15th May 2015

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Dr Mark Porter

In conversation with Roy Lilley - this is warming up to be a really good 'conversation'!

Chair of the BMA - just how relevant is the BMA; does anyone listen to them?

Health Chat at the King's Fund 18th June Details here.

No he can't 
News and Comment from Roy Lilley

No, no, no, no, no.... don't do it. That's what I would have said. Unfortunately the Prime Minister didn't ask me. Neither, I assume, did he ask you. My guess is if he'd told either of us that he was going to give a speech about NHS 7-day working we'd have said don't do it.


There are three reasons.


First; the NHS has been struggling with the 'Every Day Counts' (7 Day opening) conundrum since 2013. As far as I can tell it is stalled on the rocks of time, money and the distractions of struggling with the day job. There are case studies and examples that have not set a bushfire of enthusiasm, not been scalable and not fulfilled their potential.


Second; The Prime Minister, in support of his 7-day argument, prayed-in-aid some old, 2012, UCL research. He says; "... it is a shocking fact that mortality rates for patients admitted to hospital on a Sunday are as much as 16% higher than on a Wednesday. Really?  He may be right but the NHS's own Choices web-site debunks this and says:


"This study has not examined the reasons why there may be increased risk of death with weekend admission, so no assumptions should be drawn about staffing levels or the availability of senior staff."


Third; the PM is claiming to fund the NHS with 'an extra' 8bn. Where it will come from is his business but assuming he can deliver, it is important to drive home the point 8bn is the funding gap between what the NHS has now, possible internal improvements in productivity (for which I am yet to see a plan) and demand. 8bn keeps the lights on and that is all.


Perhaps next time he might ask us? Whoever advised him to say all this should write their reasons on the back of their P45.


There is also Dave-talk of 5,000 more GPs. As LaLite found out on yesterday's BBCR4 Today Programme (0810); that, too is a minefield. Five thousand by 2020? It takes seven years to grow a GP and probably another two years until they are really match fit. And, there is money thing...


What would we have advised Dave to say? Some home truths wouldn't be a bad idea. Asking why young doctors don't want to be GPs is a good start. One third of GP training places are vacant.



  • With the current model of care there will never be enough GP's. Most practices are too small. The obvious answer is larger organisations with continuity and access becoming the measure of success.
  • To access your GP or other clinician, for a meaningful amount of time, to assess your problem, some form of triage is required. That means doctors first and nurse second.
  • The whole labyrinthine GMS contract will have to go. It is outdated, anachronistic and clunky. So, too, most likely, practice partnerships; make way for a salaried workforce.
  • The investment needed in infrastructure may be beyond the taxpayer. A new form of funding is needed... and may be Darzi was right.
  • The issue for HEE is not 'recruiting doctors' it is recruiting the right doctors who want to be GPs, in areas of greatest need.  Do they know how to do it? 
  • The clinician of tomorrow may not be a doctor; Docs may become supervisors, team leaders and care brokers. Practice assistants, GP-supporters, a new form of generalist may be the new names on the block.
  • Keeping people healthier for longer, going up-stream to stem the tide, takes time and being tough enough to take on some vested interests.  The results may be a generation away but it has to be done.

Dave has to understand the NHS is in the middle of a workforce crisis and a funding crunch. Most Trusts can't balance the books and A&E targets are out of the window... no one has enough staff.


Doing what we do now, better, is a better idea than struggling to do more for no more.  Performance gains can be delivered with bribes, but it is a tactic that you have to keep doing and the bribes will get bigger.  Investing in productivity takes patience and money.  Politicians have little of either.


This speech (already called 'The Safe Hands' speech)  is really about bolstering the Tory Party flaky image on the NHS; underlining an 'unwavering' commitment as the DH's very political press release says.  This is a bid to move into Labour territory and use the NHS is a cornerstone of 'one nation' policies.


The question is; can Dave-Deliver? Answer, no he can't.



Just what is the future for GP practice?

Come and join me in an evening of conversation with the boss of the BMA, Dr Mark Porter

King's Fund 18th June 5

Details here. 


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