Tuesday, 17 May 2011

Balancing roles in the new NHS

The NHS continues to be a political football. All political parties agree on the need for some kind of change to manage rising expectations, new and expensive treatments and an ageing population. But what to do?

I've certainly no special wisdom but I do have concerns over the current proposals. I'm not alone in this and there is a lot of activity by David Cameron and his government recognising the disquiet of many doctors.

I've worked in the NHS for 33 years (and was training for 5 years before that) so I must confess to getting somewhat annoyed by any politician who has only recent experience of it who then pontificates about how it should be run. But again I acknowledge that wisdom is in short supply. So I'm relived when I get some clarity on my convictions.

A recent article in the British Medical Jourmal by Mark Sheehan has helped. It's title, 'It's unethical for GPs to be commissioners'. As he notes it seems that the government (and probably the Daily Mail) seem to be mainly attachment 'too much management', thus,
The government wants to liberate the English National Health Service. By this they seem to mean to liberate the NHS from managers. The idea is that managing can be done by those who are already doing another job—general practitioners.
But as he goes on to point out, this new role has great capacity for compromising the traditional role of the GP (and which am prod to be associated with) as patient advocate.

When we think of the role of doctors, we include some reference to them focusing on what is best for us. When we disagree with our doctor, we disagree about what is best for us: the doctor-patient relationship is a negotiation of the differences between the doctor’s view of my best interests and my view of my best interests. Trust and confidentiality are precisely built on the understanding that my doctor has my interests at the forefront of his or her mind. If the GP is tasked with resource allocation, there is now an additional dimension to the decision: what is best for others.

Decisions about prioritising resources have to be made, but, given the role of doctors and the importance of trust, they should not be made by GPs. Like anyone else working in the NHS, GPs should be aware of these decisions and their difficulty. But, if anything, the GP is, and ought to be, the patient’s advocate in this process.

I just don't know how one can honestly maintain the two roles of 'balancing the budget' (a decision for our politicians informed by various other groups representing the general public) and being a patient advocate.

As he concludes,
The current system of resource allocation is emerging as an increasingly functional process. There may well be issues of overmanagement to be resolved, but the solution to these problems is evolutionary, rather than a revolutionary overhaul that disbands the system in favour of general practice consortiums. The role of the GP as patient advocate is a crucial one and should not be compromised by giving GPs the additional role of resource allocation managers for the NHS.
I really hope that the government 'listening' exercise will read, mark, learn and inwardly digest such helpful voices as Mark Sheehan.

Sunday, 8 May 2011


Before much more time passes, just one more reflection on our recent holiday in the Hebrides

Oronsay looking over Islay and Jura
Just a few days ago we were on an RSPB guided walk from Colonsay across the Strand-a mile wide stretch of water which becomes accessible by foot for just a few hours each day-to the tiny island of Oronsay. It was a magical day with spectacular weather and truly wonderful views of the neighbouting island of Jura (where George Orwell completed the manuscript of 1984).

So  many birds were pointed out, including choughs, peregrines, lapwings, snipe, willow warblers and even a corncrake (heard but not seen). Indeed it was lovely to have various birdsong identified. Simon Barnes is an excellent journalist who writes  in the London Times. He has just completed a book on birdsong and wrote in yesterdays paper,

Birdsong doesn't really need to be so beautiful. Not in terms of pure gene-surviving reductionism. So why does it bother?
A rather scary Peregrine!
Indeed so. There is much beauty in this world (in the midst of so much sadness and pain). The extravagance of nature is breathtaking. There really doesn't need to be such a vast and varied universe! Although some find the vastness and complexity of it all leads them away from a creator God, ('gene surviving reductionism??'), I have to say I find it an 'intimation of immortality'.

Thursday, 5 May 2011

'And I would drive 500 miles'

With apologies to The Proclaimers and their superb song, 'I'm gonna be (500 miles)', I have just driven the 500 or so miles from Oban having spent an amazing 10 days on the island of Colonsay, one of the southern Hebriden islands off the west coast of Scotland.

Kiloran bay
 I'm a little reluctant to say much about the island least I encourage yet more visitors to this magical place. It seems I am not alone in these sentiments since I've heard before of other frequent visitors to the island who become really quite protective of their experience of the place-and perhaps even somewhat pleased with themselves for what they regard as insider knowledge.

Suffice to say that it is indeed a gem of an island and we were blessed with truly lovely weather (we've been enough times before to know not to expect it). There were so many pluses-seeing  spectacular night skies (I'm sure we saw all of the 2500 stars which are said to be visible on a clear  night), hearing birdsong which is drowned out at home, dramatic sunsets over the Atlantic, flying a kite on Kiloran beach-surely one of the most beautiful beaches in the UK-and so much more.

OK Kiloran again

I've come hope hoping that I can declutter my life a little. I guess that's not an unusual aspiration after a good holiday, and yet somehow I think it might happen. So with the motto, 'how do you eat an elephant?-one mouthful at a time'-in mind, I've made a start and have unsubscribed to the too many webites which send out automatic emails and I've decided to only read one book at a time!!

We'll see.

A message from the other side

No, not that side! But thank God got through surgery ok yesterday. And thanks to all for love support and prayer.