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Stocktake or pisstake

Continuity

Honestly, what I had in mind here was a considered take on the recently-landed ‘Next steps for integrating primary care: Fuller Stocktake report’. After all, it’s important, written by a very experienced GP and comes at a time when general practice is even rock-bottomier than usual.

But I can’t. I’ve tried, but I just can’t get past the document itself. I don’t want to be fatuous and superficial, I want to be analytical and incisive. That’s impossible, though, because for me it’s impenetrable, just like countless other previous reports I’ve read on much the same subject.

Consider these brilliant examples of meaning strangled by management-speak:

‘Systems have a role to play in articulating a clear plan for data sharing across the system to support the development of population health management approaches at neighbourhood and place level, enabled by a clear information governance framework and work closely with providers and patients to co-produce data sharing agreements where appropriate.’

And just when you’ve recovered from trying to dig the sense out of that, a few pages later, you’re hit with: ‘ICBs have an opportunity to establish a firm understanding of current spending distribution across primary care weighted by deprivation and other elements of the Core20PLUS5 approach, which can then inform discussions on how discretionary investment can be more purposefully directed to address health inequalities and form the basis of work to secure collective commitment from all system partners to this redistribution.’

By which point you may well have blacked out.

But there’s more. The document unashamedly wears the tropes of other recent portentous documents on primary care salvation. For example, we have the countless case studies of areas working ‘smarter’ and making all the rest of us feeling inadequate.

We also have the introduction of a new word to the bullshit bingo roster. This is a trend I picked up on years ago, spotting the previously unheard of ‘robust’ countless times in yet another document on how general practice should be saved. This time, it’s ‘pivot’s turn to shine. It appears five times – and, in case you’re interested, these are the things that are going to ‘pivot’:  national policy, investment and support, strategy, top-down directives and leadership. Hope that’s clear.

Of course not: such words in the corporate craposaurus never shine a light on meaning – they just serve to confirm that, while documents like this are about us, they’re not really for us. And the net result is that something which emphasises the need for engagement, mentioning it ten times, achieves the exact opposite.

Look, collectively we’re suffering, and these documents just make us suffer more. In future, how about avoiding alienation and opacity by running them through a Plain English filter and providing solid ideas on a single page? You can draw your own conclusions from any reluctance. In the meantime, I will try pivoting more. Though I notice that when I do so I always seem to be facing ‘exit’.

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

READERS' COMMENTS [9]

Hugo Hammersley 31 May, 2022 10:31 am

Here is a quote from George Orwell’s essay “Politics and the English Language”. I recommend Dr Claire Fuller reads it and takes note.

“A scrupulous writer, in every sentence that he writes, will ask himself at least four questions, thus:

1. What am I trying to say?
2. What words will express it?
3. What image or idiom will make it clearer?
4. Is this image fresh enough to have an effect?

And he will probably ask himself two more:

5. Could I put it more shortly?
6. Have I said anything that is avoidably ugly?

One can often be in doubt about the effect of a word or a phrase, and one needs rules that one can rely on when instinct fails. I think the following rules will cover most cases:

Never use a metaphor, simile, or other figure of speech which you are used to seeing in print.
Never use a long word where a short one will do.
If it is possible to cut a word out, always cut it out.
Never use the passive where you can use the active.
Never use a foreign phrase, a scientific word, or a jargon word if you can think of an everyday English equivalent.
Break any of these rules sooner than say anything outright barbarous”.

Of course Orwell wasn’t always as amusing as Copperfield, but they both speak the truth!

Old Lag 31 May, 2022 11:03 am

I learnt English as a medical student in Liverpool in the seventies. I clerked in a lad of about eighteen and asked the usual/advised – ‘how often do you open your bowels/pass stool’ etc. He hadn’t a clue, nor would I before medical school ! Only when I said ‘ how often do you have a crap’ did he understand and reply. I learnt at that moment that to communicate with patients I had to use language they understood, not medical jargon.

dean price 31 May, 2022 11:23 am

They’re surely the descendants of the «  Circumlocution Office » , so brilliantly described in Little Dorrit ( chapter X) by Dickens. And you , Copperfield are surely the descendant of that great man .

Matthew Ashton 31 May, 2022 11:34 am

Sir Humphrey lives on ! ( Yes minister)

Jonathan Heatley 31 May, 2022 12:20 pm

this report was unbelievable waffle and as copperfield says very hard to read. However towards the end the proposed solutions were to have three branches of practice- acute medicine, chronic conditions, and prevention. They don’t seem to realise we GPs do all this in one consultation.
What landed today and is more disturbing is the CQC proposal to evaluate practices using our computer data looking for our failures to monitor patients to the Nth degree so for instance checking that we have done yearly bloods on all those on diuretics or NOACs or antidepressants. I was honestly shocked at the detail of interrogation and feel this may be the final straw for my generation of GPs. Total collapse looms. (and I’m an optimist)

Douglas Callow 1 June, 2022 3:23 pm

Ben Gowland captures the essence of what we should be asking ourselves

https://ockham.healthcare/category/blog/

”All of this leaves me with the sense of a very highly politically managed process with the report trying to be pushed through, without the debate and discussion that you would normally expect for such a significant change.

It is for individuals to make their own mind up about the attractiveness of the vision laid out in the report and the extent to which they sign up to the proposed way forward. My ask would be that more clarity is brought to the implications of this report for general practice before these decisions are made, but my fear is that rapid national agreement will quickly push any real debate to a local level and the course will already be irreversible”

Got a point..

Truth Finder 1 June, 2022 5:17 pm

Doctors realize most of these managers are incompetent and just in it for themselves. Creating work for us to keep them in their jobs with tons of BS that does not help patient care or improve the services.

Malcolm Kendrick 6 June, 2022 5:47 pm

The purpose of management in the NHS should be to support those on the front line. Make their lives easier, provide to them what they need, free them up from pointless bureaucracy – and suchlike.

The reality is the management drive down pointless intiatives upon the workforce that have, in turn, descended on them from higher up.

What we have is a pyramid, with the heatlh secretary at the top, and the workers at the bottom. Flip the pyramid the other way up. With the workers at the top, and management at the bottom, with the health secretary on the very lowest level, on thier own, holding up the entire edifice.

The initiatives will now be driven from the top. Exepct the top is now those on ther front line – who used to be at the bottom. They know what they need, what will make their job easier. The role of those beneath is to make sure the front line workers get what they need, and ask for. No need for endless management bollocks reports. The styem will just, gradually, get better. A market in good ideas will develop, with the best ones taking over.

I can dream.

Patrufini Duffy 7 June, 2022 11:02 pm

Some local “estate manager” sent an email to 80+ practices saying a private surveyor is coming to see you next week to map your site and tick some dodgy boxes. Your practice manager doesn’t need to be around, just let them in and give them your policies. You what? It’s not mandatory, but “might be useful if you want to merge or close down”. I know. Get off your zoom meeting, and say that to a clinician. Managers. This is what dirty tactics is going on. They’re mapping you and creating a blueprint to bin you.