How councillors can work with GPs in the CCG to transfer money (say £10mpa) from the drugs budget (£90mpa) to treat 10,000 vulnerable patients next year with £1,000 worth of socially prescribed exercise, yoga and complementary therapy, transforming their health, reducing health inequalities, and overprescribing, polypharmacy and adverse drug reactions, which hospitalised 10,000 patients last year in our city.
How can councillors cure the great betrayal of general practice, so we can see GPs?
by John Kapp 7.2.20
As Boris Johnson delivered UK out of the EU on 31.1.20, the fear of the great betrayal of 17.4 million voters diminished, allowing us to focus on his second priority pledge when he entered Downing St, which was ‘making it easier to see a GP’. At the previous election in June 2017, health secretary Jeremy Hunt pledged an extra 5,000 GPs, but only managed to recruit a few hundred more. If Matt Hancock is to succeed, he must answer and remedy the question: why, from around 2015, did so many doctors, having been called to heal people, and studied so hard for two decades to become GPs in their 30s, suddenly decide to leave this honourable ancient healing profession in their 40s and 50s?
Some of my family members are GPs who had done so, and I asked them and others this question, but the most that anyone ever told me was ‘the NHS is too toxic’. As none would discuss it further, I have had to intuit their subconscious emotional state from what patients have told me, particularly those who feel betrayed because their lives have been wrecked by the treatments prescribed by their GPs. My conclusion is that GPs feel doubly betrayed, first by the drug companies’ propaganda, (only 10% of which is reliable), and secondly, by the government, who have reduced them to pill pushers for the drug companies, and dishonoured their profession into generally doing more harm than good by overprescribing. This makes them so ashamed that they cope by automatically going into denial, and avoid talking to anyone about it. In the most tightly regulated profession, how could this have come about beneath the radar? The short answer is because Big Pharma have bought the world, and made it taboo to mention.
This great betrayal was actually foreseen by many GPs in 1947 before the NHS was founded. My mother was a psychiatrist, and her best friend from medical school was a near neighbour, with children of my age, so was a frequent visitor who was ‘Aunty Janet’ to me. She was a GP in private practice who told me this story around 1980.
In 1947, all the GPs in Croydon (several hundred) were summoned to attend a public meeting to discuss the government’s NHS plans. Fearing that they would become political footballs, the meeting universally rejected these plans, and all the doctors verbally pledged not to have anything to do with the NHS. Janet was the only one to keep her word, and continued practicing as a sole practitioner GP until she died aged 98 in 1996. She told me this story because she was so disgusted at how her colleagues had become brainwashed and corrupted by government and drug company propaganda (and that was 40 years ago)
It is far worse now, as overprescribing has led to polypharmacy and adverse drug reactions (ADRs). The collective GP penny dropped around 2015, when the annual number of monthly prescriptions exceeded 1 bn, and the number annually hospitalised by ADRs exceeded 2 million. They then collectively realised that general practice is actually doing more harm than good, and the only way they can honour their calling to serve their patients is by voting with their feet, and not playing this harmful game any more.
The government were Inspired by Lord Layard to ‘end the Prozac nation’ in 2006, when about 2 million (1 in 25) depressed patients were on antidepressants, by introducing the Improving Access to Psychological Therapies (IAPT) programme. This successfully treated about half a million patients last year, but the waiting time is over 6 months, so GPs are still forced to prescribe antidepressants against NICE guidelines. Last year over 7 million (1 in 7) were on these ‘chemical coshes’ which don’t even claim to cure depression, and have harmful side effects (including suicide) which keeps patients coming back in a revolving door to adjust drug and dosage, and to which 4 million are addicted. The cause of the depression is the drugs prescribed to treat it (called iatrogenesis -doctor induced disease) which is overwhelming primary care.
Government’s last attempt to cure the NHS was to enact the Health and Social Care Act 2012, which passed the responsibility for primary and secondary care to local government, by devolving 2/3rds of the health budget (£80 bnpa in 2019/20, or nearly one HS2 every year) to 220 Clinical Commissioning Groups (CCGs) They reckoned that GPs, who have 40 patient contacts per day, could spend it more wisely than mandarins in Whitehall, who never saw any patients. Unfortunately this hasn’t yet worked, because GPs are not elected, so do not have the political legitimacy to take on the drug companies to reduce overprescribing. What is the solution?
The good news is that councillors on Health and Wellbeing Boards (HWBs) do have the necessary political legitimacy, so could legally cure the crisis in primary care by supporting GPs in CCGs to create a new system of social prescribing. Providers of therapeutic social interventions (such as exercise and yoga teachers and complementary therapists) could be licenced to teach patients in Community Care Centres, and be paid for their services on receipt of the used social prescription, as pharmacists are paid for drugs. The social interventions would be free at the point of use, paid for by transfers to the social prescribing budget from the drugs budget under a policy of ‘medication to meditation’.
This system has been successfully piloted in Bromley by Bow (www.bbbc.org.uk) and Brighton Health and Wellbeing Centre, (www.brightonhealthandwellbeingcentre.org,uk) which is the only practice in the city with no retention and recruitment problem, because they integrate complementary therapy with conventional health care. They let rooms in the same building to complementary therapists, who provide drug free treatments at market rates to those who can afford them, but which are subsidized from the practice’s Robin Hood charity to patients who can’t afford them.
Last year the national drugs budget was £18bnpa. My vision for the future is to reduce overprescribing by transferring £1bnpa of it next year (2020/21) to the national social prescribing budget, to provide 1 million vulnerable patients (5,000 in the city) with £1,000 worth of exercise, yoga and complementary therapy. This could transform their health. and reduce health inequalities. The same should happen progressively every year of the 10 year plan, so by 2030, the drugs budget is only £10 bnpa, eliminating overprescribing, and the social prescribing budget is £10 bnpa, providing 10 million vulnerable patients with £1,000 worth of social interventions annually. This is further described on www.prescribe.fitness. 1,115 words