I can’t quite decide whether this is a profound revelation or a statement of the bleedin’ obvious. And I suspect it’s a theme I’ve visited before. Whatever. Those two axes of evil, NICE and the CQC, have just focused my thoughts.
NICE first. Everyone says that NICE is on another planet. The thing is, I no longer think this is a metaphor. I genuinely believe that NICE is literally run by aliens.
Take the newish draft guidelines on asthma diagnosis. Take them far, far away and burn them. I absolutely guarantee, here and now, on pain of having my scrotum nailed to a windmill, that no GP in the land will ever follow them.
Why? Because we haven’t got the time, the will, the energy, the equipment or the sort of patients who are happy to devote a large part of their remaining life to clinching a firm and over-investigated label of asthma.
As we all know, but NICE doesn’t, it’s actually pretty easy to diagnose asthma with a reasonable level of accuracy – just using the history, the examination, and a trial of salbutamol. Okay, and a sodding spirometry to satisfy the QOF monster. Job done. We are confident to at least to the 90% level, and that’s the point. Because that level is perfectly adequate. We miss a handful, overdiagnose a few, but deal properly with the vast majority, all with a minimum of fuss.
And that, of course, is how general practice works – and why it’s so cheap and effective.
But the CQC doesn’t realise this, either. Here’s a teensy-weensy example from some of its blurb: ‘If a patient suffers from early-stage dementia, and needs to make a decision on whether to have the flu jab, the GP should make every effort to communicate the pros and cons of having the treatment when the patient is most alert. This is so that the patient can make a decision.’
Can you imagine a world where we really could do this? No, you can’t, because it doesn’t exist. Sorry, CQC, but seriously, we can’t repeatedly reiterate flu advice to our dements in the hope of catching a window of cognitive clarity, because we’ve got patients to see, scripts to sign, visits to do, meetings to attend, boxes to tick, admissions to avoid, targets to hit, bowels to open (sometimes our own). Oh, and sodding CQC visits to prepare for, which is how I came across this gem. Conclusion? The CQC, too, lives on Planet Bloody Clueless.
It’s simple, isn’t it? GPs do a good enough job. If you want to get from our 90% level to 100% – in other words, to pitch for all the perfection CQC and NICE imply – that extra 10% will cost about 1,000% in terms of time and effort. Law of diminishing returns, etc, etc.
So NICE should be NICA: the National Institute for Clinical Adequacy, which sounds nicer with a soft ‘C’. And the CQC should be nuked.
Anyway, I’ve finally worked it out. This is a statement of the bleedin’ obvious to those who do the work.
But a profound revelation to those that set the rules.
Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter@DocCopperfield