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Sounds of Summer

Friday 21 July 2017

Hey- great job, everybody! We’re all winners again, so gongs all round, no doubt. For the second year in succession, the Commonwealth Fund has named the NHS as the best overall healthcare system in the world. Hurrah. The US came bottom of the list, with 44% of the population on low incomes having difficulty accessing healthcare (compared to 7% in the UK). In a comparison across 11 countries using five quality measures, and taking data from the WHO, the OECD and questionnaires completed by doctors and patients, the UK was ranked in the top three for all categories apart from health outcomes, where it was second-to-last, ahead of just the US. But the report went on to say that while the UK ranks 10th in the health outcomes domain overall, it had the largest reduction in mortality amenable to healthcare during the past decade. So that’s encouraging.

But wait: a report published this week has showed that the previously steady rise in life expectancy in the UK over the past century had stalled since 2010. In 1919, the average life expectancy for a man was 52.5 years, and for a woman 56.1 years, and rose in an almost linear manner so that by 2010, this had risen to 78.7 and 82.6. However, over the next five years to 2015, it rose at a much slower rate to 79.6 and 83.1. Sir Michael Marmot, who wrote the report, says there is no reason why the rate of increase should have been expected to slow, and that the UK should be able to emulate Hong Kong, which has life expectancies of 81.1 and 87.3, the highest in the world. He blames this on the effect of deep cuts in NHS and social care spending (the word he used was “miserly”). I recall a similar view being expressed by our Director of Public Health at an STP meeting earlier this year when looking at a dip in the local figures- and that she and her colleagues thought we were looking at an early effect of austerity measures. Taking those two reports together, it would appear that we’re all doing an even more remarkable job than we previously thought to keep the NHS at the top of the pile. How long we can keep it there remains to be seen, but for now give yourself a pat on the back, and decide where you want your medal pinned.

In a quieter moment this week, I decided to tackle the letter I’d received from my medical defence organisation questioning my sanity. They wanted to know if I was engaged in any online medical activity, playing in GP hubs, or dabbling in any Out of Hours work. I’d sat looking at it and thinking about it for a bit but decided it was time to nail my colours to the mast. It offered me the chance to dob myself in online, or alternatively I could talk to a trained negotiator. I picked the latter, and within a few seconds was chatting with Sally, who wanted to know all about me. It turns out I hadn’t told them when I reduced my clinical hours to take up the LMC gavel, and not only was she able to offer me exciting new terms, but would also reduce my subscription retrospectively from when I changed my hours last year. Wow- this was going better than I’d expected. My practice manager was on a beach 2000 miles away and I knew would be well impressed with my achievements of the day so far- I’d already made some exacting executive decisions about car-park gateposts, and a workaround for the improved access arrangements. Sally wanted to know whether I was planning on taking any leave during the year? She was obviously keen to get my subscription down as much as she possibly could, and was delighted to hear that I would be away for some odd weeks here and there. That was all sorted then, until she mentioned that one session equated to four hours of clinical activity. Face to face with patients? No- anything that involved clinical decision-making, so looking at results, letters and writing reports etc. So a typical day then is now three sessions long? Sally shrugged (I imagined) and said that would be nearly five grand please, and hoped I’d have a nice day.

I’ve decided I don’t like playing Practice Manager, but at least that will give me more time to devote to my role as the CQC Registered Manager for our little flock. If you’re missing the ‘thwack’ and ‘bwap’ of Wimbledon, you’re very welcome to take a court-side seat to watch my increasingly narky rally with our lovely regulators. I’m only trying to get a new partner added to the registration, but at this rate we’ll all be retired before that happens, and we’ve had another partner join since I started this ‘journey’ (yuk). The paperwork has bounced back and forth, and their last volley cross-court was that I hadn’t stated whether employing a senior GP of 25 years good-standing in various practices across the county would add anything to our service provision. Whisky Tango Foxtrot? If the answer was a “no”, then in the next paragraph there was a box for me to explain why not, presumably just in case it hadn’t occurred to me to have a think about all this beforehand. With what I considered a deft bit of drollery, I nudged back a cheeky drop shot that really should have ended the rally and won the point, but still, somehow, they’ve managed to get the bloody thing back to me yet again. Unconventionally perhaps, I’ve now sent my PM out mid-rally, and asked her to come up with a thumping backhand winner down the line. I need a break, and some new balls, please.

Of course, it might all be a cunning retaliatory move by the regulator designed to sap my will to live, as the aforementioned new partner, himself an ex-LMC Chair, was dispatched recently as an LMC gunboat to a CQC inspection in a local practice that had been through the mill in recent years. By all accounts (well, his), the dedicated practice staff had done a remarkable job turning things around, and were well prepared for the visit. Whilst inspecting the emergency drugs, a member of the practice team was asked whether they had a record book to write down what had happened (as if that would be a priority in a scenario where the kit might be needed). “Do you mean like this one?”, said one of the practice, brandishing just such a book. The inspector perused it for a while, before pointing out that the space for entries seemed a bit small. It keeps them in a job, I suppose.

Summer is a time for festivals of all shapes and sizes, and last weekend we found ourselves invited by one of our local colleagues to a lovely event at an amazing house near Calne in Wiltshire. She had kept in touch with many of her friends from GP training, and the families meet up most years for a chilled out weekend filled with music and laughter. Our respective daughters had been invited along to provide some stand-up comedy and musical entertainment, and it was good to catch up with some familiar faces who we had worked with in the past, many now approaching or enjoying retirement. I had to sneak away from the laid-back vibe on Sunday to the Air Tattoo at Fairford for a major sensory overload fix of kerosene fumes, coloured smoke and chest-thumping afterburner action. I can’t remember what the carcinogenic dose of cured pig is, but did my best to exceed it, and headed back to the mellow charms of the festival later that day with a huge grin, a sunburnt pate and tinnitus. I take my role as a health icon very seriously.

Keen blog watchers will have been aware that “Trump Zero”, the day the orange stain was due to be expunged from the White House, according to my frenzied and complex Q-DT calculations, should have been last Saturday. My apologies for getting this wrong. There is another huge bombshell about to be dropped by the Washington Post, but I’d assumed that by the time it had been revealed that a) the gibberish-spouting Donald held secret un-minuted meetings with the leader of his country’s sworn enemy, b) his intelligence community have said that he alone is the greatest threat to national security since the Cold War, c) that GCHQ have recordings of him and his family talking to Russian money launderers, and d) he’d done his best (but failed) to take healthcare away from 30 million of his citizens whilst giving billionaires an extra $900,000 in tax breaks, he would have been out on his ear. Unfortunately, I’d failed to validate my calculator for the right target population. I’d based it on the standard EMIS sample of normal sentient human beings- albeit from Yorkshire, instead of Republican members of Congress. I’m so sorry, in every possible way.

Nick Bray

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