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A long and frustrating journey

Like many GPs, the PBC journey has been a frustrating one for Dr David John. But he’s getting somewhere at last...

Like many GPs, the PBC journey has been a frustrating one for Dr David John. But he's getting somewhere at last...

About 18 months ago I imagined organising a meeting of the two North Somerset PBC groups on the Waverley Steam Ship, the aim being to sail it out into the Bristol Channel and, to paraphrase John Peel's plan for the Eurovision song contest, ‘torpedo it'.

My frustration was borne out of lack of progress and various conflicts of interest within the two groups. PBC preparation money had been spent with very few results, either clinically or in infrastructure.

The last straw was discussion regarding the referral management centre. One group wanted to start their own, the other wanted to start one in Bristol with an organisation called GP Care.

After months of discussion it was obvious that both were unachievable, so with some trepidation our four partners, one salaried GP and 8,500 patients decided to form our own PBC cluster, despite dire warnings from everyone.

We informed the PCT and the two clusters of our intentions. Another practice contacted us to see if they could join. Since then two other practices, one from each cluster, have discussed going it alone with us, and another practice has abandoned PBC altogether. The PCT was very supportive, as it saw the move as a way of kick-starting PBC in the area. One cluster graciously offered that we could rejoin them if things became difficult.

Data collection was the first objective, particularly as our local district general hospital has severe IT problems. We therefore quickly became part of Somerset Referral Management and offered Choose and Book. As North Somerset was at the time on 0% for Choose and Book, we became very popular with the PCT.

I was then invited to the Improvement Foundation and spent three days with members of the two PBC clusters, North Somerset PCT and 600 other PCT delegates at the London Hilton at vast expense to the public purse. I learned a little, but not as much as from one volume of this magazine.

After many frustrating months when it sometimes seemed I was the only one in the area who understood the Government PBC guidance released last November, I am now invited to the three PBC strategic planning groups in North Somerset PCT, held fittingly in a venue called Waverley House. The groups oversee submitted PBC plans that have to get through four gateways. Sometimes it feels like walking through treacle.

We are now doing ‘in-house' warfarin monitoring with near patient testing and are about to start open access echo and MRI. The latter two demonstrate that you really do not have to reinvent the wheel. They are based on PBC schemes in Lincolnshire PCT.

We are in the process of organising an ‘in-house' orthopaedic outpatient session and a ‘virtual ward' based on successful pilots put forward in this magazine. We have several other plans that are in the work-up stage, involving ophthalmology, gynaecology and urology. We are also part of a combined cluster plan with Harmoni, a Home Counties firm, to reorganise front-of-house in casualty.

I do believe PBC is the way forward for general practice and we owe it to future GPs to make it work. We need to use PBC to take back much of the more complicated work from secondary care and increase our value.

We have already seen the benefits to our patients by going it alone and this has made the extra work worthwhile.

We regularly communicate with the other two clusters and share ideas. The boat trip on the Waverley has been cancelled.

Dr David John is a GP in north Somerset

pbc plans have to get through four gateways. it's like walking through treacle pbc plans have to get through four gateways. it's like walking through treacle

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