Health and Social Care Bill 2011

On recognising and naming MOOspeak from @Dhgovuk & @DeptHealthPress

19/01/2014

The Department of Health is a large organisation, with different departments performing different tasks. No doubt, there are some departments carrying out noble and important work, and many of the civil servants working at the DH are, I am sure, dedicated to trying to make a positive difference to the provision of healthcare in the UK (or is it just England now?).

But there are some departments, the ones handling the more politicised policies, that are having to plan, promote, and implement policies that are not actually positive ones, and where there are significant unintended consequences. During the debate surrounding the Health and Social Care Bill many criticisms and misgivings were articulated. The Department of Health was then having to defend these policies and the methodology by which they were being planned, and this was most evident in the statements issued to journalists in response to the critiques.

‘A spokesman for the Department of Health said, ………’; ‘a spokeswoman for the Department of Health resplied…..’. These statements were understandably designed to minimise the damage done by the critique of the moment, but it meant that they were often fatuous and disingenuous. And what was frustrating from the point of view of those of us who work within the health economy was the, for the most part, the journalists just accepted these statements at face value, even if they contained falsehoods.

An example of this was when, in February 2012, 154 senior paediatricians (including 19 professors) wrote a letter to the Lancet to voice their concerns about the damage that would be done by the Bill. This naturally received attention in the press.

The Department of Health’s response, as quoted in this article:

A spokeswoman for the Department of Health said: “We have listened and substantially strengthened the Bill following the listening exercise. It’s not true to say that the Health and Social Care Bill will fragment children’s healthcare. In fact, the Bill will help address the very concerns about fragmentation that the experts raise. It will help the NHS and other public services work together better for children, young people and their families. These 150 individuals represent just over 1% of the total members of the Royal College of Paediatricians and Children’s Health and cannot be taken as an accurate representation of the College, who we continue to work with.”

The template for these responses is seems to be something like this:

a) make a positive-sounding statement (‘we have listened and substantially strengthened the Bill’); b) refute the criticism (without responding to the substance of the criticism); c) make some positive-sounding noises about the policy (the Bill ‘will help the NHS and other public services…’; and, sometimes, d) undermine the credibility of those voicing the concerns (as in this case).

What struck me about this example at the time (and why I kept the links) was that some anonymous spokeswoman at the Department of Health (who almost certainly had no experience working in paediatrics or medicine and was in all likelihood a PR person) was implicitly afforded equal status in this debate. So we had some paediatricians saying one thing, countered by the (unsubstantiated) assertions of a ‘spokeswoman’ without any qualitifications. Paediatricians 1, Department of Health 1.

What we need is a basic analysis of these communications from the Department of Health, a deconstruction. And where the DH statements are dishonest, disingenuous, misleading, and just meaningless spin, they should be named and ‘outed’ in an efficient way.

For the moment, I am going to use the term ‘MOOspeak’, but I would be happy for any suggestions for a better term. Remember, it needs to be short so able to be used on Twitter.

I would suggest that if a journalist feels the the statement they receive qualifies as MOOspeak, that they write something like:

A spokeswoman from the the Department of Health, issued this MOOspeak statement: ‘Blah blah, etc…’

Or: A MOOspokesman for the Department of Health said, ‘Blah blah….’

Or: In a statement from the Department of Health, which sounded awfully like MOOspeak, …..

I think they would issue fewer MOOspeak statements and we would have a more honest discussion.

And then, perhaps, we could move on to politicians and their ‘speak’….

Leave a Comment » | Government Bullshit | Tagged: Government Misinformation, Health and Social Care Bill 2011, NHS, Propaganda | Permalink
Posted by gpprotest

My Submission to the Health Select Committee on GP practice boundaries

19/10/2013

[I sent this Submission to the Health Select Committee in May 2013. I have not heard from them.]

Submission by Dr George A. Farrelly, General Practitioner, regarding the Government policy intending to abolish GP practice boundaries. This submission is made in a personal capacity, though I believe I represent the views of many GP colleagues.

Summary:

The Government and Department of Health wish to abolish GP practice boundaries, saying that it will increase patient choice, drive up quality, and remove anachronistic constraints.

From my perspective as a GP with 25 years’ experience of trying to provide good quality general practice to a local community, this policy may sound attractive on the surface, but in reality will simply not work and will cause general practice to malfunction; in some cases it will be unsafe.

The Government and Department of Health are either remarkably stupid, or they have a hidden agenda and are engaged in an elaborate deception.

1. I am a GP in Tower Hamlets. My wife and I have run a small practice in Bow for 22 years (I had worked in Islington before that). The practice has grown, and we have two part-time salaried GPs and a GP registrar. Our aim has always been to provide good quality, evidence-based family medicine with a human touch. We are part of a local network of 5 practices in Bow (practices in Tower Hamlets are all part of a Network; there are 8 Networks). We are a training practice; we teach medical students.

Before studying medicine at St Bartholomew’s Hospital Medical College, I did an undergraduate degree in history (Harvard University, Magna cum laude), and a postgraduate degree in International Relations (LSE, MSc, Distinction).

In addition to my core job as a GP, I was Medical Director of the Tower Hamlets Out of Hours GP Co-Operative from 1997 to 2004. THEDOC, as it was called, provided out of hours GP cover for the Tower Hamlets population.

I feel very fortunate and privileged to be working as a GP. I feel very fortunate to be working in Tower Hamlets which has a tradition of committed GPs working collaboratively to provide good quality primary care for our population, and we have had the support of a forward-thinking PCT.

Good quality UK general practice is a national treasure, something to be nurtured, protected, sustained.

2. As GPs we serve a local community. Over the years, in our practice, we have had much experience looking after patients who have moved away, even only a few miles away in Tower Hamlets or Hackney, and who have wanted to remain registered with us.

We have found that living at a distance from the practice creates a barrier to care. We have found that these patients tend to delay being seen; that it is more difficult and time-consuming to manage their illnesses; sometimes they are too ill to travel to see us, and we are unable to visit them. At times it is unsafe.

As a result, we are firm with patients who move out of our practice area and ask them to register with a local GP.

And so when in 2009 politicians began to say that they wished to abolish practice boundaries, we were bewildered.

3. There are two main reasons why this proposal makes no sense:

a. first, because looking after patients at a distance does not work (for many reasons) and is at times unsafe; this becomes increasingly significant in proportion to the severity of the patient’s health problems. (1)

b. two, because GPs are all currently working at full capacity (indeed, in some cases, beyond their capacity). The ‘good’ practices are already ‘full’ and cannot accommodate a significant increase in demand. There is a risk that ‘outliers’ will take the place of local residents, or impact negatively on the services of local residents (further discuss in paragraph 5 below).

So there is a very serious design fault at the heart of this policy. For over two years I have been attempting to draw attention to the problems inherent in this policy by blogging, writing to MPs, and to journalists. Last Autumn I wrote 6 articles for the GP publication Pulse on this issue (2). And I published these articles on a separate self-contained blog. (3)

4. At first I thought the politicians and the policy makers were just uninformed, unaware of just how misguided the policy was. But the replies I received from the Department of Health simply did not make sense. (4) And so over time I have gradually come to the view that the evidence (evidence that is in the public domain) points towards a more disturbing process at work: that there is a hidden agenda behind this policy. My hypothesis is that the real aim here is to de-regulate general practice. At present, because it is geographically defined, it limits the type of business model that can be used to gain access to general practice. By removing the geographical element in primary care, you change significantly the business models and frameworks that can be applied.

But in order to abolish GP practice geographical boundaries, it has been necessary to create a pretext, or a series of pretexts. A narrative has been created and it has these elements: most people are happy with their GP; but some are not, and they should be able to have choice; GP practice boundaries constrain choice, they are old fashioned, anachronistic; there are a number of reasons why patients might want choice: to have a GP close to work, to register with a GP near their child’s school, to remain registered with their trusted GP should they move away; there might be a GP skilled in a disease in a practice outside their area; the only thing that is needed to make it all work is to sort out how visits will be done should the patient need one.

What this narrative leaves out are the two areas mentioned in paragraph 3 above: the systemic problems of patients living at a distance from their GP, and the problem of capacity. It also fails to mention the problems inherent in providing visits for people registered at a distance from their practice (see paragraph 9 below).

5. Some additional notes on the issue of capacity.

a. In our practice we have struggled with this. Because we are popular, people have wanted to register with us. This has driven us to a list size beyond our capacity which has a negative impact on the quality of the service we provide for our patients, and we have a workload which is unsustainable. The only way we have had to cope with this was to shrink our practice area further a few months ago. So there is no way we could cope with an additional influx of patients from Tower Hamlets (let alone anywhere in England as Andy Burnham promised in 2010); we are drowning as it is.

b. I came across an example recently which illustrates this problem quite eloquently. There is a practice in Kentish Town with a long established reputation; just the sort of practice that people for several miles around might want to join (if I did not know better, I would consider joining as they are less than 2 miles from where I live). If you go to their practice website you will see the issues they are wrestling with as raised by their patient representation group: they are having trouble providing access to their own patients to the GP of their choice. And those are their currently registered patients, all of whom reside within their practice boundary. (5)

c. Another example illustrates this in a farcical way. The Department of Health chose City and Hackney PCT as one of their pilot sites. The City of London is served by one practice, which has a list size of under 10,000. As it happens, the City of London Corporation and NHS Northeast London had commissioned a study into the practicalities of providing primary care services to the commuter population of the City and this was published. The conclusion was that something like 120,000 of the 360,000 commuters were likely to want to register with a GP practice in the City, which would require 50 more GPs, and additional practice nurses and infrastructure (6). So there was really no way that the sole City practice was going to be able to cater to commuters interested in taking part in the pilot.

6. Andy Burnham, then Secretary of State for Health, went to The King’s Fund in September 2009; in his speech he announced his Government’s intention to abolish GP boundaries within a year. He said this move would make a ‘good’ NHS ‘great’ (at least this is what the press reported; I have asked the DH to show me the press release for this occasion; thus far they have been unable to produce it). But what he said about this in his speech really amounted to nothing, it was meaningless to anyone who understands how general practice works (and does not work). (7)

7. The (Labour) Government’s ‘consultation’ on the issue of choice of GP practice was launched in March 2010. If you look at this ‘consultation’ with a critical eye it is clear that it steered the readers towards responding in certain ways to the questionnaire. It used the narrative outlined in paragraph 4 above.

When it published the results of the consultation, the DH claimed it showed that the public backed the idea of choosing your GP practice and doing away with practice boundaries. Of course it showed that, it was designed to show that. Had they been honest about the reality of general practice, the respondents would have said: given what you have told us, why are you even proposing this policy? (8)

8. The Department of Health agreed with the GPC to hold a pilot around this policy. (9) The pilot is in progress. The present Government went so far as to say, in their Mid-Term Review, that this pilot was evidence that the Government had improved the NHS. “We have improved the NHS by …..—allowing patients in six trial primary care trusts to register with a GP practice of their choice.” (10) What the report omitted to say was that GPs in two of the six PCT areas opted to boycott the pilot because of concerns of the impact on resources of the local health economy (one of the many problems inherent in this policy).(11) What they also failed to say was that out of a possible 345 practices in the pilot areas, only 42 practices had opted into the pilot, and that as of the beginning of the 2013, only 514 patients had registered with a practice under the scheme. (12)

This ‘pilot’ in no true sense tests this policy. The Government and DH say that there will be an independent evaluation of the pilot. Given their behaviour so far, my concern is that the ‘evaluation’ will somehow avoid scrutinising the policy itself, and deliver a favourable verdict. One way would be to focus on the patient experience, which will no doubt be positive.

9. The problem of visiting. People on all sides of the debate have acknowledged that the issue of visits would need to be addressed. But what most people have failed to grasp is the magnitude and breadth of this issue. At present, all patients are visited by their own GPs within working hours (8am to 6pm [or is it 6:30?]), Monday to Friday. And if the call is outside these hours, then there is a local arrangement for how these visits are covered. There have been problems with out of hours provision, with some high profile cases where patients have died due to not being assessed properly.

If this policy is enacted, then every area in England will require a structure to provide care for those who live at a distance from their registered GP. This provision will have to cover not only the out of hours time slots, but will of necessity be 24 hours a day, 7 days a week (because they will not have the cover of ‘their’ GP during working hours).

It is also important to understand that when a patient is seen out of hours, the notes from the encounter are sent to the registered GP. Almost always the notes contain a message that says something like this: ‘If not improving, for review by own GP.’ The trouble with the boundary free model is that there will be no local GP to manage the patient while unwell during working hours and at home. The out of hours service does not provide continuity of care, and does not arrange further investigation and referral where this is warranted.

10. There are a number of issues I have not mentioned in this submission, and this is by no means a complete critique of the proposed policy.

11. I think there is a case for finding a way to make good quality primary care accessible to people who work long hours at some distance from their homes. But the people designing a solution would have to adopt a sound methodology which would include honesty, common sense, and truly taking into account the ecology and practicalities of general practice.

12. Normally, if politicians or Government departments make unrealistic promises the media often provides a valuable corrective by scrutinising and challenging the claims. In the case of this policy, however, mainstream media have failed in this role, I think mainly due to ignorance of how general practice works. There have been three main waves of (limited) airing of the GP boundary issue in mainstream media: at the time of Burnham’s visit to the King’s Fund in September 2009, the launch of the Consultation in March 2010, and the press launch on 30/12/11. The mainstream press articles which appeared on those occasions essentially took the claims of the Department of Health (often misleading) and merely repeated them, as though they were ‘true’ and based in reality. (13) The mainstream press may at some stage wake up and review this issue.

13. I am making what is a serious and unsettling charge. The people involved in promoting this policy (ministers from both Labour and Conservative parties, and policy makers at the Department of Health) are trying to implement a policy which by its very design will cause primary care services to malfunction and cause real harm. These people have not done an honest risk assessment. They have promoted the policy in a very biased and misleading way. The result is that they have misled Parliament, journalists, and the citizens of England. If this policy were a financial product, it would be deemed mis-selling. In some senses, it is fraudulent.

14. I am writing as what some might call a ‘whistleblower’. That a busy GP, in a private capacity, should have to spend all this time in trying to get this message through to the politicians and those handling the levers of power seems to indicate that something is wrong. I am writing in the hope that you will listen and scrutinise this policy.

I am also writing so at least at a future date, should the policy be implemented and the inevitable problems surface, politicians and the Department of Health will not be able to say ‘Nobody warned us.’

George Farrelly

The Tredegar Practice
35 St Stephens Road
London E3 5JD

1. For an article which illustrates aspects of the problem, see an article by an inner city GP ; for some examples from our own practice.

2. Pulse articles

3. Stand-alone blog.

4. Email correspondence with DH.

5. Difficulties of a high quality practice providing access for their patients. This is a very common problem; essentially, most practices are looking after too many patients. This is a capacity issue.

6. Report on providing primary care needs to commuters to City of London.

7. For my article on Burnham’s visit to the King’s Fund.

8. For my article on the Government ‘consultation’

9. For my article on the Pilot

10. The Coalition: Together in the National Interest. Mid-Term Review; page 24.

11. http://bit.ly/12nP2UJ

12. http://bit.ly/15y86Wi

13. For my article on the press involvement

Leave a Comment » | Choosing your GP, Government Bullshit, Health Select Committee | Tagged: Choose Your GP, General Practice, GP practice boundaries, Health and Social Care Bill 2011, NHS | Permalink
Posted by gpprotest

Letter from a mum with a reason to stop privatisation NHS

06/03/2013

I received this email from Linda via 38 Degrees; it is self-explanatory. Please sign the petition if you have not already done so.

Dear George,

My name is Linda. I’m a long-standing 38 Degrees member, and I’m sending this email because I know first hand why it matters so much to stop the privatisation of our NHS.

On Friday afternoon, I will deliver a copy of the petition against NHS privatisation – which you and I have both signed – to the Health Minister.

When I hand the petition over, I will tell the Health Minister about what happened to my baby. He died when he was just seven weeks old whilst receiving care from my GP out-of-hours service – which had been recently privatised.

Can you help me have as many names as possible to hand in on Friday afternoon, by forwarding this email to as many of your friends as possible asking them to sign it too?

They can sign by simply clicking this link and adding their names:
https://secure.38degrees.org.uk/nhs-section75

Last week was a hard one for me. It was the inquest into the death of my baby son, Axel. He died last November from pneumonia. His illness went untreated despite repeated calls and visits over the course of five days to my NHS out-of-hours doctors’ service, which had been recently privatised.

I feel the inquest left many of the biggest questions unanswered – like what role NHS privatisation may have played in the mistakes which led to the death of my baby boy.

After hearing evidence of how that private health contractor had acted, I feel determined to do all I can to stop further privatisation of our NHS. That’s why I’ve decided to get more involved with 38 Degrees, and why I’m going to see the Health Minister this Friday. I’d really appreciate it you could help me get more names on the petition before I meet him.

Please, pass this email on, and ask your friends to sign the petition for this important campaign:
https://secure.38degrees.org.uk/nhs-section75

We had a bit of a breakthrough with this campaign yesterday. The government announced that because of all the pressure they would withdraw and rewrite their NHS privatisation regulations. The petition which I’d signed, along with 240,000 other 38 Degrees members, was mentioned in Parliament. That shows we can make a difference.

But I remember, as I’m sure that you will, that when the government promises to rewrite a plan, that doesn’t necessarily mean that the new version will be any better than the old one. We need to make sure they genuinely drop any attempt to force GPs to open up services to privatisation.

I would love to have as many signatures as possible by Friday afternoon when I visit the Health Minister. Please pass this message on to anyone you think might be interested: https://secure.38degrees.org.uk/nhs-section75

Thank you.

Linda

PS: You can read more about what happened to my baby in this piece in the Guardian: http://www.guardian.co.uk/society/2013/mar/02/nhs-commercialisation-bereaved-mother-fight But please sign the petition first: https://secure.38degrees.org.uk/nhs-section75

PPS: This email has been sent from Linda Peanberg King using the 38 Degrees system. Your email has not been shared with anyone else.

PPPS: In case you missed it, below is the 38 Degrees email we sent out last week at the start of this campaign:

A new fight over NHS privatisation has just begun. Jeremy Hunt is trying to use new powers, hidden within last year’s controversial NHS laws, to force local GPs to privatise more health services. [1] This is one of the things we were afraid might happen – and now our worst fears are being confirmed. We need to do all we can to stop it.

Jeremy Hunt’s new privatisation plot is contained within “NHS competition regulations”. [2] Usually these kinds of rules get quickly rubber-stamped by Parliament. This time, we need to get MPs and Lords to stand up to Hunt and block his plans. [3]

It’s a long shot, but we have a chance of stopping these changes because Hunt is breaking promises made to MPs when NHS laws were voted through last year. [4] If we generate a huge, public outcry to put pressure on the politicians who clung on to those promises last time the government attacked our NHS, we can convince them to stop these new laws.

Sign the petition against Jeremy Hunt’s new NHS privatisation plan here – we’ve got just a couple of days before we’ll need to deliver it:
https://secure.38degrees.org.uk/nhs-section75

Hunt’s new regulations (Statutory Instrument 257 under Section 75 of the Health & Social Care Act 2012) are like a catalogue of our worst fears. [5] GPs would have to open up every part of local health services to private companies, whether or not it’s what they or local people want. It would speed up the break up of the NHS, giving profit-hungry companies new rights to muscle in.

Last year, the government promised it wouldn’t go as far as forcing privatisation on local health services. Lots of MPs and Lords said these promises convinced them to vote for the NHS law. Now, we need to go back to these same MPs and Lords, and tell them to find some backbone. If they really voted for the law because of those promises, now they’ve got no excuse not to put a stop to Hunt’s latest privatising move.

Let’s build a petition to hand in to each of the MPs and Lords who believed the government’s promises on privatisation:
https://secure.38degrees.org.uk/nhs-section75

All over the country, 38 Degrees members have been working together to convince their local NHS decision makers to do the right thing and limit privatisation in their area. Now, government is trying to take that power away from local doctors and the patients they serve.

This is going to be tough. It could be the start of the second round of the fight to protect everything that’s precious about the NHS. But it’s the right thing to do, because we know that when private companies move in, all too often it doesn’t end well for patients.

Sign the petition now:
https://secure.38degrees.org.uk/nhs-section75

Leave a Comment » | When Government Policy is Harmful | Tagged: Health & Social Care Bill, Health and Social Care Bill 2011, NHS | Permalink
Posted by gpprotest

East London LMCs advise boycotting ‘Choose Your GP’ pilot

21/04/2012

Pulse has published an article on this, together with the letter.

My comment to the Pulse article:

Congratulations to the East London LMCs for taking this necessary step. Not only will the commuters using local GP practices be using local resources in terms of secondary care, community services, and prescribing costs, but do local practices really have the capacity to look after these additional patients without distracting them from their local registered populations?

PCT clusters throughout England are having to put in place contingency plans to look after patients who register at one of these pilot sites, but who then fall ill at home and need a GP. What is the cost of all of this? Where is this money coming from?

At all sorts of levels this is a crackpot policy. Either Lansley and the secret agents at the Department of Health are remarkably stupid, or, more likely, this policy is actually a smokescreen to de-regulate English general practice. Removing practice boundaries will open up general practice to an entirely different model which will be ‘liberating’ for organisations like Virgin Care, but will undermine British general practice.

They call this a pilot and they say that it will be ‘independently’ evaluated. I predict that as with other piloted policies, that plans to implement the nationwide roll-out will be made before the (sanitised?) evaluation is made public.

I believe it is possible to stop this policy, but this will require persistent clear-headed resistance to the impracticalities & inefficiencies that will inevitably be proposed. A light needs to be shone on this policy: why did none of the 3 political parties carry out a proper risk assessment of this policy? Why did the Department of Health avoid almost any mention of these risks in the so-call ‘Consultation’ two years ago?

It is really just a confidence trick, and the choice it promises is an illusion. The GP you’ve heard such good things about is actually working at full capacity already. The well-functioning practice you may have heard about works well with this population size, within this geographical area. Increase the list size, change the geography, and the system changes.

For more on this, see my blog www.onegpprotest.org

Leave a Comment » | Choosing your GP, Government Pilot, Lansley's Trojan Horse, The Illusion of Choice, Uncategorized | Tagged: Andrew Lansley, Choose Your GP, General Practice, Health and Social Care Bill 2011, Patient Registration | Permalink
Posted by gpprotest

Tower Hamlets CCG opposes Health and Social Care Bill

28/02/2012

The Tower Hamlets CCG (Clinical Commissioning Group), having conferred with the GP body in Tower Hamlets, have sent the following letter to David Cameron. See text below; see the actual letter here CCG letter opposing Health and Social Care Bill.

Tower Hamlets Clinical Commissioning Group

27 February 2012

The Right Honourable The Prime Minister

10 Downing Street

London

SW1A 2AA

Dear Prime Minister

The Board of NHS Tower Hamlets Clinical Commissioning Group ask you to reflect and to withdraw the Health and Social Care Bill.

Supporting improvements in the quality of patient care is our passion and focus. We support a strong role for clinical involvement in commissioning decisions that lead to better health outcomes for our patients. We do this already in Tower Hamlets. An Act of Parliament is not needed to make this happen.

Tower Hamlets Primary Care team has a long tradition and reputation for innovation and commitment to partnership working with patients and managers. We make the best of any challenges that come our way. Innovations include real improvements in the health of our patients with chronic illnesses like diabetes, the highest childhood vaccination rates in London, and an exemplary local out of hours service, delivered by our GPs and highly valued by patients.

We work in partnership with the community, hospital, local authority and community organisations, to improve and integrate services for the benefit of our patients. It is against this background that we represent the views of our local GPs in asking you to withdraw the Bill.

You are familiar with the submissions on the long-term implications of the Bill made by our professional representative organisations, the Royal College of General Practitioners and the British Medical Association. We share their concerns. We add to that our own experience. Clinicians, patients and managers in Tower Hamlets are determined to improve health and well-being, but your rolling restructuring of the NHS compromises our ability to focus on what really counts – improving quality of services for patients, and ensuring value for money during a period of financial restraint.

We care deeply about the patients that we see every day and we believe the improvements we all want to see in the NHS can be achieved without the bureaucracy generated by the Bill.

Your government has interpreted our commitment to our patients as support for the bill. It is not.

Yours

Dr Sam Everington

Chair, NHS Tower Hamlets Clinical Commissioning Group

c.c. Andrew Lansley, Secretary of State for Health

5 Comments | Health Bill | Tagged: CCG, Clinical Commissioning Group, General Practice, Health and Social Care Bill 2011, NHS, RCGP | Permalink
Posted by gpprotest

Exclusive: ‘DH leak reveals uncertainty over 11,000 PCT jobs’

07/01/2012

I have just read a Tweet that directed me to an article in the Health Service Journal. As a GP, I really have had no exposure to this publication, but because my wife is, as a CCG member, a subscriber, I have had a look at the online article. For those of you who have a subsciption, the link is

http://www.hsj.co.uk/news/policy/exclusive-dh-leak-reveals-uncertainty-over-11000-pct-jobs/5039825.article

What caught my eye was an online comment (and there are many). Of course it was anonymous, it would have to be under the circumstances. I will quote it, and hope the publishers of the HSJ do not mind. I have had to type it out manually as the cut and paste function does not seem to work (have they somehow disabled this?):

The trouble is that so many people are just trapped, however much they’d like to leave. It isn’t just pensions, it’s families. Not everyone can hopscotch across the country, and relocate every time there’s a reshuffle. And not everyone wants to live out of a suitcase as a consultant. Much as many people hate the drip drip drip atmosphere of low morale, uncertainty, bullying, witchfinders in HR, the top down culture, the erosion of pensions and wages–the list is endless–not many have a choice. And that’s the worst thing of all. Subjecting a system to relentless change with no thought of humanity or the impact on individual lives creates something where people just become good at survivial. And that is soul destroying.

I left 3 years ago when I hit 40 because I saw how poorly many people I’d admired and looked up to were treated when their faces didn’t fit with the new power barons or they wanted to retire early or they got ill, and I didn’t want to be in that situation in my 50s. Having put up with appalling behaviour that wouldn’t be countenanced in the private sector–bullying in the NHS is so systemic people almost expect it as part of the culture. I knew if I left it too late my chances’d be slimmer because the age profile is very different in industry, but I still work with the NHS and my heart goes out to everyone going through all this, many of whom I’ve known for > 15 years. It’s difficult everywhere–I’ve been made redundant but secured work again–and this is all going to get a lot worse as we get into the new financial year and the scale of redundancies becomes clearer.

Or is that the plan? The NHS implodes, no one wants to work in it and we have the insidious creep of privatisation like dentistry and opticians?!

I’ve delayed going to bed (it is now 23:40) in order to type this out. I’ve had to create a new category: Collateral Damage. Best wishes to the author of this comment and the authors of the other comments to this article.

There are many important things in this comment. I will mention one: ‘not many have a choice.’ How ironic: the DoH and Government want to offer ‘choice’ to all and sundry, and yet the people shovelling the shit have ‘no choice’.

I have assumed that the crap coming out of the DH was not the work of everyone in that organisation, but the wishes of a few ‘power barons’. And that there are a lot of people just trying to survive. Best wishes to those trying to survive, and a curse on the ‘power barons’ and the bullies, and the politicians who collude with all of this.

Good night to all people of good will.

Leave a Comment » | Collateral Damage | Tagged: Department of Health, Health and Social Care Bill 2011, NHS | Permalink
Posted by gpprotest

A simple story that illustrates why sick patients need a local GP

31/12/2011

Here is another story about caring for a patient at a distance

On a Tuesday in July 2011 I was taking the midday phone calls. A patient who had been seen that morning by one of my colleagues rang for further advice. My colleague had diagnosed a likely pyelonephritis and prescribed antibiotics, and sent a urine specimen to our local hospital for analysis. Pyelonephritis is a serious condition which not infrequently needs hospitalisation. The patient, under thirty and otherwise a fit and healthy person, was having shivers and felt the need for further advice. I told the patient that the ‘shivers’ might be due to a temperature and what to do about that, but that it might also be due to rigors due to the infection spreading to the blood. I advised that he/she continue taking the antibiotics, and take medication to lower his/her temperature, and to ring again if the shivering persisted or if he/she became more unwell.

The next afternoon at about 3pm the patient phoned again. The patient was still quite unwell. As it happens, I had been invited to speak to a group of mainly pyschotherapists about this blog, this Protest, and I was getting ready to leave for this meeting. I could see that the patient lived 2 blocks from the surgery and I thought I could drop by on my bicycle on the way to the meeting. I told the patient that I felt he/she needed to be seen. The patient said he/she would come to the surgery; I said to come straight away.

It took the patient 45 minutes to arrive. I assessed the patient, spoke to the duty medical team at our local hospital; we would continue to manage the patient at home, but if he/she got any worse, hospital review and possible admission would be necessary. I gave the patient a letter, in case he/she needed it.

The patient then said that he/she had moved address, and now lived in Hackney, a neighbouring borough. The patient had had to come to the surgery by minicab, hence the delay in getting to the surgery. The patient said: ‘This really does not work for me. I’ve moved but did not want to change doctors, but this does not work.’ What the patient meant was that getting medical care under his/her present circumstances was difficult, due to the distance. In fact, it did not work.

I told the patient that this had been my experience: looking after patients at a distance becomes more complex, and often unworkable. It works fine for patients who are well and do not need medical attention, but does not work if the patient becomes ill. I told the patient I was about to speak to a group about this problem, and the fact that the Health Bill was seeking to abolish practice boundaries and allow patients to register with a GP of their choice, regardless of where they lived. The patient said this did not make sense. I agreed. I encouraged the patient to find a local GP.

The next day the results of the urine test came back: the patient did in fact have a urinary tract infection, and the antibiotics she had should have treated the infection. I spoke with the patient on the phone; there had been an improvement. I warned him/her that if this recurred, he/she would need further investigation.

This is a simple story. It illustrates the problem well. The patient had delayed registering with a local GP because there were problems (limited choice given his/her new address). When he/she became ill and needed to see the GP, the practical issues became evident.

A core part of our work is looking after people who are sick. Sick people are less mobile. There is no getting away from this very basic fact. That is why patients need a primary care practice which is local, not distant. Distance is a barrier to care.

1 Comment | Examples of patient care at a distance | Tagged: Choose Your GP, GP practice boundaries, Health and Social Care Bill 2011 | Permalink
Posted by gpprotest

Thoughts on the GPC-DoH Agreement on GP Practice Boundary Issue

13/11/2011

News reached us just under 2 weeks ago the GPC and Department of Health had reached an agreement about the issue of practice boundaries. There are two provisions: 1. practices will be encouraged to reach an agreement with their PCTs about an ‘outer’ practice boundary which will allow patients to remain registered should they move outside the ‘inner’ practice boundary, ‘where clinically appropriate’. 2. There will be two or three city pilots for commuter patients to register with a participating practice close to their work, and an independent evaluation will be carried out.

I have campaigned on this issue, having seen the orignal proposed policy (patients in England being able to register with the GP practice of their choice, ‘anywhere in England’) as quite mad and unworkable. I am pleased with this outcome, and the GPC is to be commended for having negoiated this. As should the GP body that resisted the proposal.

This current arrangement implicitly recognises that general practice is a local and community-based technology, which the previous proposal (which all 3 major parties subscribed to) ignored entirely. Even the commuters will need to register with a practice not far from their work.

Of course, there are significant practicalities which will need to be addressed: who pays for the costs of the commuters? How is this money transferred? How does this fit in with Clinical Commissioning Groups and commissioning? Certain areas, such as the Isle of Dogs in Tower Hamlets which hosts Canary Wharf and a commuter population of about 100,00, will be affected very significantly. And then, what happens when the commuter is ill at home, how does he or she access local help, especially if the illness needs more than one GP encounter?

It is absolutely vital that the ‘independent evaluation organised by the Department [of Health]’ be truly independent and honest and rigorous (that is, not on the model of the so-called ‘consultation’ on this issue carried out by the DoH in March-July 2010 which was PR exercise which misled the respondents and Parliament).

It must be said that the inner and outer boundary model is something that some practices have had in place for many years already. Under the agreed provision, practices will have the option of having an ‘outer boundary’ and clearly they will have to choose a boundary that allows them to deliver a functioning service. That is well and good.

It is very important that the politicians and DoH do not attempt to resurrect this mad idea in the future, and that we make it clear to everyone that UK general practice is at its core a locally based technology which simply does not work on the same model as McDonald’s and mobile telephones. It may be possible to make exceptions in certain circumstances (such as the commuter), but this is an exception rather than the thin edge of the wedge.

A large wooden stake needs to be driven firmly into the heart of this vampire. That is why I will continue to write to MPs and continue to write about this issue because I have not covered all the ground yet.

Leave a Comment » | Choosing your GP, Health Bill, Uncategorized | Tagged: Choose Your GP, GP practice boundaries, Health and Social Care Bill 2011 | Permalink
Posted by gpprotest

Blog Stats

Recent Posts

Top Posts & Pages

Recommended

Pages

Future Posts

Categories

Search