Copperfield on the déjà vu of the Darzi review
I don’t know who’s responsible for Lord Darzi’s frontal lobotomy, but they’ve done a damn fine job. The tone of his views on GPs seems to have pivoted from one which originally considered us as a group of outliers stuck in a contractual and operational permafrost, to a dramatically revised version. A version where he sees us as undermanned, under-resourced and undermined in every conceivable way, yet cost-effective and rising above all reasonable expectations.
Which sounds about right. Hurrah for darling Darzi v2.0! If only similar neurosurgical magic could be worked on the Government. No obvious change in mindset there, because their ‘radical’ reform to the NHS is as follows: shifts from hospital to community, from analogue to digital and from sickness to prevention.
Sorry, what year is this? It has already been demonstrated ad nauseam that moving services closer to patients simply moves those services (i.e. us) closer to retirement, probably because ‘shift’ in this context becomes ‘dump’. Yet this Big Idea is wheeled out with every health service shake-up like some bed-blocking geriatric and is then returned through the A&E revolving door for want of properly resourced community support.
As for a move from analogue to digital, I have just two words for you: Matt and Hancock. It’s a bit of a worry if the best this government can do is adopt a key plank of policy from a complete policy plank.
Which leaves us focusing on prevention rather than sickness. Never heard that one before. Oh, no, wait. Those with a 76-year memory can remind us that the concept of shifting from illness to health was the whole point behind the National Health Service (there’s a clue in the name). And if the NHS has taught us anything, it’s that this simple idea is (with a few notable exceptions, specifically vaccinations) at best naive, and at worst wrong. Which is why we spend so much effort on work-generating/diminishing returns preventive ‘madicine’ that the sick don’t get a look in.
What a wasted opportunity. Citing Darzi’s diagnosis of an NHS as ‘critical’ and being able to blame the Tories for putting it in ITU in the first place, could have been the ideal justification for the Government to genuinely and radically change the NHS. Instead, we have the same old same old, plus the usual warnings that GPs can’t have a medal (despite being Darzi-nominated) and they’re not just going to throw money at the problem.
There comes a point when you hear this so often that it tips you from mere despair into psychotic depression. Not quite to neurosurgical levels, though I might join the queue for ECT. Or do we GPs do that these days?
Dr Tony Copperfield is a GP in Essex. Read more of his blogs here
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Excellent. This doesn’t get said often enough – prevention does not reduce costs, it increases them.
An elderly gentleman hears a loud banging at the door in the middle of the night. He struggles downstairs, unlocks the door and is shocked to see death standing at his doorway hand outstretched a boney finger beckoning him to follow. “There must he some mistake!”, he cries in astonishment, “my diabetes was prevented 10 years ago by a government initiative!”.. “You got dementia” comes the weary reply “this way please”
Is there a new party in Govt? Can’t say I’ve noticed. Hoping for a happy, radically progressive ending to this Reeve’s Tale come October…
Prevention reduces costs when it is done by the correct party; ie government themselves with public health measures namely implementing the Dimbleby food report to target obesity-ie primary prevention
Costs more when you medically treat primary preventable conditions like obesity with medical intervention like obesity injections, bariatric surgery or all the downhill disease from obesity-anything from diabetes-the resultant IHD/CVA/CKD/retinal through to OSA, NAFLD, TJRs. THRs, HTN, etc, etc, etc.
Could do the right thing and save the NHS billions; implement Dimbleby report.
Or be the ‘party of business’ if by business you mean Big Pharma, Junk and Fast Food industry, etc
Correction – its not about saving money its about improving quality of life. Its pretty vacuous to suggest you can prove treating obesity saves society money. Sure you can design your analysis to show it saves money within the confines of your own pre-defined goal posts – e.g. over ten years, it saves this particular department of the health service or government this much money – but to find out whats actually happening you need to move the goal posts to include the rest of that individuals life, the whole economy, every cost that person will cause over the entirety of their life extended. Everybody will die. Show me an analysis based on saving money that includes the monetary cost of a population routinely living to 100 years of age. It’s marvellous for sure, but it’s not saving society any money..not at all. Suggesting so is clearly blinkered and lacking common sense. Aka from a politician.
I generally agree AB – preventing strokes might be cost effective though
I hope we can maintain the concept of informed dissent – it seems to be getting eroded a bit
We are trained to be non-judgmental but we have a tendency to be quite judgmental if a patient fails to produce a microalbumin on time
Prevention screening hires ct scans for lung cancer, FIT tests for 56 year olds, hpv vaccinations for boys all cost money..
I remember when they closed beds in community hospitals as it just wasted money with lots of patients lying in beds with no active managent. As a med reg on call i would sometimes be called to visit a hospital to provide input foe patients who had been languishing for weeks . They were patients in CCF or with type 2 diabetes who if they had been in an acute medical unit would have been treated with diuretics and sent home after 2 days or discharged the diabetic to be seen in clinic.
Its expensive and inefective.
Very well written. You have put into words what I was thinking. The NHS might well be in critical care but primary care is in pallor mortis.