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Bit specious?

GP commissioner, Dr Clive Henderson is getting a bit weary of the argument that consultants' training needs won't be met under the reforms.

Specious. A nice word , meaning ‘having the ring of truth or plausibility but actually fallacious'.

When I first started in general practice I did intra-partum care ( delivered babies) at a GP unit 10 miles away from my practice. Day and night. I was also a member of North Yorkshire Emergency Doctors - a flying doctor.

We used to down tools during routine GP surgeries in order to attend to emergencies. Whilst routine patients waited, with a surprising amount of patience, I used to shoot out to car crashes on the local bypass, armed with a moderate amount of kit and knowledge. I used to be leaning into inverted cars trying to reach the patient whilst fire crews hydraulically took sections of the petrol perfused car apart, to gain access. Whilst they were armed with fire retardant suits, I had corduroy pants and highly flammable tweed jacket - the obligatory rural GP uniform back then. I thought I did a pretty good job with the training and facilities I had.

Trouble is I was harming patients.

By propping up an inadequately designed service, I was papering over the cracks.

Mums, babies and RTA victims needed someone who did it all the time, was fully trained, did it often enough not to forget and who wore and brought with them all the right kit. They deserved a better system than I helped sustain while neglecting my own patients back at the surgery.

Likewise. Do we really need to be undertaking lots of simple elective surgery , outpatients , pain services, dermatology , much of ophthalmology , ENT and gynaecology in an acute hospital setting?

Elective operations cancelled by acutes. Parking and transport hassle in city centres. Ambulances blocked by cars circulating to park. Doctors distracted by bleeps and crash calls. Patients intimidated by the scary edifice. Walking past the Chapel of Rest to get my toenail operation.

Why should someone who just wants a cataract doing be sucked into the vortex of an emergency hospital ?

We commissioners are being told by trusts that we should not open up elective community provision to AWP as the surgical procedures, in particular are the cash cows that keep the hospital afloat. Similarly what would happen to doctors education if such funding was removed. Ahhem, doesn't funding for this come from deaneries and medical schools. How can education happen in the"private sector ? Well dentists seem to manage. Oh yes , and private sector workers in general.

Why don't we fund and organise things differently and properly. Perhaps if less was spent on a cost per case basis in the community then secondary care could be allocated correctly targeted funds.

Some commissioners are being immediately backed off challenging the Trusts on elective care by the ‘what about the education, stability, funding of acute and tertiary services' argument.

Now this is a superficially cogent premise but on reflection, fundamentally flawed.

Specious , in fact.

dr clive henderson dr clive henderson