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The Dorsal View

Signposts for the future of general practice?      

Hopefully you’re not one of the unfortunates who will end up working Christmas day or has an otherwise heavy workload over the holiday period. If you are, perhaps somebody will keep a plate warm for you and the gravy and bread sauce won’t be too dried-out.

In the UK, GPs were recently told by the powers-that-be in the NHS that they will be compelled to offer appointments on Christmas day and St Stephen’s Day (‘Boxing Day’ for any heathens in the audience). The rationale is to cut delays in the emergency departments — personally, I’m always amazed that the flu season seems to catch health authorities off-guard each year. Every year. It’s akin to being surprised when the temperature drops in winter.

One interesting initiative has been piloted in the UK recently, whereby receptionist staff were trained-up to ‘signpost’ patients to more appropriate services. The scheme apparently freed-up 1,951 appointments in a five-month period alone in a Wakefield practice that piloted the initiative and these patients were ‘navigated’ to other care providers. ‘Care navigation’ has now been offered to other practices across the Wakefield area.

Sounds good on the face of it, but there are plenty of patients who would be less than comfortable telling the receptionist about their troublesome rash, embarrassing itch or their feelings of general dispair with the world around them.

Therefore, the scheme in Wakefield included an unused office, which was utilised as a ‘care navigation room’ where patients could discuss their healthcare needs with the receptionist (what happens at reception while this is going on, I’m not sure).

But there are obvious advantages. Those seeking repeat prescriptions were dealt with efficiently, while other patients were handled by a specialist nurse practitioner. Then again, perhaps you have seen enough patients drift across the road to the pharmacy to have their flu vaccinations and are uneasy at the prospect of more patients being siphoned-off down the many side-roads of Irish healthcare.

Yes, the ‘care navigation’ idea raises as many questions as it answers, but perhaps desperate times call for desperate measures.

In a less politically-correct era, having the receptionist handle healthcare queries may have been described by some as ‘a bit Irish’. But on this side of the Irish Sea, we have a more urgent priority — what really is ‘a bit Irish’ is the quicksand that the new GP contract seems to have stumbled into.

That should be job-one for the New Year.

Initial consultation   

At time of going to print, a 53-year-old transplant surgeon in the UK is due to face trial in surely one of the more shocking cases of 2017 involving a doctor.

Consultant surgeon Mr Simon Bramhall has been charged with causing actual bodily harm after it was alleged he burned his initials ‘SB’ onto the livers of two of his patients with an argon beam while he worked at Queen Elizabeth Hospital in Birmingham.

In the case of the second patient, her liver did not heal efficiently after her operation and it was during a follow-up procedure that the initials were allegedly spotted.

Perhaps not surprisingly, Mr Bramhall resigned his post following a disciplinary hearing but patients and colleagues have been coming out of the woodwork to support him and testify to his skill as a surgeon.

An interesting side-note to his career is that he was involved in the dramatic transplantation of a liver that was being transported on a private jet that crashed in fog at Birmingham International Airport on its way to the hospital. Miraculously, the liver survived the crash unscathed and the patient was saved.

Strangely, Mr Bramhall is still listed as an available medico-legal expert witness on a UK website that offers to provide expert testimony. Apparently, before this accusation he was involved in 10-to-15 trials per year, acting for both claimants and defendants.

Whatever the outcome of the trial, his professional and no doubt personal life are in ribbons. Even if he is acquitted, that’s not an accusation that can easily be shaken off and of course the tabloids love it.

’Tis the season

Sincere wishes for a wonderful, peaceful holiday season to all readers, whatever you are doing and whoever you’re with. Here’s a festive anecdote from the late great Spike Milligan, recalling an episode from his earlier years.

Two of his children were arguing the existence or otherwise of Santa Claus one Christmas eve. A heated dispute ensued, doors were slammed and there was much pouting.

Later that evening, Spike found a letter to Santa from one of his children. It read:

“Dear Santa, my brother doesn’t believe in you. When you visit our house tonight, can you please beat him up. Thank you.

“PS: I left a hammer under his bed for you.”

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