The Training Network NHS GPs A cry for help...

A cry for help…

If there is a word more likely to excite the cynics, I’d like to know what it is.

The word? Consultation… see! I can hear the collective groan! It is a discredited, dirty word among pressure groups, trades unions and professional organisations.

Actually, there are a lot of rules about doing it properly.

First you have to decide whether a consultation is required. Consult or engage? A legal duty or a policy? What ever the reason, if you decide to ‘consult’, you have to do it properly;

• At a time when proposals are still in a formative stage

• Give sufficient reasons and facts, clearly laid out to allow consul-tees to give intelligent consideration

• Adequate time given for consul-tees to prepare, consider and respond

• A preferred option may be expressed, provided other options are included

• The outcome must be conscientiously taken into account when the final decision is made and…

• Must be ‘fair’.

Landmark Chambers have a useful primer. Lawyers have built careers and probably a new house, on consultations going wrong, obliging judicial review.

So, now you are an expert. What about this; Digital-First Primary Care

Policy consultation on patient registration, funding and contracting rules.

In a nutshell;

Millions of commuters, when they get off to work in the morning, their GP surgery is closed. When they get home… closed. Saturday is for emergencies and Sunday they go to church… pray for a cure, or A&E.

Primary care isn’t lazy or badly run, it’s just swamped, based on a 1948 model for 2019 lifestyles. It ain’t gonna work.

Companies like Babylon, Push Doctor and others are demolishing primary care. Thousands of people are flocking to the Doc-in-yer-pocket model. They get an appointment in-hours.

Is it as good as sitting in front of your GP for 9 minutes and 59 seconds.

Probably not but as we don’t measure how accurate GP diagnosis is, (and video consultations do), what the outcomes look like (video consultations do) or what goes on behind closed doors (video consultations are recorded and given to the patient)…

… I don’t think we are in any position to argue one way or another.

The problem; GPs get a slug of money for each patient, plus ancillary fees and bungs for doing other stuff. Their business model is based on looking after people in their catchment area… locations still based around the 1948 isochrone, of walking distance.

This is all lovely but… we don’t have enough GPs and we are never going to have enough. That boat has sailed. Access is crumbling.

The Long Term Plan commits to every patient having access to digital services.

Unless your idea of digital services is a GP with an iPhone in her pyjama pocket, it ain’t gonna work without busting up how GPs get paid.

Of its nature digital services are designed to work without reference to geography and that demolishes the GP reimbursement model.

Hence the consultation.

It is a tortured document. They are tiptoeing around the fact the reimbursement model and digital first policies are bad bed-fellows.

This is a thoroughly horrible 39 pages. At one point it actually asks;

‘Do you agree that we should not create a right to allow new contract holders to set up anywhere in England?’

Has anyone told them about the Competition and Markets Authority!


‘… do you agree that PCNs could become the default means to maintain primary care provision.’

Do any of the people writing this know what a commuter is?

This is a wretched piece of work because it leaves out the two killer questions;

• Should we let a national (or regional) contract for digital provision to a couple of companies who can do this stuff, properly?

• Should we pay GPs by the number of people they see?

This is not a consultation – it is a cry for help.

Contact Roy – please use this e-address – roy.lilley
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Reproduced at by kind permission of Roy Lilley.