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Saturday 28 December 2013

I had some tests done at the hospital recently and the doctor phoned today with the results. I said to him, "So, is it good news or bad?" He replied, "Well put it this way, have you ever considered visiting Disneyland?"




At present, waits in Accident and Emergency are increasing, and the Government has placed the blame for this at the contract with general practitioners that was introduced by Labour in April 2004.  The argument of Jeremy Hunt is that since GP’s opted out of providing out of hours services, the numbers of patients attending A&E has increased and that the contract is responsible.  I doubt that is true that the contract is the reason for this. 

Lots of people in A&E have pointed out that large numbers of people who attend A&E state that they have not been able to see their GP which is why they present there, despite having a condition that is neither an Accident or an Emergency.  There are a few issues with this being blamed on GP’s.  One is that people attended Accident and Emergency before April 2004 stating that they could not get an appointment to see a GP at their surgery.  I know this is not accurate for a fact as I have worked in A&E and once, when there, a patient who was registered at a surgery with open access in the morning stated that they were not able to get an appointment.  In simple English, open access is where people attend their GP surgery in the morning and are seen, i.e. there are no issues about having to wait to see a GP in that if you need to see one, you take time off in the morning, wait and you will see one, i.e. the patient lied.  The other issue is that since 2004, out of hours care has changed.  Now if someone calls with chest pain, they are now, in many cases, sent an ambulance.  More recently this has also applied to strokes where time is now even more important considering the treatments that are available to reduce the disability caused by them.  These changes, which are medically indicated considering changes in technology and also in the understanding in the way that many medical conditions are now handled are reason that patients who in thepast would not be sent to A&E without an assessment by a doctor are nowbeing sent to the Emergency Department.

I am not saying that there are no patients who have problems making appointments to see a GP but this is not the only reason that there is an issue.

It has been argued that GP's need an increase in funding to help patients, and this is true as funding to general practice has been cut in real terms since 2010.  You can not expect GP surgeries to increase access without increasing funding to provide this.  It would be insane to go back to the 'old system' as thanks to the Quality Outcomes Framework that was put into place in 2004, patients have better care, and the government also has more information on the numbers of people with various conditions, which allows for better planning of the health of the nation.  Obtaining this information costs the NHS money to obtain, but getting this information and treating patients to the targets set saves lives.

What is important to note as well, is that there is an exodus of doctors from the country.  Those who work in A&E are leaving and the same is seen with GP's.  Unless things are made better with the work life balance of doctors, more doctors will leave the NHS which will mean that the NHS will be worse off.  That is not counting the increasing costs of advances in medical technology which in general are over and above the general inflation rate.

As I said, the NHS needs more money.  That is if we really want it to work.