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Old Harry’s Game

Friday 19 January 2018

Yesterday saw an emotional watershed moment in the history of Somerset LMC. You will be aware by now that Harry is retiring from his role as Medical Director at the end of February, and yesterday was his last ever LMC County meeting. He was initially appointed as Medical Secretary in 1996, and I am the sixth Chairperson to have benefitted from Harry’s expertise and wisdom. We go for informed, lively and often impassioned debate in our meetings, and Harry has always been there on my left, tapping the notes onto his iPad. Out of the corner of my eye, I’d look out for his pausing, clasping his hands together, and leaning forward, waiting to interject: “If I may, Chair….”. At which point, we all shut up, quietly and tidily put our toys back in the pram, and listen carefully, because we’re about to be treated to a nugget or two of pure gold, smelted into intelligible ingots by Harry’s unique brand of intellect, experience and common sense.

Whatever the meeting, and there have been some tricky ones in recent times, there are few more reassuring sights whilst waiting for proceedings to start, than to see Harry arrive to open the batting with you, iPadded-up and with notes clasped to his chest in his distinctive style. I’m welling-up already and there’s a load more eulogizing to do over the next few weeks, so I need to keep my powder and hankies at least partially dry. At the end of yesterday’s meeting, the committee presented him with an engraved tankard; it took meticulous research, and several experimental pints, to discover the particular blend of tin, copper and antimony best suited to serving ‘Old Speckled Hen’ in typical Pitminster climes. There will be a chance for everybody to give Harry the send-off he deserves on February 21st (evening) at Taunton Racecourse (details coming soon).

All practices will have now received nomination forms (sessional doctors via email) for the forthcoming LMC elections, which are held every four years; how time flies when you’re having er…fun. There has been quite a bit of movement in the committee in recent times with partners changing practices (and hence constituency), and others being elevated to heady executive heights that mean they relinquish their local representative role. If you like the sound of what the LMC does, please think seriously about putting your name forward and standing for election. We always need new blood, and it’s increasingly important that the committee reflects the make-up of the workforce we’re mandated to represent. Jill, myself or indeed any of the Executive team are always happy to answer any questions you might have about what’s involved. Don’t be daunted- nobody feels they know much when they first start, and anybody who tells you they do know everything is frankly deluded, and so shouldn’t be doing anything important (that includes you, Donald), and probably using rubber cutlery.

Visitors are welcome to come up and say hello in the LMC office, which lives on the first floor of the Crown Medical Centre in Taunton. We share an entrance with the chiropractor, and so traffic on the stairs can be slow and lurchy- at least on the way up- but turn left at the top of the stairs to find the LMC nerve-centre. Jill and the rest of the team share a large open-plan office, and we have the use of two more rooms as well. One we can justifiably call the library, which holds most of the paper records and books, another computer terminal and a small meeting area. The other is our main meeting room which has a large table, around which we can seat about ten mesomorphs, and the Batphone, on which we make our conference calls.

The Batphone has seen quite a bit of action in recent weeks. We have continued to collate practice activity data sent in to the office, and the results are extraordinary. We were involved in the daily escalation/de-escalation calls across the Health and Social care system when the crisis was at its peak a week or so ago, and it was helpful to be able to relay to representatives from the Trusts, CCG and NHS England, the incredible workload that was being tackled by local practices, whilst the national media focus was firmly fixed on A and E departments and the ambulance service. It was refreshing to hear representatives from the Trusts asking NHS England what could be done to help ease the pressure on Primary Care.

Last Thursday, the executive team gathered round the table for a catch-up Batcall with our GPC representative, Mark Sanford-Wood, who since his elevation to deputy chair of the GPC has had fewer opportunities to pop in to the office on a regular basis. We discussed most of the current hot topics, and it’s useful having his expertise and knowledge of negotiations at the very highest level. There are usually politically sensitive areas where he has to be (and always is) discrete, and wouldn’t ever directly confirm or refute any conclusions we might draw following our coded discussions. Amongst much else, we discussed the likelihood of NHS England agreeing to relax QOF reporting, in recognition of the huge pressures currently experienced on the front line. This follows on from their allowing Trusts to postpone routine surgery and clinics until the end of January, the CQC announcing the postponement of scheduled visits to practices, and the suspension of QOF by the NHS in Wales. You could argue what the point of postponing most clinics would be; I’m not sure how useful certain specialists would prove in the front line of the trenches, unless of course the plan is to fill their vacated out-patient clinics with outlying medical patients, or turn them into temporary mortuaries should things take a truly hideous turn for the worse.

The problem, as everybody apart from NHS England seems to grasp, is that postponing procedures might give temporary respite to the Trusts, but ramps up the pressure in Primary Care, which is already bursting at the seams. Staff sickness may yet add to the toxic mix; no practice can match the resilience of an acute Trust in a flu outbreak, and it takes only a few key practice staff to get lurgied for the whole system to wobble precariously. I have joined with the Chairs of Devon and Cornwall LMCs in sending a letter to NHS England, asking them to recognise the intense and unsustainable pressures in Primary Care and to request a formal suspension of QOF indices for all practices across the three counties. Such a suspension was agreed for Devon and Cornwall in 2013-14, which was demonstrated to release significant capacity, without a detrimental effect on patients. Meanwhile, discussions continue with the CCG and NHS England with regard to the SPQS specification for 2018-19. We hope to have more concrete news on this for practices by the end of the month.

Whilst dry January was never going to fly in our house, in times like these, it’s more important than ever that we can unwind and look after ourselves. One of my more exciting Christmas presents was from Maia, our frisky adolescent Labrador. It’s a pair of ‘dog-fit’ harnesses, one for each of us, attached by a couple of metres of bungee so that we can run together. We’re still in the early exploratory and mutual trust-development stages, and although the mud and ice have tempered our outings thus far, I can see loads of potential for fun, improved fitness and perchance the odd trip to A and E. Do look out if you like to walk in Long-Run meadow in Taunton, as I’d hate for us to scythe you down. It’s all fine and dandy if we’ve both reached a steady state, but should one of us get distracted, need a widdle, or just head the wrong way around a tree, it can get a bit messy. I’m learning to develop an emergency ‘pirouette-at-speed’, which has already attracted comment from startled onlookers, and over time will prove an interesting test of my superannuated menisci. What could possibly go wrong?

OK- so ‘Harry’ is cool, but don’t call me ‘Harold’. I had a difficult moment recently when I discovered I bear more than a passing resemblance to Harold Bornstein MD, Trump’s civilian physician, or at least what I would look like if I stopped shaving, exercise and lost what little dietary restraint I still possess. It was sufficiently scary for me to attach his photo to the fridge door, as the very last thing I’d want to turn into would be Trump’s GP.

Many apologies for the grammatical car-crash towards the end of the last blog, and thanks to the literally several of you for pointing out that the word I was grasping ineffectually for was a simple possessive pronoun. Of course! Every fortnight, mindful of an educated and watchful audience, I tiptoe my way through the lexicon with the greatest of care, and it’s ironic that of the roughly 80,000 words I’ve blogged to date, the first to really blow up in my face, by virtue of its absence, was ‘mine’.

One of the ‘several’ to come to my aid, inevitably, was Harry. Tomorrow, I’m off to a Medical Society reunion at our mutual Alma Mater, and hoping to seek out some of his contemporaries to discover whether, even in those black and white Movietone days, he was marked out as the genuine ‘Very Stable Genius’ we respect and admire so much today.

Enjoy your weekend,

Nick

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