Saturday, December 29, 2007

The destruction of primary care

The Department of Health is arguably one of the largest collective of malignant fucktards ever seen, the word fucktard is not quite offensive enough to communicate just how offensive and incompetent the Department's worker drones really are. They epitomise the uncompromising ignorance that is exhibited by many of this government's over controlling talon-like outposts. Dr Rant has been venting his fury rather succinctly on the Department of Health's continued assault on primary care:
"The Government are a bunch of cunts.

No, that is too restrained. They are a collection of duplicitous cunts; reneging cunts; lying cunts; and utter fucking cunt-slime of the most dishonest kind imaginable.

And they are cunts who hate doctors. At every stage of a doctors career, New Labour has introduced barriers and obstacles to fuck them over.

Fresh A-level students now have to sit a 'clinical aptitude test' which was forcibly implemented to select candidates, despite the fact it never worked.

The syllabus of a medical degree has lost the core subjects of anatomy, physiology and pathology, to be replaced by the touchy-feely bollocks approaches of 'communication', so that doctors can now empathetically tell relatives that their loved-ones have died due to the fact that they fucked up the surgery / internal medicine / disease management........"

Read on for more of this excellent summary at Dr Rant, I can't help agreeing with him but then again I can see through the government's propaganda campaign against GPs, unfortunately not everyone can. I cannot stand the way in which the agents of the state behave, the way that their vindictive cohorts bully and force, rather than listening and negotiating.

I am not pleading for sympathy or tears, I would just like people to realise that this reform is going to wreck a perfectly good primary care system. The more the government tries to control primary care in its totalitarian manner, the worse things will get. The new GP contract has actually worsened the inequality of access to primary care as the stupid target based payment systems GPs working in poorer areas even more than before.

The current reform agenda is resulting in Fisher Price Walk in Centre nurses being let loose to diagnose and treat after dumbed down four week courses. The Darzi review has not yet been completed or consulted, but strangely his ideas are already being ordered upon us at a PCT level; polyclinics will leave more surgery being done without adequate medical backup in place. An enormous amount of money is being spent to produce a cheap Third world style service, and to me this is incredibly sad.


Anonymous said...

A crucial point Dr De'ath - the public will indeed have little insight into the radical changes you have highlighted [in fact many NHS staff seem equally oblivious, in my experience].

Of course, many of Devils acolytes have postulated that the market will deliver far higher standards than the NHS ever did.

Just think once Tesco/Virgin & Co finally take over there will be no more MRSA, everybody will be seen by a consultant on the same day, and there will be appropriately designed and comprehensive services for ALL our health needs, personally I can't wait.

Dr De'Ath said...

The private versus public argument makes no sense.

Private and public systems can be incredibly bad if run by idiots, while top down systems that are unresponsive to local needs are also quite destructive.

Primary care has worked out well in this country as GPs have had plenty of freedom to run their own pratcices historically, meaning that local services are locally run and clinically driven.

The top down target based government controlled primary care system will lose all that was good of the old system.

Markets for the sake of markets will not work if the overall setup is wrong. Current events show us this.

Personally I feel the market argument is a big red herring, we need a health system that is managed better, in a way that encourages power and accountability to be placed more locally. This is the only way in which improvement can be driven, the current top down control and local blame is the worst of both worlds, while the private sector is fed big fat juicy cherries.

anthonynorth said...

But don't they do a good job of keeping a bureaucracy healthy?

Dr De'Ath said...


the US has one of the most bureaucratic systems around, so I would answer your question with a 'not neccessarily',

but you do raise a good point, as the US system and the NHS are very different but are both tending towards the dustbin in their end product!

My personal views are neither here nor there, but I would prefer to see some costs introduced to the NHS and money directly following the patient in certain ways.

The ridiculously inefficient state controlled internal market gives the worst of both worlds, however a system with lots more private provision does not neccessarily result in a slimline efficient bureaucracy.

Anonymous said...


Merry Christmas and a Happy New Year.

I've enjoyed the blog, I've got 'London' type verbal punctuation, though it's hard to suppress at times. Of course yours is not just a swear blog.

Keep up the good work, the free man has few weapons left in his fight for freedom, free speech cannot be denied in a civilised society.

the doctor said...

My local PCT has been running a scheme for GPs to open on Saturday and Sunday mornings . Several of the practices that I have spoken to report only 2-4 patients attending on Saturday but only requiring repeat prescriptions or to make an appointment . Sunday attendances are
0-2 . Not really good value for the money spent.
I do not think that Browns plan to force GPs to work longer hours are justified , merely Doc bashing .

Anonymous said...

You may be right Dr De'ath but I have heard that polyclinics will be far too big for any single GP practice [or even GP group] to manage, so it is likely they will be offered to private providers, and we already know what happened when SERCO took over out of hours GP work [as one comparison].

Add this to the growing list of ISTC's and PFI initiatives and I think there is a danger that we will reach a critical mass when it becomes almost impossible to distinguish between the public/private divide.

If you are arguing that crap managers [irrespective of sector] and their political masters are the problem then many would agree with you, but even the worst managers don't refer to nurses as "Fisher Price", at least not to our faces anyway, perhaps they have cottoned onto the fact that it is hardly likely to engender a sense of professional solidarity ?

Devil's Kitchen said...

"Add this to the growing list of ISTC's and PFI initiatives and I think there is a danger that we will reach a critical mass when it becomes almost impossible to distinguish between the public/private divide.

If you are arguing that crap managers [irrespective of sector] and their political masters are the problem then many would agree with you..."

As would I. Bad management is at the heart of the disastrous PFI and private outsourcing.

As I have said before, I severely dislike PFI but, in the end, it was not really a proper attempt to introduce private competition -- it was so that our monocular Chancellor could keep the capital expenditure off balance sheet.

Bad management is particularly bad in the case of ISTCs; the idea that the NHS should pay for 8x number of treatments when it only actually sends x people to have the procedure at ISTCs is absolutely fucking bonkers.


Dr De'Ath said...

AE Charge Nurse,

Nurses who work independently in WICs diagnosing and treating after short dumbed down 4 week courses are fairly called 'Fisher Price'- the independent unsupervised practice of medicine should be restricted to those with medical degrees who have completed the requisite amnount of supervised training

the red herring of professional 'solidarity' does not mean that the inappropriate empowerment of the non medically trained cannot be criticised!


I have a great amount of respect for the nurses who nurse and for the specialist nurses who do their specialist nursing so well

Anonymous said...

Thank you Dr De'ath - my concern is that doctors and nurses have been bleating ineffectually about their respective professional problems for far too long.

Lets face it, any blogger [with an interest in health] will tell you that we have all become stuck in a bit of a rut lately ?

Polyclinics are just another symptom of this general trend, as far as I can tell, and our collective inability to formulate any sort of coherent alternative seems to be fuelling the top down arse kicking competition.

I suspect that one of the reasons that protests about MTAS failed to engage the public [to any great extent] was because it was seen as a "doctor problem", and one affecting relatively small numbers, when compared to other sectors, including nurses by the way, who suffered significant job redundancies, as well as failure to place newly qualfied nursing students in well over 50% of cases [for cohorts in some regions].

Should we carry on bleating, or should we do something about it ?
If we do, surely support from ALL sectors of the NHS would be invaluable, at least it might finally wake the public up to the nightmare they might be sleepwalking into ?

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