Thank goodness, the new government is trying very hard to speed up the process of diagnosis and treatment to reduce waiting lists in the NHS, and I think they are on the right track. Allowing patients to book their own X-rays, scans, blood tests, rather than have to be seen by GPs is a good idea. Presumably they would be triaging with an algorithm on an online form, and those that fail would have to see a GP. Diagnostic hubs are a great idea, and using the private sector where possible (with the caveats I referred to in my previous blog) would also help. After all it is usually the same personnel.especially consultants in both private and NHS settings.

The latest wheeze they have come up with is to pay GPs £20 every time they access the “Advice and Guidance pathway” to reduce the number of referrals to hospital. Apparently when GP’s do use it the number of cases being referred for care in the hospital itself was halved, the others being referred for treatment outside hospital, which is what the government wants as it is cheaper. However apparently the hospitals are paid about £50 per case to cover the cost of consultants need to use the system, so it isn’t that cheap.

I did a lot of work on this 15 years ago, and it is essential to have such a pathway. Our scheme 2. involved GPs and Consultants getting together to formulate best practice locally and to develop local pathways which didn’t involve the consultants where it wasn’t necessary. We found that it is essential to have good relationships between doctors in primary and secondary care, and the system worked well then. But we also found that if doctors are not recompensed for the extra time in being involved,3. they will not continue to use these pathways – human nature I suppose! But will £20 cut any ice?

I saw a graph recently which shed a light on the real problem with the NHS. To see the graph click on ref 4 below. Apparently doctors, and to a lesser extent nurses have suffered the worst drop in income of any other key workers over the last 10 years. Here are the figures –

Increases in gross annual pay for key workers in UK from 2011 to 2022
gross annual pay rebased 100 = 2011
Train drivers increase to 140
All workers 134
Fire service officers 120
Nurses 110
Higher education, teachers 108
Medical practitioners decrease to 86.

I don’t know Simon Fleming, and I am assuming that these figures are true (one rather distrusts anything on twitter these days), but if it is accurate, then this shows the real reason why the NHS is not going to recover any time soon, When the last Labour Government came in and needed to rescue the NHS from the underfunding of the NHS, it was able to improve doctors’ pay considerably and it ploughed a lot of money into the NHS to develop out of hospital care. Of course some grumbled, (they always will) but general practice was a good place to work then.

You can see from the graph that train workers did best. This I presume was entirely due to the fact that even minimal reduction in flexibility in train drivers’ rotas through industrial action causes such disruption that they have a lot of financial clout. Doctors don’t strike (often) and if they do the NHS has to keep disruption to patient care to a minimum, so they don’t have much clout there. But what does happen is that they migrate. There is a world market in medical expertise and Australia, Canada, Saudi Arabis and the Middle East are able to pay much higher salaries, My Ophthalmic consultant aged 55 working full time in the NHS, decided to relocate to Saudi Arabia to earn lots of money before he retired. He hasn’t been replaced – other consultants have had to take up the load.

Every day, there are advertisements for young doctors to work in Australia and Canada, that are extremely attractive, The fact is that if the UK cannot pay a comparative rate they will not get enough fully trained doctors. So at the moment we are in a dreadful situation. I spoke to a middle manager in the NHS recently and she said that no reform or new way of using staff will work if the pay is low. Being a doctor is very stressful, but also fulfilling in most cases, but if you can’t pay the mortgage or rent it is normal to think of alternatives, and what can beat working in a functioning system in a sunnier clime?

Working doctors have recently voted against allowing Physician’s Associates (who have had 2 years of clinical training) to take some of the work of GP’s and in hospitals, because undoubtedly some mistakes will be made and some patients might suffer. I myself think that it is right to devolve functions to lesser trained individuals if you possibly can, but the problem is that it is the doctors who have to manage their workload and certify that their work is safe, and this is an additional responsibility The thinking is “with all this supervision it is easier, quicker and safer to do it myself”. I think the authorities will have to go back to the drawing board on this.

If nurses, radiographers, lab staff and everyone else can get better money working in a supermarket then they will leave too. The NHS has to be resourced properly. If it is not, voters will think that a privatised system is best. They may go for a party like Reform, which would like to privatise the NHS, even though that would turn out to be exactly the same as Brexit – the promises of better services would not materialise and 90% of people would be very much worse off. And if that privatised service was like the American system many people would be bankrupted by any serious illness. European systems are better, as they are based on a social democratic model, but costs to patients will be considerable.

So if the country is really as broke as it seems (I wonder sometimes if that is really true as Germany and France seem to have very severe economic problems too but they still manage to pay their doctors), then we are stuffed – we will never get back to the golden days of. the previous Labour government.


Refs
1.https://news.doctors.net.uk/news/32QVBGLvb9xbvQGtZUqRbq
2 The Torfaen referral evaluation project https://pubmed.ncbi.nlm.nih.gov/20051193/
3. Reducing variation in General practitioner referral rate https://pubmed.ncbi.nlm.nih.gov/21902906/
4. https://x.com/OrthopodReg/status/1613204462910246912?s=20