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We must act now

Dr Chris Hewitt

In my role leading an LMC I visit many practices, and at each one I usually detect a siege mentality, It’s not quite the Blitz in general practice although some days for many I think it must feel like it.

We can and must act and we must act now

Our whole way of life as professionals, as patients, and as carers is under threat and it is time for us to do the right thing. In some of the darkest hours of this country very few politicians thought Churchill would succeed and believed that invasion by the Nazis was inevitable. General practice is in meltdown and GPs are voting with their feet – resigning early, emigrating or changing career. We can and must act and we must act now.

We must agree a vision of what general practice needs to look like in the future.

We must prepare our story for patients, for carers, for our colleagues and ourselves.

We must be ready to explain all the options and their implications.

We must consider the option of a ‘post train crash’ world of general practice that needs to looks much better than the current solutions being developed.

We must not have a shooting-ourselves-in-the-foot ballot – the first step is to develop a clear vision.

We must develop a good list of actions to take and address all the possible implications.

We must ensure we outline the ways and means so that all of our colleagues can be prepared for the possible consequences of each step of industrial action.

We must be ready to play our ace in the pack and when we threaten undated resignations we must mean it.

We must resign in significant numbers by helping our colleagues who are fearful by describing what dealing with all the unintended consequences will look like for them.

We must support colleagues who fear dealing with commitments to patients, carers, staff and premises.

We must explain how all of this can be sorted.

We must avoid a short-term victory followed by another major conflict within a generation.

We must make a compelling case for an independent Health and Social Care Corporation (HCC) to run our health and social care system. This body will need a 25-year charter and will need guaranteed independence from day to day interference from Westminster politicians. The HCC will need to explain the costs of a modern integrated health and social care system – where ‘primary care’ and ‘secondary care’ are terms confined to history. When the HCC reviews the current situation the politicians needs to allow it to make a diagnosis and to develop a prescription, which needs to be administered in a timely fashion.

The HCC may argue any or all of the following, that:

  • The internal market has had its day
  • Bureaucracy, regulation and inspection is overcomplicated and is failing patients, carers and professionals
  • The purpose of computer technology is to serve patients not to performance manage, to over-complicate, to over-medicalise and to hide behind
  • You get what you pay for and this means a we need to invest a greater percentage of GDP in healthcare and to have an honest debate about co-payment for social care and health care costs
  • Demand is fuelled by supply, and that most of the world rations access by ensuring that those who can afford it pay something each time they use a service for wants rather than for needs

Canvassing opinion by our ‘leaders’ is all well and good, what we need to do is support the authentic and brave leaders determined to find a way forward. We don’t need to keep doing surveys to see if anyone is brave enough for the fight that lies ahead, the brave and the good have a clear vision and they will always be followed.

We must act now.

Dr Chris Hewitt is a recovering GP, having resigned from the performers list on December 31 2015. Chris now works full time as chief executive of Leicester, Leicestershire and Rutland LMC and is the elected representative for Northamptonshire, Leicestershire and Rutland on the GPC. You can follow him on Twitter @lmc_chris.

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Readers' comments (11)

  • Laudable, but 'Pie in the sky'....far too many historic tribes.

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  • Vinci Ho

    Respectable and honourable.
    I always said , NHS should be a constitutional matter but UK does not really have a definitive constitution as such and rather relys on various Acts.
    The Liberal Democrats have committed a historical sin in supporting the Tories to pass the HSCB while they were supposed to neutralise the aggression and evilness of the Tories in a coalition government . Instead , they were brainwashed and aided the passage of the legislation neutralising opposing arguments.Imagine the HSCB is to be passed now under this government . Do not forget the Trans-Atlantic Trade and Investment Partnership would not matter so much if there is no HSCB.

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  • Hi Chris,
    With you 100%. I resigned my partnership and feel that the whole contract needs to be binned. Not fit for purpose. Bizarre funding: until we get a representative proportion of GDP spent on Healthcare, like the developed countries, then no-one has any right to expect better. No gong or Fellowship for me, I realise, but I think I would refuse it anyway! Best wishes.

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  • 10:20 Spot on! No politician has the moral courage to initiate this debate: all professional politicians who need to be re-elected rather than willing to take a position on a point of clear principle and logic. Poor old Goldman Sachs having to put up with them afterwards when they finally b**ger off.
    With the Brexit debate coming up, there must be some EU colleagues who are hoping secretly that they don't have to deal with our "glorious leaders" in future.
    This song has it:

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  • No appraisal . Then no co-operation with CQC . Escalate to no OOH work for 1 month . If they're still not listening - resign. I very much doubt that we would even achieve first base . We are too fragmented and therefore doomed. It will be about people making provision for themselves . Not with a bang but a whimper.

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  • As great as your vision is, I think this profession is so fragmented that it will cease to exist before anything like this ever comes to fruition.

    We had a call yesterday from our CCG asking us why we turned away a patient who queued for an appointment on monday that was not urgent and who was offered an appointment on another day - after they spoke to their MP.

    the CCG lady asked 'why couldnt you just see the patient?' and told us 'you are in breach of contract' !

    This sort of stuff makes my blood boil, and I am in Leicestershire - until the bigwigs get their act together and sing for the sake of the service rather then their own jobs (for which they have to force through idiotic ideas to meet their own targets, like scrapping backfill for protected learning time - no way we can go to it now as a practice) then nothing will happen.

    I have been a GP for around 18 months now - and I am feeling so stressed out that I dont know if I can continue any more as a partner - CCG folk pressuring us to see patients 'who are there anyway' and then acting upon the call from the local MP (who believes homeopathy is a great thing) rather then us screaming that we cant cope is too much

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  • We need an escape plan from the NHS Gulag.
    Asking for a bit less sawdust in the soup and a few less beatings is not the way forward.

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  • We are seen as overpaid, lazy and uncaring { I read this stuff just after an eighty hour GP weekend on call with 4 hours sleep, for which there was no extra pay, some years ago ]
    If the Govt wants GPs they will have to pay for it. Otherwise, there will be very few left.
    We are only Contractors.
    Commissioning appropriate care is the task of the DOH.
    So, stop worrying about it. Not our problem.
    It is simple, if the DOH can get folks to do this for 50p /hour, they are happy. Why would they pay £1 ?

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  • We must leave

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  • Secure environments GP

    All good comments. However the vision by Chris is indeed enactable, Who can deny the wisdom of adapting to changing environmental conditions; responding to new challenges; learning from one’s mistakes as a profession and nurturing new leaders to grow... Small steps. We're attempting to turn a massive oil tanker around so all the tug boats need to pull in the right direction.

    Agreed it's a brave individual person to risk resignation and it's consequences but if the needs of the many outweigh the needs of the few, unite the profession to mitigate this risk.

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