Little clots of blood float around the cloudy pink liquid in the jam jar Henry’s placed on the desk in front of me. The medical student beside me has in mind half a dozen possible, mostly serious causes of frank haematuria (visible blood in the urine) and I can see her jotting them down. Like too many men, Henry was hoping ‘things would sort themselves out’ for several weeks, and only after his wife noticed the blood-stained toilet bowl could she cajole him to come in.
Nevertheless, what Henry really wants to talk about is his son, just out of prison on a methadone script and looking for rehab. I was hoping to discuss Henry’s worsening renal failure – a consequence of his uncontrolled diabetes and high blood pressure. His wife wants to talk about his depression and worsening memory. The jar of bloody urine stands on the desk momentarily stalling any conversation while we sit waiting to see who will speak first and about what. Nine minutes remain of the ten-minute consultation.
General practice has developed during the past 60 years of the NHS to allow GPs a monopoly over the provision of primary healthcare. Because of this we are able to develop lasting therapeutic relationships with our patients that can extend over lifetimes and generations. It is possible for me to look after Henry and his wife for the rest of their lives, guiding Henry through what will, quite soon, be his final illness, his wife through her bereavement and their son through his drug detox and subsequent relapse.
The long-term relationships that GPs have with our patients result in continuity of care. This allows us not only to manage ongoing ill health, but also to be prepared for serious illnesses. How Henry might react to a diagnosis of prostate or bladder cancer and how we might then manage it cannot be understood without knowing about how he has managed (or failed to manage) his diabetes; how his wife aids him and helps with his medication and appointments; how his depression affects his behaviour and how the chaos and distress their son brings affects them all. A familiarity with the latest guidelines for managing haematuria is essential, but negotiation and adaptation are essential if I am able to help Henry.
I’ve decided to focus on the bloody urine for now, but take time to arrange to see his son 15 minutes before my Thursday afternoon surgery (I’ll be glad of an excuse to miss the end of the meeting in which various imaging corporations pitch their services.) I send an email to our practice nurse to ask if she can fit him into the next diabetic clinic before bringing the conversation around to the jar in front of us. Six minutes remain.
I test the urine sample and decant some into specimen pots to check for cancer cells and infection. I ask about other symptoms and perform a physical examination. My ten minutes are up, but he still needs a referral. At the heart of the coalition government’s ideology is ‘patient choice’, so instead of referring Henry to the local hospital, I am obliged to spend valuable time guiding him through a range of private and voluntary providers offering services for his bloody urine.
Meaningful choice needs to be informed and considered, but Henry doesn’t know what most of the 14 tablets a day he takes are for, he can’t recall whether his blood pressure is too high or too low and he only comes to appointments if his wife reminds him on the day. Usually when I ask him why he has come to see me, he says, ‘I don’t know, you’re the doctor!’ In so many ways he is like my own father who, despite being considerably more affluent and educated, is equally ignorant of his treatment, happy to trust his GP and my mother ‘to worry about all that’.
The new commissioning organisation has made the job a little easier by restricting us to a short-list of ‘approved, value-for-money providers’. The provider I believe to be in Henry’s best interests – the local hospital – is not approved but may be ‘negotiable’. Negotiation will involve spending valuable time writing letters trying to convince the commissioners that because of Henry’s depression, diabetes, renal failure and long history of missing appointments he needs to have his care there.
Unfortunately I later discover that the urology department has been ‘decommissioned’ for being too ‘inefficient’. The ‘one-stop’ heamaturia clinic has become ‘two-stop’ because a private company has the contract for day surgery and the cystoscopies (bladder scopes) are being done at another hospital, while the local operating theatres are concentrating on more profitable gynaecology. I no longer know what is in Henry’s best interests.
What Henry wants, and more importantly needs, is to be looked after, but he’s told he must ‘take responsibility and choose’. As his advocate I must help him choose and also fight to keep the services he needs. As his GP my days may be numbered. More efficient providers will move in to provide convenient care for young healthy people who will choose not to spend time waiting to see a doctor whose clinics run late because of complicated patients like Henry. Instead of waiting, they will register with Virgin, or any number of competing providers who know healthcare is most profitable when the patients aren’t really sick.
Grassroots posters giving an alternative take on the general election
Hundreds of people surrounded the fences this weekend. Hera Lorandos spoke to women who have suffered inside.
Laying out the case for Labour's leadership of a Progressive Alliance, Jeremy Gilbert argues that far from posing a threat to the Left, the Progressive Alliance offers a golden opportunity to end Tory rule and build a 21st century government committed to social justice
The Greens have stood down in Brighton Kemptown to clear the way for Labour, and the Lib Dems won’t stand in Brighton’s other seat, Green-held Pavilion. Davy Jones, who would have been the Green candidate in Kemptown, says this shows the way forward
The snap general election represents a unique opportunity to defeat this terrible government. We believe that visual artists have a crucial role to play!
Drax is the UK's biggest source of CO2 emissions – and we're paying for it, writes Almuth Ernsting
For the past 3 years, Barby Asante and members of London-based artists' collective, sorryyoufeeluncomfortable, have been responding directly to the vision of James Baldwin. Ahead of the nationwide release of a new film about the American activist and author, they reflect on the enduring relevance of Baldwin in Britain today.
Housing campaigners' gains in Bristol are spurring on a national movement to build a renters' union, writes Stuart Melvin
A new Espionage Act threatens whistleblowers and journalists, writes Sarah Kavanagh
We need an anti-austerity alliance, not a vaguely progressive alliance, argues Michael Calderbank
Greece’s heavy load
While the UK left is divided over how to respond to Brexit, the people of Greece continue to groan under the burden of EU-backed austerity. Jane Shallice reports
On the narcissism of small differences
In an interview with the TNI's Nick Buxton, social scientist and activist Susan George reflects on the French Presidential Elections.
Why Corbyn’s ‘unpopularity’ is exaggerated: Polls show he’s more popular than most other parties’ leaders – and on the up
Headlines about Jeremy Corbyn’s poor approval ratings in polls don’t tell the whole story, writes Alex Nunns
The media wants to demoralise Corbyn’s supporters – don’t let them succeed
Michael Calderbank looks at the results of yesterday's local elections
In light of Dunkirk: What have we learned from the (lack of) response in Calais?
Amy Corcoran and Sam Walton ask who helps refugees when it matters – and who stands on the sidelines
Osborne’s first day at work – activists to pulp Evening Standards for renewable energy
This isn’t just a stunt. A new worker’s cooperative is set to employ people on a real living wage in a recycling scheme that is heavily trolling George Osborne. Jenny Nelson writes
Red Pepper’s race section: open editorial meeting 24 May
On May 24th, we’ll be holding the third of Red Pepper’s Race Section Open Editorial Meetings.
Our activism will be intersectional, or it will be bullshit…
Reflecting on a year in the environmental and anti-racist movements, Plane Stupid activist, Ali Tamlit, calls for a renewed focus on the dangers of power and privilege and the means to overcome them.
West Yorkshire calls for devolution of politics
When communities feel that power is exercised by a remote elite, anger and alienation will grow. But genuine regional democracy offers a positive alternative, argue the Same Skies Collective
How to resist the exploitation of digital gig workers
For the first time in history, we have a mass migration of labour without an actual migration of workers. Mark Graham and Alex Wood explore the consequences
The Digital Liberties cross-party campaign
Access to the internet should be considered as vital as access to power and water writes Sophia Drakopoulou
#AndABlackWomanAtThat – part III: a discussion of power and privilege
In the final article of a three-part series, Sheri Carr gives a few pointers on how to be a good ally
Event: Take Back Control Croydon
Ken Loach, Dawn Foster & Soweto Kinch to speak in Croydon at the first event of a UK-wide series organised by The World Transformed and local activists
Red Pepper’s race section: open editorial meeting 19 April
On April 19th, we’ll be holding the second of Red Pepper’s Race Section Open Editorial Meetings.
Changing our attitude to Climate Change
Paul Allen of the Centre for Alternative Technology spells out what we need to do to break through the inaction over climate change
Introducing Trump’s Inner Circle
Donald Trump’s key allies are as alarming as the man himself
#AndABlackWomanAtThat – part II: a discussion of power and privilege
In the second article of a three-part series, Sheri Carr reflects on the silencing of black women and the flaws in safe spaces
Joint statement on George Osborne’s appointment to the Evening Standard
'We have come together to denounce this brazen conflict of interest and to champion the growing need for independent, truthful and representative media'
Paul O’Connell and Michael Calderbank consider the conditions that led to the Brexit vote, and how the left in Britain should respond
On the right side of history: an interview with Mijente
Marienna Pope-Weidemann speaks to Reyna Wences, co-founder of Mijente, a radical Latinx and Chincanx organising network
Disrupting the City of London Corporation elections
The City of London Corporation is one of the most secretive and least understood institutions in the world, writes Luke Walter
#AndABlackWomanAtThat: a discussion of power and privilege
In the first article of a three-part series, Sheri Carr reflects on the oppression of her early life and how we must fight it, even in our own movement
Corbyn understands the needs of our communities
Ian Hodson reflects on the Copeland by-election and explains why Corbyn has the full support of The Bakers Food and Allied Workers Union
Red Pepper’s race section: open editorial meeting 15 March
On 15 March, we’ll be holding the first of Red Pepper’s Race Section open editorial meetings.
Social Workers Without Borders
Jenny Nelson speaks to Lauren Wroe about a group combining activism and social work with refugees
Growing up married
Laura Nicholson interviews Dr Eylem Atakav about her new film, Growing Up Married, which tells the stories of Turkey’s child brides
The Migrant Connections Festival: solidarity needs meaningful relationships
On March 4 & 5 Bethnal Green will host a migrant-led festival fostering community and solidarity for people of all backgrounds, writes Sohail Jannesari
Reclaiming Holloway Homes
The government is closing old, inner-city jails. Rebecca Roberts looks at what happens next
Intensification of state violence in the Kurdish provinces of Turkey
Oppression increases in the run up to Turkey’s constitutional referendum, writes Mehmet Ugur from Academics for Peace
Pass the domestic violence bill
Emma Snaith reports on the significance of the new anti-domestic violence bill