Anuj Sean Chathley is a UK-based GP with an extended role in medical and surgical dermatology.
Most people … the reasonable kind … accept change when it is anchored in reason.
When the why is clear, the what becomes bearable.
“We can’t afford the car … money’s tight.”
“We’ll have to budget better …. the economy’s taken a hit.”
But what do you do … what can you do … when the change is not driven by necessity, but by nonsense? When logic is not lost but thrown away, and replaced by circular mandates and bureaucratic delusions?
This is where I … we … now stand.
We were once commissioned to deliver services that worked. Efficient, patient-centred, cost-effective care. And then, without true consultation or comprehension, those same services are now under threat, or have already been taken from us — in the name of savings.
But these changes do not save. They spend — time, money, morale, and sense.
Let me show you how…
The 24-Hour ECG Service
We bought the equipment.
We trained our staff.
We ran it efficiently.
We saw patients in a week.
And here’s the part that hurts: we knew our patients — not just as cases or referrals, but as people. We knew their history, their medications, their fears. We could filter. We could reassure. We could act.
Now?
Now we refer.
Now the patient waits to see a cardiologist.
Then waits for an ECG.
Then waits to be seen again.
Then waits for the plan.
In the meantime, they worry.
They call.
They book.
They spiral.
The Ultrasound for IUD Threads
Another simple solution.
Women waiting weeks to confirm an IUD was in place …. anxious, unprotected, inconvenienced.
So we acted.
We bought scanners.
We trained.
We delivered same-day answers.
No referral. No paperwork. No ambiguity.
And then?
Then it was defunded.
Now those women wait again.
Now they are told to use other contraception.
Now they fall into the same bottleneck we once solved.
We even used the scanner for urinary retention assessments and trial without catheter. That’s gone too.
Again: a solution discarded, a problem resurrected.
The Community Skin Cancer Service
This one cuts deeper.
A network born from a shortage … a vacuum in dermatological care filled not by desperation but innovation.
GPs trained.
Skin surgery performed safely, efficiently, locally.
We were lauded at conferences.
We were a “jewel in the crown.”
We delivered results.
But year after year, the axe looms … not because we failed, but because someone whispered,
“Maybe GPs are making too much money.”
The irony is thick enough to carve:
GPs with extended roles were created to take care out of hospital.
Now they say we should go back into hospital … doing the same work, for the same patients, but through a system that costs more and delivers less.
The patients lose.
The service fragments.
The logic collapses.
So I Ask
What happens when nonsense is dressed as strategy?
When good services are sacrificed at the altar of optics and illusions of savings?
Why must we beg to continue what has already proven its worth?
“Why must we sell what should be self-evident?”
The answer lies not in numbers or evidence — for we have those in abundance. The answer lies in will. In who gets to decide what value means.
And so, as we reflect … with despair, but with clarity… we say this:
We are not the problem.
Our patients are not the burden.
The system that silences solutions is.
Featured photo by Elena Mozhvilo on Unsplash
AMEN TO THAT!!
Many clinicians CHOOSE to work for the NHS system, when they could work elsewhere in the world because of what the NHS stands for: a service treating the needs (not ‘wishes’) of all that require it regardless of who they are or the size of their wallets, done with a clear evidence base.
The NHS and its cornerstone of General Practice are being eroded by political and financial mismanagement. The clinicians’ efforts to work efficiently hence suffer, as does their morale and subsequently patient-care.
WHEN IT DOESN’THAVE TO BE THIS WAY, THIS IS DUE TO POOR CHOICES BY LEADERSHIP!
Change for change sake and attempts to fix what ain’t broken springs to mind. So many valuable patient centred services have been sacrificed in the name of strategy and outcome based commissioning!