I know, I know, I'm fat!

On UK television this evening, we watched an episode of a documentary series about Whipps Cross Hospital ( a large general hospital in north-east London). One of the featured patients was a man suffering from the usual complications of heart failure, odema, breathing difficulties, impaired mobility, etc. He was a very sick person and he freely admitted that his current plight was a result of years of over-indulgence.

At this point. a kindly volunteer arrives wheeling a mobile shop from which patients can purchase some 'treats'. Our patient buys Coca Cola, chocolate bars and other assorted confectionery that, if someone else had fed them to him, they would be at risk of being charged with attempted murder.

You might think that a rant now follows - you would be wrong! But ...

Next year, my GPs are almost certain to be given some targets for controlling obesity in our patients. I have no idea why the Department of Health thinks that we can make a difference. Who doesn't know about fibre, fat and five-a-day? Who always looks sheepish when their weight is mentioned? Who doesn't know all about eating less and exercising more?

In case you're wondering, my BMI is nearer thirty than twenty and my waist is only just surviving. Few of us do what we know to be right even when the chicken (and chips) have come home to roost like our Whipps Cross patient who confessed to sneaking into a cupboard during the night to top up his cocoa and refined sugar levels.

Alice in Budgetland

The NHS year runs from April to the following March. Over the past couple of years, we have been encouraged to take a greater interest in the cost of the medicines we prescribe for our patients. You might think that such interest would be a "given" but it is not so. The NHS relies on doctors to "do the right thing" when choosing which drug to prescribe. At the same time, these same doctors are the targets of the intense promotional activity by the drug companies. Busy doctors have little time to take a calm, measured look as the latest drugs on offer.

One positive move was the allocation of prescribing budgets to GP practices. The carrot has been the offer of allowing practices to keep a proportion of any savings they make providing these savings are reinvested in improving care for patients. At the moment, there is no "stick"; there are no sanctions for exceeding budgets but it is hard to believe that won't come in due course. Last year we saved £70k from our budget. We look forward to using these savings to add to our services. An in-house physiotherapist; an acupuncture clinic, and the like. Our budget this year is £1.33m. That's our share of a total budget of £32m for the PCT as a whole. We have worked hard to make further savings and at about the half-way point (the latest figures available) we have increased our savings to an annualised £130k. Great! We can continue to offer these extra services and add to them.

This week I received a letter from our PCT. They have finally incorporated the changes in payments to community pharmacies. These changes will have to be funded from this year's budget. It means that £1.8m additional funding has to be found. Thats about 5% of the total budget and it will have to come out of all our budgets.

Let me see. Five per cent of our budget is £66k. Gone! Half the savings we have worked hard to achieve. It is the end of month nine of our financial year. What is the point?