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Government needs to stop running the NHS like a budget airline

Social media has a habit of regurgitating old articles, past pieces bubbling to the surface like peas in soup, and last week an article based on this grand pronouncement of March 2013 attracted my attention. It was the secretary of state, singing a happy song about e-consults, and how much time we waste in general practice with our archaic ten minute slots and how much more equal some of us are than others.  

I must admit I found it interesting to observe how far down the line the DH had actually progressed with trying to run the NHS like a budget airline only three short years later.

The line of attack is simple: we will not work in a system that fails our patients

They really must be congratulated, because the original proposal is still flying quite happily in the Government’s blue sky of the future NHS. They quite clearly favour a no-frills, safety-sometimes service; all rickety wings and morose cabin crew throwing placatory junk food down your gullet at a fiver a pop.

There will be upgrade options, as such. You may pay for the privilege of jumping the queue, to increase your legroom and reduce your DVT risk from ‘certain’ to ’likely’. If the whole thing starts to fall to bits, then there may be the option to adorn your meal with cyanide sauce before you nosedive into the sea.

As I’ve written recently at length, we GPs ought to remember that our only responsibility is to the quality of our care for our patients, not the maintenance of the system. The Government continues to deliberately starve the NHS to death whilst smiling and polishing their lapel badges; the  aughably ineffectual Opposition squabbles over political whimsy and wishes lamentably that it was still 1974. Fortunately, the BMA’s newly-discovered spinal column meant that at least Dr Mark Porter was able land a few welcome blows on Budget Day.

We need to be calling the Government out on this, loudly, and taking the game to them on their own turf, ready to put into action the motions passed in January’s Special LMC Conference. Some of them found us flat-footed – although nobody can argue with the truth of Dr Kuetter’s proposal to do away with home visits, it was perhaps the wrong soil in which to eed this argument, but a glance at the agenda reveals a familiar theme.

The line of attack needs to be simple: we will not work in a system that fails our patients. We all must stop pretending that there are ever cheaper ways to do the same thing, that there are fat corners to be cut; that economy is first class and that Lambrini is champagne. To do so, those who represent us need to be brave enough to confront some necessary ugly truths. Decades of meek procrastination have, incredibly, allowed others to challenge us as principle custodian of patient advocacy. This is an absurd fallacy, where we must work to regain our position, but clearly signalling the proposed direction of travel would be a welcome start.

The old project management guff about cost, speed and quality still applies. The Government prioritises cheap over quality; us the latter. It doesn’t help us proles in the swampy lowlands when those in ivory towers give credence to unrealistic fantasies by presenting their own version of luxury primary care. We would all love to join the singing and dancing, but unless gross inequities in funding for and across general practice are properly addressed – by any means necessary – then A to B is all that we can realistically offer. All the rest is pie in the sky. 

Dr Karim Adab is a GP in Manchester

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