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Waxing Lyrical

Friday 5 July 2019

It was a genuine pleasure to catch up with our Primary Care Network Clinical Directors when the GP Board hosted a meeting to get them all together last week in Taunton. Most were able to attend, and it’s always useful to put faces to names. The overall vibe was positive, both for the meeting itself and future relationship between the CDs with the LMC and bodies such as the GP Board and Somerset Primary Health. There are some new and inspirational leaders in our midst, and we need to look after them. It wasn’t all sweetness and light, however. A few areas are struggling to get traction, and the biggest risk to PCNs establishing themselves, and providing the buttressing that the constituent practices so desperately need, is lack of clinical engagement from the GPs themselves. The reasons are patently obvious, and what we need more than ever is an early success, something palpable, easily visible to other practices/networks, that changes the way we work by reducing workload significantly and/or offering new and exciting options to those of us sitting in front of the punters for whom we can currently only stroke our chins wistfully. That’s not too much to hope for, is it?

One thing I picked up from one of the CDs at the meeting was the concept of the ‘Black Box’ exercise. No doubt mindful of how many new NHS initiatives tend to crash and burn, the concept is to imagine sitting in a meeting five years hence (it isn’t hard to do), picking over the wreckage of whatever has fallen apart, identifying what could have gone wrong to cause its demise, and coming up with possible mitigating actions to put in place now. Our colleague had been asked to imagine such a scenario for PCNs. I suspect we all could if we tried, and if as a result we end up in fewer retrospective ‘deep dives’ in years to come, it would make the LMC Executive Director, at least, very happy.

Close on the heels of our meeting with the CDs, we had a further ‘Primary Care Provider’ meeting, where representatives from the LMC/GP Board met with colleagues from SPH and other ‘at scale’ providers- the Alliance Trusts (T&S/SomPar), YDH and also Symphony Health Services. We discussed what a ‘Provider Umbrella’ organisation might look like and what it could offer to practices and networks. Towards the end I leapt to my feet and did my best to summarise the discussions in diagrammatic form on the nearby flip-chart, but was obviously short on élan, and was metaphorically elbowed out of the way by our Harry, who clearly had a much stronger mental image than me. We will be presenting our ideas to the providers and Clinical Directors shortly.

Blimey- that was quick, and I’m impressed. A fortnight ago I had a moan about the interminable CQC process to register a new partner, and issued a Trumpesque challenge to the new Chief Inspector of Primary Care, our very own Rosie Benneyworth, that perhaps she’d like to sort this stuff out? In her blog last week (other blogs are available), she announced that they’ve streamlined and simplified the processes so that the average turnaround now is twelve days, compared with the ten weeks previously agreed in the service level agreement.

That’s a great start, Rosie. The process could still be simplified further for us straightforward GP folk, but thank you and well done. I’m sure Rosie would love to have even more direct feedback from the troops, but my brain melted trying to create a ‘Medium’ account necessary to stick my opinions online. For now, let’s work on the assumption that anything about the CQC that irks us and appears in this blog one week will be rectified and confirmed in Rosie’s blog the next. So that’s all good, I think?

Last Wednesday I had my ‘GP Resilience’ interview. This is the NHS England initiative whereby GPs aged over 55 are interviewed by a senior peer in a structured format to discuss their current and future work plans. I reported on the initial meetings we’d had earlier in the year to discuss how the project might work, and that one of my LMC executive team commented to me at the time that on no account should I be allowed to become one of the ’supportive’ interviewers, perhaps conscious that I already had a few toes outside the consulting room door myself.

It was the same day that Mrs. Chair had booked herself on a foraging course with 2009 MasterChef winner Matt Follas, and was busy scouring the Dorset verges and beaches for things to nibble or quaff in the event of a no-deal Brexit, the NHS Pensions Agency going bust, or any of the various other looming catastrophes. That meant that I was on puppy-patrol, and so my chosen GP peer came to the house, not least because she’d already announced that she needed a cuddle (with the puppies). The plan was to fit our chat into their wake/destroy/sleep cycle. Rather like Duracell bunnies, they race around like mad things before running out of juice and collapsing wherever they are. I had to rope my visitor into helping search for the final two black ones that had gone AWOL, found later asleep together at the base of the densest, spikiest and most inaccessible bush left standing in that particular border. The puppies are increasingly destructive and the garden starting to look like a war-zone. What could once have graced the cover of Homes and Gardens is rapidly turning into Flanders Fields, with the odd plaintive poppy poking its proud head above the incipient compost.

The idea of the interviews is to gather and share information that might help keep more of us greying folk in harness for longer. Options from a picking list included improving work-life balance and a more supportive environment amongst others, although ‘wild horses’ didn’t feature. The conversation shifted eventually to what I might like to do in my retirement. Sport- obviously- both participating and watching, is on my agenda, hopefully with more music and writing. How about gardening, she wondered, peering out of the kitchen window across the Demilitarized Zone to the trampled foliage beyond?

‘That garden has obviously seen a lot of love…. once’.

Last Friday saw Barry and I once again sitting in front of colleagues from the CCG, but this time on our turf for our practice assurance visit. The CCG plans to visit practices every two years and discuss with the GPs how the practice is getting on and plans for the future, as well as any concerns or anomalies the CCG might have gleaned from their dashboards. Given the seniority and roles of our CCG visitors, it was inevitable that Barry and I would spend quite some time talking about wider system issues, having established early in the piece that North Petherton was a totally exceptional practice in every conceivable way (and a few you couldn’t conceive).

Does the Tory leadership election fill you with hope? About 160,000 blue-rinsed worthies will pick our Prime Minister in the next few weeks. Either our old friend, Mr Hunt, who lists his stewardship of the NHS as one of his finest achievements, or Bo-Jo, who chose the same day that Cancer Research UK announced that obesity now caused more bowel, ovarian, kidney and liver cancers than smoking, to say that he’d review the ‘unhealthy food taxes’. Inspirational stuff, all round.

Next time somebody asks you whether ‘your ears were burning’, they might just have clocked your new haircut. When did setting fire to bits of your body to improve the cosmetic appearance become a thing? I was in Poole to visit our daughter last week and having an hour free, popped into a Turkish barber’s shop on the high street. He did more or less what I’d expected and requested, and after the mirrory thing at the end, I made to get up. My new friend Berat (I noted his name later for legal reasons) pushed me back down into the seat.

‘We are not finished, friend. What about the ears?’

Admittedly I’d been teased a bit at school but am rather attached to both of them and worried about how I’d keep my glasses on if they were significantly trimmed. Alas, Berat had spotted that I’ve reached that age where all residual follicular activity is diverted through the ears and nostrils, in what our Grand Designer presumably thought would be a colossal laugh.

‘Would you like ear-waxing?’

The LMC and CCG have been involved over the years in endless discussions about removal of ear wax. There has always been a gap in commissioning for this minor medical problem, albeit a significant social one to anybody who has ever found themselves cerumenally isolated from the world around them. Look out for the exciting new local contract coming soon from a CCG near you, one aspect of which will be to pay practices via the Primary Care Incentive Scheme (PCIS) for removal of ear wax.

In an interesting twist, my new friend was offering, for a few pounds more, to top-up my ears with gloopy hot wax that he had bubbling away in a nearby saucepan. Handily, it came pre-tinted with a greeny pseudomonal hue.

‘We leave it for a while and then pull it out again. It will be painful,’ the hard sell continued, ‘but then you won’t have to repeat it for at least six weeks’.

Wow, fancy that.

He was already swathing my head in hot towels as he told me that because I hadn’t conceded to a full auricular waxing, it would have to be done ‘by flames’. Before I could say anything, not least whether or not I was in the habit of dousing my face in flammable Cologne, he was waving a flaming wand just outside both EAMs and wafting the flame to singe the hairs by creating eddy currents with his other hand. The sensation, if not the smell, was actually rather pleasant, although I suspect trying to recreate the effect in the comfort and privacy of your own home might not be advisable.

Can we still get Flamazine® cream? (Just asking for a friend).

Nick

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