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At the heart of general practice since 1960

If the NHS has to be trimmed, then spare the curlers

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Travelling for me is not about soaking up different cultures, scenery and food whilst enjoying a break from work or studies. It’s also about getting a haircut. Whilst we are not in short supply of coffee shops and Turkish barbers on our local high street, there is no better way to get a feel of the day to day life when abroad than by getting a quick trim. I love to search for a run-down barber shop to see how the locals go about their daily business.  A street haircut in Vietnam? No problem. Freshen the quiff and have a massage beside a Nepalese lake? All yours for 20 pence. Off with the beard in the Andes? Take a seat.

Our system is good

The point here is that different countries do things in different ways, and experiencing that adds to life’s rich tapestry. Medicine is no different and whilst patients will present with similar problems the world over, the organisation and provision of healthcare will vary hugely. So, have we got it right in this nation, this newly isolated UK and can we learn from further afield or our recently divorced European friends?

Well there is probably no perfect system but that doesn’t mean we cannot strive for one. Primary care is under pressure with recruitment and retention being major problems. Junior doctors are voting with their feet and leaving in droves for greener pastures, as well as more senior colleagues taking their pension at the earliest opportunity. I, too, have worked overseas prior to settling in my practice 19 years ago, having been to Australia and got the T-shirt (actually a driza-bone), twice in fact, and I learnt a great deal about medicine, life and healthcare.

But what I took for granted in the UK - single medical record, continuity of care, a responsibility to provide 24 hour care and home visits along with palliative care - was not the norm Down Under back then and it left me appreciating how great our current system is. The fee for service model leaves a lot to be desired and aspects of this can easily creep in to our fragmenting service and in my view we will need to be very cautious not to let this happen.

Apart from wonderful weather, beaches, food, geography, work-life balance, windsurfing, wildlife, sporting facilities and a relaxed living environment, Australia had nothing to offer me!

Our system is good. Fund it properly, kick out the red tape, and reduce the box ticking and we could have a fantastic facility again. Our CCG currently holds over 400 primary care contracts covering the basics and enhanced services. Imagine the hours spent monitoring that - we happily abolished the red book in 2004 to reach the promised land with less reporting and boxes to tick. Oh how we laugh.

I have no idea what the next few years will hold for our wonderful NHS - I worry that the focus will be elsewhere politically now and while our NHS enjoys its biggest haircut of all time, I make a simple plea for primary care contracting and funding as we digest the latest contract offering. Keep it simple. No perms or highlights. Ensure patient safety, trust primary care, cut the crappy monitoring, lump funds together, value the workforce, and enable GPs to do what they do best - look after patients.

Dr Richard Cook is a GP partner in Hurstpierpoint, West Sussex. You can follow him on Twitter @drmoderate

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Readers' comments (5)

  • Cobblers

    Sorry Richard I disagree on a number of areas. From the NHS viewpoint it is not sustainable. A major discussion needs to be had on funding, and co-payments would be but one way, not only for the punter to value the service but also to limit demand. A brief discussion with my daughter’s generation sees an acceptance of part paying (like dentists) with their “tap” credit cards but with that would go more accessible appointments!

    From Australia’s point of view and my COI here is I have another daughter there along with multitudes of other rellies. Asking them shows an acceptance with their lot, Medicare or fee for service is fine, along with insurance especially a payment for the “ambos” which was 50 cents a week (when I asked 20 years ago) to cover blue light stuff. As an aside the latter is long overdue to the UK.

    Your list of our advantages is spurious. In Australia you can get continuity of care. Most of my rellies have gone to the same doctor for the past 20 years. I accept that doctor hopping and lack of notes can be a problem but can it not be so with the T/R system here? 24hr care is a rarity in the world and frankly no longer occurs in the UK. The OOH system is broken. Best head for the local (if not closed) ED department. As for home visits don’t get me started. It’s an anachronism long overdue for binning. Palliative care should be for palliative care teams.

    A recent survey of longevity of life came up with Australia right up there with the UK lagging behind. Whilst not a proxy for health care per se it might give a general indicator that maybe the Aussies had got this one right?

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  • A virtual nobody

    People don't live longer in Australia because their health care system is better... it's due to life style and life style opportunities. The quality of life there is simply better than it is here. There's more space, it's less crowded, there are better opportunities to excersise, people don't sit in watching the TV like they do here, you can't surf in Newcastle UK, you can in Newcastle NSW. It's easier to be healthy in Auz.....hang on I've talked myself in to emigrating...I'm off.

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  • Cobblers

    Rubbish JimmyRiddle you can surf in Whitley Bay (Newcastle UK) just not for long, until fingers/feet and lips turn blue.

    Less chance of shark attack. Bonus.

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  • I think the nhs is sustainable, but it needs to be cut back to the bare bones. What do we really need? A good delivery unit, a working A+E, some GPs, a medical and surgical unit and a hospice. Cut everything except for these essentials and fund these superbly well.

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  • Cobblers

    Aaah the concept of "NHS-Lite" discussed on GP-UK some 20-25 years ago.

    An adult conversation is needed with society. What is NHS-Lite? What would be in it? What would not?

    I doubt that society can have that discussion bearing in mind the puerility of the debate about Brexit. But we can hope.

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