How do you feel about the new coalition government? Excited and enthused? Vaguely intrigued? Or as sceptical as ever? Labour spent 13 years promising to devolve power and encourage local leadership, while secretly controlling from the centre and bullying anyone who didn’t agree into submission (yes, I’m a sceptic). The Conservatives in opposition made some interesting noises (power back to GPs and a rebranded Department of Public Health, divorced from the day-to-day running of the NHS). But do GPs want to take control of the NHS when the money’s dried up and be mini-chancellors, taking a scalpel to public services, and copping all the flack from the press and public?
GPs are the best people to control what they know about (i.e. general practice), but not many of us have the commissioning expertise to sort out the wider NHS (and neither do many PCTs). But if PCTs are slashed back and SHAs removed altogether, it’ll be down to us to decide where the money goes and make all those efficiency savings, as well as opening our surgeries 12 hours a day, every day, and taking back control over out of hours. That’ll require an awful lot of amphetamine.
On top of that, GP commissioners are apparently going to be ‘gatekeepers to hospital reconfiguration’. Closing and merging hospitals might be necessary, but it’s the toughest job in the world because the public and press don’t like it, and MPs who are supportive in Parliament suddenly turn nasty when it’s on their patch. Also, there’s a legal duty to consult fully with the public and the threat of judicial review if we don’t. Labour’s excessively-funded NHS failed time and time again to do it properly, so what chance do GP commissioners have with all the other jobs we have to do?
These other jobs include accepting any patient who wants to join our practices (no more closed lists) and publishing performance data on individual doctors. In a year or so, significant event audits will be broadcast live on the Sky Audit Channel, and there’ll be a league table of our earnings as well as our cock ups. Any spend of public money in excess of £500 has to be searchable on Google. And someone (probably a resurrected David Laws) is to be given the job of ‘renegotiating the GP contract.’
Then there’s the tricky business of keeping the GMC and Royal Colleges afloat. Without relicensing, they have no purpose and yet the BMA is ardently against lumbering doctors with more regulation and more time away from the coal-face to tick yet more boxes. So 10 years after the Bristol Inquiry reported, we’re still wading through treacle on this one (although the Sky Live Surgery channel should pick up a few of the dangerously depressed and alcoholic).
Perhaps I’m being too sceptical but amid all the changes that inevitably accompany a new regimen, we must never lose sight of the patient. Ask patients what they want and they’ll say time, understanding, continuity, and eye contact. At present, they get a conveyer belt of target-obsessed robots staring at a computer screen and reclassifying depression as low mood so they won’t lose money if they forget to do a repeat PHQ-9 questionnaire. Medicine needs to rediscover its humanity more than anything else, and if GPs are going to be at the helm, we need to ensure that everything we do is in our patients’ best interests. If you can’t see the benefit, don’t do it—no matter how much bullying comes down from on high. Just hide under the practice manager’s desk until it goes away.G
Need a laugh? Dr Phil’s Rude Health Show is on DVD and on tour now, visit: www.drphilhammond.com
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