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Day-to-day general practice must change, say top GPs



By Susan McNulty

GPs are failing to grasp how their day-to-day clinical practice must change under the white paper reforms, according to both the PBC tsar and the chair of the Conservative Medical Association.

PBC tsar Dr James Kingsland, who is also president of the NAPC, told Practical Commissioning the focus since the white paper was published had been on the form and structure of commissioning consortiums.

‘It’s fairly sterile if we focus on that,’ he said. ‘GPs should be asking “what does it look like, what difference is it going to make?” If the answer is “no difference” and they intend going into their practice and doing the same thing, then what on earth are we bringing in a new policy for?’

Practices of the future, he said, would need to upskill other staff so that they can see patients and expand the primary care team to allow GPs to take on a commissioning role.

‘Everybody who comes into a practice needs help, but they don’t always need a GP,’ he said.

Dr Kingsland’s comments chime with those made by Conservative health policy adviser Dr Paul Charlson.

He told a recent Westminster Forum conference in London: ‘I think GPs waste a lot of time seeing trivia and it’s ridiculous to earn £100,000 plus to see people with sore throats.’

He added: ‘I think GPs are going to have to change what they do. Some will have to spend quite a lot of time doing commissioning and the rest will have to spend their time managing complex conditions and we really need other people to manage the trivia. People will bleat that they are too busy, they can’t do it, but actually they could.’

Dr Kingsland said there would be a day-to-day commissioning role of ‘reflective practice’ for GPs that would be distinct from the consortium commissioning roles that a minority of GP leaders are expected to fill locally.

The daily commissioning role would involve looking at referrals, ensuring they were appropriate, getting patients who had been admitted inappropriately by other professionals out of hospital, challenging duplication of work by consultants and freeing up time to ensure more holistic care for individual patients.

Dr Charlson said commissioning duties needed to be seen as part of the GP’s job rather than an add-on. ‘What’s often seen by colleagues who want to do just clinical work is that if you go to meetings that is an add-on. But it’s got to be seen as part of the job.’

Dr Paul Charlson: commissioning must be seen as part of the GP’s job Dr Paul Charlson: commissioning must be seen as part of the GP’s job