Thursday, November 12, 2015

Hospital Consultants: Who needs them?

In Bad Medicine, Dr No caused a heated debate about General Practice:

Today’s GPs tend to be shy of their trade roots, not to mention more than a little miffed at the general presumption that they are country cousins to the hospital’s specialists. And so, over recent decades, they have followed the classical route to professionalisation, or, as our friends in the sociology line call it, ‘occupational closure’: defining a unique core body of knowledge gained by training (the vocational training scheme for general practice), the establishment of entry qualifications and lists of accredited registered practitioners (the MRCGP, and the GMC’s GP Register and locally held ‘Performers Lists’) – prior to these developments, any doctor could work as a GP – and the setting up of a professional association – the Royal College of GPs. By these steps, a line in the medical sand has been drawn, demarcating general practitioners from other medical practitioners.

Dr No is not persuaded that an extra year (or two) of training will produce better GPs. Despite assertions to the contrary, general practice is not some form of medical rocket science; it is instead the agreeably specialised but none the less generic practice of medicine which simply does not need extended years of training. Bolting on more years of training will simply increase the divide between those who are fully qualified, and those as yet excluded. There will, if training is extended, be more GPs in training grades, and less in career grades. More seriously, the real learning – which starts with unsupervised practice – will be delayed.

Attempts to change our beloved NHS may indeed be met with the same failure experienced by some other well known brands, sometimes at great cost.

Perhaps politicians can learn from this: you can say all the bad things about the NHS and you can quote how badly we are doing but we still love our NHS for all its short comings.

Just look at the faith we have in our A&E departments to the point that Roy Lilly suggested:

inner city solution; close P'care and put GPs in A&E just like Detroit

There is even argument that GPs cannot do A&E work and A&E doctors cannot do GP work. What has gone wrong with medical training?

There is a very discrete attempt to change the name of A&E to ED.

Wow! Do people never learn from history?

No!!! NHS and A&E. Original please   

So if politicians have not been so interfering and allow us doctors, nurses and patients to make things work together we may indeed have a better NHS. All the analysis on the reform is clear about one thing: someone is going to make money and that means less money for actual health care.

I have maintained for some time that:

Most people in well paid jobs (including those at the GMC) have health insurance. GPs have traditionally been gatekeepers and asked for specialist help when needed. If we are honest about private insurance it is not about Primary Care, that most of us have quick access to; it is about Specialist Care, from IVF to Caesarian Section ( and there are no Nurse Specialists doing that yet), from Appendectomy to Colonic Cancer treatment (and Bare Foot doctors in the Mao era cannot do the latter either), from keyhole knee work for Cricketers to full hip-replacements, from Stents to Heart Transplants, from Anorexia Nervosa to Schizophrenia, from Trigeminal Neuralgia to Multifocal Glioma, from prostate cancer to kidney transplant and I could go on and on. China realised in 1986 you need well trained Specialists to do those. We do not seem to learn from the mistakes of others.

So do you really think that hospitals are not necessary, or not necessary for the average citizen of England. Soon they will be sold and it will be costly to buy them back.

What about medical training? If these hospitals are sold, who pays?

And watch out, someone, your parent, your spouse, your child and even your MP may need a Hospital Consultant one day. 

Soon rationing of health care will start. Only the view of flowers will be free!  Or at least of my photos:
©2013 Am Ang Zhang
©2013 Am Ang Zhang
©2013 Am Ang Zhang
Latest from Colin Leys

Decisions being made on the ground, however, suggest that the policy is being pushed ahead without public debate. In July NHS London explained its thinking on the reconfiguration of hospitals in the capital. Eight of London’s A&E units were to close. In their place ‘minor injury’ and ‘urgent care’ units would be opened, but located ‘away from hospitals to prevent people entering A&E unnecessarily’. Some of the eight targeted A&E departments have already been closed or are scheduled to close, and Lewisham’s would have been until Mr Hunt’s decision to close it was ruled unlawful. So it seems fair to suppose that concentrating A&E and maternity services – and the necessary depth of other supporting services – in a few very large hospitals, and in effect closing many of the rest, is one half of the model that NHS England are pursuing.


Quality premium will be paid to CCGs that achieve targets set by the board, including reducing avoidable emergency admissions, rolling out the friends and family test, reducing incidence of healthcare associated infections and reducing potential years of lives lost through amenable mortality.

A new game will start: Hospital Avoidance!!!

The part of Health Care  delivered by Hospital Consultants will be severely rationed. Many so called Foundation Trust Hospitals would be in severe financial difficulties as the new CCGs will be rationing Hospital based work from A & E to Stent procedures so that the FT Hospitals will be forced to make money from private work and mainly from overseas as most citizens are still paying for the collapse of the likes of RBS, Northern Rock & HBOS.

Just look at A & E, Urgent Care Centres are set up by the new CCGs to avoid paying hospitals and if you use OOH or A & E too often, you might by removed from their list. There will be other life style excuses to exclude even Type 2 Diabetes.

Waiting time may once again be used as an excuse for rationing and this may be because of the 49% private work load. Who knows, would many consultant still be with the State side of NHS? My dentist went totally private years ago and never looked back. Do we really have such short memories?

If you do not believe the plot, the tactics are already in place to separate Primary and Secondary Health Care: 

Care pathways
Case management
Demand management
Clinical and financial alignment
Risk stratification

Inappropriate referrals
Referral protocols 

Rules-based medicine
Referral management systems 

Admission avoidance

Doctors will not be involved to avoid problems with the GMC!!!

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