Global Warming and why is all my water in Cyprus

Now, it doesn't take a rocket scientist to figure out that chucking all this carbon into the atmosphere can't be a good idea. There seems to be irrefutable evidence that anywhere with ice on it has got decidedly less ice on it. I'm told that tests, that mean something to some boffins somewhere, confirm that we are seeing long runs of the hottest whatever it may be (year, decade) in a very long time.

We also know that the bloody cows produce far more toxic gases than cars, and we're cutting down large amounts of Brazil/Argentina to feed the sodding things.

Now don't get me wrong I like a steak, but I'm happy to forego that and my milk on my Cornflakes, if it means I can drive an Aston Martin when I retire.

The subject of this rant however, is Great Bloody Britain.

America becomes a dustbowl, Italy will soon not be able to grow pasta (Well you know what I mean), Africa gets even drier, and in England ????

It gets colder and wetter. Just how sodding typical is that.

Our football pitch has now been unplayable for four weeks.

I'm all for warmer summers, (although perhaps someone should also point out that our last three summers have been crap too), and I'll even put up with parts of the South (and preferably most of London) being lost to rising seas, but frankly the drowned state of The Lake District will just not do !

We all know that nothing South of Birmingham, and very little West of Wrexham, is really worth a visit. We have just about everything of note above that, and it's looking a tad sodden to be honest.

Of course come June we will no doubt have a drought again.

The Utility companies made record profits again, and yet they tell us it's impossible to stop leaking water pipes.

Bollocks !!.

Every time I go to Cyprus some local wag points out that they only get 14 days rain a year.....14 days.

Bleeedin' hell it must rain a lot in those 14 days, because they don't seem to have much trouble with water shortage and hosepipe bans.

Perhaps we should ring up the Cypriot Water Minister, or whatever their version is, offer him £500,000 a year and put him in charge of a nationalised water company.

Stitch that United sodding Utilities.

I'm off to buy some new wellies

What's it all about Rafa ?

Well, another season and another year of non achievement beckons
The lack of depth in our squad allowed us to chuck away our best chance of the title since God knows when, so The Fat Controller thought it would be a good idea to keep our best player happy by trying to hawk him all through January to absolutely anyone, so we could buy Gareth (How much are you offering !!) Barry.
And as we had only one striker in the squad, he made a real effort not to buy another one.
To boot, let Hyppia go on a free when we are short of European experience in the centre half department.
Result...No Alonso...no passing. His replacement not available til October and untried in the Prem.
Mascherano will be off next season.
No striker cover when Torres is injured
I predict us not qualifying for the Champions League and Rafa out of a job by the end of the year.
Bleedin ridiculous

British Summers..

Whilst I'm here, an old one from some time ago, resuscitated to recognise this great British season

Global warming today
Apparently we are due some hot summers in Blighty in the near future All because of my car apparently...Anyway, todays rant is based on the commonly stated assertion, that if July and August end up as hot as 25 degrees on average everyday, this will be cutting down Englishmen and women in their thousands !!
Now Britain is the only country in the world where Global warming seems to make us more prone to rain and flooding in the winter, so first things first. lets sort out water leaks, fix up the reservoirs, and stop losing millions of gallons of water per day.
Next fit meters to every hose, especially anyone with a swiming pool !!
And then sit back and bloody well enjoy the sun
If our summer weather was any bloody good, we wouldn't burn fossil fuels flying abroad !
As to whether we might find a few old people getting hot....and see a few more skin cancers, have you seen aboriginees and Tuaregs..They all seem to live to a ripe old age.
I don't see Italians dropping dead every time I go to Tuscany, and funnily enough, despite their penchant for dodgy jewellery and falling over and rolling on grass when an English footballer comes within a fifteen foot radius, they are exactly the same physiologically as me..so basically, it's bollocks.
The reason pensioners die in France, and might well over here (old people don't cope with extremes of temp so well ), is that, unlike more family centred countries, we to our shame, seem not to give a toss about our elderly.

Why is my ward filthy...?

As a Dr watching hospitals and GP surgeries getting muckier and muckier over the years, it has become quite clear why this should be so
First, Nurses, and Nursing auxilliaries no longer do it, and thus it's contract cleaners. They ain't scared of a dressing down from matron, in fact they don't seem to be scared of anyone.....
Second and more important, it's all about health and bloody safety. Cleaners ain't given anything that actually cleans.
Bleach, carbolic, stuff that moves grime.? er no, because that's a bit abrasive and might harm skin
Of course it harms skin, that's why it cleans things !!
Now we get some sort of biological crap that doesn't move anything.
It won't be long before we need to use cold water in case someone scalds themselves
Of course the real answer is to get Drs to wear short sleeves, no ties and no watches...
In which case why were hospitals not full of infections ten years ago ?
Hello Mr Superbug, I can't say it's a surprise to meet you

Flu, I've had it up to here....

Well, three weeks on the front line, and I still have no idea just what it is we're supposed to be doing.
We now have a flu hot-line staffed by well meaning volunteers, who having had three hours of intensive training, may know something about applying plasters, but are woefully ill equipped to deal with medical issues. Using NHS algorithms will for sure reduce the chance of major cock-ups, but will also catastrophically over treat a majority of patients and will undertreat the severe throat infections, chest infections and other possible causes for the symptoms we are asked to check for.
To boot to avoid the chance of missing meningitis, any reference to pain when looking at lights triggers an immediate recommendation to ring 999.
The fact that they keep telling the patient to ring the GP too, even having sorted out the Tamiflu, does seem to defeat the object of the exercise !!
Now then, as we're not supposed to issue more than one course per patient, what happens when the guy who had Tamiflu for his cold last week, gets swine flu for real next month ?
Will we generate resistance by dishing out Tamiflu like smarties for every viral infection suffered in the UK for the next 6 months.
I don't know, but tragically, neither it seems does anyone else....
Hmm.
And whilst I'm on..Lord Darzi !!
Having spent three years pretty effectively denigrating and deconstructing the Primary Care services in the whole country, while actually trying to fix London, his next task was to look at redesigning all his old mates in the Secondary Care sector.
"So Arya, fancy upsetting all your Consultant chums now ?"
"Err, No thanks. I think I'll resign now, while I'm ahead."
I trust they'll now put a GP in charge of that agenda..although a GP might have better insight into Hospital Care, having worked in them for three years, than an academic surgeon, who's probabaly only seen three afternoons of Primary Care in his life.

Well, 4 days into my return to work after a week off.
I returned to find the UK in the grip of what appears to be the new Black Death.
Let's ignore the fact tht there are not sufficient cases to trigger use of anti-virals during seasonal flu. Let's forget that thus far the virus seems no more virulant than seasonal flu. Let's forget the fact that we normally only treat the prostrate and the at risk population.
Instead let's suggest that GPs triage all cases only by phone. Let's define swine flu as a set of symptoms that you could also get with pneumonia, tonsillitis, Pyelonephritis or any common all garden para-influenza, and suggest that such patients should be sent via a buddy, a course of tamiflu costing nearly £17 a go.
Let's all ensure a level of hysteria that massively increases the demand on urgent services, ensuring delays for patients who may actually be ill.
Sooner than later, some poor GP is going to treat a patient needing antibiotics and clinical review with a 5 day course of Tamiflu, and then stand back and watch him/her get pilloried in the national press.
If we restricted our management to those who were really ill, or at risk, the work oad would be manageable and we could actually physically review the patients and assess them properly. Has someone forgotten that we do this every flu season anyway !!
Could it be that the Government is driving up levels of hysteria, to keep themselves and their own difficulties off the front of the papers until the summer recess......

The Black Redactor

Apparently a new figure in the House Of Commons. Somewhat like the Black Rod, but IT literate. These guys just don't get it do they ?
Firstly the approach of "Whoops, I made a mistake, have £20,000 back, that I could easily put my hands on", doesn't endear you to the public.
If I did that, the Inland Revenue would be crawling into my dark placs, and I'd be paying it back with interest. To boot, I'm not sure I'd be successful at getting the Tax Office to check my claims and then claiming for that advice too.
I work in Salford... Hazel Blears....hahahahahahahahaha. Like she's getting back in. Daft little woman. Is she the smuggest looking woman in Britain ? I think so.
Let's face it, Gordon does not want another term, as he'd have to deal with the mess he and TB (A type of pestilence) have created. He's far happier to let the Tories have a few terms struggling with it, making painful decisions and being really unpopular, whilst the recovery happens (Much like last time, although they stuck around quite a while !!).
Still, all it's done is confirm what we already know. Politicians the world over are pretty likely to take the slap, and it's pretty hard to stop them. The European Parliament is worse.
At least they don't have you shot over here..(Yet !)

Cuts to the NHS

According the the Conservatives, the NHS is going to have to face cuts. The Labour party say that patients will suffer. Well, the former are damned right, as we can't keep treating the NHS like an open cheque book, and the latter may be right if we allow some pillock from the DOH, the Govt and certain SHA/PCTs to decide what is cut.
Firstly let's point out what labour have done well.
They have invested much needed money into the NHS.
QOF, DES/LES in principle are good ideas, but have become a beaurocratic and administrative nightmare to deliver, in what was sold as a paper-light contract.
It is now umpteen times more complex, and I spend many hours a week more than previously on administration, and thus not with patients
Waiting times for Outpatients, cancer care and procedures have plumetted
Choose and Book is excellent at finding your patient an appointment, and as the waiting times are globally down, they don't really exercise much choice because they can go local quickly.
Patients really value that booking facility, and I think it's marvellous
In fact the Choice part is a joke, as you can no longer specify a particular consultant, patients do not have enough information or sophistication in the main to know what a good service entails, and as I can't specify which consultant, I can't tell the patient any outcome for a particular referral anyway, as you might see anybody. Finally, if you work in deprived areas, patients cannot exercise choice, because travel is difficult for them .
NICE works a bit, but is too easily swayed by patient pressure groups and ministers fail to back them when public opinion gets too hot. (Who'd want to be chair of that?)
We have numerous new and better equipped hospitals, and clinicians are more accountable than before with revalidation moving apace. Probably good things as long as it is done sensibly .
GPs now earn on a par with their consultant colleagues, and whilst the Govt has now decided it overpays us, it forgets that it could not recruit GPs previously. The pay recognizes similar periods spent in training, GP as a proper speciality (I'm not a "failed" anything) and that whether Consultants like it or not, they could no more do my morning surgery than I could do theirs...although I think I'd manage a better stab in their OPD, than they'd manage in my room !!
So if the axe falls, where should it fall ?
Firstly the Govt needs to get off it's "Choice" rollercoaster. They spend a lot of time talking about "wants", but these, for purely political reasons, keep turning into "needs".
If you're a purchaser you can decide what you pay for a service. Well the tax-payer is the purchaser, but the Govt has never asked anybody how much it wants to pay, just what it "needs". It's hardly surprising that when taken to the Car Salesman, the public has opted for Bentleys not Kias, because it doesn't realise it ultimately has to pay !!
The population doesn't need routine access to a GP in the evenings or weekends.
The Govt is pumping billions into this agenda, despite over 85% of the public stating they were perfectly happy with things in the first place.
Anyone familiar with front line healthcare will tell you that demand for a service expands rapidly to fill capacity.
So we can assume that a few years of making this the norm will result in politicians expanding things further, for a few votes in middle England, the next time patient satisfaction drops below 90%...90% !!! What satisfaction does the country have with its politicians. You can get elected with fewer than 50% of the country voting for you !!
The 4 hour wait in A+E !
In principle a good idea........er, No it's not. It's palpably effing bananas.
Most A+E departments in the civilised world used established validated triage to establish how quickly a patient needs to be seen
In Manchester that's Red (Now), Orange (Quick), Yellow (2 hrs ?), Green (Should at least have come to A+E, but frankly could wait until tomorrow !) and Blue (Shouldn't be here at all !!)
I've never seen blue used as it's a bit politically sensitive !!
Now by all means apply a four hour rule to Yellow/Orange and Red. They are likely to be unwell and should be concentrated on, and, for sure, should be done and dusted within 4hrs max.
The greens and blues however, should simply have to wait until the other stuff is done
Many could be seen by GP services, and it is a perverse incentive, that a patient with a non-urgent problem, ringing my surgeryat 9am, and being given an appt for say 3:30, can instead jog on down to A+E and guarantee beeing seen for his ear wax by 1pm
And believe me it happens. Bloody madness.
No-one in front line services will have been surprised to see this happen...........but guess what, no-one asked us. They will have asked a focus group in Surbiton "Should you have to wait any longer than four hours in A+E". Full stop no ancillary questions.
We have many patients now admitted costing millions each year, largely because Yellow patients cannot be worked up suficiently for discharge in A+E within four hours, and breach if they're not put on a ward. That work up could be done, if the department was not also having to run flat out clearing green and blue stuff in the same sodding timescale.
Why don't attached GP services see the patients, you ask.
Easy, because the hospitals are foundation trusts and earn money according to the numbers of patients they see, so there is another perverse incentive to keep the department heaving and the admissions earn even more money. Bonkers !!
Darzi !!
Here's a good idea. Put an academic surgeon (who just happens to be a labour life peer) in charge of redesigning primary care. Ensure all he really understands is that London's GP services are a bit of a shambles, and ask him to sort it out.
I look forward to being asked to redesign vascular surgery services shortly. 'Cos I know bugger all about that, but probably more than he knows about GP (I at least spent 6 months on a vascular surgery firm)
Brilliant. So he looks at London (A singular problem, and one that did need a good looking at), comes up with a plan (not all of it bad), and then insists the model is implemented (with no dissent allowed) all over the country. Result ? Billions spent needlessly all over the country chasing an access problem that may not really have existed barring the need for a few votes in Hampshire.
In my PCT we have four new practices opening, only one of which is truly needed or offers innovation.
And then finally privatisation.
Where is the evidence that privatisation helps
The USA model is not exactly marvellous is it
Competition is healthy, but there are many ways of driving that and quality, other than getting Richard Branson in, to give public money to shareholders and turn GP into a franchise
No patient I have met seems to want McGP.
Nearly every contract given to private providers seems to under-perform, and since the NHS is crap at writing contracts (such was the rush to get private companies in), we are now paying millions for services that are not delivered (or possibly needed)
And underpinning all this procuring, commissioning, pathway development and tendering, is an army of paid advisers from the private sector (KPMG et al), earning millions of taxpayers money, when better more appropriate local advice could be got from local people and clinicians, for the price of a small room and some sandwiches.
If the cuts must fall, this lot would be a good place to start, as it is a national scandal, and very much a product of this administrations obsession with advisers and spin.

I'll be back...

Feels sorry for Giggsy

Hmm. All over the Manchester Evening News yesterday, Ryan Giggs, a player for whom no-one could have anything but total admiration, was giving off about how United would bounce back from Rome.
Bounce back !!!!
They've won four bloody trophies.
As a Liverpool fan, that really hurts !!

M.P.'s and how they'll never quite understand.

Been an interesting month, and for those GPs amongst us a welcome change not to spend March, April and May being called lazy and overpaid, by DOH stooges, in order to justify yet another 0% pay rise.
Being as we are, one of the most trusted sets of professionals in the country, hasn't it been marvellous to see the professional equivalent of pond life, shown up for what they are, and what the public always new them to be.
Quite simply fantastic.
I'm enjoying it all enormously