Posts Tagged ‘Royal College Of General Practitioners’
When we lock in the hens at night we no longer do a headcount, the numbers are beyond our maths range. We work on the assumption that every chuck has had the good sense to head for safety, and content ourselves with a cursory sweep of the flash lamps. When we arrived at the allotments this morning we were greeted with the error of our ways, a row of late-night revellers were perched in one of the trees.
No amount of corn-scattering would entice them down, and it was quickly decided that our most agile member should use the ladder. The rest you can guess. Albert was on the ninth rung when the bough snapped. With merely a cry of Geronimo our wee pal returned to earth clinging to the ladder with six squawking hens clinging to him. For all but our hero it was an hilarious start to the day. He refused offers of a lift to our local A & E unit on the grounds that, this being Saturday, he would have recovered long before he would receive attention.
You will gather from that remark that in common with the rest of the country, with the obvious exception of Chipping Norton, our area is not well blessed with medical services at weekends. Such GPs that still practice are pursuing non-medical leisure activities, A & Es are in the hands of less-than-able junior doctors and a call to the 111 service extracts nothing more than a rendering of Beethoven’s unfinished symphony.
Being all too aware of this, we were less than surprised to read of the reception afforded to Blue Peter presenter turned Health Secretary Jeremy Hunt when he reluctantly showed up at the annual conference of GPs at Harrogate yesterday. A few days ago he had warmed the hearts of the Tory faithful by announcing that GP surgeries are to be obliged to open from 8am to 8pm, as well as at weekends.
Dr Peter Deveson, a south London GP, pointed out that such a move would entail GPs working 84-hour weeks which are neither “safe nor sustainable”. Cue an ad-hoc political response which was that 2,000 extra practitioners are in the pipeline. Dr Claire Gerada, chair of the Royal College of GPs, had done her sums and added 8,000 to Mr Hunt’s fag-packet calculation before asking if the pipeline began in outer Mongolia.
She went on to claim that spending on general practice has fallen by £400m in the past three years – representing a 7% cut for every patient. With other costs incurred as a result of the Lansley reforms the actual shortfall is now £1bn. Dr Gerada went on to warn Mr Hunt, who had by now assumed the resigned countenance of someone who has spent many an hour reading old copies of Readers Digest in A & E, that he was at risk of “destabilising the whole NHS”. She urged that “we put politics behind us and start looking for what is best for the NHS and our population”. Since politics is the only occupation known to Hunt and most other leading politicos that sounded a dubious prescription, but we know what she meant.
Several of us codgers spent many years working in the NHS, and we are appalled at the lack of understanding of medicine shown by a succession of Health Secretaries. All seem obsessed by the idea that diagnosis by telephone or email is the solution to our increasingly dysfunctional GP surgeries. Even the most experienced doctor will tell you that patients are often confused about symptoms and pain levels. To simply take them at their word without examination is dangerous in the extreme.
But the thing that most astonishes us is the enduring belief that because GPs are well paid they should be able to work extra shifts a la Tesco. A GP already sees up to 15 patients in one session. He or she has ten minutes in which to reach a conclusion as to whether there is a serious underlying condition. Take the easy route of referring patients on and expect a severe chastisement from the chosen specialist. Take the even easier option of prescribing a placebo and risk a life and an appearance before the GMC.
A GP has in many ways the most onerous role in the whole chain. How would you like to wake up each morning knowing that before you return to your bed you will have been responsible for dozens of decisions, any one of which could spell life or death. Throw in an ever increasing number of meetings resulting from the imposition of commissioning and an even greater volume of bureaucracy and the picture is a forbidding one.
Some time ago I attended a talk given by an official from the Department of Health. She displayed charts showing the number of patients seen per hour by a cross-section of London GPs. To the astonishment of her audience she concluded that the “best and most productive” doctors were those who saw the most patients per hour. That belief still exists in the corridors of power, the truth is that they are 100% wrong.
Morale of GPs is sinking fast and it is in all our interests that politicains of every colour ask themselves whether it makes any sense to turn a blind eye to tax avoidance, and to sanction money-guzzling schemes such as HS2, whilst penny-pinching on a service that at one time or another is of paramount importance to every family in the land!
When our moment of crisis comes it matters not one jot who is in 10 Downing Street. Dr Gerada is right, politics should play no part in healthcare.
THOUGHT FOR TODAY ; ” GPs are one of the last groups people trust. They don’t trust their politicians, their journalists, their bankers, their priests..in a subconscious way politicians are jealous that we are still held in high regard by society!”…Dr Clare Gerada
The more romantically inclined amongst the hen-keepers were quite touched by the pictures of our dear leader and his wife walking hand-in-hand down a deserted street to enjoy a celebratory birthday meal. They were less tearful when a newspaper reporter showed us a wider shot. The street had been closed off, and there were armed police positioned at both ends. Forget the Mills & Boon stuff, it was what the politicos like to call a photo-opportunity. After cleaning out the hens we reflected that nothing is quite what it seems in this age of spin.
So it is in the case of Andrew Mitchell. The prime minister has attempted to draw a line under the incident involving the Downing Street police by remarking that Mitchell has apologised and it is time “to move on”. The police are not prepared to do that, and for good reason. Yesterday Chris Jones, secretary of the West Midlands Police Federation, said that both our dear leader and his Chief Whip have effectively accused the police of lying.
He went on to say that the police accept the fact that he has apologised for his offensive langauge, but the fact remains that “they in effect are intimating that the officers were untruthful in a formal report. They insist that he did use the term ‘plebs’ and their integrity, and that of every other officer, is now being brought into question”. Chris Jones and numerous other leading police officers demand that Mr Mitchell either admits that he used the word or resigns.
The police are extremely concerned that the prime minister is effectively opening the door for challenges to police sworn statements in every criminal court. Defence counsels will argue, not unreasonably, that since the prime minister has accepted that police statements are falsified the one incriminating their clients may well be similar. This is the route to chaos. And those who move in senior government circles privately accept that the renowned bully Mitchell almost certainly did use his standard form of abuse for anyone considered to be below his station.
The underlying problem here seems to be a belief on the part of the establishment that the plebs – the whole nation minus the 10% who own most of the UK’s wealth – are incapable of seeing through any ruse. Nowhere is this more evident than in the case of the NHS reforms which are now in full flow. Already waiting lists are extending and many services are being rationed. There are many examples but the one concerning diabetes will suffice to illustrate what is happening.
There are a soaring number of new diabetic cases each year but 218 diabetic specialists have been dismissed. Sub-services are being outsourced and inexperienced high street commercial clinics are now providing treatment, with no knowlege of their history and no ability to carry out chacks on vascular problems. Barbara Young, head of Diabetes UK, says that the diabetic care pathway is being broken up, and the risk to patients is multiplying.
Over 400 NHS services are now in the process of privatisation. The government’s response is that GPs are taking over commissioning and they know best the needs of patients. Like the romantic birthday picture this is an illusion. The Royal College of GPs report that, despite a few enthusiasts, most of the new commissioning groups are not led by GPs, and the majority have none on their boards!
Meantime almost a third of NHS Foundation Trusts are feeling obliged to begin the process of increasing the number of beds reserved for private patients. The service that has served us all for so long is in the process of breakdown, we plebs are expected to be incapable of seeing beyond the facade.
None of which constitutes a condemnation of this particular government since society has reached the point where politicians in general have come to see the public at large as malleable, capable of believing anything.
This is the British version of what has happened in many more volatile societies. Someone has to have the moral courage to declare that enough is enough. If our dear leader was to take a stand for truth by dismissing Mitchell it would be a good sign.
We all know that the police are not beyond reproach, but they are all that stands between us and anarchy. To declare them as totally dishonest is a very dangerous practice, a lot is being put at risk to save the skin of one arrogant bully!
Ever the fantasist, Harry disturbed our concentration on the chickens this morning when he outlined his cunning plan. At present Waitrose supply Columbian Black Tail eggs to government departments. He suggests we put in a bid to take over the service. Government advisers would then fail to check the numbers and award the contract to Scruffy Codgers Ltd. Waitrose would threaten court action, the advisers would realise they had cocked-up big time and we would receive bounteous compensation for costs we didn’t incur in the first place. Harry was subsequently calmed down by a well-aimed bucket of water.
Joking apart, it has to be said that when it comes to incompetence this government woiuld take some beating. The Transport Secretary, Patrick McLoughlin, appeared on Newsnight yesterday and explained that, once the department learned of the impending judicial review it had to check its numbers carefully. It occured to us plebs that maybe they should have done that earlier. As it is there is likely to be a bill of around £100,000 by way of compensation, not to mention the effects on passenger services of a long period of uncertainty.
Attacks on governments usually centre on ideology. With this one the rows are focussed on implementation. The train franchise fiasco is but the latest in a succession of them. Today we learn that the next act is about to hit the stage. Lansley’s reforms have pulverised the health service and the hapless Jeremy Hunt, fresh from his less than glorious handling of the Murdoch affair, is racing around cancelling bits of the plan not considered to be vote-winners. But it is too late for him to cry halt on the biggest act of privatisation in NHS history.
This week 398 contracts are to be signed. Some 37 private healthcare companies are bidding for a wide range of services including musculoskelal, hearing and physchology. In many cases those bidding have already failed to deliver the standard required after earlier successful trial bids. A perfect example was provided in Cornwall where Serco was awarded the out-of-hours service. It has been shown to have falsified data to cover inadequate night-time cover.
The biggest worry of all is the fact that one national service could be provided by a large number of different companies, each focussed solely on their patch. Postcode medicine is not to be yearned for. And how have the costings been arrived at given that cross-boundary cooperation will be essential. And how can bids be compared given that different suppliers have based their numbers on differing levels of clinical expertise?
In the hospitals themselves the NHS Foundation Trusts are being pressed to increase the number of ‘private’ beds up to 50%. How has this been costed, how will it effect those who cannot afford private insurance?
Dr Clare Gerada, chair of the council of the Royal College of GPs, said yesterday that as a result of all this the NHS is “in distress – and so are we”. This, she added, is “the mother of all top-down reorganisations”.
The Labour Party is in no position to criticise. Under Blair it made numerous attempts to outsource outpatient services, and when the outcry became overwhelming, paid out millions to companies such as Netcare to cover the costs of bidding and, in some instances, of actually acquiring buildings.
But someone needs to blow a whistle. In the north-west the bus company Arriva is taking over ambulance services, and Parkwood Healthcare is taking over patient advocacy groups. In each and every case there is need for detailed cost studies, the effect on the NHS should be carefully calculated.
Many believe that profit targets and patient interests will prove a deadly combination. But the coalition is hell-bent on privatisation, and the enabling act is now law thanks to the Lib Dems. But huge unanswered questions remain about the supposed financial benefits. Costing specialities such as surgery is a notoriously difficult task. How can it be that the private sector, which will employ surgeons at NHS pay levels and has to make profit for its shareholders, is claiming to be able to undercut NHS costs?
Based on the government’s record the probability is that our whole health service is being put in jeopardy for the sake of savings proposed by private companies using logic and numbers which have not been carefully scrutinised.
The government insists that every bid has been checked out to the umpteenth degree. That is exactly what Justine Greening and Patrick McLoughlin said when Richard Branson launched his attack!
Throw some tomatoes into a chicken-run and see greed in its most naked form. One will grab one and race off to the most distant parts where it will do a Bunter and race back to steal someone else’s titbit. But are they really that different to humans? I was pondering over the question whilst watching the hoo-hah and thinking about the apparent mystery of the group of GP’s that the government has wheeled on stage as a counter to the block condemnation of the Lansley privatisation plan for the NHS. Why would any doctor be in favour of a development that Dr Clare Gerada, the chair of the Royal College of General Practitioners, yesterday warned will destroy the long-standing trust that people have in their ‘family doctors’. The answer is, I suspect, greed.
In January 50 GPs were invited to 10 Downing Street for a champagne reception. They are the leading lights of a body called the National Association of Primary Care which is officially non-political. Treading the corridors of power that evening was one Dr Charles Alessi, who two weeks earlier had penned a tabloid comment piece backing the radical pro-market plans of the Conservative part of the coalition.
And Dr Alessi makes no secret of his feelings. He has alreaday been accused of standing by whilst 500 jobs were axed at his local hospital in Kingston, Surrey. He is unrepentant and says that the changes at Kingston are a forerunner of things to come. He argues that hospital physicians are “over-treating” patients, too many people are being given drugs like those that stop elderly people going blind, a condition known as macular degeneration. But won’t patients revolt if they are not given the medicines they need? “Yes” is Dr Alessi’ view, ” it is pretty uncomfortable”. It seems reasonable to assume that Dr Lessi’s fellow champagne drinkers share his views, and although they are a small minority amongst the nations 38,00 GPs they are powerful allies of the beleagured Lansley.
Now let us be a little cynical for cynicism vies with greed amongst the human vices. If the scheme becomes reality, GPs will become the new rich. Kieran Walshe is professor of health at Manchester Business School and he has studied the likely financial outcome of GPs taking over the £80 billion NHS budget. He believes that GPs in a consortium could set up a private company which they own, and then get the consortium to contract out the comissioning of health care to that company. If that company can make savings by spending less on its patient’s care the surplus could then be distributed to the shareholders – the GPs.
Under this, or a similar arrangement, if a GP-owned company saves 5% of the budget each GP will receive £140,000. That apart each will receive £55,000 as a management allowance plus other payments yet to be determined. Professor Walshe believes that GPs will be in line to pocket £300,000, double the amount of a hospital surgeon.
We can safely assume that the carrot being dangled by Downing Street is a big one and we can safely assume that some will be tempted. But there will be a price to pay and I don’t mean simply hospital closures as private healthcare providers are brought in to ‘cherry-pick’ by commissioning consortiums. Far more horrendous will be the destruction of the doctor patient relationship. How will we feel if we suspect that our own doctor is denying us treatment to line his or her pocket?
This whole scene is building up to a huge confrontation unless the Lib Dems find their backbones. Whatever happens I would feel incredibly sad if someone I trust with my life can no longer be trusted at all. But at least that won’t happen, for my doctor, like thousands of others, has made clear that he will have nothing to do with such a brazenly unethical proposal.
Perhaps I should buy him some champagne by way of compensation for not becoming a Cameron crony!
QUOTES FOR TODAY; “Honesty is the best policy, but insanity is a better defence”….Steve Landesberg “A lie can be halfway round the world before the truth has got its boots on”….Winstin Churchill “A little inaccuracy sometimes saves a world of explanation”……Saki “There is nothing about which men lie more than their sexual powers. In this at least every man is, what in his heart he would like to be, Casanova”….Somerset Maughan “People never lie so much as after a hunt, during a war, or before an election”….Otto von Bismarck ”I have too much respect for the truth to drag it out on every trifling occasion”……Mark Twain “There’s a perfectly good explanation for this, which I’ll make up later”……Mel Brooks “If you tell the truth you don’t have to remember what you said”……Mark Twain ” A lie is an abomination unto the Lord and a very present help in times of trouble”……Adlai Stevenson “I told you a million times, don’t exaggerate”….Rik Mayall “It is hard to believe that a man is telling the truth when you know that you would lie in his place”……H L Mencken
ANSWERS TO YESTERDAY’S QUIZ; 1. Pittodrie, Aberdeen 2. John Peel’s
TODAY’S QUESTIONS; 1. Where was the liner ‘Queen Elizabeth’ destroyed by fire in the 1970s? 2. In which crime show did Martin Shaw and Lewis Collins co-star?
Despite the mild weather the football fans amongst our allotment gang seemed slightly uneasy this morning. On the one hand they all want their team to succeed but the price of doing so has just risen to ludicrous levels. Torres was deemed to be worth three times the amount that the coalition wish to save by selling off our forests and even a new boy on the block from Newcastle is apparently worth twice the saving. Express those amounts in policemen or nurses and you have the final proof that our society has lost all sense of values. Of course the money is being provided by cash-rich tycoons from abroad but it still leaves a nasty taste. No doubt the seemingly benevolent will hike up admission charges again for next season, so the fans will ultimately pay if they still have jobs to provide the readies.
Who knows, we may be heading for foreign ownership of the NHS once the overseas speculators tire of playing with Premiership football clubs. If the prestigious Lancet is to be believed the NHS is heading for an inglorious end so anything is possible. The Lancet is THE organ of the medical profession and is not given to hyperbole. It’s editorial is therefore worrying in the extreme. It predicts the end of the NHS and goes on to say that “for the Tories to call themselves the party of the NHS was a commitment that seems particularly hollow now”.
Yesterday the results of a survey carried out by the Royal College of General Practitioners were published. 1800 GPs took part and a clear majority said they were concerned the reforms would not improve patient care. Chair of the College, Clare Gerada, said that GPs are worried about the pace at which the reforms are being implemented, the danger of fragmentation of services, and the great emphasis on competition. She added “GPs fear that these reforms could cause irreparable and irreversible damage to the NHS”.
Having been involved as a Chair of both a Primary Care Trust and an acute hospiotal I had already realised that to make such drastic changes at the same time as imposing cuts of £20 billion will inevitably lead to chaos. Yesterday I learned that the government’s bill incredibly includes a payment from the NHS budget to private sector providers. For each billion contracted out, the NHS must pay a ‘subsidy’ of £140 million. The logic here escapes me, it is a further blatant example of the Cameron/Lansley determination to privatise services.
As I have commented before this will lead to cherry picking with the NHS hospitals left to provide acute services from a limited number of hospitals.Expect whiolesale closures, expect postcode medicine the like of which we have never seen before, expect waiting times to double, expect already overworked GPs to simply delegate commissioning back to the PCTs wearing a different hat.
Perhaps the most telling judgement of all came yesterday from a member of the health select committee, Andrew George. Mr George is a leading Lib Dem MP. He told the BBC that “most of the informed and authoritative commentators on this all agree this may result in a race to the bottom, and it certainly will. And I think it will compromise quality of treatment too”
Can everyone, including members of the coaltion, be so wrong. I think not. David Cameron remarked that even his brother-in-law (a doctor ) is apprehensive. We should all be, for on the rare occasions when the Lancet has taken up a position, it has always been proved right.
When every member of a family is in good health it is easy to laugh at the antics of someone like Andrew Lansley. But to current users the man is a walking nightmare. We should perhaps remember that there will inevitably be a time when the whole family is not well!. By then it may be too late and right now we have to decide whether we trust the professionals or Cameron/Lansley. Easy choice really isn’t it?
THOUGHTS FOR TODAY; ” A woman without a man is like a fish without a bicycle”…Florynce Kennedy ” Ask a woman how she feels and she will tell you all about every relationship she’s ever been in. Ask a man and he’ll tell you he feels like a pizza”….Diana Ford ” A man has to be Adolph Hitler to be called ruthless. All a woman has to do is put you on hold”….Marlo Thomas ” Feminism is a wonderful idea – until the car goes wrong”..Nicola Zweig ” The Woman’s Movement would be a lot more successful if men were running it”……. Alan Clark “In Newcastle being gay means ’owns a coat’ “….Jimmy Carr “Do men who like to dress up as women find that they can no longer parallel park?”…Roseanne “Its better to be black than gay because when you’re black you don’t have to tell your mother”….Charles Pierce “Most women are attracted to the simple things in life. Like men”….Sophia Loren ” Remember if you smoke after sex, you’re doing it too fast”….Woody Allen ” My wife and I were happy for twenty years, and then we met”….Rodney Dangerfield
ANSWERS TO YESTERDAY’S QUIZ; 1.Michael Crawford 2. Last of the Summer Wine
TODAY’S QUESTIONS; 1. Where was Gough Whitlam once prime minister? 2. What organisation did the Rev ‘Tubby’ Clayton (died in 1972) found?