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Wake up and smell the coffee

Thursday 14 September 2017

Of all the liaison meetings we've had with the CCG, last week’s was the most significant to date. Due to an administrative malfunction there was a mix-up over the timing, but we were keen not to postpone it, so turned up at the LMC offices at 7:45am, armed to the teeth with coffee, croissants, and the usual sheaf of commissioning queries, conundrums and cock-ups. This was our first chance to meet Nick Robinson, the new Chief Officer, after a few weeks in post. I suggested that he might want to spend 10-15 minutes before we started on the agenda proper, to let us know how he saw things. An hour later and we were still deep in discussion. He was very frank in his assessment of where Somerset was and how he felt that things needed to change.

There are clearly going to be some very meaty discussions happening around the county over the next weeks and months, and that initial chat flavoured most of the agenda items that followed. We made all the points you’d expect us to make about the state of Primary Care nationally, and also the particular features of GP work in Somerset. Nick Robinson is already making arrangements to visit practices, but we all agreed that a meeting with as many GPs as possible to hear how he sees things developing in Somerset, and have a chance to hear from the troops on the ground, will take place as soon as we can find a date and venue.

The day before, I’d been at the joint board that has been set up to oversee the new collaborative arrangements between T and S and SomPar. I was there in my Team GP (SGPB) capacity and had a 30-minute slot on the agenda to tell them about communications with GPs- what we need to know and how best to do it. Basically it boils down to: “How will my next Monday be better/ more manageable?”, and no, we’re not going to let every Tom, Dick and Harry start putting things in the LMC weekly update. We’re right to be protective of that, but I’ve since been approached by the communications people from both T and S and SomPar about how they can let us know about important stuff, as and when it arises.

I'm pleased to be able to report that my first serious "piece of work" as the practice's CQC Registered Manager has been a great success. It took us a mere 11 months after he started working here to register our (latest but one) new partner. Just after Wimbledon I reported feeling a bit jaded with the constant volleying back and forth of minor quibbles, issues and corrections, with ever more interesting boxes to tick. I handed the baton to the practice manager, hoping she’d finish the rally with panache, but it still took another month or so. I’m resisting the urge to have a “deep dive” into my Registered Manager’s Big Book of Regulations, but I suspect we’ve broken all sorts of rules by functioning as a practice and helping patients without his proper registration. I should probably shut the place down forthwith, or at least unpick and hand back my “well led” badge.

I'm surprised we got to hear about the result from the BMA ballot. It was always going to be a fiasco. The LMCs at their conference demanded the GPC conduct a ballot on whether practices would be prepared to close their lists (and in the process effectively breaching their contracts) in response to unmanageable workloads, but the GPC were very wary, given the reaction of what GPs actually did when push came to shove with the pensions strike of a few years ago. That explained the emphasis when the ballot came out that they wanted to know what practices would REALLY do this time, cross-your-heart-and-hope-to-die really do, as opposed to what happened last time round. It was also clear from the accompanying blurb that the GPC really could have done without this particular luke-warm potato, and the 54% vote in favour of closing lists hasn’t really helped anything. Of course, the GPC leadership has done its best to use the vote to emphasise what we all know about the current state of the workload and morale within the profession, but it’s hardly the stuff of imminent rebellion.

Several colleagues got in touch after the Birds and Bees blog, in which I mentioned sacrificing healthy poultry for the better health of the flock, and questioning whether I had a thing against chickens? Far from it. Apart from the fact that I was actually musing whether we should opt for something similar with our patients, I love everything about chicken, especially if Shashliked or Nandoed. I think it must be genetic: my younger daughter wrote and directed a play in which a spatchcocked chicken played a central, if understandably passive, role. Indeed, if it wasn’t for chickens, or more specifically a small section of their lower bowel, I wouldn’t be where I am today (barrelling across a bouncy Bay of Biscay, reminiscing about chicken guts).

Medicine was my second degree, at a time when postgraduate entry was still something of a rarity. Birmingham medical school was prepared to tailor a shortened course for me on the basis of my previous studies, on the condition that I achieved a modestly reasonable degree first time round. I was actually ploughing a hedonistic and sporty furrow towards a very unexceptional degree, until the research project of my final year, when I discovered the miracle of the chicken coprodeum. I was studying Natural Sciences, and had spent the third year specialising in pharmacology. My supervisor was the Professor himself, and sodium transport mechanisms were what got him out of bed in the morning (as they do in a more physiological way for all of us, I suppose). The coprodeum is a bit of the gut near the egg/manure/wee intersection, and the name always translated in my head as “Holy Crap”, a not unreasonable response when you appreciated just how much current could be persuaded to flow across it if fiddled with appropriately. In a doodly moment in the MRC labs canteen I worked out that if you were so inclined and really wished to make a point, rigging up all estimated 20 billion globally available chicken coprodeums in the mother of all waterbaths could power the whole of Kansas. Or was it Kettering? We kept a flock of chickens in a run behind the labs, feeding half on a normal corn diet, and the others with sodium-depleted corn. They lived a happy life, although it ended with brisk indignity, as I had only 10 minutes from the terminal cluck to get the dissected mucosa up and humming in the waterbath. In the last blog I mentioned the chicken post-mortems I witnessed with the vet that extended only into the trachea. My approach was the polar opposite, as, unfortunately for the chicken, the coprodeum lived an inch or so north of its tail end. Once mounted, bathed and wired up, I’d sprinkle various prostaglandins, thromboxane A2 and indomethacin into the mix and fiddle with an ammeter.

The results were transcribed onto a pile of Fortran cards (remember them?), and I had to book time slots on the University computer, where the obliging Wendy would take the cards from me and later send me the results in all their statistical glory. Looking back, it still astonishes that the alma mater of Alan Turing, nearly 30 years after his death, had a University computer the size of a house, with probably less computing power than are in my bathroom scales today. My project worked out better than most of my colleagues, and I must have sounded enthused when presenting my work at the end of the year, as it lifted my marks just enough to ensure I scraped into Brum. Thank you, chicken. Though not appearing in my final paper, I also learnt that turning what was left after my coprodeumectomy into something akin to what you might find on a supermarket shelf was harder than I imagined, and also inedibly tough.

By the time you read this, I'll be somewhere in Spain, trying to avoid whichever bit of the plain the rain is mainly falling on. We booked the ferry to Santander, and are then heading wherever the mood, or weather, takes us. The only thing I've promised Mrs Chair and myself, is that there won't be any Wifi, although it occurs to me it might be sensible to check-in occasionally to ensure that the remnants of Irma or any of her recalcitrant siblings aren't also planning an Iberian jaunt in their twilight days.

Sue's in charge of Team GP, and Karen's got the reins of the LMC, so that's all good. All I ask of the rest of you is to try, really, really hard, not to vote on anything whilst I'm away.


Nick Bray

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