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At the heart of general practice since 1960

Listen up, Mr Lansley. Most GPs don't give a fig about commissioning

The mood music from the new Government may sound great - but Jobbing Doctor has a nasty feeling we've been here before

The mood music from the new Government may sound great - but Jobbing Doctor has a nasty feeling we've been here before



Government are sniffing around GPs at the moment. They have started to realise over the last few years that the top-down, Government-knows-best approach has not worked in terms of delivering quality in the NHS for the extra money.

It isn't as if they weren't told. They just don't listen.

The result is that most GPs are not engaged with their agenda. We now have a new administration and also a new Secretary of State, with new Special Advisers. They are beginning to understand that to achieve results and improvements in health care, they need to work with the GPs to deliver what they want. It is also what we want.

So they are sniffing around us and starting to make noises about ‘empowerment' and putting GPs at the ‘heart of the process'. The mood music sounds great. We should be pretty happy about this, and I might be if we hadn't been here before.

What they understand by 'giving power' to GPs is not what we understand. For them it is actually about devolving responsibility, so the problem no longer sits on their desks. A problem with chiropody? That's a commissioning issue, you need to talk to GPs about this. But the power? That stays with those who set the budget, and there is absolutely no way that any politician will divest themselves of that.

The Jobbing Doctor has sat on a commissioning board for more than two years now. We have a group of practices covering around 80,000 people. We are now beginning to get a feel for what is needed in our little micro-community. So what happens? Government change the whole process once again.

A few years back I was very taken with a quote that I read from the Roman soldier, Gaius Petronius Arbiter:

'We trained hard, but it seemed that every time we were beginning to form up into teams we would be reorganised. I was to learn later in life that we tend to meet any new situation by reorganising; and a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency, and demoralisation..."

This is exactly what has happened over the last 40 years in the NHS, and the current administration are the same as all the previous ones in seeking to make changes, and reorganise. They are using commissioning as their preferred tool, indicating that they are engaging with the GPs to help develop a better service. It isn't happening.

Most of my colleagues do not give a fig about commissioning. Not a fig. They come to the practice in the morning, they see patients, do visits, do the paperwork and get on with their lives. Most GPs enjoy what they do, and are very good at it. The major issues are clinical. Commissioning is not something that most GPs care about from one month to the next.

So I am deeply cynical about the latest changes. This is largely because we have been through all this before, and it is another thing to get in the way of the day job.

This lack of engagement will also involve revalidation, which - if it is not a dead duck - is seeming less and less relevant, and other schemes.

Government have a huge job to regain the trust of the GPs. Constant denigration and sniping has taken its toll on most of us. We don't like ministers, we don't trust journalists, and we despise many of those who seem to be at the 'top' of our profession.

Warm words do not matter.

Talk to us. And listen.

The Jobbing Doctor is a general practitioner in a deprived urban area of England.

Jobbing Doctor

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