Monthly Archives: January 2015

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The Cat is Out of the Bag

Well the cat is really out of the bag this week; not one, but two ‘elephants in the room’ that many of our leaders are just too afraid to address.

Cat walks out of the bag

First of all we had Zoe Norris incensed by yet more “useless, fat cat GP” rhetoric, and then in the wake of the “Christmas 4 day break” A&E/OOH apocalypse, we had a superb blog by Prit Buttar on the access/demand issue.

What still amazes me, especially given the Twitterfest that ensued, is why addressing demand is seen by some as being so recalcitrant.

Appropriate use of resource is now part of our everyday life; we are encouraged to recycle at every turn, we are exhorted to reduce our carbon emissions, protect our rain forests and limit our consumption of fossil fuels. We have publicity campaigns to ‘switch it off’ for electricity, and ‘turn it off’ for water. The police judiciously remind us that unless we use their services wisely, they will not be free to respond when we really do need them. So why is healthcare so different?

“Free at the point of access” is the tenet of the NHS, but of course it isn’t really free; like any other commodity, it is paid for one way or another; unless people are prepared for more public money to be put into the NHS pot, we have to learn to use the budget wisely. There is no ‘magic porridge pot’ of health provision, somehow we’ve got to work with what we’ve got.

To our detractors, on the subject of GP pay, I say this. Any system that provides 90% of the activity for 9% of the budget is good value. Forget about individual pay, General Practice is a slick business system that represents huge value for money for the UK taxpayer. To those that complain about the fact that we are better paid than most of our European colleagues, I say, do you understand the complexities of the Primary Care role in the UK compared to that on the continent, where people only go to see a GP if they have a ‘simple’ self-limiting illness?

To those that complain that access is not adequate and that we should be open all day, all evening, 7 days a week, I say ok, so how are you going to pay for it? Unless the GP budget is doubled, we can’t provide the same service 24/7. And if the appointment isn’t available for you to access for your cancer diagnosis or if Granny is left waiting for 12 hours, struggling to breathe because the system is buckling under the weight of demand from people who have forgotten to order their oral contraceptive along with the Christmas Turkey are you going to be happy with that?

I actually embrace patient involvement in service provision. Believe it or not, it’s easier for me to say “Ok, you choose. Do you want cereal or toast, you can’t have both?”

For anyone that knows me, or has read my blogs, you will know that I am an upbeat, happy soul. Crazy though it seems, I really did go into medicine to help people rather than make money though I could have quite easily chosen a more lucrative career.
Stranger still, despite the constant barrage from the politicians and the media, I still enjoy my job. There I’ve said it, I still like being a doctor and helping my patients. Unfortunately, a lot of my colleagues are not so blessed with naturally high serotonin levels and are emigrating or retiring in droves and I cannot tell you how many are simply looking for a different career path.

A welcome and timely article was printed in The Sunday Times only this morning, by Professor Angus Wallace, on the looming crisis.

The trouble is, this isn’t what we signed up to. Across the land, in GP surgeries and hospitals, Doctors are collapsing under the weight of criticism & burgeoning workload. This isn’t a General Practice crisis, this is an NHS crisis.

We’ve tried to ration the services, to spread the jam as thinly as possible, to try to keep the system afloat but, now it’s time for patients to take some responsibility for their NHS and learn to use it wisely & considerately, before it’s too late.