Tuesday, April 29, 2008

George Monbiot tells it as it is.

An excellent article has been written by Mr Monbiot, a Guardian journo who is unhappy with the political direction the NHS is taking.

His article is well written and contains much insight into the current threats to YOUR health service.

Required reading, especially with local elections coming up.


Monday, April 28, 2008


I have just been described as "a lovely bit of stuff" by a female patient*. To my face.

So how should one deal with this sort of thing? Complaints are dealt with in a structured way, utilising our Practice's complaints procedure as a first step. The huge majority are dealt with in this way, insofar as no further action is taken by the complainant. Presumably most are satisfied by the resolution of the problem. Sometimes the complaints are trivial, other times more serious. Some are patently vexatious, though they are few and far between thank goodness. All complaints are dealt with as significant events in our practice, which effectively means we try and learn from them. That sounds rather "cardy" (by which I mean "cardy-wearing, leather elbow patches, touchy-feely") but generally there is something which we could change. At the very least we discuss it (partners, practice manager and if appropriate other staff). All the details are recorded and kept.

I sometimes think, though, that we don't deal with compliments as robustly as we might. I receive compliments fairly often in the form of thanks (for doing my job!). Sometimes, especially around Christmas I receive small gifts, often of the imbibing variety. Soemtimes, I receive letters or cards. I keep the cards. A few years ago I put them in my appraisal folder as I thought they might help show that my relationships with patients contributed to the evidence that the GMC should continue to register me. I no longer do that. I now keep them in a different folder, for my own benefit. I don't look at them often but I know they are there. Perhaps we should be logging all of these episodes as we do with complaints. That seems a little excessive but I suppose it would allow a veriafiable balance against the complaints.

But there is a part of me that feels that doing so might cheapen the intentions behind the gestures.

As for the ribald comment I have just been both the subject and recipient of, well, I take it as its intended and wink.

*Ok, she's 74 and partially sighted...

Friday, April 25, 2008

Tax cuts

Losing the 10p tax band has hurt my staff. not badly, but all of them.

They have each lost about £15-25 a month (they are all part-time). Those paying pension contributions have seen those drop by about £10 a month as well. None of them will be able to recoup this money as their husbands/partners are all in work as well, so no tax credits.

Thanks Gordon.

Thursday, April 24, 2008

Extended hours - some random thoughts

Still no sign of the specification of the DES to provide this apparently vital service. There has been some interim guidance published (here)by the Department of Health to allow the development of LES's by PCTs and LMCs. I noticed that our illustrious Health Secretary, Postman Pat, is now talking about "Family Doctor Services" rather than "General Practice" and that Laurence Buckman is being described as an Arthur Scargill figure (good for you Laurence). I was also disgusted to hear AJ say that he was pleased that 92% of GPs accepted their proposals, but not surprised. Firstly, 92% didn't, it was 92% of those that voted. I bloody well didn't. And the 92% had little choice, did they Alan? What was the alternative?

Anyway, back to extended hours. I can't see why anyone would want to commit to a system which has yet to be agreed, or at least published, which will result in more work for less money, for minimal benefit for a minimal number of patients.

Some GPs will it seems do anything for money. I fear a lot of GPs will just keep their heads down and get on with it anyway, even if it ends up costing them money. Some I'm sure would argue they can't take the financial hit of not doing it. Although quite how you get your practice finances in to such a state that the loss of £6000 per partner (approximately, maximally and gross) can be so catastrophic is something I struggle with.

But it isn't about the money as far as I'm concerned. Its about the hours. I have a contract. Well, I call it a contract, it can be changed at will by the Government at 3 months notice.

Some extra background about me. I'm a full timer. I work 4 and a half days a week. My half day not infrequently ends up being a "finishing a couple of hours early" day instead. I recently worked out my hours of work for my appraisal. 47 hours a week, in 4.5 days. More than most I suspect. I don't mind my hours. I'm a GP, its what I do. I'm also a married, family man.

The government reckons that 6.5 million people want us to open longer hours, an analysis of a survey which even the most ignorant of people must realise is a bogus extrapolation. For my practice of just under 6000 patients, only 42 people who were surveyed (out of 330, so 13% of those surveyed but only 0.72% (that is, not quite three quarters of one percent) of our entire list) were unhappy with our current hours. 3 felt we didn't open early enough in the mornings. 2 were unhappy that we weren't open long enough at lunchtime, although we don't actually close during the day, unlike many other surgeries. 9 felt we needed to open longer in the evenings. 15 wanted us to open on Saturdays. 4 had what is described as "other reasons", undelineated.

If we were to open for 1.5 hours in an evening and 1.5 hours on a Saturday, that would provide 12 extra appointments in the week. Bear in mind that this would be for routine, pre-booked appointments. Home visits would not be on offer. Emergency care would not be on offer (although quite how we could morally turn away someone who turns up acutely unwell is unclear to me, apparently it is not a major problem from the politicians' point of view). I would be very surprised if that service was utilised fully for some time. Indeed, the people who would eventually make use of the service on the whole are very likely to be the very people who come during the day at the moment. So the people who might "need" (for which read "want") the appointments in the extended hours would be unlikely to be able to access them because they would get filled by other people.

And we are back to square one.

And I don't wish to repeat my divorce experience, thank you very much.

Of more concern to us, in actual fact, was the perception by those surveyed that patients could not prebook appointments. Only 29% of those surveyed thought they could. In actual fact people have been able to prebook for several years. We did have a period of time where we adopted so-called Advanced Access, in other words, day only booking, to reach a target. When it became clear (within a few months) that it wasn't suiting some of our patients we started to allow a limited amount of prebooking. We are trying very hard to advertise the fact that people can. Part of that work is that we have set up our practice website. Registered patients can make appointments and request repeat prescriptions through the website.

We are actually quite pleased. The system has only been up and running for about 4-5 weeks. We already have 71 patients registered to use it. 10 patients have made appointments. We are starting to get repeat script requests through.

So things are improving. I think.

But we have no wish to open longer hours. We don't think that there is actually any demand for it.


The NUT has my support, for what it is worth.

Think about it: a 3 year pay deal which is below inflation (as per RPI, rather than the completely useless CPI) and depends on Government plans for the economy coming to fruition.

The BBC annoyed me this morning (for a change) by comparing the "average teacher's salary" of about £34k with nurses' and police constables' starting salaries, figures which they acquired form that font of all accuracy, the Government. So of course the figures are not comparable. Idiots (and Voltaire had a thing or two to say about idiots...).

The fact that the NUT and its members felt that a strike was needed speaks volumes to me. The first national strike for over 20 years by a teaching union.

(Apologies for the lack of links. Lazy perhaps, but I'm in the middle of surgery. This post is what Neighbour would describe as "housekeeping", to aid in the maintenance of my (in)sanity.)

Tuesday, April 22, 2008

Bad news

Sometimes a patient comes along who reminds me why I'm here.

Ettie is a lady of 82 years. She's been widowed for almost a quarter of a century. Apart from high blood pressure and quiescent ischaemic heart disease she is relatively fit and healthy. I've been her GP since I joined the practice in 1999. She only sees other GPs rarely, usually if I am on leave.

But Ettie wasn't well recently. She had what appeared to be a chest infection with some pleurisy. I treated her with antibiotics. She felt better in herself, but the pleurisy didn't settle so she came back to see me a month later. Although her chest was clear I arranged a chest x-ray.

The x-ray showed a shadow in the top of her right lung. It also showed some destruction of two of her ribs, just where she was still getting discomfort. Ettie probably has lung cancer, almost certainly in fact. It would also seem to have spread beyond her chest to her ribs. This is bad news.

I have seen Ettie this morning. I have spoken to her at length about what is going on, what the likely problem is, what will happen next. I have referred her to our excellent local lung cancer rapid assessment clinic.

Ettie is devastated. She is scared. She is sure that this means the end for her. It may well do. But I will be there whatever happens. I will treat whatever symptoms she develops to the best of my ability and will enlist the help of our local palliative care team if I need to (or if Ettie needs me to).

I would prefer not to have to, but I will coordinate her care, to what will hopefully not be the bitter end, but a dignified, peaceful death.

Who better than me, who has known her for so long, who she has a relationship with, who she trusts?

I am her GP.

Enough said.