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Election Doorstop Challenge

Friday 22 November 2019

It’s a gloomy Friday in November, and six of us are in London for the English LMC’s conference: Karen Sylvester (Madam Vice), Tim Horlock, Rob Weaver and me as delegates, with Jill and Mandy Mason attending as observers. Somerset has been given the honour of proposing the very last motion to be debated in the ‘And finally’ section. It’s a masterpiece from Barry in which he proposes that CQC inspectors should wear Hi-Vis jackets emblazoned with ‘How’s my inspecting?’ and a Freephone number to facilitate feedback. It’s my last conference, and unless I’ve thought of a cunning excuse or come over all liverish by this afternoon, I’ll be proposing this one, if only because I’m the only member of the team who definitely won’t be inspected by the CQC ever again. If only I could think of a suitable prop…

How’s the election campaign going for you? Compared to previous elections, where purdah seemed to be something that only happened to other folk such as Local Authorities, this feels to be ‘Purdah Plus’. Simon Stevens has written to NHS organisations laying down what they can and can’t do during the election campaign, although individuals are still entitled to express personal opinions, as long as they don’t use their official NHS roles or organisations’ social media platforms to do so.

It’s causing ripples locally. In the ‘Fit for my Future’ Health and Care Strategy review, the planned consultation for changes in certain local services is now delayed until the New Year. Purdah is discussed at the start of every meeting at the moment, and our quarterly Primary Care Commissioning meeting scheduled for the day of the election itself has been postponed to a date in January (when I can’t attend) because of an agenda item about a branch practice closure somewhere on our borders. It was felt necessary to postpone the whole meeting, which has public involvement, rather than just reschedule that one item. Last week we had a Fit for my Future meeting at the CCG where we had no papers circulated beforehand and were reminded that- even more so than usual- what happened in the room had to stay in the room (sorry).

Most people acknowledge that politics itself has changed. Over the past three years the tone and tenor of debate has undoubtedly become nastier and more polarised, and social media has added an unpleasant edge. How many parliamentary candidates will feel safe knocking on doors during this campaign, even without the freezing winter gloom to dull their policy ambitions?

We live in dangerous times. Across the pond, the impeachment proceedings against the tango toddler gather pace; who knows how big a tantrum he’ll throw, and at whom, in response to being backed into a corner? Meanwhile, the UK government’s refusal to publish the report on Russian interference in our elections and the Brexit referendum until after our forthcoming election adds to the sense of political anger on this side of the Atlantic. But it’s not just geopolitical problems that might trip us up.

A new sinister hazard lurched into view last week, one that until now has gone largely under the radar: doorstops. Yes, seriously. The full horror is documented- with graphic photos- in the Estates and Facilities Alert/2019/005. In five doom-laden pages, we learn how NHS organisations should conduct ‘a collaborative multi-disciplinary assessment in-situ at department level to identify doors stops (sic), as described in this alert, areas where used, the potential hazards and their likelihood to occur’. Furthermore, we need to schedule ‘periodic collaborative multidisciplinary reviews of procedures and environments for managing residual or changing risks e.g. increased tripping hazard due to changed patient type.’ In case you’re wondering, the multidisciplinary group ‘should also include, a fire officer, infection control lead, clinician(s) and capital planning as required for the project.’ It’s always good to give CQC something else to get exercised about.

(Just while writing this paragraph I’ve spotted one in my hotel room, trying to look innocent. I can’t do a collaborative multidisciplinary review at this time of night. I don’t trust it and won’t sleep now for worrying about it. I’ll get a pic for Twitter, and the Coroner in case it gets me during the night).

The Alliance Trust (T and S/SomPar) hosted an evening for the PCNs and CDs on Tuesday evening at Monks Yard. There was an impressive turnout, though most of those present were probably Trust employees. We heard of several initiatives from the Trust designed to link with or support networks, including the First Contact Physiotherapist (FCP) where the trust offers to pick up the unfunded 30% of the cost, new funding for mental health link workers across the 4 localities (think old PCT days), support for care homes, possible employment of additional staff by the trust, and we were introduced to the new ‘relationship managers’. There’s also an intriguing project named ‘Ubuntu’, after one of Mandela’s bodyguards. An African philosophy is that an individual’s problem is shared by everybody in that society, and the project looks to work with the most frequent users of NHS services to identify what might be driving that behaviour. Practices have been invited to name some suitable patients. Form an orderly queue with your lists.

Last week we held our first contract negotiation meeting with the CCG and set a timeline so that we can work towards getting the contract out to practices in good time for the start of the next financial year. It was an informal but constructive get-together- coffee and croissants rather than beer and sandwiches given the early hour- and both sides reflected that whilst the process wasn’t exactly derailed this year, there had been a minor wobble that delayed the spec. going out to practices as early as we would have liked. By starting the process earlier and setting the meeting dates, we hope to avoid such hiccoughs this time.

This is scheduled to be the last of the five years of the Primary Care Improvement Scheme (PCIS) that has served to level up (mainly) the funding across all practices, taking into account the loss of PMS premiums and the loss of MPIG in GMS practices, amongst other things. Five years ago, a number of us sat squinting at a vast and complex spreadsheet, with the right-hand column showing that by 2020/1 virtually all practices would be on the same per capita funding. I remember the moment when the penny dropped, and I could see how it all worked. PCIS now represents a significant funding stream into practices, and although there are aspects that we aren’t particularly keen on, it made sense at the outset and allowed the CCG to tackle the PMS review problem, whilst investing a significant amount of money into Somerset practices in a relatively light-touch contract,

The Medical Director and I have been on the road again, this time visiting the Tank Museum at Bovington in Dorset. The last time I was there was back in 1964, and although my memories are sketchy at best, it must have changed quite a bit over the last 50 years or so, not least because somebody thought it would be a laugh to stick Monkeyworld right next door. What could possibly go wrong? They have more than 300 tanks on display and many more in storage that they don’t appear to be using. Back in March I suggested that every Clinical Director should have access to a gunboat, but just imagine what a working Tiger tank might signify as a statement of intent in your neighbourhood. The CCG has been inviting bids from a number of organisations to support PCNs from an additional funding stream, and whilst I haven’t checked the small print, I don’t think armaments are specifically excluded.

Next week I’m off to ‘Fresh Looks’ at Musgrove, thirsty for knowledge and enlightenment. I had managed to delude myself that after 32 years as a GP I knew everything I’d ever need to know, until last weekend when I suddenly became aware of a gaping hole in my professional development. What is the medical condition that causes a mysterious inability to sweat, triggered- possibly- by an ‘overdose of adrenaline’, that lasts forty years or so, but can be reversed instantly by a forensic interview with Emily Maitlis? I wondered whether maybe it’s associated with a very specific population cohort. Coincidentally, Mrs. Chair shares the identical birthdate with HRHTDoY and so I’ve been quizzing her, but apparently (and devastatingly) she doesn’t recall ever having an overdose of adrenaline sufficient to turn anything off.

She’s not here to see this bloody doorstop.

Nick (in pre-podium sweat)

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