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At the heart of general practice since 1960

The future’s carrot coloured

Dr Clive Henderson looks at what’s needed to get GPs engaged with PBC

Dr Clive Henderson looks at what's needed to get GPs engaged with PBC

Until the last couple of years, PBC in our area was a vague, parochial, misunderstood and inadequately-resourced sideline. Projects were idiosyncratically based at individual practice level with erratic support.

A change of management and the introduction of a locality-commissioning forum monthly meeting, paid protected time and a fund to buy new services are proving a catalyst for change. Many projects have remained on a pilot basis at practice level but some now encompass the whole locality, such as atrial fibrillation screening and point-of-care DVT exclusion.

Many of the schemes have focused on prevention and now the financial situation calls for urgent action. Cost-effective tendering for outpatients and daycare surgery have been hightlighted as early targets. These should be provided closer to patients via Choose and Book but this plan highlights the need for estates strategies to include community operating theatres.

The scope for small-scale individual practice schemes should remain but commissioning needs to be on a more immediate, radical, PCT – or even SHA – scale.

Personally, East Riding Yorkshire PCT has been supportive in the role I have taken, facilitating my attendance at leadership events, innovation and invention meetings and more latterly the SHA-wide clinical leadership network.

In an attempt to reinvigorate and redefine what PBC should be, a Joint Board/CLE Workshop is imminent, run in conjunction with the Centre for Innovation in Health Management at the University of Leeds. The tenet is to change the role of PBC to a clinically led system, core to mainstream commissioning. Perhaps a name change to CLC – clinically-led comissioning – is warranted, reflecting its more regional and fundamental role.

Our new Government appears intent on GP-led commissioning. Most GPs do not have time or resources to achieve this with ever-increasing demands on the day job. Our own practice has seen reduced profits to the point where we have been unable to replace two outgoing salaried doctors. Our PMS contract is also ‘under review'. General practice can only be stretched so far.

The vast majority of PCT expenditure is on medicines and secondary care activity orchestrated by GPs. An overzealous approach to general practice cost-cutting could be a false economy.

Pit-face GPs need to be incentivised whether by education, altruism, peer pressure or carrots and sticks. In true benign capitalism style I would like to see some version of a carrot involved. But would such a vegetable be acceptable to certain Daily Malicious tabloids? How much of a stick will be tolerated before GPs bite the owner?

Above all, the public must not lose faith in GPs as their advocates in maximising the health economy and helping them as individuals. Exciting but testing times ahead.

Dr Clive Henderson is PBC lead of Howden, Goole and West Wolds locality commissioning group

Dr Clive Henderson is PBC lead of Howden, Goole and West Wolds locality commissioning group

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