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Spending millions while Rome burns

 I don’t know about you, but I’m fast reaching some final straw moments in my life which have made me question the purpose of my role.

The first of these is public perception of general practice, formulated through repeated vilification from the Government and the media. I used to be adept at ignoring these articles and clinging to the belief that our patients understood our value, both financially and emotionally. However, the recent GP Patient Survey reveals a significant decline in patient satisfaction with GP access, leading to the inevitable tsunami of patient complaints.

As complaints lead, I am spending hours of my time, ironically time which could be better spent seeing patients and improving access, dealing with the outpouring of vitriol about matters which GPs often have little control over. When the starting point for many patients is to go into battle with us, it is often hard to remain positive and buoyant.

But the other final straw moment for me was when I read this Pulse article about NICE approving a drug for raised triglycerides at a cost of £144 per month. With full implementation of this drug, it would cost over £20 million pounds per year in our area alone. This is on the back of other screening and preventative prescribing measures which are being pushed by NHS England and the PCN DES.

The year started with the inclisiran debacle leading to a joint statement from the BMA and RCGP expressing concerns about long-term safety and outcome data. The reimbursement offered by the drug company is only available if delivered in primary care, illustrating once again how easily big pharma can manipulate governments.

The PCN DES in England has jumped on this bandwagon through the cardiovascular and cancer prevention projects. Instead of dealing with the hordes of patients banging on our doors, we are trawling through our lists looking for eligible targets to send for prostate screening or to refer to lipid clinics. And no-one in the ivory towers has done any sort of modelling, to work out the impact of these referrals on secondary care activity, and what must be stopped by both primary and secondary care to accommodate this.

No-one is disputing that prevention is better than cure. But where is the investment in non-medical prevention such as weight loss and smoking cessation; measures that are not funded by drug companies? Before we start to identify silent diseases such as chronic kidney disease and slow growing prostate cancers, shouldn’t we be properly managing those people who are known to have a disease and are in desperate need of secondary care treatment?

I feel like I’m living in some kind of parallel universe where patients in dire need of treatment are on waiting lists to go on waiting lists for out-patient appointments, yet vast sums of money are being directed at population health management and looking for disease in an otherwise well person. This universe also allows elderly people to lie on a floor for twelve hours with a hip fracture, as well as allowing people to die of a cardiac arrest whilst waiting for an ambulance (which is obviously not the fault of the hardworking paramedics).

These days I have a sickly, sinking feeling when I have to admit a patient, as I know they will be languishing on a trolley in ED for hours, only to be discharged far too soon to make room for the next person. The reality on the ground is that we are practising third world medicine, yet the government is spending millions on appearances while Rome burns.

Dr Shaba Nabi is a GP trainer in Bristol. Read more of her blogs here

READERS' COMMENTS [8]

Sam Tapsell 5 August, 2022 4:27 pm

Agree. Just as I am sometimes guilty of “quick fix” SSRI prescription for a crying patient, the government wants quick fix pharma solutions to save millions, based on very doubtful data. Reminds me of the “amazing” new dementia medications a few years back…
Yet Dr David Unwin @lowcarbGP has genuinely amazing results for his patients with diabetes, obesity and HTN while prescribing fewer medications. There really are some cheap and effective solutions to the worsening health of the nation.
As a GP practice we are following his footsteps, and seeing amazing results in our patients, but this “unpaid” work is competing with all the other pressures of day to day GP, not to mention QOF, IIF, extended access, as well as training and supporting registrars, medical students, nursing students, network staff, dispensing staff…
I worry data based population health management will really drive us further off course, while sucking up more precious money.

Decorum Est 5 August, 2022 4:56 pm

Having a service that’s based on scientific principles, run by ‘humanities educated’ folk, is unlikely to work! ‘Opinions’ (regardless of how well meaning), simply don’t translate into facts!

Jamal Hussain 6 August, 2022 12:08 am

It’s about patient centered care, patients don’t want to do the hard yards of dietary change, weight loss or instigating regular exercise into their their lives or stopping smoking which for most people is the single most beneficial change for their health. They have busy lives to lead even the ones without jobs and retirees too. They much prefer to have an injection or a tablet to fix things. People prefer not to get a pendent alarm system because it will never happen to them or prefer not to wear it because it’s not important to them at the time. Their choice. We should respect their autonomy. And if they happen to fall and spend 12 hours on the floor that’s just the price worth paying for autonomy and personal choice. I’ve seen people after days on the floor with horrendous pressure sores almost to the bone. I heard a case of a patient who fell out of bed and got stuck between the bed and the wall and couldn’t get out or summon help in time and no one came knocking for a few days.
This isn’t the push of the article put you get my tongue in cheek jibe. The government top sliced 7% from the CCG budgets back in around 2011/2012 to put in to a cancer drugs budget for drugs that some patients wanted to try because everyone has the right to fight cancer to the bitter end and blow 250k+ Of tax payer funded money in the final year of their lives regardless of the likelihood of success.. But NICE wouldn’t approve because they weren’t cost effective/ didn’t really work. This was after some media rabble rousing by a small group about how great a certain breast cancer drug was and every single person with breast cancer should have access to it. The politicians kowtowed to media pressure. That was a damn sight more than 20million. It’s cancer the most important of all those chronic conditions and we can’t spend enough on it. See above comments on diet, exercise and self care. 10 years later things haven’t changed.

Jamal Hussain 6 August, 2022 12:26 am

Hi Sam,

Gout is a disease of purine metabolism, answer cut out purines.
diabetes is a disease of carbohydrate metabolism and there are NO essential carbohydrates. So for most type 2 diabetes patients the answer to their disease is pretty straightforward. This is not new. Trouble is most patients with T2DM are addicted to carbs. You haven’t been able to use dietitians because they don’t give the correct messaging. They’re been telling them to eat carbs for years but to have 1/3 carbs. It’s like getting an addict to drink a bit less. I’m glad to hear you and your colleagues are dipping into your own wallets and paying for a better service for your patients out with of the GMS contract. Spending time and money on this instead of pursuing other income streams. My brother works in NHS management & I’m forever telling him doctors are happiest when they are working harder and harder for less and less money. They just need a few outlets to moan.

Jonathan Heatley 9 August, 2022 7:17 am

now we are being expected to redact our patient notes for anything that might upset them or lead to a complaint against us. I have over 2000 patients and our ‘systm one’ computer system logs SO MUCH useless data, it will take hundreds of hours to do this. It uses extensive templates so that we are now ticking boxes (like 111) and generating vast amounts of useless data. I would personally love to see a return to patient centred care which worked so well until recently.

Christopher Ho 9 August, 2022 11:23 am

Could it be? A major contributor to Pulse becoming red-pilled? All that is required is the final step, Shaba – this is what you get when you socialize healthcare, i.e. ” it’s always easier to spend someone else’s money”.

Patrufini Duffy 10 August, 2022 2:39 pm

If you haven’t got it by now, let’s revisit it.
Opt out of the PCN. It’s Americans, data and control over you. Sadly only 1% get the picture, which is pretty much life’s equation.

James Cuthbertson 11 August, 2022 8:12 pm

Fix the health of the nation- more exercise, better food, supportive communities, less inequality. No cash in that though!