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PT and the Greater Good

A Frozen PT Has Time to Think

Published December 22, 2010 1:35 PM by Dean Metz

Many of you may have read that England has ground to a halt. For a rare change, my town is the least affected by this snowstorm. The roads are icy and a challenge but we're still out seeing our patients every day. The rest of the country is not doing so good. The major airports are still closed, the trains are barely squeaking by and the roads near London are impassable.

It gives one time to think and reflect upon the changes coming to health care here. It has taken me nearly a year to learn about the NHS and who is responsible for what and is governed by whom. And now it is all changing. The BBC has an excellent summary of what is going to happen:

Essentially, the government is allowing general practitioners to handle all the funding. They are the only health providers not employed by the NHS but still paid by them. They will also be able to charge higher fees now. Hmmm, not sounding so good, I think. They will determine the need for hospitals, outpatient and community-based care and will commission for those services. Does anyone else hear conflict of interest here?

The word on the street is that the Tories are effectively trying to close the NHS. In the link above you'll read that this isn't the first time it has happened. Thatcher tried the same thing in the 1980s without following through. David Cameron, "I will cut the deficit, not the NHS," seems to have a more thorough approach to holding the pillow over the face of the NHS.

The British people still complain about the NHS. They don't know how good they have it. The current government is banking on that. I'm willing to bet that in five years, the NHS as we know it may not exist. I wonder how I'll be working when that time comes.

Merry Christmas, Happy Chanukah, Happy Kwanza and Happy Festivus (for the rest of us).


Janey, Excellent questions and observations abounding in your post!

1. Think of the NHS as an insurance company (it is actually both an insurer and a provider of services). That is how doctors get paid by them but don't work for them.

2.Tories are a conservative party in the UK (The most conservative is the BNP or British National Party). The middle of the road party are the Liberal Democrats (currently in joint power with the Tories) and the most left leaning party is the Labour (that spelling thing you've mentioned) Party.

3.Ministers are the leaders of Government (Prime minister, ministers of Parliment) or of organizations (minister of health, minister of finance)

4. Commissioning is the process where local authorities purchase services for their districts. For instance they can commission a construction company to build a train station, they can commission a company to run a care home (SNF) or they can commission the NHS (or another provider which the NHS would have to pay) to provide primary care services.

With regard to the Orwell. As an American I never really understood "1984" on a gut level, I really get it now! For a more modern reference, watch "torchwood" and see how the government is portrayed.

You'll be very interested in my next post which details the Chartered Society of Physiotherapists response to the proposed changes.

I've been told I speak English, however people here think I'm Canadian most often and, interestingly, Irish on frequent occasion. Yes, learning to spell Haematology, Aenemia, Programme, and Oedema have proven a challenge to my note writing. For another literary reference on that matter read Carroll, "Through the Looking Glass"

Cheers, Dean

Dean Metz December 23, 2010 2:12 PM


Forgive my ignorance, but this comment is full of it.  Here we go:

How does it work that the health care providers are paid by an entity, but don't work for that entity?  

Who (or what) are the Tories?  

What are ministers mentioned in the article?  

What does commissioning mean?  

And, it has to be asked, Are you sure you speak English :-)  I don't envy the assimilation process you've undergone...learning new definitions, and spellings, for familiar words while navigating a foreign system of healthcare.  Ugh.  I just wrote a column on the challenges of fitting new paradigms into existing frameworks.  Seems that is where you have lived this last year.

The article says the Health Secretary sees this change as being "key to making the NHS more responsive to patients."  How can the NHS be more responsive when they are going to be making a fraction of the decisions they used to be?  Or did I miss something?

And it said, "He believes GPs know what works best and wants to tap into their entrepreneurial spirit to drive improvement from the front-line."  By definition, "entrepreneurial" includes risk and initiative.  If someone else hands me money and tells me to go spend it, I don't see a whole lot of risk or initiative there.

Sounds like one of those situations where if he says it long enough and loud enough, he's convinced people will believe him.  Or perhaps I'm just one of the sceptics mentioned in the article.

Janey Goude December 23, 2010 4:43 AM

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About this Blog

    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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