WHAT DOES THE DOCTOR THINK THIS MONTH?

Our monthly fose of wisdom from Dr Ian

December 2009.

Out-of hours cover: Recently, there has been much discussion about the perceived inadequacies in the out-of-hours cover for patient care, partly stimulated by the decision in some parts of Cambridgeshire, Suffolk and Norfolk to cancel the contract of the out of hours provider, one of whose doctors had killed a man with a massive overdose of drug. In my discussions with patients, it has become apparent that most are ignorant of the facts leading up to the current situation, so here is my version of events.

When I took over the Feltwell practice over 30 years ago, I was single-handed, was compelled to live in the village and was on call 24 hours a day, 7 days a week unless I employed a locum or had an arrangement with a neighbouring practice for a little time off. Initially, I did all my own dispensing during surgery - children always enjoyed the medicine bottle jumping up my arm and still talk about it although they are now in their 30's or 40's!. GPs looked after RTAs, usually first on the scene and having the patient/s stabilised by the time the ambulance arrived. We asked all the patients to get their visit requests in by 8am and evening surgery used to finish at about 9pm, with 3 surgeries on a Saturday. Those were hard days, especially for the children, whose father had enormous problems attending their sports days, plays, etc and whose holidays were often cancelled or interrupted because the locum arrangements had collapsed. For me, it was not so much a job as a way of life. There were frequent night visits for asthma, heart failure, diabetes and other problems. The upside was that, over the years, I established a tremendous rapport with an absolutely splendid set of patients who I still miss four years after retiring from full-time practice.

Gradually, the government inspired work load increased and something had to give. GPs got together and formed themselves into out-of-hours cooperatives. Our group comprised the Swaffham, Downham, Boughton, Watlington and Feltwell practices. We employed an answering service, car drivers and hired the DOCTOR cars with green lights and all the communications that came with them. We arranged a massive rota amongst ourselves and, as a result, the doctors had some time off at nights and weekends and the patients had a secure, safe service provided entirely by local GPs, all of whom were of a high standard. Every doctor involved paid £4,500 per annum to hire the services necessary (answering service, cars, driver, communications, etc) and the time on call was provided by the doctors at no charge. In this way, the GPs provided an efficient, safe service and we considered the £4,500 per annum well spent to increase our leisure time at nights and weekends.

Then, about 6 years ago, our jackbooted government was anxious to impose a new, much more controlling, contract upon GPs. They offered to absolve GPs from all out of hours activities (evenings, nights and weekends), in exchange for which, they would take away £6,000 per annum from each GP to fund a new out-of-hours service. Now, GPs were already paying out £4,500 per annum to run the service. The £6,000 cost would only be £1,500 more than they were already paying. £1,500 after tax relief is £900 per annum, so, for less than £2.50 per day, increasingly stressed GPs could have every evening, night and weekend off. Unsurprisingly, GPs accepted the offer and the contract was signed.

Unfortunately, the government had failed to account for the fact that the GPs were working for nothing when doing shifts for the GP cooperative. Obviously, the doctors they had to employ to run the new out-of-hours system wanted full remuneration and the whole system became very expensive. As a result, the out-of-hours system has been pared to the bone and, in my opinion, is far less than satisfactory.

The Moon Man: Last month, we discussed the little man who lives on the moon and was down at the

bottom of a crater washing his smalls in one of the few parts of the moon to have any water. You will recall that he was blown off his legs when two massive rockets arrived from earth, looking for water, and caused mighty explosions when they hit the surface of the moon. I am sure that he will be out of hospital by now and that his wife will have been to the Moon branch of Marks and Spencer (Management and I have travelled extensively around the world and we have yet to find a country without a M & S so I am sure they will already be on the moon) to buy him new underwear. The little man will be delighted to hear that NASA, who spent £49 million bombing the moon, has found "significant quantities" of frozen water. The organisers of the project are "ecstatic" that, in the one mile high plume of debris kicked up by the explosion, they found the equivalent of a dozen 2 gallon buckets of frozen water mixed with dust (that's over £4 million per bucketful!). The scientists are excited because the discovery of mucky ice at £4 million per bucketful brings closer the time when man can colonise the moon; the water could be turned into Oxygen for the men to breathe and into Hydrogen to fuel spacecraft for the onward journeys to Mars. "The way is now clear for manned missions to the far reaches of the solar system". Apparently, the Chinese and the Indians are also keen to build a presence on the moon.

Now, I am fully aware of the benefits we enjoy as a result of space technology. However, am I alone thinking that humans are displaying an amazing arrogance in planning to populate other planets in the future? We have stockpiled enough nuclear warheads to completely destroy the earth and, also, we are arguably gradually destroying our planet through pollution, overpopulation and general environmental irresponsibility. Who on earth are we to even contemplate populating other planets? We have already filled space with untold debris and now we wish to take our filthy habits to ruin other planets. I would be really interested to hear your views on this matter; it may be that I am completely out of line.

Q. Why have no women been sent to the moon? A. Because it doesn't need cleaning yet!

Q. How do you think our little moon man cuts his hair? A. Eclipse it.

Best wishes to you all - Ian G. Nisbet

Ian g Nisbet