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DH dreamers refuse to let reality intrude

It's all very well fantasising about patient self-care freeing up GPs to take complex cases off hospitals' hands – but it just isn't going to happen in the real world

It's all very well fantasising about patient self-care freeing up GPs to take complex cases off hospitals' hands – but it just isn't going to happen in the real world

The Department of Health has a dream – a grand vision for the NHS that has adorned countless Powerpoint presentations to thousands of managers and civil servants.

Imagine a gigantic healthcare pyramid, with relatively small numbers of seriously ill patients at its tip, broadening out to cover larger and larger numbers of people, who get progressively healthier as we move down to the base. Ministers dream of a progressive shift in the care of these patients, with those previously treated in hospital increasingly managed in general practice, and those who used to see a GP calling NHS Direct or visiting a walk-in centre instead. Down at the base of the pyramid, millions of patients who once drained NHS resources would now learn to treat themselves, with a little help from pharmacist minor ailment services.

It's a fine plan and one most GPs would love to become reality. It's just unfortunate that it happens to be a fantasy. It's a little like a TV sketch of a few years ago, in which inventors of a miracle cure for ageing had a stock reply for sceptics: ‘You're right – it may not work. But wouldn't it be good if it did?'

Spot the wishful thinking in the Government's justification for a 10% cut in hospital beds in just three years, revealed in Pulse this week. Health minister Ben Bradshaw opined: ‘Experts all agree this is the best way to deliver healthcare. Advances in technology and shorter stays for routine operations mean fewer beds are needed.'

But that's a huge simplification of the evidence for the Government's drive to shift secondary care work into the community. There's little doubt care provided by GPs can be more convenient for patients than sending them to hospital or keeping them there unnecessarily. But there are two key caveats. First, there was always supposed to be a concurrent shift in resources, whereas in fact resources continue to be diverted to secondary care. And second, Care Closer to Home was never a catch-all – its benefit is restricted to particular pockets of medicine.

That's not the only element of the Government's grand vision that lacks focus.

A new study reports minor ailment services – a centrepiece of the pharmacy white paper – will not, after all, ease the burden on GPs. Two of the three schemes evaluated actually seemed to increase GP workload, as patients struggled to cope with the information they were given and visited their practice for help.

It's hardly the first time the DH has been castigated for omitting to take notice of evidence. It recently scored only one out of four for ‘basing choice on evidence' in a National Audit Office review. But as its plans get ever more ambitious, the consequences for general practice get more severe. GPs risk soaking up a huge rise in complex cases without having the strain relieved elsewhere. That just won't work, however hard the Government wishes it would.


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