I am no longer certain about the future of the NHS. Whether for political or financial reasons, whether motivated by malice, conviction or simple stupidity, the NHS has gone past the tipping point and is beyond salvation.
I am no longer willing to cover up the failings of our much-loved and much-vilified institution. Most of us have devoted ourselves to the care of and advocacy for our patients and are hapless witnesses to the terminal decline of the NHS. This winter we will be told there are ‘winter pressures’ – a useless euphemism for old people getting ill in the winter and needing care. This term is a lie. The pressures are there all year round.
‘Winter pressures’ – a useless euphemism for old people getting ill in the winter and needing care. This term is a lie. The pressures are there all year round.
Like many practices, we are struggling to recruit a partner, as we are not high earners. We need more cover so we can handle the incessant (and mainly reasonable) patient demand. What takes up that last dire 10% of our labour is the workload dump from secondary care as well as the mindless welter of paperwork used as a delaying tactic and to fuel the internal market’s transactional costs. Simply taking these away would offer a large increase in appointment availability. We no longer have colleagues in the community as district provision shrivels and offers a woeful service to those with no choice. What will happen to the old and sick this winter? Who will help me keep them at home and away from a secondary sector that gets them out as fast as it can while failing to diagnose why they were there in the first place? Who will see them safely back into their house, when an overstretched transport service parks them into a chair without any social service or other support? Is this what we mean by ‘gearing up for winter pressures’?
Like many other GPs, we refuse to participate in the farce of offering extra appointments for those with relatively minor illnesses so that A&E will be able to cope with others who have even more minor illnesses. We have enough appointments for anyone who asks, but are not going to cover any politician’s backside any more. The time has come to declare ‘winter pressures’ a year-round phenomenon. We need to stop pretending that it is all the fault of patients or their GPs. This winter will be bad, but not because of the season.
The factors that will make this year even worse are mainly to do with the exodus of doctors. Young people with medical degrees do not want to go into a UK medical career. They may emigrate or just drop out. Like me, you probably know both kinds personally. They have completed foundation years in hospitals run by cavemen and worked alongside colleagues battered into near-callous indifference by financial and clinical pressures. After a few years of this, they have understandably decided to give up or go where they do not have to put up with over-zealous regulation, media vilification or the ambition of foolish politicians. I imagine that the recent permanent damaging of their pensions, the current cutting of pay and worsening of conditions have strengthened their resolve to go where they will be welcome.
My generation of idealistic NHS-exclusive GPs is also reaching the end of its days. Our replacements will not put up with this situation for long. As we retire, they will demand more for their willingness to soak up the trouble created by other parts of the NHS that repeatedly fail to do their job.
This next winter will be long and tough and there is an endless vista of cuts and reductions in service while the workers collapse under the strain. This winter will not be special. It will be a warning of much worse to come.
Dr Laurence Buckman is a GP in Finchley, north London, and ex-chair of the GPC