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The Twelve Rays of (hope for) Christmas

Friday 21 December 2018

‘Tis the season to be jolly and all that, but several of the women in my life tell me that I can be a right gloomy bastable at this time of year, and I really need to cheer up. A couple of points: Firstly, this is the way my face is. If God had intended me to smile he’d have given me shorter levator anguli oris muscles. Secondly, I’m a news junkie and I read stuff.

My lovely Practice Manager challenged me last week to come up with a festively cheerful blog to launch us into Christmas and top off the year, so here, in no particular order, are my twelve rays of hope for 2019, or at least the first three months - after that, we’re off to hell in a handcart, and all bets are off:

1. Thick mud still but a few green shoots.
The GP Careers plus scheme in Somerset has been hailed nationally as a tremendous success- justifiably so, and our own Twitter feed reported that it had ‘prevented’ 30 GPs from retiring early, although I like to think that it was less coercive and ‘handcuffy’ than that.

Our @GPinSomerset campaign has been attracting the younger cohort, and we heard at the regional Commissioning Operations Group meeting a week or so ago that Devon and Cornwall are the second and third ranked STPs in terms of GP recruitment in the country. That’s impressive, but I can’t help wondering what happens when the splurge of GPs at the beginning of their training now is released into the system, which by then will be adapted to the brave new world of a few stoical GPs supervising serried ranks of paramedics, nurses and pharmacists, inter alia. Is there a risk they’ll burst onto the scene as an expensive and superfluous commodity?

2. Excellent ‘flu immunisation figures.
Figures from NHS England last week showed that practices had already immunised more than 80% of their over-65s. That’s a fine effort given the strain that the system is under and some unflattering coverage about flu immunisation in the media. Well done, us. And whilst we’re at it…….

3. Our staff are exceptional.
Of course they are, and we should be telling them so even more these days. The exec team recently found itself gathered round the Batphone in the office having a ‘robust’ discussion with NHS England about a few practices who had missed claims for immunisation payments. Compared to the childhood pneumococcal dispute that we took legal action over a few years ago (and lost on a technicality), the figures were small, but significant to individual practices. We were advised that the claims could only be looked at if there were ‘exceptional circumstances’.

Well, yes, there are. Our nursing and admin staff are doing an exceptionally demanding job keeping up to date with the exceptionally complex immunisation schedule, jabbing exceptionally screamy children with exceptional numbers of syringes. It is a rare exceptional circumstance for a practice to miss a claim. As a rule, we’re pretty hot on all claims as our incomes depend on it, but there can be exceptions to every rule, however unwitting they might be. In one case we know that the nurse responsible for the claims had been pole-axed with an exceptionally unpleasant illness when the claim was due. Maybe if we had exceptional staffing levels and admin support then these things might never happen, but we don’t. We put in an exceptional performance around the phone, even if we say so ourselves, and hope and believe that NHS England heard us.

4. GP IT systems to be dragged into the 20th century.
Matt Hancock’s obsession with IT is well-known by now, although he does seem to have at least one foot festering in the Babylon GP at Hand camp. You might have read here before that the NHS is the world’s largest purchaser of fax machines, but when our Mazza steps into Curry’s these days, instead of turning left towards the fax machines he’s heading to the ‘white goods’ section, as the NHS is now the world’s leading buyer of refrigeration systems (you’re allowed one guess why). Now we hear that faxes are to be phased out and any further purchases verboten.

Hang on, though- I might actually miss the fax machine. I use it to send stuff to Primary Link, to reply to queries from nursing homes (which I can sign) and cancer diagnosis acknowledgements…... Ooh no…. I’m not sure about this at all. I’m too old to learn new tricks with the interweb. eReferrals are things that happen to and because of somebody else.

5. Iatrogenic GI bleeds to become a thing of the past.
There’s no naproxen. Anywhere. Simples.

6. Better access to endoscopy.
But just supposing we can get our hands on an exotic non-steroidal to gnaw its way through an important giblet, we should soon have open access to endoscopy to check on our handiwork, at least in the West of the county. Barry and I met with some nice folk from the gastroenterology/endoscopy department recently to discuss how this might work in practice and the criteria for referral and follow-up. More about this soon.

7. Mrs Chair is doing it for the environment.
Did you know that the greenest thing you can do for the planet is to stop having children, or better still, stop anybody else doing so? Mrs Chair has an occasional grumble at the 13600cc total cylinder capacity we have logged with the DVLA, but I’m sympathetic to her view and happy to let her go off to work with SWISH to help redress the balance.

Another boon to the environment is that since 2010 there has been a 40% reduction in the number of community nurses, who had insisted on driving round visiting the frail and elderly, and cluttering up the road network in the process. It’s not looking too clever for the future either. Normally there are 550 community nurses qualifying each year, but Health Education England’s national funding for their 1-year postgraduate course finishes in 2019-20, and a Government part-time 2-year apprenticeship doesn’t start until 2020, meaning potentially no community nurses arriving in the system in 2021. Zilch. Quality planning all round, chaps.

8. Ottolenghi is a thing.
I know there’s more I can do to reduce my personal carbon footprint. I might even stop eating red meat (at least for a day or two), a concept made significantly more appealing by the oeuvre of Yotam Ottolenghi, and a quick squint at (9) below. I’d always thought Ottolenghi was a form of tantric yoga, but it turns out that you can eat it and it’s rather delicious. Mrs Chair and I have been wined and dined by two lots of medical friends recently who’ve used Ottolenghi ideas and themes. We were so impressed, we bought the ‘Simple’ book, and I don’t think I’ve ever tasted anything better than his mustardy cauliflower cheese.

9. Our LMC Medical Director has guts.
He’d already shown passion in his contribution to the conference call in (3). Last week I had a text from our Bazza who was up in London for the Medical Secretarys’ conference. He had been out to a Szechwan restaurant the night before and was proud to announce he’d eaten pig intestines. Ah, “Sausages”, I replied. “No- proper lumens”, he countered. Later in the day he reported a “nice inner glow”, but alas had to cry-off from the LMC Christmas party the following day as the glow had become significantly, and violently, less “inner”.

10. Laughter is the best medicine.
Indeed, it may be the only medicine after April next year, but it was a treat to be in the audience at the Leicester Square Theatre this week to watch our Jess in the final of the ‘New Comedian of 2018’ competition. She didn’t win, at least not in the judges’ eyes, but made her old dad proud, even if he did watch most of it through his fingers, as he had a pretty shrewd idea where most of the jokes were coming from.

11. The NHS has a cunning plan.
We shouldn’t be surprised that the much-vaunted 10-year NHS plan commissioned by the prime minister when she announced the £20 billion funding settlement in the summer, initially flagged to be published in November, has been delayed and won’t now be published until January. The plan is apparently all there, but the recent Brexit carnage means that it hasn’t been reviewed by all branches of government, particularly the Treasury. Now they’ve all gone off for a two-week Christmas break, so must be happy that they have a firm grip on everything right now.

We hear that it will set out the NHS priorities for the next five years (survival, perhaps?) and targets for improvement for the next ten years. How anything can be planned when we appear to be on the brink of being plunged back into the Stone Age is beyond me.

12. I’ve got a new hat.
There is a custom lost in the mists of time that the LMC Chairman gets to wear a new significant headpiece at the Christmas party. Two years ago, at my maiden event, I was given a gold Stetson, whilst the rest of the team were topped in red, and last year, I arrived at the table to find some major antlers. The surviving members of the LMC who weren’t on sick parade had our festive bash at the racecourse last Saturday, and my place at the table was marked by a rather fetching conical number, topped with a gold star some 12 inches from the brim. It’s circled with tinsel and red baubles. Best of all, it’s emerald green and will go rather well with my new passport.

Happy Christmas one and all, and I hope we can all enjoy some well–earned rest and recuperation with our families and friends over the festive break.

I suspect 2019 might get messy.

Cheery St. Nick

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