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It's do or die for the health service

Dr Mark Sanford-Wood argues that GPs will be bearing the brunt of deteriorating NHS finances

It was George Orwell who said, ‘We have now sunk to a depth at which restatement of the obvious is the first duty of intelligent men’. Those words ring in our ears as we ponder on the announcement this week from Monitor, warning hospital Trusts across the country that their spending plans for this year do not add up. Orwell’s clarion call to think for ourselves, challenge prevailing dogma, and speak the truth could hardly be more relevant.

Hospitals across the country are struggling to meet targets set by the Government, with many subject to fines for failure. The notion that they are suffering these penalties while frittering resources on unnecessary activity is absurd. There is no more waste to cut. No fat to trim. The engine of secondary care is spluttering, starved of the resources necessary to do the job required of them. The disparity between the edicts of the central planners and the realities of life on the front line are reaching Stalinesque proportions.

So what will be the predictable response to these impossible pressures? Hospitals, in their desperation to avoid the ‘naming and shaming’ so adored by the ever-present political commissars of the NHS, will respond by pushing as much demand back into general practice as they can reasonably get away with. CCGs will be cajoled into ever tighter ‘demand management’ based on the bankrupt prospectus that much of the demand sitting on hospital waiting lists has been put there by slipshod and lazy GPs. General practice, whose resources have been cut by 13% since 2008 while activity has increased by 15% (a 28% real terms pressure increase), will be forced into managing patients who should properly be referred, and without the necessary resources.

General practice has always been the heat sink of the NHS. It is the sector that has soaked up the surges and spikes in demand and smoothed out the input into secondary care. The problem is that the heat sink is now so hot it is melting. It can absorb no more.

The restatement of the obvious that Orwell demands is quite simply that the current demand on the whole system cannot be addressed within current resources. Trusts are spending every penny of their resources on meeting government targets, yet Monitor declares that those pennies exceed the allocation. In short, Monitor’s message to Trusts is really a message to the government that it cannot expect all their targets to be hit unless they invest significantly more cash in the system. The whole system. Including the 28% more funding required to put general practice back on the even keel of 2008.

The obvious conclusion in the face of the refusal of government to invest enough resource to meet its own definition of reasonable demand is that our politicians must begin a debate with the public about curbing that demand. Yet their political grand strategy is to lecture the NHS on their own made up crisis of the need for seven-day working. In other words, they are pouring petrol on the flames. To reflect the Secretary of State’s own words, it is time for the government to ‘get real’ about the resources required to fulfil its populist agenda.

This obvious doublethink wrapped up in divisive political newspeak is just not good enough. The engine of secondary care is spluttering and the melting heatsink of general practice can no longer protect the system, regardless of the volume of rhetorical bravado coming from the top. Monitor’s declaration is the latest and starkest sign of the need for a genuinely ‘New Deal’ - a sustainable deal between the taxpaying public, politicians and beleaguered NHS staff buckling under the strain. In the absence of the courageous political leadership required to achieve this, the very future of the NHS is in doubt.

Dr Mark Sanford-Wood is medical secretary of Devon LMC

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Readers' comments (21)

  • So isn't the conclusion that they want it to fail so that the co-payments can be blamed on us?

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  • "There is no more waste to cut. No fat to trim"
    Which planet are you from ??

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  • There is diminishing mutual respect, common understanding, compassion or relationships in our system of care from parliament to the public to a GP or nurse on the high street. There is wonderful positivity out there and the NHS is still one of the most magnificent health care systems on our planet but it is awfully thin in places…..

    The disconnect and lack of trust across the system from policy making to a single local conversation is starting to bite and we bleed.

    Please let's not forget that the NHS vision is as clear today as it was in 1948. Even though we talk about delivering care having become more complex, it is the system itself which is creating much of this complexity to include elements of highly monetized marketisation, destructive competition and self fulfilling complexity, these becoming the pervading rulers of "care". Shame on those who create this complexity…. for…. what reason?? Often it is meaningless, undeliverable or indeed negatively disruptive and simply does not make a difference. Its a whole industry and with its own cost, in some cases making quality worse.

    So Mark thank you for this piece which should raise discussion and is thought provoking bringing us back to having a debate more about compassion, collaboration, care and good relationships being at the heart of everything we do. We need to reignite the NHS vision and the real purpose why we do what we do. Re lighting these beacons of hope across the nation by sharing successes, opportunities and restating our shared vision. In doing so we can help lift many from the darkness, politicians, NHS workers and clinicians alike. This also will support the rebuilding of public confidence in THE HEALTH SERVICE many fight to preserve.

    Dare I say it (waiting to be shouted at) Primary Care is at the heart of this both in delivery and commissioning alongside the populations that they serve. To realise that is key and this should raise the next debate as to how this can be honestly and truly delivered. This conversation is happening, CCGs are in place and some changes are on their way… is it too late? I raise that as a question...

    ALSO is it not the responsibility of ALL of us to lift our NHS from "the depths of darkness" by "restating the obvious", as indeed Orwell says. I think we have a Duty of Simplicity which NHS2.0 is screaming out for...

    There are solutions and answers out there and those willing to take the NHS on this journey…..


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  • The NHS will not die.Medicine remains the most popular choice at undergraduate level.The number of hospital training posts are limited.Necessity of living will ensure that there are enough,above critical threshold,number of GP trainees to keep primary care going.Non GPs will form the bulk of future primary care and it will remain free at point of delivery

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  • Privatise NHS and all problems of NHS will disappear.
    People wake up -you dont have money in the pot-
    How do you expect to deliver the same quality of care.
    If we get more money things will improve for everyone.

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  • I am sorry to say, unless people get the message one cannot get something for free, forever this is just unsustainable. When you see Mums and Dads bringing their kids/teens to medicalise non existant illnesses and start priming them for life on benefits, one dreads the future.

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  • 'normal' is not a word that exists in the NHS now.
    'healthy' is not a word that exists in the NHS now.
    'watch and wait' is not a term that exists in patients vocabulary now.

    everything is a medical problem. everything needs a medication. everything needs a prescription. everything needs a GP. everything needs a referral. and everything needs to happen NOW. everything needs to happen WHEN I want, HOW I want, WHY I want, WHERE I want. I don't care if I miss appointments, it's my RIGHT to do this ,and my RIGHT to get another appointment when I like.

    the nhs cannot continue like this.

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  • NI workload/ pay figures for 10 years from 2005, are as follows [ in general rounding up decimals] :
    Profit in real terms has fallen by 25% : we used to get £80 profit per patient year, it is now £60.
    We had 4 consultations [ £20 /consult ], today it is 6 [ £10/consult ]
    We have had a clear cut pay reduction of 50% per item. If you factor in huge increases in paperwork, documentation,pension changes, pay per item has fallen 60% or more.
    Recession causes difficulty for most people because work and orders fall. Our work has gone up and our pay has gone down.

    The GPC will not ballot for resignation as Lawrence Buckman once did, because of OBEs, MBEs etc.
    The GPC would rather get gongs and see the disintegration of General Practice.
    No group would stand for a 60% pay cut in 10 years, especially since we are Independent.

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  • NHS to survive,needs to sack a large amount of fat salaries earning top bureaucrats.When it started only five people ran the nHs tHis i was told by a GP who was there when it started.their big finacial blackhole will become a small dimple

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  • "The obvious conclusion in the face of the refusal of government to invest enough resource to meet its own definition of reasonable demand is that our politicians must begin a debate with the public about curbing that demand"
    Or how about a discussion on the £billions wasted each year running the artificial market place inside the NHS that govt's have built upon and upon over the last few decades in order to do away with a national system altogether? All that has happened, including the media and govt misrepresentation of GP surgeries and other services to alter the perception of health and how it should be managed, was laid out in govt committee papers in 1982.

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