Sunday, 14 February 2010

GPs Customs and Contracts (the PhD reprise) Chennai and Cream

Hats off to Dr Martin Scurr. He is of course, the Daily Mails resident Doctor. On Tuesday this week he launched a blistering attack on the greed of GPs, said to be second only to that of MPs. Dr Scurr’s concerns in the main relate to the introduction of 2004 GP contract and the changes in service provision that have resulted. As you may recall, this was the contract that put in place an approach to paying GPs based upon the perverse incentives of achieving so called ‘public health targets’. For every box GPs could tick they got a payment.

In reality of course it was often nurses who were giving vaccinations, undertaking cervical smears and generally providing MOTs for older people. (Just as an aside, I failed these weeks Daily Mail MOT for men. I achieved a big fat red cross against each of the 12 tests of health and well being.

GPs now earn more than they ever did for doing less than they perhaps ever wanted to. They gave up out of hour’s provision, and many other aspects of the once cradle to grave approach to health care they once represented.

And all this in the week that saw the results of the inquest into the death of David Gray alleged to have been caused by Daniel Ubani, a German doctor working here in the UK as a locum GP. David Gray was a 70 year old man who was suffering from kidney stones and renal colic and in need of relief from pain.

Interestingly, the 2004 contract resulted in many hundreds of doctors like Dr Ubani coming into the UK to provide weekend out of hours services at a cost of some £4000 a weekend. Nice work if you can get it.

Whilst we don’t want a return to the Dr Finlay’s Case Book era of soothing words and nice but not NICE proven tinctures and potions, we do deserve something better than we have today.

I came face to face with Dr Finlay’s world in my quest to find a bottle of red wine here at the conference in Chennai, India. In India wine is not a popular drink, and even in the hotels it can be difficult to find or buy. The government adds a ‘70% of the purchase price’ tax onto the price of overseas wine. It is only a 57% tax for local wines, but these are not so renowned as a drink. Whichever you chose the price can be exorbitant. While traveling between my hotel and conference centre I asked the taxi driver if he could take me to a wine shop. After a couple of false attempts we found one who had just three bottles of red wine left. After a bit of a haggle I bought two, the bottles were wrapped up, and I returned to my hotel feeling smug. However, the wine when unwrapped turned out to be rather ancient tonic wine and totally undrinkable. Just the smell of it made it impossible to get from glass to lip, and some readers will know just how much I like a glass of wine now and then.

In 1955, the year I was born, ‘Sanatogen’ was the most famous tonic wine of its time and a great favourite of my Grandmothers. Whilst the You can feel it doing you good - In these hustling, bustling days, when every hour seems a rush hour, there's a particular need for ‘Sanatogen’ Tonic Wine... may have been an applicable slogan then it certainly wasn’t in up-town Chennai on a 31oc sunny afternoon.

I will report on my experience of contributing to the conference more fully in future blog’s. India is a wonderful place, full of contradictions and excitement. Extreme wealth sits along side extreme poverty and squalor. It is a huge busy, bustling place.

Two completely unrelated and random early thoughts from this experience, the first was that despite many enquiries from delegates across India about the possibilities of coming to the UK to study and work, listening to the presentations and having many conversations with others delegates it was clear that people in Indian health care systems have much to offer us in terms of their experiences in promoting health and well being. The second thought was that as I write this blog, it is the second day of the winter Olympics, and despite the tragic news of the death of a luge contestant during a training run, the event seem to have passed the conference delegates by.

Finally, in 1940 Ginger Baker was born. He was of course, the drummer in the original super group Cream. The significance of this fact might pass some of the blogs younger readers by. Now some 70 years later he is to marry 28 year old Kudzai Machokoto, a nurse. They live in South Africa. Kudzai will be his forth wife. They are reputedly not looking to have any more children.