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Monday, 27 May 2013

Blowing a gasket



Politicians hijacked the family doctor label and used it to sell the changes in the NHS to an uncomprehending, trusting public. Now secretary of state for health, Jeremy Hunt wants family doctors back in their surgeries doing what they do best as well as running the night shift in order to keep people out of A&E. It’s not going to work.

As a nurse who trained under the old order in what was basically an apprenticeship as well as under the new order in a return to practice course, I felt ‘qualified’ to comment in my last post about nurses. I decried the idea that student nurses should spend a year working as healthcare assistants before being allowed to train as student nurses. 

A month later I find myself writing about GPs – they being the latest professionals under attack from the coalition government. My ‘qualification’ here is more third party. As the daughter of a GP and also the sister of one, I’ve plenty of experience of how the job affects family life and, having worked professionally with GPs, I feel I have an insight into their workload and, to a certain extent, what drives them. And, of course, being a patient gives me the shop window view.

I confess to more than a little hypocrisy, having complained myself about the curmudgeonly, recalcitrant nature that is at the core of many a GP (with no one being more recalcitrant than my late father who took things to another level). However, GPs having long been on a pedestal must now feel they can’t do right for doing wrong. Having been given the keys to the  commissioning purse as part of the Lansley changes to the health service thus distracting them from their day job, they are now being castigated for having given up their night role 10 years ago which apparently has only now started to affect A&E services. Speaking at the King’s Fund recently, Secretary of State Jeremy Hunt, told GPs to take responsibility for the care of their patients out of hours http://www.telegraph.co.uk/health/10077146/Jeremy-Hunt-orders-GPs-to-take-charge-of-out-of-hours-care-as-row-escalates.html

Hunt complains that we have lost sight of the concept of the family doctor. We? I think he means politicians lost sight of the family doctor when they appointed them as head honchos buying services for their patients instead of referring to them; making GPs responsible for the health of the local population when their skill lay in the clinical needs of the individual patient in front of them.

My local GP surgery, may not implement with gusto all the various public health measures that I think would be a great idea just because they are ‘ideally placed’ in the community but, when push comes to shove, they have always been on the side of the patient. They have provided excellent care to me and my family, expedited appointments and been fantastic support at times of need.

Much has been written about the problems with A&E: the rising numbers of patients being admitted via their doors and the long waits which we thought were a thing of the past. Statistics have been bandied about with a variety of commentators offering their views and reasons.  The pressures on A&E have undoubtedly been caused by a range of factors – a cut in the number of inpatient beds means people back up in A& E waiting for admission. The cuts to social care mean that people may not cope so well at home and seek admission to hospital and, with less support in the community, it is harder to discharge people from hospital.  The whole system is under pressure and the gasket is blowing in A&E.


When it comes to the arguments over A&E numbers, I found the King’s Fund’s John Appleby’s blog the most compelling argument for why numbers were increasing and why there’s no need to panic: http://www.kingsfund.org.uk/blog/2013/04/are-accident-and-emergency-attendances-increasing

His logic has to make you wonder; is the media storm over A&E nothing but a stirring of the hornet’s nest creating an impression of a ‘failing’ NHS that needs saving by the private sector? Hmmm, can’t see that working either. If there’s one thing that presents at the door of A&E it is ‘difficult’ patients and that’s one thing the private sector doesn’t want. ‘Difficult’ patients with complex social circumstances, co-morbidities and distressed relatives are time consuming and expensive. Paying for care at the entrance of A&E would truly be the end of 60 years of care free at the point of delivery. I wonder when that idea will be voiced?