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So, which part of my practice should we cut, exactly?

The Jobbing Doctor is struggling to see how NHS cuts can be implemented on the ground without harming patient care. But there is one place they could start...

News is slowly percolating through to Jobbing Doctors that there will be tough times ahead in the management of the National Health Service.

This is not too surprising, as we have seen the spectacle of a Government sleep-walking into a recession that was made in the square mile of London, and enthusiastically rubber-stamped by the aforementioned Government. They then had the hubris to claim an ‘end to boom and bust', and the triumph of the Anglo-Saxon economic model. Spectacular incompetence indeed.

So, cuts it is.

I look around me in my practice to see where the fat is that can be trimmed of this apparently bloated carcass, and I don't actually see a huge amount of wastage, to be honest.

In my practice we have a ratio of patients to doctors that has changed from 1,900 patients per doctor in 1980 to 1,787 patients per doctor in 2010. That is not a spectacular change (a reduction of just over 6% in 30 years), but during that time the intensity and complexity of my work has changed enormously. This has been a stepwise change over a long period, and did not coincide with any effects of Government policy.

Indeed, when I try and calculate the number of times each patient is seen in a year in my practice now compared with when I started, then I think our productivity has increased.

No, I don't think there is any area for reducing the number of doctors and nurses in my practice. I do think that, sometimes, policy makers forget the reason that people go to a doctor's surgery is to see doctors. Indeed, I do think it is quaint that MPs have usurped the term ‘surgery' to describe their own advice sessions to their constituents.

What has changed in my time, however, has been the increase in back-up and administration staff that we have seen. In the old days, I had one nurse, four receptionists and one cleaner. Now (even taking into account the doubling of size of the practice) we have one manager, around 30 admin staff, five nurses and five cleaners. I still reckon we are a pretty lean organisation. Some of these people are needed as a direct result of Government policy (Choose and Book, for example).

I do not feel that we can function in the roles that we perform for society if we were to make staff redundant in general practice. I really don't think this will happen, unless we see a reduction in the income coming into the practice. A pay freeze is nothing, as we have seen a de facto pay freeze for the last six years.

I have seen a huge increase in numbers of consultants in my local hospital in that time. I would guess that the change is of the order of around 400%. Nevertheless, I would not suggest that my colleagues are slacking, and the improvements in times people are waiting in the NHS are as a direct result of this increase in numbers. The key thing about hospitals is that, for me as a Jobbing Doctor, these numbers are needed to sustain a service that continues to be under pressure. Likewise, we do not see huge increases of trained nurses staffing our wards.

There is huge fat and wastage in the system, but the constraints of time, and the risk of boring my readers mean that I cannot spend time in detailing where jobs can go without making a jot or tittle of difference.

A start can be made by culling any job with 'facilitator' in the title.

Jobbing Doctor Jobbing Doctor