Cuts to the NHS

According the the Conservatives, the NHS is going to have to face cuts. The Labour party say that patients will suffer. Well, the former are damned right, as we can't keep treating the NHS like an open cheque book, and the latter may be right if we allow some pillock from the DOH, the Govt and certain SHA/PCTs to decide what is cut.
Firstly let's point out what labour have done well.
They have invested much needed money into the NHS.
QOF, DES/LES in principle are good ideas, but have become a beaurocratic and administrative nightmare to deliver, in what was sold as a paper-light contract.
It is now umpteen times more complex, and I spend many hours a week more than previously on administration, and thus not with patients
Waiting times for Outpatients, cancer care and procedures have plumetted
Choose and Book is excellent at finding your patient an appointment, and as the waiting times are globally down, they don't really exercise much choice because they can go local quickly.
Patients really value that booking facility, and I think it's marvellous
In fact the Choice part is a joke, as you can no longer specify a particular consultant, patients do not have enough information or sophistication in the main to know what a good service entails, and as I can't specify which consultant, I can't tell the patient any outcome for a particular referral anyway, as you might see anybody. Finally, if you work in deprived areas, patients cannot exercise choice, because travel is difficult for them .
NICE works a bit, but is too easily swayed by patient pressure groups and ministers fail to back them when public opinion gets too hot. (Who'd want to be chair of that?)
We have numerous new and better equipped hospitals, and clinicians are more accountable than before with revalidation moving apace. Probably good things as long as it is done sensibly .
GPs now earn on a par with their consultant colleagues, and whilst the Govt has now decided it overpays us, it forgets that it could not recruit GPs previously. The pay recognizes similar periods spent in training, GP as a proper speciality (I'm not a "failed" anything) and that whether Consultants like it or not, they could no more do my morning surgery than I could do theirs...although I think I'd manage a better stab in their OPD, than they'd manage in my room !!
So if the axe falls, where should it fall ?
Firstly the Govt needs to get off it's "Choice" rollercoaster. They spend a lot of time talking about "wants", but these, for purely political reasons, keep turning into "needs".
If you're a purchaser you can decide what you pay for a service. Well the tax-payer is the purchaser, but the Govt has never asked anybody how much it wants to pay, just what it "needs". It's hardly surprising that when taken to the Car Salesman, the public has opted for Bentleys not Kias, because it doesn't realise it ultimately has to pay !!
The population doesn't need routine access to a GP in the evenings or weekends.
The Govt is pumping billions into this agenda, despite over 85% of the public stating they were perfectly happy with things in the first place.
Anyone familiar with front line healthcare will tell you that demand for a service expands rapidly to fill capacity.
So we can assume that a few years of making this the norm will result in politicians expanding things further, for a few votes in middle England, the next time patient satisfaction drops below 90%...90% !!! What satisfaction does the country have with its politicians. You can get elected with fewer than 50% of the country voting for you !!
The 4 hour wait in A+E !
In principle a good idea........er, No it's not. It's palpably effing bananas.
Most A+E departments in the civilised world used established validated triage to establish how quickly a patient needs to be seen
In Manchester that's Red (Now), Orange (Quick), Yellow (2 hrs ?), Green (Should at least have come to A+E, but frankly could wait until tomorrow !) and Blue (Shouldn't be here at all !!)
I've never seen blue used as it's a bit politically sensitive !!
Now by all means apply a four hour rule to Yellow/Orange and Red. They are likely to be unwell and should be concentrated on, and, for sure, should be done and dusted within 4hrs max.
The greens and blues however, should simply have to wait until the other stuff is done
Many could be seen by GP services, and it is a perverse incentive, that a patient with a non-urgent problem, ringing my surgeryat 9am, and being given an appt for say 3:30, can instead jog on down to A+E and guarantee beeing seen for his ear wax by 1pm
And believe me it happens. Bloody madness.
No-one in front line services will have been surprised to see this happen...........but guess what, no-one asked us. They will have asked a focus group in Surbiton "Should you have to wait any longer than four hours in A+E". Full stop no ancillary questions.
We have many patients now admitted costing millions each year, largely because Yellow patients cannot be worked up suficiently for discharge in A+E within four hours, and breach if they're not put on a ward. That work up could be done, if the department was not also having to run flat out clearing green and blue stuff in the same sodding timescale.
Why don't attached GP services see the patients, you ask.
Easy, because the hospitals are foundation trusts and earn money according to the numbers of patients they see, so there is another perverse incentive to keep the department heaving and the admissions earn even more money. Bonkers !!
Darzi !!
Here's a good idea. Put an academic surgeon (who just happens to be a labour life peer) in charge of redesigning primary care. Ensure all he really understands is that London's GP services are a bit of a shambles, and ask him to sort it out.
I look forward to being asked to redesign vascular surgery services shortly. 'Cos I know bugger all about that, but probably more than he knows about GP (I at least spent 6 months on a vascular surgery firm)
Brilliant. So he looks at London (A singular problem, and one that did need a good looking at), comes up with a plan (not all of it bad), and then insists the model is implemented (with no dissent allowed) all over the country. Result ? Billions spent needlessly all over the country chasing an access problem that may not really have existed barring the need for a few votes in Hampshire.
In my PCT we have four new practices opening, only one of which is truly needed or offers innovation.
And then finally privatisation.
Where is the evidence that privatisation helps
The USA model is not exactly marvellous is it
Competition is healthy, but there are many ways of driving that and quality, other than getting Richard Branson in, to give public money to shareholders and turn GP into a franchise
No patient I have met seems to want McGP.
Nearly every contract given to private providers seems to under-perform, and since the NHS is crap at writing contracts (such was the rush to get private companies in), we are now paying millions for services that are not delivered (or possibly needed)
And underpinning all this procuring, commissioning, pathway development and tendering, is an army of paid advisers from the private sector (KPMG et al), earning millions of taxpayers money, when better more appropriate local advice could be got from local people and clinicians, for the price of a small room and some sandwiches.
If the cuts must fall, this lot would be a good place to start, as it is a national scandal, and very much a product of this administrations obsession with advisers and spin.

I'll be back...