Amid the gloom of budget squeezes and low morale, the big question is what can be done to save one of the finest health systems in the world?
There has been a huge amount of research into shifting specialist services to the community, the use of referral management centres, reclassifying low-priority procedures and even incentives to reduce referrals and admissions, as potential solutions to the shortfall in NHS funding. But something seems to be missing.
We all blame many of the current constraints on it, but are afraid to talk about it. It is politically unpopular to look at some of the patient-related factors that waste billions.
Most patients are careful and use the NHS when needed and appropriately. But there are a small fraction who do not appreciate the system that so comprehensively looks after their health and is free at the point of use.
Having worked in another healthcare system where you pay for each and every contact, I still find it amazing I can go and see my doctor and receive, usually, world-class treatment, without worrying about the cost. In many cases, even transport is provided. The NHS is the envy of billions around the world.
But who has not come across frequent callers to surgeries or out-of-hours services and patients who have numerous attendances at hospital for trivial reasons? Sadly, a minority of patients would be happy to call the doctor out in the winter, claiming their car is too cold for them to come in. Who has not heard about abuses of 999 services? What about those who refuse to listen to smoking cessation advice while their child keeps getting asthma attacks? Or those who get drunk and sober up at A&E? Abuse of the sick note system (or now, the fit note system) is no news to any of us.
There have been some efforts to tackle wasted resources as a result of missed appointments, mainly in hospitals. Even the potential savings from these are staggering – NHS North East, for example, puts the cost of missed appointments at around £20m a year. But there appears to be little research on missed appointments in primary care.
In our own surgery, during the last month, we have lost the equivalent of four days' work from a doctor. There are many other related areas of waste that have hardly been looked at – re-referrals after missed hospital appointments, wasted prescriptions, wasted treatment plans and requests for over-the-counter medicines on prescription.
Who is to blame? We, as doctors, either do not have time to carry out patient education or are afraid to do so.
But patients have to take the blame to a degree and accept that if this system has to improve, all of us have to improve. Patient empowerment can only be a good thing and I completely agree with ‘nothing about me, without me' – but power is accompanied by responsibility.
Sadly, there is little emphasis on patient factors amid all the commissioning talk. There is an urgent need to involve patient groups to find ways to reduce abuses of the system if we wish to make it work effectively. If charging patients when they fail to attend without prior notice is not acceptable, then we need to bring forward other solutions.
I would like our commissioners to take a lead on patient education and awareness. Otherwise, the question of whether we can afford the NHS risks fading away as we are left with an alternative system altogether.
Dr Kamal Sidhu is a GP in Blackhall, Cleveland
