Everything for everyone forever? (Philosophy, honesty and accuracy)

The London Times has several interesting letters today 23rd May 2013 and I apologise if the authors are offended by my reproducing them here. The first gives the title of this post and addresses philosophy, something the politicians seem unable to do.

“Sir, Martin Barrow (Opinion,  May 22) argues that “what is required is a massive transfer of resources  into the community. . .”. It is certainly possible that our overly  centralised health planning system could demand and implement this. However,  our hospitals are full to bursting.

Everywhere else in the developed and developing world I see new hospital  facilities being created to meet the increasing expectations of people who  are living longer and require healthcare for more years. The “experts” who  claim that we can simply transfer resources ignore the facts from almost  everywhere else.

We seem to be the only country which has commissioning, but unless we manage  expectations we cannot expect our limited GDP spend on health to achieve  everything for everyone forever.

Tony Narula, FRCS London W2″

The second is from a  manager and very honest about educating patients (and by inference the need for autonomy):

Firm action needs to be taken in educating patients on the appropriate use of NHS out-of-hours services

“Sir, I have worked in several senior management roles overseeing GP Out of  Hours (GP OOH) care in the public and private sectors before and after the  2004 contract change (report,  May 22). Post the contract change in 2004, access, not necessarily  quality, was dramatically improved. The number of patients being seen out of  hours increased nationally by millions, which resulted in GP OOH having to  increase the clinical workforce to meet demand. Instead of improving the  provision of urgent primary care needs out of hours the post-2004 system has  generated a climate within which patients seem incapable of looking after  themselves. The improved access has resulted in a plethora of choices for  the individual, choices which were not available when patients were  encouraged to use services appropriately.

A review of local OOH’s activity during December 2012 initially indicates that  30 per cent of total out-of-hours contacts were not urgent and could have  waited until the patient’s own GP opened in the morning. Firm action needs  to be taken in educating patients on appropriate use of such services. NHS  establishments need to become less risk averse and inform patients that they  will only be treated in appropriate settings.

A sobering thought is that the inappropriate use of healthcare services  directly impacts on those patients who need urgent medical attention.

Chris Cashmore Rhoose, Vale of Glamorgan”

The third is from a GP and is remarkably accurate:

“Sir, The average GP has about 2,000 patients on their list, the average  practice 8,000. Despite this, most children never need to see a  paediatrician, most women never see a gynaecologist most elderly never see a  geriatrician and most chronic diseases, such as asthma, chronic lung  disease, diabetes are managed entirely by GPs in primary care. A  consultation with a GP costs the NHS about as much as a phone call with NHS  Direct — we are hardly expensive and overpaid.

The number of consultations a general practice provides has doubled over the  past ten years.

More and more work has been moved out of hospitals to us in the community —  yet we are supposedly working less and are lazy. There is a recruitment  crisis in general practice because hospital consultants earn more and  general practice is not an easy life with short hours.

GP bashing will only aggravate this and, as Martin Barrow wrote, what is  needed is for more work to be done in primary care and more GPs to do it.

Dr Mona Kooner London SW18″

Philosophy, honesty and accuracy. Exactly what the minister needs to be told, but will the politicians listen?

Norman Gnome

This entry was posted in A Personal View, General Practitioners, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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