Monday, May 08, 2006

Meat Sandwich

I once had an unhappy client who was forever giving me meaningful looks and telling me that he "understood the supplier/customer relationship". Eventually, after numerous complaints about poor delivery and high fees, he sacked my firm. Well, specifically he sacked me. Despite leaving me feeling bruised, it was actually a happy release on both sides- the market in operation.

I recalled this as I read the Doc's charge that I'm a member of the "twittering middle class".

Now I've known Doc for longer than either of us care to remember- way back in the days when he still had his own teeth, and I could still walk without the surgical corset and the talcum powder. But he's never called me that before. "Fascist hyena", yes- fair comment. But stuck in the middle with a Ronnie Barker trilby....has it really come to this?

As those who've read Doc's recent splendid post (if not, do it here) will know, he's fed up to the back teeth (or at least, the back gums) with all of us punters moaning about the withdrawal of GPs out of hours (OOH) services. He's had thirty stressful years of being at our 2am beck and call, reckons most of the calls are trivial and/or could easily wait til morning, and he's just had enough. He thinks most GPs will never go back to offering it.

On the basis of "a mile in my shoes", I can see his point. Free at the point of use might have been fine when most people wore Ronnie Corbett flat caps and knew their place: deference to professional men like the Doc might have made people uncomfortable calling him in the early hours except in the direst emergency (especially since most punters would have had to trudge eight miles to the nearest phone). But in these days of 24/7 pizza deliveries, things are very different, as the Doc vividly explains.

On the other hand, from the customer standpoint, we're all totally hacked off. What we'd always imagined was part of our GP service package has just been unilaterally withdrawn. Even worse, it's cost us an extra £212m pa. We've had no say in it whatsoever even though we're the fuggin' customers and we're paying the fuggin' bill. That normal customer supplier relationship just doesn't exist.

And here's the real killer: although we don't have any normal customer power over our Docs, that doesn't stop us complaining to them about service shortcomings. They're our main point of contact, our NHS account executives.

Our GPs have become the classic meat in the sandwich. Senior NHS management decrees certain outcomes- be they obesity empowerment programmes or crackpot IT systems- and the Docs have to deliver them. And when we customers can't understand why the free menu doesn't include Herceptin or anything else we fancy- like calling Doc out at 2am for a bit of a chat- it's the Docs who have to deal with it. They are the ones required somehow to implement and explain the rationing entailed in "free" socialist medicine.

What it's all telling us- yet again- is that we have got to move towards a more market based healthcare system. Free healthcare produces pretty well infinite demand. Which can only be controlled by administrative rationing- just as we have now.

How much better it would be if we could control our own finances and make our own healthcare choices count with our own wallets (subject to a poverty safety net of course). GPs would not have to offer OOH services, and we would not have to pay for them. But if enough people did want to do so, then some GPs would offer them. At a price.

No meat in any sandwiches. Just that customer supplier relationship.


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