Tag Archives: Jeremy Hunt

RCGP Conference 2015: Reflections on politicians and policy

Screen Shot 2015-10-01 at 10.41.07Euan Lawson is the Deputy Editor of the BJGP.

Today was the first day of the RCGP Annual Primary Care Conference and the sun was out in Glasgow.

Jeremy Hunt turned up for the last two years but we were informed by the President, Mike Pringle, that he had a genuine excuse for non-appearance this year. Two years ago Hunt spoke without notes and with an engagingly informal approach. He did the same last year and the audience weren’t quite so charmed and the cosy style felt a little forced. This year, he would have needed more than his warm fluffy personality to charm the audience given the seven day working proposals. Although not here in person, Hunt’s presence loomed large in discusssions. Maureen Baker spoke with great passion and no little anger voicing the concerns of many GPs. The whole of the speech is available at GP Online. Regarding the recent seven day working proposals she made the RCGP position clear:

She was disparaging of Jeremy Hunt’s “so-called” new deal and demanded George Osborne ensure that general practice received 11% of the NHS budget by 2020.

Jeremy Hunt may have been congratulating himself on avoiding the stress of facing several hundred irascible GPs, but it was a good gig for Shona Robison, the Scottish Government’s Cabinet Secretary for Health, Wellbeing and Sport. She was good enough to provide the following summary of her speech:

As Scottish Health Secretary, I appreciate the opportunity to welcome GPs from all over the UK to Scotland and the City of Glasgow and your discussions this week at the RCGP Annual Conference 2015 will make an invaluable contribution.   In Scotland we are committed to collaboration with doctors, not imposing change but rather working in partnership.  We are  taking this approach with junior doctors, where we have said we will not impose new terms and conditions.  We are doing the same with GPs, where we are collaboratively developing a new contractual framework for General Practice in Scotland.

GPs are at the heart of local communities. Without the hard work and commitment of GPs and their professional colleagues, like nurses, pharmacists and physiotherapists, our health system simply wouldn’t be able to cope.

GPs care for families, but also effectively ‘look after’ the rest of the NHS, influencing by their decisions and actions a significant proportion of the activity of the whole system.

The Scottish Government has always been committed to supporting vital, front line health care services. Investment has increased in every year of this Government, and is now £80 million higher than when we took office.

However I know that GP workload is increasing, as is the complexity of health care; and where more is being delivered outside hospital settings, resources haven’t always followed in a proportionate way. The profession also faces serious challenges over recruitment, retention and increasing workload.

That is why we have been working with GPs, to agree on the good ideas and fresh thinking that are required to transform the way we provide care in Scotland.  This strategic approach puts GPs at the heart of multi-disciplinary teams of professionals, making a real difference to local communities. I have backed this work by introducing a £60 million primary care fund.

This money is being invested now in supplying new pharmacists to support GP workload, on GP leadership and recruitment and retention, on ensuring the future of the Scottish School of Primary Care and on testing new models of primary care in many parts of Scotland – from Deep End practices in Glasgow and Edinburgh dealing with inequalities to GP clusters in Grampian who are innovating in the way that they engage with their local community.

The future NHS must be very different from the past. We must develop new models of care, fit for the needs of the 21st century and the challenges ahead.

I am very proud of the NHS in Scotland. I know that General Practice is crucial to dealing with the challenges ahead. There is a firm commitment from the Scottish Government, backed by sustained investment, to continue to work with GPs to ensure the best for communities, for our people and for our families.

She saved the best for the speech itself and two promises sparkled in the Glasgow sunshine. Firstly, she announced a plan to dismantle QOF in Scotland. Yes, I know – apparently, it has “had its time”. And, finally, as befits a consummate politician she came circling back around to prey upon Jeremy Hunt. She was “appalled” by the actions of Jeremy Hunt and that the threats to junior doctors are “beyond the pale”. She offered no less than a “cast iron” guarantee that the Scottish Government will not be following Hunt’s plans to cut junior doctor pay.

The Scottish contingent of GPs were glowing and it wasn’t the unexpected dose of Glasgow UV on their faces. Those of us heading south face a long trip back in a day or two.

A letter to the Health Secretary

DSC02665Adam Staten is a GP trainee in Surrey and is on Twitter @adamstaten.

LETTER TO THE HEALTH SECRETARY

Dear Mr Hunt,

Many congratulations on being re-appointed as Secretary of State for Health in the Conservative cabinet. May I suggest we treat your re-appointment as a fresh start?

As a gynaecology SHO performing intimate examinations I was once told to ‘go in like a butterfly and come out like a lion.’ The idea was to cause minimum discomfort by combining a gentle approach with a swift withdrawal. This was not a strategy you adopted when you began your intimate examination of the NHS in 2012. It did in fact feel quite rough and quite prolonged. This time around perhaps you could be a little more gentle with your ideas and re-organisations and, when we finally get a period of stability, come out like a lion and stop meddling.

On many occasions you have talked of ending a culture of bullying within the health service and yet have yourself employed a beatings-will-continue-until-morale-improves attitude when dealing with its staff and this has endeared you to few. Attempting to bully the allied health professions of the NHS to fall into line with your ideas has not won you many friends.

For years NHS staff have hardly been able to turn on an NHS computer terminal without being greeted by your semi-psychotic stare and oddly geometric haircut as your picture has headed the endless bulletins and memoranda that spew forth from the Department of Health. Whilst producing a new edict may feel like a good days work to you, for those of us receiving it, it feels like an imposition, an interference and the promise of much more work for very little gain.

The smoke and mirrors re-organisations of the health care system that health ministers like yourself are fond of, the kind that generate a lot of activity, a rebranding or two and an apparent improvement in outcomes, actually distract from the business of treating patients.

Please remember too that the health care system is just that, a system for delivering health care. It is not a government tool to be used to address whatever national woes are troubling the electorate at any given moment. The NHS is not a branch of the benefits system nor is it an outpost of the immigration service.

Please dispense with ethically barren ideas such as denying benefits to people who refuse treatment for obesity. Doctors, nurses and other NHS staff should not feel obliged to coerce patients into treatments for purely financial reasons. Ideas such as this are eye catching and superficially gratifying to our vindictive sides but are unethical and unworkable in reality.

Neither can GPs solve the problems with immigration. Whilst it may seem an appealing idea to catch unsuspecting illegal immigrants whilst they are at their most vulnerable, the point when they seek medical help, most GPs would be reluctant to guilefully dupe immigrants into believing they were going to be given treatment for their illnesses before gleefully slinging them into detention. Please resist the compulsion to medicalise problems that are essentially social and political.

No-one would say that the NHS is a perfect system, but it is a good system. There is work to be done and changes to be made but trying to force all of them through between election cycles is devastating to the day-to-day functioning of health care.

You may like to think of the NHS as a wild stallion galloping powerfully through the plains of the UK. To tame it you can tie it up, beat it and try to break its will. This might work but, at the end of it, your stallion will be damaged both inside and out. Or you can whisper to it, coax it to your will with gentle reason and calm debate, and together we can ride off into the sunset.
I wish you well in your second stint at the helm of the NHS, and I hope you will wish us well in return.

Yours sincerely.

Jeremy Hunt and A&E: does he think people are unteachable buffoons?

DSC02665Adam Staten is a GP trainee in Surrey and is a Twitter newbie @adamstaten.

When Jeremy Hunt decided to take his children to A&E rather than wait for a GP appointment, or indeed rather than making use of the out of hours GP service, he defended his decision with a speech that included an incredibly bleak assessment of the British people. His declaration that people could no longer tell what is urgent and what is not is tantamount to describing the population as a mass of unteachable buffoons. Perhaps Hunt is projecting when he sees the public as mindlessly staggering through life constantly posing a great danger to themselves and requiring a doctor to be within arm’s length at all times.

It seems he feels that the gene pool that gave us the industrial revolution has degenerated to such an extent that it is no longer possible to teach them that a sore throat is not an emergency but that crushing central chest pain is. Hunt’s response to this is to give the people what he deems they need, GPs available all day every day.

This response is short sighted and risks entrapping the NHS in a vicious cycle of provision and demand. Increasing availability to the service will only serve to increase dependence. If we are deciding that people can’t decide for themselves what needs to a see a doctor and what does not, and what needs to be seen urgently and what does not, then surely we will need GPs available 24 hours a day, seven days a week. Then we will need more GPs available 24 hours a day. Then what? The demand is potentially limitless, trying to keep up with it is not a long term option but tackling it at source may be.

[bctt tweet=”Hunt’s response is short sighted and risks entrapping the NHS in a vicious cycle of provision and demand.”]

A cheaper and more sustainable solution would be to make a concerted and co-ordinated effort to educate the people, ideally whilst they are at school and receptive to education. For some reason we commonly do this with sexual health education but not for general health education.

There is good evidence to show that sexual health education at school works, causing adolescents to start having sex later, have fewer sexual partners and use condoms and contraception when they do have sex1. School based interventions on alcohol have also been shown to be both effective and cost –effective2.

Rampant though chlamydia and gonorrhoea may be, they will hopefully never become quite as rampant as coughs, colds and twisted ankles. Why then do we not employ the same strategy for other minor health problems? Imagine the savings in time and resources if every musculoskeletal injury presenting to primary care had already been appropriately rested, iced, elevated and treated with analgesia, or if every patient knew that antibiotics will do nothing to improve their coughs and colds? It would not be difficult to create lesson plans to teach this.

I will confess that I haven’t thoroughly costed this idea but I feel relatively safe in the assumption that it will be cheaper and easier to implement a programme whereby willing local GPs are paid the going locum rate to deliver occasional health education lectures in schools than to browbeat a whole profession into providing ever more extended hours. The legwork to provide the content for these education sessions has already been done, the information is available on the NHS website, but if people won’t access the information for themselves then we should take it to them.

We have all taken an oath that includes a commitment to teaching, perhaps now is the time to take this teaching outside the profession so we can ease the burden on our NHS.

 References

  1. Kirby, D (2008) The impact of abstinence and comprehensive sex and STD/HIV education on adolescent sexual behaviour Sexuality Research and Social Policy 5(3): 18-27
  2. NICE (2007) School Based Interventions on Alcohol NICE Public Health Guidance 7