Wednesday, November 29, 2017

Rural general practice in Scotland facing extinction

The end of rural doctors?

I make no apology for reproducing in full the press release below from the Rural GP Association of Scotland, of which my wife Susan is a member. It's quite clear from Professor Philip Wilson's devastating comments that the use of Deloitte's deeply flawed methodology could destroy general practice in the Highlands and Islands of Scotland. As he says: "If a student of mine had produced a piece of work like this, I would have expressed grave concern about the quality. The fact that both Scottish Government and the BMA negotiators appear to have fallen for this flawed economic model is utterly bewildering.”

"A boost to urban primary care at the expense of rural" 

GPs in Scotland are set to vote on a new contract which aims to make general practice more attractive to new GPs. The new contract was announced last week in a joint exercise between the British Medical Association (BMA) Scottish GP’s Committee and the Scottish Government. It has now emerged that the effect of the contract will be to give a significant boost to urban primary care at the expense of rural services. The new funding formula will see cuts to rural NHS primary care services and around 90% of practices in the North of Scotland will see their allocated funding reduced by up to two-thirds. Although there is a promise of short term funding protection in the contract, the detail of this has not been provided, and this uncertainty looks set to destabilize rural healthcare across Scotland.

"Things will become very much worse"

The Rural GP Association of Scotland (RGPAS) has expressed great concern to Scottish Government health officials and BMA representatives in the negotiating team. Dr David Hogg, Chair of RGPAS said “while we are delighted that some of our city-based GP colleagues are going to see a much-needed boost to their resources, it is very wrong that this should be at the expense of rural general practice. Rural patients, particularly those who are elderly, vulnerable or on low wages, rely more on local GP health services in order to access appropriate care. Rural GP teams provide a much wider range of services as we offer many treatments that would normally be provided in hospital. Much of this work remains unfunded. In addition, our members are called upon to administer life-saving care in remote areas, often for long periods before the ambulance arrives. Furthermore, recruiting GPs to rural practices is extremely challenging and the concerns of our younger members about the proposed contract indicate that this will become very much worse”.

"Critically unviable"

In an ongoing poll, almost all RGPAS members report a reduction in estimated funding allocation, with over a third reporting losses to their practices of 40-69%. 52% of RGPAS members said that without the offered short-term funding protection, the cuts would make their practice ‘critically unviable’.

"Utterly bewildering"

The reason for the proposed massive funding cut for rural practice is a new ‘workload allocation formula’ created by economists from Deloitte which does not take into account the fundamental differences between remote/rural and urban practices. Professor Philip Wilson, professor of primary care and rural health at the University of Aberdeen and a GP in Inverness, said: “The Deloitte team have taken a simplistic approach which assumes that health need is proportionate to the number of appointments available. They based their calculation on an old dataset derived from a small group of practices which does not represent the Scottish population. They did not make the effort to look at the complexity or time required for GP consultations. They made some very simplistic assumptions about rurality and found it did not affect their ‘workload’ model and took no account of the fact that under-doctored areas would appear to have low workload because relatively few appointments are available. If a student of mine had produced a piece of work like this, I would have expressed grave concern about the quality. The fact that both Scottish Government and the BMA negotiators appear to have fallen for this flawed economic model is utterly bewildering.”

"Reality check"

Dr Douglas Deans, a GP with wide experience in Highland and Island practice, and a former Orkney Health Board member, said “Although Deloitte have a reputation in the business community, this report shows that they have little experience of the rural environment. A reality check with those experienced in work and research in the rural environment would have quickly shown how far out this formula is.”

"Really worrying"

Dr David Hogg, GP and Chair of RGPAS, said: “This is really worrying. It shows that the workload allocation formula grossly under-values the workload and fails to acknowledge inequalities in rural Scotland. For a country where a fifth of the population lives rurally, it is extremely disappointing that our health leaders are proposing a system that has not been adequately rural-proofed.’

He added: “Whilst the proposal includes measures to protect practice income in the short- term, it is uncertain how long this will last. Furthermore, the cuts for health boards will mean that other primary care services for rural patients, such as district nursing, will lose funding. It is unclear why a formula has been selected that short-changes rural communities where there is so much dependence on the local GP team to deliver necessary healthcare services.” 

Friday, November 24, 2017

The latest Orcadian Dalliance - A tribute to the songwriting of Malcolm Young and AC/DC

No Beatcroft Social this week - but a wee tribute, courtesy of those nice people at BBC Radio Orkney, to Malcom Young of AC/DC, who died last week. I thought it would be interesting to examine the strength-in-depth of AC/DC's songwriting, something revealed to me properly when I first heard Mark Kozalek's wonderful What's Next to the Moon? album, featured here. Sometimes these songs sound...elemental, like ancient blues or country. Dark, though. darker than they appear in what can be cartoon versions within the AC/DC performance oeuvre.

Still, when you hear Malcolm's rhythm guitar, that (suitably modified and indeed recreated) ancient, single-pick-up Gretsch Jet, the sheer propulsion that allows Angus to soar and strut...AC/DC were irresistible. And despite it all, despite the deaths, the crimes, the disarray...they still are.

You can play the show on Mixcloud as usual  from the embedded player below, or go to the BBC iPlayer and stream it from there for around a month!

Tuesday, November 21, 2017

Powerlessness, politics and predators. Living in Gnomon’s Land

I don’t think I’ve ever felt so powerless.

I’m living under a dangerously incompetent UK Government. But worse than that, it’s weak, at war with itself, beset with lies, half-truths and cynical self interest. It has permitted some really toxic elements in British society not just to express their opinions, but to weaponise them online through unaccountable spending, to engineer the electoral process for their own nefarious purposes. It has encouraged an atmosphere where vicious, violent crime against people, even elected members, whose opinions are not shared by the bullies and bigots, can be promoted and perpetrated. And all of this in a technological context where control, surveillance and manipulation of the public is being allowed to run rampant.

I live in Scotland, a Scotland which even a year ago seemed capable of taking a different path. Which had, in the European referendum, voted - if not as resoundingly as one might have hoped - for cohesion, inclusivity, co-operation and openness. I felt embarrassed by my previous campaigning, in the far-off days of the Scottish Independence Referendum, confidently asserting that a vote for independence would remove us from Europe. I shifted my view towards what seemed a possible solution - Scotland in Europe, separate from a UK which seemed to be slipping towards an appalling mixture of brutal stupidity and tyranny.

But since then there has been political stasis in Scotland, with an SNP leadership uncertain how to proceed and a Labour Party apparently intent on savaging itself from within into irrelevance: And I understand the problem for Nicola and her cohorts: everything indicates that in the current climate of abject terror about the future, any second referendum for Scottish independence would bring defeat for and possibly a major fracturing of the SNP. The last thing the EU or this tottering Westminster administration wants now, as negotiations on Brexit range from flailing idiocy to dumb intransigence, is for that to be complicated by events north of the border. If there was a determined push for indyref 2, I could see London taking really drastic steps to stop it, moves that would make events in Catalonia seem like an episode from I’m a Celebrity Get Me Out of Here. Apart from anything else, the UK cannot afford to lose Scotland - it’s oil and gas, its whisky, its strategic geography, its nuclear weaponry - in the face of exit from all that Europe is and represents. For the time being, Scotland will simply not be allowed to secede.
But Nicola has the Braveheartian elements within her party to consider. The anti-tax rise tartan Tories. The immigrant-hating element of escapees to ‘pure’ Scotland. And those who despise England, along with all who sail or sailed in her. There’s realpolitik. And there’s a need to keep the saltires fluttering and the bagpipes inflated.

Meanwhile, Labour is in the grip of romantic leftism - to which I am not immune - I mean, Jeremy Corbyn, like me,once owned an MZ motorbike and rode it to Portugal and back; no-one else in politics, aside possibly from the legendary Hugh Kerr, can say such a thing. But come the crunch of yet another general election, can Labour, hopelessly compromised on Europe and beset with ugly internal conflicts ranging from anti-semitism through  sexual harassment to the shameful vilification of Kezia Dugdale (but not by The Beloved Jeremy), actually win? In this torrid atmosphere of hate crime and the ruthless, moneyed exploitation of social media by so-far unidentified forces of the extreme right?

And whither Scotland? The SNP Government seems to be desperately pushing for the retention of Holyrood powers that could easily be sacrificed by Boris, ‘Red Mike’ Gove and their chums. While facing a meltdown in public services, notably health, which can only be addressed by tax increases. A route it is poised to take, but understands could alienate yet another element of nationalist support. 

I am writing this after finishing Nick Harkaway’s hugely disturbing, vastly entertaining and - let’s be honest - quite difficult and very long book Gnomon. On the face of it, and to simplify drastically,Gnomon is a doorstop of dystopian sci-fi which reads at times like a brainstorming session involving Neal Stephenson, William Gibson and the late Iain (M) Banks. But it’s really a book about Brexit Britain, about the surveillance state, about how we ignore digital manipulation by Government at our peril. At how the evil  in our society lurks, waiting to assume control. It’s also about nationalism, dictatorship and how worldwide, we are reaping the whirlwind of identity politics.

Which of course brings me back to Scotland. Is the unutterable mess the UK wallows in right now a result of Scotland’s kicking against the Westminster pricks? Did Scotland’s drive for independence, all starry-eyed and moral, liberating and socially liberal,  unleash the poisonous forces of brutal, racist, skinhead Little Englandism?

There was undoubtedly  an element of reaction. But amid the Greek gods and Ethiopian art, the demons, sharks and books (because Gnomon is about books as much as politics, including arcane pulp references such as the word ‘Forsythean’ as in Frederick, and a submarine called Rebus) Nick Harkaway identifies a worldwide retreat into parochialism, fuelled by the ever-encroaching power of the internet. Scotland’s wee story is more symptom than cause.

What to do now? What can we do? My faith, I have to say, is in the power of words. Not this book, or not only Gnomon, but the fantastic journalistic work being done to uncover the way the Brexit referendum was corrupted and manipulated by those who stand to gain most from it. And I don’t just mean the Russians.

There are sharks everywhere. 

“What’ll I tell the kids?” 
“Tell ‘em I’m going fishing...”

Gnomon, by Nick Harkaway. Published by Heinemann. £14.99

Saturday, November 18, 2017

Janglecrunch! Beatcroft Social for 18 November - the Rickenbacker 12-string special!

As suggested by Mr Ali Wilson and confirmed by Mr Lindsay Hutton, this is a selection of some favourite songs featuring the Rickenbacker 360/12 electric guitar, or variants thereof (though I sneaked in some Voxes, a Baldwin and maybe a Burns and a Shergold).

Never having played a Rickenbacker, been close enough to a stage to see properly or even seen one in a shop, I did not know until right now that they're strung with the pairs of octave strings the other way round from an acoustic 12-string, of which I've owned far too many. You hit the thick strings first on the downward strum. All part of that distinctive twangle.

Oh, and if you fancy a brand new Rickenbacker 360/12, it will set you back a whopping £3980 if you pay the list price in the UK. Though I see Gear4 Music has it for £3280. Err...bargain!

You can play the whole show from here:

Or, if you can't stand my yakkin', here's the Spotify playlist:

Friday, November 17, 2017

It was 35 years ago...Rough Justice: Songs of Worship and Doubt. The lost Tom Morton cassette

1982. I was a worship leader, on occasion, kind of. A singer and guitar player. A songwriter. An evangelist. I'd been prayed over, blessed, sent forth with the laying on of hands and everything.  I spoke, or at least muttered, in tongues. I was a full-time worker for God, part of a mission team called Scotroc, which sounds now (and sounded then) like a form of cooking chocolate. For a year or so we (Anne, my wife, and Sandy, my son) had been living in a Charismatic community at Overtoun House near Dumbarton. With second son David on the way, we'd moved out, back to Glasgow, but things were moving - personally, spiritually, emotionally - towards utter meltdown.

Faith was falling apart. So was every other aspect of life. But it was happening in the context of having to play, perform, witness, preach and pray in order to live. It was a job. It was what I did. It was who I was. And I was getting to the point where I didn't believe in who I was anymore.

At this point, I'd recorded two previous 'Christian' albums, both released on vinyl, almost all sold at concerts. Now I was trying to write my way through the crisis in my life. The result was this cassette, full of songs which veer schizophrenically from the full-on worship anthems like I Am Empty to desperate, paranoid Costello-lite rants like Loose Talk Costs Lives. There are songs of guilt and depression, and increasingly stark portrayals of a God who seems to delight in inflicting suffering. Pain seems to be the only solution. Contrasted with an immersion in religion both fuzzily reassuring and apocalyptically crushing, bloody and cruel.

Amid all of this, watching my disintegration with no doubt some astonishment and discomfort (I never asked), were some amazing young musicians (and I was only 26). Jane Sidebottom, Ewen Vernal and Andy Brodie. I'm pretty sure Ewen was only 17. All were members of the Scotroc team. Both Andy and Ewen would become highly successful professional players. They have their own stories to tell, and I won't trespass on them here. It was a delight to meet Jane again last year - at an Aberdeen University ceremony. We both had children graduating.

Anyway, I was provoked into rummaging through various nooks and crannies, digging out my only copy of Rough Justice and transferring it into the digital realm, by a mention the other day on Facebook. The Lion Will Return (Narnia in open 'G') is apparently still worthy of inclusion in a sermon. I must admit I do wonder if any of the explicitly worshipful choruses ever surface in churches, or if my cheerfully backslidden state has rendered them unholy.

The tape was recorded over two  December days in 1982, almost exactly, as I say, 35 years ago. In the old Gospel Radio Fellowship two-track studio in Argyle Street, Glasgow, live. What you hear is not of the best quality. The only copy I have is a TDK D60 copy made from a cassette, which wasn't that great to start with. But listen hard and you'll hear some of the best fretless bass playing any Bishopbriggs 17-year-old has ever recorded. Some wonderful sax and piano. And, may I be forgiven, some guitar playing I had forgotten I was ever capable of.

Some of Rough Justice is hard going. Some is well, rough. Some is awful. Some is pretty good, I think.

 Anyway. Here it is.

Thursday, November 16, 2017

Earthbase Unst


For launching rockets into space
Unst has to be the perfect place
It isn’t very far away
Just three ferries, and several days
From the Scottish mainland, or Norway
Which is slightly nearer anyway

And the weather will make launching easy
It’s calm, and dry, and never breezy
Except maybe for the odd occasion
When the wind destroys the radar station
But really, you need have no fear
That only happens twice a year

At other times, there’s not a peep
You’ll never see a flying sheep
A tumbling caravan, or boat
Or new-built house, suddenly afloat
Don’t credit what naysayers say
It beats Cape Canaveral any day

There’s wildlife, but not really a lot
Bonxies and puffins won’t give a jot
If their peace and quiet is to be shattered
A few burnt otters? They won’t matter
And when launching  you don’t have to shoot
At airliners on the polar route

Or worry about ships at sea
It’s not as if there’s going to be
Any more drilling for oil out there
And does anybody really care
About the noise, the raucous roaring?
The silence can get rather boring

So come, oh, spacemen and women too!
Unst surely welcomes all of you!
There’s local beer, and soup and gin
And a swimming pool to frolic in
And if you ever wonder where you are
You’re only  one small step from Mars

That’s what the vikings used to say
When they decided they would stay
Like them -  relax, eat, drink and be merry
Don’t worry if you miss the ferry
Or if the launch date is delayed
Shoot for the moon some other day

Copyright Tom Morton 2017

Friday, November 10, 2017

Play guitar, loudly and crunchily: The Beatcroft Social, 11 November 2017

Back in Shetland after all the Inverness shenanigans - some great eating at the likes of the Mustard Seed and the Royal Highland, and inspirational stuff at the Rural GPs conference (which is for doctors, but I was there as light relief). Particularly enjoyed making this. More wallowing in the classics, but you know why? Because these older tracks are just better...

Friday, November 03, 2017

The Beatcroft Social: Rock'n'Roll Never Forgets. 4 November 2017

Recorded last week, and a real classic rock wallow (with the exception of the excellent Blue Rose Code of course). Currently in Inverness, but should be back home on Sunday. It's been a blast here in Dolphinsludge, Queen of the Highland Fleshpots, and I may fit in a quick trip to Glasgow tomorrow (Saturday). But the northern isles (and Dexter) are calling!