I recently spoke at an RCGP dinner during which a public health consultant said: ‘When we look back on it, I think we’ll find that 2010 was the pinnacle of the NHS.’ We were discussing whether the NHS could make savings of £20 billion by 2014 (no one was confident about that) and whether funding would increase again after that as the economy grew (not much confidence there either). There was a lot of retrospective annoyance that the record increase in funding under Labour hadn’t always been wisely spent, and had produced a service that just isn’t sustainable. But there was also widespread agreement that the NHS has improved over the last decade, even if it is now in danger of relapse.
As a journalist, I’ve spotted that most NHS disasters tend to happen with the perfect storm of rapid restructuring and huge efficiency savings. But even if we slow down the pace of change, as seems likely, most economists are predicting a gloomy future. Professor John Appleby, Chief Economist at the King’s Fund, is not a man to overdo the smiling. He’s predicting that at sometime during 2012, growth may just be back to where it was when the recession started in 2008.1 This means that the UK gross domestic product will be 15% smaller than it would have been without the recession, and that the loss is likely to be permanent.1 All this gloom means that, if we’re all still alive in 2019, we’ll find there’s a 50% shortfall in the funding Sir Derek Wanless predicted we’d need just to keep the NHS afloat.
Pessimists are often right, but they don’t live as long as optimists. When faced with a crisis, you need lots of energetic glass half-full optimists with lots of good ideas to get us out of the hole we’re in. This, I’m sure, is why GP commissioners should be given their chance. I’ve met quite a few of the really keen ones, and they have that manic excitement that often goes with sleep deprivation and workaholism. Economists tell me the evidence demonstrating that it is cheaper to provide nearly all healthcare outside hospital isn’t as robust as you’d think, but that won’t stop our keen commissioners redesigning patient pathways and moving everyone ‘upstream’.
Hopefully we’ll manage to redesign the NHS before the Care Quality Commission (CQC) starts inspecting GP surgeries. My dentist says that CQC stands for Can’t Quite Cope, and complains bitterly about the red tape surrounding his registration. It was surely an optimist who decided one organisation could regulate and inspect the whole of healthcare and social care, both NHS and private. The only people I’ve seen recently who look more exhausted than GP commissioners are CQC inspectors.
The bottom line is that safe, high-quality care occurs on the frontline, which is complex, ever changing, and needs our absolute focus. Labour tried to do too much from the top down and we need to rediscover what general practice is for. After the dinner, a GP sent me his tips for surviving the day job:
- Always look for the good in a personality. Always be encouraging, always provide hope
- Be generous with hugs (only avoid if you seriously fancy the patient!)
- Always be honest, even when it hurts
- Give bad news in a way the patient can tolerate. Sometimes, you need to drip feed information. Without hope there is no reason for living
- Be gracious when you’re wrong and no matter how under pressure you are, never take it out on your patients.
Whatever happens to the Health and Social Care Bill, GP commissioning, the economy, or the CQC, there are certain fundamentals of general practice that never change. And we can only deliver them if we don’t burn out. Now get some sleep!
Dr Phil's Rude Health Show is at the Edinburgh Fringe, 8–27 August
- Appleby J. Is this the dawn of an ice age? HSJ 2011; 2 June: 14–15.G
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