I note that Dr Stuart Bloom’s six-point plan on how he would fix the NHS (30 June) focuses predominantly on the service provided in the community by general practice. There is logic to this: more than 90% of healthcare is delivered by GP practices and other community services. But a number of his points illustrate the problem with his plan.
As a consultant gastroenterologist from an eminent London teaching hospital, Dr Bloom is well-placed to advise on how to deliver elective and emergency hospital care. But his comments demonstrate that he genuinely doesn’t understand how that 90% of healthcare workload is delivered, nor the different challenges that service faces when delivering it in inner cities compared with delivering it in market towns or dispersed rural communities.
So the point about needing to “clarify the role of GPs” is telling: GPs are the expert medical generalists, and the only remaining doctors in the UK trained to consider patients as a whole. All GPs train in hospitals alongside career hospital doctors, under the auspices of hospital consultants. Newly qualified GPs keep us appraised of the latest trends in hospital medicine. But when was the last time a hospital specialist spent a day actually seeing what their GP colleagues do?
The system is breaking due to a toxic mixture of hostile elements in the press and parliament, chronic underinvestment, overwhelming and ever-changing targets that limit innovation and flexibility, and continually changing bureaucratic management. So how to fix it? Come and talk to us – the GPs doing the work. We have a pretty good idea of what happens in the real world outside of hospitals, what’s wrong, and maybe even how to fix it.
Dr Angus Whitfield
Newbury, Berkshire
• Perhaps one reason that successive attempts to “turn the NHS around” have failed to deliver is the nature of the experts consulted, and the absence of the greatest untapped expert resource of all – the people using services, and the people supporting them to do so. I have the greatest respect for the individuals quoted in your article (‘A future worth fighting for’: five health experts on the state of the NHS at 75, 3 July). But the absence of patients’ and carers’ viewpoints means a huge amount of knowledge of what is going on in the system now is lost: there is nothing like a lengthy hospital stay to provide an anthropological insight into the workings of a hugely complex system.
I have no argument with the solutions suggested. Of course prevention is vital. And of course technology is important, from the simplest – access to decent wifi (though I might add for people using services as well as people working in the system) – to the most complex robotic procedures. But the essence of healthcare is care, which is a profoundly human interaction. Looking after the humans of the NHS is the key to saving the system.
That includes people using services: they are not a burden to be reduced or a problem to be solved, but people who need the support of others and who are entitled to receive it. To do that, the humans working in the system need care too. Clare Gerada is right when she talks about burnout and needing more time to care, and not just for GPs.
Getting it right means more attention being paid to the experiences of those closest to the action (frontline staff, patients and carers who are also experts), and then their proper involvement in the design of the solutions.
Bev Fitzsimons
The Point of Care Foundation
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