Richard Granger's mum speaks out

After Dr Rant ran the Comrade, can you spare £20 billion? blog on the 16th of October, we received a very interesting email from Richard Granger's mother.

Mrs Granger, a former teacher and local councillor, has been campaigning to keep services in her local area in Huddersfield, while her son has been destroying the NHS IT system (at huge expense).

Mrs Granger asked us not to print her comments, which we will respect.

But we did put her in touch with Jo Revill, the Observer's Health Editor, who did a piece on it in today's Observer. Sadly, the Observer didn't publish all of the very interesting personal insights into her son that Mrs Granger supplied us with (I suspect their lawyers balked at the idea of a law suit for defamation - which given Granger's reputation for being a very aggressive and uncompromising manager, and the government's unforgiving stance on media critcism, seems a reasonable assumption).

Which is a shame, because it was a great story.

Official! NHS Managers are dangerous fuckwits

GP magazine reports this week that Physician Assistants are Set to Replace retiring GPs.

According to some brain dead twat [Geraint Griffiths -Ed] who is a PCT chief executive somewhere (heaven protect them) [South Staffordshire PCT, formerly of Sandwell West Midlands -Ed] 'A PA can do anything a GP can do in the context of General Practice'*. Well, of course they fucking can. A parrot can 'do' most of a GP's workload (It's a virus, It's a virus, It's a virus...). The trick is not 'doing' the work, the trick is getting it right.

Primary care carries over 90% of clinical encounters in the NHS, and an average GP will see 150 patients a week. That's 7,500 patients a year.

Physician Assistants have only 3 years university training. A GP has at least 10 years of university and clinical training, as well as probably having been more intelligent to start with due to the selection processes.

This is the classic, if wearing a bit fucking thin, 'never mind the quality, feel the width' New Labour bollocks.

Lets be kind and say that a PA misses one important diagnosis per 1000 patients compared to a GP. Then that's 7.5 serious errors per year more for PAs. That's 7.5 more delayeed cases of meningitis/heart attack/serious asthma. Multiply that by the 100,000 GPs in this country and that's 750,000 people being harmed each year. Lets say only 1% of these mistakes lead to an avoidable death (and some of these will be children, remember), that's 7,500 avoidable deaths each year.

Managers like Geraint Griffiths are fuckwits. They are dangerous fuckwits. They are dangerous fuckwits that are going to get a lot of people killed.




*Amazingly, he also adds that "We have not found anything that they can't do" and then goes on to suggest that they are being slowed down by useless GPs ("sometimes they had been limited by the expertise of their supervisor"). It's called 'working safely within the limits of your competency', and it's what keeps patients safe. That's why it's a requirement of professional regulation that we never stray from areas that we are competent. What a fucking moron.

NOT The Annual Report!

“How many decrepit, hoary, harsh, writhen, bursten-bellied, crooked, toothless, blear-eyed, impotent, rotten old men and women shall you see flickering in every place” And that’s just the staff. If they’re not filing their nails they’re squabbling over holidays. And honestly, we know because we have to work with them.

Our practice manager has just completed our practice annual report. It is excellent and records our Stakhanovite performance in the face of overwhelming odds. It is not good enough however. It doesn’t detail all the problems specifically enough (we’re tactful) for the P.C.T.’s (the Problem Creating Tumour or Primary Cause of Trouble) liking so I thought I should help out and remedy the balance, in a kind of reverse Pangloss manoeuvre. So here it is warts and all, and no, that large glowing object on the practice manager’s head is not a wart, it’s her intra-cranial pressure monitor, and if it’s glowing red it means she is at last doing a bit of work.

As for the reception staff they are all developing themselves, some of them rather too well. They are studying for their advanced dragon levels. New clothes should be worn in their newest gloss but not when these fiery ladies are around. They come back from these courses scalier, scarier and smokier than ever. Wake up and smell the coffee? Not here: if you wake up you smell the sulphur. And then run as they’re after you! They may not frighten the enemy but by God they frighten me.

One of the receptionists is a conscientious troublemaker. She doesn’t like firing on any cylinders so she’s studying instead for her MEDUSA award. She’s a bit nonchalant towards fire, doesn’t like wearing scales and prefers the cooler approach of petrifaction. It’s become a bit of a competition as to whether the patients get petrified or flambéed but that’s good as Patricia Hewitt says that patients should have a choice of treatments. And all provided in house so no expensive referrals needed. How’s that for a locally accessible service? And great practice based commissioning savings?

We’re planning to teach the reception staff about consent issues next year but they’ve got to get their practices practised before there is anything to consent to. Timing is the art of true leadership as they say on clinical governance courses (allegedly as I didn’t actually go on the last one but I’m sure the speaker made it up just as much as I am making up this report!)

The senior dragon is so fired up that when she retires she’s going to drafted in to replace the ovens at the local crematorium. We plan to take advantage of this to offer a one stop surgery service. From entrance to cremation in one second, and that’s an efficiency record that any PCT should be proud of. The doctors will have to be quick if they want to get their cremation fees.

Not that they will be of course. This mollycoddled group of privileged bourgeois backsliders are so busy supping at advanced access to intoxicating trough of big pharma looking for share options in poisons that they quite forget why they are here. More murderous than all the weapons of mass destruction found in Iraq put together. and “Wot, no bombs?”

We don’t actually need such spiky receptionsists any more. Typical training that teaches you everything you really needed to know last year. Actually the new phone system saves us any need for this. It was promised as an improvement but we all know Hutber’s Law, don’t we? Last year’s survey showed the patients moaning about the telephone systems…..so we changed it…..and this year they still moan about the phone system. No pleasing some people is there?

As for all our targets it would be true to say that the road to hell is paved with good intentions and that despite them people still fall ill on the primrose pathway and die before we can get to them. We are truly sorry about this and will perform the act of repentance known as an audit. Then we will do the same thing again next year. We are the organisation with a memory …..and ……Altzheimer’s.

Please do chastise us with more circulars and guidelines because really we cannot make these things up for ourselves. Send us to more meetings and ensure that we develop a seamless strategy from which the wheels cannot be detached, nor the metaphors muddied or muddled, so that surely we can be yoked to the common purpose to commit omissions to history and omit commissions for the future, if you get our drift. (and assuredly we are drifting and Mrs Spewitt is raving, if not drowning)

As long as the QOF points are in soon we’ll all be QOFfing very well indeed.

I submit that our record here is quite a good one. No gargoyles have been harmed in the creation of this report, and indeed several new ones have been created by staff. You should see the looks on their faces!

I apologise if anyone has been inadvertently misrepresented in this report but remember that the devil is always making hay in the detail, just like the GPs with their new contract!

I remain sir, your obedient servant.

Francis Xaviar Rant, M.D.
“Abandon hope all ye who enter”,
Wormwood and Gall Stones Surgery,
Chipping Brimstones,
Burrow-in-Furnace.

New Labour is destroying the NHS

Dr Rant has been a bit slow to respond to the excellent posts by Dr Crippen regarding Persecuting junior doctors (complete with what I can only assume is a totally gratuitous shot of sexy dutch cyclist, or am I missing some subtle link?), the dumbing down of medical education and the disasterous effect of New Labour policy on the NHS.

At Dr Rant, we have no political allegiances, but we are depressed, angry, frustrated, and just generally fucked off by the destruction of what was an excellent if underfunded service.

Quacktitioners are being given preferential training over junior doctors, whilst there is a criminal shortage of good basic nursing care, and there is uneployment amongst the junior doctors who represent the best of our youth.

There can be only one reason for this. Power.

They want to crush any political power weilded by doctors. Not the kind the BMA uses (or rather, fails to use), but the kind of power that is exercised every day of the year by thousands of doctors up and down the country.

The power to do what is necessary for our patients.

Managers try and reduce admissions to save money. GPs ignore it with impunity because the GPs are there to protect the patients from sick fucks with suits and calculators.

Government ministers try and bring in crackpot schemes that damage patients, doctors resist. No one else in the NHS can stop them. The nurses are too busy playing doctor, but don't have the autonomy or sheer arrogance necessary to stand up to senior managers.

So, the government wants rid of doctors. It wants doctors that are afraid of losing their jobs. It wants doctors that say 'yes, mas'er' when they get told to fuck the patients over to save a few pennies for the government.

The reason I have been slow to post, is that I have spent the last few days fighting to have seriously ill patients treated. Yes, waiting times are down. Patients get seen much faster than they used to. But, the difference is, nothing happens when they are seen. They get seen and then sent home. That's it. Target met. Problem solved. It's just a shame that things that we used to take for granted, like a diagnosis and treatment, are now just a distant memory.

My patients report daily being moved from ward to ward, sometimes while they are sleeping. They report never seeing the same doctor twice. They report no-one ever speaking to them - this used to be a medical problem, but now nurses don't communicate either. They report being left for days without any help. They report having to clean the shower themselves before using it. They report patients being shouted at by untrained Health Care Assistants because they have lost continence. They report hearing patients beg for help and none comes. They report having to drag themselves out of bed to go and feed other patients that they have never met before. They report nurses that sit at their stations all day writing fictional charts about work that is not being done. They report only finding out what is going on by reading their own charts themselves.

I can't even bring myself to swear.

The disintegration of the NHS is too tragic. The cost to patients too great.

I weep for my patients. I weep for myself. I weep for my family. I weep for my children. I weep in anticipation of the hell that awaits us all when we become ill in the future.

The near future. Tomorrow.

Non Accidental Ear Piercing Injury

Dr Rant is horrified to hear from colleagues of a 2 year old child with an infection from an ear piercing.

Primal Urge in the US say on their 'infant piercing' webpage: 'We look at our children and wonder "How cute would she look with her ears pierced?". Our next thought might be, "Is this procedure safe for my child?"'

No. No it is not our next thought. Our next thought is why the fuck have social services and the criminal justice system not shut you down yet? Our very immediately next bloody thought is 'this is barnfuckingdoor child abuse'. No question about it.

The possiblity for deformity, and the lack of knowledge of the risks in many outlets (often in the more 'upmarket' outlets) has been documented back in 2001 in the UK.

Question: How can a 2 year old consent to having his/her ear pierced?
Answer: they can't.

This needs to be banned. Outlawed. The parents flogged.

Come on Dr Cardigan, get your gong-hungry pals at the BMA to take this one on. I mean, what with the smoking ban being a done deal and their total apathy towards actually acting like a union and protecting their members from the government, they must be twiddling their thumbs waiting for a new hobby to come along.

Data Rape of 50 million people

The Guardian has finally picked up on what doctors have been talking about for some time. The government is hell bent on shoving the confidential medical history of 50 million people onto a 1982 48k Sinclair ZX Spectrum in a one bedroom flat somewhere in Islington.

This highly confidential information will only be available to a select few people who work for the NHS. So, that's around 1.3 million potential hackers with physical access to the spine, and 250,000 with password access of one type or another.

The only defence against your HIV scare from your shagfest with the transexual prostitute living upstairs from your half-brother being centerfolded in the News of The World is the fact that due to the incompetent implementation of all things computer by the government, the entire system will probably by down 98% of the time.

I'm not sure what is more worrying - the fact that the entire clinical records of really sick people will be off line because of the wrong types of leaves on the broadband connection, or the fact that the government will be able to dig for medical dirt on political opponents without having to pick a single surgery lock.

And ignoring domestic and european law, the government is making participation mandatory. You won't be able to refuse! The GP's wont be able to stop them either, because the clinical systems will upload the data automatically.

What the fuck? Did Tony just declare martial law? Did I miss the tanks in Parliament Square? Because I thought we lived in a fucking democracy.

Dr Rant has been trying very, very, fucking hard to think of a reason to have a national database of clinical records. Thinks. Thinks hard. Thinks a long fucking hard time. Nope. Can't think of a single bloody reason.

Wait! Perhaps if you were allegic to penicillin and had been robbed of all of your clothes and forms of ID including your medic-alert bracelet and were unconscious so could not tell ambulance staff. But wait? If you can't tell them you are allergic to penicillin, then how can you tell them who you are? And without your date of birth, how can they look you up in the database.

So no, there is no sodding reason to spend £20 billion on this sytem.

Tony Blair says 'If I get run over in Birmingham, then the paramedics will be able to access my records'. Tony, you're not going to get run over in Birmingham because I don't live in Birmingham. But when I do catch up with the fucker, the national database won't help him because undertakers aren't being issued with NHS smart cards (yet!).

This government are increasingly looking like corrupt, evil, fuckfaced, cunty-lying, wankbucket, animalshagging bastards who deserve to be lined up against a wall and shot. And preferably tortured first.