Saturday, 31 December 2011

Some thoughts on the year 2011 from up North.


Traditionally at the year’s end people reflect backward on what has been and think about what they hope will be. Most humans are optimistic but as one ages in general practice one becomes more pessimistic with each change of Government or “new idea” that comes out of the Department of Health or local PCT.

As GPs we should treat patients. We are trained and able to do so and by and large we do. We are not so dumb that we believe that all those in jails or politicians are saints but overall most people in medicine care and try to do their best to the best of their abilities, their training and knowledge which we know varies from individual to individual and from place to place.

In 2010 the great Marshals NC/DC launched a war of liberation of the NHS something we haven’t quite got yet. It was sold as a “bottom up” liberation as opposed to a “top down” reorganization which has become even before the relevant legislation is passed a bureaucratic quagmire going nowhere fast.

Every GP is in this quagmire to some extent treading water and wasting time and money away from patient care to deliver Marshals NC/DC dream of liberation which increasingly looks like the Red Army’s advance into Eastern Europe at the end of World War 2 looked to those dreaming of democracy in countries occupied by the Nazis.

The “bottom up” reorganization with the clinician in the consulting room being in charge is prevented from doing anything useful by the (non) top down reorganization dictating the rules of engagement (ROE) while the real ROE are still being thought up on the hoof and modified on a daily basis. And that is before its codification into legislation and thereby enforceable diktat.

As a result the real net reform of NHS to date is business as usual at the frontline. A centrally, politically controlled Sovietized medicine of tick boxes that deliver piss poor patient care by ensuring that your GP gets paid to tick patient useless boxes at the expense of treating patients.

Preventative medicine is easier to control and reward. Life saving medicine is acute real time and unrewarded.

As a GP if you resuscitate a 3 month old child successfully from a cardio-respiratory arrest in your surgery or a patient of 45 who walks in feeling unwell who has a VF arrest using a defibrillator you purchased yourself because you thought it was a good idea to have one this is all available to the government for no charge. No box ticked but a clear benefit for the patient.

Do a cholesterol on a stable diabetic/angina patient or a patient with mental illness every year which is normal and requires no treatment and you are rewarded for doing so. One intervention makes a clear difference the other intervention’s benefit is of debatable benefit but rewarded.

Patients want care especially when ill and this is what most of us are trained to do. Increasing they are getting care not for acute illness which is unpredictable and therefore not Party controllable but for Party determined “illness” in the form of boxes to be ticked.

The need for boxes to be ticked to generate income, for we all need money to live, has led to more and more of our surgery time being filled by reviews of well patients and of us seeing less and less illness. Party determined “illness” is taking priority over real acute illness.

This is not medicine it is a retarded bureaucracy of medicine determined by politicians’ needs and not by patients’ real illnesses. It is said if you want to learn surgery go to war. If you want to learn bureaucracy go into general practice.

Praise be to the Party for pursuing policies of reform which are nothing more than command and control of patient care by politicians at the expense of real hands care of patients and their actual illnesses. Commissioning is not about getting good care it is about controlling costs and will be centrally controlled.

A Happy 2012 to you all and to use an expression from one of the teams’ previous lives - stay frosty. We suspect this year in United Kingdom general practice will be a bleak one with every more expected for ever less and even more interference from on high that will not benefit patients - only politicians and their friends.

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