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Rock and a Hard Place

Friday 23 June 2017

The NHS has proved remarkably resilient over the years, but has been done no favours by the political own-goals of the past 12 months. Hard on the heels of the latest electoral fiasco, we’ve had a Queen’s Speech that was brief to the point of curtness, and made no mention or acknowledgement of the funding crisis in the NHS or other public services. Whilst brevity might have been handy for ensuring Her Maj got to Royal Ascot in time for the first race on the card, it telegraphed to the troops apparent indifference from the government to the mounting problems we all face.

Do you remember the H1N1 flu epidemic in 2009? That was an outbreak of a relatively mild form of the disease, but at a system leadership meeting in February 2014, we decided that the divided post-Lansley healthcare system might have struggled to cope with a similar outbreak. As I drove back pondering this alarming fact, I had a call from the surgery to tell me that a significant portion of our practice area was under water and that the villages of Moorland and Fordgate had been evacuated. In the weeks that followed, I saw a lot of grief and anger, and learnt of family connections that I hadn’t known about before. It took nearly 3 years for some people to get their homes and lives back together, but the mental scars still run deep in some of our patients.

It feels almost indecent to mention that flood in the same context as the devastating fire in Grenfell Tower, but my point is to wonder just how the effects of such a horrific, public tragedy and loss of life, with significant political undertones and recriminations, will affect those unlucky enough to have been involved, either as residents, rescue workers, or support workers after the event. I saw an article in one of the rags this week written by a GP about how they responded to the events. She talked about the practicalities of replacing medications and all that you’d expect to be done in the immediate aftermath, but how are the local NHS services going to cope with a significantly traumatised and grieving population in the months and years to come?

As if epidemics and disasters weren’t enough of an additional challenge for the NHS, we’ve also seen it having to respond to the various recent terrorist incidents in London and Manchester. If you find the time, do try to watch this week’s Hospital (BBC2) on iPlayer. The crew was on location in St Mary’s hospital at the time of the Westminster attack. They were filming a meeting to discuss staff vacancies when their phones started to ring with first news of the incident, and records their extraordinary response. The first ambulance brought in the perpetrator. If watching this doesn’t make you proud of the NHS we work in, then nothing will. It also makes you wonder how they manage after a major bomb in the middle of Kabul, for example. Oh, and just to make it all a little bit more challenging here, we learnt recently that there has been a 96% reduction in EU nurses registering to work in the UK since the vote to leave last June. Brilliant. Hard Brexit? Maybe. The NHS as a hard place to work? Definitely.

Last week I went along for the first time to the quarterly meeting of the Somerset Sexual Health Network, held at County Hall. This was interesting for a number of reasons. Clearly there have been some familiar difficulties with the split in commissioning and provision (contraceptive services through Public Health, but run by SomPar, and the GU services provided by T and S). The service currently has no GU specialist doctors and one priority they are working on is an HIV pathway, which will specify how the patients (themselves usually very well informed) progress through a network that could involve Primary Care, the integrated sexual health service (SWISH), T and S, and the various charities involved locally. Who provides the post exposure prophylaxis (PEP/PEPSE according to whether sexual exposure or not), for example? Would you know how to advise a policeman bitten by an HIV positive individual during an arrest? I used to do a GUM clinical assistant job in the late 80’s, but clearly things have moved on. Syphilis is currently enjoying something of a resurgence- patients need a full 12 months of follow-up, there is a cluster of Hepatitis A in homosexual men that has genotypical links to Spain and “app sex” (I had to ask…), and there is already evidence of some extracurricular activity associated with the Hinkley C project. Cuts to their budgets have made SWISH try to redirect women back to Primary Care if their practice is known to fit IUDs and implants. I pointed out that patients should have a choice, that practices aren’t paid a block contract to provide these services (an item of service fee applies instead), and there is likely to be increasingly limited availability for slots in Primary Care. I was also able to discuss training, or rather lack thereof, for GPs, and to warn of the impending retirement of a large cohort of our colleagues who fit IUDs and implants in Primary Care.

On Wednesday this week, I joined the sweltering horde at Long Sutton Golf Club to present our thoughts and plans for “Team GP” to practice representatives at the SPH AGM. We are confident that we have found a formula that makes the most of our limited resources and will significantly improve our visibility and influence in the STP process. It’s an interesting time in other organisations. We were saddened to hear of the resignation of David Slack from the CCG, who has been a supporter of Primary Care over the years. Dr Sam Barrell is shortly relinquishing her role as CEO of Musgrove, and there is a new interim Medical Director at Somerset Partnership. It’s not a bad time for Primary Care to turn up to the party and present a united front to the rest of the healthcare system as it tries to regather.

We discussed this further at our joint meeting with the CCG and SPH yesterday. Despite the end of the heatwave, the LMC offices were still throbbing along at Regulo 7 due to the storage heater effect of the walls. Although the informal name of Team GP is easy to say (and requires minimal alteration to my 2012 Olympics “Team GB” stash), we decided that formally it should be known as the Somerset General Practice Board. We have agreed our terms of reference and membership of the group, and written to the STP leadership asking to attend a meeting to present our case to the Programme Executive Group, hopefully within the next few weeks. Practices will be getting a letter from us with more detail in the next week or so.

I’m off later today to have a hippy-happening at Glasto, where Mrs. Chair is doing something medical. We made a base in the dusty Festival Medical Services (FMS) field on Monday, by which time it was already starting to heave with the traders and other support services. It’s a massive operation, with some 800 assorted health professionals on site to look after the estimated 200,000 revelers once the thing is in full swing. That's roughly the population of Bournemouth, and perhaps appropriately the demographic is shifting subtly towards the greyer professional end of the spectrum as the years progress- to get a ticket requires not only a second mortgage, but also a degree of organisation: pre-registration and a bank of laptops on-line at exactly 09:00 on a Sunday in the preceding October. Alternatively, it might be simpler to train as a health professional, move to Somerset, join Festival Medical Services and get a pass that way, or better still, persuade your other half to work a few shifts there. As has become traditional, the way into the vast site was hampered by sticky gloop, although this year it was the tarmac melting in the heatwave, rather than mud.

Rock on.

Nick Bray


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