Jaimie Kaffash gives his take on the comments made by NHS England’s primary care director about the GP ‘eight o’clock rush’ of calls from patients
As I understand it, between them NHS England and the UK Government (fuelled by the media) wants GPs to: offer more face-to-face appointments; give patients the chance to see a GP; make sure they see patients within two weeks; be the first port of call for the worried well; and now end the 8am rush for appointments.
In return, they are offering no more funding and are failing to increase the number of GPs in the system.
Put like that, the absurdity of the situation speaks for itself, and I can end the blog here. But no, I feel that the comments by NHS England’s primary care director Dr Amanda Doyle deserve more scrutiny than that.
Now, I have a lot of time for Dr Doyle – I think she gets general practice. And no one can deny that being unable to get through to their practice is awful for patients. But this is (deliberately?) missing the whole context.
This is not a situation that GPs and their staff relish, either. But there is simply too much demand and too little supply – and that demand comes from patients but also from NHS England and the Government as well.
The Government and NHS England need to decide what kind of service general practice can provide. Do they want a face-to-face service or a GP-led service or a quick service or a convenient service or a comprehensive service? Because even with increased funding or a magic injection of GPs into the system, I doubt whether all these can be delivered. And they sure as hell can’t be delivered now.
Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk
Jaimie – demand does not require supply. That is where the greatest, ultimate NHS lie remains. The same with a pointless ambulance call, the same with the chaos in A+E. The same with the drivel entering NHS 111. You really need to come and sit at the coal face and document what comes in. You will be astonished and will need a sick bowl to hold onto your own marbles. Today: “I’d like a blood test, my friend had one”. “My girlfriends dad had prostate cancer, she said I should get a check up – no, I don’t have any symptoms”. “I want a referral to sexual counselling – why? – er…because I ejaculated early last week”. This isn’t some joke, but it has been made into a comical farce. They all have a “right”. Equal opportunity and “right”. And so the gatekeeper gets hammered, yet told not to refer, not to test and to save the system. Hypocritical in it’s entirety. There is an emergency group that needs urgently sorting – not the elderly, or diseased – but the lost club 20-35 – they are destroying the NHS, whether they want to take responsibility or not, and whether anyone brave enough wants to call it out, it is there and matter of fact. We can nanny the situation all day long. Live in a disreality. Hug the tree and convince ourselves that this is why you truly wanted to be a doctor. At least a neurosurgeon has an abnormal CT scan to authorise his need. Here, GPs are immeasurably playing with banter, chit chat and guesswork – boredom and utter loneliness. Almost making it up. Club 20-35 need an emergency plan, they are clogging A+E and outpatients and dragging GP consultations down the sink and misusing online access, with close to zero respect for anything, let alone a DNA. But, perversely, they are the ones DoH and GovUk are fuelling and empowering, for the future model of privatisation – as when they are 45 or 50 they will be consuming stuff like no other. I feel sorry for those in real need. They haven’t got a chance. They will die or suffer great delay waiting behind them in the endless queue. The medical book, is now watered down into a homogenous sense of grey dull and “you said what?”, where everyone thinks they have thyroid disease and wants to check a mole because Emily said her grandma has “something or another”. The face to face for a lump which “suddenly disappeared” is a waste of time and energy. And if you heard half the reasons that enter General Practice, you will realise, the demand is no longer for medicine, it is for psychological stability – no fountain of empathy or explaining of trivia will curtail what juggernaut has been created. It is beyond an avalanche. How do you create an equation for that? Procure joke solutions for the joke itself? 30-40% of GP referrals and diagnostics are an utter waste of time, made out of hopelessness and defensive gimmicks, to appease the customer and move onto the next wanter. That’s a real healthy place to work, and ethic of evidence base isn’t it. They tricked GPs into doing something, for nothing. You might want to read that again. Ask any GP and they will tell you how they have to play the game, to survive the game. An unhealthy culture. That subset of public are never fulfilled, and they just jump onto the next organ “oh, I think my hair is falling out (but it isn’t really) – I thought I could have endometriosis”. Sure you do. Did you want an ADHD referral with that too – best early rather than later, because it’ll save the discussion in 1 years time and your 3 year wait. Because, that’s the reality – as that’s what Cosmopolitan or the cat down the road said. The holy grail of help out there. It is orchestrated – this health anxiety will create insurance driven privatisation – so *it is over. They wanted it, but cannot handle what is coming their way, year on year. The public won’t have savings to manage GPs going private and being employed by Operose, HCA, BUPA, AXA, Livi, Babylon and everyone else or being like dentists. It is ugly, and a path of no return and major suffering. The nurses too will shift and ambulance teams. And new graduates will be 5 steps ahead of the curve, and will avoid this game. They were warned and they all colluded in “it”.
well said, both of you.
It’s all waffle, waffle…
GP’s should just ‘DISENGAGE’
And let the medical care system re-calibrate itself….
Simple solution. Just pay for services like in any other industry. We’re all just workers/functionaries now and as such the usual terms of service should apply (p.s. and ‘not fanciful rubbish about being an ancient respected calling’, that in fact only disempowers us, but also impoverishes and demoralises us – and maybe we could even stand up to the medieval tyranny of the GMC?).
Patients in ED asking after 4 hours of waiting just self discharging and deciding they are not that unwell after all.
Meanwhile government is preparing to ban the right to strike for nhs staff.
I will be charging 150 an hour very soon.
We have seen much senior insistance on more services without contractual support. The example set to junior NHSE, Trust, CQC and other managers is dangerous. They have in some cases insisted, with threat of sanctions, on extra contractual work, new higher standards or other, early, increased or extra services. Theft Act 1968 defines this as Blackmail, a criminal offence. As national, regional, departmental or Trust policy it would make a criminal conspiracy of epic proportions. Has anyone explored this? Even if tis fails the CPS test of ‘Public Interest’ it dioes not exclude private prosecution: Expensive as that is it is cheaper than strike action!