Obama might be onto something...

As we recline in our armchairs in the evenings, with our bottle of stella and a kebab, safe in the knowledge that should we suffer indigestion, the NHS will respond within a very short space of time, even if it is simply some (rarely provided) sage advice about getting off our arse and buying some Gaviscon from the all night chemist (They do exist, albeit twenty miles away from said armchair....), we should give some thought to the USA
The US system is not very clever, it's very expensive, it treats the well off, well, and the poor terribly.
It is very very expensive because Primary Care is inexorably linked with Health Care Organisations, who own the Hospitals. The sytem exists to produce bills. Lots of bills. These go to Insurance companies.
If you have no health care you live in the ER. No cash and no investigation
Unlike the UK, because you don't need any cash. In general now, the more you get done to you, the more the hospital earns !!
Sadly in the UK, it ain't the Insurance companies who get the bill..it's you !!
Obama knows that the system is expensive and rubbish. The Americans have long looked at British Primary Care and liked what they see. Even the hospitals know that GPs can control cost where it matters. Many states now actively recruit British GPs......I have noted this.
So bearing that in mind, if you were in charge of British Health Care, would you recreate that model...... err no.

Oh, but yes you would, it appears.
Firstly offer a GP £6000 a year for 24/7 responsibility for 2000 patients, and then act surprised when he suggests you might like to try doing it for that money yourself.
Then spend about £18,000 delivering it and still make a dog's dinner of it.
Finally blame the GPs for giving it up in the first place

Then, having emasculated Primary Care by setting up a system that encourages salaried employment, not partnerships, introduce private competition, which requires splitting of block contracts and results in duplication and loss of economies of scale.
Demonstrate very little evidence of improvement in care, but as waiting times do come down though, this makes positive headlines for the Govt.
Drive up public expectation, force throough a culture of instant access, thus filling GP surgeries, walk in centres and A+E with stuff that previously wouldn't even have eased itself off the couch.
Allow large local hospitals to become self governing (Foundation Trusts), allow them to invoice Primary Care Organisations with far smaller accounting departments, for just about everything they do.
For example. Standard Gynaecology appointments apparently do not have an examination factored into the price. So if the Doctor actually examines the patient, that's an extra charge !!!
If a blood test is taken there's another..£150 !!
This produces massive expensive administration, loads of gaming, massively inflated running costs and sets the PCOs up to fail as they cannot hope to challenge the avalanche of imaginative billing that arrives. Foundation Trusts make loads of money and build nicer and bigger hospitals with lots of glass. PCO's run at a loss. Primary Care budgets go bust, and you can then state that Foundation Trusts are obviously by far the best people to run all that inefficient primary care........Oh bugger me, we seem to be in Massachusetts.

Swine Flu...

Hmm. Several rants ago, I was giving off about the new Black Death that we were in the midst of.
You will recall that I was somewhat underwhelmed by it all.
So here we are some months later. Admittedly we have had some deaths, as we do when we see flu outbreaks. It would appear that we could even identify an at risk group, namely the usual suspects plus under 5s and pregnant ladies..
And so we leapt (?) into action. Millions of doses of Tamiflu given to millions of people who probably didn't have it..and even if they did, had not much more than a bad cold. Of those, how many courses were taken, either at all or partly...
"Tell you what Doc, I had two whole days off work and I only took one of those tablets, cos they made me feel terrible."
Could we give the vaccine away...er no. I could have walked around my patch with a sandwich board and it would have made no difference..our vaccination clinics...wastelands !!
And as for the vaccine. "Its just like normal vaccine and made in the same way..."
Rubbish. It comes in one vial, has to be made up, it's bloody white for God's sake..and your arm aches like buggery for two days afterwards..
"It's been tested"..Yeah, on tens of thousands of NHS front line staff !
And so it went on. Total hysteria and totally overblown
A Liverpool study of 30 pts given Tamiflu by the Flu "no bloody" help line, discovered that only three actually had swine flu. Of the patients given Tamiflu, who weren't in hospital (One with Malaria and two with meningitis..I kid you not), only half had bothered taking it.
At the height of this, prior to the nirvana that was some untrained bloke on a phone in Stevenage, my partners and I were only fielding about five extra calls a day each.
I didn't need a multi-million pound waste of time, and my patients would have been managed better if I'd got on with it.
The result..loads of Tamiflu used when not needed, more of it lying around expiring and Christ knows how much vaccine will be lost.
Apologists state that I'd have been looking pretty foolish if there had been a genuine epidemic that needed all this...........not convinced, and frankly if there had been, secondary care would have been swamped anyway..look what happens on a bank holiday during a cold snap !!
Any wonder we're bankrupt as a country..
I'll start on Foundation Trusts, PBC and Payment by results next time