It is an immutable fact that every chain is only as strong as its weakest link.
Exactly the same reasoning applies to the NHS: a disaster is about to happen, for reasons which the politicians either are too ignorant to see, or choose to ignore. They think that quality, innovation, productivity and prevention (QIPP) will lead to an inviting future in which the NHS saves £20 billion while delivering the same quality of healthcare. Just transfer work from secondary to primary care, become efficient, and all will be well.
But as with the euro crisis, the government has ignored a basic problem. How are GPs going to take on this extra work? Practices are already overworked, yet their funding is being squeezed: one survey suggests 25% are planning staff redundancies for the coming year. Vocational training schemes have seen a fall in applicants: it is hard to fill partnerships and obtain salaried GPs. To cap it all, the threat of pension changes has increased the number of GPs planning to retire.
Far from being on the threshold of achieving enormous savings with QIPP, the government is walking into a workforce crisis of its own creation. Yet, as with the economic debacle, few politicians seem to realise what is about to hit the NHS.
What can they do? Obviously, any resource (whether of money or time) can only be spent on one thing at once. Primary care time cannot be used for secondary care work if it is already spent administering QOF, chasing QIPP targets, attending mandatory PCT training or running clinical commissioning groups.
The good news is that primary care has the ability to take on devolved secondary care work: the bad news is that we can only do it by cutting into the 30% of our time already committed to paperwork and management. Yet streamlining our use of this time could solve everything - but first the government needs to relax its regulations on primary care management and reporting. More next week.