Do you want the money for another 1500 GPs?

Do you want the money for another 1500 GPs?
General practice is in crisis

There are c30,000 WTE GPs in England

http://www.health.org.uk/sites/default/files/FundingOverview_CurrentNHSSpendingInEngland.pdf
Workload is rising relentlessly

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00620-6/abstract
Funding is flat at very best.
Meanwhile we continue to spend a fortune on low value stuff. 
Here’s my (as anyone who knows me) favourite example….
Avastin in medical retina conditions

It’s an off label use of a licensed medicine. It works – there are no questions there. But we use a drug that is c9 times more expensive and equally effective. Because “NICE have approved it”

This isn’t a story about avastin, I’ll save that for another day.
This is a short story about opportunity cost, expressed in a way that everyone can understand.
I might get my numbers wrong and I’m happy to stand corrected. You’ll get the drift I’m sure.
Let’s say across the NHS in England we spend c£250m on a drug in a set of ophthalmic conditions. But we could get equal outcomes by spending £25m on another drug.
The freed up money could be spent on general practice and a wider model of primary care. Focused on parts of your town where the needs is greatest.
So that, in England is c£225m
At £150k for a salaried GP inc on costs (and I’m being very generous…I know you’re worth it boys and girls) this equates to c1500 GPs

At c7 GP / 1000 pop on average that’s enough GPs to doctor a medium sized town.

http://www.nuffieldtrust.org.uk/node/2540
This is all assuming we can find the GPs – oh we can’t cos we’ve spent all the training money on other things…..
Imagine what another 1,500 GPs might do to population outcomes, non elective admissions etc.
Now let’s do the same calculation for say district nurses, social workers, OTs.
At our prices £225m would pay for use to expand capacity in our stop smoking services 300 fold (I had to check the sums twice). Imagine how many heart attacks and cases of lung cancer could be avoided, and all the misery and early death that ensues!
Then shall we do the same calc for other things we all know are pointless. I’ve got my pet lists, I’m sure you’ve got yours.
Yes of course it’s more complex, and I’m happy to stand corrected on my sums – I was never very good at adding up. 
But…..sometimes we forget the simple truths in our effort to understand a complex world.
In a zero sum game, the money can ONLY come from lower value stuff.

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