‘We must tackle the unfinished business of 1948’

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?

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.