David Haslam: An organ grinder surrounded by deaf monkeys.David Haslam is a GP in Cambridgeshire and President of the Royal College of General Practitioners. He’s also a really likeable bloke, and if I was ill he is the kind of GP I would like to meet.
He’s written a superb article here which describes the importance, the low cost and the effectiveness of primary care. Good primary care saves lives, as Barbara Starfield has demonstrated.
Dr Rant hopes that Lord Darzi and team are not going to destroy the great primary care system that already exists in the UK.
However as a friend of mine put it to me,
“Haslam has always been an intelligent and stylish commentator. The task however is hopeless. GP is, and has always been, undervalued. The achievable task is to lobby the ear of the powerful and try to mitigate the endless tendency towards dramatic and high tech medicine. Success will only ever be partial.”
On here we believe in the strength and importance of primary care. Voltaire once accused doctors of, “giving pills of which they knew little, for diseases of which they knew less, to patients of whom they knew nothing.” Politicians and their ministrations to the body politic are even less informed that this.
The longer I live and practice medicine the more I realise just how demanding a rubric “First, Do no harm” is to actually achieve.
Anyway read David Haslam’s article and you’ll get a glimpse of what primary care can do for patients.
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24 comments:
im sick of hearing from people inside the medical business
we need to hear more from people who suffer from it, the patients
http://notdrrant.blogspot.com/
That's a great idea, No-One.
I'm sick of experts who know what they are talking about trying to tell us important stuff that will save lives.
I want to hear more ignorant ramblings from a bunch of ill-informed, self-important, neo-liberal auto-masturbators like you.
Real patients want real information from real experts.
yea real experts that cost the tax payers a fucking fortune
that leave them to die in their time of need
as per the recent post on my blog
how you fuckers sleep at night is beyond me
yea experts at doshing out pain killing pills when folk obviously need more pain relief than that
yea experts on lots of stuff but clever enough to know who to leave to die? yea right
you cunts dont you realise ive just been looking at your handiwork close up, it aint professional, its a fucking shambles
the medics involved with the guy ive just spent the weekend with would be hounded out of the profession in any other country
so you keep you expert status
ill just call you cunts
and self centred self fucking important cunts too
Thanks for the link to the article - a fantastic read.
Why, oh why couldn't we have somebody like Dr Haslam at the helm.
Perhaps it's because his message [supported by overwhelming research evidence] does not fit in with Johno & Bradshaws 'vision' [sic].
Incidentally, which part of Haslams paper do you dispute, no one ?
It makes perfect sense to me, although I must admit I did not fully appreciate just how VITAL a first class primary care service is to the nations health.
I have just read this post and the article it highlights and if ever the Government needed a reason for leaving our GPs alone, this is it. The fact that there have been studies from various locations that highlight the benefits of the continuity of care that is possible with our traditional GP surgeries should tell Lord Darzi and the rest of the Government that one area of the NHS that genuinely deserves to be left without Governmental interference is our GPs. These studies show that the argument for polyclinics and healthcare centres is very poor indeed, and increases the likelihood that these are ways of privatising the NHS by stealth. We should all stand up and tell this Government to leave our NHS alone.
No one
Did you actually read Dr Haslam's article?
Why not comment on this rather than you usual baseless insults.
which describes the importance, the low cost and the effectiveness of primary care
of high quality primary care. (To quote Haslam.)
doc doc
i report on what i have seen 1st hand
yes i read the article
seems like a nice guy but no real fundamental systemic fix for the inbuilt problems in the current system outlined
no one
Your responses on this are ungracious.
David Haslam is on the side of getting good medicine to patients when they need it. Good primary care is a very effective way to deliver it.
The NHS has (mostly) good primary care, and it is under appreciated and undervalued.
Darzi's plans will not improve it, and the increased fragmentation will make it worse.
If the medical system is ever to improve you need doctors onside with you.
That's a great article but it won't work in our system because the funding is not fit for purpose. We will have to get to a point where we have capitated payment for services and the GP's take financial risk.
I am sure I will get the standard "more money for me ha ha ha" comment, and yet it is working in other countries like Spain and the US, yes even in the nasty US.
Contrary to what most would think based on little or no knowledge of the system, patients have better outcomes when the primary care folks actually control the end to end budget. For example, these practices are incentivised to keep patients out of the hospital. They don't do that by denying care, they do it by being better prescribers of meds, more proactive in getting patients into their offices, sending social workers out to check on patients who dont attend. Why, well okay they care, but most importantly there is a financial downside to not doing it.
It really does move the care spectrum from curative to preventative. It also needs a certain amount of scale to work however. Doc in the box practices won't support a model like this.
dr blue
maybe
but if you read what ive posted on my own blog you should understand that im as emotionally dicked off with the nhs as its possible to be at the moment
one of my friends is a prof of general practise at one of the medical schools, and he too talks a lot of sense about primary care, off the record he also rages about the crapness of the nhs, its that balance that is missing from that paper
gracious is hard when youre watching people suffer, and you can see that interventions normal elsewhere in the world have not been used
What I find amazing is that anyone (even No-One) should think that Dr Rant thinks the NHS is working fine for patients.
Dr Rant's mission statement is 'the NHS is shit'.
We are more aware than anyone how shit the NHS is, because we see so many patients getting such shit care.
However, I don't see how destroying good General Practice and replacing it with bad General Practice is going to help.
dr pink
thanks
i think we agree the NHS is shit
if you want ill take you round some GPs and show you how shit General Practise can be for some people in this country too
General Practise is not universally good for all the people of this country
I agree Darzi is barking up the wrong trees for solutions
But defending some of the worst GPs and their staff, and the current attitudes common amongst (for instance) GP receptionists is not a viable form of defence for what is left that is good and true
Really this whole situtation has got to change
Love, Life and Peace
no one
thanks for your 2 latest messages. The NHS is not delivering the best medical care, and this is bad for patients and infuriating for doctors. Only negligence lawyers are likely to well out of such a system in which mistakes get ever more likely.
NIKU
I think you are on the right lines. GPs are as much economic actors as anyone else. Kenneth Clarke accused us of "feeling for our wallets" whenever a change was suggested. Well we have to...because of how we are paid.
The key question comes as to whether we can define what are useful health measures, and then incentivise these activities fairly.
Current NHS incentives have many unintended and perverse consequences right across the NHS.
Meanwhile "patient pathways" are being "commissioned" and navigated by managers...but they don't seem to actually deliver what my patients need or want. And no patient seems quite to fit the admission criteria to the care pathway. So they fall through the gaps in the system.
It's a glorious mess. Not good for either doctors or patients.
defending some of the worst GPs and their staff, and the current attitudes common amongst (for instance) GP receptionists is not a viable form of defence for what is left that is good and true
right. Unfortunately the BMA has to attack Darzi's proposals by pretending all GPs are good, but we all know that is not true.
(No one, I can't find your blog. I'll go on looking... )
jayann
http://notdrrant.blogspot.com/
Thank you so much, no one. I was trying notdoctorrant!
Bugger me!
It's all getting a bit cosy in here.....
I love the smell of consensus in the morning!
; )
Fuck you Mustard. Never did like your mustache.
GP is rather better than many parts of the NHS -- partly because GP practices are, in fact, still private businesses and also because GPs tend to see their patients on at least a semi-regular basis.
The former makes for a better business model and the latter can mean a better chance of a good diagnosis (as we all know, medicine is not an exact science).
Of course, I would like to do away with the NHS but, because of the way that it is structured, General Practice really wouldn't change much as far as I can see. Instead of claiming payment from the state, you'll claim payment from an insurance company (or the patient directly).
DK
P.S. No one, I had a look at your blog but ceased after the first post. Seriously, if you think that "prostrate [sic]" cancer is an easily treatable condition, then you are sadly mistaken. Try asking Bill Hicks...
Oh, and if it is attacking the chap's spine, then it has mestastasised and he is dead. Pain amelioration is about the only thing that can be done at that point, as far as I know.
Hey people! Our bodies have a finite life span (and we still don't really know why) and at some point, it's going to start falling apart.
Live fast, die young, leave a slightly less raddled and fucked up corpse...
DK
d k
yea but there are parts of the UK where the patients are forced to use the worst GP in town, and the worst GP in town can be crapper than crap can be, aka the "gentlemens agreements" even the govt thinks exists between GPs, this part of GP service will have to change one way or another
yes prostrate cancer is obviously bad in its final stages, my objection is allowing patients to get that far without the interventions surgery, freezing, radioactive pellets etc etc routine elsewhere in the world
Seems to me that Dr Haslam is restating a principle that no sane person would gainsay: 'a stitch in time saves nine'...
...and we have the people in place to render those stitches in time, so hands off.
Tragically, this bunch of vacuous, frolicking loons and liars (aka NuLabor) have no concept whatsoever of simple, tried and tested principles and practices. No, when in doubt (which seems to be 99% of the time) their first and only resort is to that game beloved of spivvy management types: bullshit bingo...HOUSE! 'modernisation' BINGO! 'reconfiguration' JACKPOT! 'Darzification'.
Interesting, that Dr Haslam published in an obscure Maltese journal, huh? Have the BMA, GMC et al 'gentleman's agreemented' this neat article off the books here? (I ask sincerely - I don't know about the internal politics here.)
Seems to me that Haslam's piece should be required reading for every single soul (though that might well exclude the loons and liars: evidence has accrued which clearly demonstrates that 'soul' is an alien concept to them...)
I think the history was he was asked to write it by the Maltese editor. He's a good writer and realised it was a good piece so he circulated it widely, hence it comingh to our attention.
But I agree it would do well in BMJ or NEJM.
Much as I love Doctors (well most of them anyway) Primary Care isn't just doctors, there are nurses, physios, dieticians, chiropodists. psychologists, health care assistants, pharmacists and myriad other folk - Incidentally my GP is brilliant (even though she is younger, better looking and thinner than me :) )
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