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The NHS. Our Sick Sacred Cow

Introduction (see here for text)

Chapter 1: The State of UK Medical Practice. A Doctor’s Point of View.

A Corporate Viewpoint

The Current Medical Playing Field. How Efficient is the NHS? What Patients think about the NHS? A Patient’s Lot. Divide and Rule. Medicine as a Machine. Doctors and Nurses as Corporate Beings. Doctor-led, or Committee-led Medicine? The Machiavellian Nature of Corporate Control

A Medical Professional’s Viewpoint

‘Lions led by donkeys?’ Changing Status. Defensive Medicine. Living with Medical Error. Errors and Cultural Difference. The Cultural Challenge. Our Health Divide. Medical Ethics. Timing and Outcome. Action or More Reconnaissance? Disillusioned and Demoralised? NHS Culture and Private Practice Culture. Are There Rogues Among Us? The Current Politics of Compliance. Propagating Knowledge. Whistle-Blowing Today. Becoming a UK medical student.

Chapter 2: The Control of UK Medical Practice

Surviving Regulation. Standardising Medical Practice. Medical Utopia? Who Controls UK Medical Practice? Learning from Wolves. A Conflict of Attitudes. A Brief History of the Bureaucratic Species. Our Medical Regulators. Big Simple Things. The Body Corporate. A Job too Risky? Clinical Risk. Draft Memo to all Medical Bureaucrats. The Politics of Medical Regulation. Corporate Folly. Interfering in the Doctor-Patient Relationship. Medical Sovereignty and the Rule of Law. Patient Individuality. Health Metrics. Professional Disgrace and Medical Bureaucracy. The Case of Jack Adcock. The Case of Surgeon Mr. David Sellu. The Beerstecher Intervention. Is Patient Confidentiality a Fiasco? Death, Bureaucracy and Clinical Management Freedom. The Case of Eva Wade. Compliance Management. ‘Good Medical Practice’. A Useful Guide or Legal Instrument? Medical Regulators as Adversaries. Beware of Spies. Image Problems. Regulators and Errors of Judgment. Guidelines used as Tramlines. Disregard for the Statistical Paradox. Modus Operandi: No Exceptions Allowed. Shock and Awe. Medical Tribunals v Legal Tribunals. Regulatory Reform: The Need for a Medical Directorate. Retribution.

Chapter 3:  Future UK Medical Practice

What Defines the Medical Service Cultural Divide? Health Maintenance Organisations (HMOs). Are they the way forward? Medicine and Artificial Intelligence. Paramedical Medicine. Future Algorithms and Common Sense. Some Basic Medical Practice Objectives. Putting Patients First. Basic Objectives for Nurses. Nurses to ‘Bring Back Compassion!’ The Good Old Days! Re-Examining the Status quo. Trivial Pursuits. Future General Practice. Some Other Political Considerations. Going Solo. A Duty to Teach Medicine? Doctors as Patient Tutors or Medical Companions. Regulators, Inspectors, and ‘Two Cultures’ (C.P. Snow). The Future of Nurses in Medical Practice. Who Else might run the NHS? Future Efficiency, Productivity, and Patients. Hospital Practice Recommendations. The Need for a Medical Directorate. A Vital Experiment: Hospitals run by Doctors and Nurses. Should the GMC / MPTS be replaced? The CQC. 




Appendix 1: Me and the GMC / Medical Practitioners Tribunal Service (MPTS)

Appendix 2: Me and the Professional Standards Authority  (PSA)



To 'The NHS. Our Sick Sacred Cow'

From 1973, when I first formed the Loughton Clinic (private medical centre), I could sit in my consulting room as a general physician and cardiologist, unhindered by any NHS or government bureaucracy. My first encounter with them came in 2014, when the CQC first asked me to attend an interview. After 41 years of practice without a single complaint from any patient, they wanted to assess my suitability as a director of a medical practice. They asked me how I intended to achieve NHS standards. I offered them a case study as an example of what all NHS patients should expect.

An NHS patient attends his GP with shortness of breath and chest pain while walking. His GP thinks he has angina, but one month will pass before he can see an NHS cardiologist. He sees a cardiologist who organises a stress ECG. One month later he gets the result and further advises the patient. Because the result is abnormal, he suggests a coronary angiogram. An appointment is made was for six weeks' time. The angiogram shows extensive coronary disease, and he advises a coronary bypass. He will then has to wait 2 - 3 months for this to happen. The members of the CQC interview panel agree. The patient's progress through the system was reasonable and typical.

I then told them how I would handle the same patient in my practice. After learning he had chest pain and shortness of breath together, I would do an exercise test on the same day. If found abnormal, I would perform a coronary angiogram within 2-3 days. A cardiac surgeon would review his angiogram on the same day and an agreement made to operate (coronary artery bypass graft) sometime soon; possibly within one week. "Does that answer your question?" I asked.

Why are many NHS patients being short-changed? Why do many die on waiting lists? Why is it becoming difficult to see a GP? Why must urgent patients wait outside A&E in ambulances, while some patients are treated in hospital corridors? There are many factors involved. I wondered what they might be, given my experience of handling 20,000 private patients over many decades.