Tuesday, 31 December 2013

The mornings after the holidays before.

First day back after a minor 2 day break and the roads in Northernshire were deserted. The GPs’ Ferraris were in top gear all the way in to work as the usual go slowers were doing just that at home and on full pay during the annual Christmas and New Year do nothing for 2 weeks other than eat and drink too much fest that is Christmas unless you are in the health service or retail therapy branch of team GP. In which case life isn’t quite that easy unless you believe Mr. Hunt.

Still not having had access to any medical care whatsoever, anywhere in the UK for a whole 2 days has led to a game of happy families here at ND Central for the doctors who we now under GMC censorship guidelines are forced to report for. Like many surgeries in the UK the GPs at ND Central offer only book on the day appointments to mop up any “illness” that could not be treated over the preceding 2 days due to the complete National Health Service shutdown over Christmas.

Most of the happy family dire emergency consultations went like this:

We all have the same symptoms which are mostly really, really, really bad coughs (note the not just a cough symptom) associated with eyes looking pleadingly towards the doctor like a hungry puppy dog desperate for some food, 


these symptoms are all no worse (but equally no better and that must be the point?) than when we were all seen with the exact same symptoms on Christmas Eve as emergencies or extras. 

Examination of all these poor suffering puppies, punters, clients patients revealed completely clear chests and a complete absence of any coughing throughout the whole of the multiple happy family consults.

Is there anything you can do for us, doc?

The advice that you were given on Christmas Eve still applies. You all have the same very, very, very minor viral upper respiratory tract infection that virtually every other “emergency” seen today has had and you were all told it will take up to 3 weeks to get better. Remember that you were told all of this only 2 days ago. 

Not happy with your GPs’ Christmas Eve advice? 

Well you could ring NHS DICK for Jeremy Hunt care but more likely you will ring (have rung) NHS 111 who will tell you, especially if it is your little Christmas cherub coughing all night, to go straight to A&E or to see your GP ASAP within a time period of hours generated by a random number generator or a more likely a modified game of odds and evens by the “highly trained” technicians answering the NHS 111 call.

If you went to A&E and were seen by a half decent doctor you have been told the same thing as your GP had told you the day, or two, before and been sent home. The ones we don’t see today will have blagged some antibiotics from A&E but will pitch up with the same story after the New Year’s Day total NHS shutdown when the antibiotics prescribed for a viral  infection haven’t worked.

And can you guess how these post booze and food fest holiday “emergency” appointments all ended? Can you?

Can we have some Calpol as we are running low, we seem to be running out, I haven’t got much left and it is a holiday etc. etc. . . .

Still 2 appointments at say £ 25 (+/- £ 59-117 an A&E appointment) to be told the same thing to blag a bottle of Calpol costing less than a fiver is a good use of NHS resources. Perhaps Sir David could vector in these facts into his "challenge" as we are sure NHS management will be sticking their fingers into the dike to prevent the 4 hour breaches given the empty CCG car park today while they expect the NHS to be open all hours that they do not work?

Still some areas are now going to allow pharmacists to dish out freebies via a scheme called Pharmacy First (just google this many areas are doing it) which will save the NHS a fortune and free up GP time in the same way that NHS dumb, dumb, dumb does. Go to the chemist blag a bottle of Calpol or headlice treatment then do the same at the doctors.

Given that headlice are endemic as are very, very, very minor viral URTI at present in some areas it won’t be long before some Arthur Daley’s start doing the rounds of their local chemists and then sell their freebies at a discount to their less bright friends in the same way drug addicts “losing” their drugs and getting a replacement have been overheard in the waiting room to say “I told you I would get you some drugs”.

No doubt all of this would have been inspired by the market forces demonstrated when one of the team going to the supermarket was met with a tsunami of customers exiting a store carrying several large boxes of Christmas crackers each and not much else. Once inside the newspeak tanoy was repeatedly telling those who had paid either £ 7.00 or £ 4.00 for quality Christmas crackers before Christmas that these were now available for £1.75 and £ 1.00 respectively, while stocks last.

Did we miss yet another tanoy idiot announcement from Jeremy Hunt that post Christmas all families can be seen free at their GPs for a fraction of the normal cost for doing so?

Praise be to the Party for ensuring that market forces means the NHS is treated like McDonalds. I want my burger and I want it now.

Unfortunately the Party forgot the bit about educating the public about illness and the fact that it sometimes takes longer than eating a burger for illness to get better and not to request another burger when you are not cured instantly of your illness over Christmas.

Or that you buy Calpol in a chemist for less than the cost of a packet of fags, a GP appointment or an A&E attendance. Still the remarkable antiviral properties of a free bottle of paracetamol are well documented even on NHS Choices and are clearly above and beyond these same properties being available by paying for the same product yourself.

Saturday, 21 December 2013

Drip, drip, drip . . .

There is at present a constant stream of negative press about the NHS and recently the lead story on the BBC was about GPs opening 8 to 8, 7 days a week which then morphed during the morning to GPs being able to apply for funding to do the same. The intro varied as the morning went on but the core bit of news did not. The devil as always is in the detail which is proving nigh on impossible to find as was this link to the BBC report.

The current Bipartite element of the Tripartite healthcare alliance are using the well known NHS reform strategy of come up with an idea, run a pilot and pump prime it with so much money that it could only fail if you put Pol Pot on crack cocaine in charge, announce its overwhelming success thus vindicating the policy and then rush the policy out nationally on a pittance and see the policy inevitably crash and burn. NHS reforms in a nutshell and all driven by part time workers called politicians.

Now our current Secretary of State for Health Khunte kinda has, as he did with the GP contract, respected the above due process by announcing that the pilots had already been a success well in advance of the pilots actually having been run. Nothing like putting the cart before the horse Khunte even before you have proved that the horse exists. 

Has anybody done the maffs for these pilots? There are apparently to be 9 pilots but what is a pilot defined as? Well once again the devil here is finding the detail as most references to this subject seem to be from October and relate to something known as “areas”. The internet is a desert of any useful information about what an “area” is. 

So let us assume that in Big Government, as in the Big Society (remember that?), small is beautiful and that each pilot area will be a GP practice staffed by Party stooges or more likely Party stooges using salaried GPs to do the work while they cream off the profits. This is the (expensively failed) Darzhole centre model of choice for primary care under the Tripartite system. 

And don’t forget the contractual limit of how many patients any such pilots will see which once reached means the rest of the NHS picks up the pieces. Remember Darzhole centres stopping seeing patients when their target was reached? 

So if we get our best crayons and slide rules out (we love new technology oop North crayons are well wicked on wall paper) then 50 million shared by 9 = £ 5,555,555.56 per yet to be defined pilot area we assume it to be a practice.

Now assuming that all of the pilot practices operate 5 days a week and provide GP core hours each day which are 08.00 to 18.30 with no extended hours at present then in order to operate 8 to 8 for seven full days this means opening for an additional 31.5 hours a week or 1638 extra hours for a full year.

Back to the slide rules now children and take £ 5,555,555.56 and share it by 1638 which works out at a whopping £ 3391.67 an hour.

There are roughly 34101 GPs in England in 8230 practices which using our trusted slide rule once again means that the average number of GPs in a practice is 34101 shared by 8230 or 4.14 GPs per practice. So if we now share £ 3391.67 by 4.14 it means that every GP in the pilots will be being paid for each extra hour £ 829.24 an hour.

Obviously they will have to pay some expenses to run the practice like staff costs heating, lighting, armed guards for the drunks etc. but the huge government bung to make the pilots succeed can be looked at in another way.

Using the same amount per hour let us assume that every GP in England works full time and agrees to do all the extended hours this means and we have to do some big times sums instead of share bys so that 34101 GPs times 1638 extra hours a year per GP times £ 829.24 per hour comes to £ 46,319,221,887.

The current NHS budget as whole is a mere £ 95 600,000,000.

£ 95 600,000,000
£ 46,319,221,887.

Well that wipes out the Nicholson challenge more than twice twice over. Somehow we suspect that when the results of the successful trials (already done in October?) are published the funding won’t quite be so generous and that is if there are enough GPs prepared to work the extra hours.

If the average GP working week is 42.8 hours a week and Khunte wants another 31.5 hours of GP work per GP a week to maintain the same cover for the extended hours where is he going to get the additional 31.5/42.8 = 0.74 WTE GP per GP from?

New GPs take a minimum of 10 years to train. So Khunte will increase the total number of GPs overnight by 75 %?

Or does Khunte want to take the current numbers of GPs and increase their working hours by 75% to a mere 74.9 hours a week + admin time.

Or like extended hours use existing GPs and diluting their availability during core hours to plug the extra hours and stretching them more thinly over the extra hours?

This means you take an already overstretched service, dilute it more thinly and expected it to solve the poitically generated A&E crisis. I can never get to see my GP at any time I’ll go to A&E . . .

A politician has even come up with the answer to this problem. Clearly a man who knows nothing about health for the Party sets what is required via QOF and no GP will dare not to do QOF which sets the working pace of GPs even down to the length of appointments offered. So GPs at present work only as efficiently as the tick boxing of QOF allows. And who sets the QOF Lord Howe?

After all the poor, poor “busy” women in the BBC report will no doubt as every patient tells their GP be doing a  “ stressful job”, works “so hard”, she can only see her GP if they open on a Sunday. Does her business operate so that any idle GP (in the future) providing 8 to 8, 7 days a week can get to see her when they get time off?

Of course not she has Sunday off, pays her taxes and we bet you would have to pay for her services too? Now that should restrict demand for her services shouldn’t it? Bet there won’t be a problem getting an appointment with her in contrast to the free at the point of abuse 7 day a week wonder world NHS of Khunta and his idiot friends.

The politicians need to butt out ASAP for every “problem” facing the NHS at present is the creation of the politicians and their meddling with the NHS over the years. They are the least qualified individuals to sort these problems out.

Praise be to Party for coming up with increasing bigger soundbytes but forgetting to engage brain before opening their mouths. The NHS has always worked 24/7 and still does for true emergencies – the crap does not need the NHS 24/7 for the more you give, the more people will take especially if there is no cost up front and it is a right without any responsibility.

Try it Jeremy H, Andy B. et al open a garage and tell everyone free petrol all day any time and see how long the tanks stay full and it takes for petrol shortages to develop. Would you last a day?