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The Cotton Buds of May

Friday 11 May 2018

The Cotton Buds of May

We’ve developed a serious meeting logjam in recent weeks, and it’s getting worse. Things were quiet over the Easter break, but new groups, including six subgroups from the A and E Delivery Board, have started meeting with increasing frequency. They are all aimed at improving the way the system works together, with increasingly squeezed budgets, and several have a specific focus  on helping the service survive next winter (assuming it’s coping better now, that is), and the timescales are frighteningly tight. The reasons are obvious. The figures for year-on-year increase in activity at A and E and also for emergency admissions are stark (15% up in March compared to last year at T and S, and even 10% up in April). I was at a hastily convened group last week  tasked with coming up with an ‘interim urgent response team’, to provide an alternative for GPs and paramedics who might visit somebody at home who, for whatever reason doesn’t need to be in an acute hospital bed, but for whom at present there is really no alternative to hospital admission. There have been numerous fragmented efforts relating to this in the past (remember the Hospital at Home idea?), but there has to be a sustainable solution found this time.

This group had three meetings arranged over successive Wednesdays in May, and other groups also have challenging schedules. They are usually heavily represented in the Trusts, Social Care, the voluntary sector, and Devon Doctors are there as well as the new OOH providers. It’s really important that we get Primary Care to the table as well, mob-handed if possible, not just because our voice needs to be heard, but because the chances of us being able to field enough people to attend all of the meetings in a particular work stream with consistency of representation are slim. Most of us are already very busy in our practices, looking for fires, if not actually putting them out, and many of the GPs attending already wear a number of hats, whether they represent the Trusts, Symphony or the CCG. Then again, there are other urgent things that might pop-up out of the blue to distract us- a practice CQC visit for example- which inevitably has to take priority over work for the wider system.

Calendar clashes are becoming commonplace. Last week I had to attend a Chairs and Chief Execs meeting that was scheduled at the same time as our long-arranged quarterly Regional LMCs meeting 20 miles away. Our fabulous Vice-Chair, Karen agreed to referee at least the morning session of what can seem like an intimidating and group of LMC execs from all round the south west, and I hot-footed it back to see how things were going as soon as I was able.

I needn’t have worried. Karen, queen of the flow-chart, had previously walked through the agenda in meticulous detail with Barry, and was more than ready for the challenge. As I slipped into the seat beside her- she was discussing a point of principle with the Chair of the LMCs UK Conference at the time- I was impressed, but not surprised, to notice her copy of the agenda, annotated in detail and covered with arrows. There was no way I could have taken over from her, and indeed no need as she had matters entirely under control, breaking for lunch just as the chips arrived, as any good Chair knows to do- wherever we are on the agenda.

It feels an age since our last County LMC meeting, when we waved goodbye to some retiring members, and I’m looking forward to officially welcoming the new committee when we get together next week. The first meeting is always fun but testing for the executive- the initiation ceremonies don’t run themselves, and goat lymph isn’t as easy to lay your hands as you might think, although I’m hoping the new Taunton Aldi might come up trumps. We are going to try to strengthen the constituency roles again and make sure we have as an effective conduit as possible between the LMC and all of our 69 practices.

A sweaty GP, a sexual health specialist, a blonde dentist and a grumpy comedian limping into a tapas bar could be the first line of a dodgy joke, but is a daily scene from the latest Bray travelogue, which sees us cycling en familia around the Extremadura region of Spain. With impeccable timing, we fled the country last weekend as the sun came out and everybody else was digging out the sunscreen and fumigating their barbecues.

We’ve encountered a few hills en route, which have proved an interesting and useful bonding experience. Dentist Amy is a regular cyclist and in charge of the route. She’s been teaching us how NHS dentists are paid, and it’s clearly most profitable for them to have a list of people in whom nothing ever needs treating. A ten minute check-up generates a single UDA (Unit of Dental Activity), but they get a standard three UDAs for any subsequent treatment, whatever that might be: a ten-minute filling for a child generating the same income as a complicated adult needing major reconstruction on multiple rotting pegs and root-canal poking, for example- and if they go onto treatment, they don’t get paid for that initial check-up. Treatment planning can therefore be complicated, but maybe not as  tricky as what she’s up to right now. I’m tapping this out in a 16th century jasmine-scented courtyard- Amy is next to me Whatsapping an old uni friend with a dental problem currently reclined in a Japanese dental chair 7000 miles away. They obviously favour heroic doses of cefaclor in the Land of the Rising Sun, and she asked me what I thought. Google Translate is a wonderful app, and I found this useful phrase for her to pass on to her friend to practice reciting for future use: Watashi no chokucho wa datsuraku shite iru yo ni kanjimasu. Watashi wa kurosutorijiumu Difficile o motte iru to omou. (phonetic Nipponese for “my bottom feels to be falling out. I think I have C. Diff”). I try to be helpful.

In addition to her day job, Jess earns folding money on the London stand-up circuit. Clearly she needs to ration her humour (if not actually charge us for it), and it has been known to run out just short of a few of the summits, but she remains the sharpest wit in the group and as the only Spanish speaker, the vitalist cog. I wondered whether she might get any inspiration for her comedy writing or performing from the trip? Whilst not actually able to speak at the time I asked, the withering sideways glance she gave me hinted that maybe the travails of a moderately well -off and functional middle class family wheezing their way to the next Parador is a world away from the usual biting grist of her late-night comedy sessions in London clubs. I think that’s it.

Never mind. I’m hoping that one of my female posse can tell me all about another logjam- this time of cotton buds. Last month, there was a picture on the Telegraph website of somebody shepherding a flotsam mass of cotton buds at a sewage treatment works (Oxford- where else?). The story was that the UK gets through 13.2 billion of the things every year. Thinking that must be a mistake, I checked the original WWF report, which confirmed this astonishing statistic. That equates to about 2,200 for every man, woman and child in the country, every year. I’ve never knowingly bought one, but over the years have fished a few out from ears, and occasionally from, er, other places, but still have no idea how we get to 13.2 billion.

A few years ago, one of my patients moved into sheltered housing, and visiting his new and bijou abode, I was intrigued to find him surrounded by an impressive armada of model galleons constructed entirely from matchsticks. They’d occupied several upstairs rooms in his previous house, and he’d never told me of them, or indeed his passion for chiselling and glueing titchy bits of wood together, although in retrospect years of inhaling the solvent fumes would have explained his dodgy LFTs, and also thrown new light on his splinter haemorrhages as well. Maybe somebody, somewhere is building a model of something else out of cotton-buds: the space shuttle, Concorde, or even one of the much-vaunted ‘new models of care’? It’s possible, but look again: that 13.2 billion figure was the number of buds that we actually throw away every year. The mystery deepens and I’m genuinely intrigued. Ideas, anybody?

Last evening was memorable. We were out to celebrate my birthday (big, minus one) and had a prime table overlooking the wonderful Plaza Mayor in Trujillo. We were in the shadow of a vast bronze statue of Francisco Pizarro, a local from these parts who went off to do a bit of conquistadoring and came back with Peru. We’d had a fabulous meal and the square was still buzzing when the waiter arrived with a cake and a single candle. I was touched and thanked him. He looked puzzled- no, he said, the cake wasn’t for my birthday. News had reached rural Spain that the South Somerset Federation/Symphony had won the Primary Care category at the BMJ awards. That’s brilliant for everybody who has put in so much time and effort, not least our own Berge Balian and Steve Edgar.

Congratulations to all, and Salut!

(Trujillo, Spain)


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