Saturday, 21 December 2013

Drip, drip, drip . . .

There is at present a constant stream of negative press about the NHS and recently the lead story on the BBC was about GPs opening 8 to 8, 7 days a week which then morphed during the morning to GPs being able to apply for funding to do the same. The intro varied as the morning went on but the core bit of news did not. The devil as always is in the detail which is proving nigh on impossible to find as was this link to the BBC report.

The current Bipartite element of the Tripartite healthcare alliance are using the well known NHS reform strategy of come up with an idea, run a pilot and pump prime it with so much money that it could only fail if you put Pol Pot on crack cocaine in charge, announce its overwhelming success thus vindicating the policy and then rush the policy out nationally on a pittance and see the policy inevitably crash and burn. NHS reforms in a nutshell and all driven by part time workers called politicians.

Now our current Secretary of State for Health Khunte kinda has, as he did with the GP contract, respected the above due process by announcing that the pilots had already been a success well in advance of the pilots actually having been run. Nothing like putting the cart before the horse Khunte even before you have proved that the horse exists. 

Has anybody done the maffs for these pilots? There are apparently to be 9 pilots but what is a pilot defined as? Well once again the devil here is finding the detail as most references to this subject seem to be from October and relate to something known as “areas”. The internet is a desert of any useful information about what an “area” is. 

So let us assume that in Big Government, as in the Big Society (remember that?), small is beautiful and that each pilot area will be a GP practice staffed by Party stooges or more likely Party stooges using salaried GPs to do the work while they cream off the profits. This is the (expensively failed) Darzhole centre model of choice for primary care under the Tripartite system. 

And don’t forget the contractual limit of how many patients any such pilots will see which once reached means the rest of the NHS picks up the pieces. Remember Darzhole centres stopping seeing patients when their target was reached? 

So if we get our best crayons and slide rules out (we love new technology oop North crayons are well wicked on wall paper) then 50 million shared by 9 = £ 5,555,555.56 per yet to be defined pilot area we assume it to be a practice.

Now assuming that all of the pilot practices operate 5 days a week and provide GP core hours each day which are 08.00 to 18.30 with no extended hours at present then in order to operate 8 to 8 for seven full days this means opening for an additional 31.5 hours a week or 1638 extra hours for a full year.

Back to the slide rules now children and take £ 5,555,555.56 and share it by 1638 which works out at a whopping £ 3391.67 an hour.

There are roughly 34101 GPs in England in 8230 practices which using our trusted slide rule once again means that the average number of GPs in a practice is 34101 shared by 8230 or 4.14 GPs per practice. So if we now share £ 3391.67 by 4.14 it means that every GP in the pilots will be being paid for each extra hour £ 829.24 an hour.

Obviously they will have to pay some expenses to run the practice like staff costs heating, lighting, armed guards for the drunks etc. but the huge government bung to make the pilots succeed can be looked at in another way.

Using the same amount per hour let us assume that every GP in England works full time and agrees to do all the extended hours this means and we have to do some big times sums instead of share bys so that 34101 GPs times 1638 extra hours a year per GP times £ 829.24 per hour comes to £ 46,319,221,887.

The current NHS budget as whole is a mere £ 95 600,000,000.

£ 95 600,000,000
£ 46,319,221,887.

Well that wipes out the Nicholson challenge more than twice twice over. Somehow we suspect that when the results of the successful trials (already done in October?) are published the funding won’t quite be so generous and that is if there are enough GPs prepared to work the extra hours.

If the average GP working week is 42.8 hours a week and Khunte wants another 31.5 hours of GP work per GP a week to maintain the same cover for the extended hours where is he going to get the additional 31.5/42.8 = 0.74 WTE GP per GP from?

New GPs take a minimum of 10 years to train. So Khunte will increase the total number of GPs overnight by 75 %?

Or does Khunte want to take the current numbers of GPs and increase their working hours by 75% to a mere 74.9 hours a week + admin time.

Or like extended hours use existing GPs and diluting their availability during core hours to plug the extra hours and stretching them more thinly over the extra hours?

This means you take an already overstretched service, dilute it more thinly and expected it to solve the poitically generated A&E crisis. I can never get to see my GP at any time I’ll go to A&E . . .

A politician has even come up with the answer to this problem. Clearly a man who knows nothing about health for the Party sets what is required via QOF and no GP will dare not to do QOF which sets the working pace of GPs even down to the length of appointments offered. So GPs at present work only as efficiently as the tick boxing of QOF allows. And who sets the QOF Lord Howe?

After all the poor, poor “busy” women in the BBC report will no doubt as every patient tells their GP be doing a  “ stressful job”, works “so hard”, she can only see her GP if they open on a Sunday. Does her business operate so that any idle GP (in the future) providing 8 to 8, 7 days a week can get to see her when they get time off?

Of course not she has Sunday off, pays her taxes and we bet you would have to pay for her services too? Now that should restrict demand for her services shouldn’t it? Bet there won’t be a problem getting an appointment with her in contrast to the free at the point of abuse 7 day a week wonder world NHS of Khunta and his idiot friends.

The politicians need to butt out ASAP for every “problem” facing the NHS at present is the creation of the politicians and their meddling with the NHS over the years. They are the least qualified individuals to sort these problems out.

Praise be to Party for coming up with increasing bigger soundbytes but forgetting to engage brain before opening their mouths. The NHS has always worked 24/7 and still does for true emergencies – the crap does not need the NHS 24/7 for the more you give, the more people will take especially if there is no cost up front and it is a right without any responsibility.

Try it Jeremy H, Andy B. et al open a garage and tell everyone free petrol all day any time and see how long the tanks stay full and it takes for petrol shortages to develop. Would you last a day?

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