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Gold, incentives and meh

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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  • Well it is good, at last, to hear from the man himself.. If I was designing the NHS from scratch I would not do away with any health care expert who had been trained in their field. I'd set off to encourage them to work together to make best use of their respective skills and to refer to colleagues, within and across professions according to the needs of patients. We all have gripes about the system... and something humerous is often good to hear. But if you direct your 'humour' in an offensive and unprofessional manner, the overall impact may not be appropriate. Also, whilst I'm all for 'having a good' laugh, shouldn't this be achieved within a spirit of respect for one's fellow professions? No matter how small or large the grains of truth, derogatory comments are not the way forward. And, if you accept that there is a grain of truth in that some collaboration between professions can (at least occasionally) be beneficial for patients, then you might imagine the embarrassment of having to explain an article like yours to medical, pharmacy and nursing students who, up and down the country, are being encouraged to work together. I rest my case. An apology would still be welcome!

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  • Some people just have absolutely no sense of humour

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  • Sad really that we Health Professionals cannot work together. Government Agencies must be loving Mr Copperfield's comments as it creates the impression that a 'divide and conquer' policy will work. So please Mr Copperfield think before you type : you may someday get your wish and live to regret it, thanks Tom Taaffe (Pharmacist)

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  • Hi Peter
    Get a grip.
    Tony only says in jocular form what all of us agree with to some degree. Most Pharmacists catch a mistake from us only rarely, and offer useful advice even more rarely.
    We need someone to dispense what we prescribe, and a good checker is always a bonus.
    As for professional advice to the public this seems to be seconded to the counter girls. Is it a wet or dry cough, followed by the sale of a useless flavoured water. Hardly what the NHS would want to commission

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  • FGS get a life, this is supposed to be a humorous column aimed at GPs to get a little respite from the daily grind. Have a laugh rather than seek offence.

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  • I can only say that Tony Copperfield is so out of touch with the role of the pharmacist that we should discard any comments he makes on this subject and listen instead to GPs who understand the meaning of collaborative patient focused care!

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  • How can you do No 6 if you have sacked all the pharmacists because you think that an entire profession is a waste of space?
    You are clearly either a) perfect (I doubt, nobody is), or b) have absolutely no idea how many times a pharmacist has saved your arse. They certainly have saved and educated me in the past and I've thanked them rather than be obnoxious about them
    So there's a few crap pharmacists out there, there's more a few crap GPs though. It doesn't make me judge the entire GP profession based on those and you really shouldn't make yourself out to be so stupid that you would judge the entire pharmacy profession by the same measure.

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  • As a GP who works with pharmacists for a significant proportion of the week, I am dismayed at the lack of basic knowledge that GPs are displaying here. We need to realise and support the fact that our patients visit the pharmacy 14 times a year on average,

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  • ...and that the pharmacists don't have a workforce crisis like we do. Google "healthy living pharmacy" to learn some of the possibilities.

    50% of our prescribing is wasted as patients don't take the meds properly, but the pharmacists can assist with adherence and improve the patient outcome.

    Finally, only a small proportion of their income is from selling things, the same as general practice. Their income is from dispensing and providing enhanced services. Our income is from core services & enhanced services.

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  • There is no place for offensive, derogatory or unprofessional.
    This is obnoxious, even where it has some truth. This reads as one of those people that causes offence for the fun of it, couldn't give a damn about anyone's feelings and if you get upset then it's your own fault for having no sense of humour.
    You really need to grow up and be a bit more intelligent with your 'humour' rather than this childish idiocy

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  • Obviously as another pharmacist who would like a job I say we make a real difference for patients. Saw 24 patients in the GP practice where I work and my patients value my medicines expertise! But even I find it hard to disagree with would you invent a pharmacist in s new NHS.

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  • Oh dear Dr Copefield.... you have not idea of what pharmacists do and they skills they have. This a very unprofessional statement which show a great degree of ignorance. Please go and work with NHS pharmacists and I sure your opinion will change. We are highly qualified individuals with a five years university degree who desire better treatment than being sack by the NHS.

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  • How much training does a pharmacist get on diagnosing illness ?

    I am genuinely interested.

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  • I'm a patient. I attended a CCG meeting (as public) on Thursday and was told that pharmacists were going to be an essential part of the 'medical' mix in future. Along with 'nurses'. I welcome nurses and nurse-prescribers in GP, and phlebotomists. But phamacists? .... I have somehow let my regular scripts be nicked by Boots. I've had mild asthma for 45 years well-controlled, don't tolerate inhaled steroids well so only use during bad spells (pollen, farming, travel,..) and use salbutamol otherwise. So my scripts are heavy on the 'reliever' and low on the 'preventer'.

    This is agreed with my GP - neither he nor I are blithering idiots and I am technical, as well as having a copy of the Haynes manual for my body and an eBNF access. There is never a problem until some do-better challenges what I am doing. It's ALWAYS the pharmacist. "You're not doing this right you have to go for assessment", "There is a mistake on your prescription I must speak to the Dr" -- which happened to me the week before last.

    But imagine the look on the face of the lady at the CCG meeting when I told her that I will under no circumstances discuss anything medical with a pharmacist. "I'm afraid you'll have to", she said.

    When I stand in a pharmacy queue and listen to the 'advice' given by pharmacists to customers I question how this quackery can still be allowed. Every ail has a pill. The very attitude GPs have been trying to eradicate since I was a boy in the 1960s. But that's what pharmacists do. They sell stuff. Can't we get them to sell something with fewer health consequences? Beds, greengrocery? Sweeties? Serve on the Pic 'n Mix counter.

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From: Copperfield

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