Friday, May 30, 2008

Fuel poverty plan being unveiled

This issue is perhaps more social than medical, but it impacts on me every year.

BBC NEWS | Business | Fuel poverty plan being unveiled

Lets get people out of fuel poverty. Good idea!

Lets collect and share data with the power companies so they can identify who to help. Then they can offer to insulate their lofts, make sure they are on the cheapest tarrifs, check the draft excluders on the windows.

Not so sure on that. You want to collect data identifying people who are at risk of fuel poverty. How would you do that? I can only imagine the Government would make use of data derived from pensions somehow.

Or (now wait a moment!) could this just be another way to try and persuade us of the merits of national ID cards?

I've just heard a minister on the Today programme, Malcolm Wicks I think it was. He was explaining why the Government thought this was a good idea. He began with the data sharing idea, which made me feel uneasy. I'm on record as to how I feel about ID cards. Given recent episodes of data insecurity I have no faith whatsoever that the Government would keep my data secure. But then he compounded the problem by stating that changing the Pensions Bill, the Government could give itself more "powers".

Government seeking more "powers".

Seeking yet more control over our lives.

Once again they forget that they are our servants, not our masters.

But there is no point in me being critical without suggesting alternatives. Of course, I speak from a position of relative ignorance, in that I am neither an expert in fuel poverty nor a Government minister (who are of course by definition infallible, like the Pope, until they decide to spend more time with their familes).

So how about this as a relatively easy, cheap to administer idea: anyone over 65 on income support gets sent a voucher to give to their energy company. No data sharing, its up to the individual to decide whether to engage with the scheme or not as they see fit. Consequently there is no need to change the Pensions Bill, with a commensurate saving of both Parliamentary time and tax-payers money (no changes/revisions means less working hours spent on it). I can't see that it would cost more than the suggested increase in executive powers. I can see that it doesn't make the Government any more top heavy. More legislation does.

But they won't listen. They never listen. They consult. They decide what they are going to do, decide on a timetable, go through a public consultation exercise (which is to inform, not seek views from, the public) then do what they decided to do. Then they pass laws designed to do what they want without thinking about the difficulties that those laws might cause. This Government is forever having to deal with the Law of unintended consequences. They usually seem to do this by retrospectively changing what they set out to do and saying that it had been their intention to do that all along.

By all means help the poor, Mr Brown. But you don't need "powers" to do that. You just need common sense.

Friday, May 23, 2008

Save Your Surgery

The NHS is 60 this year.

That means that my predecessors and I have been looking after your family from cradle to grave, personally and with knowledge about your health and illnesses built from the familiarity that comes with a relationship that may well span decades.

Gordon Brown wants to change that.

He doesn't want you to see the same doctor each time you need some help. He has bigger plans. He wants to introduce commercial companies to the sector.

"So what?" I hear you say. "You GPs are private, you just work for the NHS."

Perhaps. But who am I accountable to (exclusding for the moment the couple of dozen Quangos which can also make my life busier than it needs to be)? My patients. I have a GMS (General Medical Services) contract. It is a long term arrangement to provide care.

What about a commercial company? They have a responsibility to their shareholders, first and foremost. They will likely have something called an APMS (Alternative Personal Medical Services) contract. APMS contracts will likely be for 3-5 years maximum. so what happens when the contract runs out? Will you lose that service as well? Perhaps. But don't worry, some other company will be providing the service if the first one isn't. It really doesn't matter who you see.

Does it?

What about polyclinics, walk in centres and the like? The Government have said there will be up to 250 large new health centres. Great! More services! Sounds super! And what's that? It'll be up to local PCTs to decide if they need one? Wonderful! (Oh no it won't, they've all been told that this is a political "must do", whether they need it or not.)

Except the money that is being spent on those (around £1 million per centre I would guess) could be spent investing in the current service being provided by people like me, for people like you. That money has to come from somewhere. I am not reassured at all by Ministerial reassurances that they have no plans to disinvest in GPs. They think we are superfluous and that what we do could be done more cheaply by nurses, paramedics and pharmacists.

These polyclinics will have many more doctors than the current style of GP surgery, maybe as many as 25 doctors. Great! Easy access! It doesn't matter if you don't see the same person twice.

Does it?

If this concerns you as much as it does me (and I'm concerned equally as a patient of the system as I am as a GP) then please go to the website and sign the petition. Or visit your local surgery and sign.

Write to your MP and the local papers, the Nationals even. Espeically write to your local council, address it to their Overview and Scrutiny Committee.

But please do something.

When we're gone, it will be too late.

Musings of a Dinosaur: Why Breastfeeding is a Bad Idea

Musings of a Dinosaur: Why Breastfeeding is a Bad Idea

Please, go and read this.

It made me snort coffee on my keyboard.

Crewe and Nantwich

Schadenfreude - Wikipedia, the free encyclopedia: "Schadenfreude (IPA: [ˈʃaːdənˌfʁɔʏ̯də] Audio (German) (help·info)) is enjoyment taken from the misfortune of someone else. The word has been borrowed from German by the English language[1] and is sometimes also used as a loanword by other languages. German philosopher and sociologist Theodor Adorno defined it as 'the largely unanticipated delight in the suffering of another which is cognized as trivial and/or appropriate'.[2]"

Friday, May 09, 2008

Time to start a campaign?

(With thanks to Prit Buttar and colleagues on the BMA Communications team)

This one is mostly for my GP readers, but here is a transcript of an email I've just sent to my LMC mailing list.

I listened to Darzi on Radio 4 this morning. If anyone missed it, use
the BBC website 'listen again' thingie, it was at about 0712.

He was explicitly asked whether PCTs would be able to choose NOT to
have a polyclinic if that was what the locality decided. He said that
they would be allowed to make such a decision.

Annual budget for one of these places is going to be somewhere in the
region of £800k-1m per year.

Using PBR tariffs and the BNF, I estimate that this could be used to buy:

1,139 cataract operations
154 hip replacements
113 courses of Herceptin
or 36 full-time district nurses

Perhaps we should therefore be undertaking a survey of our patients to
find out if they want a centre of some of the above. We should then
pressurise the PCT boards to accept our findings. especially as Darzi
specifically said that PCTs should take into account local

This could be run along side the BMA campaign (see Laurence's email of
yesterday or press release on BMA website).

Window of opportunity here I think.

Any other GPs reading this: Get up and start making noise. Now is not the time to knuckle down and get on with it, or the rug will be pulled from under you. Talk to your patients. Read the bumph from the BMA which will arrive next week.

If not us, then who? If not now, then when?

Friday, May 02, 2008

I don't believe it

Last year I posted this.

She's back.

I have just had the SELF-SAME CONVERSATION with her!

Thank goodness its Friday.

Hendrick's, Fever-tree tonic and cucumber await...