Let's not forget the patients
Dr John Hague says the quality framework has improved outcomes, but at the cost of what GPs and patients value above all else – personal care. He calls for a new primary care philosophy
For three years, general practice has been scrabbling for QOF points. We have all worked our backsides off, 'overachieved' on points, and been vilified as greedy rich layabouts who are too lazy to work at weekends; and now we are about to take our second successive pay cut.
We feel angry about this, and wonder how it all went wrong. We worked hard to achieve what we'd been told to; damn it, we can even prove that we are delivering brilliant quality care. We only have to look at 'popman' to show the world how well our patients are being served.But how does it leave us feeling inside?
Do you feel the same about the job as you did 10 years ago? Do you still enjoy clinical work, or do you feel that nGMS is a betrayal of your principles, reducing you to a box-ticking automaton? Do you hanker back to the days of Balint and personal lists?
I spent a few days recently looking after good old-fashioned illness. No chronic disease, not even colds and flu – just plain life-threatening nasty stuff, such as meningitis and pulmonary embolus, in patients I'd known for 20 years.
Some time during those few days, the penny dropped – I realised I was enjoying the job. It was something to do with relationships; the satisfaction of looking after patients with whom I had built up a rapport over many years. Personal care.
How we can get it right
Then I came across a paper, from the UK but published in the USA, that seemed to sum that all up. The paper shows that what GPs find most satisfying is developing and maintaining relationships with patients, then using the knowledge gained to effect a successful outcome; put another way, we like helping people.
The paper concludes: 'Preoccupation with that which is technical and measurable in health care system reforms risks defining a model of practice with purpose and meaning not congruent with doctors' experiences of their work and may result in further destruction of professional morale.'
I think we have made one big mistake; we are preoccupied with the technical and measurable, and have forgotten individual patients, and the fact that our professional identity is inextricably linked with them. This mistake will destroy primary care – if we let it.
How do we prevent this? We need big bold leadership that transcends politics and arguments about money. We need to develop what the Americans call a 'new model of care' – a proper primary care philosophy. I think it is possible to combine personal care with the QOF – if you get the IT input right so that it helps you without dominating the consultation.
We need electronic records that really work, quietly and effectively prompting us to deliver better patient care, without being distracting. And we need better patient education and advice, both on paper, in person, and electronically. Above all else, we must make personal patient-centred care the cornerstone of our new model.
Maybe this was what was intended by nGMS. If it was, it didn't reach any coalface that I've been to recently. That is the real scandal of nGMS. We all took our eye off the ball, going for points, without first cementing a true philosophy to underpin care.
Now we must build a new model with personal care at its very heart. If we start tomorrow, we may have a job to go to in 10 years' time.
John Hague is a GP in Ipswich and mental health adviser to Suffolk PCT