“But if a large proportion opt out of evening and weekend work and there are insufficient locums to cope with the demand, what then? The likelihood is that people who would otherwise be seen by a GP will instead flood the already over-stretched casualty departments at the local hospital….So how will the system cope if it has to deal with greater demand caused by the GP contract? More to the point, how will it cope when the Working Time Directive, the European law that limits the number of hours to be worked, hits the NHS?”If I could foresee this fiasco, presumably Health Department could too but chose not to do anything about despite the pleas of many professionals. In 2004, James Johnson, chairman of the BMA council, said: ‘‘We have been trying to alert the Department of Health to the scale of the impending disaster for at least three years.”
– Philip Johnston in the Telegraph today, quoting his own warning and that of James Johnson, the then chairman of the BMA Council, in 2004 about the stone obvious dire consequences of the Labour Government’s astonishing, insane offer to GPs that they could opt out of direct responsibility for out-of-hours primary care if they so chose.
The causes of the current A&E crisis are legion; the 2004 changes to GP contracts a significant but not sole reason. The lesson though that leaps off the page, then as it does now, is that if you attempt to change one facet of a complex system without being willing, at the very least, to attempt to predict the possible consequences of that discrete change on other parts of the system you are not merely inviting catastrophe you are sending it a map and its train ticket.
And so how does this shower respond – in a ‘whole systems’ way – to the approaching whirlwind? Jeremy Hunt announces he’s going to bung some money – that may not even exist – at A&E services in the vain hope that by painting the picket fence he can stop the tornado flattening the farmhouse.
Hunt also says it’s all the GPs fault anyway. So that’s all right then. Sadly, political point scoring when you should be undertaking comprehensive root-cause analysis fixes nothing. ‘Tis hard not to recall the Guardian [bias sample accepted] and the Museum Associations Journal [same bias] surveys that asked if Jeremy Hunt had been any good as the Culture Secretary: a resounding 100% ‘No’. As Health Secretary? Who could possibly say!