My opinion of doctors isn't supposed to come across as negative really. I'm mostly trying to make the point that doctors should be doctors and not managers. Paying them to do managers work, or admin, is a poor use of resources. Their time is the finite resource and they can see more patients by spending their time in clinics, theatre and the ward instead of meetings. An effective manager gets the most out of their team.
As someone who has worked in the NHS you must also recognise that the best nurses, doctors, therapists etc get given managerial roles that they are not suited to. Then you lose your best clinical staff and you have poor managers. That's a pay structure problem because the NHS is too fixated on the hierarchy. The pay structure doesn't allow them to pay more for good staff. Managers don't have to earn more in the real world. They can be coordinators and let the good practitioners do what they are good at. The only time it seems to make sense is with doctors because they allow them to be on their own payscale and so you have managers managing better paid staff than themselves.
Morning Mike.
Now I understand the points your are making I agree whole-heartedly:
Its important we discriminate between Primary Care and Secondary Care.
Primary Care [GP Surgeries and Community Services]:
Since the Government separated Primary and Secondary Care, GP`s have the responsibility to audit and budget each service [including staffing] they provide. [Like a private company inside the health service].
Services are provided with resources by independent Care Commissioning Groups [in preparation for complete privatisation].
CCG`s arent restricted in the geographical practice areas and services they cover. Their priority is providing services as cheaply as possible - those which may be costly [on a bottom - line priority] have been closed [eg: Learning Difficulty].
The quality and provision of services has diminished and surgeries have closed.
Patients have been forced to travel many miles from home to access a GP and "local" services. - even in urban areas where a patient list can be 4000+.
These CCG`s are not directly accountable to the public or local authorities.
They are accountable to NHS England [and some private sponsors] on the basis that their services are "efficient" [cheap] and at the lowest cost per capita.
I agree with you entirely, that the focus of Professional Qualified Clinicians has to be the Patient, not the audit book. Whilst GP surgeries and CCG`s run "Public" services, pressure is placed on the shoulders of Doctors and Senior Healthcare Practitioners to "account" for every penny spent or face redundancy and closure. This means more patients are excluded from service access and effectively reduces the quality of life.
"Savings" and "efficiency" are euphemisms for CUTS, make no mistake about it. You cant compare the cost of providing a defibulator and a mental Health Consultant to a private business. Its not the point of delivery which is the problem: the focus has to be the private companies who take money out of the service - like Serco and Arriva. It has to be focused on the cost of accountants and the adoption of the Business Model by successive governments, which focuses on profit per head, not poorly patients.
The real "cost" to the nation is a population with a lower quality of physical and mental health: it means patients not receiving emergency services at home and being forced to wait for community transport [if it exists]. It means telephone appointments and more barriers to service access - Unqualified Receptionists asking clinical questions of patients who want a GP appointment - to reduce the cost to the CCG`s [who put in the lowest tender to provide services] irrespective of the effect on patients. It excludes people who require a service and ultimately pushes patients into emergency Walk-In Centres and Accident Emergencies.
Reducing the "cost" on one service by transferring it to other sectors of the health service.
Its not "saving money" - its pushing debt - CUTS - around the service.
The ramifications of the business model in the NHS for patients is a poorer quality of life, and a return of diseases and conditions [like ricketts] which we hoped had been eliminated decades ago. It means the most vulnerable people [children / elderly / those with other physical and mental health issues] become excluded and live in health poverty.
The only way to provide effective healthcare at all levels is to keep it local - a national service with regional and area authorities - who know the demographics of their local population, and ensure they are accountable to the local population through Local Authorities, emergency Services and Patients Panels.
We shouldnt despair, otherwise we have given up. We have seen our NHS emmersed in the water of chaos of the "for profit" model. It doesnt mean we have to wait for a change of Government or that we have to accept it. Many local services have been saved by local campaigns and protests - but you wont see that in the local or national media.
The ideology that has driven cuts, fragmentation and privatisation has no compassion or morals, other than to give our NHS to private pockets - whose top priority is providing profits and power to shareholders - who arent in anyway accountable.