Saturday, March 2, 2024

Blogpost: The Underfunding of Health in Tilbury.

The Underfunding of Health in Tilbury.

CQC is a smokescreen.

By Dr Emil Shehadeh

IT appears from recent comments by councillors in Thurrock that the fault of the health crisis in Tilbury may be down to the GPs.

So now we know that the poor health of the people of Tilbury is the fault of GPs! Nothing to do with bad habits such as smoking, excessive alcohol or a bad diet. Anyone who believes this myth is on a one way ticket to certain early death. No amount of GPs will save people with such a mindset.

The CQC reports have been used as a smoke screen for the failure of the NHS. Why do I say that? Because we know that disease prevalence follows deprivation. Disease burden rises with deprivation. Also management of health in deprived areas is much more labour-intensive. In a fair world, where equality reigns supreme, which the NHS claims to be, areas of higher deprivation should attract greater funding, because of the need for more doctors and nurses. Is this what SWE PCT and now the Essex AT have done?

As I write this, the Royal College of GPs (RCGP) has reiterated that General Practice nationwide is at breaking point. More GPs are leaving the profession because of the extreme pressure of additional workload, obsession with bureaucracy, and less funding.

Up to fairly recently, my practices which were PMS practices, were on £64/patient /year. At the same time, the PCT was costing the NHS circa £84/patient/year. In other words, paper pushers were costing the NHS more than care-givers. The worst part is that the average PMS practices were on £84/patient/year. This is 33% more than we were getting. One privately owned practice was on £105/patient/year. Some practices were on £140/patient/year.

If one takes into account the fact that Tilbury has one of the highest deprivation scores in the UK, and that it has the highest deprivation score in Thurrock, the funding gap is probably more akin to 50%, compared with average PM, and is more akin to 150% compared with some well funded practices. In other words, the NHS has invested 50% less than it should in the health of Tilburians. No one should get away with such a persistent failure to fund health, year on year, on year.

My wife and I provided nine months of Saturday opening both in Tilbury and Grays, grata. We demonstrated to the PCT that the attendance at A&E reduced by 10% during those nine months. We negotiated seven day opening which would have paid for itself, through the money saved from the reduced use of A&E. attendance. The PCT refused to support us. No rational explanation was given, and that is just how the NHS deals with GPs. Expensive paper pushers making GPs lives harder and making patient care less effective.

I now want to turn to the CQC report to do with my practice. I have appealed, and the slowness with which the CQC handles appeals sits in sharp contrast with the short period they expect GPs to respond to them. The CQC claims to be objective. They use local intelligence, such as prescribing and admission data, as well as a patient satisfaction questionnaire.

My published local intelligence shows that we are one of the best prescribers and referrals in Thurrock. Is this the profile of a failed practice or a practice is special measures?! The prescribing management team of the CCG would diasagree with the CQC. Where has objectivity gone? Out of the window!

As for the patient questionnaire, is it not inherently subjective? Just because a patient says they can not get to see a GP of their choice, does not mean that it is true. If you stand in reception for a few minutes, you can see how demanding some members of the public are. More specifically how objective is it to judge a practice of 10000 patients by responses of 140 patients, representing 1.4% of the list size.?! How subjective can the CQC get?! The CQC is far from objective.

CQC inspectors impose standards of their own on GPs, such as how to prepare minutes of a meeting. And where there is a difference of opinion as to whether we keep minutes, once they decide that you do not keep minutes, no amount of evidence will make them change their minds. My leadership was questioned because the CQC decided that I must inform my staff of my intentions to retire in writing!?. There are senior CQC officers who disagree with the inspectors on this point. Yet no one has had the integrity to revise our rating. We wait and dare not even ask for how long. The CQC inspector imposed on me a paper consent form for joint injections. Yet CQC senior officers tell me this is not necessary!!!

The CQC inspector acknowledged our surgery is clean. I actually challenge anyone to show me a cleaner surgery. Yet she would not accept the cleaning schedule, even though the same cleaning company used the same schedule for another practice that was passed. Indeed out infection control inspector thought there was nothing wrong with the cleaning schedule.

All the above shows one thing and one thing only: lack of objectivity in the CQC. I maintain my practice is not a bad practice. My staff and I are proud of the service we offer. The CQC need to rethink their claim to objectivity, because it is just a hollow claim and is not helping my practice, maintain a service in one of the most deprived parts of the UK; We do not need careless criticism. We need more fairness in funding.

The NHS has deprived Tilbury of NHS funding for years. The NHS should not get away with it. This must be shouted from every roof top in Tilbury. To divert attention from NHS failure with false accusations against GPs is dishonourable. No amount of smokescreens will fool my patients. I am determined to ensure it does not.


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