There is little doubt that cuts are on the way. It is up to us as a profession to guide and support the incumbent government. If we don't, be reassured that they will, and that ‘they’ in this instance will be US ‘management consultants’ overseen by rapacious lawyers. I propose three main areas that could stand considerable pruning for, as gardeners say, growth follows the knife. First, all private finance initiative (PFI) activity must cease; second, rational prescribing rigorously enforced; and third, we must regain control of our profession before the lawyers destroy it. To avoid medical bias, I give an example of lawyers in action: the government tried to outlaw sham marriage. The high court decided that to make these illegal would infringe the couple's civil liberties. I recently had dealings with an Independent Mental Capacity Advocate. My experience (27 years) and that of our very able nurses was as nought compared to someone who had done a weekend's course and was not with the patient (client?). The Modernising Medical Careers debacle, Medical Training Application Service, Mental Capacity Act, Postgraduate Medical Education and Training Board (PMETB), Independent Complaints Advocacy Service, and revalidation have all been overseen by lawyers. Need I say more? The GMC appears as a rabbit in the headlights in their fear of the law; the colleges even worse. Does anyone know what PMETB has achieved for us?
The first of these would be easy. PFI must be replaced by government-funded projects, unequivocally on a not-for-profit basis. The savings potential here runs to billions (in my trust alone, £700 million).
We need to move to rational rather than emotive prescribing, centralise drug budgets, and run a national formulary with a rigorous approach to pharma. For instance, prescribing statins in those whose life span is measured in months is hard to justify on any grounds, let alone clinically. Dialysis likewise. A charge of ageism would need to be defended but taking a robust stance, rather than the current mealy-mouthed one, would make this possible. The savings would run into billions.
To take charge of our profession would empower us once more to do the job we love and, er, are pretty good at. Who wants to devote hours to revalidation rather than see patients? Surely a ‘catch 22’; those who are good at revalidation almost certainly spend the least time on the shop floor. So, to keep the lawyers happy we are de-skilling our workforce. We must fight back before it is too late. We have to take back our profession from the men in wigs. How? Solidarity would help and this means a return to a militant BMA who talk to us and not Kaiser Permanente. The GMC and the colleges must take up the fight rather than being the fight. Abandon PMETB as not fit for purpose. Our battle cry must be re-professionalisation, not revalidation. The savings? Beyond measure.
- © British Journal of General Practice, 2010.