14 June 2008

The two Steves, polyclinics and propaganda

Dr Grumble has been reading an interesting document. As he writes he is not sure whether or not to provide a link. Since he has been outed Doc G is wary of criticising people in powerful positions. In any case, it's not the individuals he wants to criticise - it's just the wrongness of their thinking that needs addressing. Already you probably have enough information to find the document if you want it. The miracle of Google means that entering 'Steve' and 'polyclinic' should lead you there if you are at all interested. Google never ceases to amaze Dr Grumble.

Anyway, one of the Steves is a GP and gives a beautiful account of what a GP is all about. And to support the status quo he points out that British general practice is widely acknowledged as being the best in the world. He's right. Well, he was until recently. But since the new GP contract the chances of your own GP dealing with you in the night is remoter than it was. Does that matter? Very much. Dr Grumble is saddened by the number of old people shunted unnecessarily to hospital because there was no GP who knew them to deal with them at home. No wonder admissions have been shooting up though that's another story. But it does show the folly of meddling with general practice. If it ain't broke the government shouldn't go fixing it. And Steve number 1 doesn't think it UK general practice is broke.

The other Steve is a top gynaecologist. He doesn't say that general practice is broke but you can read between the lines. Dr Grumble has heard him speak. He has even exchanged a few words with him in a semi-public setting. Steve number 2 is very persuasive. He concludes, apparently convincingly, that the status quo is 'not acceptable'. Plainly he must have some killer fact to support this view. And he has. It's there as an emotive introduction to the argument. Here it is:

I think the chances of dying from breast disease in this country should be roughly the same as the chance of dying from breast disease in France, Germany, Holland or Japan. Unfortunately it is far from the case.

So that is Steve number 2's killer fact. It's a wonderful statement to bring you around to his point of view. It's a wonderful statement because nobody could disagree with it. It's a motherhood and apple pie statement. But is it true? Why has he said 'breast disease'? What breast diseases do you die from other than breast cancer? Presumably he is trying to obfuscate. Otherwise surely he would say 'breast cancer'. Steve number 2 is not daft. As Dr Grumble says, he can be very persuasive.

Do the facts support the propaganda?

So what are the facts? How does the National Breast Cancer Screening Service in the UK compare with that in other countries? Mrs Grumble says it is amongst the best. She's probably right. It's something she really knows about. Yet Steve number 2 has chosen to put the boot in on its 20th anniversary - just as figures come out showing that, in the UK, 6 out of 10 women diagnosed by screening have the same survival rates as the general population. And, of those not given a good or excellent prognosis, 86% survived fifteen years. These figures are already out-of-date. Inevitably they refer back to 15 or more years ago when the NHS was grossly underfunded. Mrs Grumble says there is a continuous improvement. So Steve number 2's killer fact is not a killer fact at all. It's not, in fact, a fact. And it has nothing to do with polyclinics. Nothing whatsoever. In any case all this is very complicated. In the UK local breast cancer survival rates vary. The reasons for this are unclear. The one thing we do know is that your chances are better if you are referred to a big centre. That is nothing to do with GPs. Nor polyclinics. Nor integration of primary and secondary care. It's to do with hospitals. Steve number 2's barely veiled criticism of GPs is unjustified - at least on the evidence he gives. It's in the hospitals that patients live or die. He needs to look to his own organisation. And, to be fair, that is what he is also doing. As well as expanding into wonderful polyclinics in, would you believe it, Abu Dhabi.

Why are we looking at polyclinics to solve the problems of integration in the NHS when most of us in secondary care can't even email our GP colleagues? And surely involving private companies is only going to make integration worse? What a crazy world!


Anonymous said...

Have you seen this Dr Grumble?


Dr Grumble said...

Thanks anonymous.I found the bit about the pressure being put on altruistic GPs and their likely response interesting. Dr Grumble agrees that there is a clash of cultures here and that GPs do have high ideals and cannot easily be bought. But if the system forces them they may, sadly, have no choice.

Below is what John Spencer says about the hapless Dr Winston Smith:

In fact, as far as Dr Smith is concerned VHC are all too aware of the fact that they can pressurize him into agreeing to decisions that he might otherwise have protested.

The plan for Dr Smith, once the first Virgin Healthcare centre was set up, was for Virgin Healthcare to use him as a ‘poster boy’ (actual term used) to convince other GPs that Virgin were worth working with and were ‘OK’.

I think the phrase ‘Trojan Horse’ springs to mind – (beware Greeks bearing gifts you GPs out there.)

I am confident that any GPs that may be considering future involvement with Virgin (there are 300 of them) would be very reluctant to enter into such a relationship knowing how the first GP had been manipulated into offering ‘little emotional resistance’ to their plans to compromise him professionally.

I must say that Dr Smith is one of the nicest people you could ever want to meet. He has an excellent reputation as a GP and I have no evidence whatsoever that he would have colluded with Virgin on these matters.

In fact, in my conversations with Dr. Smith he was very defensive of his own independence and I suspect that GPs across the country have been badly underestimated by members of the Virgin Board.

This is an interesting point (for a later article perhaps) where two very different cultures have collided – that of a large corporation where managers believe money and pressure can achieve anything that of GPs (and other healthcare professionals) where individuals are driven by an altruistic bent to protect patients, not just from disease but from all sorts of unethical shenanigans.


Dr G has actually met Sir Richard via one of his mates, Peter Emerson. He seems affable but the late Potentilla warned Dr Grumble that the nice guy image of Virgin was just that - an image.

Anonymous said...

I am John Spencer, the Whistle-Blower who lost his job at Virgin Healthcare after questioning their etthical behaviour.

Richard Taylor (MP and GP) has asked for a meeting with Alan Johnson at the DoH to dicsuss my 'alarming' concerns.

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