Views And Reviews No Holds Barred

Margaret McCartney: When a crisis is the predictable outcome of poor policy making

BMJ 2018; 360 doi: (Published 10 January 2018) Cite this as: BMJ 2018;360:k90

Re: Margaret McCartney: When a crisis is the predictable outcome of poor policy making

Spot on, Margaret. And not only have huge amounts of money been wasted on initiatives like the internal market and the white elephant darzi centres and the ultimate in futility that is the CQC. Much worse is the effect of these and other unproven and time consuming ideas like QOF and revalidation and computer prompts about frailty and sepsis and prescribing more cheaply, etc, etc - in distracting us from our day job. To take one example, QOF has massively increased the use of drugs for diabetes and the workload despite a lot of evidence that treating to their targets is actually harmful.

Similarly we have been given lots of extra work - dealing with badly behaved children, obesity, health checks, fallout from screening, ‘depression’ i.e. work and family stress, etc. None of this was part of our work in the past and no one has shown that we are effective at dealing with it. Our masters have totally failed to tell us what other work we should stop doing in order to fit it all in our day.

My experience as a GP partner for 30 years and now as a locum GP in many practices and in out of hours services and in A&E departments is that we are working far less efficiently than previously. We are in a hurry so we overprescribe, and over investigate, and our morale is really bad.

And is it inevitable that our managers should be so completely incompetent, or is that the result of them wasting so much time and energy on dealing with all the latest initiatives, and fire fighting with cost pressures, etc. that they also never really focus on the main job?

It has been said before of course ‘First, Do No Harm’. It applies as much to the management of the NHS as it does to medical practice.

Competing interests: No competing interests

12 January 2018
ted a willis