Water, water, everywhere

Andd whilst I'm on, on behalf of the whole of the UK, I'd like to point out to the tosser of the weatherman, who in March said, "Oh, we're going to need a lot more rain than this to fill up the reservoirs,", that since he's clearly got a direct line to God, could he now respectfully ask him to turn the sodding tap off, we're full up.

We all love a letter

Dear Sir, thankyou for the opportunity to waste my time confirming that Kylie is fit to appear in a televised school play. Stephen Hawking, Terry Pratchett, Stevie Wonder, umpteen children with cancer and endless smashed up A+E patients on TV, all seem to manage this without undue incident. Could you possibly, for my own education, furnish me with a list of any conditions, other than death or fulminating infectious disease (either of which, make their attendance unlikely) that would render Kylie, or any other human being, incapable of getting on with this onerous task.....P.S. Stage fright doesn't count.

A year in the life..

Not been on here in ages, largely because the DOH and our CCG seem to take delight in making me spend half my life on pointless exercises. Since the turn of the year, we have seen the old outgoing PCTs disappearing up their administrative arses trying to completely redesign a system that really needed some fine tuning. The result will be widespread redundancy of some really capable people with loads of corporate memory...some only a couple of years away from retirement, and who will be being paid as much in redundancy to sit at home as we'd have paid them to keep working until they retired !! Whilst this has allowed some clinicians to really turn around the boadrooms, I'd argue that this coud have been achieved under the old structures with a few changes. To centralise HR, accountancy, IT and buildings, to name a few is a road crash waiting to happen, and if I get paid properly at the end of March next year, I'll eat my hat, and if our computer server crashes, frankly we and our patients are screwed. As ever I have had to spend 5 to 6 hours a month churning out the same old clinical reviews, revealing the same operational problems that I've found for the previous three years of doing this, and yet no-one actually does anything with the findings. This year we are being asked to do expansive reviews of our patient's attendances at A+E borne out pf the Govt's blind insistence that people go there inappropriately because they can't get in to see their GP. Up and down the country this has been shown to be rubbish for years, and yet all GPs in the country are being asked to look into it again..and to show the same findings...it's not GP access. They are scared to death by advertising about meningitis, Strokes and heart attacks, we have no minor injury units, NHS Direct send everyone there, it's free, bright and shiny (our buildings are falling down, because all our cash is being bled into hospitals), quick (you have to be seen within 4 hours) and the Hospital has a vested interest in getting them through the doors, because they earn a minimum of £85 every time a patient walks through the turnstiles. So a year of writing the bleedin obvious, and then they'll find something equally cack-handed to waste our time on again next year..which brings us to the CQC registration. If ever there was a process that signifies all that's gone tits up in the NHS and withour leaders it's got to be this. My building is already subject to European Health and Safety regs, it has 6 monthly infection control visits and most of my administrative processes are reviewed under QOF. WTF do I need to spend hours registering with an organisation that has been labelled so crap at what it does that its head had to resign...and why should I have to pay to be registered. If the BMA (Bunch of useless wankers) had wanted GPs to stick up a finger at health reforms, here's one that overnight they'd have got 100% agreement with. We should simply have refused en masse. The Govt could have done sod all about it, The Daily Mail wouldn't have understood what was going on, and the patients wouldn't have noticed a thing. A total clusterf*ck

I've been away..

Like Ivan, I seem to have been off here a while. Largely due to Holidays, Christmas and more recently having to take a fight to NICE that we were never going to win.
Without going into the nitty gritty, and whether you agree with the decision they are about to make on Dabigatran or not, it has left me totally convinced that the current system is absolutely not fit for purpose.
Even if they have called this right, and I believe they haven't, the system by which they are called to account, in particular the appeals process is a one sided farce in keeping with a star chamber approach. We are told that neither safety nor affordability are the responsibility of the appraisals committees nor the organisation, and that the absolute rule of the QALY is all that matters..Yet the QALY is at the mercy of industry manipulation, RCT versus real life experience and full of enough guesses to make the whole thing very imprecise indeed. The result is that innovation and new technology almost always wins out, and is sanctioned for use without any thoughts as to the impact on the whole system economies it is applied to. As we keep asking, with every new drug/technology (that may, or may not save money in the long term..if the QALY really means something), how do we actually afford that NOW !!, or put another way, what do want us not to provide to pay for it....the answers from NICE (nothing to do with us) and the DOH (You've got plenty of cash..and save 20 billion please) are not exactly forthcoming. Welcome to the new world of GP led commissioning..We're screwed.