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Ten easy cuts to save the NHS

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Just about every initiative or imperative these days is about reducing ‘avoidable admissions’ – aka saving money. But the only way I know of avoiding admissions involves avoiding coming to work, which, while attractive, possibly defeats the object. So we need more realistic ways of boosting NHS coffers. Such as:

1Sack pharmacists. Let’s face it, if you were designing the NHS from scratch, you wouldn’t invent pharmacists, would you? They’re just GP wannabes who, medication-wise, duplicate what we do, but badly. To stock shelves and count pills, you just need a level of consciousness, not a pharmacy degree.

2 Sack health visitors too. Do we really need to pay professionals to fuss over minor childhood ailments, give dumb advice about infant milks and perform pointless baby checks? No. Health visitors are a coffee-slurping, biscuit-munching, seat-warming waste of caffeine/HobNobs/chairs.

3 Shake up the prescription system. The many roles of the NHS do not include subsidising the household budget for trivia. So disallow all prescriptions for minor illness treatments available over the counter on the basis that, guess what, they’re available over the counter. Also, charge a small fee to everyone, for all prescriptions – except those who ‘can’t swallow tablets’, who should pay the full cost of their liquid specials and so really would have something to gag on.

4 Charge for waiting room seating. Combine the ruthlessness of hospital car park charges with the logic of the proposed consultation fee: make patients pay a fee for sitting in the waiting room. Fees could be inversely proportional to the length of wait so patients would be less likely to moan when I’m running late.

5 Educate community nurses. Specifically, that swabbing leg ulcers is a complete waste of time. And that a positive urine dipstick in an asymptomatic elderly patient does not need treating, but should be thrown in the face of the person who took it. And that there are hundreds of other things they do that are annoying, stupid and expensive.

6 Allow pharmacists to recycle returned packs of medication. The current burn-on-sight policy is an obscene waste of money. Who cares if these drugs might have been kept at one degree above the recommended temperature? Most of them do sod-all anyway. So let pharmacists re-use them – that’s if there are still pharmacists, which I hope there aren’t.

7 Limit the number of medications a patient can be prescribed. The limit should be six. After that, compliance and the evidence base fall off a cliff. Beyond that ceiling, a one drug in/one drug out rule should apply.

8 Raise the CV risk threshold for statins. To 100% within the next 10 years. Or stick with NICE’s 10%, but only if it applies to the risk of an event in the next 10 minutes.

9 Relocate NICE to planet Earth.

10 Give an annual cash prize to the doctor who devises the 10 best ways to improve NHS finances. I’ll accept 10% commission.

Dr Tony Copperfield is a GP in Essex. You follow him on Twitter @DocCopperfield

Readers' comments (34)

  • That truly brightened my afternoon - thank you.

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  • Excellent, and actually some suggestions that would make a difference.
    Especially, ban scripts for treatments available over the counter...also, if patient must have their particular brand that costs umpteen times more than the generic, then let them pay the difference!

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  • Hazel Drury

    My answer to those automatically demanding antibiotics for commensal fauna is that if you swabbed my arse it would grow bacteria but I wouldn't treat it with antibiotics! (Albeit some might argue I should).

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  • On the topic of point 5, could we please also ask them to stop taking pointless CSUs in asymptomatic patients because the dipstick was 'positive for everything'. Of course it will be! I'd be astonished if it wasn't!

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  • yes but you missed..relocate nhse to pluto to takē the place of nice..and doh and *unt to the centre of a black hole.

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  • How about less emphasis on counting beans? You know, that 90% of the CCG who spend their time collecting "evidence" in the form of poorly thought out, but nevertheless lengthy, spreadsheets (to be completed by GPs and others) in order that they can produce a slightly prettier flowchart...

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  • You forgot the single most important cost and that is the drugs themselves, Nationalise the drug companies and instead of paying exorbitant prices actually put profits into the health service.

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  • You forget the counter over which the pharmacists sell their medicines. Without the pharmacists filtering out the dross..... it'll come our way!

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  • 3, 7 and 8 sound OK to me.........as one of the sacked pharmacists

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  • Perhaps obtain advice from a pharmacist which medication would be best to treat Copperfield's jaundiced outlook!

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  • I think the pharmacist comment refers to NHS pharmacists, not commercial ones.

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  • Sack Copperfield!

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  • sack copperfield...and appoint him PM

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  • Scrap the antiquated Consultant contract system - Make all Medical staff NHS employees - While Copperfield fiddles the NHS burns -
    You can control a Public Service but not a Privatised one- So Support Elected Public Servants

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  • Love it. #3 so overdue. A prescription needed for Diprobase? WTF? Why not stop flu's as well, save a quick billion, since Cochrane says they don't work.

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  • Point number one is simplistic and frankly offensive.

    I'm not a GP wannabe. I'm a skilled professional who provides advice- mainly to GPs on the safe and effective prescribing of medicines, utilising evidence based medicine. This allows you GPs to get on with your own work while I do your research for you. I also advise you on all those patients with overdoses, tell you that no, you shouldn't stop that medication for your pregnant patient's life threatening condition and no, you don't have to send your patient for an abortion just because they've had a couple of doses of co-codamol.

    When I locum, on evenings and weekends when your surgeries are shut, I spend a large proportion of my time dealing with prescription problems left over from the surgery- prescriptions that are dangerously wrong, prescriptions that haven't been issued, prescriptions that have been issued but which shouldn't have been.

    Kindly don't lump everyone into the same box. As a healthcare professional, you should know that such attitudes are unhelpful and destructive.

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  • 3.52: don't rise to the bait. Direct him here instead http://www.pulsetoday.co.uk/20007357.article

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  • As a promoter and advocate of inter-professional education for pharmacy, medical, nursing and social work students at De Montfort University and University of Leicester, I find Copperfield's remarks offensive, derogatory and unprofessional. This article
    should not have been published by Pulse. It serves no useful purpose when all our professional and government strategies are geared at encouraging health professionals to work together. Copperfield and Pulse should issue a prompt apology and the article should be retracted.

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  • Hi Peter, this article is not supposed to be taken too seriously as it is a blog post, and is therefore fair comment.

    Joe Davis, Digital Producer, Pulse

  • Thank you for taking the trouble to respond. I appreciate it. Well, blog or not, the article is published in the paper copy of Pulse in the 'Views' section. And I'm not sure where the notion comes from that just because it's in a blog it is not to be taken seriously?Articles like this, whether written in a blog or any other form of social media, should be taken seriously otherwise what is the point in publishing them.

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  • Thanks Peter and Joe, especially the latter, for the comment: "offensive, derogatory and unprofessional". That's exactly what I'm pitching for.
    But within every offensive, derogatory and unprofessional blog there's a germ of truth - and the extent to which it applies, I find, is proportional to the mouth-foaming of the response.
    The fact is, while the point is exaggerated for comic blog effect, I stand by it: in the context of cash constraints, if you were redesigning the NHS from scratch, you would not dream up an entire profession (pharmacy) to a) Store/stock control medications and b) Duplicate a lot of what GPs are already doing.
    I think even pharmacists realise this, as evidenced by their desperate thrashing around to decide on their role described in the features and news stories of their own trade magazines.
    Of course, they might argue that, if you were going to redesign the NHS from scratch, then you'd do away with GPs and have extended role pharmacists instead.
    In which case, fine, go ahead and make that case - I haven't had a good laugh since the 'GPs should use astrology' story.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder