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General Practice and the Scissors of Doom!

28 August 2009

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Unfortunately the headline is not the title of a forthcoming Indiana Jones blockbuster regarding a renegade army general who commandeers a mythical pair of scissors with mystical powers. The Scissors of Doom is the title attributed to the graph depicting the amount of public sector borrowing against public sector spending over the last few years and into the foreseeable future.

Over the past decade, things haven’t been too bad, with income slightly higher than expenditure. But the lines have crossed and this marks the pivot of the scissors. Alistair Darling must have felt like Quatermass peering into the Pit as he looked at the public purse only to see a gaping void.(1)

This funding gap yawns ahead into the future. Indeed, many predict that it will be 2017 before the lines meet once more. The concern is that the only way to ensure that they do converge again means much pain for many – and it’s possible that those of us working in healthcare will feel it even more, after the recent above-inflation budgets.

The timing, for those of us in the primary care sector, will make matters worse for a number of reasons. We have just seen the launch of the Next Stage Review, wherein Dr Yes promised the world (and promptly bolted off leaving the Deliverance to someone else(2)). This is coupled with The Commitments in the form of the NHS Constitution, providing “rights” to both patients and staff. Great Expectations for all at a time when there will be fewer resources with which to work.

In the past month, we have seen the kind of irresponsible reporting that we in general practice have all become used to, with the Daily Mail “exclusively revealing” just how much doctors get paid.(3) To the uninitiated it will appear scandalous. However, those who take time to read the article will see how flawed it is – a fraction of a sample and miscomprehension of the sum.

However, effective use of resources is one area where practice managers will be forced to look, yet again, in the need to make savings. And nothing can be sacred. We may not be in the days of yore when it was a case of Doctor Dolittle, but the public are already aware of the fact that GPs can opt out of the out-of-hours service when they could not do this in the past.

One Flu Over the Cuckoo’s Nest
Another drain put upon resources comes in the form of swine flu. No one can dispute that staff in primary care – those in the frontline – have done an admiral job to date. Years of planning have ensured that the pending epidemic has not reached its potential. Granted, it has been a lighter than predicted strain, and there is always a greater threat in the next wave. But we have coped.

More worrying has been the public response. There was the instant demand for information and the setting up of the National Pandemic Flu Service.4 Needless to say, there was a predictable clamour for Tamiflu. Perhaps we should have an audit on what has happened to all the packs dispensed? Inevitably, a sizeable proportion will have remained unused while some will have been hoarded away for “future use”.

Slumdoc Millionaire
The current financial situation may have one major benefit to the health sector: it is making us all face the fact that we cannot continue to fund the NHS on the basis that we do at present. We simply do not have the resources to meet the expectations – but, possibly, we could meet essential needs. It requires a major debate to decide exactly what these needs are. It is not simply a case of Educating Rita, but equipping everyone with the facts, figures and options.

But don’t look to the politicians to lead on this in the coming year. With an imminent general election ahead, they will not want to tell the electorate the truth. You can use all the sophistry you like arguing over what is a cut and what is a saving. The bottom line is that we will not be able to do the same in 2012 as we are doing today.

There will be no holding out for the Thunderball in the lottery as an additional source of funds. That is already earmarked for the Olympics and, while it may be over in 2012, I will bet you a Fistful of Dollars that one of the legacies is over-expenditure.
While we touch upon the topic of education, can I make a simple plea? Don’t allow the training budget to suffer. We all must argue that this is investment that will bring savings in the future through staff retention, greater efficiency and a happier workforce, who will feel valued.

Stand By Me
As I have said, it will not be possible to Carry on Regardless. We know the situation, and the sooner we put the wheels in motion to address it and encourage others to do likewise, the sooner we will come out the other side. And we will. Because, like many of the patients that the NHS has saved time and again, it’s not a case of You Only Live Twice.

Finally, I would like to mention a network that you should all be aware of by now: the Practice Management Network (see Resource). This is a channel that can be used to raise issues and debates such as the above – there is no excuse for the practice manager to claim to be only a Little Voice anymore. Together, we can all be Dr Who and take on the daleks in Whitehall.

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NHS Practice Management Network