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Things are hotting up

Thursday 21 July 2016

So what do you think of the new stuff on the web social media enticing GPs to come and work in Somerset https://gpinsomerset.com (twitter @GPinSomerset)? Jill and the team have done a great job, and if I wasn't gainfully employed here already, I'd certainly be tempted to up-sticks and apply for something locally. I might even delay my retirement. Apparently we have to get anybody on Facebook https://www.facebook.com/GeneralPracticeSomerset) to "like" it, and share it and then it sort of...er...takes off somehow. Obviously (and evidently), I don't do Facebook myself, but do follow Twitter, and that's certainly been one way to try to keep abreast of all the geopolitical shenanigans over the past 3 weeks or so. @drphilhammond is an entertaining one to follow for NHS stuff (not to be confused with Philip Hammond, the new Chancellor).

At least with the fallout from Brexit now settling down, we can all look forward to a fresh start with the NHS. All we needed was a fresh face at the top, a bit of honesty about what the NHS could and couldn't afford, and……oh.

Gosh. How did that happen? It could have been Boris, I suppose. There has been some interesting stuff written about how JH managed to survive in his job. Some believe that nobody else wanted the role, and it was 'imposed' on him by the PM. It would obviously weaken the government position with the implementation of the Juniors contract if there was a new hand on the tiller, and there are significant negotiations taking place now about the new consultant's contract, and the smart money says there is likely to be more conflict ahead with the government over that.

Nevertheless, there is an opportunity right now for a much-needed shift in emphasis in the NHS. Simon Stevens has been writing in the Torygraph and telling the Health Select Committee that a sizeable chunk of the money earmarked for capital spending was being used to plug gaps day-to-day funding, and that low borrowing costs now make it an "ideal moment" for the government to invest more in infrastructure. He obviously sees this as a key moment to make a push. We are told that routine access to 7 day GP services will no longer be a priority in the post-Cameron era.

Meanwhile, the RCGP conference will hear in October that “Systematic underinvestment in general practice and district nursing, coupled with deep cuts to social care, are the main factors driving financial meltdown in the NHS, according to landmark research by primary care academics”. By landmark, I suppose they mean the bl****** obvious. The mood music gets louder and louder- move the money! I hope somebody is listening, and not just that rather irritatingly anonymous DH spokesperson.

On Wednesday I attended the Leadership Group meeting. This is a gathering of the leaders of the CCG, FTs and the Local Authority, and the Chair of the LMC attends as an observer. As blogged a month or so ago, the only game in town now is the STP. The local team presented their outline plan to Simon Stevens earlier in the month, and should have formal feedback in the next week or so. Until then, such detail as there is has to remain confidential. Suffice it to say, though, that although still many more questions than answers, there feels to be some real cohesion developing between the different parties, far more than I have seen in the past at these sort of high-level meetings. The fact that their survival, and the future of our local health system depends on it, would tend to focus minds. There are some very significant developments around the corner, and an understanding that the whole thing has to be built around a sustainable Primary Care system, and that is going to be our greatest challenge- to make sure we are sustainable, and to get proper representation in future discussions. There is a Primary Care working group starting to meet soon, but who has the mandate to represent Primary Care? Practices are all in different places, and not exactly energised or with capacity to take time-out to contribute effectively to these discussions. What role could SPH play here? We are hoping to get more clarity about how Primary care will be involved in the next few weeks.

I spent an hour of my Sunday with a cyclist who' d come off his bike and was lying in a painful heap in a busy Taunton Road. There were no obviously wonky limbs, head injury or blood loss, but he was in considerable pain and unable to move. Someone had already called an ambulance and was told it had been dispatched, but it still took an hour to arrive. I was prepared for a longer wait, having heard via our LMC Yahoo group of two other much more serious incidents: One of the Musgrove consultants stopped to help an elderly gentleman who had fallen in the middle of Taunton a week or so ago. He was on warfarin and appeared to have a fractured NOF. Our colleague waited in the rain with him for 3 hours before the ambulance arrived, despite several remonstrative phone calls to SWAFT. Another of the committee members came across a motorcyclist who had sustained a pelvic injury and was in a bad way, but had to wait for 2.5 hours for an ambulance, despite several further calls to the ambulance service from her and other health professionals who had stopped to help. 60 minutes after the first call, the dispatchers were unable to tell them where the ambulance was coming from, or when it would be there. Under new dispatch rules, unless there is an immediate threat to life, the patient is conscious and breathing, and no significant external blood loss, this does not "constitute a priority”, our colleagues were informed.

We have anonymised the incidents above and reported them to the commissioners (significant incidents aren't left until the next planned liaison meeting). We know that across the country ambulance services are failing to meet their response time targets, and it doesn't take take a genius to work out where some of the added pressures on the ambulance services are coming from. Ambulances are often backed up outside A and E departments (though I understand that locally this has improved recently), and I know many of you will have ploughed through those useful 111 reports and been surprised to see, eventually, that "emergency ambulance response" is the disposition, even if these aren't always the full ambulance with blues and twos. We're told that if an ambulance has been dispatched with an Red 1 or Red 2 response (the most urgent) by an NHS 111 Pathways person, this cannot be subsequently overruled by a clinician. I made the point at the STP meetings that if we are to redesign the local health system and get it back on track, surely we have to address the front door into the system- NHS 111- but we are told that there is a central diktat that we have to use NHS 111, and the Pathways algorithms. Personally, I still think this is ridiculous, as it has knock on effects all through the rest of the system, and will continue to beat my head against the wall.

Talking of which, I had an interesting chat with a switchboard operator at Musgrove this week. A retired GP colleague phoned me to let me know that one of my patients, a retired MPH consultant himself, had been admitted over the weekend, but it seemed he was about to be discharged home despite significant concern that he wasn't fit for this. I phoned MPH and asked the operator if they could find out where my patient was (they could) and put me through to the ward (they tried). I could hear the phone ringing, but was it picked up and immediately put down again several times, and so not answered. I phoned back and spoke to same operator to ask whether they could let me know which the ward was, so I could try again myself later. I was told that they couldn't ("data protection"), but that they could tell me the extension number. Hmm. So I knew he was still on the Admissions Unit. I can understand (perhaps) why they don't want the general public being able to find out where celebs etc might be, but they weren't apparently able to phone me back on my surgery number and let a concerned GP know where his patient was. That's daft.

My eldest daughter recently graduated as a dentist, and last week heard that she's going to spend her Foundation year in what sounds to be a lovely practice in a neighbouring county. Her trainer is a recent Chair of the Local Dental Committee, so obviously a top bloke with his finger on the pulse (and pulp). Thankfully, he seems as keen as I am to get her off my payroll and onto his, and contacted her with helpful advice on how to get onto the local Performers List. At the time she was circumnavigating Majorca by sail (sounds impressive but apparently it's been done before). She had a 3G signal on her phone, and so thought she'd give NHS England a quick ring to sort it out. Oh, the innocence of youth....

After several hours of being passed from one department to another, and at one stage to a different Area Team, her mood gradually darkened. She finally gave up, expressing surprise that nobody there seemed to know what was going on.

Ho hum.

Nick Bray

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