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CAMHS won't see you now

GPs are the key to the survival of the NHS

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I am going to start this editorial with something quite unusual in today’s Britain: praise for GPs.

Slap yourself on the back – you deserve it. I have it on good authority you are responsible for saving the NHS. Yes, our cherished national institution has only survived because of your good sense.

You won’t hear it trumpeted by our national media, or in speeches by Government ministers, but on the back of GP practices the health service has become one of the most efficient in the world.

A recent King’s Fund report, Better Value in the NHS, found GPs have saved the health service £7bn over the past 40 years by prescribing generics. This allowed 490 million more items to be prescribed with no increase in total prescribing spend. The UK now has one of the highest primary care generic prescribing rates in the world, at around 84%.

Another major reason the NHS is still functioning is that GPs have taken over much more care from hospitals. For instance, diabetes is now almost completely managed in primary care.

Major reductions in hospital stays in the NHS have only been achieved by GPs following up patients and ensuring that they receive the right care in the community. In 2012, the average length of stay in UK hospitals was seven days – around 14% less than just a decade ago. This has enabled hospitals to treat more patients and avoid the cost of 10,000 extra beds.

And I am sure you could give me more examples of the health service being able to do more with less, due to the ingenuity and prudence of its greatest unsung asset. General practice.

But (and I am afraid it’s a big but) the NHS is facing the biggest financial black hole in its history. At least £22bn must be saved over the next five years if the health service is to remain on an even keel.

Never mind the seven-day access ambitions of the Prime Minister, the big issue is how a health service that has managed just 1% annual productivity gains over the past 35 years can double or triple this in order to stay afloat without harming patient care.

The King’s Fund report (I know, I have too much time on my hands) has suggestions on how to achieve this but all of them rely on GP practices having the time and resources to innovate and design better care for patients.

Earlier diagnosis, better care of the elderly, reductions in hospital admissions and tackling polypharmacy: all are good ideas – but they require a fundamental shift by the NHS. Creating ‘vanguard’ pilots or dishing out the odd million to trial pharmacists in practices is no more than tinkering at the edges. General practice is in a full-blown workforce and workload crisis that must be tackled urgently.

A burnt-out and dwindling GP workforce stretched across seven-days will not be able to deliver the revolutionary change the NHS needs. Additional funding is vital, but even more crucial is rethinking the targets and bureaucracy that are piled onto practices.

I have said this before, but free GPs from the quagmire of the QOF and the CQC and give them the tools to tackle patient demand. The health service as we know it can avoid being dragged into the financial black hole only if GPs are allowed to exercise the pioneering spirit that has served the NHS so well thus far.

The alternative is far darker.

Nigel Praities is editor of Pulse

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Readers' comments (28)

  • Nigel, you assume that the Govt does want to make the NHS work.
    It doesn't. It wants to make savage cuts in spending by getting rid of substantial chunks of the NHS and that starts by getting rid of primary care and making people pay for it directly, like dentistry.

    Whether or not you agree with that model of funding healthcare, it's a topic that can be debated.

    What is unforgiveable is that the Govt is not openly admitting that is its goal, and is instead using despicable methods to ruin GPs' livelihoods and personal finances in order to wreck primary care so that the Govt can step in as the saviour with its big business American chums and make GPs take the blame.

    Please everybody stop thinking you can tell the govt how to take the pressure off GPs and run things better. The Govt is not listening, it doesn't want to take the pressure off GPs, it is deliberately applying that pressure as part of its plan.

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  • Anonymous 10.15, couldn't agree more. I've been saying this since 2004 & it applies to both Labour & the Conservatives. The NHS will always be a bad news story so make working for it intolerable and then blame greedy GPs for the collapse as you waltz off to your lucrative directorship. It's all going to plan currently.

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  • Why would anyone want the NHS to survive?
    A system funded only by taxation has no safety valve to attract more resources. It crowds out all other options except the most bespoke services and leads to an obsession with productivity at the cost of safety.

    A better aim is for general practice, the most efficient part of UK health, to survive.

    Allow GPs to offer top up services, such as extended hours or non triaged access, to their patients for a fee set by each practice in open competition.

    Allow fully private GPs to have full access to NHS diagnostics, referrals and scripts.

    Give each patient a payment, as determined by their individual risk profile, which they can take to their nominated GP practice, thus creating incentives for practices that wish to cater for complex or demanding patients.

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  • @ 10.59

    Because we have an island mentality and can't see the blindingly obvious.

    If GPs muster the courage to go private there will be a price for them to pay. Continue as present and watch the NHS car crash unfold GPs will be blamed and there will be a price to pay. Its no win.

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  • Unfortunately general practice has reached the point of no return. We all know it but won't say it. What new doctor would want to come into the profession today? Its like asking someone to get on the titanic after letting them see the film beforehand. It will and is collapsing. It will not deteriorate in an orderly well. It will be like a domino rally. The real question as a profession is how we protect ourselves. Do we work out the legals of taking the whole practice out of the NHS and charging for consultations, and how we could do this at a moments notice? Do we jump ship now and head for warmer shores before everyone else does? Do you hand the keys to your colleague and start making a fortune as a locum?
    If you think that this is all silliness read the forum pages of newspapers. They, the public, don't care. Even when the crisis in front of us all is pointed out they don't care. They still want to tell us how stupid greedy lazy....etc we are.
    Making a plea to the media to lay off general practice hasn't and doesn't work. The beatings will continue until it is dead.
    Anybody sensible will be making plans now. This is Joseph and the technicolour dreamcoat time.

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  • Anonymous | 30 July 2015 12:04pm

    I'd rather pay the price being able to set my own renumeration for my services as per market value rather than continue in the NHS

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  • Drachula

    I think what is so sad is that we could have such a positive and cooperative process if only we could stop all the mud slinging. We all love the NHS for the fabulous things it can do for people. Just look at the stories on @bigupthenhs (FB and Twitter).
    I know, and I know you all do too, of the inefficiencies in the system which waste our time and patients'. Things like the inability of A&E departments to send people away if inappropriate, ie redirecting to more appropriate setting. I could come up with loads of things that would save money and improve patient experience in another 30 mins. It's not rocket science so why is the government fighting us? It's not us you need to fight: it's the vested interests in BigCo. Just look at all the Pharma scandals and tell me there aren't vested interests in the government!

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  • Azeem Majeed

    Thanks for your support Nigel.

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  • The Pulse popularity drive's as if they have pay per click advertising.

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  • Nigel, you underestimate by a long way. Yes, those are the easily measurable bits. But GPs start much earlier, stopping problems getting worse before they even start to clog up the hospital system, before they can be measured. The maths goes as follows: GPs see around 90% of all patient contacts. Therefore a 5% change in referrals in a GP practice changes hospital planned attendance by 50%. That's huge.
    We can't afford a US-type big business big profit healthcare system. US can't afford it, which is why Obama brought in Obamacare - 16% of GDP was crippling the country. UK Economy needs universal healthcare, to keep adults working, to keep them from worrying about their elderly parents, their own sickness, their children's health. It's simple economics.
    BUT, and it's a big BUT here's the tragedy of the commons:- our NHS, our GP practices don't pay lobbying funds to get decisions made in the public interest. We have the numbers from USA - government costs the taxpayer $2bn, but commercial interests spend $2.6bn on lobbying, no wonder they tend to get laws made in their favour. I wonder what the figures are for UK?
    There are other figures. The richest countries have the biggest tax take - developing countries approx 12% of GDP in tax, developed countries 30-40% of GDP in tax. So by trying to reduce the size of government, by reducing total tax take, this government is trying to make us a backwater developing nation. Simple numbers like that don't lie.

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