Is GP networking a Trojan Horse ?
Desperate times need desperate measures.
On the land of politics in our country, nothing is currently more controversial than the cross-party discussion of the direction Brexit will take place between Labour and Conservative parties .
For our beloved GP land , the formation of GP networks is the main theme of this new five-year GP contract . The price tags have been allocated but we are yet to see the actual money as far as the bookkeepers of the networks are concerned.
Finally , in the fantasy world of Westeros( Game of Thrones) , we saw the incest-bound union(more appropriately mating )between Daenerys Targaryen and Jon Snow , the relationship of whom we know now as aunt and nephew.
All parties of interest in these three worlds have one thing in common : their fundamental relationship is potentially competitive and antagonistic with the risk of serving as anathema to each other .
Like every new ideology appearing on the horizon, we should lay aside our prejudice for a minute and welcome it with open arms. But that , certainly, does not mean questions are not to be asked . My LMC Secretary once taught me, ‘ Do not ask the question in politics unless you knew the answers.’ So there are some questions worth considering for this notion of GP networking:
(1) Can member practices in a network live happy ever after ?
As I wrote before , it is difficult for five GP partners in a practice to agree unanimously on certain issues , how hard is it to be in a network covering 30-50,000 patients. Always remember the trilemma principle:- amongst sovereignty, integration and democracy, one can only have two out of the three but never all of them.
(2) How can the new resources injected into GP networks from the governments be evenly and fairly distributed? For example, for pharmacists , physician assistants , physiotherapists , how much time should they spend in each member practice every week? And when it comes to the new money and how to spend it; well , the caveat is in fact , a potential civil war within a network?
(3) Perhaps , that is why ‘super-practices’ come into the equation . They provide the governance to save your headaches and settle disputes with your fellow network members . Actually, this is an extraordinary phenomenon simply because the government refuses to equate super-practices with GP networks. Bottom line is , it wants to move away from investing in GP practices individually . Will this create another complex behemoth of bureaucracy stifling flexibility and hence , efficiency? What is the natural history of these big monsters eventually?
(4) We need the new money to address this current crisis of shortage in resources. We have been starved of tools to provide the current services . The objectives of this new contract , however , appear to be , by GP networking , widening the ‘dumping ground ‘ for more work to be thrown at us from all directions. Yes , you are giving us some new tools but these are easily outweighed by the number of new tasks waiting on the line . Where is the STOP button ?
5) Hence , last but not the least , GP workload . I am yet to be convinced that the government actually understood how heavy our daily workload was before it sat down to negotiate this new contract with our representatives. Because not too long ago , its propaganda media( you know who!) was still bashing and condemning us as lazy , ignorant and irresponsible ( the tone might have been changed after the Big Boss stepped down ) . If it was not for some strident figures showing a dramatic drop in the number of full-time equivalent GPs in the country ( all four nations) last few years , do you think we would have had this conversation today ? Crisis , what crisis? Remember that ?
Having said that , I understand from listening to our BMA colleague during a recent roadshow that the new contract is subjected to some path-finding and self-correction as we move down the road . But this can only be credible if the government is receptive and shows some humility.
Hence , I am looking forward to see Jaimie’s new born baby called GP workload survey report .
Step by step
Heart to heart
Left, right, left
We all fall down
Like toy soldiers
Bit by bit torn apart
We never win
But the battle wages on
For toy soldiers
Too many of our colleagues have been burnt out and fallen down . Is it my fantasy that all toy soldiers can , one day , unite together as a true army to resist our enemy who is always trying to divide and conquer us ?