News from Nowhere January 2016

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Missing the point
An ancient document from the Adam Smith Institute – The Health Alternative (1988) – has caused a stir amongst the government’s enemies, some of whom think its ideas prefigured the 2012 Health and Social Care Act. Readers can decide for themselves by looking at:

News from Nowhere’s moles are struck by what this polemic misses out. It dismisses an insurance-based health service on the (correct) grounds that the US health insurance industry is a mess, but pays no attention to the flourishing health insurance-based services in Europe, particularly in Germany and France. Neither of these countries permit any part of the population to be uninsured, and both spend more on health services than does the UK. Ironically, within three years of publication of the Health Alternative all the health services of central and eastern Europe converted from state-run health care (NHS-style) to German style health insurance systems. Perhaps the Adam Smith Institute is full of Little Englanders?

Mobbing Casualty
We all know that Accident and Emergency departments are over-run as sick people find they cannot get a GP appointment. But of course this simple and beguiling explanation is not true. A&E departments are mostly not seeing massive increases in attendance, but they are seeing more complicated ill people who take longer to stabilise and sort out. And they have back pressures from hospitals that have lost beds whilst their local populations have aged. A Nuffield Review by Nigel Edwards ( suggests that NHS management fails to understand the dynamics of the health service and so focuses on the wrong solutions. The drivers behind apparent crises in A&E departments are: patients being put in the wrong wards, who are kept in hospital too long, making the bed problem worse; GPs being given long ‘to do’ lists for patients discharged too early, and not being able to complete them all; hospitals using averages to plan how they will meet demand, which tends not to be average; discharges drifting – or being done too hurriedly; and managers wasting lots of time reporting on targets instead of solving organisational problems. The review, and the lengthy on-line discussion about it, is an education, especially for a health service that likes to blame the patient, or failing that their GP, when things go wrong.

More trouble brewing?
The Department of Health, NHS Employers and the BMA have been discussing a new contract for NHS Consultants. The HSJ reported on the contents of the agreement – which now has to be approved by the BMA’s consultant membership – just after the junior doctors’ strike plan was revived. The draft contract includes:

The removal of the present right that NHS consultants have to refuse to take part in non-emergency work in the evenings, and at night and weekends. The existing 40 hour week would be retained and no specialist would be expected to work more than 13 weekends a year;

A lower starting salary of £70,000 but fewer increments, so that consultants would reach a higher salary sooner; £93,000 after five years
Lowering the top of the consultant pay scale to £107,000 with additional amounts dependent on their role, responsibility and out of hours work.

Abolition of clinical excellence (‘merit’) awards, with removal of those currently held; and the extension of normal working hours to include evenings and Saturdays.

This makes sense to News from Nowhere. More consultants are needed at nights and during weekends to make sure that hospitals provide optimal care. The abolition of clinical excellence awards – additional salary payments given to the best specialists – is long overdue. Of course a reduction in income may be made up by increasing private practice, which the government also wants. Assuming that the BMA’s 41, 000 consultant members in England accept the proposed new contract, that is.

No more waiting?, Europe’s largest online GP marketplace, is worth watching ( It has just raised $8.2million to expand its on-line GP service in the UK. Patients can connect to GMC registered private GPs in minutes in a video-surgery, and benefit from instant access to professional medical advice from a UK doctor who can prescribe, refer or provide a sick note.  The service charges £25 for a 10-minute appointment with a General Medical Council-regulated GP, while prescriptions are £4.50 and referral letters or fit for work notes are £12.50.

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