Lies, damn lies and Gordon Brown

I am still trying to recover from the Prime Minister’s brazen effrontery on this morning's Today programme.  I was listening to it whilst reading the Times. You may “listen again” here.   The juxtaposition of Prime Ministerial lies and the real news is breathtaking. Unusually, Gordon Brown did admit to something short of papal infabillity on the question of how the abolition of the 10p tax rate was handled but, for the rest, it was a Panglossian tissue of lies.

Secret tax adds £200 to the cost of family cars
The Treasury admitted to The Times last night that it was quietly abolishing the exemption for older cars from the highest rates of vehicle excise duty. This means that owners of larger cars bought since March 2001 will find that their road tax will rise steeply from next April.

Private school demand is highest for five years despite big fee rises
The government, pledged to improved the education system, has been in power for 11 years. Forget the dinner party chatter. People are voting with their feet: "Independent schools have had the biggest increase in pupil numbers in five years as parents dig deep to avoid the state system." Explain that, if you will, prime minister.

Threat of fuel protests returns as cost of petrol hits £5 a gallon
What is Gordon Brown doing about this? Laughing all the way to the bank. "If prices remain at current levels, the Treasury could receive as much as an extra £2.5 billion."

London, one of the richest cities has 650,000 poor children.
So much, then, for Gordon Brown’s pledge to take children out of poverty

I was particularly taken by Gordon Brown’s continuing mendacity about health care. The “deep clean” programme was fraudulent (see Two days later) ; focus group determined window dressing wasting over £90 million of taxpayers’ money. The threat of MRSA and C.Difficle continues unabated. The causes are multi-factorial but, in the UK, unsustainable throughput of patients and inadequate nursing care are two parameters that the government could influence. If you are going to keep real nurses in nursing, you have to pay them properly and treat them properly.

And then he said that he had increased GP's hours and made them “more available” to patients. No he has not. The new programme has not yet been introduced. GPs will be paid for doing this extra work from the beginning of April but will not start doing it until some unspecified time (depending on PCT) in the future. Characteristically, the government has not taken advice from the profession as to how best these extra hours could be used. Complex rules and regulations have been issued in the normal top-down way forcing us to work in a protocol driven, inflexible and inefficient manner.

My practice is and always has been open during the “core hours” of 8.00 a.m. to 6.30 p.m. Unlike many practices we do not close for lunch, and we do not close on Wednesday afternoon. In addition to the core hours, we do a weekly late night surgery, which is very popular with patients. We also provide a walk-in clinic from 7.15 a.m. to 8.00 a.m. which again is much appreciated. In terms of total additional hours we already exceed the requirements of the new regulations. However, the government has decided that the extra time must be in blocks of not less than an hour and a half, that all the appointments must be ten minutes and must all (varies from PCT to PCT) be bookable forty-eight hours in advance.

We could meet these requirements easily. We could advance book the morning and evening surgeries with ten minute appointments. It would be so much easier. When I do the two hour late night sugery I will see about twenty patients, depending on demand. These will usually be patients with acute problems and, mostly, for them a shorter appointment suffices. It would be so much easier for me to book twelve ten minute appointments a week in advance. A fifth of advance bookings do not turn up, which would give me time for paperwork, and seeing the eight or nine patients who do tip up will be a doddle. We could do a Saturday morning surgery as well. To do it properly, to meet demand, this would have to be a walk in service. We are not allowed to do that. It has to be ten minute appointments, booked in advance. Again, this would mean booking twelve patients, seeing the nine who come, and then home for coffee. For our eighteen thousand patients the “improvement” in service would be imperceptible.

I know more about quantitative and qualitative patient demand than the government. When I was setting up a co-operative, and later investigating so called “advanced access”, I researched it in detail, and I continue to monitor it for the practice. Demand can be divided into two broad catgeries; acute and chronic. Most of a GPs work load is looking after the old, the very old, the very young and then, more across the age range, but still predominantly elderly, people with serious on-going illness. These people are not interested in Saturday morning, early morning or late night walk-in access. The other group, smaller in number but larger in demand, is composed of people with acute minor illnesses, hay fever, UTIs, URTIs and so on. These people do not want to book a ten minute appointment two days in advance. If a women wakes up at six o’clock in the morning with acute cystitis, she wants to be seen ASAP and, at our health centre, she knows that if she comes down at 7.15 a.m. she will be seen and treated and on her way home before 8.00 a.m. The commuters, off to work early in the morning, with acute problems are also seen immediately.

When the new regulations come in, if we are to meet the letter of the law (there is no spirit behind it) then all this will have to go. We will see fewer patients outside core hours and we will not be allowed to cater for walk-ins in the same way. Some practices are going to take a more cynical approach. They are going to turn the extra money down and work to rule. We could do that. Only open between 8.00 a.m. and 6.30 p.m.; close for lunch for two hours each day; close on Wednesday afternoon; introduce universal ten minute appointments and tell all the “walk-ins” to go away and “walk-in” to the local HCP staffed “walk-in” clinic. I do not think many GPs will do this, but some will.

The government will continue to say that they have improved the service. The only losers will be the patients. You may think that primary health care is not working well at the moment in terms of meeting demand. Maybe that is correct. But the fact that it works at all is due solely to the goodwill of most family doctors. I expect the usual flood of “waste of time over-paid lazy GP abuse” in the comments column. I shall try to ignore it, but it will be another slice off the morale salami. I shall turn to Dr Andrew Brown, and see how he copes (Are you my doctor? : A fortunate man)

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For more details of Gordon Brown's lies about the size of the tax burden, look at Brown's Porkie Fest