Monday brought the first announcements on the NHS from David Cameron and Jeremy Hunt since the election - although as John Humphrys rightly pointed out in his interview with Mr Hunt, they have been doing the job for five years already. Greeted with trepidation by NHS staff, the announcements outlined some key policies. Consequently I am disillusioned, sad and angry, in equal measures.
Jeremy Hunt confirmed to NHS primary care staff that he has no understanding of modern general practice. His solution to finding the staff and resources to allow for seven-day opening was that GPs should stop doing blood tests. I hate to burst your bubble Mr Hunt, but for any practice to have survived the last five years, the GPs certainly aren't sat taking bloods. You may wish to look up the following roles - practice nurse, advanced nurse practitioner, minor illness nurse, healthcare assistant, phlebotomist, dispenser, pharmacist, practice manager, business manager, PA, administrator, secretary, receptionist.
All of these and more are part of modern general practice. They are a skilled team, who work together to ensure that only those patients with complex illnesses and significant needs are seen by the GPs. We don't take bloods. We don't do routine asthma or diabetes reviews. We rarely see coughs and colds, rashes or urine infections. What our excellent nursing colleagues aren't able to deal with - the patients with heart disease, kidney failure, depression and cancer, who are on 20+ drugs - is what we are seeing; in-between dealing with doing a large amount of telephone triage and consultations, which comes from the lack of appointments due to not having enough doctors. Some of us offer e-mail or Skype, but these take no less time than traditional consultations, and sometimes longer. We see those hospital letters that require clinical input, because the trained admin staff and PAs have filtered out all they can. The practice dispensers and pharmacists have checked the discharge letters. These have already been coded and entered on the computer system.
Our business manager is chasing the outstanding targets for the financial year, otherwise you don't pay us and the business goes under, like those in Derbyshire last week which left 25,000 patients without a GP.
The practice manager is in a meeting with another doctor to submit a bid for a service we have always provided, but that you now want us to bid for again against "Any Qualified Provider" i.e. private companies. If we don't get the bid right, our patients lose the local service, we lose funding and staff lose their jobs. We are innovating, thinking outside the box, diversifying already. We have had to or we have failed.
So on reflection, I don't think "not doing blood tests" is going to generate much spare doctor time. You have no idea of how our team works, how hard they all work, and how we are putting in extra hours already to try and prop the NHS up. It is insulting and demoralising to realise our secretary of state for health thinks like this. Any goodwill is gone.
David Cameron stood up in an NHS "super-practice", and championed a seven-day NHS. There are inevitably aspects of the NHS that need changing to meet the presence of new technology and new ways of treating patients. But again, you've thought with your "good election headlines" cap on, not your "living in reality" one.
Let me put it this way. Despite what those who work in the NHS tell you and your business friends - that there is no profit to be made in providing public healthcare - you still seem to think it can be run like any other business. Let's talk about your business Mr Cameron. It's not doing well. It's on rocky ground. It's currently open five days a week for routine care, but 24/7 for emergencies. Every department and branch is in the red. Demand is high. You don't have the staff or resources to meet this. Money is tight. Recruitment has failed, so much so that some branches have closed completely. You are being warned by shop-floor workers that your product is putting customers at risk. It is increasingly unsafe. Morale is at rock bottom. People are leaving right, left and centre. Your reputation is going down the pan.
So you do the sensible thing - you invest in staff, you focus on the core service your customers really need, you renegotiate expensive contracts with private companies, you restore pride in the business. Yes? Well apparently, no.
What you have done is decide to push your staff further. You are going to open up seven days a week (even though you already do this and suggesting you don't shows a disconnect and contempt to those staff who work these hours. It also means you waste money on duplicating a service you already provide). Instead you plan to remove overtime payments and unsocial hours pay from those staff. You decide to cut corners; water down the skill mix with cheaper roles with less training - shortening consultant training to get more doctors quickly, against the advice of the Royal Colleges; introducing physician assistants who have trained for two years to replace those damn expensive, properly qualified doctors. As insurance costs rise to cover all this seven-day care, you make doctors pay their own which costs them up to £30,000 a year and is an excellent way of driving them away. You ignore the concerns of your staff, staying isolated or only listening to those that agree with you. You don't take up repeated offers to spend time on the shop floor and see the reality. You impose unilateral contract changes and ignore the independent pay body recommendations. You plough on regardless. You fail to stabilise the current workforce and care model before making these changes, putting customers at risk.
I'm no expert Mr Cameron, but I think your business plan is shocking. It is going to fail. It is going to push the NHS to collapse, and we are already teetering dangerously on the brink. Push it into the hands of private providers. Which the cynic in me says is your endgame.
Staff in the NHS are worried. We are worried for our jobs. Worried for our patients. Worried that you are still missing the point - that the NHS should be providing excellent core healthcare services to the population. It needs investment in staff, because caring for sick people cannot be done by a computer or an algorithm. It cannot be done by cutting corners. It needs dedicated individuals who are valued by a realistic public who know there are limits to what taxes can provide and who don't have their expectations built up to levels equivalent to private healthcare. Who are told to take responsibility for their own health by the government, not pandered to in order to win votes.
I can't see my bank manager at the weekend. I can't see a solicitor or an accountant. I can call a vet, or a plumber, and pay a fee commensurate with their expertise. Their business model doesn't work like your proposals for a reason. They provide ample opportunities during the week for their customers - which you and Mr Hunt seem to frequently insist on calling patients - to see and contact them. If you were realistic and invested more than a miserly 8% of the NHS budget into primary care, we could do the same because we would have more doctors. We could improve the Out of Hours provision by getting clinical staff into the NHS111 service, and covering the ridiculous indemnity costs for doctors at the same time.
If you sat down and talked to staff in the ambulance service, A&E departments, acute medicine, and radiology they would tell you what they need to offer the essential emergency care that is required. What they wouldn't tell you is that they expect to see routine cases at the "customers" convenience seven days a week. You need to clarify your intentions to the public and the NHS quickly. All you and Mr Hunt did on Monday was increase the panic, the uncertainty, and the number of resignations.Suggest a correction