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A faulty production line

We are being run by aliens

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I can’t quite decide whether this is a profound revelation or a statement of the bleedin’ obvious. And I suspect it’s a theme I’ve visited before. Whatever. Those two axes of evil, NICE and the CQC, have just focused my thoughts.

NICE first. Everyone says that NICE is on another planet. The thing is, I no longer think this is a metaphor. I genuinely believe that NICE is literally run by aliens.

Take the newish draft guidelines on asthma diagnosis. Take them far, far away and burn them. I absolutely guarantee, here and now, on pain of having my scrotum nailed to a windmill, that no GP in the land will ever follow them.

Why? Because we haven’t got the time, the will, the energy, the equipment or the sort of patients who are happy to devote a large part of their remaining life to clinching a firm and over-investigated label of asthma.

As we all know, but NICE doesn’t, it’s actually pretty easy to diagnose asthma with a reasonable level of accuracy – just using the history, the examination, and a trial of salbutamol. Okay, and a sodding spirometry to satisfy the QOF monster. Job done. We are confident to at least to the 90% level, and that’s the point. Because that level is perfectly adequate. We miss a handful, overdiagnose a few, but deal properly with the vast majority, all with a minimum of fuss.

And that, of course, is how general practice works – and why it’s so cheap and effective.

But the CQC doesn’t realise this, either. Here’s a teensy-weensy example from some of its blurb: ‘If a patient suffers from early-stage dementia, and needs to make a decision on whether to have the flu jab, the GP should make every effort to communicate the pros and cons of having the treatment when the patient is most alert. This is so that the patient can make a decision.’

Can you imagine a world where we really could do this? No, you can’t, because it doesn’t exist. Sorry, CQC, but seriously, we can’t repeatedly reiterate flu advice to our dements in the hope of catching a window of cognitive clarity, because we’ve got patients to see, scripts to sign, visits to do, meetings to attend, boxes to tick, admissions to avoid, targets to hit, bowels to open (sometimes our own). Oh, and sodding CQC visits to prepare for, which is how I came across this gem. Conclusion? The CQC, too, lives on Planet Bloody Clueless.

It’s simple, isn’t it? GPs do a good enough job. If you want to get from our 90% level to 100% – in other words, to pitch for all the perfection CQC and NICE imply – that extra 10% will cost about 1,000% in terms of time and effort. Law of diminishing returns, etc, etc.

So NICE should be NICA: the National Institute for Clinical Adequacy, which sounds nicer with a soft ‘C’. And the CQC should be nuked.

Anyway, I’ve finally worked it out. This is a statement of the bleedin’ obvious to those who do the work.

But a profound revelation to those that set the rules.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter@DocCopperfield   

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Readers' comments (18)

  • andrew Field

    too true

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  • The only thing I'd disagree on, is the trial of salbutamol alone. In those who have never actually had an asthma attack, using a preventer first is likely to reduce many patients getting "hooked" on overuse of the bronchodilator, then refusing to acknowledge that the "brown" inhaler does anything for them. For some reason, many patients appear to think we'd give two inhalers to do the same job, then overall, they choose the one they feel has an almost immediate effect and can "taste".

    I have seen far too many patients that have been given a salbutamol by their GP, and some years later, swear it works, yet when their technique is checked, never knew how to use the device properly.

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  • Sadly, the NICE and the CQC will never understand what GPs do, because they live on planet perfect, and as a result they will be incapable of understanding when the questions they ask are meaningless.

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  • CQC go home!

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  • surely, neither of them lives on "planet perfect", but they do in cloud cuckoo land.

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  • Brilliant as ever.
    So true.

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  • Add PHSO public service health ombudsman to your list of Aliens. ... has anyone else recently received a complaint report from them. ... its really worth wallpapering your little room with. (Sent anonymously as I no longer trust the demi gods)

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  • You know what - add Breach of Contract to CQC, NICE, Pensions, MPIG, appraisal, revalidation, 12-13 hour days, Indemnity etc and you arse so right, President - There never ever has been a better time to be a GP.
    We are being over run by aliens and some of them are in our midst - GPC, RCGP.

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  • So right, bring back some common sense, get rid of these morons or lets just ignore them as much as we can. Is anyone else sick of these hoops we have to jump through, held up by people who have no idea of working in gneral practice

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  • slightly disagree here Tony with the Asthma part. I had a diagnosis of Asthma on my medical record from (I can only presume) a well meaning but overzealous GP many years ago when I was just a toddler. As far as I remember I was:
    a) never given an inhaler.
    b) never had wheeze constituting a diagnosis of asthma
    c) never had an asthma review (which should've been done as per QOF)

    I only found out a few years ago when I changed GP and the practice nurse at the new patient review asked me about my asthma symptoms. I subsequently challenged it and they removed the diagnosis and amended the notes saying that I never had asthma.

    Medico legally I/my family could have sued my GP had I ever been denied illness/life insurance payout because of this historically inaccurate diagnosis affecting a claim (I wouldn't disclose something that I didn't have).

    Whilst the diagnosis may be fine for those 90% of people, the few mis-diagnosed people may have very serious consequences. It can sky rocket insurance costs, deny people insurance, cause all sorts of headaches for them all for a diagnosis they never had.

    FYI I love your blogs though.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder