hoolet issue 49

Summer 2006

Chris Johnstone Intro.
Miracles and Wonder
Truth or Dare
Perched on her Electric Chair
A Tale of Two Addicts
Ethics and Repression in the Bloo Toon
Enjoyable Journeys
Review: Secrets From the Black Bag
Review: Reflective Practice Writing and Professional Development
Sandyjim Saves the Day
West Highland Way Diaries
Owl of the Year?

The Policy Palsy

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

We are living in increasingly interesting times, but we are so busy chasing those lovely little pointy points that we are missing the bigger picture for examining all the pixels. We are running around like blue-arsed flies chasing the new eGFR monster, which looks like it will eat everything in sight. We are adding hundreds of little old ladies to our CKD register and scaring them to death with tales of dialysis and drug-eluting stents unless we lower their blood pressures to unrecordable. Poor little things; anyway it is doing our AF prevalence the world of good as they slump to the ground in shock.

We are chasing a whole load of 45 to 60 year olds to do their CHD primary prevention, put them through their risk calculator and start them on ACE1s, ARBs, statins and aspirin just for starters. The good thing is that this will save us a lot of time when we put them on the CKD register. I quite like the DES for CVD primary prevention. We were promised a share of £7 million pounds if we all met a collective target of 260,000 patients screened across Scotland. Looking at the details we would already have had a payment for work already done and be getting a monthly advance payment. But it is all imaginary. No patient lists have been sent out, no payments made, it is all virtual. We are working for a promise, which may be kept so late it is impossible to meet the target.

As well as terrifying patients with dementia and their carers, we are submitting severely mentally unwell patients to care plans which are never going to be met, especially in our CPN barren corner of the universe. We are hunting down those rare creatures with AF and no other illness and bringing them into the evidence-based boot camp. They will be forced into annual or biannual visits with bloods and examinations and if they don't leave with another drug added to their repeats its only because they are walking BNFs already.

To be fair, a lot of this work is falling on our nursing and administrative staff. Our practice nurses are hollow-eyed shells of their former selves, continually entering data after 45 minute long consultations of nothing but filling in endless screens on the ‘bloody, bloody computer’, as it is now officially known. The poor administrative staff are no better. I am not surprised the Post Office made its first profit in ages last year. We are sending out thousands of recall letters, screening letters, letters about results, letters to come in, letters to stay away and letters to say that it is not our fault if they didn’t receive our previous letters. We now employ a receptionist just to lick stamps.

And all this time we are making more money than ever, although we may have to take a pay drop this year, all those bloody stamps. According to one professor we are working less than before and our pay rise does not equate to our workload, even if we did achieve thousands of points. Our practices are quite the little gold mines. But down south things are a little more frightening, despite the oodles of cash. Many practices are being taken over by private firms. The cash which belongs in our moneymaking hands will be in shareholders’ hands soon. Unattractive practices, built up by poorly paid salaried GPs into thriving concerns, are being hived off to faceless corporations. Empty practices are being taken over by larger firms. They employ a lot of nurses to work the QOF and little else, with doctors from Spain or Poland on very low rates to ensure they meet the minimum requirements of a GMS contract. Your MDDUS rates are going to skyrocket soon and not because of their shiny new premises in London.

Nor are we immune to this, even in our comfy partnerships. If your practice dissolves for any reason, however reasonable, it is by no means certain that the same doctors will be allowed to run their own practice. Your practice could be put out to tender. And even if you put in the lowest bid to run your own practice you have a good chance of the contract going to an outside conglomerate, possibly one run by some of the architects of the new contract. This is happening down south and despite the widespread actions of the pressure group, Keep Our NHS Public, the government is steaming forward. We are told this will not happen in Scotland, which is very reassuring to know. However all the necesary legislation is now in place in Scotland, it was slipped as an add on to the Smoking in Public Places bill. It is under ‘Joint Ventures’ and you can find it if you look very hard. (I will put a link on the website in this article if I can find it again -- http://www.opsi.gov.uk/legislation/scotland/acts2005/50013--g.htm#37)

Anyway, I can’t stay and chat like this, I have patients to recall, screens to fill, points to score, letters to send. Got to run.

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