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.

Dr Crippen and Ben Bradshaw, GP Access and Polyclinics

Last week Under-Secretary-of-State for Health, Ben Bradshaw launched another attack on our General Practitioners (family doctors).

Dr Crippen responded. Dr Crippen admired that Ben was the first openly gay Member of Parliament (for Exeter - what it is with gay MPs in the south-west .... can you remember Jeremy Thorpe in North Devon?). Most of John's arguments were sound.

However, Dr Crippen claimed that I can turn up at any GP practice and register as a patient.

In June 2004 I turned up at my local GP clinic, on my brother's recommendation as that is where he, his partner and stepson are registered, to register myself, my wife and my daughter .... only to be told their list is "full".

We were told to try next door. Once one practice, the partners had fallen out and the building and the practice, were divided in two. Two GP practices in one building?.

Ridiculous!

So I went next door and we were registered.

Nanda, my wife, says she has 'flu. I say go and see our GP. She says Jaime (my stepson) has 'flu - "Go and see the GP" - but she doesn't speak much English. Say two words to reception "Language Line"" but I think she would rather walk into a Virgin Asda-based polyclinic.

Polyclinics and Choice

Sally Wainwright comments on Lord Darzi's latest "blog" post:

"I have just come back from a so-called consultation on the future of head and neck surgery in the Anglia Region and it is crystal clear that the PCT will be voting in July for the option chosen (without consultation)before the consultation began! This means that Ipswich Hospital will lose its head and neck cancer surgery and patients requiring this will now face a 100 mile round trip up to Norwich and back.

The more we hear about consultation and choice the less there is in reality, as the Government proceeds to impose its regionalization policies on district hospitals. It might be marginally more acceptable if the Government was honest about what it is doing and acknowledged that the Dept of Health is imposing change from the top downwards regardless of protests, petitions, patient forums and these staged consultations.

The NICE guidelines themselves are not compulsory, they leave room for flexibility; but once these guidelines pass into the iron fist of the Dept of Health they become compulsory. “Compliance” is forced upon local hospitals, with all the changes railroaded through."

This is at a time, as Pulse reports, that 100 GP surgeries in London have already been earmarked for the chop and that it is highly likely that this will increase to 400. At a time when the government claims to be increasing choice and ease of access ...

"Dr Kambiz Boomla, chair of City and East London LMC, warned polyclinics could create ‘enormous access problems’.

‘People don’t expect to take a bus to visit their doctor,’ he said. ‘People expect their GP surgeries to be in walking distance of where they live.’"

Polyclinics

Dr Rant has drawn my attention to this excellent piece yesterday by George Monbiot in the Guardian. The government's policy regarding the establishment of polyclinics is not so much about privatisation - as GP practices are already private - but about corporatisation. And it certainly is not about giving the punter more local choice as local GP practices are forced to close and punters have to travel further to attend a polyclinic. And as polyclinics take over some of the services offered by local hospitals so thje government can close down valued local hospital services ... tomorrow is election day.

NHS Manga

I have toyed with the title of this post ... Manga, Manga Medicine, Medical Manga ... but finally decided on the above.

I am totally ignorant of the Japanese cartoon and comic book art form of Manga (with both adult and children´s sub-cultures) but its influence on the cartoons now shown to UK Children is interesting as the photo of our TV screen by Jaime shows. And I would probably have been into it had I grown up at the right time.

I used to watch Tom and Jerry, Scooby Doo, Tom Cat and various other Hanna & Barbera productions, and when they are repeated on the BBC, Jaime and Kezia are equally enchanted.

However, kids are now into the enormous Manga-influenced cartoon industry and Hanna & Barbera and Disney seem to have gone out of the window.

It is notable that the violence of children´s cartoons has never changed. Tom and Jerry´s and Bugs Bunny´s sticks of dynamite may have changed to laser guns or whatever other fabulous weapons´ technology, but the violence still exists.

I don´t remember the name of the cartoon from which Jaime took his television shot but it was certainly one of his better digital photograpy efforts. He discovered the capabilities and special effects (video, colour negative, sepia, B & W etc) alot sooner than I.

In other IT developments the medical community is slowly becoming aware of the potentials of Web 2.0 - there is a small but growing awareness of how this can potentially help the medical profession.

However, the trialling of Google Health in the States, whereby patient medical records are stored on Google servers, is leading to security and privacy concerns even if one does not doubt the reliability of Google´s IT infrastructure. Certainly, in the UK, we would protest most strongly at the involvement of Google Health in our NHS IT infrastructure ... but ironically, they would probably do a better job at it than our government´s IT spine project.

Ironically, this US poster is impressed by NHS London´s use of the Web 2.0 application Second Life to promote Polyclinics. (What percentage of NHS London patients go to 2nd Life?).

Methinks, however, the BMA should shurely respond with their own 2nd Life versions of a polyclinic and a current GP practice ...

In the meantime ... I think we should use Manga-like 2nd Life avatars to teach our medical students surgery, general practice, oncology etc ... or maybe even train our NHS managers.