So, now you know. Explains a lot doesn't it. Feckin eejit.
Tuesday, 25 October 2011
What did our Health Secretary do before the current job ?
So, now you know. Explains a lot doesn't it. Feckin eejit.
Day Six
Today we ask our contestants to get slightly philosophical.
Task One.
Get someone, anyone, somewhere or anywhere to explain who, in 2013, is going to own and run all the Primary Care buildings and maintain all the IM+T infrastructure. Points will be awarded if you manage to get any reply beyond. "Can we get back to you on that"
Task Two.
See if you can find someone, anyone, somewhere or anywhere, who thought that Darzi centres were a good idea anywhere outside London....if anyone can now get the Vascular Surgeon who was asked to design that Primary Care "strategy" to explain why it was a total balls up, mega points will be awarded...in fact we may actually let them out.
Task Three.
Elicit, if possible, whether "Father Ted" actually understands how General Practice works outside the rural bits of Southern England, which is apparently where his ex wife practices and upon which sometimes, he seems to have based his total understanding.
According to his web page "Andrew frequently visits hospitals and GPs across the country, listening to clinicians and NHS professionals and is well respected across the medical profession for his knowledge fo the NHS."......fascinating, because we don't seem to be hearing that from the BMA, the RCN, The MPU or the RCGP. They seem to think he's lost the plot.
Task Four.
Come up with a compelling reason why any GP over the age of 55 should not retire, right now. (Excluding of course, child support and alimony)
Task One.
Get someone, anyone, somewhere or anywhere to explain who, in 2013, is going to own and run all the Primary Care buildings and maintain all the IM+T infrastructure. Points will be awarded if you manage to get any reply beyond. "Can we get back to you on that"
Task Two.
See if you can find someone, anyone, somewhere or anywhere, who thought that Darzi centres were a good idea anywhere outside London....if anyone can now get the Vascular Surgeon who was asked to design that Primary Care "strategy" to explain why it was a total balls up, mega points will be awarded...in fact we may actually let them out.
Task Three.
Elicit, if possible, whether "Father Ted" actually understands how General Practice works outside the rural bits of Southern England, which is apparently where his ex wife practices and upon which sometimes, he seems to have based his total understanding.
According to his web page "Andrew frequently visits hospitals and GPs across the country, listening to clinicians and NHS professionals and is well respected across the medical profession for his knowledge fo the NHS."......fascinating, because we don't seem to be hearing that from the BMA, the RCN, The MPU or the RCGP. They seem to think he's lost the plot.
Task Four.
Come up with a compelling reason why any GP over the age of 55 should not retire, right now. (Excluding of course, child support and alimony)
Day Five
As we all know the General Public are absolutely fascinated by Hospital drama. We pay homage to that today with our Casualty special.
Task 1. Write a letter to your local A+E Consultant asking for a few bits of clarification. Case in point. Why did the 24 year old with right sided chest pain, which came on as he pulled a heavy wardrobe, was worse for movement and when the source of said pain could easily be located by prodding his chest with a finger, need a) Blood tests b) an ECG C) a six hour admission whilst the pillock who ordered them waited for the perfectly normal results.
Points will be used for including the following phrases. 1 ) Laughable 2) Risk averse bollocks 3) Waste of bleeding money and 4) For Christ's sake man, grow a pair.
Task 2. Compose a short letter asking for slightly more detail, following receipt of the following brief standard discharge note from your local center of excellence.. "Self referral. Arrived by car. Amputation both heads. Discharged"
Task 3. Write a courteous letter to the SHO who kindly suggested that you should follow up the pointless investigations she ordered on your patient, who as evidenced by them sitting opposite you, looking perfectly normal, did not need any fecking investigations yesterday morning. Extra points will be awarded for including the phrase.."I'm not your bleeding houseman, I know where I sit in the pecking order sunshine, and it's a lot of rungs above you, you little gopher.
Task 4. Dear Mrs Triage Nurse, why did you let Mrs Grotte, and her Zakk her walking menagerie, past your reception desk with his head lice at two o'clock this morning. What the hell in the description above your door in 2 foot letters do you not understand.
Task 1. Write a letter to your local A+E Consultant asking for a few bits of clarification. Case in point. Why did the 24 year old with right sided chest pain, which came on as he pulled a heavy wardrobe, was worse for movement and when the source of said pain could easily be located by prodding his chest with a finger, need a) Blood tests b) an ECG C) a six hour admission whilst the pillock who ordered them waited for the perfectly normal results.
Points will be used for including the following phrases. 1 ) Laughable 2) Risk averse bollocks 3) Waste of bleeding money and 4) For Christ's sake man, grow a pair.
Task 2. Compose a short letter asking for slightly more detail, following receipt of the following brief standard discharge note from your local center of excellence.. "Self referral. Arrived by car. Amputation both heads. Discharged"
Task 3. Write a courteous letter to the SHO who kindly suggested that you should follow up the pointless investigations she ordered on your patient, who as evidenced by them sitting opposite you, looking perfectly normal, did not need any fecking investigations yesterday morning. Extra points will be awarded for including the phrase.."I'm not your bleeding houseman, I know where I sit in the pecking order sunshine, and it's a lot of rungs above you, you little gopher.
Task 4. Dear Mrs Triage Nurse, why did you let Mrs Grotte, and her Zakk her walking menagerie, past your reception desk with his head lice at two o'clock this morning. What the hell in the description above your door in 2 foot letters do you not understand.
Sunday, 23 October 2011
When you plan to redesign Primary Care...
..it helps if you sepnd a couple of moments thinking about the absolute basics.
Now, most GPs are pretty adaptable, we have to be, with these pilocks in charge, but there are two things that are absolutely vital to our day to day performance.
1) We need a building to work from
2) We can no longer function for more than 24 hrs without computers
Readers will be delighted to hear therefore, that whenever we ask a) who will maintain, support and fund the Computing systems in Primary Care, and b) who will take over the running and maintenance of Primary Care estates, no-one seems to know. And it all kicks off in 2013.
Does anyone in the DOH know anyone who can actually distinguish between an elbow and an arsehole
Reassuring ain't it.
Now, most GPs are pretty adaptable, we have to be, with these pilocks in charge, but there are two things that are absolutely vital to our day to day performance.
1) We need a building to work from
2) We can no longer function for more than 24 hrs without computers
Readers will be delighted to hear therefore, that whenever we ask a) who will maintain, support and fund the Computing systems in Primary Care, and b) who will take over the running and maintenance of Primary Care estates, no-one seems to know. And it all kicks off in 2013.
Does anyone in the DOH know anyone who can actually distinguish between an elbow and an arsehole
Reassuring ain't it.
Day Two
Day Two
The day starts with the need to explain to an insomniac 80 year old that 7:30 commuter slots are for people who work, and then signing an urgent sicknote for the person with back pain so bad that they were able to hightail it down to the surgery and stand and wait outside for the 15 minutes in the cold just to get it done. This must be done without coffee, because the sodding milk hasn't been delivered yet.
The morning's main task will be three consecutive appointments with Chronic pain patients who will require yet another explanation as to why a) you won't refer them again b) you won't give them any more drugs and c) you'd like them to stop expecting a cure. A "Dave" bonus can be awarded if you give them a big hug at the end. Points will be lost if you offer any further intervention, or if at any point you use the phrase "I sympathise, but...", because you don't.
Lunchtime requires you to sit through an hour long seminar on handwashing from a Nurse, who seems to not grasp the concept that every single one of you will have done a minimum of six months surgery and are fully conversant with how to wash your hands. She also will totally fail to understand that, a bit like the Highway Code, knowing what to do, doesn't mean you'll do it, and sitting through her boring little diatribe, isn't going to ensure any of this. Extra points are awarded for picking your nose through the presentation.
At this point anyone who hasn't tried to jump out of a third floor window, gets a point deducted simply for being stupid.
The day concludes with filling in a questionnaire on Controlled drugs, identical to the one you have filled in for the past 14 quarters. There will be no box that says "No change since last return", and you will have to fill in all the same details again. This will be sent to an email address and you will never hear anything about it all. Points are awarded for entering spurious comments (such as, "Yes I do use the Morphine returned by patients, for various personal projects" ) just to see if anything happens.
The day starts with the need to explain to an insomniac 80 year old that 7:30 commuter slots are for people who work, and then signing an urgent sicknote for the person with back pain so bad that they were able to hightail it down to the surgery and stand and wait outside for the 15 minutes in the cold just to get it done. This must be done without coffee, because the sodding milk hasn't been delivered yet.
The morning's main task will be three consecutive appointments with Chronic pain patients who will require yet another explanation as to why a) you won't refer them again b) you won't give them any more drugs and c) you'd like them to stop expecting a cure. A "Dave" bonus can be awarded if you give them a big hug at the end. Points will be lost if you offer any further intervention, or if at any point you use the phrase "I sympathise, but...", because you don't.
Lunchtime requires you to sit through an hour long seminar on handwashing from a Nurse, who seems to not grasp the concept that every single one of you will have done a minimum of six months surgery and are fully conversant with how to wash your hands. She also will totally fail to understand that, a bit like the Highway Code, knowing what to do, doesn't mean you'll do it, and sitting through her boring little diatribe, isn't going to ensure any of this. Extra points are awarded for picking your nose through the presentation.
At this point anyone who hasn't tried to jump out of a third floor window, gets a point deducted simply for being stupid.
The day concludes with filling in a questionnaire on Controlled drugs, identical to the one you have filled in for the past 14 quarters. There will be no box that says "No change since last return", and you will have to fill in all the same details again. This will be sent to an email address and you will never hear anything about it all. Points are awarded for entering spurious comments (such as, "Yes I do use the Morphine returned by patients, for various personal projects" ) just to see if anything happens.
Day Four
A series of tricky tasks today.
1) Try to get a madwife to understand the concept of haemodilution in pregnancy, as you receive yet another inappropriate request for a prescription for Iron tablets.
As an extra piece of work, and there are big bonus points here, write a short discussion paper about how it can be, that Midwives, who are "practitioners in their own right", and have taken away all the antenatal care that GPs used to provide, still ring us back up again as soon as the slightest problem arises. And if they're so suitable for taking sole charge of the whole antenatal show, WTF can't they be trusted to write their own bleedin' prescriptions for iron....a product that a patient can buy from the Pharmacy.
2) See if you can get Rapid Response to respond.
3) Find the on-call Surgeon.
4) Finally explain to Mrs Panic stricken, that Kylie has not contracted Ebola Virus, and "Yes, you can be too careful"
1) Try to get a madwife to understand the concept of haemodilution in pregnancy, as you receive yet another inappropriate request for a prescription for Iron tablets.
As an extra piece of work, and there are big bonus points here, write a short discussion paper about how it can be, that Midwives, who are "practitioners in their own right", and have taken away all the antenatal care that GPs used to provide, still ring us back up again as soon as the slightest problem arises. And if they're so suitable for taking sole charge of the whole antenatal show, WTF can't they be trusted to write their own bleedin' prescriptions for iron....a product that a patient can buy from the Pharmacy.
2) See if you can get Rapid Response to respond.
3) Find the on-call Surgeon.
4) Finally explain to Mrs Panic stricken, that Kylie has not contracted Ebola Virus, and "Yes, you can be too careful"
Day Three in the Primary Care jungle
Day Three. Tasks today are designed to show the contestants negotiating skills, and demonstrate an understanding of the Choice agenda beloved of the show's controllers.
Task 1) Convince an irate Granny that the fact that's she's waiting for a washing machine to be delivered this morning, and will be out having her hair done in the afternoon, is not an acceptable reason for a home visit to discuss her ingrowing toenail..and no, you couldn't just do a flu jab at the same time
Task 2) Explain to the nice young man at the Department of Work and Pensions that just because I happen to be the patient's GP, does not necessarily mean that I know whether the workshy, drug using little gobshite, he has in his office, is capable of managing his own cooking and cleaning, and frankly how that is relevant to whether he's entitled to benefit is beyond me, because he's currently of no fixed abode.
Task 3) Describe using only appropriate hand gestures, to Wayne, that having a tendency to get bored when sitting around for any length of time, is not an adequate explanation to put in a letter asking for exemption from jury service....especially as that very activity appears to have been his sole profession for the past seven years
Task 4) Engage in a long discussion with Mrs Entitled from the posher end of your Practice area, and explain that nothing fantastic that she has read about in The Daily Mail in the last six months is going to get prescribed for her in the current political climate and that the Health correspondants on the Daily Mail are to a man (and woman) a bunch of medical illiterates, who hate GPs and are clearly paid to write articles by Drug companies.
Task 1) Convince an irate Granny that the fact that's she's waiting for a washing machine to be delivered this morning, and will be out having her hair done in the afternoon, is not an acceptable reason for a home visit to discuss her ingrowing toenail..and no, you couldn't just do a flu jab at the same time
Task 2) Explain to the nice young man at the Department of Work and Pensions that just because I happen to be the patient's GP, does not necessarily mean that I know whether the workshy, drug using little gobshite, he has in his office, is capable of managing his own cooking and cleaning, and frankly how that is relevant to whether he's entitled to benefit is beyond me, because he's currently of no fixed abode.
Task 3) Describe using only appropriate hand gestures, to Wayne, that having a tendency to get bored when sitting around for any length of time, is not an adequate explanation to put in a letter asking for exemption from jury service....especially as that very activity appears to have been his sole profession for the past seven years
Task 4) Engage in a long discussion with Mrs Entitled from the posher end of your Practice area, and explain that nothing fantastic that she has read about in The Daily Mail in the last six months is going to get prescribed for her in the current political climate and that the Health correspondants on the Daily Mail are to a man (and woman) a bunch of medical illiterates, who hate GPs and are clearly paid to write articles by Drug companies.
Thursday, 20 October 2011
Day One
The poor incarcerated victims will be expected to spend an entire morning consulting in a small poorly ventilated room, after spending fifteen minutes with a patient, who will have rampant halitosis and body odour suggestive of something that rolled in a dead sheep. Extra points will be awarded for not gagging at any time. For an extra Cleggy bonus the competitor must have a conversation with his receptionist about booking the patient in last, not first, without using any swear words, or the phrase "you daft cow." Lunchtime entertainment will be provided by trying to find any medical reason whatsoever that Portia could not take part in TV filming. A letter will need to be provided for a TV Director, who wants reassurance that she's fit to be filmed. Points will be awarded for actually finding a reason she can't do it, and for composing a reply that includes the phrase "you moronic timewaster" Points will be lost for not attaching an invoice for at least £30. In the evening the rest period will be spent writing a report about commisioning that no-one will actually read. 2 hours must be spent doing it, clear and strict instructions will be given as to the format. The competitors will only be told it's not actually for anything useful after they've finished it.
Wednesday, 19 October 2011
I'm an NHS GP, FFS let me out of here
In association with our sister page, we announce the new game show for our times. "I'm an NHS GP, let me out of here". Over a few weeks we'll be watching the progress of hapless GPs coping with the trials and tribulations thrown at them by two smarmy idiots who'd last about three seconds on the front line. In a wicked twist, the contenders will actually be trying to get off the programme, but of course the real evil genius of the concept is that the poor buggers can't. You'll squirm as they deal with insufferable challenges, dreadful sights and smells, and the bushtucker challenge will be actually finding any time to sit down and eat something. Enjoy
Tuesday, 18 October 2011
Winter is coming.
No, I've not suddenly come over all Eddard Stark (Game of Thrones, if you're lost), it's just that we are getting dire warnings of snow to come. In the same week as plastic conifers erupt all over our retail outlets, and ITV suddenly starts telling us about crappy plastic toys and aftershaves, we are now seeing the annual appearance of bags of rock salt in the service station.
So there you have it, the new seasonal guide from Shell. Summer starts when the charcoal arrives, Winter starts when the rock salt comes in...and when British Gas announce another unavoidable price rise in gas.
Suffice to say in a week or so, should the Met Office be believed (some reason for doubt, then) we'll see our suburban streets blocked by Mercs and BMWs, labouring in two inches of snow with their rear wheel drives. Of course the massive SUVs would finally come in handy...but they won't be needed for the school run, because they'll close all the schools, Public service workers will be being given work from home advice, as temperatures plummet to minus two, and everyone else will be told not to go out in case they slide, crash or fall on a surface that might make someone liable for litigation. Welcome to the UK of 2011. No common sense, no backbone and no hope.
If as some experts tell us global climate change will result in better springs, wet summers and bloody cold winters, we really had better get a grip of this now. Can you imagine what the average resident of Maine in the USA makes of all this bollocks (Well, if he had any notion of anything going on beyond Portland that is)
Pathetic
So there you have it, the new seasonal guide from Shell. Summer starts when the charcoal arrives, Winter starts when the rock salt comes in...and when British Gas announce another unavoidable price rise in gas.
Suffice to say in a week or so, should the Met Office be believed (some reason for doubt, then) we'll see our suburban streets blocked by Mercs and BMWs, labouring in two inches of snow with their rear wheel drives. Of course the massive SUVs would finally come in handy...but they won't be needed for the school run, because they'll close all the schools, Public service workers will be being given work from home advice, as temperatures plummet to minus two, and everyone else will be told not to go out in case they slide, crash or fall on a surface that might make someone liable for litigation. Welcome to the UK of 2011. No common sense, no backbone and no hope.
If as some experts tell us global climate change will result in better springs, wet summers and bloody cold winters, we really had better get a grip of this now. Can you imagine what the average resident of Maine in the USA makes of all this bollocks (Well, if he had any notion of anything going on beyond Portland that is)
Pathetic
For God's sake Lansley, what the hell are you doing
It really does go from bad to worse. I'd have been back on here earlier, but my life is now spent producing piles and piles of reports telling my fledgling Commissioning Group the same stuff I told them last quarter, and the four quarters before that. Now I'm quite busy enough looking after my flock, without stating the bleeding obvious about the care they need and receive.
A few observations, just for a change. I thought I'd share them with a wider audience, because they don't seem to a) understand what I'm saying or b) want to do anything with the information, they keep asking for.
1) Hospitals now exist to make profit. This is a bad thing because it incentivises them to do unnecessary things to my patients, and also to make up scandalous codes to earn more money
2) If all my budget is spent making Trusts profitable and building more glass buildings on Hospital sites, (so they can make more profit), less money stays in Primary Care and so my surgery falls down for lack of maintenance budgets
3) How do I influence Nursing and community provision when some f**kwit at the DOH made us hand all our Community staff over to the Hospital Trust
4) When GPs were involved in antenatal care, our patients saw us first, and we decided if they needed assessment. Now they ring a duty midwife who admits every single one to the Hospital for assessment ."Ching" goes the Trust cash register
5) Competition is a good thing, but not if the competition is entirely over the easy, most profitable sectors leaving the difficult non-profitable stuff done by small "failing" hospitals or shunted out to over-stretched Primary Care. That is what will happen, there is nothing in this half baked bill that recognises or allows for it, because these jokers don't know what they're doing.
6) Every GP I know above the age of 55 is going to leave the profession. My generation will certainly not stick around beyond 60. The new Doctors will be stuck with working to 65+ or their pension will be worth bugger all.
7) GP recruitment and training is falling, experienced GPs (The ones they want to run all this Commissioning) are leaving in droves, leaving what in their place. A disillusioned workforce that will be forced to become salaried. When some bozo at the DOH then works out that you need 3 salaried GPs to cover the basic work of two Principals, and then have to pay someone to manage them, they'll discover the service costs more, and it will be crap. (See Out of hours provision since 2004)
8) No-one actually has a clue who is supposed to take over ownership of the estates in Primary Care, so I work in a building that will have to be sold once the PCT is dissolved in 2013.
9) Computing..not historically a strength of NHS procurement. The whole of primary Care IM+T is currently owned and maintained by PCT's. Again, no-one quite knows who's going to pick that up. The local branch of PC World perhaps !!
So there you are, buildings and computers. The two absolutely essential components of providing GP services, and no-one has a bleeding clue (with 18 months to go) who will run and maintain it all.
Surely only a total moron could get us into this sort of a mess
Don't get old in the UK boys and girls
A few observations, just for a change. I thought I'd share them with a wider audience, because they don't seem to a) understand what I'm saying or b) want to do anything with the information, they keep asking for.
1) Hospitals now exist to make profit. This is a bad thing because it incentivises them to do unnecessary things to my patients, and also to make up scandalous codes to earn more money
2) If all my budget is spent making Trusts profitable and building more glass buildings on Hospital sites, (so they can make more profit), less money stays in Primary Care and so my surgery falls down for lack of maintenance budgets
3) How do I influence Nursing and community provision when some f**kwit at the DOH made us hand all our Community staff over to the Hospital Trust
4) When GPs were involved in antenatal care, our patients saw us first, and we decided if they needed assessment. Now they ring a duty midwife who admits every single one to the Hospital for assessment ."Ching" goes the Trust cash register
5) Competition is a good thing, but not if the competition is entirely over the easy, most profitable sectors leaving the difficult non-profitable stuff done by small "failing" hospitals or shunted out to over-stretched Primary Care. That is what will happen, there is nothing in this half baked bill that recognises or allows for it, because these jokers don't know what they're doing.
6) Every GP I know above the age of 55 is going to leave the profession. My generation will certainly not stick around beyond 60. The new Doctors will be stuck with working to 65+ or their pension will be worth bugger all.
7) GP recruitment and training is falling, experienced GPs (The ones they want to run all this Commissioning) are leaving in droves, leaving what in their place. A disillusioned workforce that will be forced to become salaried. When some bozo at the DOH then works out that you need 3 salaried GPs to cover the basic work of two Principals, and then have to pay someone to manage them, they'll discover the service costs more, and it will be crap. (See Out of hours provision since 2004)
8) No-one actually has a clue who is supposed to take over ownership of the estates in Primary Care, so I work in a building that will have to be sold once the PCT is dissolved in 2013.
9) Computing..not historically a strength of NHS procurement. The whole of primary Care IM+T is currently owned and maintained by PCT's. Again, no-one quite knows who's going to pick that up. The local branch of PC World perhaps !!
So there you are, buildings and computers. The two absolutely essential components of providing GP services, and no-one has a bleeding clue (with 18 months to go) who will run and maintain it all.
Surely only a total moron could get us into this sort of a mess
Don't get old in the UK boys and girls
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