I remember when our kids were young I bought a book called The Way Things Work. I reproduce the cover here.
I’m not promoting this book. It’s just that I was thinking about this issue of ‘how things work’ yesterday and thought of the book. There has been a great deal of discussion and debate in the past months on the so-called NHS ‘reforms’. On the whole, there has not been much detail about how a given policy is supposed to work, or evidence that it does work.
My particular issue is the proposed policy to abolish GP practice boundaries. When this first came to my attention about 2 years ago, I was appalled. Why? Because I know from experience that it does not work. How do I know? Because we regularly have patients leave our area and move away, sometimes only a mile or two. Many try to stay on as patients, and when we catch up with them, we ask them to get a local GP. But we have to deal with these ‘non-local’ patients for a time and our experience has shown that it works poorly, and is sometimes actually unsafe. So in essence we have 20 years experience with this and in that sense we have been a de facto pilot site for this policy.
In March 2010 I emailed Andrew Lansley as I knew he was keen on this policy, and was in fact chastising Labour for not having implemented the policy themselves. I felt I had to ask him to show that he had a grasp of how general practice works, and that he had done a robust risk assessment. Click here to see that email exchange.
There is no evidence that Andrew Lansley did a risk asssessment; in fact, his chief of staff says in one email that she could suggest that he do a feasibility study. Now it seems to me that if you are undertaking a project of any complexity (and general practice in England is a technology of high levels of complexity) that you do a thorough assessment: 1. you check how it works; 2. you model how you would like it to work; 3. you check for unintended, unwanted effects of your proposed changes; 4. you test it, and evaluate how it works.
And you do this before you launch this as a policy.
If Andrew Lansley or any other Government minister, or MP, or Department of Health spokesperson thinks that this is an unreasonable or dispensable requirement, please let me know.
For a successful technology, reality must take precedence over public relations, for nature cannot be fooled. Richard Feynman