Posted by: Jobbing Doctor17 August 2012
Today was the last day of teaching for the academic year. We held a session for the young doctors who will be the GPs of the future, and the topic was 'the future'.
I looked around at all the young and expectant faces who wanted me to impart my wisdom, hope and enthusiasm, and I said the words. The problem was the disconnect with what I was feeling.
The first part of the afternoon was taken up by the role of clinical commissioning groups. One of the younger doctors kindly gave the presentation, which was largely based on data that seemed like it was from Conservative Central Office. It was upbeat and forward-looking, and I found myself being temporarily overtaken by the enthusiasm of the presentation. But it didn't last long.
It is important in my teaching for me not to preach my own point of view. I have a fairly jaundiced view of the capabilities and motivation of your average politician, and that is one of the problems. All the politicians I have experience of are very average.
I did not allow my strong views on commissioning to surface, as these young doctors need to make their own minds up. I did point out that 60% of all spending had already been allocated before it even reaches the clinical commissioning groups, and the remaining 40% will be spread thinly and subject to political pressures to spend on things that will keep politicians in power.
It will be difficult to close down hospitals, and rationalise services without an enormous fuss. Just look how long it has taken to sort out children’s cardiac surgery after the Bristol scandal - at least 20 years.
There are ways in which money can be saved. Service redesign for various conditions can be achieved. One simple way would be to have a system where requests from optometists for consultant review could be reviewed, as I reckon about one third of them are pointless, and they are expensive for our budgets.
The real way to improve services is to invest in general practice. Make more appointments available to people, even working with practices to ensure wider access; this must be done without paying doctors less, or making them work longer hours. That has to be the way forward.
The next presentation was on revalidation. The presentation was a Cook’s tour through what is planned, and what the timetable has been (only eight years behind schedule at the moment).
Revalidation is a perfect example of how to demoralise and subjugate a profession. You only need one cause célèbre to attempt to justify the whole process. You take an organisation (the GMC) and you de-democratise it, on the grounds of 'giving patients a voice', and then you put in a person who will put out reports that toe the Government line (choosing Dame Janet Smith to lead the Shipman enquiry is a perfect example) and then you set up a process where all doctors have to jump through an absurd number of hoops in order to stay registered.
The GMC becomes a branch of the Department of Health, doing its bidding and subjecting doctors to much paperwork and stress. The masterstroke was, of course, to get doctors to pay for it as well. Many experienced doctors feel that revalidation is bureaucratic, tedious and ineffective. There are few practising doctors who feel that it will achieve what it purports to do.
It is a sledgehammer to miss a nut.
The Jobbing Doctor is a general practitioner in a deprived urban area of England