So the results are in. The NHS now knows what the programme for the next five years is going to include. These are the Conservative manifesto highlights to look forward to, on top of finding £22billion pounds of efficiency savings, which has already been described as looking "increasingly unlikely" by the King's Fund, we have to:
1) Provide a 7/7 service - I can't be the only one scratching their head at this. We do this already. It's called your GP 8am-6.30pm, and the GP out of hours service overnight and at weekends. They do keep forgetting to mention this. It's all set up, underfunded like every other part of the primary care system, and not being shouted about at all. I wonder why? Maybe saying "you already have a free NHS service for non-emergency problems at evenings and weekends!", doesn't sound as good in an election as "we are going to provide a 7/7 service for all patients!"
2) You will able to see a GP 8-8pm 7 days a week - given that pilots for this have just ended because of underuse, and because they did not alter A&E attendance rates, this is simply expanding the service and not reducing pressure already there. There aren't predicted to be enough "new" doctors to cover five day opening until at least 2025, so what demand will there be for an appointment at 3pm on a Sunday, when it means you can't see someone at 8.30am on a Monday? You can't magic doctors from thin air, and you can't avoid the fact there simply aren't enough for at least the next 10 years.
3) Right to access a specific named GP - this is already the case for some groups of patients and is an entirely paper exercise. You will have a named GP allocated to you. You may never see them, or may much prefer to see someone else. But the box is ticked so the government can say you have one. Like it or not.
4) Same day appointments for over 75s who need them - the devil is in the detail - "who need them". Granted most over 75s do have considerable health needs, but that doesn't always mean they clinically need to be seen on the same day. If the regulatory and paperwork burden is removed from doctors, we will have time to practice truly preventative medicine and keep chronic elderly patients stable. A patient should not receive priority simply based on their age. Clinical need should dictate who is seen and when, not manifesto promises.
5) Care Quality Commission (CQC) ratings for all hospitals, care homes and GP surgeries - The CQC is the equivalent of OFSTED inspections for schools, but for healthcare providers. Getting a rating involves an inspection, and preparing for a CQC inspection is a BREEZE! It is in no way time consuming and onerous; it definitely does not take doctors away from seeing patients, or practice managers from ensuring the business is running smoothly. The simple 7 core domains split into 24 sub-sections each requiring a detailed written plan and response is not a regulatory nightmare. No. Not at all.
6) National evidence-based diabetes prevention programme - so this will begin with the regulation of the food industry, minimum alcohol unit prices, targeted obesity prevention from school upwards and aggressive treatment of the obese before they develop complications, with bariatric surgery early on, yes? Oh no wait...
7) Invest more in primary care - Hooray! So we can expect our 11% of NHS budget back, because to be honest, operating on the current 7% is getting a tiny bit tight. But I don't think the patients have noticed that there are no doctors, long waits for an appointments, hospitals declaring major incidents. No, you've got away with it really well so far.
8) Care plans for everyone diagnosed with dementia - paperwork, paperwork. "Do all patients in your practice have a dementia care plan?" - Yes (tick appropriate box)
Does this make any difference to their day to day medical or social care needs? Not in the slightest. It's just a bit of paper. What dementia patients need is high quality, joined up, personal compassionate care. The type of care their GP is now struggling to have the time to provide. But the important thing is that irrelevant care plan; it sounds great when you wheel it out with trumpets for the next election.
The British Medical Association (BMA) is the union of doctors. The RCGP is the Royal College of General Practitioners - it oversees the curriculum and training of GPs. Both have tried repeatedly in the last parliament to engage with the government about the problems with the structure of the NHS since the introduction of the Health and Social Care Act in 2012. About the chronic underfunding of the NHS, the collapse of frontline general practice, the crisis in recruitment of doctors into the roles of GPs and A&E doctors. While small concessions have been achieved, both groups have failed to have a significant impact on the government's agenda. Disillusioned primary care staff have turned to the more vocal Resilient GP group to represent and support them.
Mr Cameron has not recognised the need for an urgent reduction in non-clinical workload to free up doctors to see patients. He has not addressed inappropriate use of the NHS, and the expectation of the public that it is run for convenience as a consumer product, rather than an essential public service. He continues to pursue seven day access to routine care, despite the fact that this is already offered and paid for by the NHS. He has not listened to those of us who work outside the affluent London boroughs - in deprived inner city areas, in rural practices where the nearest hospital is 50 minutes way. He has worked with the press to undermine the role of hard-working doctors, nurses and other NHS staff.
I am just a regular doctor. I don't pretend to understand the complexities of Whitehall wrangling. So here's my suggestion to the BMA and the RCGP - stop. Stop trying to make the politicians understand. They don't care what we have to say, they aren't willing to listen and will push through their own agenda now they have a majority and a "democratic mandate". They want an American-style model driven by consumerism and the vocal wants of those who are in least need. Give up.
Turn around, and instead of facing the politicians, face us. Face the doctors, nurses and staff. Focus on us. Put all your energy into uniting us, pulling us together, getting a single, determined voice from the NHS. Whatever the politicians plan, they think we will roll over. They think we will be the apathetic, disgruntled bunch we always have been who will lie down and accept their changes. Use your power and your organisations to bring us together and show them that this is a step too far. That despite what they think, they cannot do this without us. If you are one of the NHS staff who isn't up for taking on the government, then stand aside and don't stop those of us who are. We have to have the stomach for a fight. To fight for our jobs, for our patients and for the NHS. If we don't get it right this time, there will soon be nothing left to fight for.