Message to New Labour MPs

Alan Johnson and his black and white cat yesterday

Dear Sir/Madam

Recently, you will have received a letter/'briefing note' from Alan Johnson, the Secretary of State for Health, urging you to 'attack' the BMA's position on the new 'contract' for GPs.

May I remind you that I have face-to-face, one-on-one contact with over 100 voters per week, 84% of whom ARE happy with the hours that we offer.

I take great pleasure in explaining to my patients just how incompetent your party's managing of the NHS has been, and how angry we are about the disgusting smear campaign your spin doctors have launched on GPs in the press. I explain to them that I don't earn a quarter of a million pounds per year, and that I only managed to play two rounds of golf in the whole of last year because I was so busy filling in useless fucking paperwork. On the whole, my patients find my opinions very interesting.

My practice may or may not be in a marginal Labour held constiuency.

There are around 40,000 GPs in the UK, most of whom feel like me.

Thankyou for you kind attention.

Dr Francis X Rant

Let's play at being Noctors®

Dr Rant encounters many tales from his medical colleagues around the country. A lot of them are regarding the gathering rise of the 'Noctor'. A 'Noctor' is a portmanteau term to describe a nurse acting as a doctor, but can represent any speciality who does not have a medical degree attempting to do the job of someone who should have one.

Here is a tale from one of Dr Rant's colleagues who describes a typical night on call, and a phone call from such a noctor:

While at the out-of-hours clinic, I got a phone call from an 'Emergency Care Practitioner' nurse at 2 am. The conversation went something like this:

Noctor: Eh, doctor, where can I get some Fluconazole at this time?

Me: Fluconazole-why at this time?

Noctor: Need urgently for this poor lady, she is not very well.

Me: Fluconazole!!?? What is wrong with her?

Noctor: She is 10 days post-partum and has swelling over one breast, red, hot, painful. She also has fever and chills. I have made a diagnosis of Mastitis (lot of pride in voice-well done mate!) and I need Fluconazole urgently for her as I do not want to admit her.

(They are on a mission not to admit, so that PCT can prove nurses do better than doctors. Sometimes it means asking patients to call-as they are in no condition to visit-their doctors early next morning.)

Me: Fluconazole!!!???

Noctor: (in complete confident flow now) Yes, can you tell me how to access emergency chemist? And oh-you'll also have to sign the prescription, as I don’t have the Directive for it. (Impatient now), will you help me? (Threatening tone now as “helping and supporting” them is part of our contract.)

Me: But why Fluconazole???

Noctor: (very patronizing and mocking tone now-I am, after all, only a GP; he has done all the courses.) Is that not the first choice for mastitis?

Me: Fluconazole??!!??!!

Noctor: Yes, yes, we always use it for skin infections. Isn’t it the first drug on protocol?

Me: What Protocol?

Noctor: I know doctors don’t use the protocols,(mocking, insulting) but we have one (proud) and it says fluconazole for skin infections, have you not seen that?

Me: (Like a broken record, in disbelief, and by now, just a niggle of doubt about my 20 year training and experience creeping in!) Fluconazole???###!!!??/###???###!!! Er, have you got this protocol with you?

Noctor: No, but I can show you next week, we were given it at our prescribing course. Look, we are all very busy professionals here, are you going to help me or should I call the night duty manager? (Patronizing, threatening, arrogant or just full of s**t-could not decide.)

Me: (Penny suddenly dropping now.) Do you, er, by any chance, eh, mean Flucloxacillin??

Noctor: (Silence for a long 15 seconds-----)

Me: Hello?? Are you there?

Noctor: Oh! Em , I mean, eh, yes, Eh, I think you may be correct.

Me: (thinking-yes you f*****g idiot, I am correct!) OK, so you need some fluclox?

Noctor: (Not admitting defeat, got confidence and arrogance back by now-is that taught on a course?) Yes I think we can try Fluclox, but I am sure Fluconazole is first choice!!

Me: Try drug box in car, you may find some.

Noctor: I’ll show you the protocol next week.

It is three weeks, and I am still waiting to meet this noctor, or to see the 'protocol'.

Rather than see someone who has been trained in medicine (including microbiology, breast disease and pharmacology) for five years, and has at least five years post-graduate experience dealing with these fields, the above patient was dealt with by someone who had been on a short course. Rather than use their brain to think about the pathogenesis of a breast infection, the most likely micro-organisms, and the class of antibiotic, they had followed the protocol 'mastitis = give drug beginning with F'.

For what it is worth, Fluconazole is secreted in high levels in breast milk, and is not a drug that should be given to a breastfeeding woman. Many cases of mastitis do not require antibiotics, either.

Dr Rant is aware that some doctors will act in a fashion similar to the above, but he hasn't met very many like this, and those that he has met would have backed down and apologised profusely as soon as the word 'flucloxacillin' was mentioned.

These noctors will be increasing in number. They will be seeing your families and friends in the middle of the night. They have minimal training in drugs, and can prescribe only a handful of them. How much do they know about other drugs your lil’ ol’ granny is on, at 3 am, while she is on the floor, or SOB, or confused, is any one’s guess.

There is a colossal shortfall in quality manpower of nurses out there, and taking nurses from the wards, and training them to be low quality GPs is neither wise nor productive. And in some cases will poison a newborn with an antifungal overdose.

Welcome to cost saving.

Watch this YouTube clip, then try to tell us we're being paranoid or protectionist. If you can't identify every single drug mentioned and what it's for, then you should not be prescribing anything.



With thanks to Dr Rant's colleague, who first discussed this case on another website, for his permission to use the details.

New Kid on the Block

Dr Rant isn't the only GP in town who's pissed off, and willing to shout about it. Have a look at the new GP Lite blog.

"Welcome to my blog. I am a doctor working in the embers of what used to be the great NHS. I'm self employed and have invested in my Practice and patients. The NHS is changing, not because it needs to, not because it has to, but because someone wants it to in contradiction to all the evidence."

We look forward to more from our new blogging partner, especially the advanced photoshop practice.

Greeting From Joe

Dr Rant has very kindly given me the opportunity to write a guest column on some of the cutting edge schemes being run up in my neck of the woods, in the NHS North West. My name is Joe Rafferty and being non medically trained, I feel I am perfectly qualified to design new schemes in the area of screening and diagnostics. It has been long known by us NHS managers that we know far more about medicine that the actual clinicians who have spent years and years taking exams and studying medicine.

I wrote a recent piece in the Guardian and I was pretty disappointed that it got such a cold response from some of you doctors out there. I am not terribly sure what the difference between screening and diagnostics is, but they are definitely in the same ball park, and nit picking over small details like this just detracts from the real issues. In my eyes the real issue is the fact that NHS managers are such dynamic geniuses that they should be empowered to say exactly how healthcare should be run it the future, and PCTs should have more of a role so they can become even more efficient and streamlined than ever before by arranging 'efficiency' and streamlining' meetings, and possibly employing 'efficiency' and streamlining' officers, sorry, I digress.

The whole point is that progress in the NHS is incredibly rapid, and this is because we do not modify policy on the basis of proper peer-reviewed scientific studies, we have a very different approach indeed. The clever expert politicians tell us, the managers, where they want to see policy going; we, the managers, then design some weak studies that will provide some low quality unscientific basis for these policy reforms. In this way those with any knowledge of medicine are completely ignored in forging our new cutting edge ideas such as 'polyclinics', 'WICs' and 'deep cleans'. We also bypass the scrutiny of the scientific community by only publishing our research on the DoH website, after all no journal would have it, I tried MRSA monthly but they told me to sod off. Soon there will be no experts left, as they will have all been replaced by nurse practitioners, and they only know a little bit more than the managers about medicine. The world will soon be ours. Please email me with your questions, but don't ask me what the difference between screening and diagnostics is, that is just a little bit too tricky.

joe.rafferty@northwest.nhs.uk

Deep Clean? More Like a Whitewash.

Dr Rant has finally seen evidence of Gordon Brown’s ‘Deep Clean’. And he is not impressed.

The idea behind the ‘Deep clean’ is a false one to begin with. In order to reduce ‘Hospital acquired infections’, el Gordo has proposed giving every hospital ward in the country a good clean. He has proposed removing ingrained dirt, assuming that it will lower nosocomial disease, such as MRSA, and Clostridium difficile.

It will not. MRSA is spread by a contaminated carrier either sneezing on you, or touching you. Staphylococcus aureus acquires resistance when a healthy individual is given unnecessary antibiotics. One in three of us have several million Staphylococcus hiding up our nostrils, with no ill effect. And of those, one in ten will have assymptomatic MRSA. Patients who develop MRSA septicaemia either catch it from their own body, or from someone else’s nose. They do not catch it from a bit of dust on the floor.

Likewise, ‘C diff’, or Clostridium dificile is not an organism that you will catch from a dirty door-handle, unless someone has shat on it first. Human faeces is full of bacteria. And average turd will have millions of E coli bacteria, millions of bacteroides bacteria. And also a large amount of Clostridium. C diff infections usually start when a course of antibiotics is given to an unwell person admitted to hospital, and those antibiotics kill off the rest of the bacteria present in the bowel. Unopposed, C diff then starts to cause problems, such as pseudomembranous colitis and really shitty diarrhoea. This shitty diarrhoea gets everywhere. Especially onto other patients’ beds, which are usually 18 inches away from affected patients.

So, the ‘Deep clean’ will not affect the two well known ‘super-bugs’. What will it achieve?

Well, today, Dr Rant saw some of the deep clean team at his local hospital. He knew that they were the deep clean team as they had bright yellow tee-shirts with ‘Deep clean’ on them. He watched one of them push dirt from one part of a window to another. And watched a large number of them wait by a lift, speaking what sounded like an African language.

Quite simply, the ‘deep clean’ team is simply a collection of migrant floor-cleaners, who are mopping hospital floors rather that the local McDonalds. They are not highly trained infection control workers. They are not using state of the art cleaning equipment (Dr Rant does not consider a mop to be ‘state of the art’). And they do not appear to be doing anything more than a routine hospital cleaner would be doing.

Except for the bright yellow tee-shirt, of course.

The problems with hospital acquired infections is that NHS hospitals require far more than a simple mop and bucket. Washing a layer of dirt of a twenty year-old Skoda car will not hide the fact that it has a crap engine.

Perhaps El Gordo and his postman pal would like to address some of the following problems?

• Increasing the number of nurses per patient, so that overworked nurses have time to wash properly.

• Reduce the number of beds on each ward, so that patients do not share every last fluid ounce of vomit, faeces and piss.

• Reduce bed turnover to a safe rate. If your bed is still warm from the last patient, then something is wrong. Instead, give wards a chance to clean the bed, the floor around the bed and the bedside cupboard.

• Encourage hospital to have ‘in-staff’ cleaners. Most hospitals employ outside cleaning agencies, who go on to employ staff at the cheapest possible wage, with as little encouragement as possible. These agencies are prepared to take as few risks as possible, so tell their cleaners to have as little patient contact as possible. So as a result, hospitals end up with poorly motivated immigrant cleaners, who refuse to clean up vomit from under a patient’s bed.

• Banning relatives from wards. Other countries such as Japan do not allow visitors to wards unless they have washed their hands. In the UK, we sometimes have a sign saying ‘please use the handwash gel’. Visitors with colds and obvious infections are not prevented from entering wards. Until there is some sort of barrier, friends and relatives represent a vector for all manner of infections.

• Screen staff for MRSA. As detailed above, one in thirty people will have MRSA contamination up their nose. This is probably higher in hospital staff. This can be removed with eradication programs, using nasal creams and facewashes for two weeks. However, can the NHS afford to have over one in thirty of its workforce take two week’s enforced sick-leave?

Until all these are done, the NHS will continue to be ‘dirty’. Telling doctors to remove their ties and watches will make fuck-all difference when patients are practically shitting on each other because of ward over-crowding. Four hour A+E waits force patients onto wards that have not yet been cleaned. And existing cleaners are neither motivated nor encouraged.

Gordon Brown is a second hand car salesman. He can polish his twenty year-old Skoda as much as he likes. But his ‘Deep clean’ is nothing but a shallow, ineffective, vote-massaging exercise.

He should be reminded of an old Swedish saying:

You cannot polish a turd.

There Will Be Blood (and Cider)

Click above to activate

The current mood amongst Britain's doctors is grim to say the least. Gordon Brown has completely failed to grasp his old mucker Tony's magic trick of picking a stooge like Patsy Fuckwitt to attract the anger and bile from his incompetent meddling in the health service. Gordon has taken it upon himself to pick a fight with GPs, and he alone will bear the consequences.

Dr Rant would like to draw your attention to a GP practice website. The Wells City Practice in Somerset are not exactly a hornets nest of anarchic agitators with a track record of political tomfoolery, and as such are typical of Britain's GP practices. They are most certainly not like certain GP practices in Rantingshire that one could mention.

Angry Somerset GPs say: "Gordon - I'll 'ave he!

Why are they so cross you ask? Have a look at their January Newsletter to find out. Rest assured that there are hundreds of GP practices out there that are just as angry. The coming year will see a coordinated response to Gordon's ridiculous pseudo-macho Peacock Posturing.

He's taking the 'P', and we're going to make him look like the 'Cock' he his!

Therapy to swear by

Thanks to the astute reader who spotted this excellent piece 'On swearing versus thuggery: a statistical analysis' on the Scientific Misconduct blog:

I was interested in some of the responses I received. In the words of David Kern:
When you're in an argument with a thug, there are things much more important than civility. I do not like incivility. Yet, I like thugs even less.
My feeling is that our profession cares a great deal more about decorum and a sort of "pseudo-politeness" than we do about actions that are truly immoral, anti-science, and damaging to patients. Patients seem to care rather more about scientific honesty than we imagine. I have written previously of the quotation by the Irish priest Steve Gilhooley about the relation between decorum and thuggery. The quotation was delivered as part of a sermon on El Salvador. Gilhooley spoke passionately from the pulpit:
"I said to them, '70,000 people have been butchered and none of you gave a shit.'"

There was silence. A priest had sworn in the pulpit.

"And the reason I know none of you gave a shit," he continued, "was because none of you fell off your seat when I said '70,000 had been butchered', but nearly all of you fell off your seats when I said 'shit'."

Fucking brilliant.

Europe not America

Yerp: The Final Countdown for the NHS?

This week sees the publication of a very important report by the Taxpayer’s Alliance on NHS performance compared with those of our European neighbours.

Up till now NHS debate has tended to be polarised between the “40 million uninsured” under USA healthcare system, and our “at least everyone has a right to equally (bad) treatment under the NHS”. In Britain we have tended to value equality and universal access very highly, at expense of quality of service both in terms of effectiveness and accessibility.

Now there are many major criticisms of the American healthcare system, but its key flaw is that insurance companies can pick and choose who they take on. In other words those who need healthcare cannot get insurance to pay for it.

So on Dr Rant we’ve done the comparison of NHS vs USA healthcare, because we’ve often been asked “What about the European systems?”, not least by that naughty young scamp DK. Well, up till now we haven’t had much information about these. But there is no longer an excuse for our ignorance on this following two important new publications. One is the Taxpayer’s Alliance new report “Wasting Lives” and the other is Nick Seddon’s important new book “Quite Like Heaven: options for the NHS in a consumer age.” (Civitas)

It is clear from these sources that our European neighbours have managed to achieve a combination of universal access, decent accessibility to doctors, treatments, and investigations, and effective (It works) medical (it is medicine after all) autonomy (doctor-patient interaction works). Fundamentally, it can be argued that the NHS is not as effective pound-for-pound as our European neighbours.

The NHS has suffered a “Triple Nationalisation” of funding, allocation and provision. In Europe they don’t have this.

We have a centralised bureaucratic monolith that is not giving anyone, be they doctors, patients, managers or politicians or taxpayers, what they want. It costs a lot yet no one gets value, or feels valued by this system. It’s a miserable monopoly.

The Europeans get round our problems, and the American’s problems in three ways.

They have compulsory social insurance- you have to pay, and the insurance companies have to take you. Certain basic provisions are mandatory. The government defines the mandatory minimum but it does not directly raise the money.

Secondly they have multiple providers of care. There is no national monopoly employer and there is the possibility for unsatisfied employees to move elsewhere and for dissatisfied customers to move elsewhere. This means hospitals are run by people who want to run hospitals, and to survive, they need to provide. In the UK neither the staff nor the patients can escape the system very much (NHS is >90% of UK healthcare provision- my option to set up privately and thrive is currently very limited). The patients can move from town to town, and see someone different, but it’s still the same old NHS in crumbling old workhouse hospitals, or gimcrack plainly flimsy investment newer hospitals.

Thirdly they have devolved regions and districts that make decision right for their areas. In the NHS our new PCT chief executive is not local, not representative of his area, and in fact is the DH’s man in Rantingshire. As David Nicholson, the NHS Chief Commisar, has said “The job of chief execs is to implement government policy, not to debate it.” What would happen if we brought health care back under local authority jurisdiction? It would certainly make local councils matter rather more.

(Privately a lot of DH civil servants are very unhappy with current government policy and are praying for a change.)

So in these reports we find several suggestions to get the UK away from its miserable dependence on the monolithic, hidebound and bureaucratic NHS.

Maybe in the end a combination of doctors and patients will finally put a rocket under current NHS management and both sides could free themselves to work well with each other. The expansion of NHS management, for no clear purpose, under current structures is picked up in both these reports. These reports certainly provide additional strength to our model of “The Management Spaceship”- the proposition that if we sent ALL the NHS managers and DH civil servants on a one way ticket to Mars, it would be so much the worse for the Martians. The rest of us would get on better, and would feel no need to send a rescue mission to bring any of them back.

Gordon Brown’s pouring of billions of pounds of taxpayer’s money into the NHS has been squandered. Like the Wizard of Oz, he stands exposed as a weak vascillating little man hiding behind a screen:

"Argument weak - Shout louder! Spend more!"

The publication of these two reports significantly increases our knowledge of available, effective options to achieve the desired goals of medical effectiveness, accessible services and universal coverage. They are to be welcomed for doing this.

We wonder what Devil's Kitchen will make of this. Hopefully he won't choke on his corn flakes (much).

And just as we have needed to get an Italian coach to run the England football team, we need to admit we can learn something from our European neighbours about how to run a health service. Bloody Hell. Those damn krauts, dagos, frogs, naked Volvo-drivers and watchmakers might know something we don’t.

Oh, and they don’t have polyclinics and noctors either. Strange that.

Sick as an MRSA negative trout

Peter Stringfellow, Yesterday.

A pneumothorax and several fractured ribs is a fairly unpleasant injury. Normally, it would follow trauma such as a car-crash or a severe kicking. When you are married to a premiership footballer, it can, of course, be caused by a bit of rough sex. Certainly, a level of pain relief is required, usually in the form of oral analgesia, or sometime an injection. Very rarely, stronger painkillers are required. And even more uncommonly, epidural anaesthesia is required to treat the pain.

Epidurals come with complications. One such complication is an epidural abscess - an infection around the epidural site, caused by the presence of pus-forming bacteria.

Sometimes abscesses can be caused by the 'killer bug' Methicillin Resistant Staphylococcus aureus, known to newspaper journalists as MRSA. Contrary to public belief, MRSA rarely kills people, and it is not an insect with sucking mouth-parts and overlapping wings. Rather, it is an ordinary bacteria that has acquired resistance to certain antibiotics. Bad news if you are intensive care, not too bad if you are one of the one in thirty members of the population who have it living harmlessly up your nose.

A certain actress, who for some reason required an epidural after sex with her husband, has just been awarded £5 million, for contracting the 'killer bug' MSSA from the Chelsea and Westminster hospital, according to every newspaper and news site tonight.

Hang on...MSSA?

Dr Rant asks - What the fucking fuckety fuck is MSSA? It turns out that 'MSSA' in fact stands for 'Methicillin Sensitive Staphylococcus aureus'. Or bog-standard Staphylococcus aureus ( Dr Rant will refer to bog-standard Staph aureus as BSSA for the rest of this piece). This bacterium has been causing boils and pimples for as long as mankind has suffered from boils and pimples. Over one in three of us has this bacterium living on our skin, doing not-a-lot. Occasionally, it causes a zit. And if a doctor sticks an epidural catheter through your skin, it can find its way into the epidural space and cause problems. Such as an abscess.

A few questions spring to Dr Rant's mind on reading about this remarkably tragic case.

First of all, which fuckwit put an epidural into a patient for a rib injury? Was it someone who wanted to impress a rather minor celebrity with overkill analgesia, or was it someone gullible enough to be persuaded into giving one when painkillers failed to provide absolute pain relief?

Where did the BSSA come from? Was it a skin commensual? Did it come from a friend or relative? Or was it shown, scientifically, beyond reasonable doubt, to come from a member of staff of the Chelsea and Westminster hospital?

How the fuck did someone manage to break two ribs and to puncture a lung during sex? Dr Rant is sure that even the most dedicated sadomasochist would not end up with an injury like this. In fact, having the shit kicked out of you by your husband is most likely to give you these injuries. However, as a doctor, you live and learn - not every woman with a serious injury is an apologist for an abusive, violent husband.

What happens when someone injects boiled-up cow into your lips against your will, especially when you're not really one 'to mess with nature' and such like.

The £5 million was for 'loss of earnings'. This money would have paid for roughly 500 hip replacements. Dr Rant would like to remind people that disastrous plastic surgery can also fuck up your already mediocre career, and send it into a spiral. He would like to know where the £5 million was going to come from.

Why invent a new name for a bacteria that causes pimples? Might it have something to do with flogging of a shitty autobiography? Or something to print in the papers? Or flogging off your own brand of 'infection fighting' soap?

And finally, how shit are the lawyers working for the Chelsea and Westminster Hospital? A crap, has-been actress with a face like an elderly trout allegedly gets seven bells of shit kicked out of her by her husband, demands a procedure than is not indicated, and when she gets a complication, probably arising from her own skin, makes your client's hospital out to be filthier than Satan's fuming arsehole? How hard would it have been to demonstrate that the infection had come from the hospital, rather than an alternative source? Did trout-face have a recent set of BSSA -ve swabs taken from every orifice in her body? Probably not.

Dr Rant has some advice for the actress concerned. First of all, if you are being beaten up by your husband, get in touch with the police and social services, and stop apologising for him. Secondly, if your injuries are caused by sex, then you are doing things very wrongly indeed. Thirdly, you have diverted £5 million from the healthcare of the people of west London to make up for your 'lost earnings'. Do not be surprised if there is a large backlash against you, especially when the full details of your case become public. And finally, stick with your lawyers - they have won you far more money than you will ever deserve.

The Tethered Goat

Well now we know exactly what Alan Johnson thinks of Lord Darzi, a key part of Gordon Has-Bean’s “Government of all the Talents” (GOAT)

“Some went off message and had to be reprimanded.” Johnson says: "We don't have a goat problem in this department. Our goat is tethered."

Now I don’t know about you but I suspect describing a consultant general surgeon as “a tethered goat” is hardly a tactful move. Of all doctors consultant surgeons are rebellious, rambunctious, and retain their grasp of the vernacular. They are likely to threaten immediate orchidectomy to anyone who doubts their masculinity…

I hope Sir Ara Darzi is not a eunuch, and has not lost his grasp of the vernacular. His predecessor Sir Lancelot Spratt always said that, “a successful surgeon must have the eye of a hawk, the heart of a lion and the hands of a lady.” They still do.

And I wonder where Alan Johnson’s testicles will end up. They’d be quite a coup for the collection of the Hunterian Museum at the Royal College of Surgeons. Better that than Sir Ara ending up as the scapegoat.

Traitor in our midst

A medical student who goes my the name of the pseudonym 'Alex Thomas' has been slagging off her colleagues in the Guardian. Dr Rant has heard from several reliable sources that Lana Williams may be hiding behind the cover of Alex Thomas; Lana Williams is a medical student in London who is due to graduate in 2011, so she is uniquely qualified to be giving us the benefit of her vast knowledge and experience of the NHS. The rather outlandish arrogance of this medical student has to be seen to be believed, apparently Alex has lost patience with GPs; one just wonders just how well informed this young medical student is regarding the current crisis in primary care. The piece is completely incoherent and demonstrates a real lack of understanding of the key issues:

"The main point that politicians and the general public are increasingly warming to is that if individuals do not like the offer of employment that is on the table from the Department of Health then they are free to leave the profession."

Alex, my dear, I suggest you research your stories a little bit before writing this low quality dross. The government and DoH made zero effort to negotiate with GPs for many months, while smearing GPs with a dishonest campaign of propaganda in the press, before making an insulting offer that they were not willing to negotiate at all. In a similar vein I suppose Alex thinks that the Police should just lump their insulting pay offer, as they are free to leave the Police force if they wish, what sparkling logic. The concept of 'free' is not such a black and white issue when one is tied to a mortgage, partner and children, and when one has invested many many years specialising in General Practice.

"Many senior figures within NHS management and the Department of Health have said that there are some senior doctors are refusing to attend internal and external management meetings and negotiations unless they are being paid to attend - on top of their salaries, at GMC rates that is about £100 an hour. Is it any wonder doctors are being left out of negotiations? This is scandalous and downright cheeky."

It appears that Alex likes to swallow the propaganda fed to her by the government propaganda machine, it can be very dangerous to swallow things without checking where they came from first. Next time Alex I suggest that you check what's between your lips before you gobble it down. Amazingly a medical student criticising all her senior GP colleagues has the nerve to call GPs 'cheeky'. Alex seems to think that the majority of GPs are happy with the government's management of primary care, and that the noise is only 'the rumblings of discontent from a highly vocal minority'. One wonders why the government ignored the majority of patients regarding opening hours Alex, it couldn't possibly be that they want to open up Primary Care to some rather hungry private corporations.

"They knew and I know that if they went into my old City firm with the sheer arrogance they display as medical students they would have their bollocks chewed off by lunchtime."

This quote is unbelievable. Has anyone out there ever seen anyone working in the City display arrogance? Can Alex see the rank hypocrisy of her words? Pot, kettle, black. I have many friends who work in the City and they would openly admit that many of their colleagues are unpleasantly arrogant and obnoxious, I would say the opposite of my medical colleagues, I can't comment on Alex's friends though. Maybe we aren't as militantly political as we should be as a profession, but this does no excuse the government's appalling behaviour in making no effort to cooperate or negotiate.

"I'm fed up with hearing that morale is at an all-time low when everywhere I go I see contented doctors who are happy to teach students and treat patients. They have made peace with the fact that they did not become bankers or lawyers and are happy to get on with it."

Alex Thomas seems to equally obnoxious when acting under a different pseudonym 'Spider Monkey', apparently she is 'still waiting for the exodus from the profession over MTAS, or was it MMC', obviously the Spider Monkey didn't notice the rather large number of our colleagues that have emigrated or are in the process of jacking medicine in.

" When the exodus happens at least my generation of doctors can stop worrying about their job security....Hundreds of people is not an exodus - hundreds of people go to Oz for fun and frolics every year any way."

Thanks for pointing out the benefits of MTAS and MMC to your generation Alex, it's just a great shame that you are so terribly wrong again. If you continue your career as a doctor then one day you will look back on your comments and be very very embarrassed indeed. MTAS and MMC will be extremely bad for your generation in many many ways. The government is flooding the market with doctors, so that it can force doctors of the future to work for poorer terms and conditions in the brave new NHS. This brave new privatised NHS will be bad for doctors and bad for patients, as health care is run for profit and not on the basis of clinical need. I am sure Alex thinks this is a great idea though, there will undoubtedly be a new CMO by then.

"There will not be blood in the corridors of Whitehall just because some irate GP with his own blog and an inflated sense of his own importance is fuming about his work/life balance."

I'm thinking......fuck right off you nauseating adolescent.

Server problems - apologies

As previously mentioned Dr Rant has been diagnosed as suffering from 'server problems' over the last few weeks.

Top surgeons recommended a total server transplant, which was carried out today. The patient is in a stable condition and is helping police with their enquir...er, I mean, is on the mend.

Nurse Speaking has informed Dr Informed, who in turn has told the next of kind that the next 24 hours will be critical.

Do not adjust your set.

[Blimey! At least Dr Crippen is fully functional again - Ed.]

NHS bypasses Freedom of Information Act

As the NHS continues to be sold off, more and more parts of it are called 'NHSThis' and 'NHSThat', complete with nice NHS logs and badges, but are infact limited companies with only a tenuous tie to the actual NHS.

This privatisation-by-stealth has an added advantage for a transparancy-averse government: it allows them to by-pass the Freedom of Information Act (an Act which has been a source of much embarrassment for the NHS).

When a member of NHSEmployers made a statment on the BBC supporting the changes to medical training, Dr Rant made a Freedom of Information request to NHS Employers and received the following reply*:

Dr Rant,

NHS Employers is not a public body as defined in the Freedom of Information Act and is therefore unable to respond to FOI inquiries.

Regards

Sam Ash
Communications & Marketing Officer

It turns out that NHS Employers is a limited company, which is a member of the NHS Confederation, which 'helps the NHS' (somehow).

Clearly, the 'NHS' is now simply a brand.

Shame it's become such a shit brand, but that's years of bad management for you.



* Actually, the doctor making the request was not one of the Dr Rant team, but if we had made a FOI request we would have received the same reply.

Medical Training a Mess, Shock!

The Dr Rant team are shocked to discover that the government are incompetent, useless, lying, bastards who have fucked up medical training in the UK beyond all repair and are not fit to be in charge.

Wish we'd seen that one coming.

Virgin territory

The future is bright. The future is Virgin.

Unbelievably happy, healthy, broad-smiled patients.

Unfeasibly handsome, white-coated, capped-teethed doctors.

Just like Native Americans watching the first European ships coming over the horizon carrying booze, gunpowder, and smallpox to virgin lands, I can't wait.

Technical Difficulties

We apologise for the patchy service since Christmas. Our server is playing up, making posting and editing very difficult.

Seeing any GP in the UK (Taking time off work to see your GP, part 3)

Of course the customers should be able to go to ANY gp they want - Comment by 'no-one' in part two of our series of articles on 'How to Get Off Your Lazy Arse And See A GP During Office Hours, Fuckwit'.


In fact patients are free to see ANY GP, anywhere in the UK.

There are two ways to do this.

The first is called 'temporary registration'. It usually is based on the assumption that the patient is staying at a different address from their 'home' one (hence the name), but many GPs will see patients as TRs near the place they work etc.. Simply call up the GP you are interested in seeing and ask the receptionist if you can make an appointment as a temporary resident.


The second method is to see a GP privately. You can simply call round practices asking if any of the GPs are willing to see you privately. Many GPs already see some patients privately: they're called 'American tourists'. These practice should have a fee schedule for non-NHS patients.

Sadly, your own GP won't be able to see you privately: the government put a clause in the new GMS contract banning GPs from seeing their own patients privately (to prevent GPs from 'doing a dentist' by offering a higher quality service for a fee and a lower quality service on the NHS - despite the view of many GPs that patients won't pay to get a service they can get for free, the dentists know that many patients will pay to receive a better service).

I know that 'no-one' will come back and say that there are no NHS GPs that are willing to see him/her privately/as a TR. I guess that's what you call 'market forces'.

Isn't capitalism a bitch when you're sick?

Dual Registration (Time off work to see you GP, part 2)

One comment that comes up a lot from commuters who have problems seeing their GP is that they would like to see a GP near their work.

This is called Dual Registration and involves being registered with a home GP and a second GP near your work.

GPs have been asking for this for years.

The government continually says no.

You can probably guess the reason.

(Dr Rant assumes it has something to do with the secondary GP wanting some money for providing such a service).

Reinventing The Wheel: The Sequel

A Clunk-jawed Fucktard Today.

What do politicians do when they are desperate for a quick boost in popularity? They repackage old tired ideas and pretend that they are actually revolutionary cutting edge ideas. This is certainly the case for gawping fat Gordon's latest jaw hanging warbling on health screening:

"Patients in England will be offered screening for early signs of heart disease, stroke and kidney disease, Prime Minister Gordon Brown has

You will not be surprised to learn that the Dr Rant team are characteristically unenthusiastic, and stoically unimpressed. In actual fact GPs have been screening for heart disease, diabetes, stroke and kidney disease for many years now through the Quality of Outcomes Framework (QOF) and the GMS2 contract. Unfortunately, the government won’t pay us to hit the more aggressive targets for blood pressure and cholesterol that medical evidence suggests we should hit. These are the targets which science suggests will get the best results for the population at large but the government prefers targets that are less arduous (and less expensive on the drug budget).


There is absolutely diddly-squat-fuck-all-bees-willy-gordon's-weener new about this. The only newish thing in the screening proposals is the idea to screen elderly males for abdominal aortic aneurysms (which they've actually refused to fund thus far when asked). Even if screening were brought in for these aneurysms, it would still be highly questionable as to whether the NHS would have the capacity to operate on them.

If you were wanting to introduce a genuine revolutionary shift in emphasis from disease treatment to disease prevention how would you do it? Dr Rant would discuss the concept with those that he was relying on to deliver it first, and curry favour with the 'providers' with the proven track record and the trust of the public (i.e. the GPs). The Clunk-jawed Fucktard thinks the best way to do it is keep the GPs in the dark, give his private sector mates the heads up to hand them the 'competitive' advantage, and announce/crow about it on Shit-Badger Cuntavison (aka GMTV) with the most vacuous waste of oxygen in Britain - Fiona Fucking Phillips. The fact that virtually every involvement of the private sector in Gordon's brave new NHS has thus far been a total disaster doesn't seem to have dampened his enthusiasm.

He's even gone to extraordinary lengths to alienate and anger the only people who could possibly deliver his 'grand vision'; the GPs. Presumably we're being lined up for the blame when this initiative goes the same way as all New Labour's other bright ideas - to hell in a very expensive handcart.

Fiona Phillips: Not worth the effort of thinking up a witty comment.

The biggest lies from the Clunking Fister come in the form of this new 'personalised' service that he promises us. One wonders how shutting down your local GP and forcing you to travel further to a giant portacabin polyclinic will do this. The lack of continuity of care provided by the pathetic Walk in Centres (WICs or WANKFESTs) and polyclinics will no doubt have a massive negative impact on the amount of time that is wasted in inappropriate patient attendances to Accident and Emergency departments. Not to mention the fact that WICs are often manned by non-doctor, 'Noctor' people who have had around 4 weeks of training in how to diagnose and manage medical problems, that makes them only just a little bit more expert in health that politicians.

It's another load of hot air from Gordon, and we go further down the road to generating an NHS that resembles the Soviet Union system of the 1960s, that simultaneously and paradoxically embraces the worst of pseudo free market idiocy and cronyism. Your local doctor and a good local hospital will soon be a thing of the past, as they are replaced by the unhappy medium of a distant polyclinic, which can neither provide the continuity and personalised care of your local GP, nor the high standard of care for the bread and butter medical and surgical emergencies. Gordon will give us the worst of both worlds, by cutting costs and privatising the NHS in the process.

Business as usual it would seem.

Time off work to see a GP (part 1)

Can some of the moaning twats who drone on and on and on and on about not being able to see their GP because they are only open until 6pm please explain to me why they don't just:

1. Get some time off work to see their GP.

2. Pay to see a private GP.

3. See the GP at some time during the 8am to 6pm Mon-Fri period when they are not at work?

To pre-empt any fuckwit responses, I should point out from the start that:

i. No employee is so important that they can't take an hour off work from time to time to see to their own health.

ii. Anyone who never has any time off during the working week either (a) does not work at 8pm themselves so can't talk, the selfish fucks, (b) are earning far too much money and can afford a private GP, or (c) work for Ebenezer Scrooge and need to find a better fucking job/kill their employers and stage a revolution.

And finally, those cunts at the CBI who think that the NHS should pay £200 per hour to have GPs open at 8pm just so tight-fisted money-grabbing employers can save 20p by not having to unchain their sick, miserable, overworked slave workforce from the sweatshops that they call businesses can just fuck right off. Bastards.

And to the teacher that thinks taking time off to see a GP means children not getting taught: you're school needs to get more teachers so you can cross cover each other. Supply teachers? Headmaster taking a class for an hour? For fuck's sake, wake the fuck up.

Anyway, the solution is simple. Take out the clause in the new GP contract that bans GPs from offering evening and weekend appointments to their patients if they are willing to pay for them. Dr Rant has been saying this since the new contract was first being discussed. The government put this clause in to stop GPs 'doing a dentist'. Without it, patients could choose to pay to be seen in the evenings and the weekends by their GP without taking NHS resources away from the vast majority of people who are actually, you know, sick.