Best Of NHS … And Its Worst

Leading GP Dr Andrew Dearden launched an emotional attack last week on the “quagmire” of bureaucracy in the NHS which has forced at least one doctor to take sick leave.

This is his speech to the BMA’s Local Medical Committee conference in full

Dr Kay Saunders has practiced in one of the most deprived parts of Cardiff for 12 years, building up a practice in an area where many GPs would rather not work.

She works as a single-handed GP, from what is essentially a corner in an old health centre. She provides services for a list of patients many of whom are the most vulnerable in society – the homeless, the unemployed, those with chronic illness and many who came to this country as asylum seekers.

Her practice area is ranked as the one of the most deprived in Wales. Her practice patient group, started in January this year, is alive, active and supportive. She also specifically works with and provides health services to the homeless of Cardiff and those have addiction and drug misuse problems.

I consider her to be the quintessential GP, caring, concerned, dedicated, willing to fight for what she feels is right and what her patients need. Yet today she is off sick for physical, psychological and emotional exhaustion. Why?

She has had to fight against the bureaucratic quagmire that is the NHS of today. An NHS obsessed with budgets more than patients, an NHS where saving money by cutting patient services is seen as the basis of a successful year, an NHS where it is cheaper to run a good person, a caring GP, into the ground than support her. Where the managerial avoidance of risk is more important than the quality of patient services. Where the point of many NHS staff members’ working lives is to please the whims or targets of their overlords – be they senior managers or politicians – rather than improve and expand patient care.

As an example, over the past 10 years Kay has tried every avenue to develop her practice premises. Many supportive patients, local politicians, and Assembly Members are fully and publicly supportive of her aims, yet she has spent literally months of her life in meetings, writing and reading reports, seeking help, support and funding for new premises.

But she has had promise after promise made to her and then broken over many years.

Over the past year, she has two excellent GPs waiting to join her in partnership once premises expansion happens. Yet the three of them are still waiting. They have spoken to local land owners, developers, owners of nearby suitable buildings, other GPs and even other GP practices to see if a solution can be found.

But each option has proved unsuccessful when presented to the local primary care organisation [Cardiff Local Health Board].

It seems to not fit with their “plans” and their “strategy”. It is a poor strategy that does not see the value of keeping her in the area and providing services to the local population; it is a stupid strategy that blocks further GPs who want to, from working in this deprived area.

After years of this constant unwillingness to help her, she has found herself so exhausted that she is unable to care for herself let alone her patients. She has had to take time off on the sick to recover.

The Welsh Assembly Government says this is down to the primary care organisation, the primary care organisation blames the Assembly Government.

This story demonstrates all that is best and worst in the NHS.

The best are those like Kay, and tens of thousands of GPs and their staff across Wales and throughout the UK, who provide good-quality services to patients in spite of, and not because of, the NHS and its management structures and personnel.

The worst is where often good people are forced to act in dishonest and occasionally reprehensible ways to meet the needs not of patients but of their line managers and those who pull their strings – the politicians.

When the mess that is the NHS makes us wonder why we keep fighting this type of nonsense every day, I believe it is good to have people like Kay to help to remind us why we should.

Dr Andrew Dearden is chairman of the Welsh GP Committee and is a GP in Cardiff