Tim Worstall

Polly on GPs

I rather expect to see Dr. Crippen spitting with rage at this from Our Poll. The overall argument is that GPs would be more efficient if they were run centrally, as part of the bureaucracy, rather than being, as they are, independent contractors. Well, views will differ on that, of course, there are those who believe that central planning and bureaucracy is always more efficient and those like myself who will agree that sometimes it is (oooh, say, the military: we’ve tried the free market version of that and didn’t like it very much) but such cases are extremely rare.

Fine, OK. But two things that I do think Polly got factually wrong:


GPs are visible frontline public heroes. They need four As at A-level and five years’ hard training.

Five years? Where’s that number come from? Open, as always, to correction but isn’t it eight years?

Five for the medical degree and a further three to qualify as a GP?

Further, she even contradicts herself in her own article:

Bevan’s great failure was to leave GPs as small businesses, so the NHS never controlled its key service.

One might call it a failure but that GPs have never been directly part of the NHS is true.

But it’s also time to reopen the old Bevan settlement and bring the
under-performers back in-house to be better managed as the NHS’s most
vital resource and key gatekeeper.

Back in-house when they’ve never been in-house, as you’ve already told us? Most impressive Polly, most impressive.

In

5 responses

  1. Bob B Avatar
    Bob B

    In international comparisons, France is usually rated as having the best system of healthcare:
    For the 2006 national assessments in the Euro Health Consumer Index compiled by the Health Consumer Powerhouse, a Swedish think-tank:
    “The Euro Health Consumer Index 2006 identifies the most consumer-friendly health care system in the European union, as rated by 27 Index indicators. The 2006 Index includes all the 25 EU public healthcare systems plus Switzerland for reference.
    “France emerges as the 2006 winner of the Euro Health Consumer Index, ‘with a technically efficient and generously providing healthcare system’. France scores 576 out of 750 maximum points. 2005 years winner, the Netherlands, now takes the silver position, followed by Germany. Estonia and Slovakia gets the highest ranking in the category ‘value for money’.”
    http://www.finfacts.com/irelandbusinessnews/publish/article_10006355.shtml
    For details of country marking in the index:
    http://www.healthpowerhouse.com/media/EHCI2006.pdf
    The system of healthcare in France is much less centrally managed than in Britain – unlike Britain’s NHS, the French don’t go around boasting that with 1.3 million employees, their national healthcare system is the largest single employer in all Europe. One of several reasons for the better quality of healthcare in France, is very likely that there are significantly more physicians per head of population there. With the relatively highly centralised system of healthcare in Britain, we can very sensibly ask whose fault that is?
    “Lord Hunt of Kings Heath: Figures published by the OECD show that the number of doctors per capita in the United Kingdom in 1998 was 1.7 per 1,000 head of population and that the number of doctors per capita in France was 3.0 per 1,000 head of population.
    “These figures should be interpreted with caution, as different countries calculate the figures in different ways. The UK figures include only those doctors working in the National Health Service. Most other countries include all doctors entitled to practise. Figures for France include all active doctors, including some doctors without a medical practice.”
    http://www.publications.parliament.uk/pa/ld200102/ldhansrd/vo010723/text/10723w08.htm

    Reply
  2. aristeides Avatar
    aristeides

    The most annoying thing she says is that GPs are “heroes”. My last one certainly wasn’t – collected the temporary resident’s fee before registering me, always turned up late, charged me for a private referral, and appeared to have forgotten his glasses before performing an examination. This talk of heroes and angels – the equivalent tag for nurses – takes the piss. They don’t do it out of the goodness of their own hearts.

    Reply
  3. Bob B Avatar
    Bob B

    Btw from this, it seems that by wide consensus, we owe much of the improvement in the health of Britain’s population since the mid 19th century to enlightened public administration and the sanitary engineers than to physicians and medicines.
    “Sanitation is the greatest medical milestone of the last century and a half, acccording to a poll carried out by the British Medical Journal. Sanitation was the clear winner among 15 milestones shortlisted by readers of the journal, including the development of vaccines, which has safeguarded many children’s lives, and the invention of the contraceptive pill, which was a contributory factor to significant social change. . . ”
    http://www.guardian.co.uk/medicine/story/0,,1994182,00.html
    “In nineteenth-century Britain, urban areas exhibited higher mortality rates than did rural areas.”
    http://journals.cambridge.org/production/action/cjoGetFulltext?fulltextid=282964

    Reply
  4. Glenn Athey Avatar
    Glenn Athey

    Polly “back in-house to be better managed as the NHS’s most vital resource and key gatekeeper.”
    Timmy: “Back in-house when they’ve never been in-house, as you’ve already told us? Most impressive Polly, most impressive.”
    Polly’s propaganda is worthy of the historical revisionism of the soviet politburo, no?! Pravda Tovarish Polly?
    GPs – such a mixed experience. In many of my experiences, you only get anywhere by being referred to a consultant, unless your ailment can specifically be cured or relieved by crepe bandages, parecetamol, iboprufen or a few weeks’ rest! Having said that there’s some really good GPs who give very quick and accurate diagnosis, and get things moving for you quickly in terms of treatments etc.
    I usually think of GPs as being there to ration access to the full healthcare resources at hospitals etc!

    Reply
  5. Dr Mustard Avatar
    Dr Mustard

    What Polly fails to realise (bless her) is that the only reason the NHS has been able to continue this long without disappearing up a management consultant’s arse is that GPs have never been centrally controlled.
    Before the new contract, out of hours care was effectively being provided for free by the GPs. The new contract was in part intended to actually pay for this service for the first time. It also recocognises the importance of stopping people getting ill in the first place. The ‘QOF’ is the only set of targets in the whole NHS with any evidence to back it up – it basically does ‘what’s good for patients’ rather that ‘What looks good in the Daily Mail’. The contract commisioned extra work for your benefit, and the GPs delivered in spades – hence the pay rise.
    General Practice is the most efficiently administered part of the NHS bar none. The government realises this, and expects GPs to take on more service commisioning in the future, which makes their constant bitching and negative story planting about GPs frankly bizarre. It is yet another glaring example of their incompetence and spite.
    Finally, having spent 27 years of my life in continuing education to become a GP, what sort of salary should I aspire to?
    The salaries of comparable professions have increased by more that that of GPs, and most of my rise has disappeared into my more expensive and recently capped pension.
    If you pay peanuts……

    Reply

Leave a Reply

Discover more from Tim Worstall

Subscribe now to keep reading and get access to the full archive.

Continue reading