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A Band-Aid won’t stop us ‘withering’ away



A close friend of mine had to undergo coronary artery stenting recently. Unfortunately, the puncture site bled in the middle of the night and the scene was somewhat akin to Nightmare on Elm Street. He had three nurses around his bedside trying to stem the bleeding and it wasn’t until a fourth, of the more burly variety, practically sat on him, that the bleeding subsided. The nocturnal activity didn’t stop there, though. He continued to have half-hourly pulse and blood pressure checks to ensure there was no haemodynamic compromise.

If you truly wish to resuscitate us, stop sticking plasters all over us

What my friend didn’t have was a pretty little Finding Nemo plaster stuck on his arterial puncture site, with advice to talk to the other patients if the bleeding didn’t stop. Neither was he asked to donate blood that morning, as it was his regular slot to do so. And the nurses chose not to go on their break, but to monitor him closely.

But that’s because this is clinical staff we are talking about. These are dedicated professionals who are not interested in political soundbites or gongs, but have given a lifetime of humanity to the NHS. This is not NHS England, which can hide behind the rhetoric of its so-called ‘rescue package’ while practices are forced to close or merge on a daily basis.

The vast discrepancy between the financial haemorrhage and the tiny plasters of resilience funding would be comical if it were not so tragic. Vulnerable practices may secure a few thousand pounds at most as they reel from the onslaught of MPIG removal, PMS funding reviews and 300% increases in premises service charges. And even the paltry sums on offer must be spent on ‘change managers’ or ‘project teams’.

Let’s be clear on what this rescue package is really about. It’s not about saving vulnerable practices at all. In fact, it seems they can all ‘fail and wither’ according to one NHS England director. If rescue was the aim, then the PMS review funding changes would have shifted everyone up to the highest-funded practice, and not the lowest. NHS managers would have halted the scandalous increase in service charges faced by many inner-city practices, rendering them unsustainable. And partnership seniority would have been retained and crown indemnity offered.

No, the objective of this rescue package Band-Aid is to keep practices on the life- support machine for long enough to facilitate working at scale. You see, NHS England will have a real problem on its bloody hands if too many practices hand back their contracts – the NHS would collapse before the fat cats could pounce. But keep plugging the holes with corks and they may last long enough to form takeover-friendly units of 100,000 patients.

So my message to NHS England is this – if you truly wish to resuscitate us, stop sticking plasters all over us. Give us a blood transfusion, take us to theatre and then care for us in the high-dependency unit. If not, why not put us out of our misery and pull the plug on us now?

Because if we ‘fail and wither’, so does the NHS. Maybe that’s the hidden agenda?

Dr Shaba Nabi is a GP trainer in Bristol