You dumb can you get?

I have been alerted by my colleague, Dr Crippen, about the latest in dumbing down, where a practice in Luton is running courses in minor illnesses for a week. It is calling itself the National Minor Illness centre.

Apparently it is really good, and some nurses and other people feel it is worthwhile. This is what an advanced nurse practitioner says:

"It acts as a springboard for the novice to enter into autonomous minor illness practice and for more experienced clinicians it can act as a master class…… I would recommend this course to all clinicians wishing to develop real mastery in the field of minor illness management."

Autonomous minor illness practice? A three-day course? That'll do nicely, thanks.

Another was excited about learning pharmacology:

"Pharmacology all seemed so simple and logical, everything just seemed to make sense."

So no need for degree level pharmacology then. Two days should do it.

It is encouraging that one of the tutors is a medical acupuncturist, and practices integrated medicine. That sounds really holistic, until you remember that integrated medicine is code for all sorts of quack remedies supported by HRH Prince Charles, the quacktitioner royal.

I hope that the course does not include treating minor illness with acupuncture or cranial osteopathy.

Or the participants might need to go on another three-day course to learn to deal with minor illness.

What are we going to vote?

I have a confession to make. I am a socialist by inclination.

I went into General Practice and deliberately chose to work in a deprived area because of a sense of vocation. This might seem absurdly idealistic in this era, but then in the 1970s socialism was what many young people aspired to.

Then Margaret Thatcher came along, and with her the whole paraphernalia of money, and 'there is no such thing as society'. I was still a socialist at this time, and I saw her policies further decimate the area I worked in, with many thousands of jobs being lost under her policies.

But at first she left the NHS alone. Then it was a wonderful system that delivered health care according to need, and was paid for by those who could afford it. I was proud of it (and to some extent I still am).

Then the interfering started with Margaret Thatcher at the end of her premiership (Kenneth Clarke was pretty odious at the time as the Secretary of State - not forgiven), and continued through the era of John Major. It has progressed and got worse and worse under Blair, until we have reached the nadir of Gordon Brown. Every single intervention seems to have been poorly thought through, dictatorial and ruinously expensive. The list of catastrophic decisions has been categorised over the last few years by some excellent Bloggers, and isolated and brave critics such as Allyson Pollock and George Monbiot.

In the next few months we will have a general election, and we will be given a choice of who to vote for. The choice (if that is the word) is dire.

Labour have little credibility and no support from people like me. They have been the most vindictive, undermining, venal, incompetent and mendacious Government in living memory. They have squandered money, taxpayers' money, on an ever increasing number of measures - mostly making matters worse. One or two successes seem largely as a result of chance rather than any intent. They are privatising by stealth and should be despised for what they have done to the NHS. This includes all their fellow travellers (Darzi, Black, Donaldson, Beasely) who give their agenda spurious respectability. Who can forget 'Lord' Darzi saying that "they much break the fabulous relationship between the GP and the patient?" I won't. I can't.

The Tories are probably as bad. In some senses they are keen to push the break-up of the NHS even quicker. Those of us with memories of Heath, Thatcher and Major know that they cannot be trusted to do what is in the interest of the people. The only people they support will be their own people: the rich.

The Liberal Democrats have lost their way. They are not radical or alternative, but seem to offer more of the same. Who is their health spokesman? I don't know. Mr Invisible, I imagine.

UKIP are a bunch of 'Little Britishers' and the BNP are racist thugs.

So it is voting Green or nothing for me.

I only have 3 years to go before I retire, and I have never been so depressed about the state of British Politics.

Can anyone out there help a confused Jobbing Doctor?

Where are they?

The Jobbing Doctor is a General Practitioner who blogs.

When I started blogging, there were a number of really good bloggers whose blogs encouraged the Jobbing Doctor to dip his toe in the water.

Most of them have fallen silent, or only blog occasionally. I wonder why this is.

Is it that they are too busy to blog? Or have they run out of things to say?

Are we now in a situation where Government are getting everything right in health care policy? Is Liam Donaldson an excellent CMO? Are the nurses happy with Christine Beasley?

It seems to me that the only 2 active bloggers are Nurse Anne and Dr Grumble. We have effectively lost Mousie, the Brown Stuff, A fortunate man, Dr Rant, and Nice Lady Doctor. NHS Blog Doctor seems to have gone into hibernation for now.

Where are they all?

Move on, before the solids hit the fan

Tony Blair used to be the Prime Minister.

He is now a corporate animal charging £180 for a photo, and thousands for a single lecture. He has a rich lawyer wife and a portfolio of properties and a high-octane high-profile globe-trotting life.

He is also a lucky man.

He would never have got where he wanted to be if John Smith had not died. Or if John Major's Government wasn't so bad.

He led his Government for 10 years, and left in 2007 when his 'legacy' was already unravelling. We are all left to pick up the pieces.

Next year, we expect New Labour to be unceremoniously booted out. They will be replaced, faute de mieux, by the Conservatives. Never before has the old adage that oppositions aren't voted in, Governments are voted out been quite so true. The truth is that the Jobbing Doctor has no support for any of the politicians.

One of Tony Blair's most unsavoury legacies is the current policy of break-up and privatisation of the NHS. It is being done by stealth, but it is there, and will cause untold damage. It has largely been disguised by the extra money that has been pumped into the NHS. That money stream will dry up in the next year, and what will then be squeezed will be the core services.

The thing about being a Jobbing Doctor is (a) I can see it from the patient's perspective and (b) I have been around long enough to see political ideas come and go.

Dr Grumble, my hospital based co-blogger, has noticed the appearance of the word Polysystems in talk about the NHS. This has already been used by some of the mindlessly pro-New Labour patsies, such as this manager and this doctor. When they start using different words you need to watch what is going on: it is an exercise in obfuscation and duplicity, and here is no exception. The managers are trying to change 'Lord' Darzi's polyclinics into something different, and our manager and GP are at the helm of this charm offensive.

Only it is a charm offensive without the charm.

It seems that our manager is all in favour of rationing referrals. Our doctor has a totally London-centered view of life.

Watch this space for further development of this management-type bollocks.

Swine flu again

I hear there are reports of Swine Flu becoming resistant to Tamiflu.

I am deeply uninterested in this fact.

Swine flu is a mild, highly infectious disease: occasionally (like seasonal flu) it can be very severe and fatal.

It has been absurdly overdiagnosed (I am yet to be convinced that I have seen a genuine case) and the Government's statistics are hopelessly flawed.

There is no effective treatment for it. Tamiflu can shorten the length of the illness by around 22 hours on average; it also makes the symptoms slightly less troublesome. I would not take it.

Because of its irresponsible overuse, it is becoming completely useless in swine flu (as opposed to being pretty useless).

To Jobbing Doctors this doesn't matter at all.

I get on with my job of being a proper doctor.

League Tables.

The Department of Health has spent many years trying to find a way of assessing the quality of General Practice. They seem to want to measure things with a view to setting up a series of League Tables.

They plan to develop a complicated system of performance management markers where they will start to put into place the bricks to 'assess' practices according to their criteria.

Mrs JD is Head of Mathematics in a large comprehensive school in a deprived area. She has lived with League Tables all of her professional life. They tend to skew the teaching and the way that the school behaves in such a way that they are pretty meaningless. In general, schools in middle-class areas do better than schools in poorer areas.

The proposed League Tables in primary care will be a huge bureaucratic minefield, with all the calculations being so vague and meaningless that they will signify very little.

Jobbing Doctor's practice performs well in some areas and more poorly in others. Our prescribing is over budget, our referrals are not. We try and do whatever we can to the best of our ability. Of course, anyone can be a good GP in Epsom or Solihull. The workload is much less, and the patients are healthier.

There will be millions and millions and millions of pounds spent on a largely worthless exercise. What we really need is more trained nurses on the wards and more physiotherapists.

Not more pseudo-consumerist crap.

This is what we mean.

Qualified Physiotherapist doing her main job....

Today I was talking with our main physiotherapist. We are trying to deliver a really good service for our patients, but we are overwhelmed with work.

We have approximate 25 hours of physiotherapy time a week for a practice of over 18,000 patients, and the waiting list for routine physiotherapy is now 16 weeks. We could do with double the amount of physiotherapy time. We have put aside a room in our main surgery just for physiotherapy.

I remember reading that three years ago over 90% of physiotherapy graduates could not get a job in physiotherapy services (many of them ending up working in bars, or being unemployed).

This is deeply disappointing as we have had more money put into the NHS in the last year than ever before.

So we have demand + staff + money + facilities which should = services.

Only a truly incompetent management structure could ensure that things got worse. But, friends, this is the New Labour NHS where we are spending Billions of pounds on managers, and we can see a manager in charge of a serious organisation of New Labour Bollocks squandering £800,000 on rubbish.

This is an awesome achievement of overwhelming incompetence and stupidity.

How New Labour!

You mean it's not true?

The Jobbing Doctor

Jobbing Doctor is not a fan of Holby City. He does not like Casualty. The programme Doctors he never watches.

This is probably because, after a long busy and demanding day, the last thing I want to do is to watch a medical drama. It is fiction, and of course most people understand that.

One senior hospital manager is commenting, however, that they are far-fetched and in real life staff will wash their hands, and they don't get involved in all the capers and escapades that they do in these dramas.

I actually have some sympathy for this, as people are being mislead into believing that this is what they are likely to get.

However, I think that my patients are more sophisticated than that. I would hate them to think that I am like some of the doctors on these programmes with their amorous adventures, their breaking confidentiality, the constant scrapes they get into, etc.

It is a bit like saying that the Jobbing Doctor is like George Clooney in E.R.

Mind you, when I looked in the mirror this morning........

Risk?

Every now and again I try to read and understand what goes on in management circles. I feel that, as a senior GP, I ought to be aware of best practice and so I dip into other areas of health management from time to time, just to explore what is going on.

Oh Dear, Oh Dear!

I have come across this article on reducing risk in the Health Service Journal. Now I happen to know something about this, as General Practice is all about assessing risk.

Which of these 2,000 patients I see with a headache is the one with the early brain tumour?

When should I stop diagnosing a man as Irritable Bowel and consider colonic cancer?

Which child is the one in many thousands in my area that is at serious risk of harm from their parents?

The list is endless, complex and very difficult to assess. The best hope I have is of being vigilant, reviewing diagnoses, keeping an open mind, and good old-fashioned listening to my patients.

I am informed that I have to 'create a culture of safety'. What on earth is that? Referring all 2000 patients with headaches for a brain scan, maybe?

I've read the article: it is full of irrelevant management bollocks. What will help me is having enough staff to do the job, some support from the Government in what we are trying to do, decent services that we can tap into, and not having to work an 11-12 hour day.

Not this high-carat tripe!

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.