Pharmacists – another endangered species?

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The Minister for Community and Social Care (Alistair Burt) spoke in Parliament on 24 May 2016 a few days before he silver tongued the BDA conference with similar words after which I wrote, “Much of his speech we have heard before and it did little to convince me that (NHS) dentistry is anything other than an irregular irritation in the big picture of health. There will be no more funding in the foreseeable future, no matter what sort of contract is produced, be prepared to deliver it with a tighter belt.”

Hansard has the full transcript of May 24th here but I have selected the phrases (reminiscent of Bullshit Bingo) that chimed with me, thinking back to his speech in Manchester.

We want to empower primary care health professionals to take up opportunities to embrace new ways of working with other health professionals to transform the quality of care that they provide to patients and the public. In particular, we want to free up pharmacists to spend more time delivering clinical and public health services to patients and the public in a range of settings.

I have seen at first hand the fantastic work that pharmacists are doing from within community pharmacies, such as in healthy living pharmacies and other settings, and colleagues have also paid tribute to that work. Pharmacy-led services, such as the recently recommissioned community pharmacy seasonal influenza vaccination programme, can help to relieve pressure on GPs and A&E departments……

The fund is set to rise by an additional £20 million a year. By 2020-21, we will have invested £300 million in addition to the £31 million that NHS England is investing in funding, recruiting and employing clinical pharmacists to work alongside GPs to ease current pressures in general practice and improve patient safety.

The chief pharmaceutical officer, has commissioned an independent review of community pharmacy clinical services to make recommendations on future models for commissioning pharmacy-led clinical services. Clinical pharmacists will offer complementary skills to GPs, giving patients access to a multi-disciplinary skill set, and helping GPs manage the demands on their time and provide a better experience for patients. This is a great opportunity for pharmacists wanting to make better use of their clinical skills and develop them further.

Sweet words indeed, after Alister Burt, who seemed to me to be a pragmatic and likeable (unlike his boss Mr Hunt) moved to the back benches post Brexit vote, the words are transformed into reality.

Pharmacy plan ‘could lead to High Street closures’ BBC website (October 20th 2016)

The Department of Health said it wanted to reduce the £2.8bn a year pharmacy bill by more than £200m over the next two years.
…It has been suggested cuts on this scale could lead to up to 3,000 of the 11,700 pharmacies being closed.
Currently, the average pharmacy receives £220,000 a year from the NHS.
This accounts for between 80% and 90% of their income and includes a flat rate of £25,000, which nearly all pharmacies receive.
The changes being announced scrap that and put much more emphasis on performance-related funding, with ministers understood to see the current system as outdated and inefficient…

I repeat….There will be no more funding …. no matter what sort of contract is produced, be prepare to deliver it with a tighter belt.

If only he had worn a suit and tie….

jackboots-2The CQC Borg will decide….

…..in 2014 when the inspectors last came. He had explained his philosophy and modus operandi, talking of medicine as an art form, “being a human being so patients feel they know well me enough to trust, while maintaining boundaries – compassionate detachment, I call it.”

“On that occasion,” he will recollect later, “they seemed concerned with seeing whether I was running a healthy, happy, well-functioning practice. They looked at feedback forms, talked to patients and made intuitive judgment.” They gave him a glowing report.

This time round…read here.

Michele Golden, head of inspections for London at the Care Quality Commission, says:

“We know, from various inspections, that patients will say how happy they are, and it may be that their doctor is a very nice person, but that doesn’t mean they understand if the system is actually unsafe for them.”

It would seem that Nanny may not always know best…but she holds all the cards.

There has never been a serious complaint against him, and he is exceptional in not having been called for a disciplinary hearing in all his 40 years as a GP.

Although he could continue practising as a doctor, his surgery must close with immediate effect.

Junior doctors – the real issue hasn’t gone away.

I make no apology for the length of the article linked to this blog post. A month after it was posted in the LRB nothing has fundamentally changed, it’s just that the media feeding frenzy has moved on to Brexit.

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Diary – Lana Spawls 04.02.2016

Antidiuretic hormone, also known as vasopressin, is released when levels of water in the blood become too low – when you’re dehydrated. It tells the kidneys to reabsorb water back into the bloodstream. For a while this keeps you going: it was working overtime in my system when I found myself ten hours into a Saturday shift at the hospital, without a drink or a break since my breakfast cup of tea at home. It wasn’t a shift crammed with life or death emergencies: I had a clinic in A&E reviewing patients with minor injuries, two ward rounds and a never-ending list of jobs to do. Each time I crossed one off I’d receive a bleep on my pager: another sick patient to review, scans to order, bloods to take, prescriptions and discharge letters to write. At weekends, junior doctors cover care across the whole hospital. I’d been assigned three wards. I managed to make it to the canteen, and a first mouthful of beans, before the familiar jangling started again. I went to the nearest phone to dial in: a prescription of intravenous paracetamol needed changing to oral. I added it to my list and went back to eat. A few more mouthfuls and it went off again. There was no answer when I dialled back: apparently the 15 seconds it took me to reach the phone was too long and the caller had rushed off. I added the number to my list. I’d call them back.

Four days later I’m working my ninth day in a row. On normal weekdays I’m only responsible for the forty or so patients under the care of my usual team. Usually I would split this with another first year foundation (FY1) doctor, but he’s on holiday so it’s down to me. From 4 p.m. until 9 p.m. I’m on call looking after patients from four different surgical teams. About half an hour before I should finish I’m bleeped to examine a patient who has just arrived on the ward and is due to go for surgery the next day: a teenage girl with a brain tumour. Until she has surgery we won’t know if it’s cancerous or benign. She and her mum look nervous. We talk about her older brother who’s just had a baby daughter, her favourite subjects at school (art and drama) and what she wants to do when she grows up (be a dancer). Before surgery she needs blood tests so I go to find a tourniquet, needles, bottles and gauze. It’s a ward that I don’t usually work on, and every ward keeps its equipment in a different place. On top of this, the printer for the blood bottle labels isn’t working. It takes me nearly an hour, including a trip to another ward, to get everything ready. The patient tells me how difficult – and painful – it was the last time someone took her blood. I tell her how important the tests are and how quick I will be, but now I’m getting nervous too. My first attempt is fruitless and she’s not keen to let me try again, but eventually I persuade her. This time I find a better vein, a little deeper but more bouncy, and get it straightaway. She stops crying to tell me it wasn’t actually that bad. When I leave work, nearly two hours late, the lights have been stolen from my bike, which I’d left in front of the hospital, so I cycle home in the dark. At least it’s not raining. I never find out what happened to the girl.

It continues here

 

 

The NHS needs real doctors not “Spin Doctors”

I know it’s easy to kick the NHS when it’s down but is this really the right use of resources and is it advertised in the right way? It reads like BS to me.

(I’ll be back next year but no less cynical)

From the Guardian online.

LONDON NORTH WEST HEALTHCARE NHS TRUST
Head of Communications
Salary: £59,987 – £72,244 inc. London weighting allowance (Band 8c)
Full time (37.5hrs/week)
Location: Northwick Park Hospital
Applications for this vacancy will only be accepted via our website using reference: 913998387
We are looking for a dynamic, enthusiastic and highly experienced communications/PR professional with tenacity and drive to meet the many exciting challenges and opportunities facing London North West Healthcare NHS Trust. This is a pivotal time for us as we pursue a transformational programme of activity to improve the way healthcare is delivered across the acute and community settings in North West London.
In October the Trust celebrated its first anniversary, one year on from its creation as a result of the merger between Ealing Hospital NHS Trust and The North West London Hospitals NHS Trust. The new organisation, London North West Healthcare, is one of the largest integrated NHS Trusts in the country. We employ almost 8,500 staff and provide care to a diverse population of approximately 850,000 people across four hospital sites and through community services in the London boroughs of Brent, Ealing and Harrow.
During this exciting period of opportunity and change, it will be your job to support the Trust as we transform the way we communicate and engage with staff, the public and our many stakeholders. This includes providing high level, professional advice on all aspects of communications, including staff and stakeholder engagement, whilst maximising opportunities to promote the positive work of the Trust.
You will be responsible for developing and implementing internal and external communications plans in support of the Trust’s emerging organisational strategy and will help to share examples of best practice, supporting improvement across the Trust following our inspection by the Care Quality Commission.
You will work closely with the Director of Strategy and members of the Board, providing strategic direction on all communication and engagement issues, ensuring that all stakeholders are fully informed about, and engaged in, the work of London North West Healthcare NHS Trust.
If you are a talented individual with tactical, hands on experience who can deliver the challenging, complex and exciting communication needs of the Trust – we want to hear from you. No two days will be the same.
Apply online and access a full job description and person specification at our website via the button below.
Closing date: 10 January 2016.

I have the perfect candidate – or perhaps she wrote it?:

Is That It For The NHS?

Very good piece in the London Review of Books by Peter Roderick. It describes the gradual unwinding of the NHS since 1990 and ponders the future, well worth a read.

The writer has worked with Professor Allyson Pollock who talked about dentistry having already been privatised in the 2006 edition of her book, NHS plc.

The National Health Service in England is being dismantled. But you wouldn’t know it from listening to the radio or reading the newspapers. As so often, you have to look beyond the headlines about pressures on funding and the junior doctors’ dispute to find out what’s really going on. In 1990, Kenneth Clarke introduced an internal market into the NHS, following on from the ‘options for radical reform’ set out by Oliver Letwin and John Redwood in 1988. It had three pillars: GP fund-holding (delegating budgets to individual GP practices); the replacement of health authorities by ‘NHS trusts’ (self-governing accounting centres with borrowing powers, and their own finance, human resources and PR departments) and the splitting of purchasers from providers (the planning and delivery of services was to be undertaken by separate bodies, with the money flowing between them). In its 1997 manifesto, New Labour promised to ‘end the Tory internal market’. It did get rid of GP fund-holding (only to reintroduce it later as Practice Based Commissioning), but otherwise took the Tories’ ideology even further by introducing, in 2003, the market-oriented ‘NHS foundation trusts’ and their regulator, Monitor, as well as scaling up the Private Finance Initiative. Clarke was able to say on the sixtieth birthday of the NHS in 2008 that ‘in the late 1980s I would have said it is politically impossible to do what we are now doing.’…

Continues…

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Dentistry, Dermatology, what’s next?

I was the first born and studied Dentistry, my brother born 4 years later became a Dermatologist. I have wondered if there had been any more children they would have had to take up Endocrinology and ENT to keep the alphabetical order.

So I have had more than a passing interest in “Skins” and have listened to Jon’s stories of the attacks on this vital but overlooked area of medicine with disbelief. In this piece in Monday’s Guardian, “It took my patient six years to see me – a dermatologist”, the state of this particular piece of the NHS is spelled out. There is also a link to a “day-in-the-life” companion piece.

I am no great campaigner for the NHS, I think in many areas it is a spent, inappropriate, force. I feel that the repeated lies told over the past 36 years since Margaret Thatcher first coined the phrase “The NHS is safe in our hands” have only misled the population who would understandably prefer not to consider the alternative to the English religion.

Here’s the article:

It took my patient six years to see me – a dermatologist

Dermatology is a microcosm of the challenges facing the health service. It has reached crisis point

Why am I writing about dermatology? Surely the well-publicised crises in emergency medicine and general practice deserve these column inches. Dermatology is a small specialty where a slightly strange group of doctors choose to dedicate their careers to the treatment of rashes. Yet, dermatology is a microcosm of the challenges facing the NHS; like mental health and sexual health it is a specialty that has suffered progressively through NHS reforms and has now reached crisis point.

Imagine you have a rash or a growth on your skin and your GP does not know what it is or how to treat it. It may be scary – is it a skin cancer? It may be itchy, sore, bleeding, painful or looks awful. You are not alone, you are one of the 13 million people who consulted their GP last year about a skin problem and now you are one of the 750,000 referred on to see a dermatologist. These are big numbers, skin disease is common and the impact of skin disease is similar to epilepsy and chronic kidney disease.

It is clear that you need to see a consultant dermatologist, the one specialist who has the experience and expertise to help you. One quick trip to your local hospital and you will be sorted, or so the government would like you to think. In reality this is the start of battle. Firstly your referral will be triaged, another GP or nurse will read your referral and decide if you really need that appointment, many referrals are simply rejected at this point. If you pass through this then you are likely to be redirected to a privately run community dermatology service. These services, run by international healthcare corporations, employ nurse specialists and GPs with an “interest” in dermatology to see you for the cheapest possible price. In some cases they do little more than take a photograph and send this to a specialist for an opinion. It is only once you have gone through this process that you can, if you are lucky, join the waiting list to see a consultant dermatologist. In England you will wait four or five months, in Wales waits of two years are not uncommon.

A few weeks ago I saw a lady whose life had been ruined by constant episodes of swelling of her face leaving her looking like a victim of a serious assault. Her GP had correctly diagnosed angioedema but did not know the cause or how to treat it. It took her six years to navigate through triage centres and community clinics before seeing me. I quickly identified that her blood pressure medicines was causing the problem and by stopping this tablet her symptoms resolved overnight. She was extremely grateful, yet could not believe the journey she had suffered through to see me.

Government reforms have decimated dermatology leaving only 650 consultants covering the whole of the UK. Skin cancer is the commonest cancer in humans and the rates of skin cancer are increasing at a staggering 8% year on year. Dermatologists simply cannot cope with the volume of work and many smaller departments have closed, recently even the large university hospital department in Nottingham has all but shut its doors.

Across the country there are examples of departments restricting referrals or even closing to new referrals. The government promises choice, yet if you choose to see one of the nationally renowned skin cancer dermatologists at University hospitals Birmingham you better hope that you have a south Birmingham postcode as if you don’t then they will not see you. A pattern of referral restrictions being repeated across the country.

There is now a growing acceptance that in many parts of the UK it is all but impossible to see a consultant dermatologist in the NHS. With a government limiting NHS investment to headline grabbing acute specialities, how long before the rest of the NHS follows in dermatology’s footprints?

and also worth a read: The dermatologist: shipping us out of hospitals would be a grave mistake

Practice Plan’s NHS Confidence Monitor Results…speak for themself

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