Saturday, May 25, 2013

Not me, guv.

Its actually now getting quite tedious. First it was all a bit of "fun", then it became the usual staple of black humour and now it just downright seems silly. We seem to be falling over each other to blame someone for the A&E crisis. GPs, risk averse junior doctors, social services..what have I forgot..ah yes, work shy specialists, throw in a few lazy nurses and of course throw in some of those naughty patients - and it's everybody's fault..except that I rarely hear anyone say.."actually, haven't got my own house in total can I blame someone after my house is tip-top?" Oh no, it's the standard line.."Not me, guv..its actually the fault of those.."...feel free to fill in the blank with whoever s name you want to.

I have now read reams of paper on what needs to happen..heck..even attended a few courses for the sake of it. Interestingly..everyone has the answer...on a power point or a flip chart. And I have been seeing the same "blocks", same "solutions"..since 2008. I am pretty sure they have been around since before that...but I continue to be bemused. Bemused at the fallacy that no one seems to actually be able to implement all the sagely advice.

So, you know what...a young Consultant who does significant amount of general medicine, works intrinsically with acute medicine, apart from his speciality has some tips to offer. Bear in mind, this is only for acute Trusts and their Commissioners- not for primary care or OOH. I am not a GP- so have absolutely nothing to offer as regards advice for GPs. So from the creator of the Super Six Diabetes model, here are some Super Six tips. Feel free to ignore- but is a collection of views from like minded Consultants...views shared in that high arena of cerebral debate- a pub.

1. Policy-makers:  Stop being risk averse. You will never get the perfect mix. Sometimes you have to take a leap of faith to make things happen. Cut down on the endless meetings and debates and start somewhere. You think you have heard about the perfect model from the Kings Fund / Nuffield / Faculty of Leadership...hurrah...put it in place. See what happens. Allegedly it can't get any worse.

2. Leaders: Stop lecturing others. If you are a specialist, don't lecture a GP how to run primary care.You don't do their job and possibly think the world revolves around your speciality  so give it a break. Vice versa too please by the way.

3. Leaders: Stop trying to please everyone. It doesn't work. This isn't the X factor, so there is no prize at stake by winning the popular vote. If you feel that every patient needs review everyday by a senior, either physically or at the very least a discussion with juniors and nurses, then implement it. If job plans say they should be doing it and are not, then haul to account. If not job planned  then see what will need to give or invest appropriately.Doing structured regular morning ward rounds isn't rocket maybe "boring for some", but structured job planning can put this in place.

4. Physicians: If you work in a DGH and are a physician, stop behaving like a super specialist. You are a general physician with skills in another particular speciality..well done you...and do please fulfil your specialist responsibility but AFTER you have done your generalist role for the hospital, working with your acute medical colleagues, if not for them. Don't ask the Diabetologist or Respiratory Physician or Elderly care physician to pick up your patient with cellulitis. You went to medical school, its not that complex. They are as busy as you with their outpatient work, so give it a rest. Honest. And oh yeah, also stop making ridiculously banal comments about GPs on ward rounds. You don't do their job- so chill out dude.

5. Commissioners: If you think something needs to happen, commission it boldly. A provider should deliver what is commissioned, so if you feel regular early reviews are essential, put it in the commissioning document. Heck, even CQUIN it for a laugh.If not done, hold provider to account.

6. Commissioners: You want to create integrated care as regards unscheduled care- how about going for 1 provider rather than Tom, Dick and Harry all trying to create a business margin off the poor patient? If people prefer to go to A&E, fair enough, equip it to deal with the higher pressure. Stop using phones, mobiles, telehealth or whatever else to try and create "another" avenue. I have tried it when my daughter was ill- it confused the bejeesus out of me.Hey, how about even considering using the acute Trust as the one provider organisation?

Will this work? Who knows..but you know what? If at least the acute trust delivers all of that, then at least you can't say the acute Trust isn't engaged. I have one simple mantra in life- you can point fingers at others when your own house is in order. In my training period, have seen immense variability as to how acute Trusts want to blame social care and GPs? Go ahead- but AFTER own house in tip top condition.

So do please go and try. We all now have established what the problem is and I am sure there are gazillions of powerpoint slides with solutions over it. How about trying to implement it? If then it doesn't work, then hey, maybe, just maybe, the catchphrase "Not me guv" will be taken seriously. Yes, we know the impact of social care and the rest of it...but when there are so many issues to tackle, it would make any analysis easier once one part of the system is delivering everything they ought to. Till then, otherwise, the finger pointing will continue.

1 comment:

  1. I agree with everything you say, particularly Tip number 6.

    After developing abdominal pain and losing 5kg of weight and being diagnosed with a liver lesion on an MRI scan in SE Asia, my 'cunning plan' to seek the advice of a liver specialist was to attend Kings A&E with my scan images on return to the UK. Despite the best efforts of the A&E SHO and myself speaking to the Liver reg, he refused to see me (I said I was happy to patiently wait all day) and advised me to see my GP and ask for a referral. This I duly did. The referral letter has not yet been typed. It is now the bank holiday weekend. Maybe the referral will be sent at some point next week, and I'll get seen in a provincial hospital in the next few weeks. If its anything serious, I might eventually get to see that liver reg at Kings..

    Disclaimer: I am a GP and believe that GP surgeries and hospitals should provide a 7 day a week service. We need good GP surgeries and good hospitals, period.