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Independents' Day

Dinah's proccupied with pyramids, but not the ones in Egypt

The NHS is too flabby at the top, our columnist notes, while some patients are too flabby everywhere

The NHS is too flabby at the top, our columnist notes, while some patients are too flabby everywhere


Practice Manager on holiday, send staff for coffee and put feet up for 5 mins; still enquiries coming in for business manager job. Worry about selection process; who could I get to help with interviews; should I ask them for presentations? How about something a bit different – perhaps a wine-tasting?

Practice Nurse getting married and moving off! Plan to review nursing team. Maybe a Nurse Practitioner? How should the practice develop, what services will we provide? Never thought I'd be doing workforce planning - studied workforce pyramids over the weekend, we obviously have too much at the top – theory dictates we need more self-care, health care assistants, even health trainers and coaches. Think 'When can I retire?' and make a note to phone financial advisor.

Receptionist knocks – nurse out visiting, HCA couldn't get blood – would I mind? OK, sorted (It's Mrs G, she is unfortunately obese) but make note: need more HCA support ASAP. What happened to the coffee?


Report on radio about causes of obesity, apparently human biology has failed to keep up with our sedentary lifestyle and adapt. Does this disprove Darwin's theory of evolution? Confused, arrive late for PBC Group.

Commissioning intentions discussion: how can we move resources around the system? Pyramid of care shows only 0.5% of patients using the most resources but can we re-engineer care and save money? Answer: no! Those very sick patients need that care!! Bother. Ok – take the top 20% - they are using loads of resource, could many of those patients be managed differently? Answer: yes! That's where we need to concentrate our efforts. Set population analysis in motion.

Conversation broadens into discussion about pyramids, including workforce theories. NHS is obviously an inverted pyramid: a few of us at the sharp end doing all the work – and taking all the risk - whilst above us echelons of pen-pushers populate the stratosphere with countless layers of paper.

Driving home in car, puzzle over evolutionary theory then phone knowledgeable friend. Yes, although the number of obese children and adults is increasing (despite obesity causing impotence and lack of libido, never mind the physical impossibility of sex) they'll eventually die out from heart disease and diabetes, and the gene pool will ultimately be cleansed. Plus there are other causes of death including the extremely obese man with excessive flatus who died overnight from methane poisoning; even his rescuer was hospitalised!! Ugh, disgusting.


Surgery: Mrs G has painful knees; so would anyone trying to rest 112kg of flesh on them. She wants a ‘disabled buggy', plus does passing wind help you lose weight?

Should I mention it could be fatal? Would charcoal help? (could be a life-saver! note: cost for commissioning plans). And she's brought chocolates, how kind, but nearly takes them back when I suggest giving up walking may be counter-productive.

She donates chocs to reception instead. Too bad they're on diets, I finish them after surgery, washed down with more coffee. This is the life! Whoops, was that a little wind? Sorry!


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