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At the heart of general practice since 1960

The McKinsey report softened us up. Get ready for McKinsey Mark II

The Pharaoh had a dream. He dreamt of seven fat cattle, then seven lean cattle. He then dreamt of fat ears of corn, then thin ones.

The Pharaoh had a dream. He dreamt of seven fat cattle, then seven lean cattle. He then dreamt of fat ears of corn, then thin ones.

Joseph, son of Isaac, interpreted this dream as seven years of plenty followed by seven years of famine.

And so it came to pass.

We now have our own Pharaoh, in the figure of Anthony Charles Lynton Blair, known as Tony Blair, erstwhile prime minister and latterly Middle East peace ‘envoy' and celebrity lecturer. It was he who oversaw the seven years of plenty, and he is now handing over the job of dealing with the seven lean years to his successors.

I am referring to the NHS here, and the latest reports that there are going to be several lean years coming up. This has been predicted by a firm of management consultants, McKinsey, who are just one of many private consulting firms who sit at the heart of Government.

The management types are suggesting across the board cost-cutting including around 10% of front-line clinical staff.

The Jobbing Doctor is not surprised. You see the front-line staff actually see what the money is being spent on, and very little seems to get to where it is intended. We still have roughly the same number of patients per GP as we had 10 years ago (around 1,800) and a similar number of nurses and reception and admin staff.

The expense is largely in the areas of being able to do more for more patients, and ever increasing demand.

The money has been squandered on ideology. Over the last 10 years or so there has been an inexorable move towards commercialisation in the NHS, with purchaser and provider split, hospitals being allowed more autonomy, and the whole paraphernalia of an internal market. Managerial costs have ballooned alarmingly from 3% of the budget and they are hurtling towards the American rates of 20%.

Money has been poured into a huge IT project that is years overdue, and vastly over budget, and is achieving virtually nothing. The Private Finance Initiative (a way of keeping capital expenditure off the public budget sheet) is now beginning to become ruinously expensive.

We have spent £40 million on swine flu, a mild but highly infectious bug, that has achieved nothing at all, except squander public money, and all around my patch are springing up huge buildings built with public money and privately organised, that are palaces to worship new Labour. The odd practice is incorporated into these huge Towers of Babel, and the remainder of the space is used for managerial functions.

Other catastrophes include the European Working Time Directive and the Independent Sector Treatment Centres. The list just goes on and on.

These should all be assessed independently by the National Audit Office. There won't be value for money here. But they won't.

This is typical behaviour of Government. They commission a report, and ensure that its results are completely unpalatable. They then deny it saying that they have no plans for enacting the report and wait for the furore to die down. When they introduce measures that aren't as bad as the original report, we all breathe a sigh of relief and say that it could have been worse.

I'll bet this is what happens. The McKinsey report will be shelved, and we will get McKinsey Mark II, and that will be what we end up with.

Posts will not be filled, and clinicians will be expected to do more and more work for the same money.

I've seen it before, and it will happen again.

Jobbing Doctor Jobbing Doctor

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