Today I enjoy a talk by a local consultant at the Postgraduate Medical Education Centre. The talks available here vary in quality, but the good ones reassure me that I am doing reasonably well in that area and give me insights to enable me to improve. Afterwards I talk to the speaker and suggest that GPs could probably do well over half of any particular specialist's work, but we can't do this for the burgeoning number of specialities because we would have to be up to date with the latest thinking in them all.
She agrees and tells me that she used to be a GP before she became a specialist. She made the change largely because she worried that she couldn't know enough about everything as a GP.
We also talk about the threats to the NHS posed by the latest reorganisation. It seems that her department at the local hospital is in serious trouble because the local commissioning group has awarded the entire contract to a private company, and not all the consultants want to work for that company. We agree that most doctors are not primarily motivated by money, but politicians and managers don't seem to understand this.
Caitlin Moran wrote in The Times last month about how privatisation seems to have failed the country in areas such as railways, power and water. I fear it is doing the same for the NHS. Government policy is based on the idea that health services can be broken down into into many cells, each run by the most cost-effective provider. One can see that the providers (and the people who work for them) will keep changing, causing organisational and communication difficulties. There will be plenty of opportunity for patients' needs to fall between the multiplicity of stools. I recall a comment made by the speaker at a talk on Child Protection I attended the other week: “the only hope for the NHS is professional friendships and communication”. Such friendships will be increasingly difficult to maintain in future.
Walking back home afterwards I meet one of my patients who works for the council and is doing some maintenance work in the street. He talks movingly about his mother-in-law's current illness. All this makes me think that perhaps I ought to continue working part-time in GP for a while, even though I find it hard. It feels as though I still owe something to my patients. It's not their fault the politicians are messing up the NHS and making my professional life a misery.