And in further news...

Patients will be able to boycott opt out of the uploading of their medical records.

Report in the Register here.

Well, that is a result.

The Information Commissioner's report can be found here. Astonishingly for a governmental report, it is only 4 pages long.

I especially like the following excerpt, with my own highlighting:

NHS Connecting for Health has confirmed that people living in areas
introducing Summary Care Records will be contacted before any of their
medical records are uploaded on to the NHS Care Record Service. They will be given information about their options to limit the future scope of the
information on the Summary Care Record or the option not to have one at all and they will also be given the opportunity to make arrangements to view their information before it is uploaded. They will have a specified period before
their information is uploaded to consider their options.

The initial upload will take place without explicit consent on the specified date unless you choose to utilise one of the options mentioned above. Explicit consent is only one of the conditions for processing sensitive personal data referred to in schedule three of the Data Protection Act 1998 and NHS
Connecting for Health are confident they are able to meet the requirements of
one of the other conditions.

Once the basic health information referred to above is uploaded on to the
NHS Summary Care Record:
• you will be able to choose to remove some or even all of the
information initially uploaded
• you will be able to keep the uploaded information but make the
Summary Care Record invisible.

Any further information will not be added to your Summary Care Record
unless you have agreed to it in discussion with your GP. The
Commissioner understands that these types of discussions will take place
at the next consultation you have with your GP following the initial upload.

Later on, you will have another choice. Instead of the whole record, you
will be able to choose to prevent specific information from being visible
without your consent by utilising what will be called a ‘sealed envelope’

Please note the highlighted bits. If you are in one of the pilot areas and you share my concerns about what might be termed information governance I suggest you make use of these options. As far as I am aware, I will not be in an area of "early adoption". But they can't have my info if I am.

Thank you to the BMA who were lobbying hard behind the scenes to get this sorted. Your efforts are, as always, appreciated.

More Spinal Privacy problems

As if we haven't got enough to worry about with our own national scheme, now someone in Brussels wants us to share all pour medical problems with most of Europe as well! According to the report, there are 5 million health workers across the EU, so if there is anyone who won't be able to access medical records at the drop of a hat, could they raise their hand now please?

No? Oh.

I've already posted about this twice (and on a related matter here, here and here).

Its bad enough that billions are being wasted on the UK scheme which, after £12 billion (at least) and several years, is still charitably describable as an insecure waste of money with a long term usefullness rating that most health professionals aren't convinced about.

How much will a pan-European scheme cost us and who is going to make the most money from it?

Oh, yes.

Who will benefit from the scheme?

Sorry. Forgot that one.

"The data that will be shared will include some kind of emergency care records and patients' medication histories. The aim of the scheme is that if, for example, a UK citizen falls ill while in Spain, doctors there will know what medication the patient cannot take or what existing conditions they already have."

Right. So instead of asking the patient, they can Google the patient. Great.

Still, what do I know?

Sack Patsy

There is a petition here to urge the Prime Minister to get rid of Patsy.

I urge you to read and consider whether to sign (I have).

My only slight concern is who would replace her...



(With thanks to Dr Ben Taylor for starting the petition, and Dr John Crippen for bringing it to my attention.)

Its all our fault (again)

Patsy is at it again.

Apparently, my pay should have been capped. I earn too much.

Given how the GP contract was negotiated, that of course implies that the quality of care which I am providing is of an excessively high quality. I will not however desist from providing good care. Its what I was doing before, and I see no reason why I should stop.

Ms Hewitt said: "I think if we anticipated this business of GPs taking a higher share of income in profits we would have wanted to do something to try to ensure that the ratio of profits to the total income stayed the same and therefore more money was invested in even better services for patients."

Right. So, as a self-employed, independent contractor, I may not take as much profit as I wish from my business. I have to reinvest the money into services which are otherwise inadequately funded, I have to effectively bung the DoH a sub.

"Now it is quite true that neither the government or BMA anticipated how much GPs would do in response to performance-related pay."

Well, not quite, Patsy. If you check the memo's from your negotiating team, you'll see that Dr Fradd et al did warn you that we would strive to maximise profits and do as well as we could. We are business people you see. Our business is health and illness management. That's what we do.


And then there's someone called Joyce Robbins, from Patient Concern:

However, Joyce Robins, from the health watchdog Patient Concern, told BBC News that the new contract did not represent "value for money".

"I do think that the doctors' unions took the government to the cleaners with that contract because, I mean, nobody's mentioned that in fact they do a great deal less work," she said.

"They no longer do evenings, no night work, weekend work - this has all got to be paid for somewhere else.

"And yet their money has gone up quite enormously.

"In fact, I understand that far more GPs are actually retiring early because their pensions have gone up so much that they can afford to do that."

Well, she's obviously speaking from a position of knowledge about these issues then, isn't she?

Ms Robbins, we still work about 50 hours a week, we are doing more and more during the day, and we didn't get paid for doing out of hours work before the new contract, indeed we used to pay for the privilege of working, and since the advent of nGMS, the government take 6% of our core budget off us if we opt OUT of providing out of hours services.

(Quite who Patient Concern are, I'm not sure. According to their site, they've been going for 6-7 years, but I've not heard of them before now. I'm also not sure that their agenda is as transparent as they would wish. Certainly to my mind some of their "Campaigns" are a little naive, though I agree with the principals behind some of them.)

Anyway.

If the Government aren't happy, they should try to renegotiate the contract with our representatives. All this spin is not helpful. Patients (and voters, lest we forget) don't believe it anyway, from the comments I've been getting from my patients.

In the mean time, I will continue to maximise my income to the best of my ability by caring for my patients to the best of my ability.

If its all the same to you, Patsy...

Safe Arrival

I am delighted to announce the safe arival of our new daughter Willow Rose on December 28th, at 0742, born at home (about which more in a future post), weighing in at 7lb 10oz.

My wife is doing well, so is Willow and we're smitten.

Patsy wishes you a merry Christmas

I have no idea who to credit for creating this, but thanks to Dr Evans on DNUK for posting a link for me.

http://www.elfyourself.com/?userid=ef6da7db05b5fd4e056385aG06122200

Wonderful!

Coincidence

Ok, I said I'd take a break, but nothing's happened yet, so here's another one for you.

NHS deficit: Approx £500 million

Amount spent on management consultants in the NHS last year: Approx £500 million

For fuck's sake Patsy, do the bloody sums.

In the Guardian...

Last post for a bit

Lord Warner is going. Will he be missed?

Lets hope he gets a good pension for his stirling work totally bollixing up the NHS finances.

The BMA is seeking a Judicial Review regarding the legality of the governments retrospective slash-and-burn of our pensions. How the hell they think they can get away with a gross breach of contract I don't know. Idiots...

As to why this is the last post for a bit:

Mrs B will imminently be having the baby, any time in the next 1-3 weeks. So I might be a bit busy...

(I will however post an announcement when I get chance!)

So, dear readers, take care and have a good Christmas or holiday-season-of-your-choice.

Pension Cap

I don't have full details yet, but it appears that bastard Lord Warner has written to the GPC to say that he will cap GP pensions.

Here is the text from a BMA press release:

Immediate release : Thursday, 7 December 2006

BMA to challenge the imposed cap on GPs’ pensions

Dr Hamish Meldrum, chairman of the BMA’s GPs Committee, denounced Lord
Warner’s decision to cap GP pensions as reneging on a contract agreement and
denying doctors the pensions they have already paid for.

“Most GPs are self-employed. They pay both the employers’ and the employees’
contributions into the NHS Pension Scheme. The pensions they have accrued
are in fact delayed pay resulting from a contract agreed by the government
with the profession. For Lord Warner to say they cannot have the pension
they have earned and paid for is a denial of their contractual rights. We
will be challenging his decision” said Dr Meldrum.

While family doctors have seen a substantial rise in income under the new
contract, the BMA believes the earning figures announced last week by the
government are wrong. Dr Meldrum said: “Because of a significant error, the
quoted figures are pitched at too high a level. We understand the 14%
employers’ pension contribution has been mistakenly included in the income
figures. The error means the average GP pay for 2004-05 is well below
£100,000, not the six figure income as reported. It also means the
percentage rise in pay is substantially below the 32% claimed by the
government.” Clarification of the error is being sought by the BMA.

Dr Meldrum said: “Lord Warner’s offer of a 48% rise in the pension
dynamising factor* over five years may seem superficially generous but it is
not the deal we negotiated and will seriously disadvantage GPs nearing
retirement and those who have recently retired. Those doctors retired
believing in good faith that they would receive the pensions they had earned
and paid for. Moreover, we believe the timing of the announcement is
premature, is based on estimated figures of doubtful accuracy and,
therefore, we do not accept the assertions that honouring this deal would
take money away from patient services.

“The government’s decision is a betrayal of good faith and is depriving
doctors of a pension we believe they have a legal right to receive.”

The BMA’s GPs Committee will now seek further legal advice on mounting a
challenge to Lord Warner’s announcements on capping of pensions.

Ends

This has got to be a breach of contract, never mind comp[l;etely removing any chance of healing the rift between the politicos and medics.

I will await developments with interest...

Follow up to "Spinal Privacy"

There have been further developments in the matter of Spine vs Everyone else.

Clarification has been issued to those who sent in coupons expressing a desire not to be included, here. Apparently the Department of Health "does not believe that processing their information in this way is a genuine reason linked to substantial and unwarranted distress." But I thought that distress was in the eye of the sufferer? Obviously only if the DoH thinks so to.

As a GP I'm now damned if I do, and damned if I don't.

If I do "allow" (and it doesn't look like I'll have any choice in the matter) the uploading of people's information, I could be held accountable for the breach in the confidentiality. In other words, I (as data controller for my practice) will be in Breach of the Data Protection Act and I suppose could be legitimately complained about to the GMC.

If I don't, I'll have everyone from the Health Minister (so-called) down trying to bend me over my desk...

This is also picked up today in the Torygraph.

I suspect that Tony and cronies will continue to ride roughshod over everyone, until either someone hacks the system or the opposition get of their arse and cause a fuss.

Watch this space...

The BritMeds 2006 (1)

John Crippen has started up a weekly collection of the best of British medical blogs.

Yours truly is mentioned!

Check it out...

Over-performance

Oh dear, oh dear, oh dear...

Hospitals in the South East are being told to delay routine patient appointments for eight weeks, otherwise they will not be paid for them.

Here's the link.

So, fail to achieve government targets and be damned.

Exceed them and be financially crippled (albeit temporarily).

On the other hand, I can see the Strategic Health Authority's point of view: the PCTs have to contract for an amount of "activity" and then pay for anything which exceeds that anyway (under Payment By Results, the national tariff). There's a big deficit heading Patsy's way, and of course she said that she'd take personal responsibility for achieving financial balance. Lets hope she isn't allowed to dodge it.

Although I personally thought that a bit of an oxymoron, a cabinet minister taking personal responsibility for their area of responsibility...

What about the patients? The only people who are talking about them are the consultants. But what do doctors know about health care, hmmm?

And there was me thinking the political silly season had passed already.

Redundant advertising

I read this story a couple of weeks ago. It was also posted in various other places, including the BBC, most of the national press and other media. I didn't comment on it at the time because I thought it pathognomic of the difficulties the NHS is facing, and that further comment was not necessary.

But now we have this.

So lets compare these two stories, shall we?

On the one hand, the NHS workforce has reduced in the last year by about 20,000. There are an indeterminant number of compulsory redundancies, which the Government says are just under a thousand. Yeah, right...

On the other hand, hospitals will now be able to advertise their services. who to? Not to patients, oh no. To doctors. Yes to GPs like me.

But hold on a moment. Don't I already refer to hospitals? Am I not already obliged to refer to someone I at least know of and trust to do the right thing by my patients? To quote paragraph 55 of Good Medical Practice:

Referral involves transferring some or all of the responsibility for the patient's care, usually temporarily and for a particular purpose, such as additional investigation, care or treatment that is outside your competence. You must be satisfied that any healthcare professional to whom you refer a patient is accountable to a statutory regulatory body or employed within a managed environment. If they are not, the transfer of care will be regarded as delegation, not referral. This means you remain responsible for the overall management of the patient, and accountable for your decision to delegate.

My highlighting, by the way.

But the Government is already trying to force me to abrogate my responsibility for ensuring that I know what service my patients can expect with Choose and Book: I can't refer to a named consultant, if I can refer at all!

But back to the point at hand...

So, lots of people out of work (however you want to define it), so cutting costs.

The money saved can now be invested in advertising a hospital's services to the GPs who are already referring to it, likely involving the recruitment of advertising and marketing managers. Of course that means less money for patient care. I suppose the idea is that advertising will increase the number of "service users", thus increasing income under the "Payment by Results" tariff.

What kind of buggered up system is this? That money should go towards patient care.


I'm 36. I can't wait to retire.

Five weeks to go...

There will soon be the patter of tiny feet in Chez Brown.

Mrs B is expanding on a daily basis, I'm sure she will explode soon. The baby likes Strictly Come Dancing, we can tell because she has a dance when its on. My other 2 kids are excited, we have arranged for them to be the first to meet their sibling (after us of course).

I can't wait...

Mind you, we're only just getting organised with baby-grows, nappies, clothes, etc. We were much better organised with our wedding last year at Newick Park.

And I've still got loads of painting to do :-(

I still can't wait to meet the thing that's been booting me in the ear while I'm reading or singing to it.

Of course, we still have to decide on a name...

Spinal Privacy

There is an interesting article in the Guardian today. I suggest you read it. It refers to the security (or otherwise) of the NHS spine, the computer system which is being built to house the medical records of all UK residents.
And therein lies the problem.

Given the Governments track-record on IT projects, given the fact that you can either have a functional or secure system (but for a project this size probably not both) the question you have to ask is:

"Do I really want my personal and confidential details available to any of the 250,000 staff in the NHS who have currently been given smart cards? Oh, and the police, security services, and anyone else who might have the technical skills to hack in or money to buy information from the spine?"

Speaking as a medical professional, I don't.

The Governments constant mantra of reassurance and complacent murmurings that security will be adequate completely fail to make me feel better about the scheme.

For a start, you won't have a choice about whether to be involved or not unless you opt out right at the beginning. Once your info is on the spine, its there in perpetuity (and lets not even start talking about civil liberties and the Data Protection Act).

Sadly, this scheme is just another manifestation of the current Government's inclinations to control us all. There is no safeguard with this. If it is "in the public interest" your records will be viewable by whomsoever the authorities deem. Right now, if the police want me to show them your records, they need to either provide me with your consent (in writing, and even then I usually check with people to make sure they understand what it is they've consented to) or ask a Judge to issue a Court Order (and although it has never happened, I would probably then wish to speak to the Judge myself anyway to clarify what exactly they want to see: it would be most unusual for someone's appendectomy in 1954 to be of any relevance to anything at all, really).

The Guardian also provide a page (here) with a draft letter to the Secretary of State for Health instructing that you don't want your data added to the spine. I will be writing.

The decision whether you should as well is not one I can make for you. But consider carefully before imagining that New Labour will treat your most intimate personal details with the dignity they deserve.

Disclosure statement

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It is also replicated below.

This policy is valid from 02 November 2006


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Trust me, I'm a Doctor

Well, it seems people do.

In that case, why don't the politicians listen to us?

Because they want their reforms to go down as an historical achievement.

Great. Dismantling the NHS will be such an achievement, won't it?

I'm a bit busy today, but for invective about politicians generally and the health service in particular, try clicking on some of the links listed over there ->

Enjoy!

The cost of litigiation in the NHS

Whilst indulging in some forum posting on DNUK (no you can't have a link, unless you're a registered doctor in the UK) I came across a link to a question posed in the Lords yesterday (Hansard).

NHS: Compensation and Legal Costs

Lord Steinberg asked Her Majesty's Government:

Whether the cost to the National Health Service of £175 million for compensation and legal costs as stated by the National Health Service Litigation Authority includes all outstanding cases to the end of the past financial year. [HL7454]

The Minister of State, Department of Health (Lord Warner): The NHS Litigation Authority 2005-06 accounts report expenditure of £591,586,000 on clinical and non-clinical negligence claims in the past financial year. The accounts include a provision, as at 31 March 2006, of £8,344,980,000 for all outstanding cases including an estimate for incidents that have occurred but not been reported.

Yes, you read that right.

The government have put aside £8.344 billion pounds to cover negligence claims against the NHS, both clinical and non-clinical. Doesn't say how much is put aside for non-clinical negligence though. Nor does it define what non-clinical negligence is. (Anyone fancy a Freedom of Information request there?)

Eight. Billion. Quid.

One thing that does surprise me is that no further questions were asked. Even in the current climate of rather defensive medicine (though not as bad as the USA) this figure is staggering. To put it in perspective, that would be a year's income for over 330,000 new police officers.

Yet so far, the Government (Lawd bless 'em!) have spent over £20 billion on a computer system which isn't fit for purpose and probably won't be.

God help us all...

Listening habits: the drive to work

Decisions, decisions...

Options:

1. CD. Good music (IMHO), I can sing along without discomforting anyone else (believe me, with my voice that's important) BUT I tend to play it too loud and end up with tinnitus byt the time I get to work, I don't hear the news before work.
2. Radio 1. I'm sorry, but Chris Moyles is just a big fat git who lots of teenagers finds funny. The music is at best variable, and most of what I get is actually inane drivle interspersed with occasional jingles, with the odd track of music thrown in.
3. Radio 2. Wogan. Music from elevators, humour from the 1970's but without the slapstick.
4. Radio 4. The Today show. I get the news and weather. The 0810 interview is sometimes ok, but generally just gets me angry with the vagaries and downright bastard lies from politicians (of all colours).
5. Southern FM. Really irritating adverts, not much music (and the same stuff over and over and over...), chirpy presenters (far too bright, eff off you bastards, its first thing in the morning), traffic reports every 20 minutes (but they make you listen to the bloody adverts first).
6. Southern Counties Radio. Decent traffic reports which have the advantage of being RDS, but OH MY GOD the shows are soooooooo boring I'm in danger of falling asleep at the wheel...

What to do, what to do...

Forms of nursing

It seems a week can't go by without yet another form appearing that I am supposed to use to refer patients to a particular service. I totted up how many different referal forms I have in my box file the other day: 22 . Yes, twenty-two different forms to refer patients to different NHS departments. Alot of these forms have similar information requirements: they all need demographical details of course, as well as a few details of the presenting complaint leading to the referal. Some of these forms we have managed to get in electronic form from the originator, which we can then adapt so our clinical software can automatically fill out at least some of it. Of course, we need to ensure that the forms' authors are happy with it before we can start using them. Others, we can't, for one reason or another.

A particular bug-bear I have is the fact that we now have to communicate with the District Nursing team by writing them a note on a specific form and faxing it to their offices. They have been expecting this for the last 2 years or so, ever since they were reorganised so that they were no longer attached to a specific surgery, but in a "locality". Before this, if Mabel developed a leg ulcer, we would speak to the District Nursing Sister when she came to the surgery (usually a daily occurence to collect supplies). She would check to make sure there were no matters to be discussed before she left. In addition we had a weekly Primary Health Care Team meeting in the surgery.

Not any more. Oh no.

Now face-to-face communication is non-existant. I don't know most of the nurses who visit our surgery to run clinics. You can phone, but its just an answer phone. And if you do leave a message, you get a message back saying that they need a referal form. So you send the form, they see the patient (one assumes).

Of course, we don't get one back when they discharge patients from their case load. Neither do they keep their records anywhere near ours: they have their own folders, kept at the patient's house, which are later archived somewhere mysterious, never to be seen again.

And I haven't even mentioned the referal/discharge criteria which are being introduced by the management teams.

I'll give you 3 guesses how much consultation there has been with other professionals stakeholders as to whether this is necessary, never mind a good idea. And the first 2 guesses don't count...

Where the driving force behind these changes comes from is a matter of further irritation. Yep, the good old Department of Health. Bless 'em. Except of course that the decisions where made locally, not centrally. Except of course that the decisions were basically forced upon the local health economy by financial decisions further up the food chain. Decisions made in London. See how that links up? Clever, innit?

I could go into why these changes are apparently "good for patients". All I know is that the patients complain to me that they don't see the same nurse more than two or three times. The nurses are getting more and more officious (a sure sign to my mind of the stresses they are under and their levels of dissatisfaction with the way they are working). Inevitably, there are the usual recruitment freezes periodically (though, to be fair, recently there seems to have been an influx of community nurses, less well qualified than District Nurses, though forced to do the same job).

Gets right on my wick.

Bring on Practice Based Commissioning. Care to hazard a guess at one thing we're contemplating taking over from the PCT?