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Santa Claus is coming to town

Primary Care Blues

Cornelius Rubeus

Friday, 21 December 2012

Santa with doctor.jpgFrom April 2013 a plethora of NICE recommendations for changes to QOF are to be imposed upon GPs.

I’ve looked at the list… I’ve checked it twice… and I have to conclude - how naughty is NICE !?!

Many of NICE’s recommended new indicators have a sound evidence base, might actually benefit patients and be fairly practical for GP practices to deliver alongside existing clinical work. Others look frankly unworkable in practice - with the time, manpower and effort involved simply not reasonable to expect within the resources available next year.

Taking Santa Claus as an example, we can foresee the problems GPs face. How can we possible bring such a “public health pariah” to heal? Santa, a plump couch potato, has not changed his lifestyle or behaviours in the last century, spurning the weight of evidence supporting healthier living.

He comes but once a year… What hope do we have of getting him on a structured education programme for his diabetes (11 points), pulmonary rehabilitation for his smoking related dyspnoea (5 points), a ‘GPPAQ’ assessment of his physical activity (3 points), a ‘brief intervention’ about the lack of said activity (3 points), a ‘dietary review by a suitably competent professional’ (3 points) and finally a quizzing about erectile function, contributory factors and treatment options (10 points).

Heaven help him if his blood pressure is raised. The hypertension police are lowering BP targets to 140/90 (45 points). Steady on that roof Santa… a bit of postural hypotension might just have you toppling off with the combination of sherry, mince pies and truncal obesity.

On the other side of the Pond, Santa’s smoking history has been expunged from the records. The 189 year old poem ‘Twas The Night Before Christmas’ has had its two offending lines removed by publisher, Pamela McColl. It no longer reads:

"The stump of a pipe he held tight in his teeth
And the smoke it encircled his head like a wreath."

Added to the cover is written: "Edited by Santa Claus for the benefit of children of the 21st century”. The back jacket flap further explains that "all of that old tired business of smoking" is behind him and that the reindeer can confirm his fur outerwear is ‘faux’ out of respect for animals, including the polar bears of his beloved North Pole…

Responding to McColl’s censorship, the ‘Comedy Central’ TV show beseeched: "This political correXmas must be stopped”, adding “Santa can't quit smoking, he needs that vice. You try dealing with the stress of delivering the world's toys in a single night. We're lucky he's not doing a pa rum pum pum gram of coke off of Blitzen's ass…" (http://bit.ly/VaeVWq)

Let’s ho ho hope the stress of new QoF doesn’t drive GPs to the same vices…

Merry Christmas!

Author's Image

Cornelius Rubeus

Dr Rubeus is a hardworking, jobbing GP who trained in the North of England and now works in an inner city setting. He feels passionate about the changes affecting primary care and is not afraid to voice his views. He has his patient’s best interests at heart and wants General Practice to remain as the bedrock of the NHS for years to come.
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