Wednesday, December 17, 2014

GPs...the Hail Mary pass ? Part 2

It's been fascinating having the last blog published...the reaction was as expected- a smattering of "no facts" ; "not wise for an endocrine doctor to comment"; "rhetoric" - and indeed it came from expected quarters. What however was pleasantly surprising was the positive vibes too from GP colleagues and even better were the the suggestions. I kept ribbing about people stealing my ideas for the part 2..but weren't they just fantastic ones? Wasn't it nice to see some sensible suggestions- all from GPS- suggestions which were beyond the rhetoric of "more GPs"; a display of obvious pride at the job GPs do...THAT'S what I was looking for and you know what- the NHS has indeed a future with passionate folks like that in the fray.

Let's cut to the chase- we can tango around the perennial debate whether GPs are independent private businessmen/women or not. To be honest, its immaterial- without blowing smoke up anyone else, 5 years and more of working in the community has taught me one thing- without GPs, the NHS doesn't exist. pretty simple as that. If this was a game of american football, most external folks would be perplexed at the effort the system has put to make sure the quarterback was tired and incapable of making the pass the rest of the team needs. Know what a Hail Mary pass is? Look it up...the quarterbacks are now reduced to that- and guess what, the team is losing and with it, so is the rest of the morale.

So let's get some radical thinking going. Stop thinking that only more GPs will solve it- it won't. Not to mention they are actually not out there...but more of that later. Broaden your horizon and thinking ladies and gentlemen. The RCGP and RCP have now come out with a joint statement how organisational boundaries shouldn't be a barrier to patient care- so why not start actually employing Specialists under yourselves? I hear you say where's the money- well, take some time to understand the fallacy of Payment By Results. It is a system which works well for surgical procedures but has crippled us all, Commissioners included, where Medicine or specifically long term conditions are concerned.

Like him or not, Stevens 5 year Forward View is here to stay- and irrespective of elections, is pretty much the direction of travel. Look at pages 16-20 of the PDF document- is your answer there? Can GP surgeries - if you don't like the word federation- then at least buddy up together and come up with a plan to run a long term condition? Can you show that you can employ nurses, specialists to own the whole process? I am sure I will be called naive- let me counter that by saying that most GPs don't have much idea either about Consultant contracts, Payment by results..look, ask and you shall find. By the way, read a bit beyond on that report, there is another model there too...check that out..and think whether that maybe suitable too...views on that welcome indeed!

I will give you an example- as part of our diabetes work, as a team, we go to each surgery twice a  year at the surgeries discretion. The mantra is very simple. "I" am "YOUR" employee for 3-4 hours or however long you want me  in your surgery. YOU use my skills to improve care of patients under YOUR care- as simple as that. That could be done by education sessions, chatting, seeing patients with you, audits- the call is YOURS. YOU are the quarterback- you tell me which channel to run in. I have a skill set YOU need to use for your own patients- can't be that difficult, can it?

At the moment, most GPs can't even look up beyond their daily work to think broad- I get it. But trust me, there are many like me who want to help, want to keep the NHS afloat as there is a simple realisation- given the efficiency to which GPs run, without them in the pack, you can kiss "free at the point of delivery" goodbye. Love the NHS and its ethos a lot? Then broaden your let's face it...there is no cavalry coming right now. Maybe it will- but it's going to take at least 3-4 you have the time for that? We are losing GPs NOW...when and if the cavalry arrives, what will they be left with?

I could go on and on and am sure will still be criticised for "not getting it". Maybe I don't, maybe I am too naive- but I work with GPs everyday- and I see folks every day who genuinely want to help. The future maybe different..and more on that in the next part...but for now, you need a plan pretty sharpish. Heck, you guys have been throwing plenty of Hail Mary passes...try this one out...a lot of professionals- inclusive of specialists, pharmacists, nurses are ready to make that run. The billion dollar question you trust us?


  1. Yes but the issue is risk. If I employ you additional risk transfers to me. The problem in GP is that the level of risk bourne by individuals is now excessive, hence the 'more GPs argument'. Its not just workload driving the exodus/avoidance of GP. Unless the new models spread the risk they can't work. I'd prefer to share risk with sec care.

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  3. Diabetes is a good example. Not sure it would work as well for Oncology.


    adoption of new ways of doing things is a challenge