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Columnist of the year

People wonder where the huge sums invested in the NHS are going – Phil has the answer

Four ways to waste cash

Back in the old days – say 2004 – if you suddenly felt unwell, there were only two ways you could access medical services. You could contact your GP, or you could go to the accident and emergency department of your local hospital.

In this brave new world of the modern New Labour NHS in Sunderland, there are six. As well as the aforementioned, you can call NHS Dire(ct), you can go to either of our two spanking new walk-in minor injuries units, you can access the 24/7 team (no, I don't know what that means either) or you can contact our community matrons.

This new cornucopia of options doesn't give you as much choice as you might expect. Let's have a look at each of these new services in turn.

NHS Direct I need barely mention; we are all far too familiar with this hyper-expensive telephone answering service. Patients who phone NHS Direct are asked a lengthy series of questions, and then advised to a) take some paracetamol, b) go to A&E, or c) see your doctor in the morning. At a reputed 50 quid a call, this seems poor value for money.

The minor injuries units, staffed by nurses only, also seem a bit shoddy. After the first one opened,

I was struck by the number of patients turning up as urgent extras, after having visited said establishment the night before. I was moved to perform only the second audit of my life; I collected two weeks' worth of attendance slips and had a look at what happened after our patients had presented. Roughly 70 per cent of them either went to A&E afterwards, or visited us with the same problem within 48 hours of their attendance.

This first establishment reputedly cost £5m. Admittedly my audit was performed only two months after it had opened, and maybe they have improved by

now, but they would have to improve an awful lot before this would seem a sensible use of public money.

Community matrons were introduced with the express intention of delivering care in the home environment and reducing acute hospital admissions. They have evidently failed in this aim.

At our local LMC meeting last night, we perused a graph of acute hospital admissions in our area over the past five years. We marked on the graph the date on which the walk-in centre opened, and when community matrons commenced their endeavours.

The graph continued its gradual upward gradient, oblivious of these wonderful innovations. They had made absolutely no difference

at all.

Oh dear, matron

I've had no contact at all with our community matrons since they appeared, other than a single phone call from one of them asking me what I thought she should do with one of my difficult patients. (As I hadn't seen the gentleman, I suggested she should do what she thought best, so she sent him to see me.) But I did have an illuminating conversation with another patient. 'I'm glad you're not running late today, doctor‚'

she told me. 'Why's that?' 'I need

to get home because that nice community nurse is coming to see me today. I promised to make her a cup of tea.' 'Why is she coming to see you?' 'Same reason as I'm here. I've got a bad chest.'

That's your taxes, that is.

The 24/7 team? I don't know. They don't talk to me and I don't talk to them – they could be doing anything.

People wonder where this vast recent investment in the NHS is going, and why it doesn't seem to be making any difference. Well, there's part of your answer; those four useless behemoths. None of them was introduced with any consultation with us or with any evidence that they would work, all of them have siphoned off good-quality nurses from proper jobs into unproven expensive experiments.

They all have one thing in common. If you have an acute illness or injury, your first and perhaps only contact is with a nurse, not a doctor.

Make of that what you will.

Dr Phil Peverley is a GP in Sunderland and is PPA and MJA Columnist of the

Year 2006

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