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NHS 10 Year Plan: the view from my desk

Coalface tales

James Booth

Thursday, 10 January 2019

AdobeStock_191756524_jbblog.jpgSo, another year, another big plan for the NHS. On Monday, Teresa May announced “a truly historic moment” with the reveal of the NHS Ten Year Plan. Bearing in mind this was the same day that her colleagues were being called Nazis literally at the doors of Parliament and another possibly fictional drone had shut a major airport, it might have been easy to miss this on the Today programme, but it’s here. As Phil Hammond has pointed out on this site, a grand document laying out big plans is nothing new, we’ve had well over a dozen in the last twenty years. Even the title has an air of distinct weariness, as if at the very end of a brainstorming session in Whitehall, someone had said, “Sod it, just call it the Ten Year Plan, and we can go and get a curry.”

Sitting at my desk on Monday, waiting for the door to open and the clinics to completely book by 8:15, I had a think about where the problems lie for us in primary care. I wouldn’t have said I was hopeful to hear answers later that day, but perhaps some recognition of where we are and what we need might come. 

Capacity is my main problem; I simply do not have enough doctors to meet demand. I’ve lost three GPs at my practice in the last twelve months, two of whom are emigrating.  There is now barely a day in which I don’t need locums to patch holes in the rota; I’m very lucky to have a few regular, very good ones. Those three GPs have been replaced by one new full-time colleague who is an ornament to our profession…but her eight sessions are replacing sixteen.

We are over-regulated. I accept absolutely the need for professional oversight and governance, but my PM and I have just been told at a recent inspection that the protocols we had improved since the last inspection, haven’t been improved enough. A long day of questions and analysis, that didn’t at any point see a clinician directly interact with a patient. 

The interface between my surgery, the wider NHS, and social care – especially the latter – still feels difficult and scratchy. My IT works fine, and it’s actually one part of the surgery that I really have set up to my satisfaction (largely down to a fantastic PM). It still doesn’t really talk well to the hospital, and discharge information arrives late, if at all. It’s ever more difficult to actually speak to colleagues there. Social care problems remain an enormous headache, and my team pick up social problems and manage them all the time. Jeremy Hunt’s change in job title hasn’t really changed much beyond his letterhead.

The truth is, we are demoralised, and those of us on the floundering Good Ship NHS really need to see lifeboats steaming over to us at the moment. Will the Ten Year Plan be a bright orange motorboat, or some hastily tacked together driftwood bobbing over on a stormy sea?

Well, having now read the plans, it doesn’t seem hopeful to me.

What do we read about capacity?  Well, there’s not much of substance. Despite 60% of us in the NHS agreeing that this is the major problem we have, despite one in eleven posts being vacant, the Plan doesn’t include the detail on how this need will be met, that’s coming “later.” The funding for this bit hasn’t been even set yet. We’re currently asking the 5% of the NHS workforce who come from elsewhere in the EU to pay to stay here and work, and many of them don’t earn enough to put them past the government’s plan to only allow those on more than £30k to come in to work here. The sheer ingratitude of this approach, especially at a time like this, continues to stagger me.

There’s not much in there to reassure me about overregulation as well. There’s going to be a thinning out of QOF targets (fair enough) but these are to be replaced by new QIP targets. The devil here will of course be in the detail, but at a time when we all seem to be drowning in protocols, and pathways, this strikes me as a new way to feed the insatiable appetite of the NHS for paper without seeing much for it. 

Sarah Wollaston MP – who always strikes me as wise, actually – has already commented that previous plans have been let down by a failure to address issues with social care and austerity, leading to swinging cuts with that system. With this in mind, it’s enormously reassuring to note that the social care Green Paper promised for 2017…hasn’t yet materialised.

So, we move onto IT. Now here, at least, there’s some content to get our teeth into. In fact, pretty much all of the news coverage I have seen and read about primary care in the Plan has focused on this. Our Secretary of State seems to want the white heat of a technological revolution warming our consulting rooms; he promises that in time, any patient who wants to access me digitally will be able to, or be able to use a service such as GP At Hand. He’s promised online booking (my patients already have this), and an overhaul of GP IT which – frankly – is something primary care sorted out for itself years ago. Such explicit backing for online GP services, which in my opinion still have huge questions over efficacy and safety to be answered, is just nonsense. I know my patient population; very few of them would wish to consult with me via screen and for the majority of what I see acutely, it would be simply impossible to do so safely. I’ve got my work computer set up just how I like it, in short, and I don’t want Matt Hancock fiddling with it.

So: where do I see us going with this? I’ll leave the national level strategy to other, more qualified posters on this site and elsewhere. Sad to say, I see little in this plan that reassures me that the government have an understanding of our problems, and little in the way of practical solutions. Beneath the soundbites and the eye-grabbing initiatives, there’s not much there. The ship continues to flounder, and I’m still scanning the horizon for the help that never seems to come.

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James Booth

James qualified from UCL in 2002 and has been a GP partner in Chelmsford since 2006. He is also the named GP for Safeguarding Children locally. All views expressed are his own.
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