hoolet Issue 48 - Spring 2006

Chris Johnstone Intro.
Amazon Adventure
No Jams Tomorrow
Three Theories
Pharmacopœe Forteana
May The Best Team Win
Zeitgeist
The Supporter
And The Winner Is...
A Different Holy Aisle
Letter To The Editor

The Last Waltz

By Chris Johnstone
Contact the editor by e-mail at christopher.johnstone@ntlworld.com

Welcome again to the joys of general practice, as the financial year crashes to another end. By the time you read this the rush to finish off the QoF and recruit all those recalcitrant patients will be over. You may have even received your balancing payment and you may already be in the pub drowning your guilt at bankrupting the NHS. If they thought last year was bad, we will show them this year with higher prevalences and higher achievement figures. No wonder all the those Health Boards are in such debt, it has all gone to line the pockets of us fat cat GPs, whose only care is for our bank balances. So this year we will take a pay cut and accept it quietly. However the consultants, who really did get a good deal out of their pay package, only get their pay rise staggered, as we did for many years and they go bonkers. Calling the government mean minded and generally bad eggs. Where were our guys when we were having our pay cut?

Our nnGMS contract reduces the money we get for points unless we get full marks and full marks are extended for some of the targets. We have had removed some of the easier achievements as too many of us got them. I only hope that the buggers in the Dept of Health, who thought GPs did nothing, are eating their hats as they make our lives more difficult and tortuous. I have been told that many officials in the health bureaux around Britain have little idea what happens in general practice and generally assume we are no better than incompetent consultants who fell off a pathetic hospital career ladder. Having had the first set of QoF achievements they are realising that we are a little more whizzy than they originally thought. I have no problem with this as long as they don't punish their ignorance by taking away what we have earned fair and square.

The end of March also bought an odd experience to myself and the other 300 GPs and 1000s of other health professionals in Argyll and Clyde as our Health Board finally sank. We were rescued by the SS Glasgow or SS Highland, depending on your Local Authority. It is not an experience I wish to go through again and I would not wish it upon anyone else, but I fear you may all go through it sooner rather than later under this government. I am quite involved in our LHCC and I have an interest in how our CHP will turn out. Our CHP has been very delayed due to the local politics and Argyll and Clyde's Clinical Strategy, which was a euphemism for saving some of the $60 million plus overspend. Part of this involved closing a variety of hospitals. They in turn quite rightly defended their right to exist and appealed to the Minister of Health. He decided to abolish Argyll and Clyde on the spot, which had the pleasant side-effect of delaying indefinitely the closure of a variety of units and hospitals, much to local councillors' delight.

So many of our changes were put on hold for a year and we happily wallowed as we wawaited our new masters orders. The first newsletter from the new Health Board happily welcomes everybody to the completely new structure, especially those from Argyll and Clyde who are joining us. So we know who is joining who. All this has meant that our CHP is not as developed as we would have hoped. We have not even been approved by the Scottish Executive yet. The point of this whinge is that lots of experienced professionals have left for more secure posts. Innovation has been all but totally stifled as we wait for approval for everything from our new managers, but we still do not know who most of them are yet. I do not know how the NHS mangers stay so calm, it drives me crazy. This really is no way to run a minoge.

So where will it all end? Down South they are heading hell for leather for an NHS run by private companies. They are determined to see as many practices as possible run by HMOs, rather than GPs. They are hiving off operations to outside bodies. They are rewarding GPs for commissioning and Choose and Book, which all increase the private companies influence. It will be survival of the fittest on a very steep evolutionary curve.

In Scotland Andy Kerr has said we will plough a very different furrow. In the past, Thatcher used Scotland to try out her policies. Fettes-educated Blair is happy to use England as a petri dish and see what grows. We will be integrating more with our social services colleagues, while England privatises. Old Labour versus New Labour. Old Labour had its heart in the Scottish central belt and that is where a lot of their Ministers come from. New Labour has new friends in Bilderburg, Dubya, the IMF and the World Bank. So we will we gently waltz with Local Authorities, while England tangos with transnational corporations. So as this medico-political Strictly Come Dancing comes to a climax, let us hope that the public vote for the plucky Scots.

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