Lansley promise 2011: “NHS patients will be able to pick consultant”. September 2015: Where are we now?

26/09/2015

An article appeared in The Independent in October 2011 which reported that Andrew Lansley was going to make it possible to pick the hospital consultant of your choice. It seemed to me to be a moronic idea at the time and you can see why in a post I wrote at the time. (In fact, I discover that I wrote an earlier post pointing out the absurdity of promises made in the White Paper which then led to the Health and Social Care Act; it is worth looking at both these posts in view of where we are now.)

So where are we now? Let me tell you how it is for me, referring patients to hospitals in London. Yesterday I spent about an hour trying to arrange an appointment for two patients failed by the system, entirely predictably. One concerns Patient X who has chronic back pain who has had an MRI scan of her/his lumbar spine, and the report recommended referral for possible spinal surgery (I asked for advice from our local spinal orthopaedic surgeon, he advised referral); the other concerns a baby under 1, referred to a London centre of excellence.

I referred Patient X six weeks ago through the Choose and Book system (recently rebranded as the NHS e-Referral Service). What choice did Patient X have? Well, there are two avenues for this sort of situation: a spinal orthopaedic surgeon, and a spinal neurosurgeon. I tried the orthopaedic surgeon first. The wait for our local spinal orthopaedic surgeon at the Royal London Hospital was 185 days (that is, over 6 months); there were not many other options, with similar waits. So I tried spinal neurosurgery. Here the choice was even more reduced, but there was one option: an appointment in 41 days at the National Hospital for Neurology and Neurosurgery. I clicked this option, printed the form and gave it to Patient X to book the appointment online.

When Patient X tried to book the appointment, there were no appointments; Patient X was told that she/he would be contacted by the hospital within 2 weeks regarding an appointment. This did not happen. So Patient X rang the NHS e-Referral Service; they could not help her/him, she/he needed to ring the hospital. Patient X rang the hospital and was told the they would contact her GP to confirm that a referral was necessary (a strange step as I had referred Patient X in the first place). In any event, I did not hear from the hospital.

So yesterday I rang the NHS e-Referral Service. They could not help me, it was out of their hands. I did point out a generalised problem, which was illustrated by the individual case of Patient X. In my experience, whenever the patient finds there are no listed appointments and are told they will hear within two weeks, it usually means an appointment will not be forthcoming; & when the patient pursues it with the hospital they will eventually be told there are no appointments and to go back to their GP (!). And then what I do is start again: I raise another referral through the e-Referral Service but warn the patient not to choose an option that does not give them an actual appointment. So yesterday I spoke with a manager at the NHS e-Referral Service and I told her about this problem. Initially she was evasive and defensive, but then softened and agreed that in these cases the system did not work. I suggested she take this back to her organisation and ask that they at least be honest about this issue and warn patients booking with hospitals who do not have appointments listed.

I then rang the Hospital for Neurology and Neurosurgery. I explained the situation; that the patient had been told I would be contacted; that I had not been contacted. On the NHS e-Referrals system, Patient X’s referral is currently categorised as ‘Deferred to Provider’. The staff member at the Hospital for Neurology and Neurosurgery said that this meant me, her GP. I said I did not think so; I thought it clearly referred to the hospital to whom I had referred the patient. I was then advised to fax a copy of my referral letter to the staff member and that she/he would pass it on for vetting.

With respect to the baby, exactly the same thing has happened. No appointment. Parents told to go back to their GP. I have made a new referral, and chosen only providers who actually have appointments. (The hospitals without current appointments will be listed as ‘Unknown’ as the date of next appointment).

This situation is not unusual. With respect to my local hospital, the Royal London Hospital, many specialties have long waits or are ‘Unknown’. My impression is the ‘Unknown’ category is actually a way of avoiding these referrals appearing in the statistics; if the hospital were to give an appointment that is more than so many days, then that is a breach of the targets and there is a financial penalty. So if they do not give an appointment, if they tell the patient to go back to their GP, perhaps they avoid this breach. I think it is likely that this is what is happening. I could of course chase this up further and get to the root of the problem, but I am a GP, not an investigative journalist (not many of them around these days). Our CCG sent us Tower Hamlets GPs a letter recently advising us not to refer to certain departments at Barts Health since they are having considerable problems with capacity. This is all very well, but then we refer to alternatives like the Homerton Hospital; and it does not take a genius to realise that these alternative providers also face the reality of capacity and their waits will lengthen and possibly/probably go beyond the target and then breach and be financially penalised.

So there is quite limited ‘Choice’; what Lansley and the DoH promised was moronic from the start, the current situation was entirely predictable. Is it the hospitals’ fault? No, it is an absurd Herculean task. What we need is people to be honest about this, to fight back and point out the absurdities in the demands being placed on NHS services by Morons in Government.

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For a picture of London spinal neurosurgery referral options as of yesterday, Spinal neurosurgery options on 25.9.15.

 


How does registering with a GP near your child’s school benefit you? Question to CEO of Patients Association

28/06/2014

28/6/14

Dear Katherine Murphy,

I am a GP in Tower Hamlets and have been following the Government’s policy regarding GP practice boundaries with some bewilderment over the past 4 years. I became aware that the Patients Association was also keen to abolish GP practice boundaries in the interests of giving patients more ‘choice’. You will of course be aware that the policy will be rolled out in England, on a voluntary basis, from October 2014.

My difficulty has been that the proponents of this policy do not seem to take into account some very practical problems inherent in the policy, and have made claims for the benefits of such a model which simply do not add up.

One suggested benefit will be that patients will be able to register at a practice near their child’s school. The Department of Health mentioned this in their December 2011 launch of the Choose Your GP pilot, you mentioned it in your Huffington Post posting in March 2013, it is mentioned in the first section of the Proposal by the team who then evaluated the pilot, and it has been repeated in the press.

I question the wisdom of this proposal and have asked Jeremy Hunt, the Department of Health, and NHS England the questions below, but they have not answered me. Because you have also gone on the record publicly proposing this as one of the incentives, can you please give an answer to the following questions:

a. what benefit accrues to a child or parent(s) by registering with a GP practice near their child’s school? What might they be hoping to gain from this? Does this mean a parent registering with the practice, or the child, or both? Would all the children of the family register with the practice? Would both parents, in two parents families, register with the practice?

b. how would this work from a practical point of view? When would they want to be seen? How would they make appointments?

c. what, if any, are the possible risks or drawbacks with this arrangement?

I would be grateful for your comments on this.

 

With best wishes,

George

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

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24/7/14

I have not heard from Katherine Murphy or the Patients Association. I wonder why….

Is it the same reason why the Department of Health has not answered these questions, or NHS England?

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12/10/14

I have just sent the following email to the Patients Association:

Dear Katherine Murphy,

I sent you the email above on 28/6/14. I have not received a reply, so I am trying again. I will send this in the post as well in case there is some glitch in the system.

Best wishes,

George

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

[the above items sent in Royal Mail 24/10/14]

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My email to The Patients Association in June 2011.


A question for NHS England (London) on GP boundaries and patient access

31/01/2014

I have read a draft version of your Primary Care Commissioning Intentions for London 2014/15 London Region (v 1.1) and the following caught my eye:

….access to primary care services continues to be problematic for many Londoners. We are sure that the reaction and response to Call to Action will enable us to develop plans to improve access and the patient’s experience of access. Already, as part of the GP contract settlement for 2014/15, we will see a number of changes designed to improve access:

  • Choice of GP practice. From October 2014, all GP practices will be able to register from outside their traditional boundary areas without a duty to provide home visits. This will give members of the public greater freedom to choose the GP practice that best meets their needs. Area Teams will need to arrange in-hours urgent medical care when needed at or near home for patients who register with a practice away from home.

Can you explain how boundary-free general practice is going to improve patient access? Here in Tower Hamlets we cannot see how this will help.

Please leave a comment below.


NHS 111: If they tried, could they make the communication worse?

27/07/2013

We recently received a communication from NHS 111 about a telephone encounter with one of our patients.

I have removed any identifying details, and I suggest you read it. This is supposed to let us, his GPs, know about the conversation.

If this were a parody, we would say it was over the top.

I actually spoke with this patient soon after this NHS 111 conversation. She/he was on a phone list, waiting for me to return her/his call. She/he had rung NHS 111 to ask the significance of a blood result. It would have been wiser just to wait for me to ring to discuss the result.

That this national programme should have planned for such a shockingly opaque format for communications is very very worrying.

Whoever you are, please go back to the drawing board.


GPs refusing to extend their practice boundaries, from Pulse

17/07/2012

Pulse has published an article on the resistance by GPs to extend their practice boundaries. I have posted the following comment to this article:

When a practice decides on its practice boundaries, it needs to be clear about the ecology of the practice’s functioning. What are the outer limits in allowing the practice to deliver good quality primary care, in an efficient, cost effective, and safe way? This should be the prime, and perhaps only, consideration.

GPs should resist firmly policies that undermine the ecology of good quality British general practice.

The policy to abolish GP practice boundaries is, when you scratch the surface, a hollow shell, an illusion, which will introduce all sorts of problems and give only a limited number of resourceful individuals ‘choice’.

If this policy was a financial product, it would be charged with gross mis-selling.

It is very important in the coming months that the GP community become more resolute and clear about this, and refuse to implement changes which will cause the service to malfunction. It is important that this issue becomes more public, and that mainstream journalists gain an understanding of how general practice functions. At present, they rely on press releases from the Department of Health’s media centre.

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For a series of posts on the stupidity of this policy, click here


‘This is why practice boundaries exist’

16/06/2012

An article [link below] appeared in the BMA News in January 2012 illustrating why, from a purely practical point of view, GP practice boundaries exist. I have blogged previously with examples from our own practice [link below].

The article makes a number of important points: looking after people at some distance from the practice is time consuming. Not only is it difficult to look after these individuals well and safely, but to do so will impact on the service as a whole (so the service and care to the local population is affected).

This is why practice boundaries exist    Click here

Examples of patient care at a distance    Click here

 

 


14. How can they be so stupid? The Plot Against the NHS

05/06/2012

[This is the 14th in a series of 14 posts. I suggest you scroll down and start with Number 1]

The Plot Against the NHS is a book by Colin Leys and Stewart Player; I would recommend it, read it and judge for yourself.

Briefly, their thesis is that a ‘concordat’ was negotiated in 2000 by the Independent Healthcare Association with Tony Blair’s second Secretary of State for Health, Alan Milburn. ‘The Association’s leading negotiator, Tim Evans, was very clear on the ultimate aim of the concordat. He looked forward, he said, “to a time when the NHS would simply be a kitemark attached to the institutions and activities of a system of purely private providers.”‘ (page 1)

The authors document the steps that were taken to further this aim. They call it a plot because it was covert, never made explicit, never debated. ‘Neither parliament nor the public have ever been told honestly what was intended. Misrepresentation, obfuscation and deception have been involved at every stage.’ (2)

Some excerpts:

‘So in spite of it great popularity Britain’s most famous postwar oscial achevement was unravelled through a series of step-by-step ‘reforms’ each creating the basis for the next one, and always presented as mere improvements to the NHS as a public service. They were billed as measures to reduce waiting times, to offer more ‘choice’, to achieve ‘world class’ standards, to make the NHS more ‘patient-centred’—anything but the real underlying aim of the key strategists involved, to turn the health care back into a commodity and a source of profit.’ (5)

‘Each of the so-called reforms involved persistent, behind-the-scenes lobbying and fixing by a network of insiders—inside the Department of Health, above all, but also by a wider network, closely linked to the Department: corporate executives, management consultants, ministers’ ‘speacil advisers’, academics with free market sympathies and a taste for power, doctors with entrepreneurial ambitions—and the House of Commons Health Select Committee, packed with just enough compliant back-benchers and deliberately insulated from advice from expert critics of the market agenda. Not to mention a large and growing corporate lobby.’ (5)

‘Each ‘reform’ needed its own quantum of dissimulation and occasionally downright lies. The culture of the Department of Health was radically transformed. In place of old-fashioned ideas of accountability and fidelity to facts the priority shifted to misrepresentation and spin. This was accelerated by the fact that from the late 1990s onwards more and more private sector personnel were active inside the Department, often in leading roles.’ (5-6)

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These are just a few excerpts. I have bought and read the book. To me it helps make sense of DOH behaviours which are otherwise mind-bogglingly stupid.

If you understand the ‘Choose your GP’ policy as aiming to de-regulate English general practice and open it up to for-profit companies, then it is rather clever, not stupid. But it does rely on the public being duped, and not seeing through the duplicity and deception; and the journalists, and the GPs, and other health professionals.