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“Going the extra mile” endangers doctors, patients, and NHS

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3547 (Published 26 July 2017) Cite this as: BMJ 2017;358:j3547

Re: “Going the extra mile” endangers doctors, patients, and NHS

The NHS relies very heavily on the goodwill of its staff and the 'extra mile' in the face of all its adversities and challenges. The views expressed here raise a very pertinent question that by trying to make a massively strained system work, are we just prolonging the inevitable? This also naturally raises the question about potential 'collusion'. In the face of reduced funds, efficiency cuts and staffing shortages, it is indeed a very complex challenge for the commissioners and providers alike to continue to balance the books. It is even harder to do so to continue to provide a truly quality service. Cutting corners, a system that runs on reserves all the time and with obvious or not-so-obvious compromises appears to be the norm in the newer world of health. We are already seeing a variety of direct and indirect rationing. There is also a degree of taxation through backdoor e.g. many services and treatments are not being offered under the NHS. Are we thus 'colluding'?

There is also the issue of how we as commissioners and providers explain this to the public. Do we behave as political strategists and pretend that all is well or do we be honest in what the service configurations are?

Will it be better if we all, unitedly, sent the same message that the system can only work with more resource and commitment from the powers that be? At what point do we breach the trust of our patients by continuing with the status quo?

Competing interests: No competing interests

30 July 2017
Kamalpreet Singh Sidhu
GP Partner
Castle Eden