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'Terry and Jerry'

Still practising

Chris Preece

Tuesday, 25 October 2016

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NHS_shutterstock_391037992.jpgDear Theresa and Jeremy (Terry and Jerry? No? OK then…)

It’s been a funny couple of weeks hasn’t it? I gather Jerry got booed at the NAPC Conference, and you’ve both had a certain amount of flack over the announcement that you’ll not be allocating any further funds to the NHS. (Nobody mention the bus, right?)

It’s tempting to sit here and rub more salt in the wound, but we all know that won’t change anything, so instead I’m going to offer you some help. I’m going to tell you how to “fix” the NHS (assuming you have any interest in doing so). Better still, I’m going to stick with your rules regarding no further investment in the NHS. (Though, for the record - if I were in charge, I’d stick up the taxes for people like me, and spend the lot on getting our faltering health system back on track.) So, here, in less than 1,000 words, is your answer…

Step 1 – Be honest

I didn’t say it would be easy. If you want to stand any chance of pulling this off, you’re going to have to start being honest. Stop telling everyone that the NHS is going to be OK. Stop pretending that there are a bunch of magical efficiency savings out there that will add up to £22 billion and accommodate for rising health costs.

If you want behaviour to change, you have to tell people that there’s actually a problem. If you’re not going to spend money, you have to be frank about the repercussions of that. The NHS is in crisis. You know it. I know it. Let’s stop pretending otherwise. I keep seeing all this “make Britain great again” nonsense, so let’s do try a bit of the old Dunkirk spirit shall we?

We’ll need it for…

Step 2 – Rationing

If you can’t afford everything you’re doing, then you need to stop doing some things. You know this – it’s the cornerstone of your beloved austerity politics. So let’s have a public debate about what we need to stop. (See step 1.) However, let’s move the debate away from targeting smokers and the obese – not addressing their health issues just gives you more to pay for later on and besides, these are problems typically seen in people who have little money. (You won’t solve the obesity epidemic so long as it remains cheaper to buy a bag of frozen sausage rolls then a bag of frozen apples.)

Instead, let’s target all those problems that cost the NHS money, but are entirely preventable and pretty much exclusive to those who could afford an alternative. You want to go on a skiing holiday? Ride a horse? Do some other obviously dangerous pursuit just for the fun of it? You need insurance to cover you.

Speaking of insurance – maybe the NHS should be claiming the full cost of personal injury following road traffic accidents from insurers? Perhaps it’s time that employers covered the full cost of patching up their employees as the result of work based accidents? If a private health provider makes a mistake that results in an individual needing NHS care to correct their errors, then that provider should fit the bill.

Step 3 – NHS Providers should provide full treatment pathways for all patients.

Speaking of private providers - if they want to provide NHS care, they have to provide everything in that pathway: if they do a hip replacement, they have to provide the physiotherapy afterwards too. If they want their patients to have follow up blood tests, they need to do them, or pay primary care to take on that responsibility on their behalf.

By the same token, if a provider wants to provide NHS care, they have to see everyone: no choosing patients who look like they’ll be easy. No relying on the NHS to pick up the pieces if they make a mistake. The same criteria for treatment need to apply whether it’s an NHS hospital or not. Otherwise, they don’t get to be part of the “market”.

The NHS can no longer afford to prop up the inadequacies and incompetence of our private partners.

Step 4 – Sort out Social Care

Yes, OK, I’m cheating now. However, I only actually promised not to ask for more money for the NHS. A reasonable chunk of the current strain being felt by the NHS comes down to the swathing cuts from social care. You want to get people out of hospital beds? Then you need to invest in care beds and/or home support. You want people to stop presenting to GPs and A&E with problems that aren’t medical? Give them someone else to talk to. You want to deal with obesity, smoking, alcoholism, drug addiction? Then subsidise healthier options, put gym equipment in parks, give people something to do...

You get the idea.

Step 5 – Put your policy where your mouth is.

In the unlikely event that you ever come to read the suggestions above (far from everything I could write, but my poor editor doesn’t have all week), I’m quite sure they will be dismissed. After all, from your perspective honesty won’t get you elected - nor will rationing, or shoving up everyone’s existing insurance costs. It seems equally unlikely you’ll risk upsetting all the private health providers and as for social care… You seem to have largely given upon that some time ago.

But here’s the rub. I’ve seen both of you espouse the importance of the NHS in speeches. Which is lovely, really. But you need to show you mean it. Saying you’ll make vague investments of £10 billion, but acknowledging it’s not enough doesn’t really cut it. So make a choice - either make these changes, invest in the NHS properly, or admit you have no desire to save it at all, and put us out of our collective misery.

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Chris Preece

Chris has worked as a GP Partner in North Yorkshire since 2004, and still relishes the peculiar challenge of never quite knowing what the next person through the door is going to present with. He was the chair of his local Practice Based Commissioning Group, and when this evolved into a CCG he joined the Governing Body, ultimately leaving in April 2015. He continues to work with the CCG in an advisory capacity. When not being consumed by all things medical, Chris occupies himself by writing, gaming, and indulging the whims of his children. He has previously written and performed in a number of pantomimes and occupied the fourth plinth in Trafalgar Square. Tragically, his patients no longer tell him he looks too young to be a doctor.
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