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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Did Gerry fix it?
- ann ashworth (17 December 2007)
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NHS: the Central Problem
- Justin A Robbins (19 December 2007)
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Re: NHS: the Central Problem
- L S Lewis (19 December 2007)
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Baked Beans
- Richard Bartley (20 December 2007)
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Polyclinics can work, in the right context.
- Robert E. F. Parker (15 January 2008)
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ann ashworth, freelance dietitian freelance
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Dear Rebecca, thanks for a great review. The PCT Chief Exec, when asked why the people of Rotherham could not go to the hospital said 'have you tried parking at the hospital?' implying that people would go there if only they could park their cars. Let us hope someone in the SHA watched the programme and realised that all they need to do in Rotherham is look at transport options. For example: build a 'Park and Ride' on the Polyclinic site, or regular buses, or even promote walking for those fit enough to cover the 2 mile distance. Ann Ashworth MSc RD R.SEN
Competing interests: None declared |
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Justin A Robbins, Locum GP Efford Medical Centre, Plymouth PL3 6JG
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In her review Rachel Coombes failed to mention one telling scene about half way through the programme. Sir Gerry started talking about the “central problem “ of the NHS which Mr Bhamra, orthopaedic surgeon, had “put his finger on”. This was the perverse incentives which consultants labour under. If they work hard and conscientiously and clear their NHS waiting lists they are rewarded with a sharp fall in income due to the loss of private fees. And of course the reverse applies. As a result of this manifest unfairness Mr Bhamra announced his intention of leaving the NHS. Sir Gerry expressed his consternation at the NHS losing such a valuable asset as Mr Bhamra and his dismay to Chief Executive Brian Jones that the latter could not pay Mr Bhamra on an item-for-service basis in order to induce him to stay. Disappointingly Sir Gerry did not pursue this “central problem” any further and did not seek the views of the other consultants or other staff, which would have made very interesting viewing. For many years I have thought that this whole issue is indeed a serious if not fatal flaw in the NHS and have felt that the profession and its leaders have signally failed to acknowledge it , still less to suggest a remedy. Competing interests: None declared |
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L S Lewis, GP Surgery, Newport, Pembs SA42 0TJ
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quite so, Justin - perhaps Gerry can pursue it next time ( although he signally failed to pick up on 'perverse incentives', after bumping into PCT's 'fixed budget envelopes' in the previous year !! What is to prevent the hospital management giving performance-related rewards to each of its teams - eg: ophthalmology, orthopaedics, etc. according to how much it earns off the National Tariff ? Why, the fixed budgetary envelope, of course... as Gerry learned the year before. Or have I missed something ? Competing interests: a citizen and a doctor |
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Richard Bartley, Physiotherapist Wales
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Corruption and self-interest pervades every aspect of public and private enterprise. The NHS is not immune to this. I believe the main weaknesses in the NHS is disempowerment due to public apathy. NHS employees seek compensation for this in numerous ways (financial compensation though private work or staff solidly sticking to old practices because of the security it provides). A relentless negative media onslaught doesn't help, but the value of healthcare is undermined by a uniquely British health system that encourages the public to believe that it is a commodity no different to buying baked beans or Ford Fiestas. Competing interests: None declared |
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Robert E. F. Parker, FY1 doctor University Hospital Birmingham, Raddlebarn Road, Selly Oak, Birmingham, B29 6JD.
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I have followed with interest the debate surrounding Lord Darzi's controversial plans for the introduction of polyclinics in London (and perhaps throughout England). In 2006 I spent my medical school elective at a polyclinic in Havana, Cuba, researching the Cuban primary care system. Polyclinics form a central part of the Cuban state healthcare system, bridging the gap between family doctors and secondary hospital care. The system in Cuba seemed to work extremely well, and I was most impressed with the excellent healthcare which Cubans enjoyed, despite the effects of the country’s history of political and economic isolation. In Cuba, each polyclinic serves around 10 local GP surgeries, and has its own specialist staff and equipment. The polyclinic I visited boasted, amongst other services, on-site physiotherapy, basic radiography, an ophthalmology unit, laboratory services, a dental surgery and a minor injuries clinic. Out patient clinics were run at the polyclinic by visiting hospital consultants in obstetrics and gynaecology, paediatrics, general internal medicine, dermatology, and even complementary medicine. Each polyclinic tends to serve a population of around 3-5,000 people [1], meaning that in a city like Havana there is literally a polyclinic every few blocks. In addition to the services provided by the polyclinic, each group of 10 (usually single-handed) GPs formed a ‘Basic Work Group’. This was a community-based team consisting of GPs, a community paediatrician, a visiting obstetrician/gynaecologist, an internal medicine specialist and a psychologist. Each Cuban GP has around 500 patients [1], compared with an average GP list size of 1,802 in England [2]. In urban areas in Cuba, there is a resident GP on every city block. The Cuban system works, in my opinion, because of the sheer number of trained doctors that Cuba has. World Health Organisation figures show that in 2005 Cuba had 5.91 physicians per 1,000 population [3]. According to the same source, the UK had just 2.3 per 1,000 and the USA had 2.56 per 1,000. Before Lord Darzi and others try to fix the NHS by adopting a polyclinic system, they would do well to realise that a polyclinic is merely an expensive building, unless you have the trained medical staff to actually run it. Furthermore, if there is not a polyclinic for every few blocks, then - as Gerry Robinson pointed out - the Darzi plan will merely duplicate existing hospital services, resulting in no benefit to the community. 1. Personal communication, Dr Javier Maure Barcia, General Practitioner, Havana, Cuba, May 2006. 2. Statistics for General Medical Practitioners in England : 1993 – 2003. Crown Copyright, Department of Health, London. 3. www.who.int/whosis/en/index.html Competing interests: None declared |
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