Thursday, 6 November 2008

NHS Efficiency

ND’s team is getting increasingly bored in surgery which is in part why the team have taken to blogging after many hours of reading other more established bloggers. But hang on we hear you say, how come you have so much time to do these things after all the health service “reforms” and “efficiency savings” that have been achieved?

A recent statistic shows that each year the NHS becomes 2% less efficient. Someone put it that if the Party spends £1 this year on the NHS then next year that £1 is worth 98p in terms of what it buys from the NHS and so on year on year.

Why is this so?

Well let us look at some of the reforms that the new General Medical Services contract has inflicted on one of the two front lines of the NHS = General Practice. Let us look at GP appointments and access.

Our last glorious Party leader Tony, currently struggling through the economic crises on a true socialist income of £12,000,000 a year lecturing to Americans wanted people to have access to a GP in 48 hours as all good but, paying, Americans do have?

Remember the famous “why can’t I see my GP with a booked appointment?” incident?

This hand bagging of a Prime Minister who is happy to inflict his policies on his people without knowing its impact on the front line is so typical of NHS reform and a direct result of a centrally imposed target driven culture driven by people who have never worked in healthcare. In order to get everyone seen within 48 hours some surgeries had to scrap booked appointments because of demand or lose money.

At ND Central we used to have a mix of pre booked appointments and a daily “emergency” surgery where patients were given a card and told that this was for acute illness not for things like sick notes, medication reviews, follow ups, getting results etc. We had a degree of control over what an “emergency” was.

ND Central after a couple of years also introduced ten minute appointments for purely financial reasons as despite Party Central hype income was falling. Under the rules patients could come in with any crap not with acute illness just ring up and get an appointment no questions asked. Therefore there was no control on demand. And the effect of this was?

A direct reduction in General Practice efficiency due to Party Central. Why?

The Party “working day” for a GP is 10.5 hours from 08.00hrs -18.30hrs = 52.5 hours for a five day week vs the European working time directive that the Party has signed up to of 48 hours per week.

Suppose that you could see 24 patients in 3 hours under the old system. This would give you a morning and evening surgery of 3 hours each with a gap in between of some 4.5 hours where you could fit in visits, paperwork, meetings, clinics, sign several 100 prescriptions, read hospital consultant letters, answer phone calls, supervise trainee doctors etc.

Apply ten minutes appointment to 24 patients and you get two 4 hour surgeries a day and a gap in the middle of 2.5 hours. So in order to meet the Party target you have increased the time to see the same number of patients and decreased the time available for other GP jobs unless of course you increase your working day by 2 hours (and your week to 62.5 hours) that you would not get paid for. (However Government is holy and does not believe in contracts and feels that increasing GPs' working hours without pay is an OK thing to do.)

Now doctors are human. They have families and outside interests and like a little R&R. They also get bored sitting down for 4 hours and this increases the risks of DVT by doing a trans Atlantic flight every day of the week. So after much discussion the ND team decided that 3 hours was the most it could stand and so we reduced the numbers seen to fit two 3 hour slots and not reduce the other minor things that GPs do in between surgeries that do not count towards Party tick boxes.

(Numbers used are for example not actual before the local Politburo Stasis’ start sniffing and to make the mathematics easier for any innumerate Stasi snoops reading).

Thus we are spending more time and meeting a target but doing less work as a result. If someone comes in for a simple sick note this might take 2-3 minutes leaving 7 minutes spare per appointment. If this is repeated several times a surgery then there is a hell of a lot of (unpredictable) spare time but not time that can be applied to complex tasks.

A good example of this was the first extended hours surgery the ND team did which was 4 hours long and of that 1 hour and 55 minutes was spent waiting for patients. Last extended hours surgery was 3 hrs 40 minutes of “booked” appointments with only 1 hr 46 minutes working. So a GP was waiting, not working, the best part of 2 hours on a political whim.

This is what happens when the Party Central imposes targets that have to be met so Doctors and their staff get paid. Local flexibility and doctors’ knowledge are over ridden by the superior knowledge of the Party. The end result?

A decrease in efficiency.

ND suspects that they must be using British Leyland as their model for running the health service efficiently. Maxi or Micra anyone?

So if you can’t get a GP appointment do not blame the receptionist blame the Party for they set the rules. GPs only play by them.

Praise be to the Party.

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