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A Doctor's Manifesto for the NHS - An Open Letter

Increasing NHS funding by £3billion, £8billion, £Xbillion - lovely. But where is it going to be spent? Will it be a repeat of the winter pressures funding where hardly any actually got to struggling A&E departments and GP surgeries? Another round of reorganisation will soak the whole lot up.

Dear Mr Hunt, Mr Burnham, Mr Lamb, Ms Bours, Dr Creasy, Ms Robison, and Ms Jones,

I have watched with interest over the last few days as your policies and promises regarding the NHS have been publicised. On reflection, I think perhaps you need a few pointers. I am a doctor; I am a GP working in the service that sees 90% of patients the NHS deals with every day. I hope you won't take offence at this letter, but your health policies, well, they are dreadful. I'm sure there are teachers up and down the country who feel your education policies are the same. Service personnel who feel similarly about your defence policies and so on. All I know is I am doing the job you are all purporting to improve, save, fund - whatever. And you are all wrong. My disclaimer is this - I am genuinely an undecided voter. Largely because I can't believe a word of what most of you say about the NHS, but if a party did admit that the NHS is a bottomless pit of money, and that they would truly engage with doctors, nurses, and the many other NHS staff to try and improve it and its use, instead of constantly encouraging the privatisation and consumerism of our most basic public service, you would have my vote in a heartbeat.

Allow me to briefly critique your current manifestos. I haven't separated them by party because let's be honest, they're much the same.

Promise 1 - Improve access to GPs/extend opening times/7 day a week service - you can't do any of this until NHS primary care can manage a 5 day a week service. At the minute it isn't. Ask any patient. No appointments, no doctors. The evidence shows that when extended hours are offered they often aren't used. And also offering short term funding to encourage practices to do this, then cutting it after a year, is stupid.

Promise 2 - Moving care into the community/closer to home - absolutely. But to do this you have to take funding from hospitals and put it into the community. So far, you've not grasped this simple fact. Bearing in mind all the closed community hospitals and cuts to community nursing services, you're going to struggle.

Promise 3 - End Health tourism by immigrants/foreign nationals with HIV - this accounts for a tiny tiny portion of NHS spending. Contrast it with the number of excellent immigrant doctors and nurses who work for the NHS and are propping up our lack of medical staff. You'll also be shocked to hear it comes across as a touch racist. Which I'm sure you're not.

Promise 4 - Improved mental health services - admirable and undoubtedly a massive issue. Mental health services do need significant investment, but so do all areas of primary care. I can't shake the feeling you think this will win votes because it is a high profile area, rather than because you genuinely understand the issues facing mental health patients. But maybe that's just me.

Promise 5 - Increasing NHS funding by £3billion, £8billion, £Xbillion - lovely. But where is it going to be spent? Will it be a repeat of the winter pressures funding where hardly any actually got to struggling A&E departments and GP surgeries? Another round of reorganisation will soak the whole lot up. When you do work out where it's coming from, just give it straight to the frontline services. We know where the holes are as we are all in them.

NHS general practice is on its knees and failing right now. A five-year plan is of no use. In five years, NHS primary care will no longer exist. You need to recognise there is an immediate and urgent problem, which has been here in true crisis form for the last two years at least, not simply from the start of the general election campaign when you all begin paying it such attention. My humble suggestion as someone who is doing the job, and working in the service is this: pledge an emergency 12 month plan to sort NHS General Practice out NOW. Then talk to actual NHS staff directly about the future, instead of coming up with populist ideas on the back of a napkin.

Not everyone will agree with these thoughts; there will be other doctors reading this who think I am mad. But at least I am prepared to stick my neck out and make suggestions.

Let me keep it simple. Here are the problems and how to fix them.

1) Too few doctors - yes, some doctors are leaving the country. But more than that, doctors are staying but either reducing their working hours or moving to locum posts. They are doing this because being a full-time doctor at the moment is too stressful, too horrible, too frustrating, too unsafe and too heart-breaking to see the system failing patients every day. Instead of promising to instantly provide thousands of doctors the day after the election (it takes 10 years to train a GP - and all the training schemes are half-empty), the only way you will get existing doctors to increase their hours again, is to take measures to immediately reduce the workload lumped onto General Practice. Scrap all targets so that doctors aren't chasing their tails instead of seeing patients. Suspend CQC inspections apart from in those cases where there are genuine concerns about care. Stop extended hours. Let doctors focus on providing plenty of appointments Monday to Friday, not stretching services thinly over the whole week. Suspend any project that does not directly impact on the ability of doctors to see patients. Reduce paperwork and bureaucracy - stop NHS England, Public Health England and Clinical Commissioning Groups (CCG's) from sending requests to practices for pages and pages long submissions and bids to essentially continue to provide the same service they always have. These take hours of practice time which could be better spent. Suspend the Quality and Outcomes framework (QoF) - we are all doing it anyway apart from the ludicrous ones. Stop the prescribing of all over-the-counter medications nationally. That is what pharmacies are for. You need all hands on deck, with every available doctor in every surgery for as many hours as they are available, seeing patients. If GPs need to leave the practice to attend CCG meetings or compulsory events, fund cover for a replacement doctor. I have colleagues who have had to stop contributing to the running of the NHS (that you have also given us to do), because the practice couldn't afford to replace them while they went to yet another meeting.

2) The Out of Hours problem - invest in Out of Hours services properly. Bring in clinically trained advisors to NHS 111 to improve the standard of their advice. Adequately fund and utilise the GP Out Of Hours service instead of under-resourcing it and quietly leaving it run down. Promote its use and existence to patients. Deal directly with doctors' insurance providers so we can actually afford to work in the service - indemnity premiums are so high it makes it unfeasible for many. Get the Out of Hours service on the same IT system as the rest of General Practice - it is unbelievably simple, but if Out of Hours doctors in both GP and A&E services can see and read the patients regular notes, it will save a massive amount of time and resources. Recognise that the majority of attendances to A&E are during the working week when GP services are open. Give A&E the funding to have a dedicated triage assistant whose sole job is to divert demand back to where it should be seen. Anyone presenting at A&E with a primary care problem will have their GP surgery contacted and their need triaged appropriately. And guess what, because you've implemented point one, there will be appointments! Deciding to attend A&E or wait there instead because it's nearer work or more convenient for you is NOT a reason to use emergency care. Make this clear to the public and do not shy away from the shared responsibility they hold in keeping the NHS running.

3) Reorganisation - Stop reorganising everything, Simple. Just because you think it all needs shuffling around and the names changing to make your mark on it. The last parliament has seen the biggest overhaul of the NHS in its history. It has been a nightmare to implement from start to finish, and most doctors would happily see the back of it. It is all the more ironic that it is in large part a return to a scheme called fundholding which had been tried before but then got rid of when the Government changed. So don't make all the hours and time invested so far be wasted. Let's just leave it as it is, let the CCGs carry on, stop co-commissioning and stop devolving contracting from NHS England to CCGs until we have all had chance to catch our breathe. Ask doctors where they are in 12 months time, and for the love of God, LISTEN TO THE ANSWER.

4) Money - yes it's a dirty word when you say you are giving it to GPs I know, but you are all promising billions of pounds from nowhere. So take a big chunk of it out of thin air, and give it directly to practices. Give it to each and every GP practice in the country. I promise you that if you give each surgery in this country a single windfall payment, and the freedom to use it however they see fit, you will see an instant improvement in appointment availability and patient satisfaction within a week. Some practices will use it to pay for more doctors, some for more nurses. Some need extra reception staff to answer the phones, or to process the paperwork. Some are on the brink of financial ruin, about to follow those which have already closed. The fastest improvement in primary care would come about if you actually trusted us to do what we have trained to do and have done successfully for years - the best for our patients.

5) Morale - On the back of that, tell the public that you value us. Tell them we work hard. Tell them we are killing ourselves to prop up this failing system. Stop feeding lies about how much we earn to the press. We genuinely feel hated by politicians. Stop undermining us and not recognising the fact that we as GPs are the cornerstone of the whole system. 90% of patient contacts are with us. We get less than 9% of the funding. Whatever your friends in the press think, by anyone's standards that is damn good value for money. If we had the collective guts for it, and decided to stand up for our profession, the whole NHS would collapse within a day without our input. Make us believe that YOU believe this, and that you value what we do. It feels just as crappy to be persistently vilified in the press for us as it did for you over the expenses scandal. Give us a bloody break.

I trust you will reflect on this, and I look forward to hearing your revised health policies in the coming weeks.

Yours sincerely,

Dr Zoe Norris

As part of The Huffington Post UK's Beyond The Ballot series we want to know what issues you think aren't getting enough attention in the election campaign. Tweet using the hashtag #BeyondTheBallot to tell us in 140 characters and we'll feature the best contributions

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