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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)

  • 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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From: Copperfield

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