Just about every initiative or imperative these days is about reducing ‘avoidable admissions’ – aka saving money. But the only way I know of avoiding admissions involves avoiding coming to work, which, while attractive, possibly defeats the object. So we need more realistic ways of boosting NHS coffers. Such as:
1Sack pharmacists. Let’s face it, if you were designing the NHS from scratch, you wouldn’t invent pharmacists, would you? They’re just GP wannabes who, medication-wise, duplicate what we do, but badly. To stock shelves and count pills, you just need a level of consciousness, not a pharmacy degree.
2 Sack health visitors too. Do we really need to pay professionals to fuss over minor childhood ailments, give dumb advice about infant milks and perform pointless baby checks? No. Health visitors are a coffee-slurping, biscuit-munching, seat-warming waste of caffeine/HobNobs/chairs.
3 Shake up the prescription system. The many roles of the NHS do not include subsidising the household budget for trivia. So disallow all prescriptions for minor illness treatments available over the counter on the basis that, guess what, they’re available over the counter. Also, charge a small fee to everyone, for all prescriptions – except those who ‘can’t swallow tablets’, who should pay the full cost of their liquid specials and so really would have something to gag on.
4 Charge for waiting room seating. Combine the ruthlessness of hospital car park charges with the logic of the proposed consultation fee: make patients pay a fee for sitting in the waiting room. Fees could be inversely proportional to the length of wait so patients would be less likely to moan when I’m running late.
5 Educate community nurses. Specifically, that swabbing leg ulcers is a complete waste of time. And that a positive urine dipstick in an asymptomatic elderly patient does not need treating, but should be thrown in the face of the person who took it. And that there are hundreds of other things they do that are annoying, stupid and expensive.
6 Allow pharmacists to recycle returned packs of medication. The current burn-on-sight policy is an obscene waste of money. Who cares if these drugs might have been kept at one degree above the recommended temperature? Most of them do sod-all anyway. So let pharmacists re-use them – that’s if there are still pharmacists, which I hope there aren’t.
7 Limit the number of medications a patient can be prescribed. The limit should be six. After that, compliance and the evidence base fall off a cliff. Beyond that ceiling, a one drug in/one drug out rule should apply.
8 Raise the CV risk threshold for statins. To 100% within the next 10 years. Or stick with NICE’s 10%, but only if it applies to the risk of an event in the next 10 minutes.
9 Relocate NICE to planet Earth.
10 Give an annual cash prize to the doctor who devises the 10 best ways to improve NHS finances. I’ll accept 10% commission.
Dr Tony Copperfield is a GP in Essex. You follow him on Twitter @DocCopperfield