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CAMHS won't see you now

Five urgent priorities for the new PM

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So, we are to have a new Prime Minister tomorrow. And she is probably thinking more about squaring off with Jean-Claude Juncker rather than the NHS right now. 

It is time to work out a sustainable plan for the health service

Of course Teresa May’s Brexit negotiations are absolutely crucial to get right, but I hope she is aware that another part of her predecessor David Cameron’s legacy is a health service in probably its most perilous place since 1948.

Ms May has said little to date about the NHS apart from that she would ‘cherish’ this unique institution, but unless the new PM is not careful, the whole house of cards that the Conservatives have built may come tumbling down on her watch.

A mixture of mismanagement, neglect and bloody mindedness have meant that systemic problems in the health service are now beginning to burst through the wallpaper, like long-hidden rising damp. Ms May has promised to build a country that ‘works for everyone and not just the privileged few’. This must include urgent action on the health service, the greatest post-war vehicle of social justice that is rapidly running out of steam.

I doubt that Ms May reads this column, but if anyone close to her does, then here are five areas that I believe need urgent action within her first few months of office.

One, stabilising the NHS finances. A King’s Fund report published today makes grim reading: a record deficit of £1.85bn, doubt that £22bn in ‘efficiency savings’ can be made by 2020 and an admission that ‘new models of care’ are unlikely to deliver any savings in the short term. Both sides of the EU referendum agreed that the NHS needed more cash, it is time to work out a sustainable plan for the health service to plan against.

Two, deliver on the promises in the GP Forward View. I would be asking NHS England some awkward questions about this. Have we seen an extra penny invested in general practice since the GP Forward View was announced in April? No. Where is the £16m practice resilience funding? The £30m fund to ‘release time for patients’? The much-trumpeted indemnity support scheme for GPs? These are all very nice ideas, but mean nothing if they are not acted upon. (Also, she should start making ugly noises about the lack of a similar commitment to general practice in the devolved nations, which will help quiten that pesky Nicola Sturgeon)

Three, forget seven-day GP services. This is a good time to take stock. Mr Cameron’s personal project to extend GP practice hours is unaffordable to pursue this while waiting times for appointments in core-hours are lengthening. Existing pilot schemes under the Prime Minister’s Challenge Fund are being propped up by NHS England as CCGs do not want to pay for them. Listen to your advisers and shelve the whole idea quietly.

Four, mental health. It is encouraging to hear the new PM speak about the ‘burning injustice’ of the current lack of mental health services. The Mental Health Taskforce earlier this year promised a £1bn of money for mental health, but this was contingent on CCGs raiding existing budgets (slim chance of that). With care and some attention Ms May could leave a good legacy here, but there is much to do (see here).

Five, appoint a new health secretary. It cannot have escaped Ms May’s attention that Jeremy Hunt is looking a bit tired of his brief. He has burnt all his bridges with the medical profession over the junior doctors’ contract and has no personal capital left to make any meaningful changes. I hear that the Department of Energy and Climate Change has a vacancy that you could reshuffle him to.

Nigel Praities is editor of Pulse

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Readers' comments (10)

  • Vinci Ho

    Just touched down in Heathrow
    Already felt been away for 'centuries', although I have been following the events closely .
    You have to remember if somebody told you two months ago there would be a new female PM, you could be easily labelled a lunatic.
    Every 'butterfly effect' had counted , London stock market immediately responded as Auntie May claimed the throne . Interestingly , both Japanese and Australian general election results favoured stability and the current PMs. But I think they all know how volatile and uncertainty the global situation is. Auntie has got a monumental task and her speech about tackling the previledged few , uniting the country and leadership in uncertain time can be all translated into a new 'language' applicable for both internal and external affairs . No doubt , NHS is one key sector especially she also talked about social injustice . If Britain is to really survive this storm of uncertainty , she really needs to mean and deliver these words . Any more ostentatious claims and spins will be suicidal as far as middle ground politics is concerned. Of course , the possibility of an early general election is stil there but will very much depends on how much she can achieve in next few months.

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  • 6. medical indemnity - it's out of control. as a first year GP if I want to do more than 8 hours a week of OOH work if costs me over £17000 for the year. absolutely insanity.

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  • Vinci Ho

    PM , job impossible ?
    At least , our new British Wimbledon champion wouldn't want this job......

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  • Vinci Ho

    Three 'H's for the incoming PM
    Humility , Honour and Honesty(one for all ; all for one)
    The last H is certainly not the least as how much the government is willing to spend in the health services ,will realistically translate into what can be and cannot be delivered by NHS(as being alluded by the King's think tank)
    Being a type 1 diabetic on insulin, should know very well NHS is the heartbeat of the country and the importance of flying the flag high.
    Being a person who loves shoes , should be regularly checking own reflection in the mirror .......

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  • Priorities for new PM
    1) sack Jeremy Hunt
    2) make Jeremy Hunt ambassador to the Falklands (sorry penguins)
    3) haul BoJo and Govie up on charges of treason for the harm they have done to economy
    4) free butter for pensioners
    5)recess Parliament and all go on holiday for the summer

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  • @ 9.00am. Have you ever sat in a baby vacs clinic? As a doctor you should appreciate that a little pain has long term benefits. The so called financial crisis is not affecting all sectors as can be witnessed by the FTSE recovery above pre Brexit levels. as for the pound value, I think you might find that exporters are rubbing their hands. Any crisis is fuelled by BetFred, sorry I meant bankers making a few bob - theres's nothing like a crisis to line their pockets. There are always winners and losers. I expect you are probably in the 'hang Tony Blair camp' as well? This process has shaken the establishment -something long overdue.

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  • Aunty May, as Vinci puts it, may wish to take into account that people in deprived areas voted against the establishment and try to give equal funding to UK citizens and not the privileged few in London or West Kent.

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  • With the revelation by Danny Boyle that those in power wanted the NHS pulled from the opening ceremony of the 2012 Olympics, I doubt there are many in the party who wish it to remain Nationalised. The NHS is seen as an employment service that does a bit of illness. Because it is such an emotive subject for the nation it is far better to let the NHS die by slow strangulation of resources, which leads to industrial action. Then the blame can be squarely on those greedy agency staff and immigrants who bleed the NHS dry. So sad that the honesty about how much it costs to run the service is lost in that rhetoric. The demise of the independent contractor status is playing into the hands of large corporate groups to offer quick fix solutions that will end up costing more in the long run. The personal responsibility for a registered list will go and with it the ingenuity and autonomy of primary care.

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  • I think he could be good in energy and climate change. Anywhere but health

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  • It is this unrealistic demand for more and more of the nation's wealth, with no consideration for looking to where savings could be made, that give our profession a bad name. Of course it is good politics in support of a more left wing "Corbinista" government, but we are years away from a general election and we have no business playing party politics as the Junior Doctors have discovered.

    How about offering 5 ways to reduce expenditure so we can do some core work well?

    1. How about saving a quarter of the NHS budget by accepting people make mistakes and things don't always go to plan and limiting compensation to cases where doctors have acted maliciously.
    2. What about accepting that prolonging life of the body when the mind has long ceased to exist is both cruel and huge expense. Approaching old age fillse with fear, not because of death, but because theedical profession, (and I do not hold myself blameless in this), will keep me alive long after life has ceased to be a pleasure.
    3. How about using Brexit to get rid of the Specialist List and so allow easy transition from hospital medicine to General Practice. How about accepting that GPs are NOT Consultants working in the community. It is all very well wanting to offer a Rolls Royce service but how about being realistic and accepting we only have the finances to run a Ford Fiesta? How about, just for once, we put our country and our patients above our desire to be "consultants?
    4. How about we get tid of uneccassary bureaucracy that diminishes our productivity? Get rid of CQC, NICE, CCGs, and the rest. Lets get rid of QofS and QUALs that cause a practice to offer cervical smears to the local convent in order to meet a target.
    5. Let us acknowledge that the introduction of the computer into tje consultation has halved productivity. Before computers, average consultation times were 6 to 7 minutes. Now we run at about 14 minutes.
    GPs have benefited enormously from the new contract introduced under Tony Blair's government. Now we are reaping the rewards as it proves impossibly expensive to maintain a system WE created.
    Get Real.

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