“Extended hours saved my life.” Exclusive Not!

An interesting article on the front page of one of the GP rags this week. Clearly a total vindication of Mr Clarkson’s intellectually impaired Caledonian premier’s extended hours Policy for no extra money known as a pay cut. However, we are in hard times, and so comrades these policies are necessary for the war effort.

Whose life has been saved by the all wise Caledonian gentleman’s omnipotent wisdom?

None other than the:

NHS Director-General for Commissioning and System Management

who is one of the officials responsible for extended GP opening hours.

A good Comrade Commissar at a senior level check out his importance here in the Comic.

Our staff are incredibly grateful to him for their lost weekends, early starts and late finishes but then they are not paid as much as he is and so that is all right, comrade.

Now a man of this importance you would expect to be able to organize his life as well as destroy the NHS healthcare system.

He would after all, if he were buying a house, be unable to see a solicitor or an estate agent due to the fact that he “often works 12 hour days”, as he is clearly an important person and for some reason has not mandated extended hours for any other profession. We like the word “often” it can hide many things like “never”.

Time off from being NHS Director-General for Commissioning and System Management to see a GP would clearly lead to disastrous National Consequences.

Something might happen (for the better) comrade.
.
So a disorganised part timer then thinks that a crap policy has saved his pathetic life?
(There are plenty of time management courses available to you full of useful tips like “write things down to remember them”. You might even get a MBA from the NHS University.)

A senior NHS official who would have “brushed concerns about his own health aside had he not been able to make an evening appointment”. No self preservation?

Clearly a true hero of the Soviet Union beyond all others in the Great Patriotic War! A true Comrade Worker!

Clearly a man who cannot look after himself other than on a political whim is the ideal person to be in charge of everyone elses’ healthcare being destroyed by the escalating mushroom cloud of management know as (de)commissioning.

Surely if he started work as a GP at 08.00 hrs and did a 12 hour day he could easily have made a 19.00hrs appointment? However he probably starts his twelve hour days at 06.00hrs so having late opening makes sense if you can believe this Party propaganda.

He made some interesting comments re “the primary and secondary care interface” (sorry re jargon his words) and how he couldn’t get any incontinence pads from his district nurse.

Management bullsh*t (sorry re grunt speak but this is manna from heaven!) is a particularly offensive and smelly discharge especially if you are a patient who experiences its results so this would have been a huge problem for him every time he opened his mouth.

Now for those that work in Northernshire who have “world class commissioning” this would have never have happened.

In Northernshire there are no longer any district nurses or health visitors as the idiot Commissioning Mangers have decided that these are not required in GP practices. If there was a problem with the District Nursing services we as GPs could leave a message on an answer machine and hope something might happen. This is commissioning, sorry world class commissioning, in action as this manager has seen himself.

Following his treatment he has agreed to take part in a “scheme piloting patient reported outcome measures” which will surely mean that the NHS he is destroying will turn out to be even more excellent? After all “manager patients” advising managers how good the NHS is can only lead to one thing?

'Our doctors and nurses are fantastic,' he said.

Yes they are. And if left on their own could do so much more to improve things.

'But we need a new generation of clinical leads who are less tolerant of failure and want to bear down on poor performance.'

More incompetant managers or “world class commissioning”? No "clinical engagement here then"?

If this manager has a problem with any of the services he experienced then he has only one person to blame.

Himself.

Praise be to the Party and its world class decommissioning of anything useful that works. Things will only get worse comrades, ever worse, as now the Comrade Commissar patient has been born. More managers coming our way.

QOF and the insidious creep of graphs and managers into medical practice.

For most members of the general public seeing a GP has not changed much in the last 60 years. You make an appointment go along and hopefully are treated.

We at ND wish we could say the same of medicine in the NHS but every politician who has seen his GP knows that the system is crap (after all they designed it) and regularly change it based on their 5 minutes at the doctors without asking anyone in their constant attempts to make it worse.

We here in Northernshire wonder if any other doctors have noticed how NHS managers are using QOF (Quality and Outcomes Framework) to direct medical practice? Or could it be that we are silently moving towards centrally controlled and regulated health care that works in a similar way to former communist states?

One of the concepts of the new contract was that it should be a “high trust contract”. We know from surveys that doctors are generally regarded as the most trust worthy members of society but ND’s team do not think anyone has asked about NHS managers trust, or even ability, ratings.

In Northernshire we have noticed that managers have discovered that certain spreadsheet programs can draw graphs.

For those that have used computers since the 1960s this is nothing new. We used to write the software ourselves to solve a particular problem and print graphs off using Xs to create the lines on the graph.

However in the 21st century there are now ready written software packages that do the same job. For the thick that are NHS mangers this is a godsend because they think they can now identify fraud or deviation from Party Policy by looking at a picture, sorry graph. For every QOF indicator they now draw, or more likely employ consultants to draw for them (we jest not on this one), lots and lots of graphs. They then look at the pictures, don’t understand them and point to anything that looks different.

The local commissars then send enforcers out to try to understand why some practices are different. They have no idea about this as they cannot work out why people have different heights but height is not standardised as per QOF so they don’t have to worry about height - just their graphs.

The thickerazzi then have little words in peoples’ ears and tell them they should do something different or else there will be sanctions.

And so the thickerazzi managers massage their figures to come into line with everyone else’s. Thus they show to Party Central that they are good comrade commissar managers as their graphs are the same as everyone else’s and so the local Soviet’s tractor production is on target. All is then well in the world of the MHS (Management Health Service).

Good idea unless you are a patient with a disease who needs treatment in the NHS. This massaging of figures by morons will lead only to one thing. Increased political and management interference with patient treatment and care. Patients are individuals and are different not collections of figures drawn on a graph.

Given that NHS managers are in the bottom third of your school in terms of ability you can see what this will do to your medical care? GP thinks you need this treatment but manager decides otherwise. Your treatment is not in line with the graphs and graphs must not be out with the Party’s targets.

This is already happening. ND stumbled across members of the team being told by the local commissar manager for an important disease that now needs treating (having been ignored for years by the same manager) that the Practice did not have enough people with the disease and so they would not get paid unless they found a few more patients with the disease. So we know have to find or invent patients with this particular disease in order to meet a local Politburo target and then subject them to unnecessary intervention so that the idiot managers can tick a few more boxes. And draw graphs to show they have met targets.

So dear patients when you cannot access a particular treatment that your doctor thinks you should have please do not blame us. Our hands are well and truly tied by all the thick people in your class at school who never went to medical school. They probably struggled in their maths lessons to draw graphs but with the advent of computers they don’t have to. The graphs are even in colour and have lines that aren’t made up of Xs. Isn’t progress great?

Praise be to the Party and NHS managers for keeping communist working practices alive in the democracy that is the NHS. And for drawing graphs that are so essential for good patient care.

The 12 Rules of NHS Management (aka Politicians and NHS Managers reforming the health service)

1) If there is no problem make one
2) If it is simple make it complicated
3) If you can’t find a solution have another meeting
4) If other meetings don’t work employ more managers
5) Do not involve anyone with ability as they might come up with the solution and put you out of a job
6) If you fail you will be promoted. If you are not, set up a consultancy (see 7)
7) If 1-6 do not work employ management consultants (not consultants see rule 5).
8) All new policies must generate extra work for all involved to achieve the same goal or ideally less and cost more.
9) If a change is unpopular tell them you are re-applying for your job or change your job title and tell them it’s someone else’s department.
10) If you have cocked up have a listening exercise. Hear and change nothing.
11) You have power and are unaccountable.
12) Reinventing the wheel is called innovation. Remember to make sure that the new wheel is a square one.
13) Managers can’t be expected to count.


Northern Doc wishes to add that NHS management is the pauper of UK management. Anyone with ability and management skills works for the private sector because they are rewarded for their skills.

So if you wish to tell some war veteran or a young mother who is a cancer suffer they can’t have treatment become a NHS manager You need no ability, no knowledge or understanding of science or medicine and no compassion. You don’t have to talk to patients just make their lives miserable and the Nuremberg “I was only following orders” excuse will work every time as per rules 6 & 11 as you are untouchable. You can make all the intelligent people lives you knew when you were bottom of the class at school, hell.

And get paid for it.

Power to the Party (and its ever wise managers).