Sunday, November 17, 2013

A normal day at the NHS

Those of us in the US who have been overwhelmed lately by overly excited health care stories in the media look fondly across the Pond. We are confident that we can find a much calmer discourse about these issues in the UK.  After all, a single payer system, well established, and held in fond regard by the populace can’t be very controversial.  Well maybe.

Here’s a synopsis of one day’s news coverage about the NHS from The Times and The Daily Telegraph.  Make sure you read all the way to the last one.  My head is spinning.

•A hospital trust whose staff were allegedly forced to alter waiting times of cancer patients has been put in “special measures” by Monitor, the health regulator.  An “improvement director” will be appointed by Monitor to ensure the [Colchester Hospital University NHS Foundation Trust] turns itself around. “The leadership of the trust will be reviewed as part of our scrutiny of the trust’s governance arrangements and, if necessary, further regulatory action will be taken.”

•Hundreds of teenage girls have had genital cosmetic surgery on the NHS, prompting doctors to call for an end to state-funded “designer vaginas.” Internet pornography has driven a five-fold increase in female genital surgery in the past decade and more than 2,000 women a year now have the procedure on the NHS.  Ruptures are reported in up to a third of cases and NHS surgeons report seeing women with complications caused by surgery in the private sector. There is no evidence that the surgery improves women’s lives.

•Nine of the world’s biggest pharmaceutical companies have warned that innovative new medicines are being blocked from use in the NHS and are calling for an overhaul of the commissioning process.  They said that, since 2005, the National Institute for Health and Clinical Excellence (NICE), the body that selects drugs for use in the NHS, has approved “fewer than one-in-three medicines” and needs to be given a new mandate to make the UK a world leader in innovation. In a statement, NICE said the companies had “wildly underestimated” the proportion of drugs approved and it “supports more than 80pc of the drugs appraised. The NHS needs to be confident that the treatments it buys with its increasingly stretched resources are both clinically and cost effective.”

•Wider use of statins will have minimal benefit and could needlessly expose thousands to severe side-effects, a leading doctor has claimed following a change in US prescription guidelines. Dr. Aseem Malhotra, a cardiology specialist registrar at Croyden University Hospital, south London, said he would be “disturbed” if Britain followed America in changing prescription guidelines to widen use of statins. Side-effects experienced by up to one in five patients include severe muscle aches, memory disturbances, sexual dysfunction, cataracts and diabetes.

•And here are two presentations of the same story:

The Daily Telegraph story, headlined, “Return of ‘proper family doctors:’”

A new contract for GPS will see the return of “proper family doctors” responsible for out-of-hours care for the elderly, Jeremy Hunt, the Health Secretary, announced today.  The deal agreed with the British Medical Association reverses changes introduced by Labour that allowed family doctors to abandon responsibility for care outside office hours. Mr. Hunt says that the changes are crucial because the failure to care for older patients is behind a crisis in NHS emergency care, with millions of patients admitted to hospital because they cannot get help in time from their GPs.

The Times headline was, “GPs told to reveal their pay:”

Family doctors will have to reveal their salaries from next year, under changes to be outlined today by the Health Secretary. Jeremy Hunt said that he had secured the agreement of the British Medical Association to publish the pay of GPs, in return for waiving a series of targets and handing nearly £300 million of performance-related pay directly to doctors.

[Hunt said,] “Transparency is always uncomfortable. People will get used to it, but it needs to be linked to outstanding performance.”

Both stories talk about the elimination of 40 percent of GP performance targets.  Here’s the Telegraph quote:

Under the targets framework, doctors have been paid for improving their handwriting, or ensuring staff undergo training, or for asking their patients how often they take part in activities such as DIY, cooking or gardening.

And the Times quotes Dr. Chaand Nagpaul, chairman of the BMA’s GP committee, applauding the change as:

Freeing up resources for GPs to use their clinical judgment—not a checklist—when treating their patients.

And finally:

•GPs are seeing up to ten patients a day who are lonely rather than ill, according to research. Three quarters of GPs questioned said it was usual to see between one and five patients a day in their surgeries primarily because they were desperate for human contact. However, some doctors had even higher rates of patients suffering loneliness with one in ten saying that they saw up to ten patients a day who came in for the company. Half said they were not confident about whether they could help their lonely patients.


Mk Sheikh said...

I think the last anecdote is just as true here as overseas. My father used to tell me there was a significant portion of his patients just wanting someone to talk to. He always liked the personal contact so had no problem with it, in fact he rather enjoyed it, but I don't know that modern training and evidence based medicine has an algorithm designed for symptoms of loneliness.

Anonymous said...

In the military, prescriptions are "free" if they are picked up at the pharmacy (versus co-pay for mail-order). Many patients will choose to come to the pharmacy even though they have to drive long distances and wait a long time for the prescription because it is a social occasion for them (they also take time to eat in the cafeteria).