Friday, September 9, 2011

Let the Games begin: No, not the Olympics! The New NHS

Looks like the games have started: There are two types, one they overdo things and another they under-do them.

The first one was highlighted dramatically in Panorama. The other is in Pulse. Both are the results in my view of the “Internal Market.” Or Money! Money! Money! 

It is the same patient and and the same money: our money. 

The Jobbing doctor is not happy:

Dear Jobbing Doctor,
'This patient has had a scan which shows........XXXX.'
Please will you arrange (and here comes a list of blood tests - clearly straight out of a set of guidelines) these blood tests prior to them attending hospital clinic.
Yours Sincerely,
Middle Grade Doctor

I suppose it was because this letter was the third in a list of letters I had on that day with instructions for me to do things on behalf of other clinicians. But this one irritated me. I was on-call, it was Friday afternoon. I had never seen the patient and didn’t refer, either. It was also the haughty, superior tone of the letter. I snapped, and decided to ring the hospital. The doctor concerned was 'not available' to speak to a GP, so I was transferred to speak to the secretary.

It is really important that you don’t shout at secretaries, as it really is not their fault who they work for. I composed myself and relied on my acting skills.

I spoke to her, explained that a hospital doctor had asked me to arrange a number of tests on one of our patients. I said it was not usual for clinicians to expect others to do their work for them, and I would respectfully suggest that if Doctor M wanted to have the results of tests, then he could organise it himself. If you request tests, then you should interpret those results yourself.

Internal Market:
The internal market has its advantages but the pitfalls are more than its worth. If reform is about better patient care then it is definitely the wrong way as it encourages distortion of good and efficient healthcare.

Mayo did well without it and we could as well. In fact we used to. Such a perverse system has caused a rift between primary and secondary care and is not helpful.

Many argued that it was there to pave the way for partial privatisation. I cannot honestly provide any counter argument. Why waste so much effort for so little return.

The only other possibility is that it is a covert form of rationing and soon not so covert but it would be done by your trusted family doctors, the GPs. It is the shifting of blame.

It has also been argued by those that promote privately controlled consortia that GPs stand to make lots of money. This could be directly from the total health budget or through some financial wizardry on the Stock Market. Remember Four Seasons, Qatar and RBS (our money) buy back?

The Royal Bank of Scotland, the biggest debt provider in a lending syndicate of more than 100, has agreed along with other senior lenders to cut the debts of the embattled Four Seasons by more than 50pc to £780m.

That is why many GPs in the consortia have links with private providers.

So primary care tried to save money and secondary care, for survival tried to extract as much as they could. Patients lose out in the process. It also encourages gross distortion of service at the hospital end and if allowed to continue leads to unholy “gaming” strategies.

On the other hand it is also very easy for some hospitals to fail and be gobbled up by privateers whose interest would be that of the money making specialties and not those that cannot be nicely packaged.

Patients come first:
A friend’s wife consulted me for a second opinion about her cardiac condition as her doctor husband has passed away a few years back. I am no cardiologist so I wrote to my cardiologist classmates (two in Hong Kong and one in the US) and within hours I had three very useful answers: all free. In our new NHS such consultations would have to be paid for. Sad really.

Mayo cross consult bottom to top and top to bottom as well. Who knows the bright young things might really be bright young things (quoted in one of my blogs).

Virtually all Mayo employees are salaried with no incentive payments, separating the number of patients seen or procedures performed from personal gain. That was how it was in our NHS hospitals. Payment for performance encourages gaming.

This sound perverse and is very much against the bonus culture. But remember such culture saw the collapse of the US financial system and ours and a few other EU countries including France.

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