We now earn £ 600,000 plus a bit of sense for a change.

Well we idle over paid GPs have had another sun drenched 4 days off work in the form of a Royal Wedding Bank holiday and a May Day Bank holiday (comrades) in contrast to all those hard working PCT managers who felt that we should not have the same as they are entitled to. This gave the team the chance to do some reading of everyones favourite GP bashing newspaper The Mail on Sunday (MoS).

Now how could anyone ignore this headline that your “average” (sarcasm) family GP is on £ 665,000 a year for doing bugger all?

This is up a massive £ 165,000 in just a year according to the MoS yet only a year earlier they were earning on “average” £ 380,000 a year and getting £ 200 an hour for work they used to do for free!

So in less than 2 years your “average” GP has seen their income rise from £ 380,000 in December 2009 to a massive £ 665,000 now. No wonder new medical graduates sleep rough in our car park and pester us as we walk from our Ferraris as our staff hold umbrellas above our heads to shade us from the sun as we are carried in our sedan chairs into our large offices to await the great unwashed unwell who frequent our humble abodes and pay us so much to do so little.

Who would not beg to be a GP Registrar if you knew that according to the Mail on Sunday your income would increase by just under £ 16,000 a month, month on month in just 18 months? No wonder the government of hypocrites sees fit to relieve of us about 70% of every illgotten tax pound we earn. Digusting it shouldn’t be allowed.

But a more in depth trawl of the MoS publication led us to find this little gem.

Now if you have been reading UK medico-political blogs over the last 3 years this is nothing new but this little gem that should be shining out much more brightly was hidden in the Review section of the MoS. Reviews are normally about about opera, theatre and the finer things in life for some who read what are popularly known as the broadsheets. Regular readers of the Stoat Tickler's Gazette, our favourite rural read here at ND Cnetral, can't even spell review.

On the day before the death of Osama Bin Laden is reported the MoS has finally realized that there are people in the UK who have done more to terrorize the frail and vulnerable in our society than any terrorist or maverick GP has.

Terrorists usually target the fit and healthy. NHS managers get to target the opposite and it is these people who need the NHS the most and are most frequently let down by NHS managers. We call this institionalized incompetence and the 2 individuals in the MoS articles are masters of it and if the article is to be believed totally unapologetic in one case.

Now Bin Laden is no longer the world’s most wanted person, that title will undoubtably pass to the man, or the woman, who got the head shot, will the UK’s government turn its attention to those mass murderers who continue in the NHS?

Probably not for if every hospital is to become an NHS Foundation Trust the Party will need more of them.

Praise be to the Party for rewarding incompetence with promotion. For if a NHS manager screws up they are moved sideways into a new career.

Shipman did the honourable thing, Bin Laden was taken out and what will Nicholson et al do? They will just carry on and kill create more Foundatin Trusts as per Party orders and get away with it for NHS managers are never wrong and there is no GMC for NHS managers.

Only promotions and honours.

Blue on blue on blue.

In the military the expression blue on blue refers to the fact that friendly units are firing on friendly units. This is not good as the idea of war is that blue should fire on orange i.e. friendly forces should destroy enemy forces as per the former Cold War.

Most politicians can comprehend this concept but when it comes to shooting fish in a barrel or taking pot shots at anything that cannot fight back the NHS is a classic blue on blue situation.

Politicians of all Parties claim to be “friendly” towards the NHS but most are covertly hostile and all of them like to take pot shots at it for it is an easy political target to hit.

So Za Nu Labour and the ConDems all have the same ill fated plans being reinvented and thrust down the throats of all in healthcare and thereby they inflict them on patients who may, or may not, have voted for their (covert) plans.

The NHS is experiencing the biggest onslaught of friendly fire in its history from not the usual 2 fronts (Conservative and Labour) but 3 the latest blue being the Lib Dems. Imagine a previously solid British square at Waterloo being assaulted by an Apache gunship, a cruise missile and an Abram’s tank all within 2 years. Anyone fancy a punt on who is going to win?

Blue on blue on blue. A great way to win a war - keep shooting your own and the enemy will win without a fight.

Question is who is the enemy? It can’t be the NHS for all three Parties are standing firmly behind their “own” personal friend the NHS with their jackboots in its back about to push it off a cliff.

For simple grunts on the ground this is the question. Most of the NHS works and that which does not can often be fixed cheaply locally.

If a car's spark plug does not work do you fix it by taking it to a crusher? Anyone in Westminster heard the expression “if it ain’t bust don’t fix it”?

Praise be to the Party for giving us more war with each reform but not defining the enemy. We on the frontline are fighting the enemy of illness on one front while fighting a constant rear guard action against political interference.

A war on two fronts is not usually a good idea but most medics have done this since the inception of the NHS. Anyone wonder why the NHS isn’t working? Most healthcare workers faces are well and truly bruised by the politicians smacking us in the faces time and time again.

For what?

Compare the market . . . ?

Some of the team have been freezing their rocks off in a good cause in a dull, cold, mist and cloud covered part of the world devoid of the internet but via other electronic media we have been able to warm up our little frozen bits upon the warmth of wisdom dispensed by none other than the Secretary of State for Health Andrew Lansley MP. We heard him while mobile with nothing else to do other than concentrate on the narrow tracks we were driving along through the dense mist with precipitous drops to one side and hard rocks to the other.

Come to think of it that isn’t too dissimilar to our day jobs in helping patients “navigate” their hazardous NHS “journey” - oops slipped into buzzword bingo land lets get back to the blog world.

He was interviewed on the Radio 2 Jeremy Vine program and you can listen to it here. It is fairly obvious that the knowledge of the health secretary appears to be an integer located in the range –1 to 1 as he has not a clue about general practice in particular and the NHS in general. Come to think about the same applies to his interviewer.

We cannot recount the whole of the interview but some bits did almost distract us from driving the “Ferrari” we were in. Bits of it to our crude grunt minds explained the huge “differences” between the “old” NHS and the “old” Party’s reform s and the “new” NHS and the "new" Party’s reforms and we recalled another failed "market" system from a while ago as a result.

So are we sitting comfortably? The Lansley bit starts at 18.24 so if you move your sliders to about there we will begin.

We start with Dorothy’s knee. You can see poor Dorothy sitting at home, all alone in the world, in her high backed chair, with her 1950’s NHS specs and her ill fitting false teeth from the last time she had NHS dentistry, white haired and with swollen ankles unloved by anyone other than a Radio 2 presenter and her “new” good friend Andrew. Andrew is clearly Dorothy’s advocate for almost immediately he says the most important thing for Dorothy is that she

“. . . gets really good care . . .”.

The implication is that presently Dorothy’s knee is ignored. Dorothy’s new friend, in addition to the scarecrow, the cowardly lion and the tin man, Andrew goes onto to say he wants to

“. . . hold everyone to account for the outcomes we deliver . . .”

note the royal we that will never apply to him?

Andrew continues to say that if Dorothy has a knee operation then the operation done box is ticked but no-one checks on poor old Dorothy (aah how sad dear readers Dorothy is all alone in the world again apart from her new knee that no-one cares about). So all of the patients seen post joint replacement in outpatient clinics are not being checked but Dorothy’s other new friend Jeremy says he thought that was the point of all those new targets you hated so much.

The blind leading the blind? So Andrew has

“ . . . set out for the first time a really systematic view of what those outcomes should be . . .”.

Isn’t Andrew so kind to poor Dorothy and her new knee? A return to the cradle to the grave healthcare by abolishing targets and replacing them with “outcomes”. No new bureauocrats here checking up on Dorothy (and her knee).

Dorothy’s other new friend Jeremy then goes on to say that if a private company run by the Wicked Witch from overseas (boo) sets up a “knee place” this will drive the Good Witch of the local hospital out of business. Andrew is quick to reply and says that the

“NHS sets a price”.

Starting to sound familiar? All good Conservative free market stuff here but it won’t be a tariff will it?

Words like GPs and patients commissioning the care and the money follows the patient follow. Jeremy then starts to talk (dirty) free market saying if the successful overseas Wicked Witch provider does so well that the local hospital shuts down then she doubles her prices what happens then?

What follows then is a core Conservative value of the laissez faire philosophy summed up in the phrase from Dorothy’s new friend Andrew:

“it is not a free market”

which he says not once but twice. At this point our traveling companions were in hysterics and what followed at about 24.00 minutes forced the driver to slam on the brakes.

“ . . . and there is a regulated market with regulated prices but it is a social market not a free market . . .”

In 6 minutes of driving over hazardous terrain we had heard the architect of the liberation of the NHS describe what exactly?

What we have heard for the last 13 years but being played by a slightly different instrument? We thought the Cold War had been won but when you hear the words “ . . . and there is a regulated market with regulated prices but it is a social market not a free market . . .” you realize what a huge chasm of grey British political party’s healthcare policy is and it is all the same horrible shade.

You could if you wish listen to the bitter end at 39.07 but we think we heard the best bit. If you fancy a laugh have a listen but be quick as we do not know how long the link will be on the website and please do not listen and drive – a safety warning from the team at ND Central.

Praise be to the Party for inventing the art of reinvention in order to better us all via more bureaucracy and regulation. Isn’t it about time they did the same to other markets like supermarkets or has that been done before somewhere in the East?

We smirk as we wonder what the last great Conservative “reformer” of the health service must think of her new boy and his words. Is it time for a trip for someone to see Matron for some speech therapy?

Defence reviews, the NHS and who is the real enemy?

This week in the UK there has been published a defence review which is a euphemism for defence cuts against a background of a bankrupt economy which must see things go.

Certain things here at ND Central struck us at how defence and the NHS ride a similar route to obtain the same result. While defence is about protecting us from without should we not be looking at the enemy within namely Government and Party ideologically driven incompetence?

One of the biggest things in the defence review is that the UK will spend £ 6 billion on 2 new aircraft carriers. Most excellent news apart from the fact that they will have no jet aircraft on them for many a few years to come.

This would never happen in the NHS. No-one would be daft enough to spend £ 12 billion on a failed computer system meant to do 90% of all NHS referrals by December 2006 that only now just manages 50% of referrals. Would they?

No-one would top slice budgets to fund privately run ISTCs (Independent Sector Treatment Centres) which run at below capacity but, at which whatever level they run, still cost the tax payer 100% of cost regardless of numbers of patients treated (or aircraft taking off from them?). Would they?

New defence threats have been identified like that of an influenza pandemic. Did we not have one of those PanicDemics last year whereby the collective incompetence of Government invented a nonexistent threat that almost took down general practice due to goading of the Public to panic in mass numbers? Nobody would be that daft, would they?

Cyber terrorism is identified as a “new” threat to the UK. This is made so much easier by incompetent but expensive IT provision at the behest of the State. NHS IT is a victim of its own incompetence as the drive towards centralisation of medical records leaves it open to being crippled by a few well placed pounds of explosive or a local IT idiot who knows nothing. No-one would design a central medical records’ system that vulnerable to being crippled on a regular basis by its own, would they?

All of these of examples of how poor the NHS/Defence departments are. All of the above of examples whereby there is an enemy which impacts on those on the front line.

Who is that enemy? Well in general practice it is the Department of Health and the local Soviets aka PCTs who for years have been mismanaging locally central policy and whenever they cock up it is our problem to sort out even though it is their responsibility.

And the MOD? Well far be it for us to comment given that locally jobs will go.

Praise be to the Party for all of their reviews. They serve us all so well.

We in general practice, and our colleagues in secondary care, will carry on picking up the pieces. The Party may not be happy for some “aircraft” may be forced to land on "aircraft carriers" that they should not be allowed to.

And that is less expensive and better than ditching in the drink . . . but GP commissioning should stop all of that by delivering empty carriers like the defence department?

The absurdity of the NHS internal “market”.

A while ago one of the team flew a sortie to another part of the UK for a meet with fellow comrades from grunt school some of whom had come from other countries. As with all reunions it is a time for catch up, compare and contrast individuals’ experiences and consume a few naturally fermented organic chemical containing beverages.

Specialities tend to congregate and after a while the conversation turned to GP commissioning and what was happening locally. What was interesting was the compare and contrast element against a worldwide background.

One of the squad told us that in their patch a Darzi practice, paid for from the public purse to benefit the private sector had been so “successful” that it had been told to stop “treating” patients. Others said that those Darzhole practices on their patch(es) were being terminated due to the fact that they cost more than local GPs but then the lawyers became involved . . .

Despite the fact the collective IQ at this point was in the thousands, the individual blood alcohol levels were well above local legal driving limits, everyone had a Homer Simpson “D” word moment as these issues were discussed. A heated conversation followed and there was a diverse nature of opinions about this situation, always the case when more than 2 doctors meet and talk especially when they were from different specialities and parts of the world.

One group said this made no economic sense for although a Darzhole centre was successful it was public money paid to the private sector and the private sector should be exploited to the full.

Another group said can you imagine if this was McDonalds who had opened a new restaurant that had exceed targets would they shut it down? Hell no they would chuck more money at it and milk their success.

A third group (way?) said this is the current NHS “market” whereby contracts operate within the framework of the alleged free market but the NHS commissars who administer them are former Soviet Bloc Party driven target obsessed commissars who cannot see that what they have done is a) successful b) an efficient use of public funds and c) that by their actions and inabilities they are actually denying patients healthcare which is what they are charged with to provide and were actually meant to provide as comrade commissar NHS “commissioners”.

There was a lot of input from those overseas saying that they wished they were in that position for they could use the increased success to improve capacity and therefore income while increasing the provision of service to patients albeit at a price. There were also a lot of opinions at this stage of the evening that were unprintable.

This led onto a discussion about GP led commissioning as proposed by the current Party(s). Fine in principle, the alleged free market one, but if applied against the background of a (failed) Soviet styled centrally fixed price market and heaps and heaps of paper shifting between bureaucrats as opposed to hands on patient care will generate what exactly?

The same but different?

Will the White Paper improve things or will it drown us as GPs in a sea of mountainous bureaucracy while denying us seeing any patients? The overwhelming opinion based on this discussion is that it will.

It is like trying to break the 100m spirit world record while wearing leg irons. However much you talk it up you will never succeed under the current rules of engagement.

But then it will all be the GPs’ fault won’t it?

The market. Certain elements are successful for example private medicine and McDonalds and then there is the NHS “internal” market.

Our patients tell us which they would like and also which one they actually get, and will get, as they tell us we currently have billions to spend (not).

Praise be to the Party for all new NHS reforms. We are lucky to have once again met up with our colleagues from grunt school. The debate will continue. And what of patient care?

Whatever. Politicians come, bugger up the NHS, and go. Doctors and nurses pick up the pieces time and time again. It will be no different this time.

A particularly British way of doing things.

There was not much real news in the UK last week as the main news channels seemed more interested in covering the motorcades of a man dressed in white but a couple of the early birds at ND Central caught some bits of “real” news last week.

The first is that the UK is entering a synchronized swimming team in an international competition for the first time in 15 years. The second is that a cardinal has described Britain as a third world country.

So you might ask what is the connection between these and healthcare? Well bear with us as we explain what caught our imagination about these seemingly unrelated events.

The first is that the last UK synchronized swimming team used to train as individuals and only meet up as a team for a couple of weekends a year. Now did we miss something or are teams not groups of individuals working together for a common purpose?

And then look at how political reform of the NHS has operated.

Every group in Government has come in with their own politically led way of doing things. A bit like every coach in isolation training an individual swimmer but for some unknown reason ignoring the bigger picture of making a team, here the NHS, work.

Fine at an individual level but, for large groups of people, or teams, to work they need to work together in a co-ordinated not a repeatedly fragmented fashion.

Perhaps the success in the last 15 years of British synchronized swimming is on a par with the success of the last 15 years of NHS reform? They both utilize the same “training” tactics and no doubt share similar results.

Still the swimmers seem to have realized the error of their ways and, for some unknown reason, for the last 3 years have been training together at the same pool.

And an ill informed, possibly racist, remark by a 77 year old German cardinal is no different to your average local 77 year old patient’s and their relatives’ comments about their local healthcare.

“We have been in hospital X and no-one talks to each other. We are sent home without anything . . . it is like a third world country”.

Could synchronized swimming GB and NHS GB have one or two things in common? One of them appears to have now learnt the error of their ways.

Praise be to the Party all of whom are team players. Shame none of them are on the healthcare professionals’ or the patients’ team.

We do have a particularly British way of doing things in sport and healthcare don’t we?

We all know it is not the winning, it is the taking part that is important . . . or is it just playing the “Game”?