These days, nothing really happens until it happens on social media. Apart from curmudgeonly old duffers like Dr No, anybody who is anything is busy on twitter. Why, even HRH is on twitter! The NHS, it seems, is all over twitter like pigeons all over Trafalgar Square. Hospital trusts, ambulance control centres, continence control services, you name them, there they are on twitter, tweeting away, like pigeons all over…
In case he is missing something – perhaps he is, since everyone is at it – Dr No decided to observe in real time the emerging tweets of one NHS twitter account over a period of one hour. In the interests of openness and accountability, he presents his observations and, being twitter, it should be read from the bottom of the post upwards. But then, Dr No has never suggested twitter ever made any sense…
Hot Burning Coales, the enigmatic London GP who has for a time been a thorn in the side of the Royal College of GPs, is showing signs that she is about to start hammering at them like a pneumatic drill. She is alarmed by the absurd pattern of results from the College’s Clinical Skills Assessment, the ‘exit’ exam for trainee GPs. Her concern is that white British candidates go through on the nod, while Asian International (non-UK medical school – IMG) graduate candidates are systematically failed, on the grounds that they are not ‘one of us’. Certainly the raw figures appear to back up the suggestion that there is a case to be answered. The College’s own statistics (page 28 
Over the years Dr No has encountered a number of single handed general practices. His first encounter was on a Scottish island, as a student, in a practice made memorable by two things: the sweet malt smell from the oil drum sized barrel of beer that brewed beside the kitchen range, and the loan of the practice Land Rover, with a licence to roam the island. Later, as a locum, he found single-handed GPs on leave a reliable source of work: he could be transported, as if by a revolving door, to the seat of a single handed GP. For a week or two, he had eyes-only access to almost every aspect of the practice. He saw the intimate details first hand, not as a squinting sociologist might, but as a living participant. And living practices they certainly were, but pretty rum many of them were too. Too often for comfort, opening a drawer in search of a prescription pad, Dr No was greeted not with a jumble of papers, tongue depressors and broken tape measures, but with the clink-chink of bottles of high proof but non-surgical spirit.
A good traveller leaves no track
The title for this post arises because Dr No has idly been playing Shorter Titles, the I’m Sorry I haven’t A Clue game in which panellists are invited to submit film (or song) titles where a single letter omission changes the meaning – Oldfinger, The King’s Peech, Rear Widow, The Godfarter, The Tird Man, that sort of thing – but as Jack Dee would say, they don’t work in print – the original title here being Left Shift, the hypothetical statistical fancy much beloved of the medical Islingtonistas who favour alcohol minimum unit pricing. Left shift is the notion that in populations the body wags the tail: the mean determines the extremes. Applied to alcohol minimum pricing, left shift has it that if average consumption falls because of raised minimum unit prices, then so too will heavy consumption fall. Populations, according to this hypothesis, behave like a blancmange made with excess gelatine: a nudge in the middle, and the whole pud moves across. 
Twitter health news of the weekend was iDoc, a Department of Health initiative to slash surgery visits by replacing them with technology, and so save nearly £3 billion. The fire was started late on Saturday evening at 11:11pm – 11 minutes, Dr No notes, after the end of The Killing (BBC Four), the Danish villains in high places procedural – by the ever vigilant Dr G, who 
Just as there is gold for drug companies in them thar pills, so there is gold for GPs in them thar patients. Historically, GPs were paid chiefly on a patient head-count basis, topped up with item of service fees for ‘extras’ such as vaccinations and contraception. The simplest way for GPs to boost income under this system was to increase list size, sometimes to absurd levels where the GP could not hope to provide adequate care for all the patients on the list. Some even gamed the system, by sneaking ghost patients on their lists. Governments disliked crude head-count based pay, not least because it offered no scope to influence GP activity. Item of service payments were an attempt to change that, but the capitation fee was still paid whatever the doctor did, or didn’t, do. The below par golfing GP trousered the fee in equal measure to his more conscientious colleague on the other side of town. 
The idea the there is gold in them thar pills is, one might say, as old as the hills: the 
Just over three years ago, when few had heard of him, Dr No wrote a post called