What do patients really think?

From The Conversation.

Gavin Brookes and Paul Baker were “tasked” with looking at patients’ opinions. An analysis of a total of 228,000 comments from the NHS Choices website, coming in at a huge 29m words. Their results have been published in the BMJ and as a book.

They spent three years on the project and Prof Baker said, “it’s taught me more about what it means to be human than any other project I’ve been involved with. It also reveals how some staff, such as surgeons, are almost universally praised, while others, particularly receptionists, unfairly take the flak when the system breaks down.

Some conclusions:

“…complaints about the technical ability of staff to make us well are less common, suggesting that the NHS is mostly doing a good job, but is overstretched and struggling to meet demand.”

“…patients like predictability – they have a set of expectations and are generally happy if they’re met.”

“…“attitude” tends to be at the heart of the majority of complaints about the NHS,…”

Dentists.

“…some staff members do especially well, with surgeons, dentists and paramedics being evaluated positively 95% of the time.’

“Dentists, who came second in our comparison, also attracted strong praise, consistently being called “great”. The broader language used to describe dentists was also revealing, though. Many patients wrote about having a dentist phobia but then being pleasantly surprised when the actual visit was painless. The good feedback dentists received, then, was often related to a sense of relief.”

Clinical freedom in a time of austerity.

First published online in Dentistry Blog on 8th April 2019. Full article.

Clinical freedom is becoming an aspiration rather than reality.

I regularly have to straddle a line between what principals need and what associates want, whilst attempting to keep both sides happy.

Often this involves money and the phrase ‘clinical freedom’.

Amongst the things they never teach you at dental school is that you must cover your costs before you can take anything out for yourself.

Increasing overheads makes this hard.

For instance, a 13% increase in CQC fees to ‘better align the cost of regulation’ must be borne by business owners.

As far as NHS practices are concerned, the minimal rise in fees during a decade of austerity have been swamped by rising costs.

Where contracts are fixed and consume a week’s full-time work to achieve them, there is little or no room for increasing productivity.

Associates, who have the dubiously privileged position of being self-employed, must take their share of the repeated squeezes on practice owners.

Either earn more (difficult with a fixed contract) or cost less.

Because previous generations earned a bigger slice than you, unfortunately does not mean that there is any divine right.

In any profession it is time and expertise for which people pay.

The third party fee setter (the NHS) took a set of fees from a decade and a half ago and continues to run with them.

This ignores the flexibility and evolution that existed in the dental contracts for nearly six decades, which helped practices stay agile in order to remain profitable.

Sometimes these money pressures are manifested in a reduction in quality of working conditions; for instance equipment might not be maintained, materials and laboratories are chosen on cost and choice is limited and staff might be ‘bargain basement’.

As the first casualty of war is truth, so clinical freedom can become an aspiration rather than a reality.

The Weekend Read – This is Going to Hurt by Adam Kay

Very few, if any, books have made me weep with laughter and cry with upset in the space of a couple of pages but Adam Kay’s memoir of his years as a junior hospital doctor managed it. The final chapter left me in bits for many reasons.

I ordered the book thinking it would be a 21st century continuation of Richard Gordon’s, “Doctor in the House” or Colin Douglas’s “The Houseman’s Tale”. In one sense it is; the language is not entirely medical, Adam refers to Obs & Gynae, his chosen speciality, as “brats and twats” and there is plenty of normal hospital human behaviour. Clearly the author was able to tolerate the life of a junior doctor even though, “The hours are terrible, the pay is terrible . . . But there’s no better job in the world”, until something happened.

The significant difference is that whilst the idealism, the diseases, the people and their mistakes have remained much the same, the political interference and attitude to professionals has fundamentally changed. Doctor in the House was written in the idealism of the immediate post-Bevan years (1952) and The Houseman’s Tale just pre-Thatcher (1978) when I was just starting my spell as a hospital resident. This is set in am era dominated by Jeremy Hunt’s predecessors and their ilk, (the author includes an open letter to The Secretary of State for Health) where there has been a slow strangulation of health care in spite of the best efforts of those working within it the system. These diaries were written during the years 2006-10, sadly things have not improved.

Essential reading for anyone who works in or is a recipient of healthcare in the UK – perhaps not if you and your partner are expecting your first child.

Available from The Book Depository HERE

 

 

Peter Ward exposes the NHS(E)’s “Cunning Plan”

Nice editorial in the BDJ from BDA Chief Exec Peter Ward. HERE

Edited highlights only

Death by commissioning

….That master plan looks like a determined effort to wrest away NHS dental care from small autonomous units. That model that has been supplied by a legion of conscientious practitioners ever since the beginning of the NHS. This applies both in salaried dental service and in general practice.…….

….’Savings’ is the name of the game. That coupled with ongoing ‘efficiency’ signals a race to the bottom, as each year becomes more and more squeezed than the last. It can’t be long before the social enterprises seek freedom from the obligations of NHS terms and conditions – think about the savings to be had there!…..

…..So, it is clear that the NHS in England stands to gain by ‘going large’ in all its areas of practice. But its gain is at the expense of the dentists who serve it. In essence, the wholesale dismantling of access to NHS terms and conditions provides the opportunity for savings. Proposing such a move overtly would be met with horror and outrage. Doing it stealthily and by downstream consequence may be less dramatic but the result is the same. It is not a good result for either dentists practising in England, or for patients expecting enduring, high quality care…

If only it was as easy to dismiss as Baldrick…

 

Playing the “What If” game.

I delivered my presentation, “Is Dentistry Making You Sick?” in Gloucestershire a couple of days ago and introduced a game that I suggest participants play with their teams and partners. It’s called “What If” and the rules are simple in the extreme, you come up with the most unlikely thing that you can imagine and make plans on how you will deal with it on a personal and business level. Then move on to the second most unlikely and so on – I think you get the drift.

Visualise scenarios, research, plan and rehearse.

The example I used was of the owner of a 95% NHS dental practice who had been planning for the new NHS contract to replace the shameful 2006 edition, it has been promised over and over by successive governments. The contract will emphasise prevention and have a level of capitation payments. It will have been trialled and tested and approved by the BDA.

The What If game when played on Monday at 9am would have had them wake up one day and discover that the government had called a general election in order to concentrate on Brexit. The side effects of the likely victory would be to railroad their austerity programme through until 2022 and also enable them to kick any positive change in the dental contract into the the longest of long grass until who knows when.

Now what would you do if that happened – apart from ringing Lily Head?

What If – what’s next?

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.

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