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At the heart of general practice since 1960

Osborne’s billions are too little, too late

Dr Chris Hewitt

From Dr Chris Hewitt, chief executive of Leicester, Leicestershire and Rutland LMC

Health and social care in our region is in meltdown and the damage could take a generation to fix. If general practice in the area were a patient I would say it is on its last legs, heading for a life support machine with the Government preparing to pull the plug.

GPs and their teams in the region are struggling - many large practices are now down to the ‘last man standing’ with just a single GP running practices of up to 10,000 patients with help from whatever locum doctors and nurses they can find each week.

I believe that the impact of huge cuts to social care since 2010 means that GP surgeries and hospital accident departments will drown this winter under the weight of a rising tide of demand. You get what you pay for, and as far as spending on public services is concerned our region is one of the worst funded in the UK. Even with the £3.8bn now allocated to NHS England from April next year, this is too little too late. George Osborne is very good at conjuring tricks and he has dismantled the funding ring fence to protect public health and NHS education – robbing Peter and Mary to pay Paul. I feel very sad that the deep cuts to social care spending since 2010 will be responsible for the overwhelming of local healthcare services this winter – the talk of seven-day opening is just a distraction, Monday to Friday services have been starved for too long.

I fear there will be large queues of ambulances outside the Leicester Royal this winter as patients will be stuck in hospital beds with nowhere to go to - A&E will be backed up.

We estimate that £3.8bn of additional funding to NHS England from next April will only result in £60 per person in Leicestershire and Rutland (which gets a poor deal compared to most other parts of the UK). With the reduction of acute trust and CCG deficits and the impact of other public health and social care cuts this could account for up to £50 per person. The net result is likely to be just £10 extra funding per person per year across the NHS in our region – of which GP services may just receive 60p per person. From our surveys of members we believe that general practice services receive just 6% of the local health funding and have to deal with 93% of the patient appointments.

Local GPs already offer over six appointments per person per year, in addition to many other services previously only available in hospital, with funding of only £120 per person (less than £20 per appointment) – 60p will be too little too late.

Medical students and doctors in training do not want to be GPs any more as the system is unsafe, unsustainable and can be a very frightening place in which to work. This autumn over 40% of GP training posts remain vacant in the East Midlands. GPs and their teams are taking early retirement, changing careers or emigrating.

I am profoundly sad for patients and carers in the area I have grown up and worked in - I fear that people do not realise just how far down the international league tables we have fallen in terms of how little we spend on looking after each other. If we don’t start to make meaningful investment in our care now we will spend a generation regretting it.

We need new thinking and the brightest minds to review the broken systems in health and social care - the issues are usually very nuanced and complex, and vary from one postcode area to another, and even within the same postcode area. As Einstein once said: ’We can’t solve problems by using the same kind of thinking we used when we created them.’

The main obstacle to solving all of this is that we have politicians, managers and professional bodies continuing to do what they have always done - people appear unable to think or act differently, or to persuade others to think or act differently. This must change and it must change now.

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Readers' comments (13)

  • Need there be any further comment! The article says it all...like reading a Holy scripture about the End of Days!

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  • But dont forget a Brimstone missile costs £22,000, so all these savings will be good for Syria.

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  • Spot on! Well said.

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  • Theresa Eynon

    It is horrible to watch the slow death of a loved friend. It is even worse watching those with the skills and resources needed to save them faffing about, missing the point and failing to work together.
    Jeremy Hunt's battle with the BMA over so-called Seven Day working and Junior Doctor pay is the classic magician's trick. Keep the audience distracted while, out of sight, you are pulling resources out of social care, public health and planning. Below the radar, social care is now a skeleton service being propped up by CCGs and community Trusts. Meanwhile, the private sector is building Care Villages in our countryside as, stripped of strategic managers, health and social care don't even have the manpower to comment let alone claim and spend developer contributions to mitigate their impact on GP and community care.
    The NHS is the visible icon of a welfare state that the Tories are committed to bringing to its knees. Those practices who are surviving the current storm need to stand firm with colleagues who are running into difficulties. If we don't, the private sector will sweep up the debris and take the profits home.

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  • Dr David Barrett

    Sad but so true and insightful.

    It may take a generation to fix the mess, but what I'm seeing is those "able" to think and act differently are already making wise choices - emigrate, portfolio, locum, retire early, leaving medicine all together. When the generation needed to fix the problem are already leaving in their droves they'll be nobody to sit down on any chairs when music stops!

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  • Vinci Ho

    I found it very emotionally 'difficult' to read this excellent article , Chris. I felt the agony and despair of every word in it. The truth is so painful as it is getting more difficult to uphold our flag everyday .
    A mentor of politics taught me one, a political problem needs a political solution and two , politics is really not a game for normal human being and you really have to prepare to sell your soul first .
    Issues in NHS and general practice have been so politicised (hence , becoming political problems needing political solutions)that I do believe whichever government is in power , we are always up against it. Question is how far extreme are politicians wanting to go? Enough is enough and only a 'revolution' is the answer at some point.
    Yes. People do feel our representatives like in LMCs, GPC(probably forget about the college) are not militant enough to fight this war but I do also see how difficult leadership had been in last 5 years . Osbourne's obsession and personal crusade to become the greatest Chancellor in early 21st century to reach surplus economy in the post apocalypse from the financial crisis in 2008, is single-minded , reckless and he is willing to sacrifice anything including people's lives and normal way of living. And the health secretary is merely a subordinate of Cameron and Osbourne.
    But I do have an alternative angle ; our youngsters are whole-heartedly willing to stand up against this tyranny and in fact, I see them as our 'only' hope . May be we need even more young bloods to represent the profession on the frontline to fight for us . These are the worst of times but these are also the best of times as Charles Dickens said.
    As I said in the last few weeks , this government is showing signs of vulnerability . While I do not believe Osbourne was that 'lucky' to have so called windfall money to save his plan of pushing tax credit cut and police budget, the U turn was a crack against the pressure from oppositions from directions, inside and outside of his party . And this is not going to be the last U turn.Even Cameron knew the whole politics has gone too far . Look at the row between him and the Tory council leader of his own constituency about cutting in frontline services.Also watch his face when he talked yesterday about the bullying scandal leading to the death of this young soul who was actually an activist of his party .
    Yes. The opposition party led by Corbyn does not look politically 'pretty' and presentable enough to win the next election(actually long way to go) , but at least it is playing some old(not new as Corbyn described) fox politics : gentleman first , the scoundrel follows . The check and balance of power was never there under Ed Milliband( he was merely bullied by Cameron , in my opinion ) . It was fascinating politics to see McDonnell throwing Mao's red book right to Osbourne , although I thought the latter still responded with good reflex . The issue of whether to bomb Syria will be a lot more straight forward if Ed Milliband is still opposition leader . Whichever side you are on in this dilemma , at least there is an accountable opposition and I feel Corbyn should let his ministers have free vote with honour as he already said they should have a voice.
    Parliamentary democracy was virtually there shortly before an election and evaporated rapidly afterwards. When indirect democracy fails , we will revert to direct democracy .
    I do not believe the fight is over and the revolution starts with our younger colleagues' actions on Tuesday ......


    Tho’ much is taken, much abides; and tho’
    We are not now that strength which in old days
    Moved earth and heaven, that which we are, we are;
    One equal temper of heroic hearts,
    Made weak by time and fate, but strong in will
    To strive, to seek, to find, and not to yield.

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  • Thank you for your kind feedback Vinci - I feel honoured that you have taken the time to contribute such a thought provoking comment.

    To add to your quote from Tennyson's Ullyses - a favourite line of mine is:

    Come, my friends,
    'T is not too late to seek a newer world.

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  • You do a great job Chris of explaining with simplicity the profoundly bewildering state we are in.

    Folks, we waste our energy on trying to resusitate this NHS. Let us instead turn to planning how we will live without it. Its done.

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  • Good article. Worth saying that Labour did not promise any additional funding and historically have cut NHS funding in real terms (e.g. at start of the Blair government). All in all times are looking very tough and we need more discussion about how to respond

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  • 1. Plan what you need to retain your practice.
    2. Resign from the NHS
    3. Write to patients/NHSE to tell them what your fees now are.

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