Open All Hours?

The row about evening surgeries and out-of-hours rumbles on. I think most people are wondering why GPs are making such a fuss about this. What's the matter with a couple of extra hours a week after all? I'm going to try and explain what is happening and what is the possible solution to this for both parties.

GPs are contracted to work from 8-6pm, Monday to Friday. This adds up to 50 hours. Under the European Work Time Directive, they are only meant to be working 48 hours, which means they are in breach of European law and this is going to kick in in 2009, when this comes into full force. If on top of that, they work an extra evening surgery, they will be breaking the law again. Because their contract is such that it does not allow a shift system, (they have to work from 8-6pm)there is no way round this at present.

Local GPs are already providing the emergency doctor service for NHS 24 in their area. If they are working an evening surgery, that is taking them away from the out-of-hours service, which is arguably more important than someone who just wants a convenient time to see the doctor. The government does not appear willing to employ more GPs, so a choice needs to be made.

There are safety issues regarding evening surgeries. It is one thing to be called out to a house by a specific person who can be traced; it is quite another sitting in an empty surgery, where you are a target for any ned who happens to be passing by and fancies his chances to get some drugs.

This all begs the question; why has evening surgeries become an issue? There are a couple of possible answers to that, but one of them is that NHS 24 has proved to be twice as expensive as the government expected it to be, and A&E admissions are at a ten year high. The government cannot get out of NHS 24 just now, because of contractual obligations, but if it could persuade doctors to work an evening surgery during out-of-hours time, it could save some money on A&E admissions at least.

Maybe it could work, if doctors were allowed flexi-time and if the government employed more doctors to help, so that OOH would not be left short. But the real solution to this problem is; scrap NHS 24 and go back to the old OOH cooperative system, properly funded and with sufficient numbers of doctors. It'll be cheaper in the long run.

Building Bridges?

Ok , I'm back. And what brought me back was this article today in the Herald. Nicola Sturgeon and her Irish and Welsh counterparts have written a letter to Alan Johnston, asking why he has gone ahead with negotiations about pay deals with NHS workers, without referring to them, and asking him to hold back from any major decisions until they have been consulted. Now, some might see this as political posturing. But I don't see it that way. This is the nub of a far more complex and troubling problem that is the NHS.

The NHS in Scotland, Wales and Northern Ireland has always had a life of its own. But the idea of the NHS was that it was just that; a national health service that delivered an agreed standard of health care across the UK. Over the past few years, England and the rest of the UK have moved further and further apart. England is much further down the road to privatisation than its UK counterparts, whereas the devolved parliaments have largely steered away from this. Wales in particular took a scunner to PFI deals; its parliament shut its Private Finance Unit in 2004. So the question is; is there any point trying to influence what is happening in England, or should we just burn the bridges and keep privatisation out at the border? Judging by this letter from the three health ministers, they have opted to go for influencing the English, rather than leave them to their own devices.

There may be a couple of reasons for this decision. Westminster controls the budget for Scotland (and NI and Wales) through the lump sum that it gets every year. Therefore it still controls Scotland's health budget, although indirectly. If the Scottish Government takes the decision to use central funding for things like the Southern General, it will have to take a bite out of the cake slice that Westminster gives it. Therefore, it cannot ignore what is going on down south.

Secondly, companies such as United Healthcare and Atos are no respectors of borders. If Scotland decides simply to put up the shutters, it might not be enough. Perhaps the fight does have to be taken to them.

The main difference between England and the rest of the UK at the moment, is that England is the only part of the UK that still has first-past-the-post. Consequently, things move much slower politically in England than they do here; there is no room for independents to jouk in and shake things up as the St Johns Livingston crowd did in Lothian. There is not a party in England that you could call the friend of the NHS at the moment, and it is extremely worrying that there is an agreed deafening silence on privatisation of health in England.

So should we burn the bridges or should we cross them to invade? I would go for a third option. England badly needs proportional representation, so that the voice of the ordinary English can be heard on this issue.I don't think the English want privatisation any more than we do. But the people who have not spoken yet, need to find their voice.

Is it That Time Already?

Gee whizz!

My last post was on 18th February(!) Reminds me of someone I bumped into and I said,' John, I haven't seen you for ages! I thought you were dead!'
'And you never came to the funeral,' he said without blinking..