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Driving us crazy

This month our diarist goes to a think tank meeting and finds himself pondering some big health questions and what they mean for PBC

http://www.pulsetoday.co.uk/practical-commissioningl

This month our diarist goes to a think tank meeting and finds himself pondering some big health questions and what they mean for PBC.

The story so far

Dr Peter Weaving, a GP in Cumbria and a locality lead for Cumbria PCT, is proud of his area's PBC achievements so far, not least how it helped the PCT out of financial deficit. But a new PBC chapter is beginning that involves trying to get two ambitious integrated care projects off the ground amid anticipation of lean times ahead...

It was the phone call every GP dreads.

‘Hello, Dr Weaving, you've a few patients waiting and we wondered when you'd be in to start your surgery?'

The answer is tomorrow because today I'm working for the PCT and about to tackle the tip of the electronic iceberg my inbox has become. I am so double-booked.

More importantly, this afternoon the PCT is running a think tank at a ‘convenient central Cumbria location' to futureproof itself, our practices and our two embryonic integrated care organisations – ICOs – at a central location in Cumbria. Paul Corrigan, health adviser to Tony Blair when he was PM and the architect of Foundation Trusts, has kindly agreed to advise us. A unique opportunity compared with the daily grind of surgeries, phone calls and home visits.

A colleague is bribed to cover the rest of the day and I am think-tank bound.

The convenient location is reached by more than an hour's drive, the last stretch of which winds down the shores of Ullswater. The room we work in looks over manicured lawns sweeping down to the lake, majestic fells soaring up on the other side.

‘Bermondsey. That's what my usual view is,' begins Professor Corrigan. ‘This...' waving at the mountains, ‘freaks me out'.

We discuss a few scenarios that freak me out. What would you do if 20% of your GP workforce retired? How would you cope if your budget was cut by 10%? How would you function without a PCT? How will you support GPs through revalidation?

Paul Corrigan explains to us that even without the credit crunch, every developed country's healthcare system ‘will go bust' in the next few years under the demographic timebomb of the ageing population – unless we change the way we work.

Demand management of secondary care referrals must be applied with the same vigour and rigour that has been used in prescribing cost control. Our ICOs must demonstrate greater technical efficiency than current services and greater ‘allocative' efficiency – this means asking yourselves how you would allocate the budget, if you held it, to best secure value for money.

It's also essential that as we commission modern services, so must we decommission those they are meant to replace. We need to involve patients, especially the elderly, in managing their own healthcare – consider supermarkets and banks where we, the customers, now do the work. Do we complain about this? On the contrary, we prefer it because it's more convenient.

As well as financial storms we also face political ones, but will that mean a move away from PBC? Definitely not – the Tories are, if anything, even keener on developing PBC than the current government.

I drive slowly home as an inch of rain falls (this is the Lake District) and ponder the messages of the day. It is going to get worse, but the current direction of travel – with GPs in the driving seat making those medical decisions that in turn dictate the financial decisions – is the only way forward.

llustration by Daniel Mackie llustration by Daniel Mackie

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