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Nanomanaged to death

Nanomanaged to death

I’m sorry to bang on about PCN matters again, but as I need make no apology for bringing to your attention utter outrage and bonkersness, then, in fact, I’m not sorry at all. Not least because history has shown us that PCN developments tend to get trailed so far in advance that the fury they ought to generate gets put on a mental ‘to do’ list which then gets lost down the back of the surgery sofa.  Which means that, by the time we realise what’s happening, it’s too late.

So just in case you missed them, here are three highlights from the recently released new PCN service requirements.

1: We must review patient records to identify any with a historical BP of >140/90 (or >135/85 in a community setting) to ensure they’ve had the full potential hypertension work-up. The obvious flaw here being that every patient who’s ever had their BP recorded will have had a BP above these levels at some point. Cue utter shitstorm.

2: We must try to opportunistically detect atrial fibrillation during BP checks ‘in line with NICE guidance CG180’. Er, a few problems here. CG180 does not exist. And this is most certainly not ‘in line’ with the guidance that replaced it. And this initiative is completely non evidence based, is not recommended by the National Screening Committee and represents the introduction of a national screening programme by the back door.

3: Before I introduce you to ‘3’, which, believe me, is the real coup-de-grace, I suggest you take a massive slug of whatever your favoured alcoholic drink is, then another, and another, and then sit down somewhere very quiet, away from walls, sharp objects, people etc. Take a few deep breaths. Hold on tight. And read this from the ‘Personalised care’ spec:  ‘By 30th September 2022, a PCN must ensure all clinical staff complete the Personalised Care Institute’s 30min e-learning refresher training for Shared Decision Making Conversations’.

No, I didn’t make #3 up. It’s there, check for yourself if you like. What the people who invent these directives don’t realise is that, while it may only be half an hour’s mandatory training representing thirty minutes of our life we’ll never get back, it’s also a significant nudge for those GPs who are already on the cliff-edge of quitting ie all of us. And those people must also, I’m forced to conclude, work for the department of Fatuous, Misguided, Infuriating, Deprofessionalising, Infantalising, Whimsically-Based Bollockyfuckwit Nanomanagement. That is to say, in short, they’re twats.

And I make no apologies for saying that, either.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at



Please note, only GPs are permitted to add comments to articles

Michael Mullineux 1 September, 2021 1:46 pm

Spot on TC. These join the other nuggets of PCN micromanagement for the sake of bloated NHSE administration self-justification. The ‘better in than out” argument for PCN’s becomes flimsier with each new PCN service requirement. Embrace Kafka or revert to some small semblance of independence and decision making until core contract is changed? Just saying ..

Hank Beerstecher 1 September, 2021 3:18 pm

PCN specifications arrived at through shared decision making no doubt. First lesson in shared decision making learned.

terry sullivan 1 September, 2021 4:09 pm

nhse would not be missed if it was abolished–surely one lot of bureaucrats is enough? de we need nhse phe and dfhsc?

and all the other parasites

Dave Haddock 1 September, 2021 8:17 pm

There is still one measure by which the NHS is still World Class; unfortunately that measure is the ability to squander money and good will on ever more pointless bureaucracy.

David Bush 2 September, 2021 8:42 am

Mmmm. Here’s a radical idea. Let’s just spend our working day seeing the patients who are waiting to try to clear the backlog.

Dr N 2 September, 2021 9:06 am

Are 98% of practices going to continue to sign up to PCN work next March – of course they are – We are as stupid as stupid ourselves.

Patrufini Duffy 2 September, 2021 1:09 pm

Opted out. Long time ago.

David OHagan 2 September, 2021 1:21 pm

NHSE only exists ‘virtually’ at present. It is a nickname, AKA, a lie.
The NHS commissioning board has spent its entire life telling everyone it is called NHS England.

Now it is forcing a bill through parliament to change its name to NHS England.
From April NHS England may come into being.

Perhaps all other untruths stem from this one.

Guy Wilkinson 2 September, 2021 2:03 pm

Totes agree TC. The latest brainfart from Kanani and Waller. They are literally making it up as they go along.
This mess of unevidenced tosh will no doubt be touted as “investment in GP” – but is in reality the start of an obstacle course of hoops to jump through to access short term staff funding – ready to be pulled away from under you in future.

GWYN HARRIS 3 September, 2021 12:23 pm

I fear that you may be being too optimistic about this Dr Copperfield.
Even if we decide not to do these things and forego some funding what do you reckon are the chances this will form a key part of the next round of CQC inspections?
At which point, RI or worse beckons for those who have either not signed up to the PCN DES or have failed to live down to its micromanaging standards.

C Ovid 11 September, 2021 3:34 pm

Well done Tony! It’s all just the same recycled QOFfy bullsh*t from 2004. As for the “Personalised care” element… WE could write the book on this. Patronising is a polite word. Some “woke” newby at your PCN or the DoH seems to have learned about this for the first time… been on a course or something, and made the mistake of preaching to those of us who have done this and realised it was b*llocks and moved on to reality….probably in about 2005. (The year they reached puberty)