The Witch Doctor

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THE WITCH DOCTOR’S OFFERING

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Posted by: Witch Doctor | May 8, 2008

Modernising Medical Careers - Third report

” In March 2007, thousands of junior doctors took part in public demonstrations in London and Glasgow. Their protests were followed over the next few weeks by the resignation of several leaders of the medical profession, a legal challenge to the Secretary of State for Health, and a series of emergency statements in parliament. The source of this acrimony was a new recruitment system for selecting junior doctors for training places, the Medical Training Application Service (MTAS). The introduction of MTAS was part of a wider reform programme known as Modernising Medical Careers (MMC).”

MODERNISING MEDICAL CAREERS - HEALTH COMMITTEE THIRD REPORT 8 May 2008 - HTML

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Posted by: Witch Doctor | May 6, 2008

Entrepreneurs wanted for the NOT polyclinics

POLY IS DEAD!

You’ve been delving into the DOH website, My Black Cat?

You’ve found a document on polyclinics where the word “polyclinic” is not mentioned?

“Health Centre” is what your looking for, My Black Cat.

Remember we decided a few weeks ago they would ditch the “polyclinic” word. It was becoming troublesome.

You want to know the meaning of “entrepreneur, My Black Cat?

It’s all to do with judgment and business and investment and risk and money.

Making money.

Lots of money. The aim of most entrepreneurs is to become rich I think. Although some will deny this, of course.

Here are a few definitions:

“A person who organizes, operates, and assumes the risk for a business venture.”

“One who assumes the financial risk of starting and operating a business venture. Usually carries the connotation of being creative, self-motivated, and visionary

“One who assumes the financial risk of the initiation, operation and management of a given business or undertaking.”

STRENGTHENING FAMILY DOCTOR SERVICES

Why do they keep talking about money for GPs, My Black Cat?

“Twelve new GP practices will be set up in some of the more poorly served areas in England. A consultation will also shortly be launched with the BMA on a proposed £105 million investment in existing GP practices to further expand clinical services and to improve access for patients, as well as the implementation of the Doctors’ and Dentists’ Review Body annual recommendations for GP pay.”

“The first practices are expected to be open to patients in less than a year’s time. Primary Care Trusts will work with clinicians and the public to develop patient services that reflect local needs and then look to potential providers to come forward with innovative proposals for the new practices.”

“We will also be consulting on proposals to invest an extra £105 million in family doctor services to improve clinical services and care to patients, deliver better access and improve the responsiveness of GP services, and implement the Doctors’ and Dentists’ Review Body annual recommendations for GP pay.”

“The Doctors and Dentists Review Body recommendations for 2008/09 saw an increase of 2.7% in payments to GP practices for providing core services known as the Global Sum. Taking account of the cost of expenses and the planned impact to correct factor payments would equate to a 0.2% increase in GP earnings.”

Get out the abacus and work out how much of a rise the GP’s will get, My Black Cat?

£100,000 =100%
£10,000 = 10%
£1000 = 1%
£100 = 0.1%
£200 = 0.2%

Less Tax?

You don’t get it, My Black Cat?

Neither do I.

“The 152 health centres we are opening in towns and cities are funded with new money and will sit alongside traditional general practice as an option for patients who want very easy evening and weekend access to their GP.

The clients!

“Improving access to primary care is also a key priority if we are to deliver more personalised care that meets the needs of individuals and communities, especially those in more disadvantaged or deprived areas. Evidence shows there is a direct link between low numbers of GP surgeries and poor health within a community.

Altruism?

Smokescreen!

“This is not just about building extra primary care capacity but developing high-quality, responsive services with a strong focus on prevention. This is a great opportunity for entrepreneurial GPs as well as social enterprises, voluntary organisations and the independent sector to develop innovative services for patients.”

Doctors in the UK made a decision not to be entrepreneurs when they entered medicine. MBChB is the wrong degree for entrepreneurs.

Now, they don’t get it.

Do they, My Black Cat?

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Posted by: Witch Doctor | May 6, 2008

Polyclinics - watch out, poachers about

FROM TODAY’S “TIMES”

“The Times have run off with your abacus, My Black Cat….

Don’t be ridiculous!

“LENDER AND A BORROWER BE

Spend a lifetime in an isolated cave with a gnarled soothsayer and an abacus and you may be able to make sense of the following……….”

And look out for the shadowy figures with torches….

“What’s more, polyclinics will be instructed to poach patients from practices, according to official government documents obtained by Pulse “

And I see the great Sleeping Warrior of Arran has roused and made his way to “The Times” too, My Black Cat.

“Dr John Ip, of Greater Glasgow and Clyde LMC, told the conference that Darzi is hellbent on running down general practice and should be ashamed of himself “for becoming Gordon Brown’s puppet”

“Crescendo” they say.

Crescendo!

They may be right about that, My Black Cat.

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FROM TODAY’S “GUARDIAN”

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Posted by: Witch Doctor | May 6, 2008

The people of London want polyclinics!

You’re looking for details of a statutory consultation, My Black Cat.

You want to get the abacus out and confirm the design and the statistics.

Just in case there is a rat hiding there……..

Keep mooching around, it’ll be hidden somewhere.

“Results of a statutory consultation on the London plan, seen by the Guardian, showed 51% of people and organisations were in favour of amalgamating almost all GP practices into 150 polyclinics, with 29% against and 20% undecided. Commissioners from 31 primary care trusts are expected to give the go-ahead next month for pilot schemes costing about £20m apiece. They would be built next year and start treating patients in 2010.”

And you think the tactics are now to get clinics set up in London first.

Boris doesn’t seem to have much of a say in this.

Not within his remit.

Wonder if he has access to the document?

You think polyclinics for the rest of the country is too much of a hot potato to tackle at present.

Later, you think, My Black Cat.

After London has been set up…….

Ha, I love the bit about the “roving hospital consultants”

That’s one way of putting it.

They tried it once before.

It was not cost effective.

Wonder what they’ll do to make it cost effective this time?

Eh, My Black Cat?

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Posted by: Witch Doctor | May 5, 2008

More from never never land

What have you unearthed now, My Black Cat?

NEVER EVER

” The controversy over “never events”. Cigna recently published a revised list of “potentially non-reimbursable” events that has the medical blogosphere all aflutter. Me included. Apparently, urinary tract infections from indwelling Foley catheters ought NEVER to happen. Nor is it conceivable that the little old lady on the floor one week after abdominal surgery could lose her balance, fall and break a hip. And central lines aren’t allowed to get infected anymore. Decubitus ulcers in demented nursing home invalids who swing by the ICU for a short stay will no longer be accepted. The sickening thing is that this is all done under the guise of “improving patient care”. In reality it’s about controlling costs. So I don’t get paid when I get consulted to debride a rancid sacral ulcer that’s been there for probably a year? ID doesn’t get paid for their consultation on an elderly patient with urosepsis?”

NHS - An alternative

What is it, My Black Cat?

I’m resting and reading…..

“……..My wife had minor surgery in September. It was ambulatory surgery where she went in the morning and went home that afternoon/evening. Even though we have full PPO coverage and it was participating doctors, hospital, etc. my out-of-pocket costs after insurance were almost $3000! The surgeon received a whopping $472 from the insurance company for the operation and the hospital billed like 17k! When I called the hospital they said they did not expect to get paid that much, but had to bill it so they could get as much as they could. I than had to negotiate what I would pay out of pocket beyond that. I also had to pay the anesthesia, the prescriptions, etc………”

Can you imagine being very ill, My Black Cat, counting up each item of service, selling the house to pay the bills, and after all that, just dying!

Obscene!

THE MARKETPLACE IN HEALTHCARE

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Posted by: Witch Doctor | May 4, 2008

Labour MP breaks ranks on polyclinics

YORK POLYCLINIC PROPOSAL ATTACKED

“CONTROVERSIAL Government plans for a new privately-owned “super-surgery” in York have come under attack from an unexpected source - the city’s Labour MP.

Hugh Bayley has broken party ranks to urge ministers to tear up plans for a giant polyclinic which would bring GP, pharmacy and social care services together under one roof, creating fears that patients could be forced to pay to see a doctor……”

a red apple ……………………

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POSSIBLE POST-GRADUATE TRAINING STRUCTURE

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Posted by: Witch Doctor | May 4, 2008

The Role of the Doctor and MMC

MY BLACK CAT’S HOMEWORK

They are starting to consider “The Role of the Doctor”

And they have scrapped the nasty yellow and blue boxes from last year.

Do you think they have, My Black Cat?

First look at this proposed training structure. It is still a bit confusing and at the moment raises more questions than it gives answers.

Now, once you have studied that, download this PDF below.

THE ROLE OF THE DOCTOR

Study it carefully.

Very carefully.

And once you have done that, scroll down and review the content of two posts we put up last year when we were of the opinion that ALL doctors should be offered training posts.

Tell me whether you think things are moving towards this slowly.

And tell me how the new structure fits in with the skills escalator.

And whether it sets the scene for LEVEL 8 medical consultant practitioners who become inter-twingled with other shady consultant practitioners who have come up the skills escalator.

And tell me whether you think the “expert” consultants will sit at Level 9 of the Skills Escalator?

Do you think they will be real experts in their field?

How many will there be and how do they get there?

Consider the vulnerability of this structure at consultant level.

Consider how easy it would be for Level 9 consultants to be selected for their “leadership” qualities, rather than clinical expertise.

LEADERSHIP is becoming a buzz word.

So, consider what this government might mean by “leadership”

Will you do that, My Black Cat.

Because I’m having a lull for a full week while I try to digest the full implications of the Lords opinions on the BAPIO judgement.

Witch Doctors are not good at reading legal documents.

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Here are the two old posts I want you to read while I’m gone, My Black Cat…….

(The Original MMC diagram has been removed from the link.)

A NEW KIND OF MMC 25 April 2007

LOOK AT HIM. HE’S TAKING A BREATHER BUT STILL WORKING. WHAT’S WRONG WITH THAT?

Interactive version of the MMC Master Plan

Yes, get rid of the scary Yellow Box and the two threatening Pale Blue Boxes too!

They need to be buried for good.

And stop meddling with little fistfuls of feeble competencies.

Many competencies are essential in the development of an Independent Medical Practitioner. But so are attributes.

Collecting a smattering of competences is just a smoke screen that will allow Great Uncle MMC to pretend “Yellow Box Doctors” are “Independent Medical Practitioners.”

Just a smoke screen.

Just a way of fooling everyone that the NHS is not crumbling.

WHAT IS THE ANSWER?

The answer is a single spine training structure with the yellow and pale blue boxes removed and dumped. Permanently. Instead there needs to be, at certain stages, many “taking a breathing space” places for those that need it, when they need it.

Think about it. With a 70% female workforce many Breathing Spaces will be needed. It is better they are planned than happen by default. A significant number of male doctors may choose to get their breath back too.

There are many reasons for occupying a Breathing Space. Pregnancy, children, elderly relatives, physical and mental illness, quality of life issues, quality study time, research, or just a welcome break from the bureaucracy that is the NHS today.

But taking a breather does not mean taking a break. It does not mean not working. It is not a holiday, nor leave of absence. It does not mean leaving and feeling threatened that there is no way back into the system. It does not mean being a second class doctor. It does mean, for some, a slower rate of progression. And a few may, for their own reasons, take a permanent breather, and may never reach their original goal. The choice of the doctor, not the establishment. There is no leaving so there is no problem returning. The door is always open because it was never closed.

This is possible, but as well as altruism and vision, it will need meticulous attention to detail. It is a complex system. It requires many more training posts, many of them moving in and out of part-time hours in time with the Breathing Spaces of any individual. It will need to be personalised and will take a lot of planning locally. However, it is possible and indeed necessary.

And it must be piloted.

Nevertheless, Breathing Spaces are the only way to ensure that the potential of a 70% female workforce will be realised. It is the only way that will give the necessary flexibility dictated by a 70% female workforce.

And a common training spine is the only route that all junior doctors should take to become Independent Medical Practitioners. Any other route has the potential of compromising patient safety.

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COMPETENT CHRISTMAS TREES - 8 August 2007.

CHRISTMAS TREES WITH A MESSAGE (2)

Read this.

“Competency based workforce planning

DH and the Workforce Review Team (WRT) that leads workforce planning across the health care workforce, are now working to develop the ‘Christmas tree’ model as a generic workforce-modelling tool. This will allow national and local workforce planning by individual, local organisations, to assess skills needs and future workforce requirements across levels rather than professions. In the long run this will support the development of competency based workforce planning across the whole healthcare workforce: determining the skills and competencies needed to deliver services and defining these by care group and pathways, rather than specific healthcare professions.

This X-tree modelling approach will enable the roles of the doctors of the future to be captured as part of the multi-disciplinary teams serving patients, and planning the medical workforce could then focus on those roles that only doctors can deliver.“

And below is The Witch Doctor’s interpretation of this:

It is a fact that “Christmas Tree” modelling tools are now being rolled out across the UK.

To the hospital where you work.

Soon the hospital “Talent Spotters” will appear to document the competencies you have already acquired.

It will be slow at first but it will gather momentum.

The Professions are dwindling.

Those remaining professionals will construct protocols, advise, interview, test, examine.

And, take the blame.

As for the medical profession…….

They have to be “Captured” in order to serve.

Captured into the 9 tier Practitioner system between levels 5 to 9.

Many “doctoring” tasks will be removed, so doctors will do what only doctors can do……

Competencies, protocols and clipboards will do everything else. They will become the “talents” of tomorrows health care.

Is this why some groups say we are producing too many doctors?

Probably.

Why then, is Sir Liam Donaldson a voice in the wilderness consistently saying we need more doctors?

Who knows!

Why does The Witch Doctor/CMO Pretender also say we need more doctors?

Because this far-fetched paper exercise is ill-conceived. Its conception is as flawed as a silly old bat without wings. It is more flawed than MTAS. The Witch Doctor can understand why it was conceived. There is a major demographic problem. The stragegic thinking beind this proposed solution to the problem is clever, and on the drawing board is well thought out. It will serve politicians well in the short term. It will make an interesting spreadsheet. Excel diagrams and Powerpoint presentations will love it. However, ultimately, patients will not. Staff will not. This huge undertaking, this elephant in the room, is an unkown quantity, is far too complex, the capability is not present within the NHS to see it through, and demoralised staff will not buy into it. Staff and patients will swim around in a shark infested soup of competencies but the system as it stands will not deliver. Futhermore, it ignores some basic fundamentals of healthcare.

It simply will not work.

In not working it will waste vast amounts of public money.

That’s why we need, and will continue to need more doctors.

That’s why every single junior doctor in this country should be placed within the system so that they are trained to be the very best they can be.

Placed within the system now.

In training posts.

All of them.

Training posts with breathing spaces if necessary.

Training posts which allow these doctors to develop into more than competencies.

Much, much more.

Competencies too. Of course. As it has ever been. Competencies that do not stand alone, but are firmly embedded in the judgement that comes with the experience and excellence earned within the discipline of a sound and learned profession.

A learned profession that this government, and a few slumbering but influential members of the medical profession itself, will soon discard.

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LINK TO UK MISSING KIDS WEBSITE

LINK TO MISSING PERSONS WEBSITE

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The Witch Doctor - Link to a random page

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Posted by: Witch Doctor | May 3, 2008

Hands off! I’m learning!

A WITCH REVISITING A WEEKEND A LONG TIME AGO

The words below ring true with the witching community because we believe learning at its highest level requires freedom and a dash of anarchy.

“Everything that is really great and inspiring is created by the individual who can labor in freedom.”

“Intellectuals solve problems; geniuses prevent them.”

“To punish me for my contempt for authority, fate made me an authority myself.”

ALBERT EINSTEIN

We witches relax a bit by flying around committees looking for an opportunity to cast our Blue Bottle Spells.

But we also are interested to learn from The Humankind, because on occasion we find they talk a little sense. So, we also keep a close eye on all the conferences and meetings going on, and often gatecrash them. We do this very unobtrusively, of course, by remaining invisible. The only giveaway is the gentle Whoosh of The Broomstick as we arrive. You should always listen for this at any meetings you attend. We witches can make The Broomsticks invisible but have never mastered the art of making them completely silent.

Sometimes, we become so interested in what is going on that we want to put in our tuppence worth. When this happens, we disguise ourselves as one of The Humankind and people chatter away to us, never suspecting, of course, that they are conversing with a witch.

THE DISGUISE-A-WITCH SPELL

The Witch Doctor remembers one such occasion many years ago. It was a weekend course on education. It was organised in a university through the Faculty of Medicine by one particular individual who had an interest in undergraduate and postgraduate education. The course was not just about educating doctors. It was about how people learn. It covered learning at its most basic (rote learning), to problem solving, right through the various stages to the highest level of learning - the mind-set of the genius. And fascinating stuff it was too! So fascinating in fact, that The Witch Doctor decided to become visible in order to participate the following day by casting The Disguise-a-Witch spell.

THE PINNACLE OF LEARNING

So on the Sunday, The Witch Doctor mingled with the participants and even contributed a few witch thoughts that doubtless were considered rather bizarre by The Humankind.

The Witch Doctor (disguised) decided to go over and talk to “The Organiser” at the coffee break. This is, very roughly, what he said.

“Some people might argue that if highly intelligent, well motivated individuals who, in addition to their intelligence have been self disciplined enough to collect a fistful of straight A grades in one go, then training them in medicine is easy.

Once they have learned their “times tables” of medicine during their undergraduate years, postgraduate training will easily fall into place by giving each young doctor a list of things they need to know and a list of procedures they need to be able to do. All doors must be left wide open for them. This is a very important part. Thereafter, there should be masterly inactivity by those “educating” them. Left alone, these young doctors in their different ways will train themselves and as they do so, many will move on to the very highest levels of learning. If permitted, they will become the geniuses of tomorrow”

The Organiser asked what I thought of that.

I agreed.

Because that is how we witches learn.

The Organiser was little known then.

But later, he became renowned in his areas of expertise (he had several).

The Organiser brought people together, motivated them, and then – hands off. He left them alone to get on with it.

And they did.

The Organiser, himself, was a very high level learner.

You will all have heard of him.

All of you.

But we witches never reveal those we meet up with when we cast our “Disguise-a-Witch” spell.

Never.

a red apple ……………………

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Tags: Albert Einstein, genius, Learning

Posted by: Witch Doctor | April 30, 2008

Chilling…….

LOCATION, LOCATION, LOCATION

READ THIS

AND THIS

Consider whether you would like your GP to be employed by a multi-national and where the surgery should be located.

Think about it every time you eat a crunchy strawberry or a pear like a turnip.

Then think about freedom.

a red apple ……………………

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WHAT MORE CAN THE GOVERNMENT SHUT DOWN?

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Tags: Polyclinics

Posted by: Witch Doctor | April 29, 2008

George Monbiot on Polyclinics

A “MUST READ” SUMMARY IN TODAY’S GUARDIAN

It is good that George Monbiot thinks it is important to continue to write about polyclinics, because his ability to transfer his thought processes to pen and paper is exceptional.

In today’s Guardian, he has a piece called “The Great Consolidation”

OH YES, DOCTOR’S SURGERIES

Below are a few snippets to whet your appetite.

It puts everything that is happening under the aegis of “The NHS Plan” in sharp perspective.

SHARP PERSPECTIVE

Are you old enough to remember Beeching?

“But we haven’t seen anything yet. We are about to be confronted with the biggest shutdown of all: the government has started the process of closing England’s network of doctors’ surgeries.”

A little paragraph says it all. Hide the important bit right in the middle. Then neither the punters who read forwards nor backwards will get to it!

“If you know nothing of this, don’t blame yourself. The announcement was buried in an interim report published last October by a health minister(1). The report was 52 pages long, and the policy was explained in a single paragraph on pages 25 and 26.”

About Lord Darzi’s “consultations.” The dead citizen’s jury in Birmingham perhaps. The evanescent report that has gone “walkies” on the WWW.

“The policy was launched by Ara Darzi, a colorectal surgeon who has been raised to the peerage and made under-secretary of state for health. He wrote his interim report in three months, during which he claims to have spoken to thousands of people. But it contains no record of who they are, how they were selected or what their answers were: he reveals only that “their views have helped shape this interim report.”(3) His final report will not be published until June, but the Department of Health has instructed England’s primary care trusts (PCTs) to advertise for bidders for the new polyclinics by May 2008(4): the first notices have already been posted in the Health Service Journal.”

The “for profit” and the clandestine “not for profit” multinationals.

“What mysterious hold on policy do the corporations possess, that they can persuade this government to wreck Labour’s finest achievement and damage its chances of re-election?”

Please read it all by clicking on the RED LINK.

Please!

a red apple ……………………

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Posted by: Witch Doctor | April 29, 2008

Roy Lilley on “Creative Discomfort”

ARE DOCTORS VICTIMS OF CREATIVE DISCOMFORT?

The Witch Doctor remembers the time when Roy Lilley was a darling of the 1990 Thatcher health reforms, and sometimes wondered what had become of him.

He popped up on Friday on Radio 4.

He was one of the people interviewed on “ANALYSIS, WAR ON THE PROFESSIONS”

Presumably he was invited to give “balance’ to the programme which was dominated by “The Professions”

This is what Roy Lilley thinks is happening to “The Professions”

“We’re seeing effectively the de-skilling of the professions, so their power is I think ebbing away.”

“And I think also there’s the general erosion of the professions now within the health service. Much of what doctors used to do is now done by nurses. Much of what nurses used to do is now done by healthcare assistants. We’re seeing effectively the de-skilling of the professions, so their power is I think ebbing away.

“Wherever there are professions, I think they’re under pressure. The technology and de-skilling is undermining them all.”

His views on disciplinary committees for “Professionals”:

“I think that all discipline committees should be composed entirely of lay members”

On putting pressure on “The Professions”:

“You have to put the pressure on the professions. For example, I think the government’s policy to introduce the private sector with independent treatment centres, that was a very good example of creative discomfort because we had the private sector arrive with (in some) a caravan in the car park and they did the cataract operations, and so all the cataract operations were done by a South African company in a caravan in a car park and it was done very well and the caravans were fantastic operating suites”

Mr Roy Lilley is a Freeman of the City of London, a Fellow of the Institute of Directors and a Fellow of the Royal Society of Arts. He paints in watercolour, plays the guitar, dances ballroom dances, writes books, will design a Powerpoint presetation for you, gives after dinner speeches and is even A MAGICIAN.

He tries to eat a gluten and wheat free diet.

(The Witch Doctor, at this point, discarding all protocols, has made a differential diagnosis and is well on the way towards a definitive diagnosis)

He is a very creative man.

Is it any wonder, therefore that he thinks discomfort should be creative too?

Perhaps the GP’s are being targeted as an art form.

“GP’s, Polyclinics, Creative Discomfort.”

You say you can feel a Turner Prize coming on using this creative concept, My Black Cat?

Don’t be silly, My Black Cat, “Creative Discomfort” is just a silly old Blue Bottle Spell!

A Blue Bottle Spell that has travelled far but should have been nipped in the bud.

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Tags: Add new tag, Creative discomfort, de-skilling, Professionalism, Roy Lilley

Posted by: Witch Doctor | April 28, 2008

The Witch Doctor’s WRATH!

A PERMANENT CHANGE IN ROUTINE

As from tomorrow, The Witch Doctor, The Witch Family and The Witch Extended family, will shop in our small local struggling high street shops for meat, fish, fruit, vegetables, washing powder, baked beans, tomato ketchup and everything else you can think of.

WE WILL HELP THEM THRIVE!

We will free ourselves.

For evermore!

From tomorrow.

Absolutely!

Why now?

Why the wrath?

You ask.

a red apple ……………………

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CHEZ SAM’s- WAR ON THE PROFESSIONS

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Polyclinics

Tags: Add new tag, Shopping

Posted by: Witch Doctor | April 27, 2008

BLITZ. Why? Why now?

THE ATTACK ON PROFESSIONALISM - WHAT MIGHT BE THE MOTIVE?

On Friday, Sam unearthed an important interview that was broadcast on radio 4.

It is due to be repeated tonight. (Sunday 27th April at 21.30 BST)

It is called:

“ANALYSIS: WAR ON THE PROFESSIONS”

Three groups of professionals representing architecture, law, and medicine were interviewed.

The cast of medical practitioners who gave their opinions on various matters were, in order of appearance:

Mr Bernard Ribeiro
President of the Royal College of Surgeons of England

Professor Peter Rubin
Chair of Postgraduate Medical Education and Training Board (PMETB)

Sir John Tooke
Senior Physician, Chair of the Medical Schools Council

If you know the background to recent controversies regarding NHS reforms, you will know why not all these doctors are in total agreement.

This government has divided and has attempted to rule the medical profession.

The Witch Doctor recommends you visit Chez Sam’s for further information and links. She will lead you to a transcript and audio of the whole text of this programme. She is uploading other very informative posts too.

BLITZ

It is the first time that The Witch Doctor has come across the term the “The Skills Escalator” used in a very public domain like the BBC. Normally it is hidden well within government websites or is given an airing by medical or academic bloggers.

My Black Cat is of the opinion, that the Blogosphere is now making its mark on society over serious matters, and governments and the media ignore what is being said by bloggers at their peril. She says those in the high places are now reading blogs on a daily basis and sometimes acting upon them.

Of course, My Black Cat has always had delusions of grandeur, so this notion has to be taken with a pinch of salt.

There is A New Cult being generated by this government: A cult that attacks professionalism: A cult that undermines intellectual capacity: A cult that is attempting to sway this nation into worshiping competency rather than the excellence that professionalism continuously strives to grasp: A cult that is attempting to turn healthcare into a commodity in order to generate a market share. The government has complex reasons for promoting such a cult. The Witch Doctor believes what this government is doing is very short-sighted and in the long term will be very damaging for the future health, knowledge base, and ultimately the freedom of this nation. The Witch Doctor also recognises that the present government has picked up, and cloned on a culture that was initiated by a conservative government many years ago. However, the conservative “vision” seems to have metamorphosed and is moving in a much more damaging direction than was ever intended then.

Dr. Grumble has picked up too on Sam’s lead and has written one of his rare new posts and re-published two previous posts that are relevant.

DR GRUMBLE - TOOKE FOR THE TOWER?

Some time ago, Dr Grumble closed his blog, because his identity had been revealed and he felt it was unsafe to continue. From time to time he releases old posts written a while ago and when he does this it is because they are relevant to something that is currently in the news. Indeed, it seems as if Dr Grumble is some kind of a prophet, if not a witch, since many of his old deliberations have come to pass. Very, very occasionally, Dr Grumble writes a brand new post and when he does this, The Witch Doctor always pays particular attention, because this means that Dr Grumble feels so strongly about the matter that it is worth speaking out in spite of any danger to himself.

So, keep a close eye out for Dr Grumble’s rare new posts and think carefully about why he has chosen to write them in spite of closing his blog.

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NHS EXPOSED - A NEW LOOK - A NEW NAME

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1 Comment

Categories:

Tags: Chez Sams, Dr Grumble, Mr Bernard Ribeiro, Professionalism, Professor Peter Rubin, Sir John Tooke, The Skills Escalator

Posted by: Witch Doctor | April 26, 2008

NHS - Behind the Headlines

NHS EXPOSED IS BACK!

You’ve been very worried about Dr Rita Pal, My Black Cat, haven’t you?

She just vanished off the face of the earth, and you’ve been missing the titbits of “Sheba” she used to leave lying around for you!

Yes, The Witch Doctor was a bit worried too!

But we knew, some place, some time she would bounce back into the World Wide Web.

And here she is, at the same old address.

Good!

SCOTTTISH LMCs VOTE FOR IMMEDIATE RESIGNATION OF LORD DARZI

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NHS

Tags: NHS - Behind the Headlines, NHS Exposed

Posted by: Witch Doctor | April 25, 2008

Darzi - The Sleeping Warrier is angry!

AN UPDATE ON LAST WEEK’S POST

“GPs voted unanimously that the government was putting patients at risk and belittling the role and expertise of GPs by allowing unqualified doctors to staff Darzi surgeries…”

and

SCOTTISH GPs SET TO BREAK FROM UK CONTRACT

” ‘It’s not us who’s diverging – it’s England who’s going off in a completely different direction,’

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LAST WEEKS POST - CLOUDS GATHERING?

Have you ever been to the Isle of Arran?

A quiet peaceful place off the West Coast of Scotland.

Pretty beaches, waterfalls, standing stones, craft shops, wild honeysuckle, castles and a mountain intriguingly called “Goat Fell”

An unlikely place for an uprising.

Mmm. The mountains of Arran have a configuration known locally as “The Sleeping Warrier”

So maybe not so unlikely, My Black Cat.

ARRAN
LORD DARZI, WATCH OUT, THE SCOTS ARE GATHERING

However, the doctors in Ayrshire and Arran, far removed from the the English polyclinics, global health care predators, Virgin in the wings, dumbing down, wheelie bin doctors, have decided they have had enough of English madness.

Next week, they are going to debate whether they should call for the resignation of Lord Darzi at their annual conference.

” Scottish LMCs may call for the immediate resignation of health minister Lord Darzi at their annual conference next week.

Ayrshire and Arran LMC proposed the motion, which will be debated at the Scottish LMCs conference in Clydebank next Thursday. The LMC says that Darzi’s plans to allow unqualified doctors to staff polyclinics, revealed in GP last month, ‘belittles the role and expertise of general practitioners’.

There is a rising in the East of Scotland too.

“Another motion under discussion at the conference will call for an end to the UK-wide contract, so that Scotland can prioritise its own health needs.

‘Everything at the moment appears to be predicated on the needs of London and the south east,’ said Dr John Rankin, secretary of Forth Valley LMC, who proposed the motion.

He cited polyclinics and extended hours as ‘solutions to problems that don’t exist in the rest of the UK being foisted on us’.

Ha, the Scots are forming a posse!

Maybe it takes outsiders looking in to see, and feel, and take on the madness?

Eh, My Black Cat?

a red apple ……………………

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POLYCLINIC COMMENTS FROM HANSARD

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1 Comment

Categories:

Tags: Arran, Lord Darzi, Polyclinics, Scotland

Posted by: Witch Doctor | April 24, 2008

Hansard on Polyclinics

“That this House supports the family doctor service, and recognises that it is the first point of contact for the majority of patients; further recognises the invaluable role that GPs have in the NHS; regrets the undermining and undervaluing of GPs by the Government; is concerned about the lack of empirical and clinical evidence for the establishment of polyclinics in every primary care trust; opposes the central imposition of polyclinics against local health needs and requirements;…………”

a red apple ……………………

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LABOUR’S SECRET BLUEPRINT FOR POLYCLINICS

Categories:

Tags: Hansard, Polclinics

Posted by: Witch Doctor | April 23, 2008

Polyclinic secrets

MORE MISTRUST - THE EVIDENCE IS EMERGING

You’ve found an interesting link, My Black Cat.

“Hundreds of pages of guidance on polyclinics buried in an obscure section of the Department of Health website reveal the true threat to local GP surgeries.

The guidance shows:

- Labour is planning to end the era of independent, local GP surgeries in almost every area

- Existing GPs are to be left out of the planning for polyclinics

- The Department of Health has advised Primary Care Trusts on ways to avoid consulting local people on polyclinics

Andrew Lansley, the Shadow Health Secretary, said:

“These Government documents show that Labour plan the destruction of the family doctor service as we know it and its replacement by large polyclinic style contractors.”

And he warned that “the independence of GPs and their ability to manage care for their patients” would be lost under Labour’s polyclinic plans.”

Well, go and hunt around for these obscure pages, My Black Cat, and find out for yourself what exactly is being said.

Don’t just take the opposition’s word for this.

And let me know what you find…..

(I bet these pages will be removed by the time she gets there!)

a red apple ……………………

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Categories:

Tags: General practice, Polyclinics

Posted by: Witch Doctor | April 23, 2008

Bernard Ribeiro on post CCT training

MISTRUST!

The Witch Doctor, having been around for many centuries, remembers well the days when fully trained senior registrars would devote a year or so learning a new skill before becoming consultants. This sometimes meant travelling to a foreign land to work at the feet of “the master.” The extra training was not really necessary to give a competitive edge in the job market, because in those days a senior registrar was pretty much assured of a consultant post. It was rather so that they would become the best they could be, in their chosen branch of medicine or surgery.

The Witch Doctor remembers one surgical senior registrar, in particular, who brought back important new vascular surgery skills to a large UK city before he became a consultant within the same health board. Everybody benefited. His surgical skills were impeccable. Patients were in the safest hands possible when they had their ballooning (or burst) aortas repaired, and this surgeon acted as a nucleus for training others in what were then new techniques.

A good thing, you would think.

FOUR HANDS - TWO HANDS LEARNING

The President of The Royal College of Surgeons, Mr Bernard Ribeiro, however, seems to have been criticised in some way for promoting post-CCT fellowships. He says himself in his latest newsletter to the college:

“So why now? There have been those who have been suspicious about my motives for pressing for post-CCT fellowships. Let me try and allay those suspicions. First, it has nothing to do with the creation of a subconsultant grade. The fellowships are designed to enhance the skills of trainees about to embark on consultant practice in a challenging area of surgery. It will inevitably involve a niche area of subspecialist practice.

As a member of the MMC programme board, I have argued the case for additional training posts in surgery and other disciplines where there is a case for consultant expansion. It was clear that further NTNs could not be created while we still had a large pool of post-CCT trainees waiting for consultant jobs.We currently estimate there are 86 CCT holders in surgery who are in transition between formalised training and consultant appointments. The College’s proposals for post-CCT fellowships developed by Professor Norman Williams and Professor Tony Mundy during the course of 2007 were approved by Council in December 2007. Professor Norman Williams was tasked with developing a programme with the specialist associations that would identify centres able to provide such enhanced training without detriment to existing trainees.

The aims of the national surgical fellowship scheme are:

1. To provide an opportunity for post-CCT trainees to obtain skills and experience in their specialty that are not readily available to them within their training programme.

2. To provide a cadre of superspecialists who will deliver their services within a larger group of specialists based within a regional centre

3. To develop research networks within each surgical specialty with the specific aim of conducting large multi-centre clinical trials particularly related to innovative surgical therapy and to provide an improved evidence base for our discipline.”

“These fellowships are not a passport to a subconsultant grade; on the contrary, they will provide successful fellows with new skills in an accredited centre where training will be monitored and quality assured by this College and the relevant specialty association. This will in fact make them more competitive.”
“

POST-CCT FELLOWSHIPS

Since reading the Tooke Report, The Witch Doctor has been wondering whether the concept of post-CCT training would be accepted because of the possibility of it becoming mixed up with a sub-consultant grade ie getting stuck at Level 8 rather than Level 9 of the Skills Escalator perhaps?

The problem, of course, is one of mistrust and suspicion over this government’s agenda for the medical profession and for the future of the NHS.

This mistrust is a very sad state of affairs, My Black Cat, which will not be easily reversed.

The MTAS/MMC affair is reverberating throughout the whole of medicine.

But the problem is not really about the training of junior doctors. It is about the role of the doctor in a complex system which was was discretely being reorganised in a way that excluded the medical profession.

What a lot of damage has been done!

a red apple ……………………

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HOSPITALS BAR NAMED CONSULTANT REFERRALS VIA CHOOSE AND BOOK

Categories:

Tags: Add new tag, MMC, Mr Bernard Ribeiro, MTAS, Post-CCT, Royal College of Surgeons, Subconsultant grade

Posted by: Witch Doctor | April 22, 2008

Pernicious Choose and Book

RECOGNISE THIS CREEP, WILL YOU

“Pulse” carries an article today on how three-quarters of hospital trusts are defying Department of Health guidance and refusing to allow GPs to book appointments with named consultants via Choose and Book.

We’ve been waiting for this gathering momentum.

Haven’t we, My Black Cat?

One in four trusts plan to phase out paper referrals altogether.

They are making the 18 week waiting time an excuse!

In The Witch Doctor’s not so humble opinion, this creep must stop. Unless of course you want to become a Wheelie-Bin Doctor. If you do, this is certainly the route to take.

Can GP’s and consultants not get together to put and end to this pernicious fiddling with the chain of responsibility for patients?

Do you not see where it’s going, for pity’s sake?

We witches despair of The Humankind!

Bah!

a red apple ……………………

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6. MANCHESTER EVENING NEWS

Categories:

Tags: Choose and Book, GP referrals, Wheelie-Bin Doctors

Posted by: Witch Doctor | April 22, 2008

More on Polyclinics

POLYCLINIC COMMENTS FROM THE MEDIA

1. PULSE

2. PHARMA TIMES

3. THE NORTHERN ECHO

4. GUARDIAN

5. TELEGRAPH

7. MEDICAL NEWS TODAY

8. COVENTRY TELEGRAPH

9. ECHO

10. MORE PULSE

11. EVEN MORE PULSE

12. WEBCAMERON

a red apple ……………………

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DAVID CAMERON - TODAY’S SPEECH ON PRIMARY CARE

Categories:

Polyclinics

Tags: Polyclinics

Posted by: Witch Doctor | April 21, 2008

Policy by Powerpoint

A MAJOR ELECTION ISSSUE?

The Witch Doctor fancies that David Cameron and his advisors feel the time is politically right for them to address the polyclinic issue.

The Humankind don’t click much for some reason, so here are some extracts.

But click too, will you!

SHOULD THE GOVERNMENT EMULATE SURGEONS OR GPs?

…..”For too long the NHS has been treated by Government like a surgeon treats a patient - laid out unconscious on the operating table, passively receiving major invasive surgery. Instead we should treat the NHS more like a walking, talking, conscious adult, in its right mind: in need of treatment, yes, but able to understand what’s going on and, most importantly, able to take significant responsibility itself. In a word, we politicians need to treat the NHS as if we were its GP, not its surgeon….”

ABOUT ASSAULTS ON THE NHS

“It is genuinely impossible, looking back, to trace any coherent direction in the path of Labour’s health policy over the last 10 years. The one constant has been a restless series of changes which, to the NHS itself, have felt like a series of frontal assaults. It all reflects Labour’s seduction by management consultants.

It’s said in the private sector that no-one ever got fired for hiring IBM. The same seems to go for the NHS. You see it in all the constant upheavals: the PCGs and the PCTs, the SHAs and the StHAs, the fiasco of the junior doctors system which replaced recruitment by human beings with recruitment by a computer, and an incompetent computer at that; the billions - literally billions - of pounds of public money wasted.

It’s all the product of Labour’s bureaucratic mindset, or what I call policy by PowerPoint: clever flowcharts and organograms which ignore the human relationships that are the most important aspect of healthcare.”

ABOUT THE GP CONTRACT

“It is fundamentally dishonest for the Government to blame GPs for agreeing to a contract that ministers negotiated and urged GPs to accept. Nor is it GPs’ fault that they are being paid far more than they or the Government intended - it’s the Government’s fault for miscalculating doctors’ workload. And that’s what happens when you organise the health service using top-down bureaucratic methods dressed up to look good on a PowerPoint presentation.”

ABOUT PRIVATE PROVIDERS

“I often can’t help thinking that Labour have been blinded by the private sector - not just management consultants but private providers too.”

ABOUT THE WORST OF BOTH WORLDS

“Indeed, the Government has spent 10 years oscillating between the rhetoric of local decision making on one hand and their instinct for central control on the other.”

ABOUT THE ROLE OF THE GP

“And there is a good health rationale for GP budget-holding too: what’s called the continuity of care. The family doctor service is the way to ensure that - even though the patients may see many specialists - there is always one doctor in charge: the doctor closest to the patient. This is especially important when it comes to preventative action or the management of chronic conditions, which require significant patient involvement.”

ABOUT POLYCLINICS

“Now they are trying to abolish the family doctor service. Communities which have lost their Post Office, their local shops, their local police station, are going to lose their doctor. So the Conservative Party will fight Labour’s plans to close GP surgeries. We pledge to save the family doctor service from Gordon Brown’s NHS cuts.”

ABOUT MODERNISATION

“A truly modern health service would enhance the small local GP surgery, not abolish it.”

ABOUT GP’S PETITION

“I want us to establish now the consensus we need for a primary care led health service in the future.”

ABOUT THE FUTURE

“So we will formally make the NHS independent of Government control. And then last - the conclusion of these reforms - a transformation of the Department of Health itself. From the national manager of primary and acute care, to the agency responsible for public health.”

Well, My Black Cat, the NHS is going to become a major election issue.

Mr Brown would do well to realise that every voter in the land uses the NHS, works in the NHS, or has a close relative who uses or works in the NHS.

Everyone!

Elections can be won or lost on the NHS!

And sooner or later, this government’s spin that is demeaning the medical profession, so that voters are blinded to the multinationals waiting in the wings, will turn sour.

On that we agree, My Black Cat.

a red apple ……………………

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