as per contract, gets rich and then what? Stops seeing patients even though there is still demand and worse still local spare capacity to see and treat them that is not being used. The world-class managers who “commissioned” this spare capacity are preventing its use at a time of need.

Who then mops up the rest of illness? Local GPs and A&E?

Option 3

The current NHS nGMS contract is a godsend to both the private sector and Government for it allows unlimited dumping on GPs (and A&Es) regardless of capacity. We note that GPs do not have any fixed capacity in the way that Darzi centres have and so workload is potentially infinite but resources very finite.

So we have seen a 50% increase per GP in workload but we do not get paid anymore but still have to absorb increased demand and costs associated with meeting this demand.

If you are, as all GPs in Northernshire are, so heavily over doctored that we export them overseas by the container load, and spend more time on the golf course than in the surgery, this scenario will never be a problem. You just drop a round, or two, of golf.

This will of course only ever happen in PCTs such as ours due to their world-class commissioning activities by their Harvard and Yale educated PCT commissars, who were never so dumb as to agree an option 2 Darzhole centre currently absorbing NHS funding while delivering bugger all.

Patients abusively demand of our staff “urgent” appointments and then do not show. When they do show it is virtually never urgent e.g. constipated for a month in a 7 year old busily trashing the surgery toys or I have had this unchanging mole for 40 years and thought I would get it checked NOW (bad night on telly) or I want my blood pressure checking (which was OK this morning when nurse checked it?).

There is no responsibility for the patient to attend their appointments, to use healthcare responsibly but their god given right to bear arms, oops wrong country, to abuse daily the NHS is used without any fear of sanction or cost across the land. Even dentists can charge for missed appointments but not GPs or hospitals or A&E departments and remember dentists were allowed to do this when they were once part of the NHS.

If you are really genuinely ill and need to be seen which model do you think you would serve a genuine need best?

Would you be prepared to pay £50 to be seen as an emergency or go for the no charge to be seen and wait option 3? The future of the NHS as we know it?

Option 1, currently not widely available, but allows the “customer” the market choice of putting their money where their currently abusive mouths are.

Option 2 GP commissioning which will make the private sector rich at your expense and for more cost will provide you with less care. This is current NHS “world-class commissioning” by morons on your behalf.

Option 3 the current situation where you will get care on the cheap and quality to match. You also have to wait but then you are not paying the piper directly so you have no choice of tune, quality or speed of access which is centrally controlled not locally determined.

Everyone says they would be prepared to pay more for a better NHS but talk is cheap and increasing taxes is never popular but abuse towards our reception staff is a democratic right and free to all who wish to use it.

Praise be to the Party for giving the NHS a market. At present our staff would embrace the free market and invest in shares given the current demand for they would be rich given the workload and abuse they are enduring.

Unfortunately the NHS market means we are all the poorer for pandering to the pathetic the most pathetic of which are the politicians. Bet you none of them are BUPA positive?

For BUPA positive press option 1 . . .for NHS press option 3 . . . for no, or limited care try option 2.

How thick can they get?

An article in one of the GP news rags made us wonder just how thick you need to be in order to dictate UK health care policy? We suspect that a medical degree would automatically disqualify one. We also suspect that an art’s degree and the word politician automatically qualifies one to dabble in areas where one has no experience and as a result come up with ideas of how to screw up the health service.

The article is here.

Read through it. The second paragraph rings alarm bells for it says that:

“GP consortia will roll out the Department of Health’s flagship urgent care clinical dashboard . . .”

Is a “clinical dashboard” the same as another buzzword bingo word called “tool” or “toolkit” which is usually a functionally useless, but expensive piece of crap software paid for by NHS managers who think that if it is on a computer it works for they don’t?

A bad workman is said to blame their tools but in the health service bad care is usually the rest of “tools” manufactured by even worse “tools”. Think productive ward.

This dashboard “will hold GPs in their area to account for their patients’ A&E attendance, unscheduled admissions and hospitals”.

Take for example the condition known as appendicitis. This is an unpredictable surgical emergency and as it is such it would be classed as an unscheduled admission. Should GPs now beat with rubber hoses any patient that dares have an “unscheduled admission” with appendicitis after reading their dashboard?

Have a look at some real dashboards. Virtually all overpaid lazy GPs will recognize the first one for they drive into work each day and use this one. For your average overpaid hospital consultant they will probably recognize this one for they will fly it into their office each day before counting their ill gotten overtime for working extra hours in their free time.

Then have a look at this Department of Health’s flagship urgent care clinical dashboard. We bet your average GP would like to sit down on its bespoke leather heated electrically adjustable seats, smell that expensive new dashboard and get their sweaty palms on this “tool” before pressing some “knobs” and buttons hard enough to push this “tool” to its max to feel its throbbing boost to their professional performance.

Unfortunately there will be, and have been, some retarded enough to do so.

There is even an NHS website (no surprise there then) so you can spend hours going round in circles.

There is even a video where the time expired grey haired lady speaks for herself if you can stand the crude editing. It reminded the team of something similar from a few years ago regarding C&B. Grey haired Northernshire time expired lady GPs being used to foist sh*te on those still in work? Is this a new trend in pr (not the medical kind)?

Read on and weep as the dashboards performance stats are that it:

can slash unscheduled admissions by 20% (we know slash has another meaning?)

and

help hospitals cut length of stay by a quarter (ditto length?).

Look here and see what is claimed with a bit less spin. Can you see how many practices can achieve this success story before a roll out as per Choose and Book occurs? One out of how many?

In contrast to the Ferrari and the 747 dashboards, both of which have controls that allow the user to adjust performance in real time, where are the controls, the accelerators, the brakes, the flaps needed to restore an acceptable level of performance on the Department of Health’s flagship urgent care clinical dashboard?

If the car goes too fast you can slow down, if the aircraft goes too high you can level off but the clinical dashboard?

The final paragraph of the article makes out how really good the project is:

“The project delivery will be the responsibility of the local NHS/PCT/GP consortia and there is no central funding available to provide local resources, hardware or software.”

Imagine Boeing or Airbus saying we have a new aircraft but cannot provide the aircraft, fuel it or fly it. What do you have as a result that is flyable?

Still they want 10 GP commissioning consortia to start “piloting” the Department of Health’s flagship urgent care clinical dashboard. Sink estate, or spearhead PCTs, and their consortia only should apply. And probably will.

Praise be to the Party for spending on offensive brown smelling ideas instead of what patients actually want and need.

Healthcare from those that can deliver it.

You don’t need a dashboard to do that, just training.

Extended hours to be axed?

One of the team did an extra Gordon shift (subtract the f from the word after Gordon to understand what this actually means, and what he meant, to GPs, their staff and their families in the UK) this evening and we were once again overwhelmed by how many people turned up.

Combine this non attendance of patients ,with Za Nu Labour’s Sovietization of healthcare which dictated that all patients needed a ten minute centrally controlled and dictated appointments when in fact many only require two, it meant that what would have taken less than 45 minutes tops to achieve if GPs, as professionals working at their own time and speed, had dictated the pace rather than sitting around doing nothing for most of two hours.

Still while hanging around doing nothing medically useful we did think what could we as caring overpaid medical professionals being doing as we sat idle?

We thought perhaps we would be better off at home beating the kids and sending them up a few chimneys for it has been cold in Northernshire this winter and chimneys need to be swept? That would be a few more pounds of petrol for the Ferrari. We could feed the ferrets and whippets and when the animals had been fed the kids could have the leftovers for they would be warm but hungry after doing some homework.

We could be having a quick pint of Southern Comfort followed by a beer chaser of Old Scroty Grunge bitter, 98% by volume, to ease it down before asking ones butler to ease the Ferrari home to its nocturnal roost as all overpaid, underworked GPs do in the evening according to certain media sectors.

Still, despite all these better things we could be doing we did find this article to read.

Our hearts felt heavy as we read the comments afterwards for weep all ye good GPs for if there is no money for extended hours how will we as dedicated GPs be able to cope with not fulfilling this Gordon determined (alleged) need?

For we do remember that Gordon, the man who saved the world, did ignore a hugely expensive survey of patients that his Party had paid for which said that 85% of patients were happy with GP hours and use a much smaller survey to impose extra hours for no extra pay. He was all wise in all things to do with healthcare for he had spent so many more years doing (something to) it than our humble healthcare assistants in their 20s have in their short NHS careers.

(Note to Ed something in that last sentence might not quite be right but we are not Scottish enough to see what it is.)

The article says that if funding was to be removed “GPs would be left with the unenviable choice of either stopping offering patients evening and weekend surgeries, or continuing to run shifts without additional resources”.

Well given the overwhelming demand that Gordon had decreed this evening, and the deafening sound of patients banging on the doors demanding to be seen, “the unenviable choice” of sitting doing nothing in an empty consulting room or swigging another pint of Old Scroty Grunge was not going to be one that this grunt would have any difficulty making.

Praise be to the Party for even considering this option. Any guesses what will happen?

Pull the funding, “consult” with the profession and make it part of a “newer” contract? Simples.

The Swine Flu Panicdemic returns.

If you are dumb enough to have a NHS email account with all the benefits that any NHS IT solution provides, in this case free access to unlimited NHS sponsored spam, you will be aware of the second wave of the great NHS swine flu panicdemic arriving daily in your inbox.

For a more in depth analysis than we here at ND Central or the Department of Health could every hope to provide we provide this link but please be aware there are a few grunt words in this piece which might be on a par with edicts from government in terms of accuracy and believability.

Several chats with colleagues all reveal the same conditions that that we are starting to get bored with, the monotonous roll call of life threatening coughs. For most GP grunts in the field we seem to be seeing 3 major types of illness in our patients all of whom say they:

1) are really ill and think we have flu (but are in surgery despite the hot and cold feeling and sweats that we have as we listen to your tale of woe, aching all over and joint pain too?)

2) have a really sore throat (as opposed to the sore throat we just happen to have?)

3) have a really painful cough (as opposed to the cough that hurts which we just happen to have as well?)

4) have a croaky voice (like we have and have to ration to listen to 50 other people like you through the day?)

Well pathetic dudes welcome to common illnesses that happen every year at this time and most of us get and more importantly and unbeknown to all the actors and actresses we see actually get better on their own. They have occurred for centuries and get better despite of not, because of free access to wellcare, or is it healthcare?

If you have the above and your cough is dry it is likely to be a viral upper respiratory tract infection and needs no treatment. This is group one and most of them will probably not have noticed that the nice blond receptionist who booked them in had exactly the same symptoms and sounded like an 8 stone Brian Blessed instead of a shrill soprano but they still clocked your peffy cough and mousey pathetic voice on the phone blagging an urgent appointment.

If you are coughing up loads of crap, as our patients tell us they are, then depending on what kind of crap you are coughing up, sometimes antibiotics are required especially if your doctor is lucky enough to hear some signs of genuine illness when they examine your chest. This is our second commonest group.

The third group may have sinus distribution headaches as well as all of the above and again some of these may merit antibiotics. That, at present, represents 95% of our workload here at ND Central.

When it comes to swine flu we can honestly say we now know of 2 confirmed cases, not the “I am so ill I must go home as I think I have flu” confirmed case. This is pretty good for last year we were allowed to do one swine flu swab on all of our patients to confirm or refute the diagnosis of swine flu and so like most doctors we do not know if we have EVER seen a case of swine flu apart from the 2 cases confirmed in hospital we now know of. We have seen neither of these patients ourselves.

It is like trying to diagnosis AIDS/HIV without a blood test (and some of us are old enough to recall the HIV panicdemic without serological proof to confirm the diagnosis). Without accurate confirmation of a disease it is not possible to refine ones skills of recognising the clinical signs of a particular disease. Hence it is difficult to reliably guess how many of our patients, if any, may actually have swine flu.

Which is probably why none of us have diagnosed a case of swine flu preferring instead the term viral upper respiratory tract infection instead. Obviously this is primitive Northernshire medicine for there are a lot more GPs out there who are better at guessing swine flu than we are for “confirmed” cases (guesses) are rising and these expert guessers probably have MRCGP after their names.

So an email today which spoke of high level communication along the lines of a James Bond SPECTRE international meeting of criminal minds where those Blofelds in the DoH are stroking their pussys and dictating to their underlings in the soon to vanish SHAs and local Soviets that swine flu bad, vaccination and anti virals good.

This meeting of alleged minds was described as a teleconference which would have been a laugh as we can see those grainy black and white flickering images with several seconds of delay between mouths moving and speech sounding for the NHS broadband connections can be downed by one person watching a video on Youtube so the thought of a “conference” between more than one person is probably closer to a delusion than reality or was just a one way video from Youtube called a “teleconference”?

Still the DoH has set new “outcomes” for the comrade GPs to meet as well as new “outcomes” to try and clear the unused vaccines and antivirals as well. We love the new Party can anyone tell the difference yet?

Still back to the grindstone. Dry painful cough, sore throat, husky voice, temperature "it’s a virus" next (as we think of Brian Conley’s it’s a puppet clip) . . . NEXT!

And don’t let your practice manager catch you watching this at work after they report the slow speed of your practice computer system to your local Soviet’s IT department. You have been warned!!

Praise be to the Party for priming the country to panic and condemning pharmacists for engaging in anti free market activities. Whatever next selling the NHS off to the private sector to make a profit for someone?

Welfare.

When the ConDem coalition started “liberating” the NHS, a colleague made a comment to the effect of “I hope they sort welfare out before they sort out healthcare.” This was a few months ago but some comments register and subsequent events have confirmed the incisiveness of this off the cuff remark within the context that it was made.

The “welfare” referred to here was social care in the UK as opposed to healthcare.

“Social care” is usually provided for by local councils via social services or social work departments. It is for things like home carers for elderly people, for example who help with preparing meals and dressing, or those with disability and a whole host of other things that aren’t strictly medical but often the line gets very blurred.

Since 1947 and the inception of the health service huge sections of UK society have realized that the old concept of “family” so beloved of any TV soap you care to watch has been replaced by any problem with anyone = ring the GP or go to A&E or ring social services. For many of our patients this is the default position.

An example might be a dementing relative living on their own in sheltered housing, becoming increasingly confused with an uncaring relative as the next of kin who is happy to pocket the benefits as the “responsible” adult/carer. If the relative’s carers ring and say there is a problem their response is to always ask for a home visit from a GP.

This is the current situation. The family don’t care. It is not their responsibility and they do not speak to GPs when requested to be present on home visit for often they don't bother to come. Social service carers ring for visits but they too are too busy to be there when GPs visit unless by chance. Home visits by GP are then useless for the demented patient perceives no problem and never remembers seeing the GP.

So who is responsible? Post 1947, clearly a priori the State, for when the family in the nanosecond they ring the NHS/social services are completely cleansed with bleach and Agent Orange of any iota of responsibility for their relatives because they cannot cope or more likely can’t be bothered.

If the NHS and social services cannot cope that ain’t the relative’s problem. They have their benefits and occasionally have paid their taxes too. (Note to readers this happens in both the least well off of society and those who could easily afford to pay it is universal).

So pre ConDems what happened? Social services would try and keep such people in their own homes but ultimately this was a no win scenario. The relatives become more drunk, sorry demanding, the patient becomes more frail and ultimately someone calls for divine intervention and dials 999.

Hear the Hallelujah chorus for instantly the family’s, together with the GP’s and social service’s, responsibility for a situation they can do nothing for is lifted for the demented uncared for by family Mabel is transported to A&E who realize that she cannot manage in anything other than a care home after she spends several days on a very expensive hospital medical ward.

This self evident fact was something that social services and GP had realized years ago but had been blocked by relatives and under the current rules of engagement we just play the game as per the rules. So Mabel becomes a bed blocker as relatives don’t want to lose her drink benefit they so freely spend.

This situation will tend to take weeks or months to sort out especially as the Mental Capacity Act will rear its ugly but well intentioned head and there are not enough psychiatrists to do the in depth assessments to determine Mabel’s mental capacity to make decisions for herself.

GPs and social workers know Mabel’s mental capacity is zero for they have seen it decline but the State thinks otherwise for Big Brother knows best. Mabel’s relatives are looking after their best financial interests and so will resist any change to their own personal vested interests.

So Mabel will block beds as Mabels and Georges have done for decades.

The problem is that there are more Mabels and Georges than ever and less hospital beds than ever. This is despite a 20% increase in population in our lifetimes, most of them elderly, and some councils up North are being forced to make 20% cuts in budgets with possibly the loss of 1 in 5 staff which will impact on social care which is becoming increasingly rationed usually on the cheapest, not necessarily the best, option available.

So will an at present cash strapped and under resourced council provided social service be able to cope with the Mabels and Georges as local authorities cut costs?

The answer is we don’t know as yet but the default position has been that if social care can’t cope Mabels and Georges become medical problems and hospital managers don’t like bed blockers for it deprives them of income. Doctors don’t like bed blockers for seeing the same face on wards rounds better, but going nowhere fast, deprives them of beds to treat ill patients.

So a reduction in social care, coupled with no real increases in healthcare spending and 100% bed occupancy is going to do what exactly? Discuss but remember what someone said at the start of the NHS liberation?

“I hope they sort welfare out before they sort out healthcare.”

Have they?

Praise be to the Party for by social cuts to the most vulnerable they will inevitably cut medical care to the more needy. Unless they sort out welfare well the health service is just going having to cope.

Is it time now for the Big Society (whatever that is?) or family (see above) to cope? Or do the ConDems know better . . .?

Logan’s Run anyone?

Recycling.

For those of us in medicine who are really old there was an idea in the 1970s that oil would run out (by now?) and we would not have enough of anything and so we should recycle everything that was well recyclable. This is now called being environmentally friendly.

Not exactly a daft idea for if you realize that we live in a world of finite resources, are not proposing to go to any new worlds that space might potentially offer, and the population increases year on year without any increase in resources then you may have to make do and mend in order to keep humanity going.

The same applies to keeping the supertanker called NHS afloat and steaming somewhere useful although many working in it are seeing it rot from within as numerous “reforms” corrode away at its core idea(ls).

A few articles recently and some events local make us realize that the NHS is a recyclable body par excellence but not necessarily of items useful.

It does not recycle expensive healthcare products for one of the team recalls chucking away acres of rain forests when they worked in an anaesthetic department when in order to fill 50mls worth of syringes you probably filled a bin full of 500ml of paper, cardboard, plastic and glass.

NHS reforms recycle nothing but produce mountains of paper to be read that ultimately will land up in a landfill and have achieved what exactly? Anyone remember the paper not patients initiative a few years ago?

We think we got that one right(?) but how many practices have seen their stationary bills fall since the paperless Choose and Book system was introduced? How many hospitals have seen the same thing happen there?

Politicians do not recycle anything but merely reinvent the wheel. The current ConDem regime is no different. Politicians do not even listen to their own let alone those who elect them. Most GPs will listen to more political opinions in week than politicians will base their policies on as a result of listening to focus groups for years or their own busy once or twice a month “surgeries”.

One group of people have to listen to people to do their job the other pretends to listen to people but actually listen only to their cronies. People when they go and see a doctor or nurse want to get better. This means they need access to something called treatment.

When we as GPs talk to our patients they have a problem. If we can treat them we do so but some patients, for example someone with suspected appendicitis, cannot be treated in General Practice we need to refer them on to an appropriate specialist.

Our patients do not at the free of point of care NHS normally ask us how much commissioning has been involved in order to get their operation they just want treatment. This is in contrast to politicians of any Party who think that commissioning is what healthcare really is. They concentrate on the management of healthcare not its provision. The desire for treatment is not an irrational human ambition but the rational desire to get better. If you are ill you want treatment to get better not management.

Commissioning is nothing more than a bureaucracy or management structure created to deliver nothing other than more management. It does not deliver healthcare, for healthcare, amazingly enough, is delivered by healthcare workers not managers or politicians.

Commissioning is a failed policy that has been recycled by the ConDem coalition from the burnt out ashes of fundholding. These ashes were breathed on and reinvented by Za Nu Labour as commissioning, nay not just any commissioning, but “world-class” commissioning ®™, that was never fundholding, and is now recycled as GP led commissioning. Ain’t recycling great?

NHS management is also on the bandwagon of recycling as a lot of useless bureaucrats were (hopefully) going to lose their jobs. The medical press have been full of scare stories as to the fact that commissioning will not work as senior people are leaving in droves and we have noted this earlier. These senior people are the same ones who have not made it work so their loss is of dubious significance.

According to the medical press even those at the top are being recycled but unfortunately not into anything useful for the healthcare of Jo Patient.

The new NHS as per the White Paper allows clinicians the potential to redesign the NHS.

However it also denies them the ability to do so for already the so called abandoned targets are to be replaced by new “outcomes” all centrally dictated by the likes of NICE, the NHS Commissioning Board, Monitor and the Care Quality commission all of which are recycled versions of Za Nu Labour’s centrally controlled failed NHS.

Just as in any good Gulag you can do anything you want as long as the guards approve. The current perimeter fence of commissioning, aka healthcare provision to real patients by PCTs is being torn down and the inmates in some Gulags are running a few yards further beyond the fence but only as far as the next newly built and ever thickening bureaucratic fence. So freedom in the NHS Gulag is a nice word but a very limited concept in the new, “liberated” NHS.

Instead of recycling valuable resources that are in short supply on the planet in order to preserve their useful existence the politicians are taking that which has fed numerous mushroom farms and are planning to redeploy the same mushroom farm food under the direction of GPs.

If you are a turkey waiting for Christmas you would want to preserve your head as long as possible. So PCTs are doing the same. They are still in charge and locally are doing their damnedest to stop GPs doing anything useful. At the same time they are devising structures that mean that when PCTs do finally go the same idiots that are now running the show will still be running the show for they are not allowing GPs to do anything different.

Stop GPs doing anything useful now and when they are allowed power in a couple of years time they will have no choice but to preserve the status quo and the ancien regime.

And instead of the Department of Health there will be a new layer of (additional) management called the NHS Commissioning Board et al. In the current NHS management begets management but it rarely, if ever, creates or improves hands on healthcare merely hampers it.

Plus ca change plus c’est la meme chose it is said but we bet at the end things will be well so much more bureaucratic.

Just as someone once said the bomber will always get through so in the current world of (NHS) healthcare the manager will always get through and like the bomber what the manager delivers is merely destructive to those needing healthcare. And it keeps coming in waves and waves and destroys the crews of those in healthcare just like Bomber Command destroyed bombers and their crews for bombers are cheap and quick to produce.

Ultimately the Germans rebuilt and perhaps after another half century the NHS may do the same. Who will get the blame for failure if the new commissioning does not work? Not the bombers that are NHS managers but those that will be forced to take over the flying of these bombers from the managers - the GPs.

There will be more Dresdens than there will ever be Cologne cathedrals left standing but still the NHS will have done some more recycling.

Praise be to the Party for that which is to be recycled will be the flotsam and jetsam that has denied first world care to many while providing world class commissioning to most. Once again the wheel is being recycled, reinvented and lots of time and money will be spent to make sure it is less round than the last square one.

Commissioning failed in a time of relative plenty but is now being recycled in a time of famine. Only one group of people will lose from recycling and that is those that we are meant to serve. Our patients - but they will, once again, be better managed.