OK, so I'm ranting on but what about?   Well, today Lord Darzi released an important Report on the NHS.  After all, that is what he is paid to do.   Part of that Report deals with that very popular knockabout subject, GP out of hours (OOH) provision.   It still hasn't penetrated the consciousness of even eminent medical Labour Ministers that they entered freely into a contract with GPs from a position of the utmost ignorance.  An ignorance which Darzi is still illustrating.  Neither he nor earlier supernumeries in the Health Department had the vaguest clue as to how hard pre-contract GPs were working to provide OOH care to their patients.

The politicians came from the position that GPs were idle buggers - and overpaid at that.

Sadly for them, and our patients, since they, the government through PCTs, willingly took on the provision of OOH care they have found it to be anything but a sinecure and that GPs had been working bloody hard.   No wonder, given the opportunity to opt out of OOH provision the vast majority of GPs  welcomed normal family life into their lives.

The response of this government was as honorable as you could expect from a government whose last two Prime Ministers were named Blair and Brown.   They whinged and spun and spun and lied and lied about the situation.  Anything rather than get on with honouring their obligations to the country by providing an efficient OOH service.  But, of course, they hadn't a clue - again - how to go about that and nor had the PCTs.   The result is a shambolic situation where patients are coming to great harm and even dieing.

Instead, Brown and Johnson - Secretary of State for Health - force feed a sympathetic media with stories of fat, idle, vastly overpaid family doctors.   Even the Tory Press seems to have learnt nothing form 10 years of Labour spin and lies.

So, now we find ourselves in the position where GPs are to be compelled to provide OOH.  It will be interesting to find out how the younger doctor just entering general practice take to this wheeze.   The older ones will simply bring forward their retirement date and leave Brown to get on with it.

Anyway, the trigger for this rant was the Press release from the Patients Forum which follows:

-----

Responding to Lord Darzi’s initial vision for the NHS, in the report ‘Our NHS, Our Future', Sharon Grant Chair of Commission for Patient and Public Involvement in Health, commented:

"We welcome many of the specific initiatives proposed in Lord Darzi's review - the extension of GP opening hours and the focus on dignity in health and social care have long been public concerns.

However, we are concerned that there is as yet little progress on the issue of accountability to patients and the wider community. Where there is mention of empowerment, it is with reference to staff rather than to users and the public. And there will be concern too that there are to be groups of staff, meeting behind closed doors, all across the country in future months to discuss the future of the NHS. That is not a way of working that is nowadays acceptable - and is inconsistent with current policy.

There are hard decisions to be faced in the future for the NHS, and they are far better made with the fullest involvement of patients and communities, working alongside managers, clinicians and staff. Staff are important, but so are the people who use and pay for the NHS and know their communities. Communities must not be excluded from the next stage of Lord Darzi's review - and out of it must come real answers on the accountability of the NHS of the future".

Notes

1.    Patient and Public Involvement (PPI) Forums began operation in December 2003 after almost 5,000 volunteers were recruited to over 400 PPI Forums. There is a PPI Forum for every NHS Trust, Primary Care Trust, and Foundation Trust in England.

2.   The Government is planning to abolish PPI Forums in 2008 and set up Local Involvement Networks (LINks) to replace them.  The Local Government and Public Involvement in Health Bill, the legislation which brings this change into force, is currently on its journey through Parliament.

----------------

A major major part of an OOH service is that it should be comprehensive and I haven't seen or heard any Minister, even important surgeons, make any pronouncement about that because it would have to be paid for (and they won't) and they couldn't get the staff, anyway.

What do I mean by "comprehensive"?  Simply that if a patient comes to an OOH routine surgery and is in need of urgent out-patient care, laboratory tests, bloods, X-rays, scans and the like, they should also be available OOH.   Otherwise, what's the point?

Even the Patients Forum spokesman doesn't seem to have twigged that.  Rather, he has jumped vigorously onto the government propaganda band-wagon, accepted that GPs are there to be pushed around and agreed that a GP OOH service is essential.  By the way, what they mean by a GP OOH service is not just doctors visiting houses at all hours but running routine surgeries for the convenience of the few.  Evidence?  A recent government survey - and I bet the result came as something of a shock to them - showed that 84% of patients were content with the GP service.  Oh, yes and 95% trusted their doctor whilst, was it really, 2% trusted the politicians since Blair's appearance on the scene.

So, for the sake of the ignorant Ministers and patient groups I will give a list of those health workers involved in the provision of primary care services.  The very people who will need to be found and paid if a proper OOH service is to be provided.  By the way, I bet the CBI didn't take these into its ludicrous calculations recently.

Here goes.   A GP surgery needs multiples of:  receptionists, secretaries, nurses, doctors, dispensers (or chemists will have to be open and will have to be staffed), community nurses, health visitors, midwives, social workers (Hah!), cleaners and, at the hospital (for what is the purpose of having a surgery open if the hospital isn't), extra telephonists, nurses, out-patient staff of all kinds, consultants, junior doctors (in sufficient numbers), laboratory technicians of all kinds, X-ray staff - and so we go on - and on.

All this in every town throughout the country! 

And all this expense and duplication of staff for the few people who don't think their health is important enough to take a little time off work.  Talk about waste.

All this ignorance in the Health Department even when there is an important surgeon in post as a Minister!

They must be rip-roaring mad!

Maybe if Blair, Brown and Co hadn't killed off medical goodwill with their constant lies and spin they may have had a chance but now?  I think not.   It's nice to be able to go out of an evening, perhaps to the school Open Evening.  Yes, GPs do have children.

I missed a lot of mine whilst they were growing up and I wouldn't do it again.

David Roberts

5/10/07)