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Doublespeak and doublethink – the 5YFV review

Forgive me for thinking I’d woken up yesterday in 1984 when the headline ran, “Waits for routine operations will increase from 18 weeks in order to enable improvements in other areas…”

Everything in this sentence shouts what is wrong with NHS leadership thinking.  To a patient, operations aren’t urgent/routine:  they are what they need, with a million different meanings, some clinical, some personal and social.  18 weeks is not a “good” number, just an arbitrary one.  Increased waits will for most cause harm, and to label this for the sake of improvement – I gasp.

We have shown repeatably and sustainably that with a change of thinking and method GPs can provide astonishing patient service, minutes instead of days, and at the same or lower cost.

We haven’t worked in secondary care but friends who have know that the same is true, slashed waiting times and increased morale all round, better flow and the same resources.  Waiting longer for a “routine” operation is dismissed as if it were like puttng off that new sofa.  No:  this is causing pain, distress, and harm to patients in need, and it’s the pathetically lazy thinking in NHS England that allows it to continue.  There is no excuse.

We do know what works in primary care, and it is unrecognisable from the official NHS England 5YFV update.  A one pager in HSJ gets the gist.

Bigger, longer hours, hubs, bla bla bla, all the things which NAO and NHS England’s own evaluations have shown to waste resources.  They don’t even bother to measure what matters to patients, how fast they can get help, and of course all these “plans” cut continuity (as discussed last week, one thing shown to reduce hospital admissions)

Forgive me for not joining in the chorus of praise for this doublethink document.  We are not dedicated followers of fashion, we are dedicated seekers after what works, looking for evidence and relentlessly applying it.  If Simon Stevens is reading this and is prepared to listen to a constructive “no” man, he can call.

And now for some good news.  I was at RCGP City Health conference on Thursday and the very best bit was Michelle Drage restating the values of general practice.

The registered list… the consultation… the relationship.

See the whole lot here through the wonders of Twitter.

We have to keep doing this because they are being undermined, and from the very quarters who should be doing everything in their power to build on them.

In 1948 Nye Bevan was the revolutionary who created the NHS against the entrenched establishment.  NHS England has become that tired, tawdry, mean spirited establishment.  What we need now is radical, different, generous thinking, and the method to make it happen.  Join us.

Harry Longman

07939 148618

PS Three practices launched in Northern Ireland this week, GPs and patients absolutely delighted at  Cullybackey, Ahoghill and Fintona.  Prize competition:  any certified English person who can pronounce all three correctly on my voicemail wins an all expenses paid day trip to visit them in an emerald tour of  Antrim and Tyrone.  I’m the April fool.

2 responses to “Doublespeak and doublethink – the 5YFV review”

  1. Peter Cureton says:


    THanks for your intermittent emails which I do read and they make huge sense. I think we need to get you over to my practice!

  2. Charlie Kenward says:

    Harry, once again thank you for your inspirational and clear writing. I am working on a CCG review of the hub models at the moment and would be very interested in any further references to NAO or NHSE evaluations of such hubs.

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