My Intial Thoughts On the NHS White Paper.

The NHS White Paper is out and I've read pages and pages of analysis, although I'm yet to read the White Paper myself. It's sitting in my reading queue waiting to be read.

The big change is the PCTs who currently 'purchase' healthcare will go the way of the dodo to be replaced by 'consortia' of GPs. The thought being that GPs know better the needs of their community.

While I am sure that there are plenty of conscientious, well trained, thoughtful and management minded GPs out there, certainly in my part of London they seem a bit few and far between.

As an example, my crewmate and I were sent to a patient who had seen the GP who had thought that she might need hospital treatment. The patient was described as 'ambulant'.

She was 'ambulant', in that she had walked to the GP surgery – at least one mile away, and the GP had sent her home to await the ambulance.

As soon as I walked into the room I knew that we would be wheeling the patient out on our chair. She was so short of breath she was breathing forty times a minute, her oxygen levels were way below what they should have been (86% – even with someone with chronic lung disease, this would be a worry), her pulse was racing at over 120 beats per minute.

She was a very sick lady – and yet the GP had sent her to walk home.

Similarly I've been to patients in the later stages of shock who have been sat out in the waiting room for the ambulance and I've had patients who the doctor has, correctly, diagnosed a heart attack sitting on the wall outside the surgery.

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Now, I understand that not every GP is like this and that I only tend to go to the patients that are seen by these worryingly poor GPs, but how many of them will be holding onto the public's purse strings in the future.

In some places they can't even arrange decent out-of-hours coverage with GPs who are able to speak English.

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The other worry is what happens if a GP consortia decide that they don't want the LAS handling emergency calls in a certain postcode? Will we be refusing calls because privateambulanceservicecompany will hold that contract? Will we no longer be London-wide, but tasked to only cover certain areas.

Given yesterday's announcement about 'Big Society', will the ambulance service be broken up to be replaced by volunteer services? I heard rumours that the Olympic planning people wanted LAS staff to volunteer to cover the Olympics as they didn't want to pay them, was that just the start of this?

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Still, lets wait and see what happens in the consultations before we start panicking. After all it's not like consultations in the past have ignored all the good points in opposition to what the government want to do…

12 thoughts on “My Intial Thoughts On the NHS White Paper.”

  1. Having spoken to various GPs on my patch there seems to be mixed feelings whether these white paper proposals are good or bad. These range from “Thank god i am retiring soon and dont want any involvement in this”. To ” I spend so much of my time at PCT meetings just geting frustrated that i look forward to being able to direct funds where i see fit “.Fair points i suppose ,rural and urban practices will have different issues.

    This now brings us onto Ambulance providers. You know what you are getting with an NHS Service and so do the public. The current system is held in such high esteem because road staff and to be fair, control staff ,are generally prepared to go the extra mile. Now i am sure that the private sector will claim that if contracted they would be bound by the same criteria. Doubtless there are some very proffessional companies out there, but we all know many are not. Which brings up the main issue.

    The private sector good or bad will always have to show a profit. The nature of what we do is variable, ie ,time spent on scene, that plus many other issues that ambulance staff have to deal with in the “jack of all trades “job we do means that a privatized system is doomed to fail. Whilst it is clear that the NHS is unsustainable in its present form it is still a beacon of our humanity and needs to be fought for and not thrown to the corporate wolves.

  2. This has concerned me. As a fornmer nurse and now someone who needs medical care frequently I do have a good doctor, but not everyone does. I know of more bad than good in this area of Leeds.The 'Big Society' idea concerns me even more. I fear as has been said, services taken over by well meaning amateurs and disasterous things happening. Then, they'll say it needs to be farmed out to private companies and we'll end up with a a semi or whole privatised system.

  3. Still, lets wait and see what happens in the consultations before we start panicking.________________

    What consultations?

    Start panicking now.

  4. Dont worry become a firefighter instead, the Home Office wont let chief Fire Officers to become in charge of the budget, they are too busy sleeping Opps sorry restinghttp://www.bbc.co.uk/news/uk-england-manchester-10701633

  5. Dear Tim,Don't worry, everything will turn out just fine.

    For us.

    You're totally fucked, but we'll be just fine.

    Sincerely,

    Your Government

  6. The one thing that you can be sure the Government wants is to drive a series of wedges between the various groups that look after patients.Hospital doctors vs GPs, nurses vs doctors, managers vs everyone and so on.

    Silly, tittle tattle and spurious stories about the odd bad GP do nothing other than play into the hands of the people who want to destroy the NHS.

    I have hundreds of experiences of the men in green pyjamas being incompetent, arrogant, lazy and generally hopeless but to use those stories as a means of criticising a wholesale structural reorganisation of the NHS would be not just childish but also irrelevant.

  7. It's bad enough the thought of private & NHS ambulances working in adjacent areas. However, what happens when more than one practice covers an area?If practice A is still NHS and practice B (boo! hiss!) is private, but essentially they cover the same area, does that mean we'll have twice as many crews in the area to make sure they reach their target times?

    Even if every patient living in an area was with a doctor who wanted private ambulances, the NHS couldn't just leave the place – what happens in the street, either when there's illness or say a RTC?

  8. You are correct about the Olympics wanting the LAS to provide ambulances for the olympics and thier staff on holiday to provide the crews so that it does not cost as much as say using SJA. They also want people who are very inexpereinced with only an FAW and Aed qualifications to volunteer to provide the basic first aid as well as other HCP's to volunteer during their holidays for a minimum of ten days.

  9. Unfortunately the Big Society started during the last Tory government in the 1980's.Before then the NHS was one big happy family with patient care as the main focus.

    Hospitals took thier money from a central pot for the number of patients that they treated. So the busiest hospitals got more money. Unfortunately this did not go well with the medical school tie network. Especially the Tory party members of the Whitechapel. Who with maggie came up of the bright idea of public private partnerships and fund holding hospitals. This meant that the old medical school tie network could still hold onto their empires.

    So from that point on commpn sense, value for money and patient care went down the drain.

    Demographic data shows that the busiest multi system trauma hospital in London was Whipps Cross, with 16 cases in 1988. Whitechapel saw 0. In fact any category of trauma you would take a look at, Whipps Cross was seeing over double what the Whitechapel was seeing. Bad news for the medical school tie network. Bad news for common sense.

    So trauma centres and centre's of excellence was introduced. Not where the work was for these centres, but down at the Whitechapel group. Unfortunately Whipps is in the same SHA as the Whitechapel. If everyone carryed on going to Whipps as it was easier to get to and where the work was, the Whitechapel would go out of buisness. So Whipps has been strangled for the sake of the Whitechapel.

    What amazed me was why the Ambulance service didn't protest. But that may be down to the Medical Director being in the same club.

    Why did Sir Nigel Crisp the chief civil servant resign on the monday and the government annouce the most expensive PPI on the tuesday for the Whitechapel.

    Why do we need 4 trauma centres? Why do we need helicopters that cost a fortune to run and are not cost effective? Yet the public are duped to give charity donations to help fund them so people are taken back to the medical school tie network under the disguse of better patient care. Centres of excellence are bricks and motar at the end of the day, you can build them where you want them. Then tell the staff where they are working.

    The NHS only exists in name now. All parts of it have been privatised under the cloak of being more efficient. The teaching and training of staff is fragmented. The team ethos has gone. The medical school tie network have their pockets full of money. The patient has no choice. The medical School tie network, including Dr Darzi who was at St. Mary's W2, (thats a trauma centre as well!) and the politicians from both parties has killed the NHS OFF. AMEN

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