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Looking back and ahead

Medicine Balls

Phil Hammond

Monday, 19 December 2011

Phil_Hammond_Blog3_19thDecember2011.jpgWhat was the most significant event of 2011? The never-ending car crash that is the Health and Social Care Bill? The Mid Staffs Inquiry exposing just how inhumane the NHS can be? The handing over of a district general hospital to the private sector? Or realising you’re not going to be sued for misdiagnosing angina as indigestion?

Medicine is complex and stressful enough even without the backdrop of continuous redisorganisation. I recently sat in on a GP phone triage surgery where a valiantly calm and extraordinarily efficient GP fielded sixty calls in a few hours, at an average of two minutes each despite a computer system that kept freezing. They’d introduced phone triage to try to reduce the demand for consultations but – in a very deprived area – the demand had simply expanded to fill the slots available. Desperate patients with complex needs who couldn’t make it to the surgery or couldn’t get a regular appointment; the GP was their first port of call for just about everything. It was stressful enough just to watch but to do it every day would make your head explode.

The tidal waves of rising demand, expectation, longevity and chronic disease threatens to completely submerge general practice. No matter how many ‘work smarter’ seminars you go to, the demand doesn’t seem to go away, and creaming off GPs to become commissioners will simply send receptionists into tailspin as they desperately search for appointments on a Friday afternoon. It’ll be interesting to see how Circle manages to balance the books and keep patients and staff happy at Hinchingbrooke hospital but in general practice, private companies have come and gone in the NHS, unable to make profits without cherry picking.

One solution is for primary and secondary to integrate and share the load. The best integrated care organizations in America do everything they can to support community care and keep patients out of hospital. Indeed, any hospital admission is seen as a failure. Primary and secondary care share the same IT systems and it’s not unusual for, say, your ophthalmologist to remind you that you’re due a cervical smear. Above all, they lavish care on those with multiple chronic diseases who consume most of the resources to stop them getting sick. They have several advantages over the NHS – they don’t have the obligations of training and research and they can decide simply not to operate in, say, Pittsburgh if the patients are simply too sick and expensive. But the idea of a joined up service is surely something that the NHS should be striving for.

There are some really good examples of integration already in the NHS, but they remain islands of excellence in a sea of mediocrity. The NHS, far from being a service, is all too often a game of pass the buck between the different parts, hoping somebody else picks up the tab. The latest NHS Atlas of Variation has again revealed that your chances of receiving decent care or surviving an illness depends on where you live. But it also depends on the time of day. If you’re fortunate enough to have your life-threatening illness ‘in hours’, the chances of survival are greater than if you have it ‘out of hours’. The notion that there are designated hours for illnesses that predict whether you make it out of the NHS alive is ridiculous. Department of Health research has found that you’re 11% more likely to die on a Saturday and 16% more likely to die on a Sunday compared to being admitted on a Wednesday. At the very least we should rename every day Wednesday.

So Happy New Year to all those brave souls who have grasped the commissioning nettle and are trying to turn their local NHS into a high quality, joined up, closer to home, 24/7 service while making 4% efficiency savings. An even happier New Year to all those left behind in the surgery, trying to keep it afloat and spot the difference between angina and heartburn in a two minute phone call. 2012 is apparently the year of ‘more for less.’ But work is always limitless, time is always limited and the NHS will collapse like a soufflé if the staff burn out. If we want a better NHS, we need to look after the people working in it. Can someone stick that in Andrew Lansley’s cracker?

Author's Image

Phil Hammond

Phil Hammond is an NHS doctor, journalist, author, broadcaster, speaker and comedian. He qualified in 1987 and worked part time in general practice for over 20 years. For the past seven years he has worked in a specialist NHS team for young people with chronic fatigue. He presented five series of Trust Me, I’m a Doctor on BBC2, encouraging patients to be more involved, assertive and questioning. Phil is Private Eye’s medical correspondent; in 2012, he was shortlisted with Andrew Bousfield for the Martha Gellhorn Prize for Journalism for ‘Shoot the Messenger’, an investigation into the shocking treatment of NHS whistleblowers. In 2013 and 2014, he was judged to be one of the top 100 clinical leaders in the NHS by the Health Service Journal. As a comedian, Phil was half of the award-winning double-act Struck Off and Die, with Tony Gardner. He has done five solo UK tours, appeared on several TV shows, and has written five books.
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