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How to save the NHS millions by stopping taking the piss – literally

Welcome to the Copperfield Financial Think Tank - a repository of common-sense, money-saving ideas which will help the NHS kick some financial bottom

I'll come straight to the point: I can save the NHS millions. So can you. This occurred to me as I ploughed through the turgid tedium of a typical duty doc stint yesterday. And no, my financial masterplan doesn't include old favourites like shooting heartsinks or nuking nursing homes. That would be Phase B.

Here, off the top of my head, are my ideas:

• Stop nurses taking pointless urinalyses, such as from catheterised patients (always abnormal) and during ‘routine checks' of the asymptomatic (inevitably revealing a pseudo-infection). This all leads to unnecessary MSUs, unnecessary consultations and unnecessary treatment. Conclusion? They're unnecessary. So nursies: stop wasting money by taking the piss, then so will I.

• Ban hospitals from including PPIs in patients' discharge medication without a clear indication. Down our way, PPI stands for ‘Pointless Prescription Initiation' - its appearance on the TTAs is now as much a tradition as the non-appearance of a discharge letter or all promised follow-up. Inevitably, the PPI transfers to the patient's repeat prescribing list, bleeding prescribing budgets dry. Forever.

• Revise the ridiculously draconian rules stating all drugs returned to pharmacists have to be destroyed. It's a grotesque waste of money. So what if they might not have been stored at the right temperature? For most, the NNT is about 50 anyway - what difference will it make?

• Make it a criminal offence for Macmillan and community nurses to request prescriptions for expensive nutritional supplements. People dying tend to lose weight, is that so hard to understand? And prescribing supplements to ‘build them up' will just ruin whatever residual appetite – and therefore pleasure in food – remains. Fools.

• Stop A&E sending us pointless letters. Yesterday, I worked my way through 20 of the buggers, with diagnoses such as ‘URTI' and ‘Head, unspecified' – and treatment like ‘Nil' and ‘Patient didn't wait'. Look, I'm not interested*: it's a waste of time, paper and money.

• Ban community nurses from taking swabs of leg ulcers. It's like a Pavlovian reflux, except with swabs rather than drool. OK, maybe with drool too. Everyone knows the results are meaningless. Except, apparently, community nurses.

You'll note that, in my typically GP-centric way, I'm blaming everyone but us for this profligacy. That's because it is, in fact, everyone else's fault. Having said that, we are the ones who rubber-stamp a lot of this crap and so, to extend the analogy, we are guilty of flushing NHS money down the bog.

Enough. With a sensible hospital prescribing policy here, an administrative A&E tweak there and some nurse training just about everywhere, the NHS could be quids in. And we could wipe out those PCT deficits before we even inherit them.

So the Copperfield Financial Think Tank starts here. You nodded at all the above, didn't you? And you have your own brilliant money-saving suggestions, don't you? Good. Send them in. Let's kick some financial bottom.

I'll collect them up and distribute them to every commissioning group in the land when the Big Bang comes. Then – and only then – will I distribute the firearms and the weapons of mass destruction.

*Actually, I am interested in the patient with the unspecified head.

'Sick Notes' by Dr Tony Copperfield is out now, available from Monday Books.

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