Pyjama man, redux.

I have just been looking at the two websites that have been launched to 'rate' doctors. These are iwantgreatcare.org and NHS Choices.

I think it is fair at the moment to describe both of these schemes as unmitigated failures.

Let us take NHS Choices. This hugely expensive website (millions and millions of pounds in the developing and running) gives people a portal for 'rating' their doctors' surgeries. I think it has been live for around 2 months now, and I have checked my locality to look for reviews. In the 95 practices listed as adjacent to my surgery, there have been a total of 7 reviews. The other 88 have nothing at all. Scarcely a ringing endorsement, is it? A lot of money for a consumerist damp squib that serves no obvious useful purpose.

If NHS Choices is pretty useless, then iwantgreatcare [lousy name, lousy site] is even worse. It has been around for 2 years, and if I put in the town in which I work, then 26 names come up. Not a single one of my practice is on their database, and of the 26 names at least 6 have retired, several have moved away (one hasn't been in this area for 10 years!) and one isn't even a GP any more. We have had a total of 3 reviews for these 26 doctors in 2 years. There should be around 100 names. Useless.

But when I think of this rubbish website, I think of my 'old friend' Professor Chris Bulstrode. He is a professor of trauma at Oxford, and is closely linked into the site (see posts passim). He now has more ratings than the whole of Wales put together!

There is a rather fetching picture of him on his website wearing what appears to be a pair of pyjamas. He must be soliciting reviews from patients (and presumably only from the satisfied ones).

Clearly pyjama man is superhuman - is he a bird, is he a plane....?

No it's pyjamaman!

Congratulations, Ben.

My Hero

Over the last 18 months of blogging, I have had reason to examine closely what many of the leaders in the Health professions and in science get up to.

It seems to me that, generally, the more baubles and honours people get, the less likely they are to be of any use to Jobbing Doctors, indeed the reverse seems to take place in that many people who have ascended the greasy pole of ambition and influence are there simply because they are willing to abandon their roots and take the Government's shilling. This is why, in my blog, you see the use of the single inverted commas ('Sir' Liam Donaldson, 'Dame' Carol Black, 'Lord' Ara Darzi, 'Professor' David Colin-Thome and so on).

Tim and again I have discovered that our leaders have feet of clay. It is so very disappointing.

The Health Service Journal has come up with their list of 50 most influential people in the NHS. In among the placemen, servants, renegades, over-promoted and self-promoters there are one or two who I genuinely feel are doing a good job.

The first is Steve Field. As chair of the RCGP he has been at the helm at a time of huge change and threat. His media appearances are excellent (much better than Jobbing Doctor who would use too much 'language') and he has made the best of a difficult job. I don't agree with everything he says (I believe he is a West Brom supporter - tut tut!), but he has done well.

The other star in this tawdry firmament creeps in at Number 50. That is Ben Goldacre. Ben writes a weekly column for the Guardian Newspaper, and also a blog. His debunking of pseudoscience and wibble is a delight, and he (and the Guardian) managed to confront and defeat Matthias Rath, one of the most dangerous quacks in recent living memory. He is a bit of a hero to me.

Number 50, Ben?

Well done.

Another stupid idea.

One never ceases to be amazed at the capacity of people high up in the strategic areas of medicine to get things so spectacularly wrong.

There is a litany of cock-ups and bad decisions going back down the years that I have commented on since I started this blog 18 months ago.

We have now arrived at possibly the most stupid idea to emanate out of the sphincter of the department and the strategy makers since, well, the last one.

First, a little history. General Practice maternity care was a component of General Practice when JD became a GP. For some reason (I never worked out why - and it was certainly not due to any evidence of lack of safety), the Conservative Government ennobled a compliant patsy to write a report on maternity services ('Dame' Julia Cumberledge) which restructured it to exclude GPs from Maternity Care. Perinatal Mortality has not changed since, and the Caesarean Section rate has increased inexorably over the last 20 years. The service is no better.

GPs are becoming de-skilled in maternity care. That is dangerous.

Now they want to do the same with Paediatrics. Develop a special cadre of clinicians working in Paediatrics in the community and take routine paediatric care off GPs.

Why?

I can't think why.

It fragments and weakens the base of General Practice that has been the core of the successful primary care sector in the UK. It takes us towards the US model again. The thing about General Practice is that it is, ermm, General. Unsurprisingly, it develops from the superficial and flawed ideas of the (now resigned) health minister and surgeon, 'Lord' Darzi.

It is a stupid, stupid idea that has come from management, and will be resisted by the profession. It is stupid in so many ways.

Are they asking Jobbing Doctors about this?

No. I didn't think so.

Go away Mr 'so-called' expert.

I rather get fed up of regular reports that say 'GPs should do this....' or 'GPs should do that.....' or 'GPs shouldn't do the other.

They usually emanate from 'experts' with a vested interest in their tiny little bit of medicine, and who do not see the number of patients we do or the number of areas of medicine that we deal with.

Here we go again with some European expert telling us to prescribe antibiotics less frequently.

Mr Dominic Monnet, an 'expert' at the European Centre for Disease Monitoring and Control [whatever that is] is sounding off. Apparently we won't be able to do hip replacements, or chemotherapy or tranplants if trends continue - according to them - so GPs must prescribe less antibiotics.

I have some news for you, Mr so-called European expert. We don't prescribe antibiotics that frequently, often preferring to manage things with explanation and simple remedies.

Go back into your little office and stop being so bloody offensive.

An idea!

I have a suggestion for our latest health ministers. Now, let me see, who are the health ministers this month? Ah Yes, Mr Andrew 'Andy' Burnham MP and Mr Michael 'Mike' O'Brien MP.

But before I reveal my suggestion, may I say that it is entirely in keeping with this current Government that the Secretary of State should 'suddenly' be unable to attend a conference at the last minute because he has an important engagement somewhere else (this time it is in the USA). So Mr Burnham sends one of his deputies, Mr O'Brien, to address the conference. Not exactly a vote of confidence in the workforce is it?

Now Mr O'Brien did his best, but he implied that the Royal College of GPs supports the latest 'idea' of the Department and their advisers to abolish practice boundaries for General Practice. Superficially this has some attractions (and superficially is what the Department of Health does). But it is an irrelevant, unworkable gimmick that will gently die a death. It won't really work to sort out their perceived problem.

What is the problem? Big business does not like people having time off work to visit their doctors - it reduces productivity and profits for the bosses. So doctors should be available when big business want. People commute to work and the doctors are closed when they get home. Force the doctors to abolish boundaries.

The idea would be that, if big business is that concerned that they want some medical help whilst people can stay at work, then they can have a medical department of their own: employ some doctors so that people can be seen at work. That would be really easy, wouldn't it. Not disruptive.

Or maybe allow people to leave work early so that they can get to the doctors before 8 pm (we have appointments up till 8 pm monday to thursday).

What's so hard about that?

The second idea would be a collaborative and supportive way forward. Go to the professionals, say to them 'How can we address these issues, and will you work with us on a solution?' The current way they decide a solution is in a cabal of advisers - all of whom have either an agenda to fulfill or demonstrate remarkable ignorance on the subject they are advising on - and force it on the profession by a combination of spin, distortions and bullying.

Why don't they start listening to the front line workers and not Darzi (Surgeon - ignorant of primary care), Thome (Retired and a Government placeman), or Donaldson (Disaster)? Nor should they listen to Corrigan (Political Agenda), Stevens (Works for American Health) or Richard Smith (former BMJ editor and renegade) - or any others.

If Government want to build bridges and work with Professionals they need to learn to listen to impartial advice from people who know. Not go 'la-la-la' with their fingers in their ears.

The example of Professor David Nutt is a perfect demonstration of the shallow, publicity-seeking, appealing to emotion-type policies that are all to common.

It does not bode well.

This is disturbing

Most doctors have apparently abandoned their support for New Labour. I'm actually quite surprised that any GPs are actually supporting the Government: I certainly don't - not because they have not done some good things in the NHS [they have], but because of their orchestrated spin campaign against doctors over the last few years.

Many have gravitated towards the Tories, but I doubt whether the Tories will be any better. Anyway, I usually assumed that GPs were Tory in inclination. Jobbing Doctor is, of course, a pretty unreconstituted socialist.

But what on earth is this?

Apparently 2% will be supporting the British National Party. I am deeply ashamed of this statistic. The BNP are a bunch of brainless right-wing bigots. Racists as well. I assumed that all their supporters were low IQ thugs with short hair and tattoos.

This statistic is deeply disturbing. I hope that this is a sampling error.

I really hope so, because the alternative is that people in a position of authority are racist bigots.

It can't be true, can it?

Great Music: the War Requiem

Mrs JD is planning to do 2 school assemblies for the Remembrance Day commemoration. We have been discussing what might be an appropriate for sixth-formers.

You cannot cover the remembrance day without considering the war poets. Of all the poets the greatest (and indeed most tragic) is Wilfred Owen. Many of his poems bear repeated reading as there is such depth in them. They will be familiar to music lovers as being part of Benjamin Britten's War Requiem.

The War Requiem continues to divide people about its greatness, but I am convinced that it is a really great piece of music, and drama. Britten's understanding of the words of the Requiem mass is extraordinary ('Lacrimosa' as sung by Galina Vishnyevskaya is a highlight), whereas many other composers use the words as a way of setting music (Verdi is a prime example), Britten seems to live the words, and the interpolation of Owen's poetry is stunning.

Two sonnets are amazing, and many people know the Anthem for Doomed Youth, which bears repeated reading. The other sonnet is used by Britten (although he only uses 6 lines).

Be slowly lifted up, thou long black arm, 

Great gun towering towards Heaven, about to curse;

Sway steep against them, and for years rehearse

Huge imprecations like a blasting charm! 

Reach at that Arrogance which needs thy harm, 

And beat it down before its sins grow worse; 

Spend our resentment, cannon,—yea, disburse 

Our gold in shapes of flame, our breaths in storm.  

Yet, for men’s sakes whom thy vast malison 

Must wither innocent of enmity, 

Be not withdrawn, dark arm, thy spoilure done, 

Safe to the bosom of our prosperity. 

But when thy spell be cast complete and whole, 

May God curse thee, and cut thee from our soul!

Britten only uses the highlighted words and this is very effective - as part of the Dies Irae - and always brings a lump to my throat. 

So Mrs JD will use this small section for her assembly.

It is important to remember.

Surprise, surprise.

If you asked the Jobbing Doctor to complete Mozart's C minor mass, he would botch it. The end result would be, at best, a crude pastiche. This is despite the fact that I regard Mozart as a great man, and am quite musical myself.

The key thing is to get the best help from those best qualified to do things.

I was reminded of this when I heard the news that the new 'Darzi' centres have been a failure. I do not mind extra provision of primary care - God knows we are working under pressure at the moment - but the Government's chosen solution was badly thought through. Squandering public money on a type of provision designed by a foreign-born, foreign-trained tertiary hospital specialised surgeon was bound not to understand the nuances of how primary care has developed in the UK.

In my area around £9 million pounds has been set aside for all these various centres - pump primed over three years - and then expected to be taken out of the global sum. So far the only centre opened in my area has taken on around 500 patients. This is far from the basic numbers needed to make them viable. This money could have been spent on better front-line services (more district nurses, more community physiotherapy, a whole host of beneficial developments) but all we have is a vanity project from 'Lord' Darzi.

Money wasted again.

Who can we call to account for this profligacy? Darzi has resigned, and I hope is now doing something that he knows about (abdominal cancer surgery). The ministers keep changing. Blair has gone. Brown will soon be gone. The advisers will stay put, wormtongue-like, to advise the next lot of politicians.

We will be left with these white elephants.

No help to Jobbing Doctors at all.

Another lightweight.

We have another lightweight politician as Secretary of State for Health. He has become the latest in a long line of people ill-suited to the job and without the intellectual calibre and management skills to do the job. They come and they go.

The latest person in the revolving seat (average tenure 18 months) is Mr Andrew 'Andy' Burnham MP. He is a likeable cheeky-chappie kind of politician with no experience in the real world, and has risen through the ranks of new labour - following school, there will be Oxbridge, Research and non-job, MP and Minister.

He is now tasked with looking at the shambles of New Labour policy on health and picking out the good bits from the carcass.

Apparently, according to a study, primary care in the UK is very strong and effective when compared with what goes on in other countries.

According to Mr Andrew 'Andy' Burnham, this is all thanks to New Labour policies. New Labour should take all the credit.

Sorry, Mr Burnham, but that is not the way it looks like on the ground. Primary Care has always been efficient and effective in the UK. It continues to do so despite rather than because of Government policies.

Remember that people get excellent Primary Care in the vast majority of the UK for the cost of medical insurance of a Hamster. Do not look towards America for your answers.

For those who seriously want to look at how Health Care is wastefully managed in the USA, just look at this random case: $1920 for a ten minute consultation for a broken thumb - and that's before the attending doctor's and radiologist's bill.

Maybe there's something to think about, Mr Burnham.

Milton Keynes?

Milton Keynes.

Milton Keynes in now the new gateway to the north. In the past Barbarians started north of Watford, but now the space on the map where it is marked 'Here be barbarians' now starts at Milton Keynes.

Milton Keynes has a national hockey centre, and a football team that was stolen from Wimbledon. They have a lot of concrete cows. They also have the Open University based there (a good thing). But for a town whose inspirations came from our greatest economist (J Maynard Keynes) and one of our greatest poets (John Milton), they have a Primary Care Trust (PCT) full of idiots.

The PCT must have thought that Milton was the economist and Keynes was the poet.

Why am I so disparaging about people I scarcely know? Because they have spent public money commissioning 'Dr' Neil Bacon's rubbish ratings site (you know the one, it rates dead doctors and has a hopelessly out of date database).

'Dr' Bacon (whose faltering career as a specialist ground to a halt) is understandably delighted. He spouts the usual rubbish. The doctors in Milton Keynes will be mightily impressed with this nonsense. A manager says they are at the forefront. Huh!

Come to Milton Keynes and allow virtual strangers to libel you on a publicly funded site!

Nobody really thinks that Milton Keynes is at the cutting edge of anything.

Except pompous stupidity in its PCT. What are the GP representatives on the PCT thinking of?

Wake up and smell the coffee, guys!

Nutts to you.

The row about the sacking of Professor David Nutt rumbles on, and it is interesting to see where the fault lines are drawn.

On the one side we have a home secretary who has been in the job less than a year (Alan Johnson), the downmarket redtops and the ghastly Daily Mail (led by their great thinkers Amanda Platell and Melanie Phillips), Professor Robin Murray and Ann Widdecombe - all cheered on by the mainstream parties. The Tories have only criticised the Government in not acting sooner.

On the other side we have the broadsheet media, the huge majority of scientific opinion and bloggers like Dr Grumble, the Ferret Fancier and Jobbing Doctor. I would also like to suggest that 400 years of enlightened liberal thought as well.

Drugs policy is a complete mess. Every day I am picking up the pieces of shattered lives. It is rare for me not to have to deal with some sort of addiction and drug problem in each surgery I run. The solution the Government has is to carry on regardless, ignore the evidence, play to the gallery and watch the problem getting worse. And sack those who dare to disagree with the party line.

Henry II took this approach when he got rid of Thomas a-Becket in 1170. It is a shame that Government thinking is mired in that same 'dark ages' era of thinking.

Things that sit on my desk 2.

I am a professional that works with 4 of 5 senses: sight, hearing, touch and smell. I don't taste much in my daily work apart from maybe filter coffee.

I have two ears, two eyes and one mouth, and I like to use them in that proportion. So I would say that one of my most important tools are my glasses. I wear them now for reading many many documents that come my way (today, another idiot's guide to depression has been sent to me by NICE - that will be filed in the round metal filing cabinet on the floor), the e-mails and other electronic documents as well.

I need my glasses to look at the patient, to see if they are jaundiced (yellow), nauseated (green), in heart failure (blue), have end-stage emphysema (purple), have carbon monoxide poisoning (red) or anaemic (white).

As the day goes on I need my glasses more and more, and I have to say that they make me look quite clever (see my picture at the top of my blog - hem hem).

They sit on my desk.

I need them, and I am a better doctor for having them.