Austerity in the GP surgery

Curious.

We – my wife and I together – joined our current GP practice because the service was simply so much better than any other we’d known.

The practice is associated with a walk-in centre, which itself provided great support for patients: anyone needing care immediately but not urgently – in other words, patients who were sick or in pain but not obviously suffering from anything potentially life-threatening – could attend the centre and be seen, seven days a week, from early morning into the evening.

A generous service. But not one it pays to cut

That’s a relatively expensive service to provide. There is at large today, throughout the Western world, a view that such expense should be cut back wherever possible. I wrote the other day that it’s often in the little things that we see austerity economics at work, and our GP practice is no exception.

Today, Saturday, I tried to renew a prescription on-line. That didn’t work. I could log in to the system but the buttons thoughtfully provided to select a medication to renew simply didn’t react if I clicked on them (and, before I’m challenged as a computer illiterate, let me assure you that I tried on two machines, using tree different browsers between them).

I then phoned the surgery but was told that, while the walk-in centre was open, the surgery itself was not. Could I ring in again on Monday?

“Yes,” my wife told me, “we’ve had a couple of letters. Funding’s been reduced so that they can’t stay open at weekends any longer.”

Once more, I felt the glacial fingers of austerity gripping my innards.

If the GP practice is facing cutbacks, the walk-in centre won’t be far behind.

While the service it provides seems generous, it’s only those with the narrowest of account-book outlooks, entirely focused on the short term – in other words, Conservatives – who can persuade themselves that such a cutback makes sense. It’s true that shutting down a walk-in centre would save a lot more money than shutting any other kind of practice but, unfortunately, the patients who use it won’t go away. They still feel ill or in pain, so if they can’t find care from a GP, they’ll go to the emergency department of the local hospital instead.

An emergency department is far more expensively equipped than any GP surgery. I’m not just talking about physical equipment, much of which is indeed costly: for instance, devices to provide a view of what’s happening inside a human body, whether by ultrasound, radiology, or some of the more powerful and sophisticated techniques now available such as CT or MRI scanning. However, even that fades into insignificance compared to cost of staff: medical and nursing staff on a wide hierarchical range, professional support such as pharmacists and various types of therapists, and even administrative staff.

The result is that while it may cost £50 to see a GP, it can cost £124 on average to attend an emergency department.

Cutting back on GP care is, therefore, a false economy.

There’s nothing unusual in that consequence of Conservative healthcare policy. All over England, hospitals are spending a fortune on agency or bank staff (“bank” is in effect overtime: existing staff doing additional hours on a far more expensive, hourly-paid basis). Why are they spending so much? Because they’re being denied the funds to take on more permanent staff, though that would be cheaper.

Of course, the false economy of shutting the walk-in centre would turn into a real one, if the patients denied treatment were unable to attend an emergency department instead. But for that to happen, our local hospital would have to close, or be replaced by a private one which only treated patients who could pay the full, economic cost of the care it provided.

I suspect a lot of people at the top of the Conservative Party would be perfectly easy about that happening.

However, I wonder if all their voters, further down the income range, would agree with them…

Don't mess with the NHS

If there’s one institution that the English are particularly fond of it has to be the National Health Service. Even fonder, I sometimes think, than they are of the royal family.

That doesn’t mean we don’t complain about it. Everyone has a horror story of nurses behaving with cruel indifference, doctors failing to make obvious diagnoses, or staff generally being incompetent or downright lazy.

But raise a finger to damage our NHS and the English will be down on you like a ton of bricks. That’s ours. Lay off.

Funny considering that anti-healthcare reform Americans pointed to the NHS as a cautionary tale of how awful a national system could be. And yet over this side of the Atlantic, we love that curious old institution.



The cry running through the land

So if you’re going to come up with a brave new plan to revolutionise the way the NHS works, you’d better make sure everyone out there thinks it’s really smart, really good and really going to deliver everything you claim for it.

Which is why it looks as though the present government is about to scrap all the most radical proposals in the reforms it proclaimed with great fanfares on taking office last year. It hasn’t convinced anybody very much that they’re going to make things any better. Or even that they’ll avoid making things a lot worse.

In particular, it looks as though the government will massively water down the plan to hand over budgets for hospital care to General Practitioners. It sounded like a good idea when they first came up with it but, you know what they say, the devil’s in the detail.

On the surface, it makes perfect sense to have GPs controlling hospital care. After all, they’re doctors so they know what the treatment involves and they know whether the patient needs it. What could be more appropriate?

The problem arises when you start to dig down a bit into the detail, into the actual practicalities of how to make the idea work.

First of all GPs are supposed to be treating patients. When are they supposed to be negotiating with hospitals about the care they’re going to provide? When are GPs going to find the time to get the best deal on the charges for that care? Because, oh, yes, if GPs hold budgets, they’ll have to get up to speed with financial management. And why should we imagine that because they’ve had seven or more years training in medicine, GPs are going to be particularly good at running businesses and managing finances?

It’s curious how many people seem to think that management doesn’t need specific skills. Management, like parenting, is one of the jobs that society generally assumes we can take on without any kind of training. The media report daily on the trail of disasters in family life or the business world that demonstrate how dangerous it is to make such blithe assumptions.

With neither the time to do the job themselves nor the specific skills or training , GPs would take on professional managers to do the job for them while they concentrate on delivering care to patients.

Which is exactly the way things are now. Making it surprising that anyone should propose to spend so much money, at a time when funds are in such short supply, on a series of reforms that would change so little.

Now it looks as though they’re going to abandon the reforms anyway. Which might make some of us wonder why they put them forward in the first place. Then again, perhaps it’s unfair of me, a mere private citizen, to expect to understand the subtle workings of the minds that get to the top in politics.

On the other hand, it may not be irrelevant that politics is another of those areas in which people expect to be able to shine with no specific training. And no particular evidence of skill either, for that matter.