Sunday, 4 September 2011

Mystic Darzi foretells the future of the NHS.

One of the few advantages of being a GP is that when you have found the right patch you are a bit like a good copper and you get to know your manor or beat.

You get to know:

the patients (some of whom are villains most are just punters taking a free ride a few are actually ill),

the local hospitals (the local CID and CSI when you are stuck),

your staff (hopefully a highly trained professional team who will back you in a firefight),

the Harvard and Yale MBA commissars at your local PCT (the local Russian Mafia when it comes to shafting patients and their healthcare)

and there evolves over time a status quo with some of the players competing with others to provide first world medicine while others wish to bash such hopes on the rocks of incompetence which usually succeed at the expense of patients. You also start to see the impact of international crime on your patch illegal drugs in the case of the Police but NHS privitisation in the case of the GP.

Of course not all are so lucky to live in enlightened Northernshire and if, under current training arrangements, you start as a newly qualified GP you will have left school at 18 and be just under thirty before you can practise as a GP principal. If you are lucky and find your niche you may then be there for up to 35 years – longer if current pension reforms continue the way they are – although most GPs have had enough (of NHS bureaucracy) and tend to retire, if they can, at age 60.

Politicians, unless you are a certain Colonel G in North Africa, are never there that long in one job or place but amazingly if you listen to them they listen far more than your average GP. They even have listening "exercises" and no doubt a few personal "trainers" to help them benefit from "exercise" and ensure that they are “fit” to govern.

Which is why some (now) very rich (allegedly socialist) former Za Nu Labour politicians thought who better to consult on reforming NHS General Practice than Mystic (Lord) Darzi a man whose days in general practice could be counted on the remaining fingers of Abu Hamza’s hands

This consultation process was no different to the politicians of old consulting oracles or basing decisions on the entrails of sacrificed animals prior to going out to wage war (Iraq) or spend huge amounts of money on follies (NHS IT, commissioning).

Their consultation of a high priest all wise in General Practice who is an Armenian born Irish trained surgeon would be like the Americans consulting the oracle of Pol Pot about the Apollo space programme and who best should they employ to make the rocket take off as opposed to hit ground zero something all three political parties seem to regard as the end result of the space race that is current NHS “reform”.

Well it appears that Mystic Darzi is turning out to be on a par with mystic Meg as an accurate foreteller of healthcare to come. He may just by chance, rather than ability in his chosen field of general practice, been consulted but his oracle like predictions and advice to the Party are showing us what may happen with the current round of entrail driven NHS reforms.

All three Parties are no different for all three are busily typing away like monkeys at random hoping to produce Shakespeare not realizing that all that has past has failed but each is still hoping that maybe one of them will get lucky and healthcare right if they change a few words here and there.

You can have quality healthcare, you can have universal healthcare and you can have cheap healthcare. You can however only ever have 2 out of the 3.

We hear that the Darzi centres and their drive for equitable access are about to be ditched in some parts despite all the “world-class commissioning” of their contracts which in some cases have failed spectacularly. Costs are far greater than normal general practices and they deliver less and cost more.

So what will happen if Darzi centres slowly fold? You would have thought that under the great war of liberation of the current NHS there would be hundreds of any willing providers queuing up to say “Yes we can” do it better and cheaper than they anyone else in the "free" NHS market where price is not negotiable only “quality” which is the new “choice” word which is strange as all Darzi centres were put out to a competitive tender process run by the Soviet run PCTs.

So there will be no worries regarding where patients will go for the remaining PCTs, under the supervision of their PCT clusters, the result of reduced NHS bureaucracy, will be busy commissioning any willing providers to fill the gap. We hear rumours from colleagues down South that they have already found many cost efficient (un)willing providers to mop up the Darzi centre patients as the local Soviets start to shut them down.

And who do you think these any (un)willing providers cost efficient providers will be? None other than the existing hugely inefficient local GPs that Darzi centres were meant to replace. Of course under the NHS Choice agenda those who did choose to run Darzi centres (for profit) could choose to do so while those who have to pick up the pieces of their expensive failure are given true NHS choice which is none.

It is not difficult to see the same thing happening using Mystic Darzi’s model in a few years time. GP commissioning groups will reinvent the Darzhole centre or its then political equivalent and when the Party changes have to find another (un)willing provider to replace it when people realize how much things cost and how little they deliver.

Who will have seen this process come and go for decades and realise that history often repeats itself? Those who at best last a decade in politics or those that provide consistent healthcare for families for decades?

There has been a listening exercise recently but no-one has listened for politicians never listen. GPs listen to the failings of the politically driven NHS bureaucracy they are called patients but we cannot spend all our time fighting it. If we did we would cease to see patients so we have to ask them to do so. Politicians spend so much time listening to patients who they sprinkle like spices into their speeches to show that they care (for you) but spend far more time ignoring them when it comes to their political actions when they are caring for those that they truly love.

Praise be to the Party who forever quote from history but rarely learn from it. Any guesses who will be mopping up the next load of politically driven expensive private failures? Whatever then remains of the non private NHS.

GPs perhaps? It has started already and Mystic Darzi has shown us the way.


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