Fairburn Ings 27th December 2011

A bank holiday and mild and sunny weather. We went to our local bird reserve, Fairburn Ings, in the afternoon. It was packed with people and there were more birds that we have ever see. It was teaming with birds. We saw robins, sparrows, green and gold finches, ducks coots. We saw a woodpecker and a jay. There is a relatively new kingfisher viewing area. Kath saw one. I missed it as it flew off. What a great facility to have near where we live.

Visit to Abdul

Yesterday three of us who were at University College with Abdul (Steve, Grahame and I) drove in my car to North London in the morning to spend some time with Abdul, another fellow medical student. I had not seen him for many years and the others had seen him more recently. The three of us from Yorkshire had a good old catch up in the car. The round trip for me was 375 miles but I was grateful to Grahame
e who shared the driving. We all have our medical problems at our ages now and it was good to see Abdul in such good form despite a complicated neurological condition. He is a really talented artist and we looked at lots of his excellent work . Above is an example of his work that he emailed me a while ago.

We had a great lunch at an Iranian restaurant in Finchley. Beautiful food. Then back to Abdul and Yasmin's house (she was at work, unfortunately) for a quick coffee before setting off back home.

We must not leave it so long next time.

Abdul was so generous. He had already posted me one of his works. He gave Steve and Graham a painting each and insisted on paying for lunch. Thank you, Abdul.

Family Doctor

My father, George, was the first Dr Sloan.

QEGS

I had a wonderful morning yesterday. I contacted my old school after I was awarded the MBE in this June's Birthday Honours (I will write up that experience on my Professorpavov blog later). Neal Rigby, retired history master and President of the Old Savilians' Club, took me on a tour. He was absolutely great. The last time I nosed about the school was in 1980. I was a pupil there from 1953 to 1963.
What fantastic changes have been made. However, I could picture the biology and chemistry labs even though they were in other use. I remembered all the other classrooms I had been in. He gave me the latest tie and a fascinating book on the history of the school to celebrate its 400th anniversary in 1991. I note that my headmaster, Mr E J Baggaley, is the only head since 1591 not to have gone to Oxbridge and the only head with a science degree!!! I am so grateful to the school for setting me up with my education.

Easter Sunday 24 4

We had a great lunch with a friend at Monk Fryston Hall Hotel. The first photo is of Kath there today and the second in 1966.

22 4 2011

Friday 22nd April 2011
Fantastic weather here day after day. A week of firsts. Yesterday I went with the group of retired G Ps and locums on a tour of an estate of the ECO houses that are being built near where we live. I manage these monthly meetings which have been held for about 4 years) It is the biggest such estate in the United Kingdom. The houses are very heavily insulated and heated by a huge communal wood burner. The ash from that can be used as a fertilizer. Each house has a cleansing device so the bath and washing up water can be cleansed and used to flush the lavatory.

I found, a couple of weeks ago, where one of my ex trainee doctors was working in California. Adrian Rawlinson. My second favourite trainee!! I could not be obtain his email address is so I posted him a letter. I got a great he email back with photographs of his lovely wife and children. He told me what he was doing and wants to talk to me for 30 MINs about of project. He wants is to use Skype. He also wants to be a patron of the Castleford Choral Society!! I have this on my computer but have never used it. I contacted Martin Smith, our relation in Leeds and asked him if I could try it out with him. He phoned me this morning and told me to set up a video link with him. We had a chat while he was eating his porridge for his breakfast before going to church. What an amazing facility. The other thing I’ve done this week is to speak to publishing company based in the USA. I have written about 6000 words about my experience of the first 18 months being a medical student. I’m not sure anyone will be interested. The publishing company has an editing facility and looks good to me and makes me think of writing a book about what I think has been my fascinating life. Have I got delusions of grandeur?

20 4 2011

Wednesday April 20th
For the last few days we have had wonderful weather with temperatures warmer than Greece. Kath and I have twice been for walks. We went to Stanley Marsh in Wakefield at the weekend which was a new discovery. Yesterday we went on a 2 mile walk near the river Aire at Fryston. Lots of new paths have been made and there is a map of the walks there that I have printed. We are having loads of work done on the inside of Hill House – decoration and new carpets and bedroom furniture. The bedrooms have not been touched for decades. The lounge carpet was successfully cleaned yesterday and we have had to walk about wearing blue shoe protectors until it dried. Yesterday I met Liz Moulton for coffee at the Deanery in Leeds University. I was the first associate director of postgraduate general practice education and Liz is now the deputy director. We had a good catching up session. We have had a great professional relationship for many years. It was good to meet Esme again. Head from Katia in Italy that our cleaner of our Italian house, Luisa, has had an operation on her knee but all has been sorted out for our forthcoming visit.

April 11th 2011

Monday April 11th
On Saturday we sang in the Castleford Choral Society’s Spring Concert. Kath is the secretary of the society for very many years and I have been the Patrons’ Secretary since 1997. I have resigned as I want to do something different for the choir. Kath and I also open up the church where we rehearse and I am responsible for putting out the chairs. Kath works very hard indeed for the society producing all the tickets and programmes and has had to take over as seating organiser from Colin who has been ill. She has also done the publicity in our local paper. The society has its own website: www.castlefordchoralsociety.co.uk. We rehearse each Wednesday evening in the United Reformed Church in Castleford. The programme we put on was a great mixture and the venue, Trinity Methodist Church Castleford, was packed. The soloist (Pam Waddingon Muse), trumpeter (Anthony Thompson) made the evening a success as did our accompanist, Claire Burden who played the organ. We had really good positive feedback. It is a hard day for me and Kath, particularly Kath. In the morning a small gang helps to erect the stage and put out the seats. In the early afternoon we have a dress rehearsal and this year the conductor was particularly grumpy. I decided to change how I treated the patrons in the interval. In previous years I had brought all sorts to eat and used a small back room. There was always loads of food wasted. This year I decided to have a table in the main interval hall and serve coffee and teas to the patrons. The society gave the church a contribution and they put out chocolate cakes and biscuits for the patrons. These went down particularly well. I mis-judged the time and effort it took to serve teas to 30 people and thank goodness Kath came along to help. I managed to talk briefly to some of our friends before the second half of the concert.
Someone in the audincewas given permission to video parts of the performance you can look at the itenms on youtube by searching for Castleford Choral SocietyI then helped putting away the chairs and dismantling the stage before going home. We always have some (quite a lot) red wine and cheese and biscuits after a concert. This year Kath had pate as she had given up cheese for lent.
On Sunday, after we had prepared two rooms for the decorators, we had a day of rest. While Kath was at church I went for a walk in Fryston. It was a beautiful day and the walk is next to the River Aire. In the afternoon we failed to park at the Pugneys Park because of the crowds and drove up to Emly Moor TV mast ( the highest freestanding structure in the UK). The views from up there were pretty good. A curry in the evening followed by Lewis.

Diary 7 4 2011

Wednesday April 7th
Plasterers came on Tuesday morning to work in our conservatory before the decorators start next Monday. Mike, the chairman of the Airedale Neighbourhood Management Board came to get a cheque from me (which I forgot to sign) – a contribution to the board to pay some young lads to deliver the newsletter I have organised.
Today I delivered newsletters to Fryston village and half of a long road called Fryston Road. Occasionally I met people I knew as a GP which was very nice.I could write an essay on letterboxes. It was a beautiful day – the warmest of the year and the first day I did not wear a jumper. I practiced singing some music we are doing for the Castleford Choral Society concert on Saturday and in the evening went to a choir rehearsal. Kath is stressed with all this as she is the secretary of the choir and two people who do significant work are ill. So she is doing the work of the seating secretary as well as everything else.

Diary April 4th

Monday April 4th

The morning was spent organising painters and a plasterer as we are doing decoration of 5 rooms of our house starting with the sitting room and conservatory. Quite boring for a diary. The main thing for today was that the minister of state for health, Andrew Lansley came to the commons to make a statement about having a pause for the dreadful new health bill he wants to get through which could end up privatising large elements of the NHS. I have been writing loads of letters and submissions about this. I have followed the bill’s progress closely and below is my submission to the scrutiny committee:

1. I worked as a general practitioner in Castleford from 1978 until 2005. Throughout most of that time I was deeply involved with postgraduate general practice education and worked as a GP trainer; vocational training scheme course organiser; continuing medical education tutor and an associate director of postgraduate general practice education at the Yorkshire Deanery. Towards the end of my general practice career I worked part time for our Primary Care Trust, now called NHS Wakefield. I managed the education courses as well as the appraisal scheme for approximately 250 general practitioners. I was responsible for the training and development of 17 appraisers. I also dealt with underperforming and ill GPs. I was an appraiser myself as well as a quality outcome framework medical assessor and mentor. I retired from the PCT job at the end of May 2010. My qualifications are MB, BS, BSc, PhD, FRCGP and I have a post graduate certificate in primary care education.
2. I would like to outline what I feel my “relevant expertise and experience” is before informing the committee some factual information about general practice in the Wakefield District and then my views. During the many years I was involved with the training of prospective G P’s I taught communication skills both one to one and on an annual deanery summer school. I was an assessor of consultation skills. For several years I was tutor in ethics on a deanery summer school. When I was a course organiser I had to visit and inspect many training practises. More recently as an appraiser and quality outcome framework assessor I visited about 26 practises a year. Undertaking an appraisal could take up to 3 and of conversation with a general practitioner discussing in depth his or her work and plans for the future. No one is disputed that in the last six years of my work for the Primary Care Trust that I met more general practitioners than any other person working in this area. As the PCT’s appraisal lead, each year I read approximately 250 GP appraisal documents and made a note of each personal development plan.
3. This paragraph is about my ethical concerns. I was a very reluctant fundholder when this was introduced and resisted cooperating until we were forced because financial resources were being taken away from our practice. The reason I was anti fundholding was on ethical grounds. I could see savings being made by practices referring less to secondary care, prescribing cheaper drugs and are undertaking less investigations. It is obviously good practice to honesty look at referral patterns and see if the result of this indicates inappropriate referrals that could have been dealt with in house. It is also good practice to look at prescribing patterns and rational prescribing which could mean prescribing a similar drug that costs less. I am sure the fundholding created a conflict of interest during the consultation. One GP told me that he was telling patients they could no longer have a particular drug and that the government had instructed him to prescribe an alternative. When I pointed out to the GP that this was unethical he simply agreed and continued with his approach. At the time of fundholding I was a disability living allowance assessor. I was appalled that some of the patients I was assessing were not being referred to secondary care. Savings made by fundholding practices could be used to benefit the patients and also to build on to surgeries to provide extra space. There is nothing wrong with that but GPs generally own the surgery buildings and therefore are able to sell the building either to remaining partners on retirement or to a private company and realise very significant profits. I can see a similar situation arising if the bill is implemented. Section 223L (1) states “the board may after the end of the financial year, make payments to commissioning consortium if, in the light of an assessment carried out under section 14Z1, it considers that the consortium is performed well during that year.” Section 223Z (7) states “A commissioning consortium may distribute any payments received by it under this section among its members proportions as it considers appropriate”. I am grateful to Alice Miles writing in the New Statesman on the 7th of February, 2011 for pointing me towards this part of the bill. This reminds me very much of the ethical problems I saw with fundholding. The members receive money from the board and if the rule is that this money should be used to improve patient care then I can see buildings being expanded again and profits taken from this. I cannot see a surgery building owned by GPs extended and that extension owned by another body.
4. I would now like to inform of some of the activities of general practices that I have observed and heard about in this area over the past five years or so. One or two practices (and these were dedicated fundholders in the past) have created huge businesses by purchasing the buildings of small practices and employing GPs on a salaried basis. This has resulted in the absence of some of the partners from their base practice in order to pursue business or clinical activities in these purchased surgeries. The situation has caused one partner to move from one of these practices to another in order to continue with the excellent clinical care he wants to provide without having to deal with business affairs. The majority of GPs in this area are like him. Another practice has an operating theatre and secondary care consultants provide a service there which on the one hand is a good thing for their patients but on the other hand is diverting secondary care clinicians from their base. I have no idea what the financial arrangements for this are but I am worried about a conflict of interest here when the practice is involved with commissioning decisions of its consortia. I know that all these activities are allowed under the rules and are within the law. A few GPs make huge profits whatever system of primary care organisation is in place. These same few general practitioners who profited from fundholding, primary care groups and trusts and are now becoming seriously involved with the consortia.
5. I mentioned above that I was responsible for managing the appraisal scheme for NHS Wakefield for 6 years. Annex 1 is an extract from my fairly recent annual appraisal report (2009/10) which I believe was presented at a meeting of the PCT’s Board which was open to the public. These are examples of what GPs want to focus on in their learning plans. I did not have to remove anything for confidentiality reasons. “Maintenance” means “keeping up to date”. You can see from these, which are representative of the learning plans of the whole group, that the focus their education not on business matters but on clinical matters. It is to be noted that one GP put “let go of management” in his or her personal development plan.
6. The people I worked closely with for six years at the PCT were hard working, loyal and had the improvement of patient care as their main objective. I had two line managers, who were directors, one of whom was an ex midwife and the other worked for one day a week as a general practitioner. Part of my job was to deal with underperforming and ill general practitioners. I worked with each of these two directors on this. This was complex time- consuming work and required knowledge of employment law, the General Medical Council and the National Clinical Assessment Service. In the past there was the Local Medical Committee’s Professional Support Group of which I was a member. This attempted to do similar work and the members undertook this work voluntarily. Meetings had to be in the evenings and we had a senior member from the health authority to guide us. That work was amateurish compared with the approach of the Primary Care Trust. The expertise to protect the patients from underperforming and ill general practitioners will disappear on the abolition of the PCT’s. This is just one example, as I see it, of the consequence of the new proposals. Both of these are directors have left the primary Care Trust, one to work in secondary care and the other returning to fulltime general practice. There is no one working in this area with that experience or expertise. I could give other examples of a highly skilled and experienced people are leaving or planning to leave in the near future. The Primary Care Trust was a model employer with an excellent human resources department. I am afraid to say that many general practices are certainly not model employers or as good managers and I am worried that this will be reflected in the activities of consortia.
7. I am a member of the British Medical Association and proud to be a Fellow of the Royal College of General Practitioners. Of each of these bodies are representing my worries and I know each will be giving evidence to you. I feel so worried about the future of the NHS as a consequence of implementation of this bill. . I am not sure how much weight the committee gives to the views of individuals. However, the title of the guidance for submitting evidence is entitled “now have your say” he and I feel I have done that. I feel I have addressed matters contained within the bill, concentrated on issues where I have a special interest or expertise and included factual information of which I want the committee to be aware.
I watched the Minister of State for Health’s statements and the questions that followed this afternoon. Towards the end of all this a labour MP asked a question that was obviously very hostile. Mr Lansley answered that the MP should talk to Stewart Findlay who is the lead GP in Northumberland. Stewart is married to my second cousin Lorna and they live next door to William Hague. When we meet we leave talking about the NHS to just before we are leaving as we have such opposing views. I have emailed them to tell them I am embarrassed at having someone in the family with such views but in order to maintain family unity I will not tell the opposition all I know about Stewart. Actually, he is a very nice bloke and like us, has a property in Italy. Here is the Hansard entry:

Grahame M. Morris (Easington) (Lab): I would like to thank the Secretary of State for single-handedly destroying the Government's reputation on the NHS through this Bill. No amount of minor changes or slowing down of the pace will address the Bill's fundamental failure to protect the public from privatisation by stealth. If he refuses to resign, is he worthy of his nickname, Broken Arrow-he doesn't work and he can't be fired?
Mr Lansley: The hon. Gentleman might like to talk to Dr Stewart Findlay, who is among those leading the pathfinder consortium in County Durham. He might like to talk to people locally who are piloting the new 111 telephone system, which will give better access and better urgent care to patients. Instead of sitting there making rather absurd political points, why does he not go and talk to people who are delivering services to patients? That is what the NHS is really about.


I am very pleased that Shirley Williams has come out against this bill. She is very articulate and incise and I have great respect for her.

Diary 3 4 11

Sunday April 3rd
Yesterday was a pretty quiet day. We went to Sainsbury’s the morning and in the early afternoon I went swimming Banatynes in Wakefield. I have been going there for about five years and I love it. I have a chat with somebody I have got to know. We were in the Jacuzzi. He knows I am a doctor and on one occasion got hold my hand and put my finger on his eyelid so I can feel a cyst! This was while we were in the Jacuzzi. In the afternoon I watched Andrew Neil’s This Week on the television and then had a disastrous time on the Internet. I booked a Virgin Atlantic flight from Manchester to Orlando for the November and forgot to time the last letter of Sloan. I could not work out how to remedy this until this morning when I phoned in. It cost me £30.00! A couple of years ago I booked flights for 4 of us to Perugia and was a year out. That also cost me to change.
I watched a great Daniel Barenboim masterclass teaching the piano. He is a phenomenon and can play complex pieces without music and without looking at the keyboard. In th afternoon we bought some new bedroom furniture for the spare bedroom and went for a walk in Fryston in order to ward off the effects of a Chinese meal we will have tonight. I had a nice email form a Cambridge University student whom I have promised a DVD about the 1984 miners’ strike. He came up to interview me about my experiences for his degree dissertation. He deserves to do well. I weighed 50 newsletters as I wanted a method of counting them easily tomorrow morning when we manage their distribution. I have donated some money to enable some young or unemployed people to earn a bit of something delivering these. I have started reading John Mortimer’s “Summer Lease” which is great and am pleased that the bin man’s (Sean Donnelly aka MC NxtGen) anti NHS reforms rap has been such a hit. It has had 200000 hits on youtube and he has been asked to do one for the royal wedding.

Diary 1 4 11

Friday April 1st

This morning there was a board meeting and of the Airedale Neighbourhood Management Board. We had a look round Chrysalis, a Methodist church inspired project that has a computer refurbishment shop, a bricklaying tuition set up and car repair teaching centre. There is also a garge that teaches students. This is a greatly successful project and needs all our support. The most upsetting thing about the meeting was that George Rutten told us he had been made redundant by the PCT. This is criminal as he is one of the best workers with creative ideas I have ever met. I told him this, offered a reference and will write a strong letter to the PCT.
The Airedale Neighbourhood Management Pilot was set up in 2006 and was managed by Wakefield and district Housing (WDH). Last year The Airedale Neighbourhood Management pilot ended and it became self-governing board.
Board members include 8 residents all of whom applied in writing and were selected by interview. The residents are volunteers. On the board are our three local councilors of Wakefield District Metropolitan Council (WMDC) as well as a senior police officer, the principal of Airedale high School and senior employee of the Primary Care trust (PCT) and Wakefield District Housing.
WMDC, WDH, the PCT, education and police are known as “partners”.
What is the function of the board?
Broadly we are trying to:

• coordinate the monies coming into our area to get the best value from these funding schemes
• improve our living conditions by reducing crime, fear of crime and anti-social behavior. We want to improve the quality of the physical environment, housing management and leisure provision for young people.
• tackle poor public services by reducing educational underachievement, worklessness, poor health, teenage conceptions and offending.
• transform our neighbourhood by connecting communities with major regeneration in the district including housing and job markets where this is possible.
• enable local people to get involved and have a say in local decisions, foster a community spirit
I find this the most interesting group I have ever been in.

In the afternoon three of us continued inserting both a menu from the new social enterprise café based in the library and a leaflet about young people drinking alcohol into a significant number of the 7000 newsletters that I had produced and which will be posted into houses in the patch. It is a daunting task but worthwhile. After that I went for a walk in Fryston by the river and then came home.
A day of the Airedale Neighbourhood Management Board.

Diary 31 3 11

Thursday 31st March.
I’m often asked what I’m doing in my retirement. At the moment, I am reading Chris Mullin’s book “Decline and Fall” which is of the second book of his diary. I like the style of his diary in that he does not simply write what he has done but explains and expands on issues and people.
I thought I would write a diary for about a month. Today is my friend George Goodenough’s 65th birthday. I am just over four months old and George and have known him since his birth. We do not usually exchange birthday cards but I sent him one on this occasion. I wrote a quote of Doris Lessing on it. “The great secret that all old people share is that you really haven’t changed in 70 or 80 years. Your body changes, but you don’t change at all. And that, of course, causes great confusion.”
I run a group called the educational support group for GPS without a base and I sent a letter to the PCT about the next meeting to the members. I also emailed the pharmaceutical company who are sponsoring our meeting.
I am doing some research on body temperatures of and spent a little time analysing the results of a questionnaire I sent out to 41 GPs.
After going to Castleford for some shopping I went for my almost daily swim at the pool were in Wakefield. In the Jacuzzi I had a conversation with someone I have got to know about the flatulence she was getting on simvastatin tablets.
After lunch with Kath, I met Alison Evans in her house for coffee and a general discussion about her work running the appraisal scheme for the PCT. She’s doing really well and told me all sorts of gossip about what was happening in general practice with the onset of the reorganisation of the NHS. It was nice to meet her family and catch up.
I had written a newsletter of the Airedale Neighbourhood Management Board and we had 7000 copies printed by some students at the school. I joined two of my colleagues who are on the board to help additional leaflets into the newsletter. Unless we get a load of volunteers who will be a nightmare delivering these. I must say I am proud of the newsletter and one of the inserts was a menu from Healthy Eating and Lifestyle Ltd., A social enterprise venture which has opened the café in our local library. I hope they do really well. We will continue with this work tomorrow afternoon.
Kath and I usually spend the evening watching TV after a nice meal.

VAT rise and diesel

Nine Hours after the VAT rise I drove past the British Petroleum garage I regularly use to fill up my car with diesel. I noticed that the price of diesel had risen to just over 131p per litre. Two hours later I returned to the garage and proceeded to fill my tank. I noticed that the indicator on the pump was showing I was spending at a rate faster than £1.00 per second. I then noticed that the price of diesel had increased to just over 132p per litre sometime in the previous two hours. The garage manager confirmed to me that the fuel supplier had just instructed him to increase the pump prices. I doubt if many people will notice this tactless additional burden on drivers.