Thursday, March 14, 2013

And the Challenge Continues

Now that 2013 is well and truly here and the partying is over, what can we expect from the NHS? Well, one thing is for sure, there isn’t going to be any new money in a hurry. The economy is failing to bounce back as the Chancellor had hoped, the top earners in the country are being plucked to a state of baldness and thus leaving these shores in droves to escape being skinned into the bargain, and the queues at the Food Banks are becoming longer; as is the waiting list for Tribunals to hear people’s appeals against the withdrawal of their state benefits.

The queue outside my surgery at 7.45am is not much better, either. We still cannot meet the burgeoning demand for appointments; the Department of Health is imposing even greater impossible targets onto us, and patients still book valuable GP appointments and then fail to keep them. GPs, overwhelmed by the aforementioned pressures, coupled with ultimatums from the Care Quality Commission, the requirement for revalidation with the General Medical Council, the expectation that we will balance the failing NHS budget through our work in the Clinical Commissioning Group, and the growing assault on NHS pensions, will continue to retire early or look for alternative employment. In the terms of Charles Dickens, the NHS is indeed a very bleak house.

Some months ago, I mentioned the Nicholson Challenge; essentially the challenge to find the difference between NHS funding and spending. Now, as any self-respecting housewife or businessman (oh, alright, any house-husband or business-woman) will tell you, there are only so many cost-savings that can be made before ‘cutbacks’ and ‘rationing’ come into play. With no extra funding, and costs rising by 4% minimum year-on-year, the problem is more than just a challenge, Nicholson or not; before long it will become impossible without some fundamental changes.

Cue crystal ball and zoom forward to 2015 and beyond. What is happening in the world of NHS General Practice? Well, for a start, I cannot see many small practices around; having either closed under the financial and quality-improvement pressures, or amalgamated with larger practices. There are also fewer older GPs working, having seen the sense of early retirement against ‘early-death-through-exhaustion’. Some practices have been taken over by private companies, staffed by a steady flow of changing faces; young, inexperienced doctors, many of whom are set on bigger goals. In more affluent areas, private GP surgeries are beginning to appear, where for a fee of £50 or so, you can see a GP for half-an hour in state-of-the-art premises. Those patients still dependent on the NHS are still in queues for just about everything; except that now, just like prescription charges, there is a ‘token fee’ for all sorts of things including blood tests, x-ray and scans, contraception, maternity care and A&E attendances. Hospitals still provide care, but families supply the food and bed-linen.

You think I am joking? Well, come and look at the finance books and tell me how it is not going to happen. The golden days of the NHS are fast becoming a memory.

(First published in the Scunthorpe Telegraph, Thursday, 10th January2013)

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