Thursday, 20 January 2011

A busy few days at the office. To privatitize, or not to privatitize the NHS, that is the question . . .?


The last few days here at ND Central the King Canute like tide of wellness has been well and truly lapping at your average Northernshire GPs’ throne like a tsunami.

A combination of a shortage of doctors and a huge surge of alleged illness has resulted in the number of extras per GP spiralling. Coupled with our ever loving, and increasingly abusive, patients the few doctors and reception staff still standing on the frontline are struggling to cope.

We think the last time it was this busy was in the mid nineties but at least then most people we saw were actually ill and polite with it in contrast to now where very few are. As an example at last night’s surgery 9 extras demanded to be seen in one GP’s branch surgery session. The alleged “emergencies” broke down as follows:

Number of life threatening conditions seen = 0.
Number of ill patients seen = 0.
Number or prescriptions issued = 0.
Number of self limiting minor illness seen requiring no treatment = 9.

At the same time as the local healthcare markets are burning with alleged illness, but with no extra resources to quench the fires of demand for instant medical care, our political masters are fiddling away and tell us how competition and markets are the way forward to improve healthcare. Hmmm.

As very simple grunts on the frontline we thought about how would we cope with the situation of too many (allegedly ill patients) with too few doctors. We present 3 options based on current, and past Za Nu Labour/ConDem, policies:

Option 1:

In a true market the patient as the consumer would pay directly for healthcare. The healthcare provider (GP) could then charge the market rate. If demand = illness was high and healthcare provision = supply was sparse then the laws of supply and demand would dictate that in order to see a GP costs would rise as demand does in order to reduce GP workload.

Examples might be you can see a GP for a routine appointment in a couple of days and we will charge you £20. If you, as the customer demand that your illness is an emergency, your NHS Choice, we will charge you £50.00 to be seen the same day. If you feel that you cannot possibly come to surgery then we will charge you £100.00 for a home visit.

To reduce unnecessary demand in a free market then A&E departments if busy could up their charges to say £70 a shot. £250 if you call an ambulance.

Think about which of the above options you would choose and whether the cost would determine whether your condition was a true emergency or could wait. At the moment if we were on piece rates we would be more than happy to cope with demand as it is now for our extra effort, and that of our staff via overtime, would be richly rewarded.

Works well for lawyers, accountants and, possibly, consultants too?

Option 2:

In the pseudo free world Soviet regulated by the internal (non) market, a Soviet institution called a PCT agrees a contract with a private provider and limits the number of patients they are allowed to see. In other words there is a cap on how much illness the private provider can see and treat. This we have commented upon before.

Oh no comrade patient you are illness case 101,326 this month but the Party’s contract allows us only 101,325 illness commissioned events by your preferred contracted provider this month so you cannot be treated until next month. We do have a contract you know regardless of your illness.”

So the private sector treats as per contract, gets rich and then what? Stops seeing patients even though there is still demand and worse still local spare capacity to see and treat them that is not being used. The world-class managers who “commissioned” this spare capacity are preventing its use at a time of need.

Who then mops up the rest of illness? Local GPs and A&E?

Option 3

The current NHS nGMS contract is a godsend to both the private sector and Government for it allows unlimited dumping on GPs (and A&Es) regardless of capacity. We note that GPs do not have any fixed capacity in the way that Darzi centres have and so workload is potentially infinite but resources very finite.

So we have seen a 50% increase per GP in workload but we do not get paid anymore but still have to absorb increased demand and costs associated with meeting this demand.

If you are, as all GPs in Northernshire are, so heavily over doctored that we export them overseas by the container load, and spend more time on the golf course than in the surgery, this scenario will never be a problem. You just drop a round, or two, of golf.

This will of course only ever happen in PCTs such as ours due to their world-class commissioning activities by their Harvard and Yale educated PCT commissars, who were never so dumb as to agree an option 2 Darzhole centre currently absorbing NHS funding while delivering bugger all.

Patients abusively demand of our staff “urgent” appointments and then do not show. When they do show it is virtually never urgent e.g. constipated for a month in a 7 year old busily trashing the surgery toys or I have had this unchanging mole for 40 years and thought I would get it checked NOW (bad night on telly) or I want my blood pressure checking (which was OK this morning when nurse checked it?).

There is no responsibility for the patient to attend their appointments, to use healthcare responsibly but their god given right to bear arms, oops wrong country, to abuse daily the NHS is used without any fear of sanction or cost across the land. Even dentists can charge for missed appointments but not GPs or hospitals or A&E departments and remember dentists were allowed to do this when they were once part of the NHS.

If you are really genuinely ill and need to be seen which model do you think you would serve a genuine need best?

Would you be prepared to pay £50 to be seen as an emergency or go for the no charge to be seen and wait option 3? The future of the NHS as we know it?

Option 1, currently not widely available, but allows the “customer” the market choice of putting their money where their currently abusive mouths are.

Option 2 GP commissioning which will make the private sector rich at your expense and for more cost will provide you with less care. This is current NHS “world-class commissioning” by morons on your behalf.

Option 3 the current situation where you will get care on the cheap and quality to match. You also have to wait but then you are not paying the piper directly so you have no choice of tune, quality or speed of access which is centrally controlled not locally determined.

Everyone says they would be prepared to pay more for a better NHS but talk is cheap and increasing taxes is never popular but abuse towards our reception staff is a democratic right and free to all who wish to use it.

Praise be to the Party for giving the NHS a market. At present our staff would embrace the free market and invest in shares given the current demand for they would be rich given the workload and abuse they are enduring.

Unfortunately the NHS market means we are all the poorer for pandering to the pathetic the most pathetic of which are the politicians. Bet you none of them are BUPA positive?

For BUPA positive press option 1 . . .for NHS press option 3 . . . for no, or limited care try option 2.

2 comments:

middlemanager said...

Can this increase in unreasonable and rude demands be linked to the habit of politicians increasingly calling patients 'customers'? The customer has no responsibility to ration his demands, only to pay his bill, and since there is no bill for the NHS = no responsibilities. NOt that I want people charged for visiting the HP, in the increasingly tough environment for poor people this will result in tragedies as people make a choice between shoes for their kids or getting that lump checked out. Neo liberal nonsense that has a lot to answer for.

Personally I have never wanted to be called a customer of a GP, patient is a perfectly respectable term. I am a customer of TalkTalk but it has never stopped them giving me pretty awful service.

Just like 'client' again perfectly respectable term meaning someone using a professional service but due to some ignoramus only recognising it in relation to prostitution was virtualy banned in Social Services - I like to irritate the pc brigade in my SS department by using it constantly.

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