It seems to me this is like the abolition of slavery. Rather than go for an all out bill, the abolitionists got a technical bill passed that made it illegal to do the things that made slaving possible, and then followed up a few years later with the actual abolition. It seems the same is happening in Primary Care. Austerity has squeezed GP-land to half the percentage of NHS funding it had in 2004, but with double the workload. We’re making pareto’s law look lazy, doing 90% of the work for 7.5% of the cash. So what’s the catch? I don’t think the question is what can or will happen anymore.
We’ve been saying for 3 years at least that the domino effect will bring the whole house down. The real question is whether this is as a result of HMG incompetence or deliberate act. And if the later, what is it they want out of it?
Sure, primary care at scale, lots of other improvements, but given that we’re already the most efficient health service in the world (Commonwealth fund), how much will this improve things? The Ancient Greeks used the term ‘perfect’ a state from which any change would only make things worse. We’re far from perfect, but I like the Hebrew concept of ‘goodness’ – a dynamic state of constant improvement where good begets more of good.
And on the ground I’ve been banging on about training the board-calibre Primary Care leaders for these models since we started scaling up locally a few years back, but all we get from the NHSE guys is fliers for lean process training and project management – more middle manager stuff than system leadership.
Its inevitable that Primary Care needs to radically change to take its place at the table and help sort out the system as a whole. But at present the purchaser-provider split, and independent contractor status mitigate against much of this. GPs are the only people with personal skin in the game, and Bevan’s intention to have them come into the NHS fully might be the overall aim (with PACS via STPs) that the sneakery is headed to. With capitulated budgets that might just work, as they would no longer be preventing tariff-gaming, but helping keep the gate once more.
Article written by Paul Conroy – Practice Manager at Mersea Island Medical Practice