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At the heart of general practice since 1960

The NHS is sliding towards Narnia

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The existence of a publicly funded comprehensive health service feels under threat like never before.

In England, there are currently 3.9 million patients waiting for treatment, the most since December 2007. The three million mark used to be considered a watershed, but no longer. In Scotland, nearly one in 10 patients is waiting longer than 12 weeks for an outpatient appointment.

The NHS is entering a Narnia-like ‘perpetual winter’ 

As GPs know, these are not just numbers, but millions of patients and their families anxiously awaiting that operation, or a diagnosis; untold pain and mental anguish that is now regarded as the new normal.

And the problem is not restricted to outpatients. Pulse has received reports of dangerous delays in ambulance services across the country and GPs in Kent were recently warned not to use ambulance services unless ‘clinically appropriate’ (as if they would).

Practices in Hertfordshire were advised to redirect non-urgent appointments to a private provider to take the pressure off a local hospital. And – perhaps even more insidiously – there has been a 6% jump in private referrals after CCGs in one area of England gave GPs a ‘gentle reminder’ to ask patients to consider using private health insurance if they have it, as Pulse revealed last month.

These are symptoms of a system struggling to cope. The head of NHS Providers recently warned that there is an ‘unbridgeable gap’ between what the NHS is required to deliver and the money there is to pay for it. And that is putting it politely.

NHS leaders have warned the NHS is entering a Narnia-like ‘perpetual winter’ with pressures that used to be the exception now becoming the norm. It may be too early to cast the Prime Minister in the Tilda Swinton role, but she is certainly no Mr Tumnus.

We are sliding into a situation where our health service may cease to meet the expectations of the society it serves, and that is dangerous territory. I predict more lurid headlines about the care in NHS hospitals before the year is out, and the battle over the junior doctor contract is not over by any means. Last winter was relatively mild, but a prolonged cold snap this year could tip services over the edge. The public’s trust in its beloved health service is holding, but for how much longer?

The sad thing is that the one area that could take the pressure off secondary care is in its own underfunding crisis. Yes, general practice could be the saviour of the NHS if it had been adequately supported over the past few years. But practices are still struggling to recruit and retain. The Capita debacle in England has not helped. As we show in our investigation, so-called ’resilience’ funding is not reaching practices.

The GPC’s solution is to bat unfunded work back to hospitals, cap patient contacts at 25 a day and siphon off all other urgent care to local ‘hubs’. This could be an effective and relatively speedy solution to the GP workload crisis – and credit is due to Dr Brian Balmer for pioneering it; GPs often tell me they don’t want more money, just less work.

But this retraction of the health service will have consequences. Patients will see greater restrictions and those with the means may go elsewhere. We all know there is a wing of the Conservative party that sees a publicly funded NHS as an anachronism. And I worry all this may play right into their hands.

Nigel Praities is editor of Pulse

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Readers' comments (14)

  • Much of this problem is driven by demand. If GP's were respected by patients and allowed to use their professional judgement about who to refer, instead of pandering to the popularity vote and giving patients everything they want or percieve they need, then there wouldn't be such a huge demand for unnecessary outpatient appointments. Who supports us when we say no to patients?

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  • The problem is driven by us ( or by you practicing GPs).

    Too many politically driven Gps and 'educationalist' types ( who often work very part time) keep talking to language of meeting demands and wants.

    It is clear the NHS cannot meet those in need - to keep pandering and wasting time on wants, creating and encouraging more use ( e-GP etc) is criminal.

    I saw a great practice where the lead GP proudly talked how they were meeting demands by employing NP's and has E-GP. But when you talk to the NP's and reception they were clear that patients were unhappier - their needs were not being met and the NP was being used beyond her remit.

    What is shocking is that a solicitor has not yet targeted practices that use E-GP as being medically unsafe or those who have too many consults with NP's as high risk.

    Until we understand the depth of the crisis nothing will change

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  • I think we are getting close to a time when we might have to say to patients that we can only do our best and not deal with everything that patients, politicians and the media think we can treat. I walked out 15/12 ago aged 49yrs because I had just had enough of problems like:
    'I am 94 yrs old, my back hurts and I can't go on the cruise I want to.'
    I have eaten so much that I now weigh 29st and can't walk.'
    'my wife has found out that I have been having an affair with her best friend for seven years and kicked me out and I feel unhappy'
    'I have smoked 40 cigarettes a day and now my breathing is poor'
    'my life is s**t and I would like a tablet to make it better'
    'I have chosen to take illegal drugs for 20yrs and now I am mentally unwell'
    'I am a useless parent and now my badly behaved child need a medical diagnosis and treatment'

    and so it goes on, the never ending medicalisation of non-medical problems and the very unrealistic expectation of what a GP can do in ten minutes.
    Good luck to you all but the ship has nearly sunk.

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  • How comes those at the very top cannot see this?

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  • So, 'Honest from Yorkshire' you REALLY don't see ANY way that you can help the patients you mention ? How about just being a compassionate human being with relevant knowledge & contacts, recognising honesty & remorse & a plea for help from a desperate flawed fellow man/woman ? Just how do YOU define a 'medical problem' ??

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  • Hi June, I spent 22yrs as F/T partner being compassionate and eventually realised that however hard I tried I was failing to improve the problems of many patients who just had completely unrealistic expectations of what we can achieve. Unfortunately current resources are limited in both finances and manpower and the situation is likely to worsen. At some point I think we will have to reduce patient expectation and increase patient responsibility, unfortunately I could not wait any longer for this to start happening so I left.

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  • Vinci Ho

    I know there must be all kinds of sentiment going through some of us as the Juniors have cancelled all industrial actions as well as the small group of JDs got 'defeated' by the SOS in High Court last week .

    ''Arguments about justice and rights are often arguments about the purpose ,or telos,of a social institution, which in turn reflect competing notions of the virtues the institution should honour and reward.'
    Justice
    Michael J Sandel

    In our case , the social institution here is NHS. And if the hierarchy in control of the institution has a secret agenda to betray all these virtues , the arguments or debates in any negotiation cannot be conducted in conventional diplomatic terms, based on a shared hypothesis that all contestants played an open hand, meant what they said, without covert motives. (Referenced from Julian Tudor Hart's article on BMJ 7/9/2016)
    And according Julian, this government actually wants to secretly set a new version of 'virtue' for the institution ,''Should we not recognise at least the possibility of a different hypothesis: that in the eyes of majority public opinion, responsibility for collapse of the NHS as we have known it might seem transferable from government to healthcare professionals?''
    And he concluded ,''Sadly, this hypothesis now seems to have more explanatory and predictive power than conventional pretences that both medical science, and staff privileged to apply it to real communities, can defend their integrity by pretending to believe whatever good manners demand.''

    To me , it is always about what Mencius said ,'Those who have no virtues holding high positions in the hierarchy , are spreading evils through the most .'

    ''There is a point far out there when the structure fail you , when the rules aren't weapon anymore.
    They are shackles letting the bad guys get ahead.''
    Jim Gordon
    Dark Knight rises


    For JDs, for all of us and NHS,the war goes on......
    And Nigel , thank you.

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  • Honest from Yorkshire, I get everything you say. Some people still like to believe that we should be responsible for everyone's health but the reality is everyone is responsible for their own health. Few people actually bother to look after themselves as it requires too much effort.
    Soon people will have to face the issues this raises themselves once the NHS ends.
    I think there will be fewer appointments made when people have to pay for their failings themselves- if there are any doctors left to do even the paid work!

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  • How about the Drs bashers here go take a walk someplace else. This magazine gets thoroughly depressing when ever there is an 'out break' of commenting from folk with axes to grind. There are very few places Drs can comment candidly about issues that effect them yet there are literally hundreds of on line forums for people to moan about Drs. Why don't you go there instead? Your comments are boring. It's comments like these that make make me think twice about reading PULSE. Maybe your trying to make his web magazine irrelevant and unread? Leave 'honest from Yorkshire' to speak their mind. I totally understand where this poster a coming from. I've also met plenty for people like the ones replying. You aren't unique, you aren't interesting, you have nothing to say that we all haven't already come across in spades. Take your inward looking moaning somewhere else. It's depressing, negative and demonstrates you really don't understand what was actually being said because you haven't had the experiences nesessary to get it.

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  • June knows lot of things like 'compassion burnout' but has an enormous inability to empathise with a typical GP in the UK. Perhaps she has never worked as a GP! May be she has 30 minutes with a patient and see only 15 a day compared to 10 minutes per patient and a 40 a day!

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