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The golden rules of PBC

After wrestling with PBC strategy for nearly two years, Dr Jim O’Donnell has learned four essential truths

After wrestling with PBC strategy for nearly two years, Dr Jim O'Donnell has learned four essential truths

I have come to the conclusion there are four essentials for PBC: a functioning team, agreed agendas, honesty, and open-mindedness.

The functioning team includes informed, trained, resourced and motivated PCT personnel at director level. Where a PCT is dysfunctional, it fails to retain talented staff.

The pathognomonic clincher is the inability to obtain any useful data on the clinical behaviour or outcomes upon which we depend to make intelligent deductions and plans for clinical priorities. This sad and demoralising state of affairs exists within an accountability vacuum. Who ya gonna call – Ghostbusters?

I feel sorry for the small number of dedicated and talented officers who know they are not being led or fed in a cohesive manner. You see it in their eyes, and hear it towards the ends of sentences that simply tail off into a chasm of nothingness...

The functioning team also includes local GPs who are well-informed and adequately resourced.

By agreed agendas, I mean that PBC must focus on services to patients that fully address clinical need in a cost-effective manner. I have encountered only support from patients once they understand that cost-effective care and high clinical standards are simply common sense, and enable us to deliver more services.

Why should our local A&E unit insist on seeing primary care patients at double the tariff, while obstructing all attempts to provide a cheaper, more experienced, more clinically appropriate solution?

This should have been choked off at the first opportunity by firm cooperation between the acute trust and the PCT. We had to bring it to the attention of the local council to exert pressure on both to come to a agreement. As GPs we should recoil from any system that condones wasting valuable resources.

Maintaining standards

Agreed agendas also include the principle of treating patients nearer their homes – which they want and like, as long as clinical standards are maintained.

GPs need to fully embrace recognised clinical care pathways that ensure common conditions are managed according to high-standard guidelines and patients are only referred when the condition fails to respond.

The standard of referral letters needs to improve significantly – too often they seem written in haste, omitting key factors that influence clinical management decisions or outcomes.

Honesty means accurate clinical coding by acute trusts, and trained GPs and practice staff who can spot expensive through-the-nose discharge summaries at 50m. It means an end to hospital letters that say one thing when the patient firmly says the opposite.

It also means GPs being willing to admit to lacking a relevant skill and undertaking the necessary training.

Open-mindedness means being prepared to accept that whatever we think we want, whatever we now feel is in our patients' interests, whatever we expect will happen within our areas of experience and competence, the future will surprise us all.

Let us proceed confidently, knowing that if we keep in our minds our vision of doing our very best to meet our patients' individual clinical needs as cost-effectively as possible, we shall have nothing to fear, and everything to look forward to.

Dr Jim O'Donnell is Slough locality PBC lead at East Berkshire PCT and a GP in Slough

This sad state of affairs exists within a PCT accountability vacuum. Who ya gonna call - Ghostbusters?

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