'Are you ready?'

'I'm not sure...'

The Duchess is always ready for an outing. It's her New Year resolution to 'get out more'; to the shops, the gastro-pub for her weekly glass of champagne, or Starbuck's for a small-flat-white.

Today she hesitated. The district nurse might be popping-in. She couldn't remember.

'No problem, I'll ring the surgery'.

It took nearly 12mins to get through; probably longer. The phone system is choc-a-bloc. I only looked at my watch when I realised I'd been hanging on for ages. The phone was answered by a recorded-voice. Press one for this, two for that. Press 3 three repeatedly if you have anxiety symptoms. Press 7 if you want an appointment and feel lucky. The recorded voice apologised and said they were very busy. Ring, ring, we are very busy. Ring, ring, we are very busy. Ring, ring, we are very b... 'Surgery, how can I help'?

Is Mum down for a visit from the district nurse today, please....

'Sorry, we can't tell you. We don't know where they go. They don't work out of the practice anymore; you'll have to ring another number....'

This time a voice mail; 'This is the District Nursing Team. We work from blah, blah to blah, blah. There is no one here... leave a message and we'll answer it when we get back. Or, you could ring our main office at blah, blah.... '

I rang the blah, blah main office and spoke to a real person.

No, she couldn't help; We have no central record or call lists for the DNs. They don't know where they go. You are 'head office?' Yes, but we don't know where any of them are.

At that moment the doorbell rang... the cheerful, irrepressible DN arrived; 'Merry Christmas!'  Heart winning smile, angst melted.

Here's the story. "No one has our list because there is nowhere for us to publish it. We use RiO software and only have one computer between all of us. The GPs are on EMIS. They don't know where we are. Often, we visit someone and whilst we are out the GPs might ring, leave a message on the Answerphone and say can we take a blood test, or something. We don't find out until we get back. It happens all the time. It's hopeless isn't it?"

Aaaaaaaaaaaaaaaaaaaaargh!

Yes, it is... hopeless. The DNs are run by Virgin, the practices are run by the practice partners and the patients run between the two of them in the innocent hope that the might of the NHS and the entrepreneurial glitz of Virgin might combine to produce a National, or even Neighbourhood  Health Service and some semblance of the organisation we might take for granted in a chip shop.

The simple, unglamorous hope that two service providers might talk to each other is as wild an ambition as it is to expect to find a row of council flats on Mars.

I have since made enquiries and discovered the GPs have gone from fury to resigned acceptance that the idea of a DN being in and out of the surgery, talking about case work and patients is a fond memory, reserved for reruns of Dr Findlay's Case Book.

I would have thought in the interests of journey planning, duplication, carbon reduction, efficient use of resources, case load, skills and experience, continuity of care, improved outcomes and safe working... it might be an idea to know where everyone is, what they are doing and when. And, perhaps even what it costs? It might be an idea to be able to text them, call them; have a face time facility for the DNs to get on the spot advice and help. And, last but very definitely not least; security and Lone Worker's Policy.

Here is a simple New Year's message. Forget the grandiose, the IT, strategy, templates, targets, forward-views, plans, budgets, pathways... just figure out how to find a DN on a Monday morning.

The Carbuncle is planning 7 day working and talking:

It would be nice if we could concentrate on the simple things, first.  Do what we are doing now, properly. If the NHS is in the mood for resolutions... can we make 2015 the year of getting the basics sorted out? 

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What's the future for primary care?

If you want to know, too, join me, the NHSE Primary care Tsar and Deputy Medical Director Mike Bewick, leading GP Dr Clare Gerada and the president of the NAPC and former policy advisor Dr James Kingsland, at the Kings Fund for a night of

 The Big Conversation about Primary Care. 

  Details here. 

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