Our National Health Service was founded on the principles that good healthcare should be available to all – free at the point of delivery. Seventy years on, does this still hold true? It is not uncommon for NHS trusts to run their on-call services (for their urgent work) with insufficient junior and senior staff to the point that it becomes unsafe. Many hospitals spend more than their incomes on treating the rising number of patients. GP surgeries close. Waiting times rise. Patients look for alternatives for which they have to pay, such as online providers or private hospitals.
Long waiting times are a big problem for those in physical or emotional distress. It takes around 20 weeks, if not longer, to see an NHS physiotherapist in our area – patients often have acute pain, loss of function, are off work and losing earnings. They can lose faith altogether and disengage from NHS services, or turn to private healthcare. Sometimes they pay for private physiotherapy, but then they start and stop after one or two sessions when the money runs out.
Prescribing is another area with restrictions. Doctors are told by NHS England to not prescribe low-value medications or those that can be purchased over the counter (for instance drugs for diarrhoea, constipation, eczema, hay fever, indigestion, eye symptoms and pain). The price varies from cheap, non-branded painkillers to expensive emollient for eczema. A few years ago my son, who has eczema, was going through a 500g tub of emollient every two weeks prescribed by our GP. This is now £12 or more to buy over the counter, not a small amount, with many eczema sufferers needing many tubs a year. Those who really need treatments are the ones who will suffer from lack of affordability.
Many treatments are now classified as criteria-based or needing individual funding requests (that is, not routinely funded unless a detailed application is submitted by a GP or hospital specialist with evidence such as trials/research of its benefits and especially over any other patient with the same problem). So, for instance, a patient with pain and loss of hand function from a ganglion cyst would need an individual funding request. Clinical commissioning groups have a long list of conditions that need such approval – such as varicose veins, tonsillectomies and hernia surgery. Most of my applications are rejected as almost no one (despite the level of their suffering) is deemed exceptional.
A friend has left hospital medicine, which had been her lifelong passion to pursue a non-clinical career. She described the moment when she woke up one morning not knowing why she was a doctor any more. She said there seemed to be no purpose to what she was doing. She had “perpetual anxiety, an unmanageable workload and a dawning realisation that she could not provide free and safe healthcare for her patients”.
But there is hope, too, if we can equip the NHS to deliver free and world-class healthcare, and if staff believe they make a real difference to people’s lives. And if we can continue the goodwill of those who work within it, which is what oils its wheels. Without this, as it stands now, 70 years on, the NHS will continue its sad path to disintegration and privatisation.
• Zara Aziz is a GP in inner-city Bristol