This blog fully supports the NHS reforms. It is absolutely essential, in order to create a modern patient focused health service, to put the GPs at the centre, as it their ownership of the patient which will bring a much more logical thread to the way health care actually operates. This is all in my book, which was published in 2009. For some decades the NHS has bent the patient to fit its own bureaucratic shape. This has been costly, inefficient and too often given bad experience to the vulnerable.
I can speak with significant consumer experience. My father contracted TB when I was four years old. I suspect the disease had been dormant since his serving at the front for the whole of WWI. There was no treatment, only remedies. A partnership between the GP and my mother, who had a practical understanding of medical care, kept him alive through my childhood and almost all my teens, with a quality of life for all of us which was outstanding in the circumstances. Half a century later I put this experience to work as full time carer for my youngest (of six) children, who was born with a very rare congenital condition, from which, at the age of twelve, she died.
Calling on the experience of my father, I was lucky to be able to work through our GP for our daughter, since at the time our family doctor was in a fund holding practice and acted as conductor of the orchestra of clinical and other specialists involved in her care. Later on we moved and as this was after the Labour victories of ’97 and ’01, we found ourselves in a different medical relationship in our new location.
Our new family doctor was marvellous and we worked as a team, but he was for all practical purposes cut out of the loop with the clinicians at the hospital. Each was operating independently in separate trusts. Everything was divided into primary, secondary, tertiary and ancillary care. This structural arrangement was driven by organisational neatness, not patient need. It defied the logic of how illness, particularly chronic illness, evolves. In the resultant, confusion medical errors, made with the best of intentions, cost the child her life. On that dark day I saw, what few politicians dare acknowledge, that the NHS was no longer responsive to people, only to process, fail safe procedures and targets. It is not worth the money we spend on it. There is a better way.
To treat a patient, especially those with chronic conditions (as opposed to injuries) you have to know the patient well and treat them in the round. This cannot be done if you are a respiratory specialist, if there are also kidney issues and digestive difficulties. There is also family impact. The GP knows (or jolly well should) the whole story and because of that can bring together all the other specialists and services in timely fashion, with an efficiency and user friendliness which the current system is utterly unable to deliver.
Arrayed against the embattled Health Department is a daunting array of politicians, clinicians, nurses and other medics, all crying too much, too big, too fast. That this formidable opposition is assembled is due to the appalling way in which these reforms have been presented. The Tory end of the Coalition is, in fact, in something of a crisis over this. Now is the time for it to gird up and re-explain, but at all costs stand firm. The government can listen but it must also challenge. It must challenge the BMA and its vested interests, as well as political ideologues, who confuse healthcare with religion based on folk memories irrelevant in today’s world, as well as Twitter, Facebook and rapper campaigners driven by fear of change, music sales and website hits. There must be no retreat. That would turn a crisis into a catastrophe.