Another @richardjmurphy entire failure to understand what is being talked about

One of the ways McKinsey has decided it’s possible to save £20 billion in the NHS is to reduce the number of acute admissions made to hospitals.

Acute admissions are, of course, the emergency ones, that go through accident and emergency or straight into a medical assessment unit.

I am now aware that some Primary Care Trusts are asking GPs to reduce the number of these admissions by 20%.  This is a curious target. Only 25% of acute admissions are referred into hospital by GPs. The rest of these admissions, all of whom are by definition GP patients and are therefore logged against their names, turn up in hospitals inthe back of ambulances, or are driven there by their friends or relatives when seriously ill.

To deliver the reduction in acute admissions demanded of GPs they either have to stop their referral of people who front up with heart attacks in their surgeries by 80%, or they have to ignore meningitis in children, or send people home with deep vein thromboses. Alternatively, they have to set up roadblocks that prevent ambulances carrying their patients arriving at accident and emergency units.

No Richard.

You\’re wrong, entirely and completely.

The aim is not to reduce acute admissions in general and most certainly not to either block ambulances or to treat heart attacks or meningitis in the GP surgery. To claim such is grossly irresponsible fear mongering by yourself: whether by design or ignorance I don\’t know.

There\’s an important part of the story you\’ve missed:

Exclusive: GPs are facing demands to deliver unprecedented reductions in hospital activity over the current financial year, with NHS managers setting targets for cuts in admissions of 15% or more by next April, a Pulse investigation reveals.

In November, Pulse revealed Sir John Oldham, DH national clinical lead for quality and productivity, had warned GPs that by the end of 2013/14, they would have to cut unscheduled admissions of patients with long-term conditions by a fifth and help reduce A&E attendance by 10% and length of stay by 25%.

Primary care organisations are going far further than even the Department of Health had planned, and demanding GPs deliver major cuts in hospital activity in less than half the time set out in the national QIPP programme. GPs warned the plans were unachievable and that there was a risk they could damage patient care.

To emphasise what you\’ve missed: reduce acute/unscheduled admissions of patients with long-term conditions.

This is nothing to do with people presenting with new conditions: those heart attacks, that meningitis. It\’s to do with those with chronic conditions. Please stop packing them off to A&E at the drop of a hat and get on with a bit more doctoring yourselves would you, dear GPs?

17 thoughts on “Another @richardjmurphy entire failure to understand what is being talked about”

  1. How many doctors did you discuss the matter with?

    I do – often, and not just the one I’m married to

    The position I make is one most doctors would agree with

    Yours is just, as ever, nit picking

    And there’s a good reason – almost all people over 70 have long term conditions – they’re associated with old age

    So your arguments just don’t work – as ever

    Nit picking is not and never has been a substitute for sound thinking – and you don’t do the latter

    Tim adds: Face it Richard, you’ve been caught. You have claimed that emergency admissions, like for heart attacks or meningitis, are to be curtailed. I’ve shown that absolutely nothing of the sort is being demanded: this is about reducing unplanned admissions of those with chronic conditions, nothing at all to do with those presenting with new conditions.

    Why is it that you can never act as an adult? “Eh? What? I’ve got it wrong have I? Oh my, thanks for bringing that to my attention” perhaps. “Yah Boo Sucks to You!” as you’ve just done is the reaction of a spoilt child deprived of its lollipop.

  2. Alternatively Mr Murphy, your hyperbole got the better of you on this one. The target is ostensibly aimed at getting GPs to ensure that their patients with long-term conditions are better able to manage those conditions. For example, I have quite severe asthma. On occasion I’ve been referred to A&E by a GP because it’d got so bad I could barely breathe. This was down to me not managing my condition effectively.

    It is wholly laudable to want to reduce the number of admissions for patients with long-term conditions, as that indicates that their condition is being better managed. GPs believing that the timescales are too exacting is an objection, but not the one that you made.

  3. Not withstanding that our friends opening gambit is a wholly fallacious appeal to authority.

  4. Don’t know about the UK these days but here in the Basque Country, the biggest single problem the ERs have are non-emergency admissions – using ERs as a fall-back: doctors, parents, patients because it is easier and you are seen to immediately.

    Actually you are not. The paediatric
    section is frequently full of parents with kids with a temperature. They divide: emergencies one way and the rest wait.

    I am a father, have been bollo**ed for inappropriate use (proud to say they apologised when they realised my kid would have died if I hadn’t taken him and waited until Monday to see the family doctor).

    The truth is they are far more tolerant of parents with young kids. We all know what it’s like a 3.00 in the morning and a kid with a temp. of over 39ºC.

    I’m married to a doctor too. Moved in those sort of circles for over 30 years. Know dozens of docs and health department people. I’m pretty privileged that way. It’s been a big (public) debate here. Doctors have been advised in the same way as in the UK. Somebody somewhere has to put a figure on it.

    Don’t think I would dare to say what most doctors think, though.

    If somebody has a serious injury or life-threatening moment they have to go to an ER. If not, not. My father is over 80, hips replaced, cataracts, prostate cancer and requires statins. No reason at all for him to hit an ER.

    This winter due to global warming, he slipped on the ice that shouldn’t have been there. Actually cracked a bone. Very painful for 5 minutes, not too painful after, went to the doc the next day. Got the whole thing sorted with out an ER. Obviously, if he had been in real pain, go. He didn’t.

    The health system has other options for chronic cases, minor injuries, ranging from home visits (here, special doctors with white cars with drivers, not your regular family doctor, known as ‘milkcarts’) to new IT solutions, 24 hour pharmacies.

    ER rooms are incredibly expensive and required for emergencies. What percentage in the UK are classified as non-appropriate? This is the key.

    Here, doctors were taking the ER room as the easy way out. Palming off patients to get them fast treatment. Bad use of public resources. The Health Department is trying to get them on side (I suspect a certain amount of professional ‘bullying’ is going on) Happen in UK?

    Does this sound like the UK? If it is, it is not nit-picking (something I do at home when the kids pick them up at school) but sound health service management.

    Emergency means emergency. Urgent is not necessarily an emergency. Serious is not necessarily an emergency.

    I have no doubt, what constitutes an emergency is clearly indicated somewhere in the NHS and I am willing to bet (quite a sum, a year’s supply of lollipops?) that there are a large number of inappropriate admissions.

  5. Must say.

    Mr. Murphy’s reaction does seem, how should I put it, a trifle over the top. Makes me wonder if it is really him or somebody else taking the mickey out of Tim. No, it’s him.

    I wonder, if I were ever to visit his site again and leave such a furious non-reasoned attack; what would happen to my comment?

    In fact, what would happen to my comment if I happened to take a fact-based stance different to his?

  6. Just to nitpick, isn’t “acute” a specific term which is not the same as “accident and emergency”?

    My understanding of what the G is trying to do here is to improve triage a bit, and so reduce the reliance on A&E so that A&E departments only deal with accidents and emergencies, rather than people who could get an appointment in advance.

    The health discussion has become ridiculously partisan, with people who don’t like the Tories and LibDems attacking proposals which were already underway under Labour. If the Tories really hated the NHS they would leave it to collapse under its own weight.

  7. I like the way Richard always accuses someone of “nitpicking” when someone’s completely destroyed his argument.

    Although it’s actually quite a good line of defence. Whenever you’re 100%, completely wrong, your opponents are just “nitpicking”.

  8. I’m surprised Ritchie Boy isn’t having this discussion on his own blog. Oh wait, only fawning is permitted in the comments there.

  9. What Blue Eyes said: ‘acute’ in a medical context means ‘not chronic’, that is, ‘of sudden onset’. I bruise my knee it is an acute injury, but probably requires no medical intervention at all, unless I have a chronic sense of entitlement.

  10. just adore the Murphmeister’s ability to construct a cogent argument. he would be wonderful in front of a jury, wouldn’t he?

  11. If you leave a chronic condition untreated, unmanaged or undiagnosed long enough,it becomes acute.

  12. Has the RAfromW understood the figures that £7 outof every £10 spent in the NHS resulted from people with chronic conditions being admitted from those conditions becoming acute?

    In other words, get the primary care system working properly, the chronic conditions will not become acute so often and everyone, especially the patient, is much happier.


  13. Murphy: “Acute admissions are, of course, the emergency ones, that go through accident and emergency or straight into a medical assessment unit. I am now aware that some Primary Care Trusts are asking GPs to reduce the number of these admissions by 20%.”

    Worstall: “to cut unscheduled admissions of patients with long-term conditions by a fifth and help reduce A&E attendance by 10%”

    Murphy is clearly wrong. Murphy: “You’re just nitpicking.”

    What a dweeb.

  14. Just imaging Ritchie’s hand instinctively hovering to delete the above comments only for him to realise he’s not on his poxy little totalitarian blog.

  15. Old people vote. Old people have long term conditions.
    so the politicians can drop dead.
    In the past the emmergency place was often full of people with sore throats or bruises etc – who had gone directly there bypassing the GP.
    because it was quicker , it was perceived the hospital has the high technology and people like the ambiance.

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