I'm a GP, and I'm sick of the NHS always winning
Another Spending Review, another promise of increased funding for the NHS. This week Rachel Reeves has said £30 billion will be invested over the next five years in day-to-day maintenance and repair of the health service estate. But will these cash injections ever be enough? Or is a centrally run and funded system simply no longer able to keep pace with the population's needs and demands for healthcare in our modern era?
The Times has also reported on Government plans to drastically shift care from hospitals into the community, in a bid to create a 'neighbourhood health service'; with the bulk of routine specialist appointments delivered in locations such as GP surgeries and high street opticians.
How GP surgeries are expected to cope with the extra demand – when many patients are already unable to secure an appointment – is not made clear. Yet the crux of the matter is not primarily where appointments take place; but individual decisions made by the public around when, where and how they use the health service.
Starmer is clutching at straws to meet his manifesto pledge for 92 per cent of patients to be seen within 18 weeks after referral for non-urgent conditions. Currently only 60 per cent of patients are receiving treatment within this timeframe. However, since Labour are focussing on the wrong problem, their solution will fail.
Working as a GP in the NHS, it has frequently struck me how much of the healthcare demand in the UK might disappear if the public were contributing in some way. Take the patient who calls to discuss their child's difficult bedtime routine, or one who recently asked for exceptional NHS funding to have a small fatty lump removed from their back. Day after day, GPs see patients who would not contact the health service if they even had to pay £10 for an appointment.
The same is repeated in A&E departments and outpatient clinics. Demand has been spiralling for years without the counterbalance that comes from a degree of personal responsibility. The result is that patients are offered tests and investigations they don't need, hospital referrals that may offer minimal benefit, and now many simply cannot get through to their GP at all.
Emergency departments in the UK mirror scenes you might expect to see in a warzone: patients covered in blood and vomit, writhing in pain, or being left for hours in hospital corridors. Nobody seems able to rationalise which services the NHS should be delivering; meanwhile the system is descending into chaos and delivering increasingly substandard care.
The Amazon Prime generation expects healthcare demands to be met at the click of a button – but better still, it is free! If the NHS can offer weight loss surgery, knee replacements, diabetes medication and more; then what is the point in striving to improve your health? The British public have, to a degree, learnt to expect the health service to pick up the pieces for their poor lifestyle choices. The results are seen across society: from overweight children in our primary schools, to millions declared unfit to work due to mental health conditions.
Despite healthcare expenditure continuing to increase, and accounting for a larger share of the UK's GDP; productivity in NHS hospitals has fallen, waiting times for outpatient appointments have ballooned, the UK has markedly higher cancer mortality rates than other countries, and life expectancy improvements have stalled. Coupled with the number of working-aged people who are economically inactive due to long-term sickness, it is not unreasonable to wonder how long this can continue.
Labour are right to identify that too many patients currently receive hospital treatment for conditions that could be managed by GPs, but they fail to see the bigger picture on the need for healthcare reform. If the definition of insanity is doing the same thing over and over, while expecting different results – this seems to reflect our position on the NHS.
Dr Katie Musgrave is a general practitioner
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