Competition or collaboration?

In my week, I have some time allocated to teach the young doctors of the future. More specifically, young primary care doctors.

It is an enjoyable and rewarding part of my week. I work with several other established GPs who are a wonderfully coherent team. We are paid for 2 sessions a week, and certainly earn that money, as we are training more than 60 doctors in our little corner of this Sceptered Isle.

Today we had a session that was led by me, and we had a radiologist from the local hospital talking about effective use of radiology. We have access to a wide range of radiological investigations, including ultrasound, CT scans and MRI scans. It looks like General Practice costs for radiology in our area is around £1.2 million - spent, per annum, on diagnostic imaging. This might seem a good deal of money, but when the whole lot is totted up, and the usage from General Practice is analysed, then it seems a pretty effective and important use of resources.

When the service was opened up to primary care in around 2007, there was the usual argument about GPs being irresponsible in their usage of diagnostic radiology. This is actually quite far off the mark, and it would appear that many requests are carefully thought through, and the clinicians follow one JD's basic rules:

What difference would the results of these investigations make to a patient?

This also encompasses normal results, as a normal result of a CT scan of the brain for an adult with headaches, or a non-specific MRI scan of a chronic back pain will save using up valuable hospital resources. Do not underestimate the value of a normal result. We have shown we use these tests sparingly and efficiently, and my colleague was happy to confirm this.

This is really about sharing facilities, respecting each others' expertise, and relying on good clinical judgement.

That is the way it should be.

Collaboration every time.

Spirit of Stalin

Spirit of the times?  

The spirit of Stalin lingers on, I'm afraid.

We do live in a liberal democracy (liberal in the old fashioned sense of the word, meaning "free") and I cherish the freedoms that we do have. However, I am aware of an increasing illiberality streak that exists these days in which free speech can be criticised as being offensive in some quarters.

We all have our limits as to how free speech is tolerated. I am not prepared to countenance views that I regard as racist or homophobic; others would regard comments on religion as being offensive (I do not), and it was Voltaire who said

"I hate what you say, but I defend to the death your right to say it"

As a citizen in a liberal democracy, I feel comfortable about criticising Government policy. I feel I have a civic duty to do so. I have done so over the years in an area I am quite knowledgeable about - health care. I don't think I have any friends in Downing Street, but I do have colleagues with whom I disagree about issues. That is healthy.

What is not healthy is reports of attempts to silence critics of Government policy. I have always believed this to be the case, and it is unsurprising that this report confirms it. With doctors, if you speak out your are threatened with being reported to the General Medical Council - a Government appointed quango that tries to control doctors. I know of several bloggers who have been threatened with this.

So - a simple question - if the new Government proposals are so good, why are there threats to silence those who disagree?

Has the spirit of Stalin returned?


PS Since I wrote this this afternoon, this has come to light - Josef Dyugashvilli in Cumbria......

Leadership.

Where there is no leadership, the people perish: Proverbs 29:18

I have been reflecting on leadership tonight.

What makes a great leader? Someone who inspires those who are happy to be led. One who listens to the concerns, aspirations and hopes of supporters. One who sees the right way forward. Someone who takes a moral stance, without considering their own position.

There are other types of leader. Those who lead from the front and use all their authority to change events by engaging with those whom they disagree with, and seek to adjust events by subtle co-operation. They modify the emotions of their followers, seeking to channel their views through reasoned and principled argument.

There is another kind of leader. One who instinctively knows they are right, and will brook no argument. One who seeks counsel only from those who agree, and dismisses the opposition by ignoring them.

These are the three types of leader evident today in the news about the Health Bill.

They all lead. They all think they are right.

I am happy to support only one of them, the first one. The second will sit on the fence until the iron enters his soul, and the third is the first lemming off the cliff. Leader, fence-sitter, lemming.

Any suggestions?

Why the Liberal Democrats support the Health and Social Care Bill?

I never really understood why the Liberal Democrats were so supportive of the Health and Social Care Bill.

Until now.

The silence from what used to be a Liberal leaning party in allowing such an illeberal piece of legislation through has been surprising.

Until now.

But what has happened?

This has come to light. Accumulated money of half a million pounds given to the Liberal Democrats by a private healthcare firm. The firm is called Alpha Health care. They are likely to benefit from the new Bill. Probably significantly.

It all adds up. £££££££.

He who pays the piper calls the tune.

Panic, panic......

The Prime Minster is arranging a summit to discuss the current Health and Social Care Bill. That is great news. I wonder who he will invite?

Maybe the organisation that represents the key professionals who are expected to deliver his ideas for commissioning would be good to have there. Yes, some GPs would be good to have invited. Then we could have a discussion about why we need primary legislation.

Will he invite a democratically elected representative of the Royal College of General Practitioners?

Will he invite the leaders of the doctors' professional organisation, the British Medical Association?

Will he invite the leaders of the country's nurses, the Royal College of Nursing?

Will he invite the leaders of the Royal College of Radiologists?

Will he invite the leaders of the country's midwives, the Royal College of Midwives?

Will he invite the leaders of the Royal College of Paediatrics and Child Health?

Will he invite the leaders of the Chartered Institute of Physiotherapy?

How about Unite and Unison?

He won't invite any of them, because they disagree with the Government. All who will come will be the craven, the right-wing, the believers, those on the make. Individual GPs will be invited, maybe Dr Michael Dixon or Dr Charles Alessi. Members of the Future Forum will be there in force. Possibly the leaders of the Royal College of Surgeons.

I look forward to hearing who will be invited.

I won't be, for sure!

I pay tax

I have always, always paid my taxes. I feel that it is a civic duty to do so. I have not been party to any scams, or sharp practice as I regard it to be dishonourable and unprofessional to do so.

I have an accountant who helps me with my tax affairs. He tells me what is appropriate and what is not. For example I have never paid a member of my own family to answer the phone when I was out, and I have only claimed a percentage of my car expenses that is appropriate to my own usage.

Looking at the way that other people treat their tax affairs, I might be considered a naive fool. But at least I am at peace with my conscience.

I learn that senior people in the Department of Health (at least 25 of them) have been getting paid by getting it sent to private firms based at their own addresses, and that minister have sought to confuse the matter by saying that "no civil servant" has been paid this way (knowing that none of these senior people are defined as civil servants).

It's all coming out that there are clearly 2 sets of rules: one for Jobbing Doctors, and one for senior people on the Department of Health.

"We're all in this together," said David Cameron and George Osborne.

No we aren't, and getting the minister, Mr Simon "Third-Degree" Burns MP to give partial answers to tabled questions makes me want to question the integrity of these people.

I don't mind.....

I don't mind if people complain about the service we give for our patients.

I don't mind if I have to deal with issues about clinical decision making.

I don't mind if people want to feedback about how we can improve services, especially if they are sensible and affordable.

I don't mind taking the time to deal with e-mails and letters to explain the way people have been dealt with.

I do object to having to deal with offensive e-mails because a fit young patient can't see the doctor of his choice on the day of his choice at the time of his choice (wanted to be seen at 10 pm on a friday night). I have now spent 30 minutes of my free time dealing with this.

Am I being unreasonable in being irritated by this?

Here I am

Jobbing Doctor at the end of the day....

So here I am, a doctor of a certain age, having spent another 12 hour shift at my practice. I was able to stop for a 20 minute lunch and that is all.

I am working harder and harder just to deliver as good care as I can for my patients, who are generally very appreciative.

All I read in the Papers is about GPs coining it in, and playing Golf.

Maybe some people would like to spend a day with me doing what I do. Its not easy.

Zzzzzzzz.

Desperate Measures

You hear it from time to time. "Things are not what they used to be."  "Standards have declined."  "We're going to Hell in a handcart, etc.."

However it is really sad to see a once useful and impartial source decline so steeply.

The "Independent" newspaper has now joined the other News International papers (News of the World, Sun) and the Daily Mail as a repository for Government spin and cheap nasty spoon-fed journalism.

Firstly, we have the journalist Johann Hari, who leaves the paper after being shown to be a serial plagiariser, and over the last 2 days we have two pieces of snide and nasty journalism by Oliver Wright, the first taking an unwarranted aim at Dr Clare Gerada (that's right Oliver, she's a woman and a 'Dr', not a 'Ms') and now with a pathetic piece saying a poll is not representative of the Royal College of GPs. In this piece Mr Wright quotes two members of council - one says the opposition is 'political', another says it relied on an online poll. RCGP Council consists of around 90 GPs, and I know one member of Council who is ardently pro-Government. To find two opponents is not surprising. The vast majority of GPs are vehemently against the Bill.

These two pieces have been put in at the behest of Tory central office, for which Mr Wright is clearly a conduit. It is a sign of the decline of the Independent, and the desperation of the Government.

Bad, bad, bad.

"My full support"

You've seen it before.

Week 1.   The Manager has the "full support of the Chairman and Board of the Football club."

Week 2.   "We will work with the Manager to ensure a successful season."

Week 3.   Manager resigns or is sacked.

We are now in Week 1. Andrew Lansley has the "full support of the Prime Minister."

If I were Andrew Lansley, I would start to prepare to return to the back benches, and watch out for Stephen Dorrell MP.

Reaching crisis point.

Sir Bruce Keogh, a surgeon who has been promoted through the NHS and given a Knighthood, has said that the Government has no powers to insist that Private Providers remove faulty or potentially faulty breast implants.

So they can do as much or as little as they feel is right.

Nobody in this row is really considering the patient in all of this.

This will be a good example for all those who wish to see the current Health and Social Care Bill become law.

There is now a real head of steam building up, and Lansley will need to be sacked and the Bill withdrawn. Then the Government needs to start building bridges with the Professionals that they have so cavalierly ignored and denigrated.

I have a Tory MP in a marginal constituency. This MP (a real cheerleader for the reforms) will have one GP telling patients exactly who to blame, and I'm sure I can influence several hundred in the next 3 years. That MP will be out of a job come the next election. Especially as my view chimes in with 90% of other GPs.

Now is the time for the Prime Minister to show some political nous. The Bill, and Andrew Lansley MP need to be got rid of. Of the two, it is the Bill that is the problem. Andrew Lansley can stay, if his Bill goes.

What will David Cameron do?

Continuity

A Family Doctor

The clue is in the name "Family Doctor".

Today I did a task that I do do from time to time, the new baby clinic (with first immunisations). I like doing the baby clinic, as it is essentially well babies, with proud mums and (usually) dads. The injections do hurt the babies, to be sure, but that is a small price to pay for dealing with small babies. I do enjoy it, although the paperwork is pretty irritating.

Today, I saw a proud new mum with her baby.

I actually delivered her on the GP maternity ward (when we had them) and gave her her immunisations. Now I'm doing it to her baby.

That is a job to be proud of - being her family doctor and seeing another generation into the world.

*sigh*

From above

This week, the Health and Social Care Bill returns to the House of Commons for further perusal. This Bill has been a slow burner, partly as a result of its complexity, but there seems to be generally agreement amongst great swathes of those working in the NHS that it is, effectively, a large turd that is due to be dropped on the country.

I'm sorry about the rather scatalogical language, but for me this is the best metaphor. Something large and unpleasant that drops from above.

It is fair to say that the HSCB is a complex piece of legislation, that is not well understood by people. Even those whose job is to scrutinise legislation struggle. My historical mind turns to a parallel which is the Schleswig-Holstein question, of which Lord Palmerston said:

"There are only three people who understand the Schleswig-Holstein question: one is Prince Albert, who is dead, the second is a German Professor, who has gone mad, and the third is me and I've forgotten the answer"

The Bill will be returning to the commons, and will be debated. Over a 1,000 amendments have been tabled. Many of these are semantic alterations, but some are at the behest of the NHS Future Forum. This is a group of people, under the chairmanship of Steve Field, who have been asked to advise on the HSCB and other issues by the Government. They are described in the media as 'Independent', but they are hand picked by the Secretary of State. That is not independence.

They might regard themselves as giving genuine advice to the Government to mitigate some inconsistencies on the Bill.

I don't, however, see their role as that. I see what they have done is a sanitation job, a sugar coating of Lansley's complex turd.

They might regard what they have done to be a good job. I regret I cannot.

A sugar-coated turd may be less unpleasant, superficially.

But a turd is still a turd.