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The Eyes Have It

Friday 21 June 2019

Welcome to the longest day. Hasn’t the weather been just glorious? Assuming you’re reading this after midday, we’ve started our hurtle back to winter, and in only a few days our cleaner will tell me the nights are drawing in again. Never mind- we’ve still got bags of summer excitement to go: there’s Glastoswamp, Wimbledon, the pointy end of the cricket World Cup, and then a whole Ashes series to enjoy. Meanwhile, there’s much local activity as our networks get themselves organised and the relevant paperwork completed with the CCG prior to the July 1st ‘go-live’ date.

Three of our new Clinical Directors were in London for the BMA conference earlier in the month, and I suggest you have a look at Rob Weaver’s excellent account here if you haven’t already done so. The LMC/GP Board is hosting an evening event next Tuesday to get the Board and Clinical Directors together so we can share learning and establish how we can work cohesively and collaboratively as Networks embed themselves in the system.

On Wednesday morning I found myself in the Westland’s Entertainment Venue in Yeovil for a meeting of the boards and directors of the Foundation Trusts and the CGG. I’d been asked to give a presentation on Primary Care Networks (PCNs) and how things were progressing across the county. Also on the bill was an update on the financial position and the cunning plan to sort that out from one of the Chief Execs, a CCG double-act from Maria Heard and Alex Murray about recent developments in the Fit For My Future programme, and Ed Ford gave the latest thinking about the march towards an Integrated Care System (ICS) in Somerset, before the inevitable group work and feedback from tables. The acoustics were terrible, and picking up the golden nuggets scattered by the speakers wasn’t helped by the noisy air-conditioning, with one of the Chairs commenting that Westland appeared to have chosen a helicopter engine to power the fans. It was funny at the time.

Non-executive directors are drawn from different walks of life and picked, indeed expected, to provide a challenge to those running the organisations. As such, they tend not to hold back when asking questions and express their opinions in a forthright manner. Many were concerned about the perceived lack of progress in making the difficult decisions that everybody in the system knows will need to be tackled sooner or later. There were no punches pulled by any of the presenters about the enormity of the financial turnaround needed in the next 18 months or so. It felt like we’ve reached a tipping point- we’ll see.

We had another meeting with our gastroenterology colleagues at Musgrove last week, to discuss the direct access to endoscopy project. It’s refreshing and satisfying to have direct clinician to clinician contact, sharing experience and plotting a path through anticipated bear-traps. We need far more discussion between Primary and Secondary care colleagues across the board. Following comments we made in a liaison meeting a month or so ago, T&S have been discussing whether it’s possible to re-open the Consultant Connect service for acute medicine, or at least something like it. It was disappointing to hear from one of the medics that a few consultants had thought some of the CC contacts they’d had were of ‘low value’. We bristled at that but have arranged a further meeting at T&S next week to explore this further. We fully appreciate how irksome it is to be phoned about one problem when you’re trying to deal with another, but hey, that’s what we do all the time.

The LMC executive had a further meeting with our local CQC inspectors recently. The Annual Regulatory Reviews (ARRs) were on the agenda, and the general perception from practices is that they’ve not been too troublesome, at least not for most. Alas I hadn’t been able to stop myself owning up to our practice now performing vasectomies, and as a result am now steeling the practice for an inspection. Well done, me. As the LMC/CQC meeting finished, one of the inspectors took me to one side, saying that she’d not been able to find our online ‘Statement of Purpose’ form. I might not have been in the best place mentally to take in what she was telling me we needed to do, and she did her best to guide me through the various forms available online. I must have looked blank. Did we have a mission statement, the inspector wondered, as that might help?

Hmm.

I’m not one for visions, mission statements, or ‘plans on pages’, and have lost far too many hours/days/weeks in recent times staring blankly at them in meetings. Who are they for, exactly? Does some higher power imagine that, confronted by a particularly thorny problem, we’ll stroll out down the corridor, gaze at something framed on the wall and suddenly see a way through the murk? Barry, my esteemed LMC and practice colleague feels that ‘Serving North Petherton right’ would probably fit everybody’s bill at our manor. The LMC has a similarly succinct ditty, but Juliet Foxtrot Delta India- that’s the expanded version- wouldn’t fill much of the space available on their form, even if you can work out where you need to put it (so to speak).

Our lovely practice manager found a paper ‘Statement of Purpose’ form in our CQC documentation, but it really needs to be on line, and preferably up to date, neither of which ours turned out to be. Our inspector had helpfully reminded me that we can be fined real folding money for such transgressions and I’ve been doing my best since to put things right, but…. have you ever tried doing stuff on the CQC website? I moaned about the Pensions Agency a few weeks back, but that’s a walk in the park compared to the CQC site. Hopefully now that we have the eminently sensible Rosie B at the helm, she can come up with something a little more user-, or at least GP-, friendly?

Maybe it’s to help me get through stuff like this, I drink far more coffee these days than I used to, and the first thing that most of us do when arriving anywhere for a meeting is make a dash for the beans. For the sake of the NHS alone, I hope somebody’s thought about coffee supplies in the event of a no-deal Brexit. It was reassuring therefore to read the recent Queen Mary University/British Heart Foundation study of more than 8000 patients showing that drinking 5 cups of coffee daily, (and up to 25 cups of coffee daily in some subjects) was no worse for the arteries, as assessed by cardiac MRIs and infrared pulse tests, than drinking less than one cup daily. That’s not to say it doesn’t have other untoward effects- and may explain why I miss my bisoprolol if I’m more than a few hours late taking it.

One of the joys of topping-up the serum caffeine in the M&S cafe before meetings at Musgrove is the chance to bump into all sorts of people. It often provides an opportunity to catch up with consultant colleagues, and to earwig snippets of nursey gossip from neighbouring tables. Last week I was at the hospital to get some therapeutic rays on my dodgy knee (an X-ray normally sorts things out, I find), and bumped into one of my elder daughter’s school friends and hockey team-mates, now a junior doctor at Musgrove. She was dressed in scrubs and I didn’t recognise her until she hailed me as we passed. She’d just finished a shift and looked less than her usual impeccably shevelled self. We caught up on her career hopes (General Practice- hurrah), before I pointed to the large stained patch on the front of her scrubs. It looked like a tough night- was in blood? Urine? Amniotic fluid? CSF?? She looked down and lifted the hem of her top and sniffed it. “Hoisin sauce”, she said.

Puppy update: they’re lovely. Now five weeks old, they’re getting bigger on a daily basis and into everything, at least when not asleep or fertilising the flooring. We’ve got them for at least another three weeks- Doris and Fudge still need homes- and I’m going to miss them all. If you just skimmed through your recent copy of the Proceedings of the National Academy of Sciences, you might have missed the article about dog eyes. Having spent the last few weeks staring into seven pairs of Labrador eyes, it was fascinating to read about the development of the levator anguli oculi medialis (LAOM) muscles in domesticated breeds of dogs. They developed after they branched away from wolves, and the theory is that the muscle has become more developed over the last 20,000 years of domestication of dogs as an evolutionary feature in order to make their faces more appealing to humans. I don’t wish to sound cruel, but I can think of several patients who could do with a bit of LAOM action as well.

Keep on howling at the moon, everyone.

Nick

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