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Trying to keep continuity



I think we would mostly agree that continuity is a good thing? I’m referring mainly to the provision of healthcare of course, not to the continued skulduggery of our tormentor in chief, the secretary of what a state, Jeremy Hunt. I suspect he feels that continuity involves maintaining a Tory government and his own job. He has been in post for over four years, but is struggling to make any association with that appointment and the ‘completely unacceptable’ state of the NHS. If he was a football manager, let’s just say he would have received the full backing from the board.

This can’t be the way to provide care

Out here in the real world, we struggle on trying to make the best of inadequate funding of social care, primary care and secondary care. Obviously our main priority though is to eliminate all overseas scroungers and organise ourselves to provide an even more watered down service for longer hours each week. You find yourself asking if the Department of Health will ever follow evidence or seek meaningful advice. A recent study found that patients seeing the same GP was the key to reducing hospital admissions, telling us all what we probably knew already, but meeting huge demand at any cost, seeing whichever member of the team can tick the box fastest, at whatever hour of the day or night remains the Government’s main goal. If it was about goals, and scoring them though, the football board would have a very close look and might be in the market for a new striker.

I had dinner last week with my wife and two other medical colleagues, sharing over 100 years of NHS working experience between us. We had all had the misfortune to encounter either personal or close family member illnesses requiring hospital attention in the last year. Even for us, who know our way around the NHS and understand medical procedures, the one problem that stood out was the huge difficulty we had in obtaining any meaningful, consistent information or even, on occasions, speak to a doctor directly influencing the care being provided. There was no ‘go to’ clinician – one colleague even commented that the ward clerk was the most helpful member of the team. This can’t be right? It can’t be the way to provide care, but most likely represents the time pressures staff face and the way teams are now organised. The individual clinicians were (usually) excellent.

Back in the day, of course, things were different. As a house officer, you provided that point of continuity and took pride in knowing every detail of every patient under your watch. My consultant colleague tells me this responsibility is now his. In primary care of course it is ours – we are well placed to do it, and need to organise ourselves so we are able to fulfil that responsibility, both to minimise the risk to patients, and, I believe, maintain some enjoyment and motivation for our role.

How do we do this? Well, we had some discussion at the end of dinner about STPs. We all declined to get involved – the ham hock had got me beaten and I think I would have found it unpalatable, and undigestable.

Sticky toffee pudding was a step too far. Sometimes you simply have to say no.

Dr Richard Cook is a GP partner in Hurstpierpoint, West Sussex. You can follow him on Twitter @drmoderate