Tuesday, February 10, 2009

Polyclinics, Lorenzo and other Madness

I am generally sympathetic with the UK GP blogging community's (or at least those that I read) criticisms of NuLabour's policies on reform and the advancement of quality in the National Health Service and Lord Darzi's Next Stage Review where he and the party promote the creation of large geographically distant "polyclinics" to replace local GP services, where local hospital A & E services are to be replaced by Emergency Care Units with only the more urgent cases to be transported to a more distant hospital within the ambulance service's government's target times, in both of which you will probably first be seen by a "nurse specialist" rather than a doctor (how is Tom Reynold's to evaluate where to take me? Is Tom Reynold's or his control centre going to decide - methinks Tom you ain't seen nuffink yet - when NuLabor really turns its eye on ambulance services).

A brief explanation to any international readers - our primary care medical system is based on private general physicians contracted by the NHS to provide primary care services to the NHS.

When we had to evacuate Kezia to the UK for her leukaemia, she was seen in the local hospital A & E and then paediatric department on a Sunday by a "sooty" SHO (i.e. still in training and if my future head of state can call my daughter Sooty then I am permitted to call him and my daughter, stepson and wife Sooty and Sweep , chimney sweeps - just as the Royal Estate of Sandringham has been selling golliwogs) who provisionally diagnosed correctly leukaemia. Dr. Khalil - you're a wog. Rochdale Infirmary's A & E and paediatric departments are to be closed, the former to be staffed I assume by "nurse practitioners".

But I do have a little tiny bit of sympathy with the "polyclinic" idea.

Over the Xmas period Nanda, Kezia and I all came down with a nasty cold which pretty much knocked us out for a couple of days. In the case of Nanda and myself there was really no point in wasting our GP's time with a viral infection for which you can just drop paracetamol to alleviate the symptoms whilst you sit it out. But in Kezia's case I thought it wise to telephone the hospital, which advised us that in the first place we should go and see the GP practice with whom we are registered and got an apointment for Kezia to be seen within the hour - impressive indeed!

No problems at all - a 10 minute bus/taxi ride and we were seen within 5 minutes of arrival. The doctor we saw was efficient, if somewhat impersonal (another "Sooty" by the way - but Rochdale is full of "Sooties" so we need a few culturally sensitive "Sooty" doctors). Kezia is prescribed paediatric paracetamol, and, as a prophylaxis, an antibiotic. Excellent!

In the physically-connected building next door is another GP practice. My brother and sister-in-law are registered there. On our arrival in the UK my brother recommmended we register with their GP practice. We duly went and were told there were no "spaces" - "Try next door".

It seems that two senior partners had a row and divided the practice and the building.

So we have two GP practices, serving the same community, receiving funds from the same Primary Care Trust, next door to each other. My brother Pete reommended the one to which he and Paula are registered so I went to register us all only to be to told "our books are full - try next door". Next door welcomed us with "open arms".

(A question to Drs Crippen and Rant - under your practice NHS contracts are you allowed to turn us away?).

So with presciption in hand we cross the road from the two neighbouring GP practices to two pharmacies accepting (in the case of a child under-five, free) NHS presciptions with four doors separating them.

Meanwhile our GP practice has been trialling for the Heywood, Middleton and Rochdale Primary Care Trust (PCT) the new NHS Connecting for Health system for electronically communicating test results from the nearest hospital lab (x miles away in Oldham) to their practice. They have concluded it is brilliant. So it is going to be deployed it in every GP practice in the PCT. So at least one function of our Connecting for Health IT programme functions in the north-west where the Lorenzo Patient Summary Care Record has been a complete fiasco/disaster.

More lunacy follows ...

My employer and its employees have decided to recvise the local medical compensation plan (part of the larger local compensation plan). One of the revised clauses states that the cost of "over-the-counter" medications, even if prescribed by a licensed physician, would not be reimbursed. In Africa any drug available in a pharmacy, from aspirin though diazepam to morphine is available "over-the-counter". So any medication that work doc does not have in work supplies but presribes will now have to come out of our own pockets.

By the way, the new head of state of the most powerful state in the world is not called Barack Obama, but Sooty.

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