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Working at scale? I'd rather just do my job, thanks

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So we want you to work at scale.

Why?

How can we waste our talents?

Well, it’s a good idea, you know, to group together.

Why?

Well, we just think it is, probably good for patients, and commissioning and stuff.

Oh really? Does that work better then?

Well, we think it might. Maybe. We don’t really know. We’ve done some pilots and stuff.

Oh really? How big will the group need to be?

Well, we don’t really know. 30,000 patients probably, maybe up to 50,000 probably not more, could be fewer, there might be some exceptions.

Ok. Who’s organising that?

Um, well, you are. STPs, 5YFV and all that, group together to survive. Power in numbers.

Oh, right. Sounds pretty shit. I think I’d probably better get back to work, you know, patients to see and all that mundane everyday type stuff. 

There’s only really one number we need to know as a GP. That’s the number one. As in 1.

There is one patient that we see in each consultation. One patient who demands our attention and care each time we consult. One patient who expects and deserves our full attention. That’s why we are there, that’s why we went through years of training, that’s why we sweated blood and tears for long hours, sharing the best and worst life events with our patients. How could we give that up? How can we waste our talents?

Call me old-fashioned, but if we wanted to sit in some bollocky meeting room drinking nescafé, eating film wrapped biscuits, drowning in powerpoint and listening to the latest crackpot NHS job creation management programme speak, we probably would have chosen a different career path. When I rule the world, doctors will be doctors, nurses will be nurses, paramedics will be paramedics, and pharmacists will be pharmacists.

Politicians? They can go forth, sit in their palace and claim expenses, but keep their mucky little paws out of the NHS. They can devise their disgusting plans to ostracise the poor, weak and needy, creating enemies around the world and putting barriers up around our island. They don’t need any practice at that - they’ve pretty much got it nailed.

Given the right tools, we can provide wonderful care. The NHS is currently fumbling in the dark. The ‘leadership’ has no clue about the work at ground level. Footprints? More like hand and knee prints as we scrabble around on the floor for survival. STPs up and down the country have given cut and paste a new lease of life. They exhibit a laudable list of aspirations, but there’s nothing exciting in them, not much indication of how the plans will be achieved, and not much evidence of transformation or sustainability. Some might say they are not even plans…

If you work long enough in the NHS, you’ve seen it all before. Great ideas, five year plans, restructuring, bigger groups, smaller groups, skill mix, personalised care, round and round and round again. There is one constant factor though.

One patient, that’s all that really matters.

Dr Richard Cook is a GP partner in Hurstpierpoint, West Sussex. You can follow him on Twitter @drmoderate

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Readers' comments (6)

  • I went to a recent meeting where the geniuses had this great new idea to attach Health Visitors to each Practice. Hilarious. They destroy a perfectly good service, then a few years later bring it back as a "great new idea". Clowns.

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  • There is no way of squeezing more toothpaste out of the already empty tube.

    Of course NHSE, Federation Leads and CCGs have to be seen to do 'something'.

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  • STPs will destroy what they propose to save. There is no point to them.

    GPs may help create them but they will not want to work in them.

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  • Healthy Cynic

    Richard - I agree with you entirely, and as someone who sits on a CCG board I am becoming increasingly uncomfortable with my position. We are starting to commission what we are told to, and not what we want or need.
    I note that in HSJ today, Simon Stevens states that there is a "huge latent enthusiasm" for working at scale. What on earth does that mean? It has to be the king of all oxymorons. He seems to be suggesting that you and I would love to 'work at scale', but we just don't realise it yet!

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  • It seems to me that ccg boards are the firewall for NHSE who are the firewall for the DOH .The whole function of the edifice being one of top down control from the DoH to undertake their agenda and we all know what that is dont we JH.

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  • Richard thank you.It is worth a lot at the end of the week to be reminded of why it matters when we do what we were trained to do and why the other stuff is usually bollocks.I don't want to work at scale,the way I work is fine the way it is.It always was.

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