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At the heart of general practice since 1960

The great NHS stitch-up

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Had I eavesdropped on recent conversations in Whitehall about the NHS, this is what I might have heard:

‘We can’t offer more funding because – well – we don’t want to. It’s costing a bomb and people just keep getting older. Turns out when we talk about 7/7 access, it makes patients want more. Who knew? We can’t privatise it because people keep noticing when we try. Bloody lefties. We tried giving all the problems to CCGs and saying they were GP-led so they’d get the blame, not us, but it’s still not working. So it’s time to ramp it up a notch. After months of blue-sky thinking, brainstorming and input from self-appointed friendly experts, ministers, I give you... the Sustainability and Transformation Plans.

This is a restructuring, NOT a reorganisation. Totally different things

‘We said no more reorganisations in the last general election campaign. So let’s be clear, this is a restructuring, NOT a reorganisation. Totally different things. Totally.

‘Here’s the plan. We throw health and social care together in one big pot – they are our biggest headaches after all – cost a fortune! Then we carve the country up into big areas. We can call them “footprints” – people will have images of following in the footsteps of giants, that sort of thing… very trendy.

‘Hmm? Will it matter that they cover such huge areas? Of course not. I mean, everyone has the same healthcare needs, don’t they? And social care isn’t really an issue, because we know how rich old people are – they’ll just pay themselves, or their families will look after them for free.

‘So we get everyone who provides health and social care within each footprint in a room, and lock the door, because we don’t want the press or those people who rave about transparency getting in. We’ll make sure the people in the rooms are saying what we want – Sunday opening, 7/7 agenda, 24-hour GP care, help for the elderly, blah blah.

‘Doctors? Oh they always want their say. Get a tame GP or two into the room, which ticks that box. The further we can keep LMCs and the BMA away, the better. If LMCs whittle on about being “the only statutory body to represent all GPs” then nod and frown but do not let them in. Same with the consultants – we can say it’s all community based and they won’t have a clue. And we don’t need to involve patients, just keep telling them how much extra we are investing, works every time. Smile and wave, boys, smile and wave…

‘Extra funding? Well, there’s a couple of billion kicking around but that’s needed to bail out acute trusts. They’ll have to reorganise… er, I mean restructure... to solve cash problems.

‘Here’s the best bit – we don’t give STPs statutory status, so they can do what they like and no one can complain! They can make the cuts we don’t want to, and the huge deficit is their problem, not ours. We can do some head shaking and tutting if it goes down badly.

‘You worry the public might get wind of it? Easily solved – set a super tight deadline, and hey presto! Decisions made with no pesky campaigners, before anyone even realises. Responsibility for health and social care handed to someone else. That’s the NHS sorted. Would you like to hear my ideas for Brexit?’

Dr Zoe Norris is a GP in Hull. You can follow her on Twitter @dr_zo

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Readers' comments (9)

  • Excellent analysis

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  • I am campaigning against the secrecy of STP. But my Chichester 38 degrees NHS campaign colleagues are meeting with the Sussex and Surrey STP lead soon to discuss public engagement which is what Commissioners are supposed to do. The STP started out as a way of combining planning of health and social care together (a good thing) but without saying how it would be paid for and who would pay for it. Later it turned out that the STP involved a £22bn cut in NHS funding. So I messaged NHS England on their website complaining about the secrecy and the obduracy and the whole STP thing saying that, unless they came clean about the whole thing, I may have to organise their abolition. Just threaten NHS England with abolition until they squeal.

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  • Brighton Royal Sussex County Hospital is apparently counted as being in Special Measures for failing to meet targets but this is because of severe underfunding and the commissioners try to distract us from this truth by threatening to merge RSCH (A Teaching Hospital) with Worthing DGH which is inappropriate. Sack all commissioners from NHS England downwards and use the money on training and recruiting more doctors and nurses, shortening waiting times and improving the care of the patients. Commissioning has raised the administration charge on the NHS budget from the 5% it started at, up to 15% or more to no benefit to the patients or the NHS and, combined with severe NHS underfunding, is causing the NHS to descend into chaos and wasting more many than ever on commissioning failures.

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  • We mus again remember that Mr Hunt is a master of obfuscation .

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  • STP . STP - before sustainability and transformation plan it stood for serenity ,tranquility peace . An amphetamine based hallucinogen. Somebody in high office has been scoffing too much of it and is seeing something that isn't there. Like resources and GP's

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  • Chill out folks! To help deal with all these pesky emotions why didn't you go the Balint Society jolly in Ireland this weekend? Only cost you the price of travel £n; £198 accommodation for 2nights ,and over £100 registration - oh sorry membership is a measly £50. If you still feel stressed there is 'The network of 'Mindfulness for Doctors' whwich isw/was running country wide by Gwen Adshead ex Chair Coll of Psychs ethics ctte; Shaun Banherjee psych now known as 'Lord of the Sages' since becoming a member of a Buddhist sect,and Mark Radcliffe..don't expect to get something for nothing mind..(hint - check out who is running any course and check their credentials first) or if stillmoaning and complaining how about a bit of resilience training.sounds like you need it but remember the cost will lead you into needing a financial advisor on top of everything else.

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  • " And we don’t need to involve patients,"
    and Anu Singh with Jane Cummings are sure making that the case.
    In case you don't know, Anu Singh was been appointed as Director of Patient and Public Participation and Insight (PPPI) a year ago, and as her 1st substantial contribution to PPPI?
    She unilaterally, overnight, shut down NHS-Citizen & Gather, NHS-England's one and only online interactive Forum for we P&P.
    P&P were held in suspense for 6 months until at a hastily convened Tell-In packed with Charity Chums was told "There are no done deals" only to find that at the next NHS-E Board there were. All neatly tied up and passed on the nod despite intensive lobbying for discussions with P&P.
    However, the best-laid plans have been gnawed at by mice, and the 2 week implementation schedule has fallen apart, and P&P still haven't got a PPPI vehicle.
    And there's naive me thinking that it was Our=NHS, after all WE pay for it, and THEY are the Executives, not the owners??

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  • Phil Yates

    This article is such a misrepresentation of what STPs are trying to do. If we think the old system of PbR worked sucking all the money into the hospital sector that's disappointing.
    The issues that still exists is how to get true integration including general practice. Most areas are struggling with that but, if we can get this right, with proper investment in IT too, there should be better VFM and concurrently better integrated services. It's the boldest, most hopeful bit of policy I've seen coming through in 15 years - that's not to say it won't get sabotaged by organisational or professional self-interest though

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  • As long as Payment by results stays for the hospital it will not work. Rule change needed Mr Hunt.

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