Paul Muller: Reduce manager numbers in NHS and give us more doctors

DURING the last 25 years, more and more managers have been employed in the NHS. They now outnumber the doctors and have run the NHS into a financial pit and unfortunately keep digging. They are now blaming the older generation (who have been given a longer lease of life) for causing the chaos in the National Health Service.

This overlooks the fact that it takes 10 years of study and training to qualify as a GP. It takes 15 years of study and training to become a consultant in medicine or surgery. At the end of this, doctors know how to make a diagnosis and treat a patient.

When I first qualified in medicine, I was told my duty to my patients was to care for them 24 hours a day, seven days a week. This can be done on a rota basis. In general practice, a rota basis can be set up to care for their patients on a 24/7 basis.

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Medicine is a full-time job – patients need help any time of the day or night the GP is the first call of help; it must be their duty to see the patient that day or night. This can again be done on a rota basis in general practice as it was before I retired. Now there are too many part-time doctors.

The European Work Directive has all but ruined the training and duties of doctors.

Most junior doctors work more than 48 hours a week; some do 60 to 80 hours a week. But they are only paid for 48 hours a week. Germany and France do not take a blind bit of notice about these rules; they are paid for the work they do.

In the UK the managers will only pay them for 48 hours a week, but then have to pay exorbitant fees to doctors to fill in the times not filled by junior doctors, thus wasting millions.

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General practice must change from being a gate keeper and just a referral service. There should be an open-door policy in GP surgeries. Each GP must also train in different specialities in medicine for example cardiology, general medicine, diabetes, paediatrics, dermatology, geriatrics (dementia) and psychiatry and the early diagnosis of cancer. (We are the worst in Europe for diagnosing malignant disease early). That is why our cure rate for cancer is lower than anywhere in Europe.

When an older person becomes ill they usually have one overriding organ failure, they may well have had many other illnesses in the past which have been treated or are being

The trick is to find which organ is failing and to treat this. If they have multiple organ failure, they will die. They do not take up a disproportionate amount of time in comparison to younger patients.

In the UK there are fewer hospital beds available per 100,000 patients than anywhere in Europe; in Dewsbury 250 beds will soon be closed.

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All the closed wards in hospitals must be reopened for patients. This means the nurse and the medical staff who ran these wards must be reemployed. This can be costed by removing most of the management staff who have run the NHS into the ground. At the moment there is hardly any care in the community. Care in the community must be run by GPs together with the district nurse. This means the GP will have to see their patients again at nights and weekends.

The one patient that usually can’t be treated at home is the older patient. As you get older you become less competent at looking after yourself and this usually gets worse when you are ill.

In hospitals admission wards must be closed. Nurses and doctors cannot deal with many different illnesses and injuries on one ward. The patient that is seen by the GP or in A&E must be referred urgently to the appropriate surgical, orthopaedic, medical, paediatric or gynaecology ward.

The initial diagnosis in A&E must be made by the most senior doctor and then referred immediately to the appropriate ward for treatment. Very few investigations need to be done in A&E. Waiting in A&E up to four hours is a disgrace; and does not happen anywhere else in the world. Casualty departments must see their patients immediately (patients must not wait in ambulances outside A&E for up to an hour). Triage to be done by the senior consultant (not a receptionist, porter or junior doctor). The patient must be sent to the appropriate ward or operating theatre for treatment.

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We must train many more nurses and midwives to run our hospital wards and nurses to work in general practice as district nurses. Managers in the NHS must be seriously reduced in numbers. They earn too much for what they do. Their idea of efficiency is to reduce the number of nurses and salaries and get rid of consultant secretaries. There are more senior managers in Mid Yorkshire’s hospitals, for example, than there are Cabinet members in the government.

Let doctors and nurses treat patients without interference from managers. Less following of targets and more love, empathy and compassion for patients and relatives should be the motto of hospitals.

Paul Muller, from Wakefield, is a retired general surgeon and fellow of the Royal College of Surgeons. He began his career in medicine in 1956.