Dr David Turner on what he would do to improve the NHS if he could go back in time
There is a famous joke about a tourist in Ireland asking a passer-by the way to Dublin. The passer-by responds:
‘Well, I wouldn’t start from here.’
I know the feeling, and Wes Streeting must also be beginning to understand the sentiment of this quote by now.
As healthcare professionals, I’m sure most of us get asked what we would do to improve the health service and I’m sure for many of us the answer is: build a time machine and go back a decade or so and start from then.
If Dr Who were available to provide me with the appropriate transport, I would firstly go back to 2004 and stop the introduction of QOF. Sold to us as a way of paying for performance, but really a trojan horse that led the way to the strangulating micromanagement we are now subject to.
While I was back in the past, I might point out to the government of the day how much OOH was going to cost them, and perhaps suggest they might like to give GPs just a fraction of that money and allow them to carry on organising their own OOH through cooperatives – which worked perfectly well for most.
I would caution against the introduction of NHS Direct, the predecessor of NHS 111, which has driven the demand for the ‘healthcare at the push of a button’ culture we now seem to be stuck with.
To the accountant examining their spreadsheet and looking at ways to save a few quid, I would point out the folly of scrapping the weekly postgraduate meetings most hospitals held, where consultants and GPs got to meet each other. I would advise the pen-pusher that the loose change they would save by cancelling these valuable networking events, would, in a couple of decades, be a significant factor in the breakdown of communication between primary and secondary care; their survival may have helped prevent the entrenchment of the ‘us and them’ mentality between GPs and our secondary care colleagues that we are now experiencing.
I might also speak to whoever was managing GP referrals and counsel against forcing all referrals to be made via anonymous online forms. If time permitted, I might explain that most things in life work better when one person is able to contact another directly by using their name.
If Dr Who was not in too much of a rush to get back to the future, I might stroll along to some of the community trusts and reassure them how valuable our district nurses, OTs, health visitors and CPNs are and how us seeing them regularly in our surgeries helps enormously in the day to day management of our most needy and vulnerable patients and how only the most myopic of spreadsheet gazers would do anything except increase the funding to these invaluable teams.
If the good doctor would indulge me with a bit more time in the Tardis, I would ask for a quick trip back to 1991 to have a word with Kenneth Baker, the then health secretary…
‘Internal market, bad idea Ken. The NHS is a service not a business. It says so on the tin’
Unfortunately though, we are where we are. We will have to wait for the latest review of what is wrong with the NHS and how Labour proposes to fix it.
… to be undertaken by a laparoscopic surgeon.
Dr David Turner is a GP in Hertfordshire. Read more of his blogs here.
Pulse's survey on collective action
GP partners in England - tell us your thoughts on collective action and you might win £100 of John Lewis tokens
Yes.
Going back to a time when General Practice, while not perfect, was working a darn sight better than it is now. Great idea.
This includes scrapping PCNs
Incentivise practices to work together or amalgamate in small groups that work well locally. There used to be a ‘Group Practice allowance’ That worked and didn’t need expensive Clinical Directors.
Its interesting to contemplate great swaths of these stupid ideas came from a labour government
We need to start again without PCNs and PCN CDs.
All other gradual NHS /Primary care changes and improvements will then follow.
Why are we allowing the insatiable greed of a small unrepresentative group of indifferent PCN CDs (not all) to continue to profit and line their own pockets while backing the deceiving & destructive government PCN vehicles which continue to impair on a piecemeal basis, the entire of core General Practice, the latter which we know is significantly more cost effective and allow these PCN CDs to extinguish/place on hold, the careers of countless newly qualified GPs amongst other primary care healthcare groups .
PCN CDs (as they are the undesirable upholding influence) remain the principal negative factor above any other causation in Primary Care perpetuating fragmentation via PCNs as they continue to be motivated by significant selfish personal financial gains and incentives to the detriment of all their colleagues and Primary Care as a whole.
PCN CDs , PCN CD payments and PCNs are the most wasteful use of NHS taxpayer resources in the chequered history of the NHS in my view.
While this ridiculous PCN CD group continues to be the main contact between true Primary Care and ICBs/NHSE they will continue to influence and promote their own personal financial gains at the cost to all others including their colleagues.
Long overdue time to scrap the NHS Titanic and replace with something that works.
At least labour funded it. Or allowed it to have inflationary uplifts