Just in case…

It’s hard to imagine the NHS without GPs.

Pre-NHS, Britain had a haphazard network of family practitioners. Small businesses, in general, trading from home, providing fee-based healthcare to families in their neighbourhood.

Come 1948 they were mostly reluctant to join a behemoth, the NHS, fearing they would lose their independence, be overwhelmed by government bureaucracy and become, as their 1945, anti-NHS campaign put it; ‘little more than common servants’.

They evolved into the gatekeepers of the NHS. Dealing with the troubles of working families. Convenient, continuous and cheaper than everyone going to hospital.

Since then, early fears have materialised into an actuality. They are budget managers for government, delivering healthcare within guidance and policy. Servants of the State in all but name.

They’ve gone from gate-keeper to manning the barricades… keeping people out; not just hospital but force-majeure, out of jam-packed, practice waiting rooms.

We plead for an appointment and probably get one when our hiatus has passed or increasingly likely, fobbed off by a telephone conversation with someone who’ll book you into Zumba classes!

Getting +90% of first contacts, for under 11% of the total budget was never going to work. Primary care is crushed by an avalanche of unmanageable demand.

Can we dig it out?

We all know family practice is gone. Pressures of demand and woeful workforce planning have left us with few options; merging primary care with secondary care (why should there be a difference) or consolidation… primary care at scale.

Last week, a trades union, the BMA and NHSE jointly published; ‘Investment and Evolution’: A five-year framework for GP contract reform to implement The NHS Long Term Plan.

It’s an expensive JCB… there are bungs-a-plenty; £4.5bn by 2023/4.

A hundred or so pages. I’ll save you the bother, there are three key sections.

Page 8… Workforce.

‘Why we’re in a mess’ is misdiagnosed (1.2);

‘The causes of the workforce shortfall are… well known… including… rising frailty … growth in population.’

No, no… the cause is not-responding to frailty and population trends earlier, with a workforce plan that worked!

The pages that follow are the heart of the document.

New roles… more people we can’t recruit and won’t be able to see… to stop us seeing the GP, that we can’t see?

That’s too cynical… the report is frank, recognising;

‘The scope [of new workers]… extends gradually…’

Remember, this is a five year plan, not a five minute fix.

The second most important section starts on page 33… Digital First.

An elegant sentence disguises the secret worry.

‘Progress on digital delivery will be important to maintain social solidarity behind the general practice model…’

That means; pull yer finger before everyone floods to Babylon.

However, Babylon’s access to funding drops by about 10% and the investment goes into immature and developing systems at local level, where the GPs will still have to answer the phone. Opportunity lost?

There’s another pull-yer-finger-out message;

‘… interoperability between systems, underpinned by common standards… a new centrally-funded programme… creating a framework for digital suppliers to offer platforms on standard NHS terms.’

The message is; we want practice data, system provers either can’t or won’t provide… we are going to make them do it or block them out of the market.

Alas it will take until 2021.

Back to page 25 for the main driver… GP practice at scale… consolidation and merging with community;

‘CCGs [will be compelled] … to offer a Network Contract, Direct Enhanced Services to all practices.

Pull-yer-finger-out… registration no later than 15th May.

What’s the up-sum?

Comprehensive, thoughtful, workmanlike. To be brutal; practices, marooned in buildings they can’t expand, will struggle. Forcing networking on small businesses who cherish their independence, a risk.

The real benefits of ‘digital’ are not to be found in doing what you do now, on-a-screen. They are in doing what you do on someone-else’s-screen. Where are the call-centres managing long-term conditions?

Staffing? Forecasting recruitment in a post Brexit economy… a mug’s game.

In the short run, it looks to me the BMA have reason to celebrate. In the long-run, NHSE will need to keep the digger, just in case.

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Reproduced at by kind permission of Roy Lilley.