Wow! What a response!!

Patsy,

The speed of your response is breathtaking. Thank you.

Thank you for the names I requested as examples of very bestest practice. I'm ashamed to admit that I thought you might find it a little difficult to find a name but so many?? That's truly impressive stuff. I've already had a preliminary chat with most of them and will update you further once I 've had the chance to absorb the 28-carat nuggets that were forthcoming. However, these are my first impressions:

John Prescott was really helpful (I think). It was a little difficult to find him at first. I wasn't sure which car he was in and to which of his government-provided houses he was being driven but I am nothing if not persistent and, like the mounties, got my man. He had much to say. I must confess that I did lose the thread occasionally but this is only to be expected when dealing with a man who runs much of the country when TB is away (which seems to be rather a lot these days). (Off the record, he really is worth more than the £150,000 a year plus expenses plus cars plus offices plus staff plus pension etc. A bargain if you ask me). Lord Prescott will only add lustre to the upper house (should he need a third).

Next came John Reid. I really struck gold here since he was able to arrange a "four-way" teleconference between the two of us AND Charles Clarke and David Blunkett. This I was able to get the collective wisdom of all the players who had delivered a Home Office which frankly is an example to us all. It also completely clarified what is meant by "fitness for purpose". Gosh, don't we have a long way to go?

Perhaps the most difficult interview was with Frank Dobson who as your predecessor in 1997 can take all the credit for demolishing those appalling Tory gimmicks such as internal markets, devolved budgets, etc etc. It is still a puzzle to see why he came a bad third to Ken Livingstone and Steve Norris in the London mayoral elections. Clearly it has left its mark. Still he did have some words of praise for the Treasury who have always been so supportive of his efforts.

I've left a message for Ruth Kelly at Education but she's not taking calls. I don't have a number for Margaret Hodge so all-in-all Education is a proving a tad tricky.

Steven Byers suggested floating our surgery on the stock market and then cancelling the shares but was a little vague on detail. David Miliband at Defra suggested I could learn a thing or two about making every penny count by looking at his department's work on the common agricultural policy.

I've left the best until last. Our beloved London Mayor was unsparing in his help and was generous in providing me with a text-book study on spending £800+ millions that wasn't in his budget on buses that now run every ten seconds in packs of five meanwhile taxing the overpaid bourgeoisie swanning around London in their 4x4 tanks to pay for it. Surely there is no better example on how to soak those rich GP bastards. You can rely on Ken.

I am so totally energised by your timely response. You have only increased my determination to prove that we in the health service can do just as well as our beloved leader has done for the people of Iraq.

What a team! What results! What an example to us all.

Your greatest fan

p.s. my thanks to my good friend Dick for his input.

An Appeal

Dear Patsy,

I am writing to say how sorry we are to have been the cause of so much inconveniece to you and your team at the Depratment of Health. How could we have been so inconsiderate? How could we have so exceeded your performance expectations and quality targets. Please, please calm yourself. The solution is at hand.

Our partners have cancelled all their sessions for this week in order to focus on re-establishing the "cost trajectories" that had been established in your original plan. In doing so they are helping in two ways: firstly, it will lower our quality indicators scores and start us on a firm trend towards the 777 points you assumed we "average" practices would achieve. Secondly, we will stop registering new patients which will lower our totals thus directly reducing our income. It has been most pleasing to help you achieve these most important objectives. Of course, we need to look to the longer term. God forbid that we should ever be accused of short-term thinking.

We will be issuing redundancy notices to the two health care assistants that we recruited to shoulder much of the administrative and routine monitoring tasks. Such actions have both good and bad outcomes with which we are
wrestling: we will achieve less and thus earn less which surely is a good thing? The trouble is we will spend less so we will still appear to be the same greedy money-grabbing bastards you have led with such grace, such aplomb since your appointment. Our nurse practitioner has now finished her nurse prescribing course and which for the past four months we have been trying desparately to get our PCT to authorise so she could use the knowledge she has worked so hard to learn. We didn't realise that their gross inefficiency is part of your master plan to reduce our prescribing spending. So, our pursuit of the appropriate signature will cease immediately.

Reducing our staff brings other benefits. We now have some spare equipment so if you know of anyone who wants two Celeron P2 PCs with less memory than the average Alzheimer victim, together with two HP 959c printers with worn print heads and wonky power lead sockets and who provided they can outbid our local museum, then they are theirs for the asking.

However, let's not be negative. There are some real win/wins on offer. We have decided only to refer patients if secondary care can be booked via your wonderful Choose and Book system. Thus you will soon be able to claim that everybody is using Choose and Book successfully and you never know, one day it might actually be true. What a day that will be. In the meantime, we continue to enjoy the built-in restrictions that slow down the whole process thus in turn reducing spending. We especially like the way you have camouflaged these sophisticated barriers as technical problems, slow connections and inexplicable log outs. Darned clever those computer boffins.

I'll need your help on the next one. Could you point me in the direction of another government-led organisation that has been too successful and resulted in over-generous incentive payments? I would like to have a "heads up" with your opposite number in whatever ministry they work to get the griff on how to claw back the money whilst maintaining morale and improving output. One will do, although two names would provide me with more depth of experience. No rush on this one.

Finally I do feel the need to confess that we may unwittingly provided ammunition to those who feel that your views on general practitioners may be anything but entirely well-informed and wholly accurate. So, with immediate effect, we are withdrawing our labours from our local out-of-hours service so that we cannot be accused of earning too much from private fees. I have to confess that we failed to opt out and reduce our income by the fifty-odd thousand quid our partners could have spent on you rather than on themselves but it's no use crying over spilt milk. I don't like a "blame culture" any more than you, but quite frankly, it wouldn't have been a problem if our local GP co-op wasn't so damned efficient. Then out-of-hours cover would have cost us the fortune it seems to cost in most other places. Still, I have now hit our co-op manager round the back of the head with a plank and let the air out of her tyres and this should do the trick.

Please find enclosed a cheque from the practice which represents a downpayment on the repayment of the scandalous Tsunami of cash that has come our way. More will follow I am sure. Perhaps we should send it direct to Accenture who nearly lost so much money on NPfIT? Didn't you used to work for them? Perhaps you could let me have the address of one of your colleagues?

Always here to help,

Bestest wishes