Columnist Dr Shaba Nabi draws on nautical imagery to portray the plight of the good ship NHS and all who sail in it
Working as a clinical lead in a fully salaried GP practice, I like to think we are all equally involved in decision making at regular team meetings. Once the hot topics have been discussed, such as filling the Saturday clinics or managing the strep A hysteria, conversations invariably focus on patient access to the practice.
There are so many different ways to deliver this: a remote-first model (which we’re still using), personal lists or fully face-to-face, hybrid or duty GP models.
The one thing all these have in common is that they are just moving deckchairs around the Titanic, when we actually need twice the number of chairs.
A remote-first model prioritises deckchairs for passengers with mobility issues who can’t stand easily on deck, but upsets the standing passengers. Some models allocate two passengers to each deckchair, but this upsets everyone. More recently, the sun deck is closed as soon as all deckchairs are taken, which creates an overspill onto the crew deck, leaving passengers and crew complaining.
The obvious question is, why can’t we just provide more deckchairs? Crew members often look to the bygone GoldLine Cruise service, which had enough deckchairs for every single passenger and crew member. The problem is, that sort of service costs passengers much more – and they are unwilling to pay for it. Fair enough, they have other things to worry about. As a result, it doesn’t look likely any company bosses (even those who are looking to take over when the shareholders’ election comes round) will be keen on such a service.
Instead, we are stuck with CheapCruise, which offers theoretically unlimited deckchairs for a mandatory upfront charge. The management show brochures full of photos of passengers sipping cocktails on sunbeds on spacious decks, being waited on by crew in Caribbean Whites. And they even suggest passengers relax on a deckchair if they have very minor problems, such as a cough.
Sadly, the CheapCruise service simply can’t handle the demand created by the bosses’ grand illusion and struggles to stay afloat. The crew is heading back onshore and the company is unable to get new members on board, despite repeated pledges. This is not surprising since the crew is abused and blamed for the bosses’ incompetence. The suggestion that passengers pay an additional £10 to hire a deckchair (excluding the poorest) gets short shrift.
More recently, CheapCruise has been seeking innovative solutions to these deckchair shortages and has been laying out towels in between chairs to offer more space to sunbathe. The younger, fitter passengers are happy to absorb a few rays in this way, but the frailer passengers are still needing a deckchair after trying out the towels. And because the towels offer no shade, occasionally even the fitter passengers have been sunburned, and this has cost the company huge fees in compensation.
Management has now reached a fundamental juncture. Does it offer a GoldLine service and double the cost of cruises to provide a comfortable experience? Or try to keep costs low and market cruises as a ‘no-frills’ experience, with add-ons for those willing and able to pay for them?
The company knows that doing nothing is not an option because it is only a matter of time before all that is left on board the ships is a bunch of broken, overturned deckchairs and some discarded towels left in the corner. And no crew to be seen anywhere.
Dr Shaba Nabi is a GP trainer in Bristol. Read more of her blogs here
The metaphor is also correct in that it actually no longer matters how many deckchairs there are, because it has been driven into an iceberg and is sinking.
Perhaps the real question is ‘are there enough lifeboats to enable both patients and staff to emerge alive (albeit traumatised) after it has gone down?’.
BMA needs to have a conversation with the Dentists about what their lifeboat looked like, and the government need to decide whether to try one last time to patch up the boat, and maybe change the navigators, or let it sink and build a new one.
Don’t worry..the Labour Party has a plan. They’re going to give all the passengers a ‘direct booking line’ number for the cabin allocation department. If you don’t like the deck chairs just book yourself a cabin with a bed. The deck chair staff are crap. Everyone deserves a cabin and a bed.
Ultimately, folk/patients/relatives etc are going to have a put their hands in their pockets for anything beyond the most basic service. It’s unfortunate but not a new concept.
Very clever analogy!
As a recently retired GP (30+ yrs full time with extras) and still, I like to feel, in my prime, I am amazed that no-one has contacted me to ask what it would take for me to come back and get a couple of extra deck chairs out and look after their occupants. You never know, if enough of us did then it would help til a newer (probably private) ship is launched and crewed.
Maybe I could run the statin clinic that TC so aptly describes in his piece…
PT
PS – I would come back when gov.uk recognises the mess we are in, removes all the bureaucratic bovine scattology, QOF, referral management, QOF, statinsforall, appraisals and properly educates the public instead of stoking demand, pays nurses and ambulance crew appropriately, increases my pension for extra work. Not to mention limiting numbers of patients I would need to see.
Good luck all as you sail on into the weknowdarnwellwhatisgoingtohappen