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by in Funny, GP Practice Management, Political

By Nicola Hayward

SurvivalFirst month of the year over already. Just where does the time go?  My Nan always said once I’d hit 21, the years would fly by… I didn’t think she actually meant that they would whizz at a rate of knots, so much so, that each week now is just a blur!

I’m actually working on a Saturday this week – not because I need to do extra to catch up (although I could do that quite easily with the workload being what it is!) but we’re having some work done and it’s easier to get the plumber and the carpenter in on a Saturday when the surgeries are closed.   The other positive is that I can work relatively uninterrupted and actually get on.  I have a ‘door always open’ policy; it’s not that I’m hugely friendly and happy to be interrupted at all hours of the day, but when my door is shut it sends out a very obvious message that I can’t be disturbed (or rather, I really don’t want to be disturbed!).  Unfortunately, it isn’t always successful – but being approachable, I feel, is a better style and it makes for a happier workforce.  This might not be a style that works for everyone – we each have our own way of doing things, but the crucial bit is really about survival.  Without some tricks up our sleeves to manage our day (and get to the end of it without wanting to damage someone or something), we’d not survive.

There’s a lot of talk at the moment, locally and nationally, about ‘Sustainability and Transformation’. The ‘survival’ of the NHS… but it mostly revolves around secondary care and how they can be more sustainable and transform themselves.  But what about us? What about our survival?

I duly attended a local STP consultation meeting in our village hall and listened to a lovely Communications chap from our local trust talking about what the CCG/trust are doing, how they are consulting with Joe Public blah blah blah blah blah… well it will come as no surprise to any of you to say I gave him my two’penneth on the whole subject.   I may have managed to actually get one of the decision makers down into primary care to chat with us – after all, 80% of what happens in secondary care starts off at our door – and we ALL know how they could save money, improve efficiencies of working etc., but all too often, we don’t get so much as a sniff.  So, I’ve offered them an opportunity to come and work with me for a day – see what happens at the coal face (I make it sound like we’re down t’pit but you know what I mean!). OR they can meet a group of us and have a sensible discussion and we WILL give them useful hints and tips, whether they want them or not!

I can’t say that I’m holding my breath;  it possibly (probably) won’t happen; but I’ll reference my Nan again – if you don’t ask you don’t get – though my Grandfather used to say if God didn’t want me to speak he wouldn’t have put a tongue in my head.  If I believed in God, I might ask him if he ever regretted that decision!!

The NHS has gone through so many changes over the years (and I’ve seen a few!), but this latest crisis really is the worst it’s ever been.  So how are we going to survive it?  Some really difficult decisions are already being made – I heard recently that one CCG up t’north has made a decision that you won’t get a joint replacement unless you’re absolutely crippled in pain (not sure how they’re evidencing the ‘crippled’ or ‘pain’ though) but is this what it’s going to come to?

Should we be asking for metal prosthetics to be removed upon death to be re-used? A recycled prosthetic could potentially be put to use again… could it?!  Should we be looking at changing how we charge for prescriptions?  I have banged on about that before, but regular readers might remember the response I got from Mrs May’s comms team last year, telling us that this had been looked at and discounted.

My own opinion, for what it’s worth, is that until we place a value on the services we give to the ‘user’, they won’t put any value on it at all.  It’s always been free at the point of access, therefore it doesn’t matter what we provide, the cost is unseen so it goes unnoticed, unremarked, unaccounted.   Perhaps it is time to start charging people who forget their appointment or just don’t turn up; perhaps it is time the decision makers grew a set and said out loud what we’re all thinking. Until this happens, we’re all heading in a downward spiral of doom and gloom – so my tip for survival… chocolate and wine, in relatively large quantities but appropriately consumed at the right time, obviously!  It might not save the NHS of course, but I’ll be fat and drunk so what will I care?!


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Nicola Davies

Nicola Davies

Practice Manager regularly ranting about the NHS. 30 years in Primary Care and still getting irritated by constant change for change sake!

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One Response to “Survival…”
  1. Avatar
    Steve Mowatt Says:

    As businesses we are hamstrung by the fact that we can’t charge our own patients for the services that we offer. Conversely, if we offer space to organisations that can charge patients and pay us for the room, we get penalised in our notional rent. This is not good business practice.

    Like dentists, we should charge for DNAs; we should be able to offer private flu vax instead of Asda etc; minor ops or specialist treatment – for example, we have a Novacor device that can be fitted to patients with heart irregularities. The GP fits it, downloads the readings a week later and then interprets them for the patient’s usual GP. The CCG won’t fund this so, if I decide that we will no longer offer this service, then patients have to go to the local hospital on a very long waiting list. They will pay for travel, parking etc, so why not allow us to charge a nominal fee instead?

    Funding has to come from somewhere and, if it’s not from government, then it has to be patients.


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