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Problem solved in the blink of an I



It has just occurred to me that the ongoing and massive problems afflicting our glorious NHS actually boil down to just one letter of the alphabet.

To explain: on looking through our appointments for January 2020, I noticed two things. One, there aren’t any. And, two, that’s because all the slots are taken up by the following: health checks, medication reviews, learning disability medicals, mental health reviews, rheumatoid reviews, dementia annual reviews, multimorbidity reviews, BP checks, diabetes checks, COPD checks, asthma checks, annual checks to check that patients are getting all their checks, and so on.

So there it is. We’re constantly and compulsively checking patients: the OCDr will see you now. All these reviews and medicals mean 90% of our work is labour-intensive, low-yield, box-ticking claptrap imposed via diktat from NICE/QOF/CQC/DES/LES et al.

And all this mind-numbing labour seems to achieve is more work. To give just one example: that health check inevitably generates a borderline BP, resulting in 24-hour ambulatory monitoring, associated bloods and ECG, initiation of treatment, follow-up appointments and further monitoring. About 10 appointments just to get the patient stabilised on treatment, not counting calls and visits to address anxieties, misconceptions and side-effects. Then a lifelong cycle of call, recall, monitoring and, yes, checks. Last time I looked, the NNT to prevent one death from hypertension was around 100, and that’s if patients take their meds, which they don’t.

Besides, that ‘one’ in the NNT: he doesn’t live forever. If a CV event doesn’t get him, then CKD, cancer, dementia or whatever will. So I’m not sure what we’re saving him from, except, perhaps, a swifter, cleaner exit, although here the health economical and philosophical arguments get a bit murky.

We spend so long trying to keep people healthy we have no capacity to manage the sick

And this is going to get worse, because the Hancock-eyed NHS of the future promises more cancer screening, enhanced CV checks and DNA testing for newborns.

Conclusion? We’re still being peddled that Utopian illusion that prevention is better than cure, that more medicine equals a healthier population. With few exceptions (off the top of my head: childhood immunisations) the opposite is true: the more contact people have with medical services, the more ill they become. And not only because of what the medical profession imposes on them. After all, no sane punter takes time out of their busy schedule for a ‘check’ without getting their money’s worth with two or three ‘while I’m heres’.

So medicalisation leads to more medicalisation. Meanwhile, the genuinely ill simply can’t get seen. Hence frustrating waits for appointments, 111 dysfunction and overflowing A&E. The NHS can only do so much, and we waste so much time trying to keep people healthy that we have no capacity to manage the sick.

Is this what medicine is for? We need to get our priorities right, and we could start by replacing the letter ‘H’ with the letter ‘I’. National Illness Service, anyone?

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield or follow him on Twitter @doccopperfield