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

 

 

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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.

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?:

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