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July 16, 2024, 05:14:46 PM

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CM gives opening address at medical conference - May 2023

Started by Bad Ambassador, May 18, 2023, 02:58:53 PM

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Bad Ambassador


Spoiler alert
I'm just here to sort of fill in at the start of the day to pad the day out, because there's not much going on. Steve Barclay seems to have sorted out the crisis in general practice by deciding that you can't have a crisis in general practice if general practice doesn't exist.

He also seems to realise that you can tell patients anything because he's not going to be here in 18 months to carry the can. In fact, Wes Streeting is going to have to do that. He's going to have to answer to the service, which will at that time be carried out by Superdrug and children with stethoscopes.

Katie phoned me up and she said, 'Hello, I'm Katie Bramall-Stainer [UK LMCs Conference chair], and I think that Matt Hancock should have his eyes pulled out through Andrew Lansley's arse'. She said, 'I'm chairing the LMC conference and you will be saying a few words at the start.'

And I said, 'Okay, but really, what can I usefully say to a room full of doctors? I don't know anything that they don't know. I can't do that. I'm like a Harley Street GP, I'm not properly qualified.'

She said to say something about being a patient from a patient's point of view. And I said, 'Well, okay, I still consider myself quite lucky because I hardly ever go to the doctor. I don't really feel like a patient.' Which was true at the start of the call.

Three hours later, I had ruptured eardrums. A nosebleed. I felt dizzy. I felt faint. I had stabbing chest pains. Breathlessness. It was very much like the time I phoned Babylon and they diagnosed trigger thumb.

Actually, I should say I'm worse than under-qualified to speak to you, because both of my parents were GPs. So my idea of your job is that all you have to do is say, 'Leave it alone, and it'll get better.'

I grew up in a rural practice in the early 1960s. The surgery was in the house, the practice phone rang in the kitchen. It was 24/7 care. At that point, it was a stressful life. My parents' standing orders – what they were paying out – was greater than their combined income, and across the country practices were dropping like flies. It was before The Family Doctor Charter of 1965. Of course, I understood very little about the stress of general practice at that stage, I was two. So one day, on a Sunday, everyone in church got some idea, because when the communion bell rang, I shouted out, 'Bloody phone!'.

So why am I talking about general practice? I mean, both my parents have died now. So I think there's an emotional attachment, the idea of trying to maintain something they believed in. But more immediately as a patient, I am definitely concerned with chronic underfunding and the pressures on general practice.

And I'm distressed in principle by a government that seems to be incapable of understanding the doctor-patient relationship, who sees policy the spin, and are hell bent on micromanaging through metrics rather than letting GPs do what they do best.

And my other non-qualification is that my godmother, Betty, was married to John Eskil – John Sassall in John Berger's A Fortunate Man. And by the way, has anyone read a book called The Fortunate Woman, which came out last year? It's Polly Morland's brilliant portrait of the same practice 50 years on, and it's a subtle and a very strong argument for continuity of care. And also, by the way it reinstates Betty's role in John Eskil's practice. I don't think she got mentioned in John Berger's book. But she was absolutely crucial to the running of the practice. And indeed, as you probably know, to keeping John alive.

So that was my father's first practice as a trainee, he studies under John Eskil, and he learns a lot. He learns about the doctor's place in the community. He learns about weird and arcane medical practices, like taking a swab before you prescribe antibiotics. My father travelled everywhere with a saw in the back of the car, in the desperate hope that he kind of was somebody trapped under a tree.

Because things have changed, I realised that things have changed a lot. And that we now know that what you're meant to do with antibiotics is develop bacterial resistance as fast as possible, so that lots of us die. And then there are enough doctors to go around.

And so I was thinking about all this, as I struggled with the symptoms caused by Katie's unnecessarily violent phone man, and I made my way in some pain to my local general practice. When I got there, written in splotchy paint on the door were the words, 'Sorry, closed.' And underneath an arrow, it said, 'Doctor down there.' And I looked down the road, and saw one of those red and white tents that you used to see when people used to mend the road. And I went down and there was a haunted looking woman sitting on a box.

'Dr Dunmore, I said, scarcely recognising the ravaged husk of my once named doctor. 'Yes, she said, but this isn't a contact. You're not contacting me even though it may look like it. This is not a contact. I've got all these contacts on the phone. I've got 406 of them waiting. I've got to get through them all. Could you sign this please.' And she signed me an old PPE blue rubber glove, which had, 'I did not contact you.'

'If I don't do all of this, my contract's toast. We're trying, we're really trying.' To which point there was another voice. 'Concentrate on the patient, don't talk about yourself.' And I realised there was a partition in the tent, and a hand drove back and there was a man hunched over an iPad, punching furiously into it. I said, 'Hello, who are you?' And he said, 'I am the federated data platform. I'm here to automatically assess this doctor's practice of medicine for delivery against government goals.'

I said, 'Oh, I thought you were meant to be a sort of computer system. 'Very funny,' he said. 'Are you implying that we've fallen behind schedule? Are you implying that the new NHS IT system, which shows every interaction between doctor and patient on a dashboard in Whitehall, was conceived by control freaks who were also idiots who have no idea how to build it? Why don't you try the new health centre down the road?' He said they've got a really good website.

On the website, there was actually a sort of promotional video and all the doctors were sort of swaggering down the corridors and smiling with a jacket slung over their shoulders.

And I said, 'Okay, I'll go and give that a go. And I went in, and the first person I saw was one of the doctors from the promotional video. I said, 'Oh, hello. I've just seen you walking down a corridor.'

'Can I help?' he said. 'Well, yes, as it happens. Yes, I've got some very alarming symptoms,' I said. 'Well, you won't be seeing me then,' he said. 'I'm a doctor.' And he pointed to some shattered-looking youngsters huddling in a corner just beyond a statue of Julian Tudor Hart.

At that point, my chest exploded, and I fell to my knees. 'Do you want to see our nutritionist?' said the doctor. 'Thanks,' I said. My own practice, didn't have one of those, but it did open during Covid. And the thought occurred to me and I said to him, 'Did you open during Covid?' He said, 'Of course not, but we did set up a special vaccination centre, and that delivered huge and undeniable benefits to all of our shareholders.'

All right, so how come my old partnership practice up the road did stay open throughout Covid? They did face-to-face appointments when necessary. They delivered vaccines. How come my parents' GP, also a GMS contract, would do house visits and drop into see patients as they grew frail, and would even come in on their way home to pick up a sample and take it to the local lab? How come, despite what the health department and their poisonous scribes in Fleet Street would have you believe, GP appointments are up 20% on pre-pandemic levels and with fewer staff? How come all of this happens with only 8% of the health budget going on primary care? And isn't it obvious that if you spend more on general practice, you can train more doctors, you could increase staff retention, you could give more patients better treatment and actually save money down the line?

And by the way, how come Jeremy Hunt put his name to a half decent health select committee report last autumn? We said that the Government should spend more money on general practice recruitment and retention, they should strengthen the partnership model, and they should give more money to practices in deprived areas. How come he has actually said all that, and now he's in charge of the purse strings and says you can't have any of that?

The doctor took a moment. He looks at me and he says, 'Right. Well, all that may be valid, but none of it matters, because soon you'll be dead. And then we won't have to hear any more of your antiquated old rubbish. The end. Well, it's not the end because I couldn't end like that, that's too downbeat.

I thought that is the kind of end, but then if I just keep talking, maybe something else will happen. So imagine the doctor just said that to me. And then he pointed to a mural behind him, which showed a picture of his face, a big face, and on his outstretched hand a tiny little Wes Streeting. You could see it was him, with his startled bird face. And you could see a little USB port on the side of his neck where people jam in flashcards to make him same stuff. 'All GPs on salaries love the private sector, self-referral tonsillectomy by app, and DIY small bowel resection.'

And I saw that the Wes Streeting in the man's hand was saluting proudly, as he stood to attention next to the doctor's signet ring, which had the letters 'NHS' in the colours of the stars and stripes.

Right, so that's no better. I'll have one more go. So how about this: I laid gasping on the floor. And suddenly my family doctor appeared in the doorway. She said, I couldn't leave you in this place. I've sorted out my 406 callers, god knows how. She shoved aside the doctor in the suit. She checked me out and said, 'You're not having a heart attack, but we'll get you checked over by cardiologist just to see what's going on.' I had an ECG, they found nothing to worry about.

The next time I saw the doctor, she knew all about me because she remembered who I was. And I said to her, 'How come you're even here, I thought they shut you down?' And she said, 'It's 2025 now and they shut down the APMS place down the road because it wasn't returning 25% to its shareholders.' And someone jammed the health select committee report into West Streeting's neck... That better?

It's maybe a bit Pollyanna-ish, but isn't there a feeling that the penny is dropping a bit? Patients do appreciate general practice. And I speak for all of them, and I do that because the recent report, which showed high levels of dissatisfaction with the NHS, also showed that those patients who had actually seen their doctors were extremely satisfied with what they got. You could put it another way, you could say 100% of patients said they would rather see their GP than Therese Coffey. But I think patients do trust their doctors.

I was at the RMS on Monday where Matthew Taylor gave a speech and he was advocating for decentralisation, and he quoted research that showed that in health care, bottom up works better than top down. So that's an argument against NHS England control, which seems like a good idea. I'm sure you know, there's research from Norway, which shows that continuity of care increases life expectancy, I think by up to 25%.

Polly's book, which I mentioned earlier, is a Sunday Times bestseller spreading the word and describing the hearts of general practice and the aspirations of general practice across Britain. Our local doctor is under 40. He believes in all of that stuff. It's not just quite an old fashioned, and I've spoken to GPs in Cumbria, York, Bristol, Durham. I spoke to one in Hackney yesterday, who I mean, I haven't checked this out, but it sounded like he was doing an incredible job. He wasn't boasting. But basically, patients have a named doctor. They practice continuity of care, they do home visits. It's a partnership practice with five partners and 10,000 patients, and I was really surprised to hear they do nearly all appointments face to face. They have very few phone consultations because he said you just learn so much more in face-to-face appointments. And they have no eight o'clock rush, they have four receptionists. I'm going to visit the place because I'm so interested to discover who's making this work seemingly against the grain. He didn't sound stressed, and he didn't sound mad.

I'll report back to Katie, but I was encouraged by that. It seems to me that there's 18 months to shape health policy for the next 10 years. And that is time to create something like a new family doctor charter, based around the idea of growing partnership practices, of improving continuity of care, of increasing payments in poor areas. All that can be put on a USB stick and jammed into Wes Streeting's neck.

Petey Pate

It's hard to not think that both of his parents being GPs was a large part of the inspiration behind the numerous doctor sketches in Blue Jam and Jam.

Pink Gregory

Thanks for this, always nice to see CM in different contexts


Nice! Thanks for sharing this. Got a few smirks and the odd chuckle from me.

Mister Six


I hope he mentioned that The Day Shall Come was on RTE last week. Very important that.

Egyptian Feast

Thanks! Nice to see the little Wes Streeting brought to life in Chris's hand.


Couple of right miserable beggers on that panel. The one with the grey hair doesn't once crack a smile.


Why has he been speaking to so many GPs? Won't just have been as research for the speech, will it? Wonder if it's to do with his next project.


Will he be touring the medical conference circuit this summer? He should do more of these. Maybe you'll get a peck on the cheek like Katie did at the end there.