The story so far:
Dr Peter Weaving, a self-confessed commissioning enthusiast, is a locality lead in Cumbria and has just been elected vice-chair of a newly formed Cumbrian CCG that will cover six localities and a population of 500,000. Keen to pursue what clinical commissioning can achieve, he is also a realist about the scale of the challenges ahead. Time will tell how the next commissioning chapter pans out…
‘Once I stood here and I could see three motor cars – it was the most cars I had ever seen together.' My former senior partner was standing on the front step of our surgery building in the market square, musing to himself. I knew what would happen next – he would point across the square to the greengrocer's and tell me how the whole practice used to operate out of the front room of the shop. It would be divided down the middle by a curtain; waiting room on one side and consulting on the other. Every consultation audible to the waiting patients and disappearing feet indicative of an examination of some sort.
The next generation of docs would tell me that when they started, the dispensary had three bottles of, effectively, coloured water – to prescribe and be recorded in the ledger. There were no notes. These guys remember when diuretics and ß-blockers were introduced.
It is my 35-year medical school reunion this weekend and I am to speak on the subject of what I have been up to – a layabout who failed public health, achieved the rare distinction of a second-class degree in medical sciences and whose last qualification was a certificate in substance misuse 15 years ago. My mother has more recent qualifications. Hence my reminiscing about my predecessors in the practice.
Will my early memories now seem as archaic? When I started in the early 80s we did everything for our patients – from dealing with their ingrowing toenails to delivering their babies. We would visit demented Dad on a Sunday because ‘something had to be done' and turn out to terrible trauma on the highway because the ambulance station was 10 miles away and it would be you and the poor policeman when you both wanted a paramedic.
I would write to consultants pleading for patients to be moved up waiting lists; I would watch patients go from disabled to housebound on a routine four-year waiting list for an arthroplasty. Then came the internal market and targets and waiting list initiatives – we got below 18 weeks as secondary care learned to maximise its income streams. People were in hospital for 24 hours for these procedures, not two weeks. Cataract surgery – which you didn't seek until you were walking into doors because you needed a general anaesthetic and ended up with glasses like jar bottoms – transformed into a local-anaesthetic day-case procedure. It is so safe people have it done with 6/6 vision to correct a bit of dazzle when driving into low winter sun.
The market has done its job, but we need to move on. I need to commission pathways of care. I need specialists to upskill community staff and improve the management of long-term conditions. Will I be able to stand on the surgery step in my dotage and remember when the NHS woke up, shook off tariffs and stepped forward?
