RIP Neil Armstrong RIP a generation of dreams but not the dreamers.

Last weekend we awoke to the sad news that the first man on the moon Neil Armstrong had died.

For many at ND Central this was a man we first knew when we watched in glorious black and white him land on the moon back in 1969 in the early hours of a morning when TV was not 24 hours a day and channels could be counted on less fingers than a hand. These are images that will stay with us for they represented the achievement of a dream namely that of man to break free from earth to another planet.

In the Sixties there was a get to and go mentality and the American president at that time, although flawed, encapsulated this when he said his ambition was to put a man on the moon and get him back within a decade.

He did not live to see this but several generations did and it was achieved using many nationalities some formerly hostile to the USA but it was achieved using the best minds in order to crack a problem. Such things are not cheap but their legacy sits daily on all of our desktops, and our mobile phones where we have more computing power there than was required to land on the moon and more importantly to bring Apollo 13 back to Earth.

Consider President Blair and his huge failed Apollo project the NHS computer system. He no doubt thought that project Tony would achieve a similar outcome but in contrast to JFK he did not employ any of the best brains in the world. This is why GPs throughout the land take longer to change between screens on their computers every day than did the radio transmissions take from the moon and back in the 1960s.

It has cost at least £ 12 billion but no one has landed on the moon brought back some moon rock and we have an NHS IT system that the world must regard as a joke.

Our respects go out to the family of Neil Armstrong who seems to have been a quiet man who just got on with his job whether as a military pilot, a test pilot or an astronaut. The dreams we were brought up with of jet cars and trips to Mars have long gone but many similar ideas fortunately are still alive in the brains of those who think beyond this earth.

The health service is full of them but these ideas are not fostered and funded by the likes of JFK they are instead scuppered on the rocks of retards called Blair and his followers who feel that top down is best and ability is second best to political dogma.

Quality top down is best and when combined with quality bottom up implementation it is unbeatable. Unfortunately British politicians of all Party's at present do not do quality top down and discourage any form of quality bottom up innovation, which is why something more expensive than the Apollo space program has failed. So will GP commissioning.

Thanks Neil for your inspiration it has left many of us to strive per ardua ad astra since seeing your first steps on the moon for we know that not all of us can be astronauts. It does not stop us from trying harder to do better if only for our patients.

Praise be to the Party for ensuring that excellence in any field is just a dirty word to be stamped on. Thank you Neil for going one step better than this and one step further too than anyone before you. A unique achievement.

Many a true word spoken in jest.

The more artistically inclined here at ND Central noticed this little piece on the BBC website. It is regarding the top 5 jokes at the Edinburgh fringe. The joke that caught our eye was number 4.

Anyone who does home visits as part of their job will have realized this self evident truth years ago for the more deprived a residence you visit the larger the wall mounted TV screen. This was so many decades ago when we started in general practice for we discussed it at our vocational training meetings as trainees (now GP registrars). Its extension is not only the size of the TV screens but also the numbers of TVs in a house which outnumber those who reside there and are never turned off or their volume down during the visit.

Praise be to the Party for ensuring that when it comes to the size of your TV screen seen on a home visit we are all truly equal.

Deranged dictators, revalidation and timings.

We have touched upon the annual pain in the backside to all doctors that is appraisal and its evil spawn to be foisted upon doctors called revalidation that will never catch a Shipman. Any modern day Shipman will tick all the retarded boxes and will be so nice to their local appraisers for most of those who are doing local appraisals have volunteered in order to create a smoke screen for their own professional inadequacies.

However that is not to be the purpose of "revalidation" and you can read loads more here. In the same way that QOF is neither quality nor outcomes so revalidation is nothing more than another set of tick boxes devoid of quality medicine but which may have a far more sinister purpose.

A trip down south to see a fellow grunt led one of the team to have sight of a letter from their local Soviet regarding revalidation. The letter was boredom and redardocracy personified but the terms used struck a chill in the reader.

For in the same way as the National Commissioning Board (NCB) has morphed in a couple of weeks to become the NHS CB so no one over forty will think that the NCB is a pile of sh*te the letter we had sight of and referring to the GMC's revalidation process had in it the sinister term "year zero".

Are we thick here up North or did not a former despotic dictator in the Far East make reference to the year zero in the 1970s?

Could there now be another despotic dictator who has ideas along similar lines? Such is the power of the new GMC revolution that year zero has been redefined to mean 3 months but then year one is a year.

Praise be to the Party for increasing its control of the professions and for reeducating us as to what a year is or isn't. Will the killing fields of Cambodia be repeated once again with the killing fields of revalidation?

I love my job, I like seeing patients but I have had enough . . .

If you are a GP or a hospital doctor who has been in the game for a number of years, or a medical student or a doctor in training you will have heard, or will hear at some point during your career, the above statement or something similar from one of your colleagues. Who makes such a statement?

It is usually a senior doctor approaching retirement. Note what they say and its implications:

1) I love my job.

Most doctors' do but only if it is just confined to providing medical care something they were trained for, have spent years refining as a professional and hopefully getting it right.

2) I like seeing patients.

Most doctors like to see patients and discover their as yet undiagnosed illnesses. It is challenging and rewarding even though we know we sometimes cannot always treat our true enemy disease.

3) I have had enough.

Have had enough of what?

Well lots of things each in isolation a mere irritant but when such crap as appraisal, revalidation, protocols, NICE, QOF, tick box medicine not good quality patient care, care pathways, CQC, pathetic targets, yet another rearranging of deck chairs on the NHS Titanic called "reform" etc.etc. get in the way of and make treating patients harder not easier then something has to give.

An analogy we heard of is that of the bamboo curtain. A single piece of bamboo is easy enough to snap and walk through. But if you have many thousands of such pieces of bamboo arranged around you row upon row of retarded centrally determined government policy, locally enforced by PCT morons over many years that are medically of no use to patients you will realize why GPs and hospital doctors cannot wait to retire.

Some retire early and use their reduced pension to support themselves and also work as locums where they get paid better to do less and avoid the administrative burden that hampers their provision of good care.

Such statements are not said the day before they leave. Often it is a few years before they do so and by that time they have lost the urge to resist the institutionized retardation that increasingly gets in the way of good quality patient care. So they quietly plod on shrugging their shoulders as the next layer of bureaucratic retardation comes along counting the days until they can get out.

Most will yearn for a return to the past and almost all are fearful of the future for they know that at some point they will become patients and they like not what they see being done to their patients but they are powerless to change it. They can only protest but no one listens for the power is no longer with the clinicians.

In a younger doctor people would call this burnout but what would you call this pre retirement? Is a form of Stockholm syndrome?

We have seen it many times at ND Central over the years and also when we worked in hospital. It is like looking at a brightly burning Olympic torch and watching the flame go out. The torch is still there but the light has gone out.

The doctors' job is no longer an inspiration it is a once proud inspiration which when they retire will be put out onto NHS eBay for the next highest bidder for the job who will go exactly the same way given time.

Praise be to the Party for ensuring that highly experienced medics both in hospital and general practice can't wait to get out. It is a sad reflection of how little NHS society values its doctor's, and other workers' experience in the work place not by making it better but by making it harder for them to do what they are good at.

And the Party wants to make people work longer? Bet you that retirement on ill health rates due to mental illness go up.

The NHS taking the p***.

There has been a very popular charity called Help for Heroes in the United Kingdom which you can read about here. We will not dwell on it too much save to say that it seems to fill in the gaps for those servicemen and women who are injured between what the Forces' and NHS medical and social care provide.

On our travels we frequently see people raising cash for them in all sorts of ways. Sometimes even if you walk into a colleague's surgery staff there will be collecting usually because someone they know or know off is serving or has served in the armed forces. It was only founded in 2007 and seems to have caught the public imagination.

Well the Party has followed this trend and come up with its own idea in he last few days and we would not suggest that they have no imagination and are copying a successful idea but have a look here and at the official website here.

Who would you nominate to receive a "recognition certificate"? Will Mr. Lansley be signing them personally and touring the troops to award them to the "heroes" in the glare of national press coverage? Perhaps it will go a stage further and a Lansley Star or Nicholson Cross be issued as well that staff could pin to they uniforms for state visits?

Of course the question is who would you nominate? Given the recent announcements about the reductions inchildren's cardiac surgery our minds here at ND Central were drawn back to the person who blew the whistle at Bristol and suffered great personal loss as result of going above and beyond the call of duty, Surely someone who should receive such a recognition certificate?

Unfortunately he cannot, as you have to work for, not have worked for, the NHS. So if you have nothing else to do if you know someone who has a cup of tea, a hand to hold, a shoulder to lean on who always goes the extra mile visit this website.

On the other hand it if you know someone who can't hold a cup of tea because they have no hand, who has no shoulder and who would love to walk the extra mile but cannot you may like to consider another website we have mentioned and do something useful instead.

Praise be to the Party for its complete lack of imagination and for taking the urinal by doing so.

Friends.

In general practice all our patients have friends and lots of them as a lot of our patients never attend of their own volition. Someone, a friend, a relative or sometimes an anonymous complete stranger always tells them to attend.

However a recent consult made us think about just how many friends our patients have and how much work these friends generate for us as GPs. Our patients' friends advise them daily on health care surely obliterating the need for Big Party NHS (re) direct and 111 interventions?

Take last week and a few examples of what our patients' friends advising them:

A friend said I ought to see you because I have had a car accident (and they said can you make sure something is in my notes?).

Friend = money grabbing patient/lawyer or claim's management company.

I could not sleep and a friend gave me a couple of these tablets and suggested I have a few more weeks of these to help me sleep.

Friend = drug dealer or drug user who is using you to get currency. No deal.

A friend said if I get a letter from a doctor I could get a holiday in Barbados/get a new house/a new television like they did from the social/council etc.   . . .

Forget it.

A friend said I did not look well and should have a few weeks off as they thought I had (insert) name of disease after reading (insert name of learned journal) magazine . . .

Isn't it amazing how many friends our patients have in general practice all of whom have given such considered opinions and worthy advice to our patients to attend their primary care physicians urgently to address their health needs?

Praise be to the Party for ensuring that as a result of all the friends our patients have GPs and their staff will never ever be lonely. Best of all it doesn't cost their friends a penny.

Dave's big society, little charities and big commerce.

For those of us old enough to remember such TV series as Quincy and MASH there was a perenniel message of the Golden Hour whereby if a seriously ill casuality was transferred to a trauma centre within an hour after resuscitation their chances of survival were greatly increased. In the Korean and Vietnam wars the use of helicopters had pioneered this before it was transferred to civilain practice.

Unfortunately the United Kingdom is very backward in introducing new technology that works. So what was available in Korea in the 1950s, in Vietnam in the 1970s is only now available in the UK via charitable donations or commercial sponsorship. It is not provided for by the Party unless in the form of the Air Sea Rescue or Coastguard service. That is right dear reader a once first world country cannot afford to provide air ambulances for its population charities do it for them instead.

So the story we refer to is about how a hairy, our affection term for our biker breathern fellow road using friends, discovered an anomaly in the way that the air ambulances provided by charitable donations are taxed on fuel. So a Mr Ken Sharpe started an epetition which has attracted over 150,000 signitures and several mentions in Parliament.

Air ambulance charity VAT in fuel.

RNLI another charity no VAT on fuel.

Both are charities and provide assistance to those in extremis often staffed by volunteers.

Commercial aviation private enterprise no VAT on fuel.

Paid staff often providing excessive luxery to those able to pay.

So we thank our hairy friends for exposing that while big profit huge consumers of fuel have 0% VAT on their fuel a charity that has to employ volunteers to raise its income to try and help injuried persons attempt to receive first world medical care NOT provided by Big Dave's State are charged a VAT premium for the priviledge of doing so.

Big Dave's big society is increasingly looking like care on the cheap and you can look after your own at your expense unless you can go private when we will give you tax breaks.

Just goes to show you always have to respect the hairies. As for Big Dave's Big Society . . .

Praise be to the Party for ensuring that when when it comes to Big Society we all have to pay and pay some more in addition to the tax we have already paid to ensure that the "State" provides its citizens with an air ambulance service.

Thanks, call me Dave and his little buddy hopalong Clegg, for showing how you expect the big Society to work for your Chancellor's benefit.