Thursday, 23 February 2012

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.

Monday, 20 February 2012

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.

Tuesday, 14 February 2012

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 . . .?

Saturday, 11 February 2012

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.