The Times and the NHS again

The Times used to be a newspaper, one of the world’s greatest, and checked its facts and by and large didn’t say things that are not true.

Its leader is reported to me as saying :-

‘GPs bear some responsibility… It is hardly surprising that A&E departments are overrun in areas where they are the only part of the health service open after 5pm or at weekends… Yet the introduction of roundtheclock GP service is being fiercely resisted by claims of insufficient funds… Given their current terms of employment… GPs must earn their generous wages… By doing more to ease the burden on hospitals.’

There are no areas of the country where A&E Departments are the only parts of the NHS open after 5pm or 6 pm or 7pm overnight or at weekends. None. (BTW, the people working in them like to call them Emergency Medicine Departments this century) .

General Practice provides a service around the clock, including at weekends. It is provided by GPs, the same GPs in general who provide a day time routine service.

The service is not identical, expecting to have a routine blood pressure check and advice on treatment from your GP who knows you is sensible, but expecting to have it at 0300 as well as at 1000 hours is not sensible, there is only one of me, I’m a diurnal mammal and I sleep some of the time. If I’m your GP I suggest you see me, not someone random unless you are suddenly ill.

However, if we were to run 24 hour surgeries for all routine work, to which you would presumably arrive on the 24 hour bus or Tube service, by the taxis which run as well at night in all parts of the country as they do in the day, or by walking along the roads which perhaps have their lights turned out to save power at night, there would need to be more of us, or we would need to be less available in daytime.

Also open all the time is the 111 service.

111 sends a lot of people urgently to Casualty (A&E, ED) departments often by ambulance. This isn’t helping.

111 is a franchise, let by the government to various corporations and others, and is only regarded as a great success by those running it, or in positions which would be imperilled by an admission that it is not the greatest thing since sliced processed cheese.

What is the agenda of the Times and its leader writer? And what investigative journalism did they do, and fact-checking? Does the Times still employ a fact-checker?

Dr Ebdy’s letter to the Daily Telegraph

Sir,
You report today (p6) that the coalition has achieved an improvement in cancer survival rates.
How is it that when statistics are poor it is my fault, but when they are good it is down to the Government?

Dr Mike Ebdy
General Practitioner
Health Centre,
Mark Square,
Tarleton,
West Lancashire
PR4 6UJ

Oddly, not published but to the point.

(As another colleague points out, the cancer survival figures are for cases starting at least 5 years ago, and therefore actions leading to improvement are not very likely to have been initiated in this government.)

Hacks: political and journalist

One of the striking changes at the interface of politics and journalism is the briefings to and reported by political editors or correspondents rather than health correspondents. The latter wouldn’t say that the RCGP is the representative body – that is the BMA – for instance.

They might also ask more searching and health-related questions, rather than falling in with the Party desire to treat health and the technical aspects of provision of healthcare as poltical rather than health, or technical.

eg http://www.theguardian.com/society/2014/oct/04/tory-health-minister-earl-howe-tells-gps-stop-moaning

My colleague is correct

This is all true and correct. Your best interests, if not now, then later, are not served by the proposed changes. And you’ll be paying for them – who else would there be?

I suggest you tell your MP rather soon that this is a steaming pile of shit.

Chris Preece

I’ve had various people ask me today what I think of the Government’s proposals to guarantee that GP surgeries will be open 8-8, 7 days a week. So I’ve decided to scribble down a few of my thoughts. (You may want to make a cup of tea first.)

My biggest issue with the proposals is that they contain within them a colossal piece of deception – but I’ll come back to that, as there are plenty of other concerns to pick at first.

There’s the question of whether it’s really necessary for starters. Whilst it’s undeniably “nice” to be able to access a doctor whenever it suits you, there’s very little evidence that it reduces activity in hospitals (the oft cited reason for doing so). It doesn’t appear to make a wild amount of difference to patient satisfaction either. What it does do, of course, is reiterate the notion that health isn’t terribly important. It’s something to be worked around because, apparently, it’s more important that we all put in a full days work every moment we’re given. There is no pressure on employers to free you for your medical appointments – simply pressure to make sure your medical appointments suit your employers. As an overall public health message, I’d argue there’s something slightly wrong there. It also rather undermines the message we’re supposed to be conveying to patients regarding self management.

But of course proponents will argue that these are “soft” points, and I guess they are. They will point out that people are really unhappy with out of hours services across the UK. There have, they will point out, been a number of “successful” pilots of 7 day opening nationally. Except there are (to my knowledge) no publically available reports from these pilots, the majority of which have been up and running for only 1 month, and many of which don’t actually offer full 7 day opening as yet anyway. Once again we have a major national initiative based on a pilot no-one’s waited to check the results of.

Still, that’s not my major bugbear. Nor even is the other obvious criticism that the maths doesn’t add up. The Government’s promised £400million over the next 5 years for this. A quick back of the envelope calculation puts this as about £28 a practice per day (with rounding up). That won’t pay for the receptionist, let alone anyone else.

Of course there’s the issue of the national shortage of GPs, made worse by the lowest figures for GP trainee numbers since the data for such things was standardised. The promise is for an extra 5000 doctors, but with deaneries now admitting they are accepting doctors they would previously have refused (and Hell, they allowed me in) and an increasingly less favourable attitude to (much needed) immigrant doctors, you wonder where these people will come from, and what they’ll be like.
Still, not my main gripe either. It’s not even launching this at the same time as announcing the freezing of benefits – guaranteeing further pressures on health and social care as we struggle to prop up the most disadvantaged members of our community.

Nope, I said my issue was a “colossal deception” so here it is. The Government made two promises today. The first was that everyone will have a named GP – this seems largely uncontroversial, and indeed many of my patients already think they have one. The second was that patients will be able to see their GP 8-8, 7 days a week. The problem then, is this – “your GP” in the first instance is not the same as “your GP” in the second.
Let’s be clear. You are not going to be able to see your named GP 8-8, 7 days a week. They have a life too. Nothing in any of the DoH documents I’ve seen regarding this, or the pilots has suggested anything close. No. You will be able to see “your practice” 8-8, 7 days a week. Which is very different.

“So what?” You may be thinking, Well, let’s consider everything we’ve heard already – there’s insufficient funding, there aren’t enough doctors, there’s not really any evidence it’ll save a single penny. How can you make it work? It’s easy – all the GP surgeries which cannot possibly deliver the proposed service have to join together. This is pretty much already happening (and is essentially Government policy) as GPs form “Federations” in order to benefit from economies of scale, compete for services, and generally weather the storm. This will absolutely force the issue.

These federated practices will then, jointly, offer 8-8 services, 7 days a week. Indeed variations of that theme seem to be what’s happening in most of the pilots. So you can book an appointment in these hours. But it might not be “your” surgery. It might be that other one they joined up with on the other side of the town/city/county. It might not be “your” doctor – just the one who’s been landed with that particular shift.

It will no longer be the local, responsive service, with the people you know and trust. It will be provided by one big organisation with a floating roster of staff in a place that may well be far from your home. (I appreciate for some of you that’s already what you have, and I apologise. Shit isn’t it?)

I don’t think this is what people picture when the Government says they can access their GP 7 days a week. I think they picture their GP and their practice, and that just isn’t what they’re talking about. At all.

What they’re talking about is the same Out of Hours service that everyone’s been complaining about, only they offer appointments now. (Let’s be clear, this isn’t me slagging off out of hours doctors – certainly our local guys do a difficult job, very well, often with little information. But I don’t think any of them would argue it’s how General Practice should be done routinely.)
This is, at best, an averaging out of quality. From good in hours, to basics only out of hours, to not-very-good at any time of day.

So it’s a lie. A carefully constructed, utterly misleading, bare-faced lie. A lie concocted to get the votes of the healthy, whilst ignoring the needs of the sick.

Why do this? Because it’s a vote winner. Because it plays into the on going demonization of the sick beloved of this current Government. But most of all – because small independent corner shop like GP surgeries are not an appetising prospect for private investment. But massive organisations providing 8-8 7 day a week healthcare absolutely are.

Traditional General Practice is about to go the way of the Dodo.

Please people, make some noise for once…

promises – figures.

Open letter to Ed Miliband and Westminster

Dear Mr Miliband (and every other politician for that matter),

Do you honestly believe that 2.7 billion pounds (which is not even guaranteed given the sources you have proposed) has the ability to “rescue” the NHS? What you’ve done is given the general public a figure that sounds very impressive (a billion sounds a huge amount to a most voters, many of whom are currently finding it difficult to scrape together enough cash to feed their family at the end of the month). You are all unwilling to face the facts and every one of you, regardless of party, should be ashamed.

Let’s have a look at the facts shall we?

The NHS treats 1 million patients every 36 hours.

Compared to 10 years ago, in 2012/13 there were –
55% more attendances at Accident & Emergency departments (14.0 million to 21.7 million).
4 million more hospital admissions (even though trusts have been forced to cut more than 8,000 beds since 1997).
60% more operations performed by the NHS (6.6 million to 10.6 million).
75 million patients seen in outpatient departments (an increase of 1 million on the previous year alone!)

How about some financial statistics?

As you will be aware the NHS has a budget of 110 billion pounds per year and spends 77 billion on patients with chronic illnesses. Taking diabetes as an example, we spend £25,000 every minute, £1,500,000 every hour, £13,000,000,000 every year (12% of the total NHS budget) on managing this condition. So why, do I ask, are we going to tax cigarette companies and people with big houses? After all, smoking-related illness only costs about 5 billion pounds per year. It wouldn’t be so easy to put a tax on junk food now would it? I believe it is because they are easy targets and you think it will win you some easy votes. Surely it’s not because you actually believe it will work?

Let us look at the utter scandal that is PFI, introduced by the Conservatives and abused by Labour –
The NHS will end up spending 80 billion pounds on hospitals that cost 11 billion to build (I believe one PFI hospital for example, will end up paying 4 billion pounds for their 380 million pound hospital).
Most trusts that reside in a PFI building end up spending over 6% of their annual budget on PFI repayments and this can include extortionate maintenance costs.
The largest single player in the UK PFI market currently owns or co-owns 19 UK hospitals (and remarkably it only has 25 employees in stark contrast to the 1.7 million employed by the NHS). Their profit margin was 53 per cent in 2010 (apparently most successful FTSE 100 companies make margins of around 6 per cent). The founder and chief executive of this company, in 2010, owned almost three-quarters of the company (or 14 UK hospitals) and collected pay and dividends of £8.6 million, a significant proportion of which is essentially tax-payers money (I suppose that’s not very much when you consider it would only pay for the treatment of diabetes for just over five and a half hours, but still, it’s all relative).

Compared to other healthcare systems and despite coming 10th in the category of “Healthy Living”, in 2012 –
Health expenditure in the UK was 9% of GDP (USA 17%, Netherlands 12%, France 12%, Germany, Denmark and Canada 11%).
The UK had 2.8 physicians per 1000 population (4.0 in Germany, 3.9 in Italy, 3.8 in Spain, 3.3 in France, 3.3 in Australia).
The UK had 2.8 hospital beds per 1000 population (8.3 in Germany, 6.3 in France, 3.4 in Italy, 3.0 in Spain).
Average length of stay in the UK was 7 days (9.2 in Germany, 8.2 in New Zealand, 7.7 in Italy, 7.4 in Canada).
In comparison with the healthcare systems of ten other countries (USA, Canada, Australia, France, Germany, Netherlands, New Zealand, Norway, Sweden, and Switzerland) this year the NHS was found to be the most impressive overall by the Commonwealth Fund. It was rated as the best healthcare system in terms of efficiency, effective care, safe care, coordinated care, patient-centered care and cost-related problems.

And do you know why Members of Parliament?

It is because of the remarkable individuals who work for the NHS. The wonderful nurses, the healthcare assistants (who now do the old nursing job thanks to government bureaucracy), the midwives, the cleaners, the porters, the allied health professionals, the secretaries, the researchers and the incredible doctors who are keeping the NHS the best it can possibly be. The public needs to know the facts and appreciate the pressure they are working under. It has been them, not you that have made it the best healthcare system in the world. It is the best in spite of what you have done, not because of what you have done.

But sadly it can’t continue like this. The number of doctors leaving the NHS to work abroad has increased by 20% since 2009. Morale amongst nursing staff is at an all time low. We’re getting better at keeping people alive for longer, which puts pressure on community and social care. You’re going to make us work longer and so we’re going to have to keep people healthy for as long as possible. Thankfully we’re curing more and more cancers, however it isn’t cheap to cure (5 billion pounds per year). As a nation we’re getting more obese and we’re either having to make people’s stomachs smaller or manage the complications of their poor health (9 billion pounds per year). You want more patients to be managed at home but the community services can’t cope as it is (9 billion pounds of cuts to Primary Care services since 2004). Pharmaceutical companies keep inventing excellent groundbreaking treatments but they’re extremely expensive because like the oil industry, the companies put profits “into research” as well as into the pockets of shareholders. The UK population is set to increase by another 7 million (more than 10%) in the next 15 years. And yet, every Wednesday at midday, on the green leather benches, all I hear are the same old arguments and excuses.

So Westminster…….given all of this, can we have an proper plan of action?

Yours faithfully,

Mr Richard Laing
General Surgical Registrar

Competing interests: No competing interests

http://www.bmj.com/content/349/bmj.g5875/rapid-responses