...... surely thats enough

Just got back form the Hawthorns. West Brom are 3 point clear of 3rd place with a +13 goal difference over Hull City. Surely thats job done. Stranger things have happened. But not often. dare I open the champagne? Sod it why not. ! 

Congratulations to Tony Mowbray and the boys. You have, as ever, nearly given me a heart attack this year. but I think thats Job Done. 

Boing ! Boing!

Oh dear!

I appear to have contracted what The Jobbing Doctor describes as Blogorrhoea.

The only thing that is guaranteed is.......

I've just read an article in todays Guardian. I was prompted to do so by The Jobbing Doctor's latest post. Oh dear! I work in a practice very close to the front door of A+E and we have a persistent problem with people attending A+E inappropriately. 

Or we thought we did...

We decided to look at it. we reviewed our A+E attendances with the help of data from the local department (who were extremely helpful and with whom we have good relationships). And guess what...

Some people attended A+E inappropriately.

but......

lots of people had accidents........ got ill...... needed emergency treatment!

We have recently undertaken a review of our non-elective admissions in our elderly population. This review involved a comprehensive integrated medical and social assessment of potential at risk patients.  Guess what.......

A few admissions could have been avoided

but......

A lot of elderly patients with multiple pathologies needed the specialist care that could only be provided in hospitals. 

As GPs we have taken on the management of many conditions that in the past would have in been dealt with in secondary care (e.g. Diabetes, COPD, Heart failure) . In my brief career I have seen some condition that would have been managed at home moved toward secondary care (e.g. MI's, Strokes, Labour). It is likely that such flux will continue. 

I am a GP trainer and registrars frequently come to me with the question "how can I keep this patient at home?" This bothers me. Surely the first question should be " Is it appropriate to keep this patient at home?"

The reality is patients should get the best care in the most appropriate environment based on best practice at that point in time.  The vast majority of GP's seek to use both elective and non elective secondary care services as appropriately as possible. A small number of people (both patients and doctors) will misuse the service but to penalize any part of the health service for this small amount of inappropriate use is to the detriment of everyone. 

I fear that practices close to A+E departments will be unfairly penalized under this system. Most of these practices are in areas of high depravation (you can't build a large building like a hospital in affluent areas these days the land is too valuable).

There is only one certainty in life and that is death. For the majority this is proceeded by a period of ill health. The vast majority of people only use the health services when they need them. People go to hospital mainly because they are sick. I hope when my time comes that the services I need are available and I can be cared for in the right place. 

The cost of a justice system that is based on "Innocence until proved guilty beyond reasonable doubt" (something our regulating body has recently dropped!) is that some guilty people go free. The cost of a health service that is free at the point of delivery is some abuse of the system. 

I realize that the above is a little disjoined but what i am trying to say is "free" health care "costs". Its expensive but its worth it. 

Are we prepared to pay or are we going to allow the system to be squeezed out of existence?

Well deserved

A colleague of mine will be receiving a prestigious award tonight for their services to General Practice education. I cannot be there to celebrate with him due to family commitments but I wish him all the best and hope he enjoys it. 

He has been one of the most influential figures in my career development and like many excellent GP's working in our area I owe him a great deal of gratitude. 

Thank You..... You know who you are!

.... we will not tolerate offensive language

I recently had the good fortune to visit Wembley stadium. My team where playing in the FA cup semi-final. This was my first visit to the new Wembley and despite reports I had received from others I was genuinely impressed with the new national stadium.

Prior to kick off there was a rolling series of notices on the big screen. This included a clear statement that the use of foul and abusive language would not be tolerated and that offenders would be removed from the ground. This is entirely appropriate an FA Cup semi is a family occasion and abusive behavior has no place in football on or off the pitch (something many professional players would do well to remember).

In an attempt to keep the crowds entertained prior to kick of the clubs home ground announcers were invited onto the pitch to encourage supporters to make some noise. 

The Pompy announcer dutifully called for a chorus of the Pompy chimes and the crowd obliged...A harmless ditty.

Then the West Bromwich Albion announcer stepped up......  and encouraged the crowd to sing a long to " The liquidator". For those of you unfamiliar with this it basically involves repeatedly singing:

"F*%k off the Wolves......West Brom"

Genius! Well done thanks for making it a family occasion. Needless to say 33,000 Albion fans were not removed from the ground. And before any Albion fans start having a go let we make it clear I am an Albion fan. 

The West Brom/Wolves rivalry was recently voted the most bitter in the country. The games are often marked with violent outbreaks (granted from literally a handful of idiots...but it happens). This is often not helped by unnecessary media hype for the week prior to the game.

If the Albion do get to Wembley again (and I hope its not this season for a play off final!.....I want promotion done and dusted by then) someone at the FA could ensure everyone is singing from the same hymn sheet. 

"The Lords my Shepherd" would do nicely.

I bet there's no one listening who........

About 12 months ago I changes the radio station I listen to in the mornings on my way to work.

 The rolling news station I used to listen to had joined the ranks of many in the media and jumped on the "lets have a go at GP's 'cause they earn too much money, spend all their time playing golf and by default  are poor doctors" bandwagon. (a bandwagon that i suspect has strong government backing). The daily stream of ill informed reporting on my chosen profession was frankly demotivating and did little to help me deliver quality care on arrival at surgery.  I chose to be a GP not by default because I couldn't do anything else but because I felt it was where I could be most effective. To constantly hear General Practice being undermined on my daily commute was simply not good for my own mental well being. I made a choice and switched to my local commercial radio station. (my options were limited I am too old for Radio One, not culturally aware enough for radio three, too culturally aware for classic FM and i don't like Terry Wogan)

This worked. No malicious doctor bashing, harmless middle of the road music and the occasional bit of banter that made me smile. I arrived at surgery having be entertained and I hope I was a better doctor for it. 

all was well until recently.........

The breakfast show introduced a new feature entitled " I bet there is no one listening who............". listeners are encouraged to phone in with their experiences for the general amusement of others. Harmless stuff you might say however recent examples have drifted in a rather odd direction.  they have included:-

• ......... has been arrested while drunk
• ......... spied on their partner
• ......... had a threesome

Now these examples may seem a little inappropriate for a radio station listened to by many whilst on the school run but their latest offering was just plain dangerous.

• ........ Who is putting their makeup on whilst driving.  

Genius! lets encourage people who are already driving without due care and attention to make a phone call at the wheel. People of the midlands don't leave your house unless you are in an armor plated vehicle its not safe. 

I am considering switching back to the news station. I'm not sure it which style of "journalism" is more harmful for my well being!