David Starkey was on Question Time last night. He was offensive, and took apparent pride in it. He was opinionated, which is fine, but was stupid with it, which is not. And he was also just plain wrong the vast majority of the time.
Nowhere was this more apparent than when he discussed NHS GPs. His claim was GPs now work 9 to 5 for more than £100,000 a year and do not give a damn about their patients. No one really challenged him, least of all the Lib Dem's Jo Swinson or John Redwood from the Tories, because both have to believe this true if they think GPs can now manage the NHS.
And he's wrong. This is something I know about. I am married to a part time, 3 day a week, GP. I, of course, think my wife is special, but actually her work rate seems similar to that of the many GPs I know.
The day starts early even when not in to do the 7am surgery. She and her colleagues are in before 8. They take over from the night service at 8. That's the first Starkey myth shattered. Surgery start times vary - as does patient demand. Many will be seeing patients by 8.30.
They'll see more than 30 patients each in surgery a day. The doctor on call - seeing emergencies - will often see many more.
My wife's practice covers a number of large old people's homes. Some have 100 beds. Most require what are in effect ward rounds several days a week. Starkey does not see that, or realise that this is work GPs now do instead of hospitals. And there may be four home visits a doctor each a day as well. They have responsibility for all calls for home visits until 6.30 when the night service takes over. The last home visit is often well after 7 as a result, and often on the way home - which is frequently not until after 8. Another Starkey myth shattered.
And then during the day there are referrals to write, transfer of patients into hospital to negotiate, test results to check and follow ups to arrange. And there are repeat prescriptions to do. Starkey moaned it takes 2 days to get one. Yes, for good reason. He may well, given his age and likely blood pressure, be on many drugs. A repeat prescription is not a matter of printing and signing: it may involve a medication review, a check that the patient does not need to be called in, a reflection on whether the mix of drugs needs to be changed, and usually a vist to the notes and an entry needing to be made. Oh yes: GPs need to document all they do on the way as well, in detail. Perhaps he'd like all that foregone so he can get a repeat printed in a couple of minutes.He wouldn't be happy with the risk he'd take though. Repeats can take well over an hour, every day.
And yes, there's risk. Starkey doesn't lie awake at night wondering if the patient is all right. He doesn't call in in the morning to check people he saw yesterday are still alive, having lost most of the night wondering what the diagnosis is, and having read late into the night to understand the complex co-morbidities they have presented. Because, unlike Starkey's view of the world, medicine is complicated and uncertain, and there's no time for that reading in the day.
After that there are also people to manage in the practice. And management decisions to be made. And the rest of the NHS to deal with. And sometimes colleagues are on holiday and it gets tougher.
But he'd like GPs to be on night duty as well. So they do 12 or thirteen hours a day, as is normal, and then stay up all night on call and then do 12 or thirteen hours the next day. That's simply not safe. It's not even possible. But Starkey wants it anyway.
Now yes, I agree GPs are well paid. But they're also human beings: often now working at the limits of what is humanly possible. That's why they're well paid. And pay was increased because people would no longer do the job. That, by the way, is happening again right now.
Starkey made his comment without appraising himself of any of this, In that sense his comment was like his history, evidence light or even evidence free. But it's his type of soundbite that is destroying the NHS.
And The Tories and Lib Dems believe all this - because they think GPs can also run the NHS between all this. Or rather they either think this and are wrong or know this and are setting GPs up to fail so the private sector can be invited in.
Either way, Starkey showed himself to be a nasty, stupid and utterly ill informed man.
The trouble is, Starkey's thinking is the basis for Tory NHS policy. And that's really worrying.
PS I'm talking about the NHS in King's Lynn Town Hall at 7 tonight and tomorrow at the Forum, Norwich, 11 am.