Finally improving

Outside of normal working hours, Jobbing Doctor likes to go dancing.

I am not very good at dancing, and so when I can make my weekly evening class (which with pressure of work is only 2 in 3), I tend to stay at the remedial end of the class. I don't mind so much, except I would like to be better than just 'not very good'.

Just occasionally, however, I get it.

The steps are right, the rhythm is right, and Mrs JD and I actually manage to go around the dance floor and not look like a couple of sacks of potatoes (see picture).

Last night was that night. We finally (after quite a while) managed a passable imitation of the Tango, without mistakes. We could do some of the head movements, and kept to time. It was great, for a few minutes.

Then we moved on to the Samba and we were rubbish as usual. But for a few minutes I was on the dance floor in Buenos Aires, looking good.

Never trust a doctor who......

When I was in training for my career in General Practice, and looking for a post, I was given quite a lot of advice.

Always ask 'why is a post available?', I was told [Good advice].

Always see whether a practice has a regular change in personnel [Bad sign]

Remember it is not the area that you work with, but the people you work with that is important.

Do the 'monday morning' test - are these people you want to meet after you've had a bad weekend?

And finally, I was told to

'Never trust a doctor who can't keep his pot plants alive'

I looked at the Monstera Deliciosa (Swiss Cheese Plant) outside my door this morning. It was looking pretty sorry for itself (see picture).

I have watered it today, and hope it revives.

More from the tabloid press.

Here we go again.

Like a broken record that keeps repeating itself, the Daily Mail is having another go at me.

The strap headline is

"Shorter Hours, higher pay and yet complaints about GPs soar by 12% in one year"

This is a fairly desperate piece by a journalist called 'Daniel Martin', that commits all the usual sins of tabloid journalism of partial reporting, old data linked to new, screaming language (since when is 12% 'soaring'?), innuendo and falsehood to develop a story.

Over the weekend, the Jobbing Doctor was participating in running a conference for GP trainers, who gave up their weekend to attend. It was an important and valuable conference, all done in our spare time. Jobbing Doctor ran a couple of sessions on medical statistics in the 'graveyard slots' (these are when people's attention is at their lowest). There was a lively debate about absolute and relative risk.

Relative risk is saying something like a 12% increase in complaints in one year (like the Daily Wail headline): Absolute risk is saying that the number is a percentage of a total number of at least 300,000,000 consultations per year (0.0001333 is the rate).

They then include some data about a pay rise which took place in 2004 (ignoring the 6 year pay freeze ever since). An attempt to smear GPs by innuendo about the privatised out-of-hours service is, unfortunately, typical of this kind of sub-teen journalism.

So, fairly routine stuff from a very tacky and unpleasant apology for a newspaper.

Hey! Ho!

I'm off to work for another typical 11-hour day.

No time for golf!

Whistleblower news.

It is as difficult now to be a whistleblower as ever it was. We are not expected to notify organisations of problems, as they have a tendency to shoot the messenger. The labour Government introduced new legislation to protect whistleblowers [they said], but (as is expected with most Government legislation these days) it doesn't work.

It is a disgraceful litany of people being hounded and victimised by the authorities, and it is (frankly) shameful.

The list of those victimised for their integrity, bravery and decency for speaking out is a long one, and we should all be ashamed of the way they have been treated.

Dr Steve Bolsin, who first helped lift the lid on the Bristol heart unit scandal now works in Australia.

Dr Rita Pal, a fellow blogger, has had her career blighted because of pointing out terrible problems in North Staffordshire hospital.

Margaret Haywood went undercover with the BBC to expose unsatisfactory nursing care in Brighton. She was struck off.

Shirine Boardman spoke of less than satisfactory care of Diabetics in Leamington spa. She was sacked as a consultant on a technical breach of confidentiality by a trust that numbers some doctors who were in breach of the law themselves.

Raj Mattu was suspended for 7 years by Walsgrave Hospital for speaking out about inferior care in his hospital.

These are just the ones I am familiar with. I'll bet there are more.

It is a litany of shame.

More management nonsense

We've had a lot of management being imposed on the NHS.

There seems to be a view that all management is generic, and all we need for lasting success to to adopt the latest management techniques to be able to do everything better, cheaper, cleaner, nicer etc etc.

There is some element of truth in this, although it is limited, and we have been subjected over the last few years to repeated reorganisations, changes, rebrandings, rebadges and management theories: all in the name of change.

According to management gurus, change is good. Indeed change is their raison d'etre. But I am going to be controversial and say that most change is bad.

I loved this saying when I first read it. It bears repeating.

"We trained hard . . . but it seemed that every time we were beginning to form up into teams we would be reorganized. I was to learn later in life that we tend to meet any new situation by reorganizing; and a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency, and demoralization."

It is wrongly attributed to Gaius Petronius Arbiter, but I don't really care where it came from. It is true.

The Jobbing Doctor missed an afternoon surgery of 18 patient appointments this week to go to a meeting about a possible new development in management in General Practice. It looks quite promising, but only because it will have extra staff co-ordinating an important area of vulnerable and ill patients in their own homes.

In amongst the management bollocks we had a simple message. Properly trained an experienced staff who work within the unit of a practice can make a big difference. It had to be cloaked in rubbish, of course, and the latest rubbish is:

(drum roll).........

QIPPP.

This is Quality, Innovation, Productivity, Performance and Partnership.

It is Motherhood and Apple Pie.

It is stating the bleeding obvious.

Doubtless we will all be sent on QIPPP courses now.

More stuff in the offing....

The instrument that the Government uses to try to control everything in the health service is an organisation called the Strategic Health Authority. Here we have administrators, managers and mandarins trying to roll out Government policy in the English regions, particularly.

The Jobbing Doctor does not think that the SHA is very strategic, doesn't have much to do with health and (amongst the workers) lacks authority. It has power, but for any student of political science, the difference between authority and power are clear.

The Strategic Health Authority are fattening up another branch of the NHS for privatisation. This is the provider arm of the Primary Care Trusts. The provider arm runs the community services such as District Nurses and Midwives, Therapists such as physiotherapists, audiologists, dieticians and others.

There is a push from the SHAs to divest these from the PCTs and have them run by other organisations. We know what that means, don't we? In the sidelines will be UHE (with Dr Richard Smith advising) or Boots (helped by Patricia Hewitt MP) and also the acute trusts.

I can confidently predict that if this happens then it will be pretty disastrous: District Nursing will be buried in an acute trust and will always come off second best. We will lose the independence and professionalism of our community staff.

Brick by brick the NHS is being salami sliced into the grasping hands of the private sector.

Things can only get worse.

Unacceptable.

We have had thorough and comprehensive comment on the case of Dr Jane Barton, who was looking after patients at Gosport Memorial Hospital in Hampshire. The case has been well covered by a number of bloggers, and I have been following it with some fascination and with a growing sense of dismay.

I must admit that I have not felt the necessity to deal with the story because of this, because others had been dealing with it much better than I could.

It would seem that I am to be castigated as an 'establishment blogger' because of this. Lack of comment does not imply complicity.

I am therefore happy to set the record straight in that the case in Gosport Memorial Hospital has troubled me in two respects: firstly, the nature of what clearly went on in this hospital, which seems most unacceptable; secondly, it would seem that this particular doctor has been treated quite favourably by the GMC - certainly when compared to the way that others have been dealt with - and whether it is coincidental that her brother is Professor Chris Bulstrode, a former luminary in the GMC.

I would suggest that we follow the details in Rita Pal's blog, which is required reading for those who wish to follow the case.

I can assure Rita that I do not find what went on edifying or acceptable. It is just that she does it so much better than me.

Bye bye Dobbin.....

We have now the coroner's report on the death of David Gray who was unlawfully killed by a German locum who was flown into Cambridgeshire to do a shift with the out-of-hours service. Pretty excoriating reading it is too.

Very few of the participants in this catastrophe come out of it with any credit.

The Private provider of out-of-hours service is roundly criticised, the PCT who commissioned the service is criticised, and there is scant reassurance for the General Medical Council.

Today the Department of Health has issued a letter from the Chief Executive, 'Sir' David Nicholson, releasing a report from Steve Field and David Colin-Thome (who he?), tightening the regulation of the service and making recommendations for how services are run. The Department is really good at unravelling many rolls of red tape. That's what they do. Every time.

But they don't ever ask themselves why this happened.

It is because the service was privatised.

Will HMG learn from this unfortunate case? No, of course not.

This document, worthy though it might be, is slamming the stable door after the horse has bolted.

Good money after bad.

I have blogged in the past about the Government's ridiculous attempts to help their friends in the private sector to make money on NHS patients. The whole idea is predicated on the rather absurd (but very prevalent) view that private organisations can manage things better (and cheaper) than public organisations.

I think we just need to look at our disgraceful railway system to begin to question that folly.

First, we had the Out-of-hours take over by the private sector. But we did not speak out, because out-of-hours was exhausting us.

The we had the Private Finance Initiative run by the private sector. But we did not speak out, because the bills will be paid by our children and grandchildren.

Then we had the management consultants from the private sector. But we did not speak out because we thought they might say something useful.

Now we have the Independent Sector Treatment Centres. But we did not speak out, because we believed what the Government said about benefitting the NHS.

But now we do need to speak out. The Government (via their client organisations) wants GPs to refer to these expensive white elephants, and want to bribe us with money to do so. This is disgraceful, and I hope my colleagues and I will have nothing to do with it.

This money, that has been squandered on these privately inspired projects, could have been put into the existing hospitals to develop their services effectively, cheaply and better. That is what should have been done.

But we are getting the absurd situation of Government paying Doctors to use inferior services, just because they are benefitting their friends in the private sector.

Shameful.

Staggering....

I picked this information up via the esteemed and occasional blogger, Dr John Grumble. I think it makes quite interesting reading because it starkly throws into the focus the enormity of the incompetence and profligacy of New Labour.

I have blogged before about the appalling irresponsibility of New Labour and Tory administrations with the Private Finance Initiative. They have attempted to keep the details of the deals secret from the taxpayer, but information is seeping out.

These people need to be put in jail, frankly, for developing and running with a financial scheme that is almost as bad as the Ponzi scheme run by Mr Bernie Madoff.

I'll just pick out one salient fact.

Norfolk and Norwich University Hospital: Projected cost £229 million. Actual cost £16 Billion. That is, by my shaky maths, some £15.701 billion more than we expected. More than 40 times the cost!

This, ladies and gentlemen is where all the money has gone.

I urge you to read this article. But try not to read it if you suffer from high blood pressure.

It might cause you some damage.

The good and the bad.

A visit from the Doctor (Edgar van Heemskerck the younger)

For every good and measured piece of journalism, we have a matched rant from boneheads. I'm sorry to be predictable, but this is as unchanging as banker's bonuses - it will always be with us.

There is a really good letter in the Guardian, that is signed by some of the most trusted and respected members of our profession. It is about the lack of debate about the privatisation project in the NHS. Included are such people as Wendy Savage, Julian Tudor Hart, Harry Keen and Allyson Pollock.

It is a shame that it is not signed by people who hold the reins of power and inflence at the moment, although I suspect that Steve Field and John Black (Number 1 GP and Number 1 Surgeon) would agree.

The sadness is that there is almost no debate about the role of the private sector in the NHS, and all the politicians regard it as a 'good' thing.

But it isn't.

Here is a searing example from our old friends at the Daily Mail. The out-of-hours provision (privatised since 2004) is a disgrace. It costs much more and delivers terrible care. Yet no politicians will criticise the underlying philosophy.

The Mail, of course, has blamed GPs for something that they had taken off them by the zealous privatisers in Government, and this time they do not include the usual obligatory and snide dig at our income (which has gone down year-by-year in the last 6 years).

The service needs looking at in detail, and the politicians ought to take time out of their busy electioneering to maybe speak to the Patients about what they think.

And to Jobbing Doctors as well.

That would be a first.

Rewriting history.

Well, I don't know. We had around 1 inch of snow here in Dullsville, and the whole road system ground to a halt. A journey that should have taken me 10 minutes took me 40 minutes. I had the car radio on.

Normally, I don't hear the main interview on the BBC Today Programme on the Radio (which is at 8.10 am), but today I did. The interviewer was John Humphrys, and the interviewee was Mr Andrew 'Andy' Burnham MP, Secretary of state for health.

Mr Burnham is not very convincing on the radio, and Mr Humphrys was reasonably acerbic. We had the usual evasions and distortions beloved of New Labour politicians, but when he started to be asked questions about the Primary Care out-of-hours service things became quite interesting.

The reason that things were changed in 2004 in the New GP Contract was because the service was failing, according to the politician.

They were looking at the situation again, he stated, and were taking advice from experts in primary care.

I'm glad I was stationary at the time, as I could have easily crashed my car. In 2004 I was doing regular out-of-hours care in the local GP co-operative. It was an efficient and effective service, excellently run, and staffed by local GPs who were just about coping with the pressure of this plus a more-than-full-time job. I must admit, I found it a bit of a strain, but it was a really good service.

Then came the new GP contract.

The Government were keen to trial the break up of GP services by privatising out-of-hours services, so they made an offer to the GPs that we could not refuse.

Then they invited applications from private providers to run this part of the NHS. And what a complete pig's ear the private companies have made of it. You don't need me to tell you the stories of one GP for 300,000 people; the exponential increases of referrals to A & E; the inability of nurses to be able to GPs' work; the waiting for up to 8 hours for a GP visit at the weekend. It has been a catastrophic cock-up, completely organised and initiated by Government.

Don't blame Jobbing Doctors for the crap out-of-hours service. We were never even consulted. It was a done deal.

Now everyone can see that we are spending much much more on a worse service, the Government say that they are taking advice from Primary Care "experts". Who are these experts, then? Is it David Colin-Thome, the primary care tsar? He hasn't done clinical work for years, and so he no longer qualifies as an expert. Maybe 'Sir' Liam Donaldson (chief medical officer) can help. He knows bugger all about General Practice, but that hasn't stopped him pontificating before now.

Maybe an academic like Steve Field? At least he still does some clinical work at his surgery in Birmingham. That would be better.

No, the experts you need to speak to are those who are doing the job, and hearing daily stories of the shortcomings of the out-of-hours services. I mean Jobbing Doctors up and down the country.

Hmmm. Consulting with us would be a really good idea.

It won't happen, of course. Mr Burnham can keep getting away with distortions about a 'failing' service.

But he doesn't fool the Jobbing Doctor.

The start of something new.

Tomorrow is another day.

However, I am feeling very positive about things, because it is the start of a new month, and January - cold, miserable, January - is over.

Our practice is welcoming two new partners tomorrow, and this will give a huge new impetus to what we are going to be able to achieve, and will be able to give our patients a much improved service. In a small group like a partnership, the welcoming of two new doctors at the same time is a bit of a risk, but I am really happy about it.

I can see how the practice is going to be configured when I retire, and I am happy about that too (although that is some years away).

We could have opted for non-doctors, such as physician's assistants (a local practice to us is teaching them), but instead have put our faith in the quality of the doctors we are appointing. The local Darzi centre (which is placed in our old practice area) has proved to be no threat at all to our numbers, and has actually proved to be something of a waste of public money, frankly.

So we will all take a cut in our pay (that is what happens in partnerships) and hope that it will be not too bad.

I hope we have made the right decision. My guts say so.

My head still worries.

Mid-Staffordshire redux.

Many will remember the reports of the catastrophic failings of Mid-Staffordshire Hospitals trust. This was an acute trust that covered hospital care in Stafford and Cannock hospitals.

Many people will see to see the events there as a rogue hospital trust with unique circumstances which will not be repeated.

I would urge you not to be that complacent. This kind of thing is going on up and down the country, and the real culprits for this event are not just the managers at the trust, but the policy makers at the Department of Health and 10 Downing Street, the lobbyists for Big Business, and the quangocrats in places like the Care Quality Commission, The Royal College of Nursing and the General Medical Council.

How can the Jobbing Doctor point the finger at so many people? Largely because I have been an impotent spectator of these events as they are rolling out all over the country.

Many factors contribute to the latest catastrophe. Many people are complicit.

Reduction in number of hospital beds.

This is a deliberate policy to cut costs. Hospital beds have reduced in numbers by at least 20% over the last decade. This is at a time when more can be done for ill people, and the population is getting older overall. The numbers should have been increased.

Setting up an internal market.

This is part of the privatisation process that was rammed through a sceptical, yet feeble Parliament with Foundation trusts being set up to have the aim of independence and profitability. So care and compassion are out of the window: only money counts. The increased numbers of managers and ballooning PR and advertising budgets are a feature of this.

Nursing Numbers.

The reduction in number of front-line staff and dumbing-down of qualifications and quality of those delivering the care. If you pay peanuts, you get monkeys.

Silence of the Lambs.

The lack of complaints from senior nurses about staffing as they comply with the party line and wait for their OBEs and Damehoods. Senior doctors too.

'Lord' Darzi

The bussing in of a brilliant but gullible surgeon the front the changes.

Hounding of Whistleblowers.

The climate of fear and opprobrium where whistleblowers risk their careers if they speak out. Ask Steve Boisin and the amazing Rita Pal about this.

The GMC.

The fact that the GMC has been changed from an independent regulator with Professionals having respect for it as an organisation to a Government quango stuff full of yes-men and women. Then when there appears to be a prima facie case of malpractice, like in the Jane Barton case, the GMC are absurdly lenient. Is this because she is not Asian, and her brother used to be a senior figure at the GMC? Makes you think, doesn't it.

This list is by no means exhaustive. I have not even mentioned people like Smith, Corrigan and Stephens who were/are advisers to the Prime Minister. How about Hewitt and Warner? Create the mess and run off into the arms of big business.

A confederacy of Dunces.

More life in consultant land.

I was discussing matters of infection control the other day with a colleague.

She is married to a hospital consultant. He's a very good consultant, indeed. He works at a good hospital.

She tells me some of the stories of life in consultant land, and I can't really believe my ears.

This chap is a stickler for cleanliness. Not obsessive or compulsive about it, but he washes his hands very frequently each day. There should be no risk of cross-infection as he wears short sleeves, and no tie or watch; this is by diktat of the management. He is pretty assiduous about this.

This particular hospital has developed a scheme, where staff are handed yellow and red cards, and if staff - any staff - feel that someone is not washing their hands sufficiently, then they hold up a yellow card to the person in question, a little like a football (soccer) referee would do when cautioning a player.

The other day he was yellow carded twice by people whose perception was that he had not washed his hands sufficiently. He was furious, and I can see why.

Has it really come to this? Are we now subject to puerile gimmicks that undermine people?

I would be more sanguine if I thought that there were any scientific grounds for this nonsense, but I have yet to see any evidence.

Doctors used to wear white coats. They were laundered daily, and heated to 100 degrees celsius. Then the management discovered a huge saving in laundering them to 80 degrees only. So this was changed, and then they were only intermittently done, and now doctors don't wear white coats at all. Has this got anything to do with rates of infection?

Soon we'll all be in scrubs.

I cannot get the image out of my mind of some pasty-faced gauleiter holding up a yellow card in triumph. It seems trivial beyond belief.

Only small doses possible.

Yesterday I had a busy and long day, so I was unable to watch any television.

I was unable to watch anything of our former Prime Minister on TV appearing at the Chilcot enquiry about the Iraq war. This is probably just as well.

I cannot deny my deep-seated loathing for Tony Blair's actions as Prime Minister. There is little in his record that actually chimes in with a left-of-centre politician. His privatisation project in the NHS will in the next 10 years destroy the service, but his foreign policy decisions have been much much worse.

He was nervous at the start of his evidence, but then to justify what he did he would have to be nervous. Then we had the remaining evidence which was a self-congratulatory justification of decisions, and showed him in a pretty poor light (from what I could see). I found what I saw on the media made me want to grind my teeth.

Apologies and regrets there were none.

We shall have to wait and see what the view of others is (they are more astute and politically savant than me, after all I am merely a Jobbing Doctor); and the judgement of history. I have already made my mind up about this tawdry apologia pro vita sua.

This has been helped by the unequivocal support for him of the ghastly Melanie Phillips.