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At the heart of general practice since 1960

‘We must tackle the unfinished business of 1948’

Sofia Lind caught up with the GP tasked with making the Five Year Forward View a reality

Sir Sam Everington has always been an agitator, although he now largely does his trouble-making behind closed doors.

Knight of the realm and a previous adviser to both Labour and Conservative ministers, Sir Sam looks like a paid-up member of the establishment. But don’t be fooled.

He is the man who slept outside the Royal London Hospital to highlight doctors’ long working hours in the 1980s and helped uncover outrageous levels of racial discrimination within the medical profession in the 1990s.

Now he is leading one of the most radical CCGs in the country – NHS Tower Hamlets – and is spearheading what some might argue is the first-ever ‘bottom-up’ revolution in the history of the health service.

As one of NHS England’s top advisers steering the Five Year Forward View, Sir Sam speaks to Pulse just after finishing a tour of all the new ‘vanguard’ projects testing new models of care. He describes himself as a ‘pathological optimist’, but is his sunny outlook justified?

Dr Sam Everington 330x330

Tell us about your role at NHS England.

It’s as a national adviser to the vanguards, of which there are now 29 across the country. We have just visited all of them over the past month, trying to work out what sort of help they need.

What is coming out of the whole process are a lot of issues around procurement, funding systems and staffing. Some common themes are emerging, but the solutions aren’t always the same.

Do you think NHS chief executive Simon Stevens understands the problems of general practice?

I think Simon is very clear about the problems and it was interesting watching him on Andrew Marr’s show on the BBC recently. He made clear that 10 years of downward funding have put massive pressure on primary care. I think there is also understanding across all the political parties about primary care being part of the solution to managing the costs in the NHS, and also to improving services.

But what are you advising him?

The Five Year Forward View is very unusual and it talks a lot about primary care, which is very new; if you go back five years it was uncommon for politicians or the press to talk about primary care. It was all about hospitals closing, casualty – all those sorts of things. Now it is very different, which I think reflects the fact that people see primary care has a lot of the solutions.

It is very much part of what I call the unfinished business of 1948, which is about bringing consultants and GPs together again to work in teams, creating those connections again. I envisage a time when I will be able to email a consultant with my mobile phone number and the email address and the mobile phone number of the patient, and the consultant can give us both advice.

All this cannot be achieved without more GPs.

If I go back 10 years, it was still pretty common for GPs to be practising at the age of 80. Now I see most of my colleagues retiring at 60. So we have to think about saying to those colleagues: ‘What do we need to do for you to come back in?’ That might be as an adviser or a clinical leader, but we need to bring retired doctors back in some way. I would apply that also to medical school training. If 50% of doctors will end up in general practice, maybe 50% of the training should be geared at general practice. That is a seismic shift, but we know that if people spend a lot of time in general practice, they are much more likely to come back.

Do you think the Five Year Forward View will lead to a shift towards a salaried workforce?

When I started as a GP 25 years ago the sense was this was like marriage, this was for life. It’s completely different now. In Tower Hamlets, for instance, 65% of GPs are salaried. A lot of doctors are voting with their feet and are choosing to be salaried for a raft of different issues, such as work-life balance or wanting portfolio careers. To me it is about ensuring you have the flexible options for all doctors to achieve what they want in their professional lives. Some will want to be salaried, some to be salaried with leadership roles, some to be partners. It’s that mix that is important.

So not everyone will go salaried?

No, and not least, I would argue, because one of the reasons why primary care is so cost effective is the partnership model.

Can you tell us about the pilot in Tower Hamlets?

Tower Hamlets is one of the vanguards. There are 36 practices, linked in federations. They are also part of a community interest company, combining with the local authority, community health services, the acute trust and the mental health trust to provide a holistic healthcare service to the community.

We have created dashboards for general practice so I as a GP can see how I’m delivering against any other GP. I can go to a GP who may be doing better than me at something and ask ‘what is the secret? How are you doing it?’ It might be prescribing of aspirin in heart attacks, or the number of patients with terminal illness that they manage to get home. GPs might share any little bit of information to help each other improve the quality of services we are providing.

Are GPs largely on board with these plans for Tower Hamlets?

Yes, there is great support for it. We have also got the Prime Minister’s Challenge Fund for seven-day access. But GPs in the borough are also stressed. As you know, Tower Hamlets started the campaign to support practices affected by the MPIG withdrawal, with all of us marching on the streets on at least three occasions. And that was a massive challenge.

How do you rate Jeremy Hunt?

Andrew Lansley was the first health secretary who really recognised the important role of primary care. I am not saying there weren’t a lot of other problems in terms of the Health and Social Care Act reforms, but it was the first recognition of the importance of primary care. That is what you see from Jeremy Hunt. He talks all the time about the importance of primary care and the need for more GPs.

So, you are feeling hopeful?

Well, I always define myself as a pathological optimist. General practice is going through hard times – it feels similar to 1989 with junior doctors. But I think there are strong messages about the importance of general practice and with those will come a more positive attitude and the kind of resources GPs need. Perhaps we will finally be able to deal with the unfinished business of 1948 and bring GPs and consultants together.

CV

Age

58

Family

Wife and five children aged 12-22, one of which has just qualified as a doctor

Education

1976

Qualified as a barrister at Inns of Court School of Law and began medical training

1984

Qualified as a doctor

1989

Qualified as a GP after training at the Royal Free in London

Career

1993

Arrested for making fraudulent job applications as part of a research study of racial discrimination in medical recruitment

1999

Awarded OBE for services to inner-city primary care

2012-present

NHS Tower Hamlets CCG chair

2014-present

BMA Council member

2015

Knighted for services to primary care

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Readers' comments (10)

  • a truly honorable guy

    but as many good people they get roped in by clever manipulative governments and will end up as the fall guy.

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  • Glad to see someone recognised, but is tiptoeing around Lansley and Hunt- speak up once more; they talk about primary care, but I do not think they listen or are going to do anything about it.
    I went ot med school late 80s wanting to be a GP- got talked out of it and did surgical rotation as
    GP was sold as a pile of shit. Became GP 1997 and it was hard work but it wasn't the bigger pile of shit that we have now. It goes in cycles but one thing remains the same- sdoemthing needs dumping, dump to GP

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  • I wasn't even in Born in 1948. It's now 2015 mate.

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  • I was born in 1948 and am in MUCH better shape than the NHS. !!! But then I am not run run by bureaucrats and bean counters and used as a political football !!
    The NHS is grossly over managed and underfunded and is about to topple over under the weight of all these unproductive employees while the clinicians are so stretched that they are leaving in droves.

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  • "So we have to think about saying to those colleagues: ‘What do we need to do for you to come back in?.."
    Suspend appraisal and revalidation.

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  • This man seems to value us and we more of him
    Some of our CCG retired gps are just nodding to old pct redundant managers and on high salaries
    I went to one meeting as a lead and tore up 5 years of work that team developed through managers

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  • Sir Sam sounds like he has sold his soul and his fellow GPs.

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  • Lansley TALKED about the importance of primary care, so does Hunt (when he's not busy denigrating our "clocking off at 7 PM " culture). But their actions speak for louder than their words...
    Hunt demonstrated as culture secretary his total lack of integrity or probity- he is absolutely not to be trusted

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  • How refreshing and wise of Sam Everington to focus on using performance indicators to stimulate enquiry and sharing of ideas as the means of improving standards.. This used to be the case in Dorset until the HA abolished them. "Driving down and forcing up" has never and will never work. Doctors don't want to do their work badly but they need encouragement to adopt new ideas and the ideas need to be tested to ensure they are sound, effective and practicable. I wish him every success and hope he will continue to be "awkward".

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  • Sir Sam has a past history of doing a lot for GPs. But I agree with the anonymous comment above that he has sold his soul and all his fellow GPs. I doubt he will achieve much without good premises, adequate staff and adequate doctor-patient time.All this will require loads of money which is not forthcoming from anywhere.There are more generals than soldiers, in the NHS and general practice in particular.

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