Friday, June 29, 2012

It's not the money..silly


It's interesting to see responses to blogs...either in private or via other social media vehicles I regularly use ergo Facebook and twitter. The question has been whether I have ever quite taken a stance as to whether we should fight for our pensions or not. "Foot in both camps" was the term used and when it came from a junior doc who, I must admit, reminds me a lot of myself ( the brashness, the desire to fight the world, the tongue in cheek humour, the burning sense of "we have to make it better"), it felt like it was appropriate to take a fresh new look at the issue. Take the politics away, forget the posturing, forget the Daily Mail headlines about greedy doctors and see it for what it's worth. So I did...spent some time on the DH website, looking at the pension calculator and thought would use myself as a case study.

A bit of a struggle to actually work all the details out, what with the multiple websites, resetting of the pension bar multiple times ( so do excuse if the figures are a bit off, though not by much) but as per the pension calculator, if nothing changed and somehow miraculously, we managed to reverse the pension plans, I could retire at 65, get approximately 43k/ year and on top of that get a lump sum,tax free of 130k. For that, I contribute approximately 8% of my salary to the pension scheme. So far so good and crystal clear.Based on that, I had made some plans looking at the future.
Then comes the change scenario. Now the government wants me to pay, in an incremental basis up to 14.5% of my salary to the pension pot which would ask me to work up to 68, get 44k/year and a tax free lump sum of 115k.Again...crystal clear. Further variations to those numbers exists if I chose to take a bigger lump sum, which would drop my yearly pension, but roughly those are the figures. Compared to the past scheme, I work a bit more, pay more into the scheme and get a bit less.

So lets have a look at the arguments. The main gripe is that the goalposts have been changed and it's true that we have had a pension shake up in 2008, so why again? The reverse question from me to all them is this...forget the past for a second and answer this...if someone offered you a job worth 6 figures for life and a pension of 44k, along with a tax free lump-sum in 6 figures,when you retire at 68, would you take it or not? Agreed that in comparison to the past it looks less attractive but if you don't compare, what would you say? My gut feeling is most would accept and dare I say our nursing colleagues would bite anyone's hand off to have even a part of that. Again, I maybe wrong but that's my feeling. Yes, it was fantastic in the past but we are where we are now, so what to do about that?
Then comes the argument that we pay less than other folks in different walks of lives eg: MPs and as before it becomes a comparative exercise. Similar to the comparison to the past, this one is a comparison to other professionals. Yep, so it looks unfair; yes, it looks like we have been singled out but again, the question is not how it looks compared to other available schemes..the question is how does it look in isolation?
Most importantly , if this is being done to you now- and you are 30 years old, do you have time to adjust for the future? My plans are surely scuppered by the pension change, but that doesn't mean I join the picket lines, it means, at least for me, a meeting with my financial advisor and planning ahead. Still 30 years till I retire..with a very VERY distinct possibility I am unlikely to work that late.

And that is EXACTLY where the biggest problem for me lies with the proposed scheme. it's not about the money, it's about the 68 year old doctor. Now I am no ageist, but I am not convinced or keen to be operated upon by someone who is 68 till I am 100% convinced that that particular Consultants skills or ability to make sharp, quick decisions, ability to keep up with the advances of modern medicine hasn't been dimmed by the advances of Father Time. And that is where the BMA have missed a trick. This battle could have been about patient safety, fighting the case whereby working till 68 may not be a safe option for patients. With the greatest respect to all other walks of life, this is a profession whose quick sharp judgements decides whether someone gets better or not, whether someone lives or not. Is that worth fighting for? Definitely. Would we have engaged the public on this issue? Absolutely we would have. Now, as a double whammy, the BMA wants a repeal of the Health Bill,considers whether to engage with the commissioning process.In isolation, a good plan, as most trade unions who don't agree with a policy direction of their employers would do...problem is, now it looks like we are wanting to do all this because the money being offered as pensions isn't "enough". So in 2 strokes, the BMA have missed the opportunity to get the patients on their side and perhaps some political backing too. Golden rule of negotiations? Never let the other person call your bluff...BMA decided to strike...the other party shrugged their shoulders, no patient support, unsympathetic press, no peer group, co-professional group support...lesson? don't say "raise" when you have such a weak hand.

Finally, the last argument I have heard is that why should we support others pension deficit ( as the doctors pension pot is already in surplus etc etc). Forgetting the socialist argument that we earn more and should perhaps contribute to others (and yes, so should all others who earn more than 100k in the public sector)...and you believe in the view that what I earn is mine/ I have no intention of contributing to others pensions working in the public sector...well, bottom line is...don't like it...fine, why don't you leave the scheme? I am intrigued to hear what my financial advisor says...after all the changes, is the NHS pension scheme still the best or could I put that 14.5% of my salary somewhere else? That is my individual choice and is based on what I think will make MY life comfortable later. For that, to make a point, I will not strike work and as I have said before, let's not kid ourselves that patient care is not harmed by downing tools, elective or non elective. Whatever the label, a patient sees me in an appointment because they are not well in some shape or form, not to discuss the weather.

So to those who still think my position isn't clear..here you go. On face value, the pension being offered is good enough for me. I don't like the fact that goalposts have been changed but it's not going to drive me to poverty and I have plenty of time to adjust accordingly. If my financial advisor says there's something better out there, then I leave the NHS pension scheme, simple as that. What concerns me more is the age uplift due to patient safety, and that is something that SHOULD be looked at.  
Finally, do I say that to curry favour or an ambition to be a politician? Well, there's no hope in hell I will be a politician with my lack of political correctness, and frankly I have moved through the management ranks because of my desire to stay outside the conformity box, not inside. I am not asking anyone else to follow or agree with what I am doing, but it's my life, my finances, my pensions...and that's what I am doing. As I have said previously, what I say in my blog is my individual view and if you don't like it, heck, that's democracy. 
Dennis Waitley once said.."Chase your passion, not your pension". The day my passion to improve diabetes care dims, I will start concentrating on my pension. Till then..the picket lines are not for me.



Thursday, June 21, 2012

Good night..and Good Luck


By the time this is posted, the strike will be nearing it's end. The media will be pouring over whether it was a success or a damp squib, you will have both parties claiming "victory", few stories about how "patients have suffered", a few on how hospitals and GP surgeries have functioned on "skeletal staff" and as usual the truth will lie somewhere in between. In the middle of all this are caught countless doctors, not quite sure whether to twist or stick, caught between the ethical dilemma of refusing to see patients and the right to protest. And it's been fascinating to watch all this.
So far, I have broadly seen 4 groups: the "militants" who think this doesn't go far enough and we should down tools completely and bring the establishment to their knees; the "moralists" who believe we should never stop seeing patients as this is a vocation, the "careerists" who are using this opportunity to denigrate their fellow strikers and sidle up to the powers that be, mentioning how committed they are compared to their dastardly colleagues and then there is the "inbetweeners"- folks who are a mixture of the first 2 groups to varying degrees and who simply don't know what to do.

I rarely read the Daily Mail but today I thought it would be entertaining enough. True to style,it mentions the money the taxpayers will have to pay to bolster those greedy doctors, it dedicates a box to the BMA chair, Hamish Meldrum, showing how much of a wealthy person he is, what sort of house he lives in, he was even given the title of "architect of chaos"..you could nearly hear Aquaman from the  Spongebob Squarepants cartoon shouting in the background.."Eeevvvillll". Now I don't know Dr Meldrum but to me he has come across not as a money grabbing, scheming man but someone who has been extremely dignified in answering all the provocative questions thrown at him by the media.  I am pretty convinced that if someone pointed him out to me as my GP, I would feel more than reassured to see him.Maybe it’s the distinct Scottish accent..but he doesn’t come across as a tax-dodger..or a comedian for that matter…

Anyhow, a few personal stories over the last few days perhaps crystallises the problems doctors face. Recently one of my patients nominated me for an award in the local press. Tongue in cheek I forwarded it to my friends one of whom mentioned jocularly that it was the Kar self promotion at work...and it showcased what inherently we doctors are uncomfortable about..we are uncomfortable about telling others what we do. It's supposed to be a vocation, isn't it...so why tell others that we work hard, do a damn good job and be proud when patients turn around and say thank you? It's just part and parcel of what we do, isn't it? Actually, yes, it probably is...and for all those feeding the tabloids, we also do work darn hard to earn it too.  I get paid a 6 figure salary for a 46 hour week. In my last  week, I have spent in excess of 90 at work...that my friend is the vocational element, that is what we provide without cribbing about it. So the angst is understandable when the media labels doctors in a sweeping statement as a money grabbing, greedy bunch. We are not, and frankly, if we did become so, the NHS as we all know it, will cease to exist.
The second one was me going to a patient support group last evening,for the press folks, a voluntary exercise at 7 pm in the evening- after I had been at work since 730 am. It was an open forum..a meet the Consultant session...and the first question was.."Are you on strike tomorrow, doc?" Answer to the negative drew consenting nods and it was apparent that we doctors had lost the battle of perceptions. We hadn't been able to get across the level of angst that drives a profession built on caring and desire to help to take a drastic step such as refusing to work.  And if you don't have the public on your side, then the battle is lost.

So what could doctors have done...without splitting themselves into the aforementioned groups or giving that opportunity to the press to paint us as the heartless souls we have now become? Think of a scenario where all doctors, unanimously decide to stop answering any emails, phone calls or correspondence, apart from those directly related to the patient in front of you? If I did that today, refused to go to any management meetings, stopped all my emails apart from those directly related to patient care, then without harming a single patient, the powers that be will take notice- as without doctors indulging in paperwork, the supertanker called the NHS stalls. Would have made life easier if the BMA asked us to boycott all non-clinical work for 1 month…apart from making our lives so much better, it would cause enough sludge in the system for folks to take notice. Would we have had patients divided in their support for us? Unlikely. Would we have had the press on our back? Very unlikely.

Then there is the Health Bill, a situation which has created a strange chasm amongst professionals, those who want to use the opportunity to try and see whether the clinician being in charge can make a difference- to those who vehemently oppose it, believe that the NHS as we know it will be damaged beyond recognition. Look at the twittosphere, it's full of clashes between professionals of those 2 camps...we, as things stand, are a divided lot. If we as doctors wanted to make a stand and opted to show the powers that be, then all that may have been needed was a disengagement from the existing process for a month or two...and maybe, just maybe, we may have had both the public but also political will on our side. When doctors as a group fail to protest against the "dismantling of the NHS", as some like to call it and then choose to down tools for their pension, in times of austerity, then its a battle lost even before it began. Heck, we couldn't even get all the Royal Colleges to join forces go oppose the bill...what hope for pensions??

As regards promises that a strike won't harm patient care, unfortunately it does ring a bit hollow. Yes, emergency care continues to be provided, but even when electives are cancelled, harm is done. When the elderly lady who has been waiting for her hip operation patiently, struggling through pain killers, waiting for that day when the operation would give her some relief from the incessant daily struggle...only to find her operation has been postponed...folks...harm has been done…harm has been done to our reputation, harm has been done to that lady. So, as you see my friends, in this particular battle..we have conceded the moral high ground. Look at the deafening silence from any other professional organisations, lack of any public support from nursing unions, physiotherapists, pharmacists..i.e. folks we work with every day...and even on that front, we have been isolated. Lest we forget, the BMA was also the organisation which publicly opposed the formation of the NHS itself, so their track record of standing up for "just causes" isn't the best either! So..in chess parlance..the player at the other end of the table hasn't said "Check, your move"...they have actually said..."check mate" and walked away.

So what now for the disgruntled doctors? We live to fight another day? More strikes? I doubt it as I don't think the public, press or even the fraternity will have the appetite for it. It's likely most will shrug their shoulders and get on to do what they do best..trudge back to work, roll up their sleeves, apologise to their patient for the distress caused...and carry on with the daily grind.  As for me..it's always been pretty easy...contribute 14.5% of my salary in the hope of getting a pension after 68? You must be kidding me!

Have a think...here's scenario A. I am 38 now, perhaps work till mid 50s and then walk away from it all...I would rather at that stage someone younger, fresher took my job while I use my skills in poorer countries, perhaps do some charity work, try and repay back to society a bit of the debts owed...and travel the world at my own leisure and choice for holidays. All that on one side weighed up against Scenario B, where I am trudging to work at 67, in an unrecognisable NHS, but still secure in the belief that I will get a healthy pension at 68. Well, that may appeal to some...but it's one life guys...so no contest in my book at least. And how the heck do I anyway know I will make it to 68?? Do it all for the kids? Sorry...but I hope to educate them enough so they can stand on their own feet- not count the day till dad corks it to claim his pension. 

So, no strikes from me...While I am at this job, I will give 110%,maybe even more... but when I am done...I am done. As Edward Murrow would say with a flourish… "Good Night…and Good Luck”...one gets the feeling that the BMA has just been told that too by the government.

Friday, June 15, 2012

Notes from Philly...

Jet-lag is an absolute pain in the backside...economy class privileges don't quite give you the benefits of ignoring all that, nope, no silk pyjamas or bed, heck, we don't even get silver cutlery! Outrageous I say and down with the capitalists..off with their heads..( of course none of that is true if I am upgraded...British Airways, I love you..don't you forget that...) Add in the fact that my hero, Barack decided to take a visit to Philly which temporarily shut down the airport, causing a near tail ending of aircrafts and the mood wasn't exactly sparkly to say the least.
However, behind all that, lay a fabulous few days.Philadelphia was a fantastic experience on a personal level. It was the American Diabetes Associations annual conference and it's always fascinating to see whether the Yanks way of looking after diabetes is different or not. For once, I had decided to become a student again! Managed to download the app on my IPad, did my own itinerary and I was ready...everyday morning, diligently, I was the at the Pennsylvania Conference centre, attending lectures, going around posters and there was so much to learn! No big nights this time around, people even asked whether I was "ok"! Thought it best to concentrate on type 1 diabetes and adolescents and learnt plenty about exercise and effect on glucose levels, when to advise patients to do aerobic exercise, when to undertake resistance exercise, all dependant on their blood glucose, the concept of fast bursts of exercise to prevent blood sugars dropping low...all very very fascinating indeed.
I sat fascinated furiously typing into my IPad listening to the advances made in type 1 diabetes, listening to some of the great researchers quietly confident that they will have something to reverse or prevent Type 1 diabetes, the science behind it, the hours spent by the researchers.

Beyond the world of Type 1 diabetes, I heard about the surveys done in residential homes, nursing homes around the US and the startling facts and figures. Made me wonder why we hadn't got such financial figures in the UK and promptly sent off an email to Alan SInclair...ahh the joys of technology!!
A walk around the posters revealed some intriguing studies in progress, new drugs in trial, Glimins, new GLP-1 analogies, new basal analoque insulins...no shortage of research all over the world in an effort to make diabetes care just that bit better.Stood by and then tweeted about Roselle Herrings poster at ADA, an example of innovation at Guildford looking into preventing admissions for folks with diabetes.. who says we in the UK don't do good work? Further also made a mental note to set up a session for the team in the department updating them about the "new" things I had learnt in Philadelphia...even managed to surprise myself with the level of diligence...or maybe I was just getting older.

And then there was the company. Apart from folks who I see regularly...it was particularly fun to catch up with the Scottish contingent. I don't know what it is about them...but somehow they don't take themselves too seriously. Gerry, David, Chris, Russell...fabulous company to have around, especially when an England football game was on. In our table at the sports bar, I was perhaps the only guy rooting for England, surrounded by a Welshman, multiple Scots and a Canadian!
Evenings were spent amongst experts debating studies, debating the relevance of tight control of diabetes,and it was a delight to talk to national leading lights such as Simon Heller, Gerry Rayman et al hearing their views on studies. Frankly a better educational event I have rarely been to....but...there was a but lingering in the background.
Time after time, it came back to one thing.... whenever healthcare professionals working in England got together. It was the variability of diabetes care around the country.An underlying zeal burnt amongst all to "make it better" but somehow the answer wasn't there, somehow the frustration bubbled under the surface. Before setting foot on the plane, I had promised myself not to indulge in politics, not to "sort out the world"...this was a trip for my own learning, wasn't it? But as they say, who ventures wins...so it was certainly time the last few evenings to revert to type.
I sat down with Gary Tan, a scarily intelligent man and a better visionary I have yet to meet, sat down with Stephen Lawrence, a mild mannered man with passion, zeal and charm....and it was fascinating to exchange ideas.One theme stood out...if one thinks of it, Diabetes in England are blighted by the multiple organisations they have...Diabetes UK, ABCD,PCDS, CDC,NHS Diabetes...it's like going through an alphabet...the point being that for the general mass out there, a lack of cohesive vision has not, does not help.
Thus were borne the idea of a think tank...why not form a think tank of 8-10 folks taken from all organisations who could come up with a plan or a model which would deliver integrated diabetes care in the country? Throw in people like Gary, Niru Goenka, Jonathan Valabhji ergo people who have actually done this in their locality and you could, potentially, come up with a model whereby patients get optimum diabetes care irrespective of where they live. The recent NHS Atlas of variation of diabetes care makes scary reading and it's time to accept that we ALL have failed our patients, not because we are not committed, but because we haven't been able to rise above the politics to work together.

A document outlining how to deliver an integrated or coordinated diabetes care with all diabetes organisations ( primary, specialist and patient groups) behind it should be accepted by all doubters and in this present climate where the avalanche of data shows suboptimal diabetes care...surely the NHS Commissioning Board and Department of Health would ignore at their own peril? Use the media, show what we are doing as a united force...and trust me, it will work. As I have said previously, the Type 1 young patient struggling with their hypos or the Type 2 patient needing their foot care done, does not care who we work for..they just want to be seen by qualified professionals who know what they are doing and are adult enough about working together, not isolated in silos strong in their belief that "no one else can do it" or "we don't need anyone else".

So for a day, in comic book parlance, I wasn't Tony Stark, the maverick who doesn't work well within teams, I wasn't Bruce Wayne walking the thin line between light and darkness...for a day, I was someone who just wanted to get everyone to the table. It stayed with me even through that jet lag and was the first thing I did when I opened my computer...an email to all the organisations suggesting the think tank, suggesting the possibility of working together with the caveat that we have little time to lose. April 2013 is when all Clinical Commissioning groups go live..and we must have something ready for all CCG to use for diabetes commissioning before this opportunity passes us by. Initial responses have been positive...so I wait...with cautious optimism.
If that comes to pass, then the trip to Philadelphia would have been an immensely successful one..not only would I have learnt something educationally but maybe, just maybe I may have some sort of teeny weeny contribution to improving diabetes care in this country.

And oh yes, sorry about giving up the uber cool role of Tony Stark/Iron Man? Not in the slightest...remember the man who got all the Avengers to the table...? He was Nick Fury aka Sam Jackson...the coolest badass in the planet. Now where did I place that eyepatch....

Thursday, June 7, 2012

Will you....or shall I?


Cattle class..evidently that's the term used for Economy Class nowadays..and you do start to feel it on a long haul flight sometimes. Especially when the movie options are so utterly rubbish too...well, there's only so many times one can watch Mark Wahlberg sleepwalk
through yet another movie or Denzel trying his utmost to make a Ryan Reynolds flick look half decent.3rd option was some movie about a skinny chap ( the teenaged girl next to me squealed something about R-Pat)..evidently he is some sort of heartthrob...tell you what, don't know about his dashing looks, but that fella certainly needs his haemoglobin checked. Anyhow, I digress..in short, the movies were utter rubbish and with 3 hours to go till touch down in the city of Rocky, it certainly was time to have a crack at putting some thoughts down in a blog.

Just before boarding the plane, I was having a conversation with a very dear friend of mine, Mayank ( you should all meet him....he's sort of like the son my mum never had; someone I aspire to be but never will; Clark Kent to my Bruce Wayne..you get the drift..) and we were discussing how a recent job advert in Southampton had attracted candidates of "average" quality. Had an identical conversation with another colleague from Bath who mentioned how 11 candidates had applied but of them 7 hadn't even bothered contacting the department, same conversation a few months back from a job advert in Norwich..and then you read and hear how jobs are scarce, our trainees are all going to join the dole queue, workforce planning is shocking etc etc...and you have to wonder how in a market of such apparent lack of opportunities, the posts being advertised are not having candidates applying in droves, falling over each other to get that job.You ask Consultants around the country doing teaching programmes, educating and you can sense their palpable sense of worry about the quality of trainees coming out.
Don't get me wrong, there are some fantastic trainees out there, on the verge of doing something big, becoming the new stars of the system....but their numbers are a handful. Those stars of the future will be fine, there will be no problems for the Roselle Herrings and Paul Grants in their desire to get jobs, if anything, they will be head hunted...the question is what about the vast majority? I don't know about other Deaneries but in ours, the ones you look at and go "yep, would love to have him or her as a colleague" seems to be far less than previous. Something's missing, there seems to be a general sense of apathy amongst many....it seems that turning up for your work and going home is enough..it's just a job, isn't it?Ask the folks who do annual assessments of specialist trainees...and the general theme is of a few sparkling diamonds and a majority of folks who do as they are told, do as their rota suggests.

Is it because we are attracting the wrong folks? Are we failing to energise our bunch of trainees or is it simply because the bleak picture of job prospects by all of us is just having a demoralised effect on all concerned? Maybe all of the above but maybe a solution could be provided. Or at least tried. My motto in life has always been to look at solutions...do they always work? Of course not...but it's still tons better than just sitting back and moaning about it. Case in point, in 2004, I went to Diabetes UK annual Conference and attended the Consultant-SpR session...god..a more soul sapping, morale destroying session I have yet to see. Figures were shown, bright piecharts screamed back at the audience...there were no jobs, we were all screwed. 8 years later? the same refrain continues...and one is yet to see any position papers, national guidelines from anyone as to what a Consultant Diabetes specialists responsibility is.

The question is whose responsibility it is to do so. As per their tag line, the Association of British Clinical Diabetologists (ABCD), professes to represent the interests of Specialists..fair enough...in that case, why don't you do one? if you want to protect the future workforce, get present trainees to energise themselves, paint a brighter picture, why not a position paper on Consultant Diabetes roles? We all seem to bristle with indignation when GP colleagues question what our role is...why can't we put it down on paper? A position paper on Metformin and Vitamin B12 deficiency, as attractive as it is, is not, honestly, going to change an individuals perception. I will be honest, if I want to make my mind up on the relationship between Metformin and Vitamin deficiency, I am not going to look at ABCD position statements, I will be doing an online search, go through PubMed, weigh it up and make my decision. Similarly for topics such as analogue and non analogue insulins. However, if ABCD come up with a position paper on the role of Diabetes Consultants in the modern NHS, fellas, I am listening.

So..if you want to listen to someone who has never cared for reputations...here's a suggestion or two. Sit down with the YDF, listen to what the SpRs would like to do in a job, talk to Consultants around the country, listen to the frustrations, engage with GP organisations such as PCDS or even political ones such as NAPC, NHS Alliance, find out what they think Consultants should be doing and most importantly sit down with patients or patient groups to hear their views. Listen to all and then come up with a position statement on role of Consultants, what their role should be win an acute Trust, what they should be doing in the community, how their educator role can be used to improve patient care etc etc. Come on guys!! it cannot be that difficult, can it?
In previous blogs, I have mentioned what Consultants should be / could be doing within an acute Trust and within the community. How difficult can it be to create a 10 PA Diabetes Consultant job template?? As regards Direct Clinical Care sessions,think of the sessions one can do using the super specialist skills in areas such as pregnancy, foot disease,pumps...think of the sessions needed to provide leadership to the service, develop it, think of the sessions one can devote to community.As regards Supporting Professional Activity or SPA sessions, think of the sessions needed for educating juniors, primary and specialist setting, leading on audits to assess performance, personal revalidation.......does an ideal 10 PA job sound too difficult to construct? I say again...come on guys!!! You still think we need to flounder around having to do more General Medicine to justify our existence? Let's stop being the poor cousin..we have much to do!!

Once done and all parties have agreed to the position statement, then use publicity appropriately. Engage with the NHS confederation, engage with the media, the NHSCB, send out the statement to Acute Trust Execs, get departmental Clinical Directors to use it for job planning discussion...what have we got to lose? The media is crying hoarse over how poor diabetes care is...who doesn't think this is is THE ideal moment to showcase what a Diabetes Consultant should be doing.
So, my colleagues at ABCD, If you are who you profess to be, if you do genuinely believe that you represent specialists, present and future...then this is the time for some bold leadership. It's not about being worried what others will think of us, about us being perceived as being brash. That doesn't involve saying we can do it better, it's about saying that there're some things we are trained better, have spent taxpayers money to be trained and we should be leading care in such areas of diabetes. it's about saying we will be there to support our primary care colleagues, not do it all ourselves.

Bu then again, what if ABCD feel they can't or shouldn't? Our trainees will love some clear direction on their future, would appreciate the fact if national bodies approve it and jobs are appropriately placed and created using this document as a template It may just be the catalyst for those rare jobs being fought over, improving the overall urge for trainees to do something extra in their careers...something to look forward to, not the looming possibility of staring into the abyss of joblessness.
So if not ABCD, who then? Shall I? Should I talk to colleagues, similar minded folks, do all that I have suggested, use my links with the GP groups, NHS Confederation...or should I for once pause before taking on another challenge? I probably will answer that in my own mind very soon....but till then, I wait to see whether ABCD pick up the gauntlet..or not.

Remember this... if someday somebody analyses that the lack of clarity of specialist roles have harmed patient care, then the onus for not raising that will be upon us...and there won't be a single patient who would understand or care to understand the politics that stopped us from doing so.
So...my colleagues in the ABCD Executive team...will you...or shall I? Clocks ticking...:-)

Friday, June 1, 2012

What's luck got to do with it?



Today I am in the mood to tell a story...don't know why..maybe it's just that there's a long weekend starting...maybe I am just in a good mood...maybe the fact I am travelling to the big smoke....whatever be the reason..definitely in a story telling mood. So how does one do that again...oh yes..."Once upon a time"....Ok, so here goes...

Once upon a time, in a far away land called Pompeyshire, there used to live in the big castle a posse of big bad dragons..also called Consultants. In the villages, the commoners or the GPs used to live amongst themselves afraid of the dragons who used to scare them into sending them gifts called patients to the castle of sugar....who the dragons feasted upon. The dragons grew stronger, they had all the wealth..and the villagers cowed down ..wondering when their shining knight would arrive. And then they did..they were called PCTs or Commissioners...they started to stop sending gifts..the dragons snapped, snarled...while the commoners looked on. The impasse grew, the dragons fought hard...and then one day, the unthinkable happened. The commoners became the knights themselves, they had access to shiny weapons and throughout the land of Britain, it was clear..the end of the dragons were nigh. The dragons were after all beasts to be feared...the myth was strong,they belched fire, took pleasure in chomping on the gifts offered slowly...nothing was spared!! Well deserved..the mob shouted...they bayed for blood....down with their heads, screamed someone....and then something happened. A little girl squeaked..."But I haven't seen any dragon, mummy, have you?"

Throughout the swirling crowds, the whispers spread like wildfire..surely someone had seen these mystical creatures....it couldn't all be old wives tales..they were horrible, arrogant, fire spewing obnoxious beasts...someone must have seen them?? Somebody? Anybody?....And slowly it dawned on all that no one actually had seen this dragon...over the ages it had been handed down how dreadful they were...but nope..no one had "actually" seen the beast!!

But throughout the land, these dragons sulked in their castles..angry at not being the ones who could rule with fear..they had lost their powers...and they felt..hurt. Hurt at being left out, hurt at being ignored...they may have been labelled as dragons...but they weren't...in their mind, they were tying to help. All those gifts the villagers sent..they hadn't destroyed them, they had looked after them..they had tried to make things better for everybody...so what happened?? just because they hadn't wanted to speak to the villagers when they had the powers..surely that didn't mean they should be left out now, should it?

But the times were changing and in the shire of Pompey, the dragons thought different...they got together and hatched a nefarious plot to steal back the higher ground. There was the Professorax ( sorry if I am mixing my dragons up with dinosaurs!) sage like...nodding at suggestions while chewing on his favourite diet..lipids...there was Iainosaurus who put forward lots of questions but kept playing with his gadgets and regularly turned up late for the meetings, Darrylex..prone to bursting into anger at the incompetence of the system but happy to calm down once given a few feet to chomp on..and then there was Karosauros..the young buck who thought he had the answer to everything and the rest agreed that he actually needed a hair cut. But between them, those dinos were clever...cunning. They thought of something incredibly dastardly, something that would make young readers blood curdle....they decided...here it comes...to join the villagers!!!
The senior dinos thought that copious amount of disguise would be needed while the younger one thought they actually looked a lot like the villagers! Anyhow, after lots of debate, (mostly because Iainosaurus had triple booked himself into playing with his toys AND dealing with the rare gifts arriving from the villages AND the meeting of course), Karosauros was sent out to meet the villagers....

The villagers were cautious...but then it was discovered that the dinos and the villagers could actually live together. The gifts they had sent to the sugar castle hadn't been devoured, the villagers found some of them had actually been well looked after. The dragons promised to be less fearsome, promised to go to the local inn to mingle with all, the villagers accepted there were prejudices on both sides...they all had a big party together and danced the night away in merriment. And of course they hoped to live happily ever after. End of story.

So why, I am sure, you ask, do I tell you this story? You know why? Simply because I want to bury a sweeping generalisation that Consultants are not being involved in any Commissioning decision. That may very well be true and I am sure the faults for that lie with either or both sides..either the Consultants refuse to engage, refuse to change or the Commissioners concerned are so obsessed with the necessity to save money, appropriate clinical care, nay, SAFE clinical care has gone out of the window.

Locally however it's been a different story- or at least as far as diabetes has been concerned. I am sure there are plenty of challenges ahead and not for a moment would I suggest it's "all ok" but whatever you do, you certainly cannot accuse the Commissioners of not engaging with the Consultants. People have said we are "lucky"... So let me bristle suitably at that suggestion...luck had nothing to do with it, amigos. I would love to take credit for all that has been achieved, the contracts signed, the acceptance of the Super Six model, the bidding process etc....but I simply can't. The has been some fabulous people on the way, who have helped immensely. apart from my colleagues ( Mike, Iain,Darryl) standing by me, allowing me as the most junior colleague to run the gauntlet, putting express faith in me..from the hospital Executives such as Simon, Ursula,Richard to the "old style" Commissioners such as Melissa and Jo, to the new power bases i.e. GP Commissioners such as Andrew,Koyih,Barbara and Jim....it has been a fabulous joint effort. Thank you all for being there over such a long and tiresome journey...but you know what..at least we have finished the process...now to get on and do the most important job ergo get patient care better. Luck has had nothing to do with it..it's been the coming together of lots of people who have just wanted to do good..wanted to help.

Is that my way of blowing smoke or sucking up to anyone I mentioned? What can I say...if you think I would indulge in such things, then you don't know me enough. But yes, I am not that arrogant either to not take a pause and thank those who made it happen. I remember evenings coming out of meetings late at night, with even my legendary confidence dented..only to turn around and see someone like Jim put a hand on your shoulder and say..don't worry, keep at it..we will get it done. When a GP Commissioner tells you that late on a Thursday evening, you smile, charge up the energy shields and...go again. When Darryl turns around and says "We want you to lead this, as you can make it happen".. You don't think of it as empty talk..it gives you renewed vigour to join swords over a negotiating table..one more time. So..you know what...this is my way of saying...Thank you.

Much more to do but the relationships are now built. There is a belief and a trust that is mutual and as Consultants, we don't feel out of the loop anymore. We are involved in it, in the thick of it...and the team consists of Consultants, GPs, Managers...all on a equal footing. So the dragons and the villagers got together...and they both got to know each other. That happened as both gave each other a chance.

So..I ask you again...what's luck got to do with it?